University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK; School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ.
School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ.
Physiotherapy. 2023 Mar;118:20-30. doi: 10.1016/j.physio.2022.06.002. Epub 2022 Jun 20.
OBJECTIVE(S): To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.
Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively.
6 UK Stroke Units PARTICIPANTS: 89 therapy sessions were observed, involving 55 clinicians and 57 patients.
Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1-8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset.
To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke.
Clinicaltrials.gov (NCT03792126). CONTRIBUTION OF THE PAPER.
描述 a) 在中风后物理治疗中如何应用运动学习原理，重点是下肢康复；以及 b) 这些原理在与患者和/或任务特征相关的情况下使用的背景。
直接非参与观察常规物理治疗课程，通过视频记录收集数据。使用结构化分析矩阵和预先商定的定义来识别、计数和记录：活动类型；重复次数；指导和反馈语句（频率和类型）；策略，如观察学习和增强反馈。使用散点图可视化数据，并进行描述性分析。
6 家英国中风病房
观察了 89 次治疗课程，涉及 55 名治疗师和 57 名患者。
每次治疗课程中活跃时间的比例从 26%到 98%不等（平均值 85，标准差 19）。任务重复的频率差异很大，中位数为每分钟 3.7 次（IQR 2.1-8.6）。指导语句很常见（每分钟 6.46 次），其中 52%归类为指导，14%为反馈，34%为口头提示/激励性语句。13%的指导和 6%的反馈语句是外部焦点。根据患者特征检查不同指导行为的使用情况，没有发现关联。总体而言，整个数据集的实践差异很大。
为了最大限度地提高运动技能学习的潜力，治疗师必须操纵他们的指导语言（他们说什么、说多少和什么时候说）和实践设计（任务的类型、数量、难度和变异性）的特征。有机会更一致地实施运动学习原则，以受益于中风后的运动技能恢复。
Clinicaltrials.gov（NCT03792126）。
论文的贡献。
