Date Presented 4/17/2015
In this poster, we present the perspectives of stroke survivors on their experience with past home exercise programs for improved upper-extremity function. We also cover their experiences with a technology-based, upper-extremity intervention designed for use in the home.
SIGNIFICANCE: Due to limited time in the clinic and poor carryover with home exercise programs, stroke survivors often struggle to make gains in upper-extremity function, with at least 50% of stroke survivors experiencing hemiparesis at 6 mo poststroke (Roger et al., 2012). To address this, different applications of technology have been designed to increase adherence and enjoyment; however, few researchers have investigated the clients’ perspectives on home exercise programs or the experience of using technology to support home exercise. In this qualitative study, we aim to increase the understanding of stroke survivors’ perspectives on these topics.
INNOVATION: This qualitative study was part of a mixed-method effort to evaluate the preliminary effectiveness of neurogame therapy (NGT). NGT is a novel application of surface electromyography through a video game. This system allows participants in the chronic phase of recovery to utilize the muscle signals from their affected upper extremity to control a video game.
APPROACH: Our research aim was to characterize stroke survivors’ perceptions of upper extremity use in daily life, perceptions of previous home exercise programs, and experience with NGT. Little is known about stroke survivors’ perspectives on home exercise programs or their experience using gaming technology in the home. We sought to better understand stroke survivors’ perspectives to enhance home exercise programming, potentially improving adherence and effectiveness.
METHOD: We took a qualitative, descriptive approach using two nested, one-on-one, semistructured interviews—one prior to the intervention and one after the intervention. Interviews occurred in a quiet room on campus; the intervention occurred in the home. Participants were recruited through local hospitals, clinics, and support groups. A purposeful sample (n = 10) completed the qualitative portion of the study.
Participants were at least 6 mo poststroke, with one-sided motor impairments ranging in severity from no active hand movement to only some difficulty manipulating objects. Participants had to have vision and hearing sufficient to engage in all aspects of the study. Exclusion criteria included being non-English speaking, having substantial cognitive and communication deficits, or having recent alterations to their medical management of spasticity.
The data sources consisted of transcripts from the semistructured interviews. The interviews were audio-recorded and transcribed verbatim. We analyzed data using qualitative content analysis, generating codes from the data with an initial coding structure and then grouping them into categories.
RESULTS: Participants described affected upper-extremity use as limited in daily activities, and most participants reported feeling that they should use it more. Participants also recalled previous home exercise programs as being nonspecific and at times modified independent of a therapist. Participants also reported multiple barriers to implementation of home programs. After an approximately 4-wk trial of NGT, participants indicated that it was engaging, but most participants noted no changes in functional use of their arm.
CONCLUSION: The implementation of home exercise programs should be reexamined to support stroke survivors in managing the barriers that are faced during independent implementation. The use of gaming and/or remote monitoring applications may be valuable in this effort.
References
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., . . . Turner, M. B. (2012). Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation, 125, e2–e220. https://dx-doi-org.web.bisu.edu.cn/10.1161/CIR.0b013e31823ac046
