Developing connections for engagement in stroke rehabilitation

Nicola M. Kayes; Christine Cummins; Kathryn M. McPherson; Linda Worrall; Felicity A. S. Bright

doi:10.1071/IB22005

RESEARCH ARTICLE

Previous Contents Vol 23(1)

Developing connections for engagement in stroke rehabilitation

Nicola M. Kayes

^A ^* , Christine Cummins ^A , Kathryn M. McPherson ^B , Linda Worrall ^C and Felicity A. S. Bright ^A

+ Author Affiliations

- Author Affiliations

^A Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand

^B Office of the Vice Chancellor, Auckland University of Technology, Auckland, New Zealand

^C School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia

^* Correspondence to: nicola.kayes@aut.ac.nz

Brain Impairment 23(1) 42-59 https://doi.org/10.1017/BrImp.2021.27

Submitted: 6 January 2021 Accepted: 27 October 2021 Published: 27 December 2021

© The Author(s), 2021. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (https://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.

Abstract

Background and Aims:

Engagement is increasingly recognised as important for maximising rehabilitation outcome following stroke. However, engagement can be challenging when neurological impairment impacts a persons’ ability to activate the regulatory processes necessary for engagement and in the context of a changed self. We explored engagement in stroke rehabilitation from the perspective of people with stroke with a primary focus on identifying key processes that appeared important to engagement in stroke rehabilitation.

Design and Methods:

This study drew on Interpretive Description methodology. Maximum variation and theoretical sampling were used to capture diversity in the sample and access a depth and breadth of perspectives. Data collection included semi-structured interviews with people with stroke (n = 19). Data were analysed through a collaborative and iterative process drawing on range of analytical tools including coding, memoing, diagramming and group discussions.

Findings:

Our findings highlight that engagement is a complex, nuanced, responsive, flexible and inherently two-way process. Developing connections appeared central to engagement with connections taking various forms. The most fundamental was the therapeutic connection between the person with stroke and their practitioner as it provided the foundation on which to build other connections. Connection was made possible through five collaborative processes: Knowing, Entrusting, Adapting, Investing and Reciprocating.

Conclusions:

Engagement is a social and relational process enabled through an inherently person-centred approach and active and ongoing reflexivity – highlighting the importance of a humanising approach to care where aspects of self, care and emotion are evident, for both the person with stroke and their practitioner.

Keywords: Engagement, stroke rehabilitation, connection, therapeutic relationship, collaborative processes.

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