The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Procedures
2.4. Data Analysis
2.5. Research Team and Reflexivity
3. Results
3.1. The Individual
3.1.1. Theme 1: Mindset Is a Strong and Consistent Influencer of Daily Physical Activity and Overall Recovery
- P12:
- What do I think influenced the most of my recovery of my walking? (laughs) Oh, determination? (…) I had all the volition in the world to get better and I wasn’t satisfied. (…) Hard work, will, determination.
- P22:
- I’m very stubborn. If there’s a way to do it, I’ll figure it out.
- P18:
- We never, never give up and never really accept that you can’t do anything. You just keep pushing forward. (…) I’m very motivated in that sense.
- P43:
- I’m seeing a counselor to help overcome the fear of falling. And I think that’s probably my biggest inhibitor.
3.1.2. Theme 2: Severe Physical Impairment Limits Physical Activity and Recovery, Regardless of Other Factors
- P33:
- Because my hand is not functional enough to do a lot of things, my arm doesn’t get used.
- P18:
- My left arm unfortunately is not really—I really can’t use it for a lot because of its condition.
- P15:
- I try. I try but I can’t.
3.1.3. Theme 3: Negative Perception of Disability Impacts Mindset and Willingness to Move in Public Places
- P12:
- I don’t like the way I look when I walk. I don’t like the speed that I walk with. I just did whatever I had to do, strengthening, whatever to improve it.
- P33:
- I walk funny when I see myself in the mirror and I walk—it’s clear, when people stare at me, and they wonder what’s wrong. (…) I feel like a slug, and that bothers me a lot.
- P10:
- I don’t see the need for people to see me handicapped.
- P39:
- When I’m inside I feel safer, especially at home. Whereas when you are outside, you run into the society. Maybe there are rushing kids or something. That’s when you really have to be careful what you are doing.
- P10:
- When I take a first step, when I go outside, I naturally get a smile on my face like. Like wow I’m going to do this.
- P31:
- My mother is one thing. She [walks] every day. So, I have to walk with her.
- P22:
- My grandson said you have to play handball. Well, I’m going to figure out how to not fall and play handball.
- P46:
- If I had someone who could walk around with me, I would try [to walk] a little bit farther.
- P05:
- I also think living by myself, because—because seeing people who have a spouse or people who were living by themselves, I find that people living by themselves improved faster, because they were forced to.
3.2. The Task—Theme 5: Participation in Meaningful Activities Increases Physical Activity and Promotes Long-Term Recovery
- P31:
- I like to play [video]games, and I’m going to play these games no matter how much it takes.
- P18:
- I’m very lucky that I was always very active before my stroke, and then when I had the stroke, because of the volunteer activities that I did, kept me very active and I learned a lot.
- P17:
- [I] sweep the whole floor in the hallway and then I mopped. So, it was a lot of work yesterday, but you know, I don’t look at it as work, I look at it as therapy or exercise and (…) so I’m good with that.
- P37:
- --having my dog, because I have to walk her. I don’t have to, of course, I could get somebody else to do it, but it gives me motivation to walk.
3.3. Content Analysis
4. Discussion
4.1. Strategies to Integrate Patient Perspectives into Neurorehabilitation: Current Possibilities and Future Directions
4.2. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Mean ± SD or % |
---|---|
Gender (%) | Men: 60.0 Women: 36.7 Non-binary: 3.3 |
Age (years) | 58.6 ± 13.1 |
Race (%) | American Indian or Alaska Native: 0 Asian: 16.7 Black: 16.7 Native Hawaiian or Pacific Islander: 10 White or Caucasian: 36.7 More than one Race: 16.7 Not reported/unknown: 3.3 |
Ethnicity (%) | Hispanic: 30.0 Non-Hispanic: 70.0 |
Time since stroke (years) | 7.6 ± 4.5 (range: 1.0–21.2) |
Hemisphere affected by the stroke (%) | Left: 60.0 Right: 40.0 |
Dominance of arm affected by stroke (%) | Dominant: 53.3 Non-Dominant: 46.7 |
National Institutes of Health Stroke Scale—Best Language (%) | No aphasia: 73.3 Aphasia: 26.6 |
Montreal Cognitive Assessment (/30) | 24.7 ± 3.4 |
Fugl-Meyer Assessment Upper Extremity (/66) | 41.2 ± 18.0 (Range: 18–66) |
Functional ambulation category (%) | 3 (supervision): 13.3 4 (independent, level surfaces): 26.7 5 (independent, all surfaces): 60.0 |
10-m walk test (m/s) | Self-paced: 0.75 ± 0.40 Fast-paced: 0.96 ± 0.53 |
Use of assistive device (%) | Yes: 66.67 No: 33.33 |
Positive Factors | Limiting Factors | ||||
---|---|---|---|---|---|
Enabler | Representative Quote | N | Barrier | Representative Quote | N |
Strategies to incorporate paretic arm | P18: “really, it’s whatever task I’m working on. I mean, I (…) I basically live alone so I do everything myself. You know, when I’m folding clothes or when I’m cooking, I use tools to help me where I’m typically just using my [unaffected] arm, but when I’m doing other kinds of tasks, if I’m gluing something or if I’m repairing a device, I will use my [affected] arm to steady it. | 20 | Physical obstacles in the environment | P46: “I don’t like going up and down on sidewalks or anything like that. I don’t feel comfortable”. | 24 |
Positive mindset | P29: “So as far as what motivates me, I tell myself I have to do better every day. And even if you don’t see end results every day, I tell myself a week later was better than it was a week before”. | 25 | Lack of function | P02: “[sigh] If my arm is good, I’ll do everything, but I can’t use it now”. | 15 |
Support and encouragements from family and peers | P09: “[My daughter] would tell me, “Mom, you’re overextending your knee. Mom, try to walk better.” So when I will walk to the restroom, I’ll be like, “Use your leg”, “left, right, left, right, left, right,” and then, and then I’ll just start doing it over by myself.” | 21 | Fear | P39: “It’s more of the fear of maybe getting bumped into or falling or something. That’s when we need to be even more careful”. | 11 |
Therapeutic approaches and exercise | P17: “I think exercise, the gym. That’s what gets me tired, but when I recuperate from the tiredness, I see the difference, I can see improvements. I would say the exercise is what helps me the most”. | 19 | Perception of others | P10: “Like when I’m around people […] I get conscious, you know, I try to act like I’m normal”. | 8 |
Desire for independence | P35: “I don’t want anybody to have to push me in a wheelchair and wash my face and nothing. I want to be independent as long as I can”. | 16 | Lack of social support | P35: “I think things have changed because of my disability. I don’t think people realize that there’s such a thing as social exclusion”. | 7 |
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Cain, A.; Winstein, C.J.; Demers, M. The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis. Healthcare 2024, 12, 1523. https://doi.org/10.3390/healthcare12151523
Cain A, Winstein CJ, Demers M. The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis. Healthcare. 2024; 12(15):1523. https://doi.org/10.3390/healthcare12151523
Chicago/Turabian StyleCain, Amelia, Carolee J. Winstein, and Marika Demers. 2024. "The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis" Healthcare 12, no. 15: 1523. https://doi.org/10.3390/healthcare12151523