Clinicians’ Perspectives on Cross-Education in Stroke Rehabilitation

• Author / Creator

  Russell, William H

• Purpose: Cross-education is a neural phenomenon where an untrained limb improves after unilateral training of the opposite homologous limb. It has been extensively studied in the healthy population and shows promise for post-stroke rehabilitation. Despite this promise, cross-education has not been adopted into clinical rehabilitation practice. Cross-education is contrary to current best practice for upper extremity post-stroke rehabilitation which is focused on training the affected limb. The objective of this study was to understand: current post-stroke upper extremity rehabilitation practice, clinician’s perspectives on cross-education, and facilitators and barriers to implementation of a cross-education intervention. Methods: An Interpretive Description framework guided this study. Twenty- two occupational therapists and 2 physiotherapists were interviewed in 4 focus groups and 1 individual interview in a rehabilitation hospital and 3 acute care hospitals. After transcription, line-by-line coding was done by 2 investigators. A third investigator, who was not part of data collection, reviewed the process and agreed on the primary categories. Results: Cross-education is antithetical yet promising was the lone theme which was reiterated in every data collection session. The primary theme was captured in 3 descriptive categories. The therapists described working in a (1) forced-use paradigm, yet they also described how that paradigm did not meet the needs of all of their patients. They recognized this as a (2) gap in current practice. They also hypothesized that (3) cross-education used as an adjunct could be quite effective within their current practice for specific patients. The primary theme weaves between the 3 categories. Conclusions: Therapists perceived that cross-education would be most appropriate for patients with a severely impaired upper extremity. They suggested that educational materials for clinicians, patients, and patient families would be essential to the success of cross-education in order to explain training the less affected limb. This study provides important foundational information about clinician perspectives that will help transition cross-education into clinical stroke rehabilitation research and eventually practice.

• Subjects / Keywords

  • Stroke Rehabilitation
  • Barriers
  • Facilitators
  • Implementation
  • Cross-Education

• Graduation date

  Fall 2016

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3PN8XM3B

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.