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This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

In stroke rehabilitation, measurement tools measuring self-efficacy with sound psychometric properties are needed. The Stroke Self-Efficacy Questionnaire (SSEQ) has recently been translated and validated into a Danish version (SSEQ–DK). To evaluate the test–retest reliability of the SSEQ-DK. Fifty people with stroke ≥ 18 years in the sub-acute and chronic phase were included from February 2019 to August 2020. The SSEQ-DK was completed twice; on day 1 and day 7–14. Test–retest reliability of the single items was assessed using weighted Cohen's kappa and percentage agreement. The activity and self-management scales were assessed by the intraclass correlation coefficient (ICC). Measurement error was assessed by calculating the Smallest Detectable Change (SDC) based on the standard error of measurement. Overall, kappa values showed fair to substantial test–retest reliability of the single items. However, several kappa values were missing as the statistical prerequisites were not present. The percentage agreement ranged from 78% to 94%. Based on the reported confidence interval of the estimated intraclass correlation coefficient, the test–retest reliability of the activity and self-management scales was poor to excellent in all analysis. Ceiling effects appeared in the single items. Conversely, no floor effect was seen. The SSEQ-DK showed good test–retest reliability of the single items based on agreement among a population with stroke in the subacute and chronic phase. Broad ICC confidence intervals bar any firm conclusions concerning the test–retest reliability of the activity and self-management scales. ClinicalTrials.gov NCT03183960. Reg. 15 June 2017. [ABSTRACT FROM AUTHOR]

Background: Stroke has been described as a rupture of current life, causing changes in the patient's identity. This has important consequences for the patient's life after stroke. Nevertheless, there is still a lack of science on the subject and also a lack of consistency in how to confront this in rehabilitation. Aim: The aim of this study is to explore how interaction between patient and physiotherapist is conducted and how an approach inspired by phenomenology might support and develop identity. Design and Methods: A qualitative study based on empirical data consisting of 146 short videos of physiotherapist and patient interactions as well as observations and interviews of physiotherapists and patients. Twelve patients were included, and data was constructed throughout their rehabilitation process (on average 2.5 years). Data was analyzed using an analytical model for multimodal interaction. Result: Four themes emerged: 1) feedback as a bodily knowledge; 2) control of the process; 3) adjustment; and 4) the bodily approach. The results revealed the importance of approaching the patient body as both an object and a subject in order to interact with the patient's bodily knowledge. Conclusion: A phenomenological approach to the patient can support the patient's embodied knowledge, and can thereby support and develop the patient's identity. [ABSTRACT FROM AUTHOR]

The rehabilitation process after a stroke transits through different treatment options organised in different settings, which thereby structure the patient's possibilities for constructing identity. To investigate how physiotherapy located in hospitals, municipal rehabilitation, and private clinics during rehabilitation after stroke provide different practices related to the patient body and how this creates different and opposed positions for construction identity after stroke. A qualitative longitudinal study based on empirical data that followed 12 patients with stroke through their rehabilitation, consisted of observations of interactions between physiotherapists and patients, as well as individual in-depth interviews with physiotherapists and patients. Building on Bourdieu's notions of field, capital, and habitus, different bodily habitus seemed to work as capital throughout the rehabilitation process. Positions available for habitus were around the disembodied body, the malfunctioning body, the defective body, the remodelled body, and the body altered. These different bodies interwove and shifted across the different sites and phases of the patient's rehabilitation. The relations between patients, physiotherapists and field constructed different bodily positions in the physiotherapeutic practice, where some bodies were included while other bodies were excluded. This shaped varying practices and different potentials for the patients' identity reconstruction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Development of clinical practice at a Danish neurorehabilitation centre was delegated to a group of health professional developers. Their job function lacked conceptual foundation, and it was unclear how their working tasks contributed to evidence-based practice. OBJECTIVE: Conceptual clarification of the job function and pattern analysis of activity distributions for health professional developers. METHODS: Health professional developers kept continuous time geographical diaries for two weeks. Meaningful categories were subtracted through content analysis. Patterns were analysed within activity distributions with regards to evidence-based practice. RESULTS: A total of 213 diaries were collected from 21 health professional developers of three professions (physiotherapists, occupational therapists and nurses). Each participant reported 6–13 workdays (median 10 days). Eleven main categories of work tasks emerged with 42 subcategories. Overall, 7% of total time reported was spent on external knowledge, with minimal variation between professions and contractual time allocation. CONCLUSION: Conceptual clarification of work tasks was established for health professional developers. Their work activity distributions contributed mainly to maintenance of existing level of professional knowledge rather than to implementation of new knowledge, which did not fulfil the intended responsibility for development of evidence-based practice. Educational competence boost and data-driven change of organisation structure was recommended. [ABSTRACT FROM AUTHOR]

Background. In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients’ motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. Methods. A qualitative investigation of patients’ and therapists’ perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants’ perceptions and interpretations. Results. Five key themes were identified from the patients’ perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Conclusion. Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients’ moods and engagement and seemed to promote a “gung-ho” spirit, so they felt that they could perform more repetitions. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore the experiences of professional specialists in early rehabilitation who face demanding pedagogical challenges in facilitating and promoting participation of the severe acquired brain injury patient. Method: In a qualitative study, using phenomenological philosophy and thinking, the experiences of specialist professional experts were investigated. Data were generated in five individual interviews and one focus-group interview. The interview questions were grounded in a preliminary field study. In a four-step phenomenological analysis, empirical themes were identified, using the computer program N-Vivo10; they were structured and organized, and the results were theoretically stated and supported. Results: Important practice knowledge emerged in this study that led to the proposal of a determined, client-centred approach when facilitating the promotion of severe acquired brain injury patients' participation in early rehabilitation. Four factors are important in this approach: (i) gain contact, (ii) register responses, (iii) intentional interaction, (iv) partial participation. Together they constitute the elements in a proposal for a new model: the GRIP model. Conclusion: The four factors that shape the GRIP model can enrich neurorehabilitation services and support professional experts in early rehabilitation interventions with severe acquired brain injury patients regaining participation and functioning in everyday life. [ABSTRACT FROM AUTHOR]

Purpose:To isolate characteristics of a stroke population five years after first stroke, focusing on functioning and health.Methods:The subjects in the present study were identified in a computerized National Bureau of Health Register over a six month period in 2003 in a well-defined area of 353,284 inhabitants.Results:Survival rate five years after first stroke was 52%. As regards functioning 50% of the group were able to look after own affairs. Thirty-one percent reported themselves as being moderately disabled. Seventeen percent had moderate to severe disability. In the responding group 53% below 65 years of age were disability pensioners. Half of the responding group had suffered a further stroke or another severe illness during the previous five years. There was a positive correlation between functioning and health.Conclusion:Stroke survivors cannot be seen as a homogenous group as regard to functioning and health five years after the incidence. It is recommended that professionals identify the stroke individual's level of functioning before rehabilitation is concluded, and that they give stroke individuals with moderate to severe disabilities a well-considered and individualized follow-up. Professionals should be more aware of the working potential of stroke survivors below 65 years. [ABSTRACT FROM AUTHOR]

Background. Increased intensity of training in the subacute phase after acquired brain injury facilitates plasticity and enhances better function. Group training can be a motivating factor and an effective means of increasing intensity. Reports on patients' and health care professionals' experiences on increasing the amount of active practice through group training during in-patient rehabilitation after acquired brain injury have been limited. Methods. Two focus groups, patients and health care professionals, participated each in two interviews, before and after implementation of the Activity block, i.e., 2-hour daily intensive group training. The data from the interviews were analyzed from a phenomenological perspective. Results. Three categories emerged from the data analyzes (i) training intensity, (ii) motivation and meaningfulness, and (iii) expectations and concerns. Both groups experienced that the training after implementation of the Activity block had become more intense and that motivation was increased induced by the group setting. Also, both groups found self-management enhanced. Some challenges were also reported. Patients expressed concerns to finding a balance between rest and activity, while the health professionals mentioned practical challenges, i.e., planning the content of the day and finding their role in the Activity block. Conclusion. Activity block benefitted a heterogeneous group of patients with acquired brain injury and was perceived as an overall positive experience by patients and health personnel. Matching the training to the individuals' need for support, finding a balance between rest and activity and using tasks that support patients' motivation, appeared important. [ABSTRACT FROM AUTHOR]