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Purpose: Nature has been found to improve and promote health and prevent disease. Nature-based rehabilitation (NBR) delivered as part of neurorehabilitation is a developing approach. Yet to date the research is sparse. Following an acquired brain injury (ABI), people often experience impairments that cause limitations in activity and participation in daily life, which can impact the quality of life long-term. NBR delivered in neurorehabilitation has previously been explored from the perspective of occupational therapists and physiotherapists, however, to date patients' experiences are yet to be explored. This study aims to explore patients' experiences and perspectives of NBR delivered as part of standard neurorehabilitation. Methods: This qualitative study had a constructivist and phenomenological design. Semi-structured focus group interviews were carried out across three healthcare settings in Denmark with 17 participants. Data was analysed using content analysis. Results: The analysis generated three categories: 1. Outdoor versus indoor environment, 2. The natural environment as a co-therapist, and 3. Interrelatedness. Conclusion: The study provides insight into participants' experiences of NBR. They reported that interacting with the natural environment as part of neurorehabilitation enhanced activity. Moreover, being in nature increased their self-efficacy, sense of autonomy, community spirit, cooperation, and joy, and led to a feeling of peace. IMPLICATIONS FOR REHABILITATION: Nature-based rehabilitation (NBR) delivered as part of neurorehabilitation provides an alternative to indoor rehabilitation. The natural environment offers multisensory stimulation, sensory-motor training, and opportunities for mental restoration. NBR promotes social engagement, cooperation, and feelings of being in the same boat and may increase autonomy, self-efficacy, activity, and participation. NBR can be designed and delivered in a way where the natural environment and the intervention promote individual and group rehabilitation. The benefits of NBR in neurorehabilitation for patients appear to be an underexposed topic, and the intervention may provide an opportunity for improving rehabilitation for patients with acquired brain injury. [ABSTRACT FROM AUTHOR]

Nature-based rehabilitation (NBR) is increasingly used within neurorehabilitation. The theoretical base is rooted in traditional neurorehabilitation professions, especially physiotherapy and occupational therapy, and relate to nature-based approaches. Objective: The objective was to explore the therapists' experiences of and rationale for applying NBR in neurorehabilitation when providing NBR to patients with acquired brain injury (ABI). Patients with ABI often experience severe consequences impacting their rehabilitation, activity, participation and quality of life. Qualitative focus group interviews with therapists were conducted at two Danish rehabilitation hospitals, Hammel Neurorehabilitation and Research Center (HNRC) (Hospital 1) and Vejlefjord Rehabilitation (VFR) (Hospital 2). These are highly specialized neurorehabilitation hospitals for patients in the acute-subacute and subacute-chronic phases. HNRC has several sensory gardens and VFR has a park and an inlet nearby. Content analysis was employed to analyze the interviews. An occupational perspective of health was a frame to analyze and conceptualize the results. The analysis produced two main categories: What does nature offer – approach and rationale; Therapeutic rationale for conducting NBR. The therapists applied known theories and methods; they perceived the natural environment as an extended room for training and activity, as a means for targeted rehabilitation and beneficial to the patients. [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]

Background: The literature on participation in rehabilitation by those with the most severe acquired brain injury is very sparse. Objectives: The aim of this study was to explore how physiotherapists promote the participation of patients with severe brain injury in therapeutic and daily-life situations in early rehabilitation. Methods: In a qualitative study employing phenomenological philosophy, several video-recorded sessions of patients with a Rancho Los Amigos Scale score of 3-4 were analysed. Empirical themes were identified by four different investigators through individual and consensus-based analyses. The results were theoretically stated and supported. Results: In an effort to achieve patient participation, the following four themes seemed to be significant: 1) consciously encountering the patient in the moment, 2) the employment of concepts surrounding the interaction between body and environment, 3) timing and flow of the activities and 4) comprehensive bodily support, guidance and facilitation of the activity and participation in daily-life skills. Conclusions: The dynamic use of these four themes seemed to enrich early rehabilitation interventions for patients with severe brain injury and low level of consciousness in terms of their participation and functioning in everyday life. [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]

Aim:The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions. Methodology:A qualitative study was chosen. The field study involved five patients (aged 39–64) and included: participant observation and video recordings of 41 rehabilitation situations, five individual interviews and one focus group interview with multidisciplinary rehabilitation experts; together with document review of hospital charts and memos. The data were analyzed using a four-step phenomenological analysis and NVivo 10. Major findings:Participation comes into play in various practices around the patient. Three main themes seem to be important: (1) The dynamic interplay of the multidisciplinary team as an element that influences participation, (2) significant relational encounters and meetings as aspects that impact on the promotion of participation, and (3) significant frameworks that affect involvement, engagement and participation. Principal conclusion:Patients’ participation and recovery are facilitated by a combination of the clinicians’ professional skills, their ability to create a rehabilitation environment in which patients can perform activities, the right framework for the meeting, and a suitable approach, to facilitate fruitful interaction with the patients. [ABSTRACT FROM PUBLISHER]

An estimated 125–137 Danish children with acquired brain injury (ABI) require rehabilitation annually, 30–40 of these at a highly specialized level. Constraint-induced movement therapy (CIMT) has shown significant effects in increasing function in children with cerebral palsy. More knowledge of how CIMT can be adapted for the rehabilitation of children with ABI is needed. The primary purpose of the study was to generate new knowledge about the pedagogical initiatives and frameworks involved in children’s participation in and activities during CIMT. Four children with ABI participated in the 60 h intervention. Data generation consisted of qualitative research through participant observations and healthcare professional evaluations. A didactical approach with individualization and a solid structural framework enhanced the possibility of securing the children’s motivation for and participation in the intervention. Adaptation, compensation and individualization were crucial factors in the achievement of changes in functional skills. Spontaneous functional use and natural bimanual involvement increased, indicating that CIMT intervention encourages the retrieval of natural involvement of the impaired upper limb after ABI. Individualization, attention, firm structure and goal-specific tasks are key didactical factors to maintain children’s motivation to participate during CIMT to increase functional skills and spontaneous and natural bimanual involvement of the impaired upper limb during activities. [ABSTRACT FROM PUBLISHER]

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]

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]