Examining Guided and Directed Cues in Strategy Training and Usual Rehabilitation.
Stephanie Rouch, Elizabeth R Skidmore
PMID 29444624WHAT IT FOUND
In 20 inpatient stroke rehabilitation video sessions, strategy training used more guided cues than usual occupational or physical therapy: 42.5% guided versus 3% to 4%.
It also used fewer cues per minute. This describes therapist behavior, not patient outcomes.
Key findings
01Strategy training sessions averaged 2.6 cues per minute, compared with 3.5 in occupational therapy and 3.4 in physical therapy.
02Strategy training cues were 42.5% guided, while occupational therapy cues were 4% guided and physical therapy cues were 3% guided.
03No guided gesture cues were observed, and guided cue proportions varied from 18% to 91% across strategy training sessions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 20 strategy training participants were analysed, with one strategy training session, one occupational therapy session, and one physical therapy session per participant. The videos came from a single institution, so they may not represent usual practice elsewhere. Participants had mild to no aphasia and met narrow cognitive impairment criteria, so results may not apply to people with severe communication or cognitive problems. Physical assistance was not coded, so hands-on guidance was not included in the cue counts. Only 20% of participants received usual care speech-language pathology, and those sessions were not analysed. The analysis measured therapist cueing, not patient engagement, function, or recovery. Guided cue use varied widely across strategy training sessions, from 18% to 91%, so there was no single consistent strategy training cueing pattern.
Declared interests
The authors declared no conflict of interest and no financial or proprietary interest in the materials presented.
The easy way to misread this
Do not conclude that guided cues improve rehabilitation outcomes. This study only coded therapist verbal and gesture cues in 20 strategy training participants and did not measure functional outcomes; the authors state that the functional implications are unclear until the ongoing trial is completed.