29 Challenging Rehabilitation Environment for older persons Patient-regulated exercise Apart from the therapy sessions, patient-regulated exercise is a way to increase the amount of therapy time without increasing staff levels. Among other things, it can be used for motor goals and for goals related to aphasia. Patients rehabilitating after stroke were positive about this form of therapy; they found it useful, enjoyed it, would recommend it to other patients, and considered it an acceptable complement to face-to-face therapy.40,41 Patients appeared to practice less than recommended (ie 5-15 min per session for 7 days, whereas 30 min per session during 28 days was recommended). Therefore, it is important to ensure that the exercises are challenging, fit the level of the patient, and are tailored to personal interests.41,42 Limited research was found regarding patient-regulated exercise for inpatient rehabilitation. A small study in 2002 reported no benefits after four weeks independent practice of motor tasks. In this latter study, only 5 patients in the intervention group were tested after the intervention; moreover, these patients missed 20% of the intervention.43 Later studies showed some improvement in strength, dexterity, word-finding and confidence in talking; however, due to small study populations and different research goals, no significant results could be extrapolated.41,42 In patients rehabilitating after stroke, an increase in autonomy was related to regained abilities and self-confidence. Autonomy can be enhanced by minimizing care routines and by providing room for performing activities independently and privately. Attention to patients’ autonomy improved patients’ active participation in rehabilitation, quality of life, and independent living after discharge.44 In stroke patients, self-regulation appeared useful and feasible for improving task performance that demands both motor and cognitive abilities, by promoting information processing and active learning.45 Family participation For patients rehabilitating after stroke, prior living conditions (ie, living alone vs not living alone) were predictive for discharge destination. The availability of a caregiver at home was important for discharge to the community after stroke rehabilitation. Therefore, it is important for the caregiver to participate in the 2
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