Essay: Motivational factors affecting stroke patients’ rehabilitation for recovery

Rationale
Stroke affects people of all ages. One can survive the attack of a stroke, but stroke will have effects. Most common effect is the disability to perform basic motor movements in an area of the body. People who experience this needs to undergo therapy or rehabilitation, in order to get back to their normal lives and get back their motor movements. In this way, they can get back to their normal lives and get back their motor movements. However, due to the long and difficult rehabilitation process, many patients lose motivation and quit the process. There are many factors that affects their motivation. It may be caused by lack of support from relatives, lack of support from caregivers, and even lack of support within.
According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled (strokecenter.org, n.d.). Out of this people approximately 6.2 million die per year. In every ten seconds, a person dies because of this disease. Imagine that there are a total 6 persons who experience death in every passing minute. As of now, our world finds it hard to lessen this casualty. Indonesia is the leading country for having the highest death rate from stroke. It is followed by Sierra Leone, and then followed by Mongolia (worldlifeexpectancy.com, 2017).
In the context of the Philippines, stroke is a current epidemic that most of the Filipinos encounter. The Philippines rank top 29 worldwide, in terms of death rate from stroke (worldlifeexpectancy.com, 2017). We are highly at risk in having stroke, because of the tropical climate as well as the variety of food that we intake; fast food and street food. This led to stroke being the second leading cause of death and the leading cause of disability in our country. Stroke is widely prevalent, and is getting worse day by day. Through an observation on one’s personal environment and surrounding, s/he can immediately have an overview of how bad the effect of stroke is.
People who are living here in the Metro has higher chance of having stroke than the people who are living in the provinces and this is because of the kind of lifestyle that we have. In fact, according to the Philippine Statistics Authority, there are over 130,000 fast food chains in the philippines, most of it are in the metros. One thing about stroke is that it can strike at you any time. Believe it or not it can occur through all ages, even on newborn babies and by the age of 55 above, the chances of a person to have stroke doubles. Stroke is described as a blood clot in the artery, which sometimes causes the artery to burst. At this instance, you might have a 50-50% chance at life. Even if a person would have survived this, s/he will have disabilities, might it be with your motor movements, speech and even vision. S/he will have a hard time in recovering from it. Rehabilitation from stroke is quite a difficult task. If the researchers successfully found the best motivation for patients, they will find rehabilitation an easier task.
This issues led to the idea of the researchers to investigate on how they can help our locality with this global epidemic. A study is required in order to make this long and difficult process, as a short and easier process. This will help all of those people who will undergo the rehabilitation process. It will be hard to come up with prevention or cure, instead the researchers thought about how they can reduce the struggles in recovering from stroke, and increase the chances of a survivor in getting his/her life back to normal. By the end of this research the researchers will have a summary of the motivational factors and its effectiveness to the rehabilitation process.
Statement of the Problem
This study aims to discover the motivational factors affecting stroke patients’ rehabilitation for recovery. This specifically seeks to find:
What are their disabilities caused by stroke?
What rehabilitation program did they participate in?
When did the rehabilitation program begin?
When did the rehabilitation program end?
Who were involved in the rehabilitation program?
How did the rehabilitation program improve their condition?
What drove them to adhere to the clinical advice about practicing rehabilitation frequently and intensively?
Scopes and Delimitations
This study will only focus on the different motivational factors of patients’ rehabilitation and recovery. This study will include only those patients who are capable of communicating orally. Those patients who have cognitive impairments and has speaking, hearing and seeing disabilities are excluded from being respondents.
This study will not result to a complete and effective program of exercises for rehabilitation of motor movements. This study will focus more on the psychological and emotional state, rather than the physical. Coming up with a full-blown program is more difficult and requires more quantitative research. A medical background is much needed for the program to be very effective. A series of tests is included for the program, so it is time consuming. The researchers only have a limited time to come up with a research on stroke patients.
Significance of the Study
Motivation plays a big role in recovering in stroke. Every stroke patient needs motivation for them to participate fully with rehabilitation. A patients motivation usually comes from external factors, like family and friends. It can emanate from their loved ones or those people who give special attention or care to the stroke survivor (caregivers). This study will discover other factors and their importance. This study will be of great benefit to the patients undergoing rehabilitation, for they can have an easy recovery. This will also be beneficial to the caregivers, family, friends and future researchers.
A stroke’s patients goal is to recover from all the disabilities and get his/her life back. During rehabilitation most patients lack motivation to push through the process. They deem it difficult to perform every practice need for their betterment. It is truly hard to do those exercises, physically, mentally and emotionally. Patients encounter emotional breakdowns in between the exercises; thus, disabling them to finish. The recovery of the patient lies mostly on his/her willingness to improve. It is in the state of mind, and then the body will follow. With the knowledge of the different factors that affect a patients motivation, the patient can consider this helpful factors in order to succeed with the rehabilitation process.
The stroke’s rehabilitation process does not only consist of the patients, it also consists of the caregiver, who will help with the rehabilitation practices. If the patient encounters a problem during the process, the caregivers are also affected and it also becomes their problem. If the patient has no motivation to continue, that will be a great problem to the caregiver. S/he cannot be able to help the patient if the patient doesn’t want to be aided. Apart from the patients need to know the different motivations for his/her rehabilitation, the caregiver should be the next one to also have this knowledge. It will help the caregiver to have effective techniques to affect the patients motivation in recovering.
Aside from the challenges and struggles that stroke brought to the patient, it also brought burden to his/her family and loved ones. Having stroke can be quite expensive. Initially there are stacking hospital bills. After completing those hospital bills and and getting out the institution, here comes the recovery process. Rehabilitation is also pricey, considering that it consists of many sessions, and it is difficult to do. You need to pay a hefty amount of money for the caregiver to endure the process. Aside from financial needs, the family will also struggle with emotions. Seeing a loved one disabled, and sometimes hopeless, is a heart breaking scene to watch. Relatives try their best in order to help both financially and emotionally. This study can be of great help to the patient’s family. Their knowledge of the factors that affect the patient’s motivation, is useful for their aid in his/her rehabilitation.
This study will discover the different motivational factors and its effectiveness. This is a start for an easier and manageable rehabilitation process. This will be beneficial for the future researchers who would like to know techniques for a faster and effective recovery. With the motivational factors out of the way, future researchers can conduct a research about the actual practices or exercises. They can provide a routine or a program of different exercises that are appropriate for their therapy. They can use these motivational factors in order to spark better results for the research.
Definition of Terms
The following terms are used in the current study and are defined operationally for purposes of the research:
Motivation refers to the biological, emotional, social, and cognitive forces that activate behavior. In everyday usage, the term motivation is frequently used to describe why a person does something.
Recovery refers to the return to a normal state of health, mind, or strength (google dictionary, 2018). Stroke patients obtain disabilities and abnormalities. In order to recover from it, they should be able to get back to normal.
Rehabilitation/ Physical Therapy refers to the process of helping a person who has suffered an illness or injury restore lost skills and so regain maximum self-sufficiency. For example, rehabilitation work after a stroke may help the patient walk and speak clearly again. Physical therapy is appropriate for many types of patients, from infants born with musculoskeletal birth defects, to adults suffering from sciatica or the after effects of injury or surgery, to elderly post-stroke patients (medicinenet.com, 2016).
Stroke refers to the sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain. Sudden loss of speech, weakness, or paralysis of one side of the body can be symptoms. Some of the most common effects of stroke are physical. You may experience muscle weakness, paralysis, stiffness, or changes in sensation, usually on one side of your body. These effects can make it harder to move some parts of your body, and you may struggle with everyday activities (medicinenet.com, 2017). This is the illness that is focused in the study.
Chapter 2
REVIEW OF RELATED LITERATURE
Chapter 2
The researchers reviewed existing literature which answers the set of research questions. The first part of this chapter contains the related literature which focuses on motivating ideas about stroke rehabilitation and discouraging ideas about stroke rehabilitation. Moreover, the motivating ideas are divided into two subparts. First are the statements from the patient and the caregiver, and followed by general statements on rehabilitation motivation. The discouraging ideas are also divided into two subparts, statements about lack of improvement after rehabilitation and information about bad rehabilitation process.
The second half includes the related studies and is divided into two parts, the positive outlook and the negative outlook. Furthermore, the positive outlook consists of motivation within the patient and motivation with the surroundings. However, the negative outlook is divided between the problems with patient and problems with environment. These related literature and related studies helps answer the research questions.
Related Literature
When the blood flow is damaged inside the brain, a stroke called “brain attack” also occurs. The researchers obtained different information about the motivations of stroke patients from different articles, as well as some of their statements. These statements come from the patients themselves about how they are rehabilitated. In addition, the researchers also learned about the different situations of stroke accidents and the difficulty of different patients’ recovery process.
The patients who experienced stroke has a lot of things to say about the rehabilitation process. Their statements are considered the most valid ones, in regards to the description of the experience because they have gone through it first hand. According to Manuel Acosta (as cited in Neuroscience Institute, 2018), “I am a walking miracle, thanks to my wife and this incredible team of people who took care of me”. His wife, Daisy, recognized the signs right away when she saw his face drooping and his inability to speak clearly. It wasn’t long before he was paralyzed on the left side. Thanks to her immediate call to BSO and the pre-notification actions of EMS, Acosta arrived at the hospital with a Memorial Regional Hospital cath lab and team ready to remove the brain clot. He left the hospital a few days later without the need for rehabilitation. Today, he wakes up at 4:30 am each day, tends to his garden and his wife by making her delicious healthy meals. In addition to that, a Neurogym director named Mr. Nativ, remarked that, “What separates John from some other people is his motivation. This is downright crazy, what he has accomplished.” Mr. Nativ says nobody knows what the limits are for stroke patients. “We’re making our own evidence as we go, and every person is different,” he said. “As long as (Mr. Anderson) gets better, I never know the line. It’s always amazing for me to find out.” Mrs. Anderson wants more stroke survivors to have a chance to reach their potential and has organized the Stroke Recovery Conference around the premise that “We can do better after stroke.” His remarks are based on the patients he have handled, and from what he had observed.
Tsouna-Hadjis, Vemmos, et. Al. says that high levels of family support instrumental and emotional are associated with progressive improvement of functional status, mainly in severely impaired patients, while the psychosocial status is also affected. To intensify the point, Shinichiro Maeshima stated that family members have an important role to play in the reintegration of the patient into society. Therefore, both the patient and his or her family members must be provided with guidance while the patient is still in the hospital. Family members must understand the illness and learn techniques to assist the patient. When family members are engaged in rehabilitation with the patient, the duration of training sessions often lengthens and functionality improves. However, the types of training selected for family members to engage in with the patients must be simple and safe, and it must be possible to practice the activities continually. These activities must be simple yet important actions that can be repeated such as practicing standing up, maintaining a standing position, and walking with the aid of handrails or around tables. If patients do not spend their time in bed when they are not practicing rehabilitation, but rather engage in self-training with the help of family members, clear changes in the recovery process can be observed after 2 to 3 weeks. Most importantly, family members can easily observe that the patient is making a progress toward recovery, and an early discharge from the hospital becomes possible.
To intensify the role of motivation in rehabilitation, according to B. Johansson (as cited in NIA , 2010) stroke units that combined good medical and nursing care with task oriented intense training in an environment that provides confidence , stimulation and motivation significantly improve outcome. For patient it’s important for them to see everyone involved in full spectrum of their care so they understand what each member and component does towards their recovery. For staff it is important to see their patient and how they involved and improved so they can see the extraordinary work they do and continue to inspire future patient for their best outcome. Stroke rehabilitation is a combined and coordinated use of medical, social, educational, and vocational measures to retrain a person who has suffered a stroke to his/her maximal physical, psychological, social, and vocational potential, consistent with physiologic and environmental limitations (Bruno-Retina, 2018).
Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realized any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multi-joint movements on tasks that increase independence and enrich daily activity (Dobkins , 2004). Muth claims that one of the goals after a stroke is to regain as much function and independence as possible. Stroke rehabilitation encompasses a spectrum of activities designed to optimize recovery after stroke. Stroke rehabilitation often involves a team of people with various specializations. Dobkins argues that neurologic rehabilitation aims to reduce impairments and disabilities so that persons with serious stroke can return to participation in usual self-care and daily activities as independently as feasible. D. Keller claims in rehabilitation, any different kind of enriched therapy activating previously unsolicited brain regions will usually lead to an improvement in patients’ function. “This is just tapping into a domain where we have underused the brain that is going beyond traditional motor rehabilitation, traditional speech rehabilitation but just using new auditory, emotional, and musical clues to improve function,” he said. Additionally, Maujean and Davis states that stroke survivors with a high level of self-efficacy should be better prepared to overcome the many obstacles they face in their daily life and hence be better able to adapt to their changed circumstances.
Stroke is an alarming phenomenon that can happen to anybody, and it is quite difficult to recover from it. As claimed by Lippincott Williams and Wilkins, ischemic stroke incidence has been in decline over the past 60 years, the same has not been observed among individuals younger than 55 years. Recent reports have shown a substantial increase in young stroke incidence yet little is known about young stroke survivors. According to Noelia Guttierez (as cited in Neuroscience Institute, 2018) “it’s not supposed to happen to someone young like me” who first thought she was having a bad reaction to a sushi lunch she was sharing with her mom. “All of a sudden it hit me. I knew i was having a stroke so I was able to call 9-1-1 before I became paralyzed.”
Stroke has a huge impact on the patient’s physical and mental health. The usefulness of daily exercise can also have a significant impact on the patient’s post-stroke stagnation and personal satisfaction. Depression negatively affects the stroke specific quality of life of the patients and the more strongly effected domains of the quality of life are social roles, family roles, thinking and energy (K. Batool, S. Ehsan et.al.) Annick Maujean and Penelope Davis says that self-efficacy, especially in psychosocial functioning, can and does influence the well-being of stroke survivors. It is clear that stroke survivors can continue to have considerable influence over their well-being and quality of life. There are no mutually agreed primary outcome measures for rehabilitation trials. Thus the essential components of stroke rehabilitation remain elusive (Mi,  English, et.al.).
Related Studies
A stroke patient with a high motivating factor for rehabilitation is the target of everyone who meets a stroke patient. Because of this, the researchers reviewed these different studies, they shared positive and negative views about the healing process. Researchers can determine the factors that affect both outcomes. Patients participating in the study had different levels of motivation, which greatly affected the outcome.
Rehabilitation is one thing that helps stroke patients improve neurocognitive function that has been lost or reduced. Highly motivated patients may consider rehabilitation as the most important means of rehabilitation and enable them to play an active role in rehabilitation. More groups agree that stroke rehabilitation patients have more benefits through rehabilitation and continue to show improvement through this stroke.
According to the study of N. Maclean (as cited in BMJ Publising Group, 2000) There are some differences in beliefs between stroke patients identified as having low or high motivation for rehabilitation. These beliefs seem to be influenced by the environment in which the patient is rehabilitated. Professionals and carers should be made aware of the ways in which their behavior can positively and negatively affect motivation. The main purpose of rehabilitation is to maximize the survivor functional independence, facilitate re-iteration into the community and enhance participation in the life roles. These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke (C. Winstein, J Stein, et.al.). In addition, the studies conducted by S. Page, P. Levine, et.al. show the results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke. These changes are clinically significant. It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programs for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms (Gonzales-Suarez, Grimmer et.al). Mental practice may complement physical therapy to improve motor function after stroke. In the case of Zimmerman-Schlatter, Schuster et.al., current evidence suggests that Motor imagery provides additional benefits to conventional physiotherapy or occupational therapy. However, larger and methodologically sounder studies should be conducted to assess the benefits of Motor imagery. On the other hand, Nordin, Azlin, et.al confirms that family-assisted home therapy was viewed as a potential approach to continued rehabilitation for long term stroke survivors, given careful planning to overcome several family-related issues. Yet, Baskett, Broad et.al. found that a supervised home-based program is as effective as outpatient or day hospital therapy.
About 15 million people suffer from severe stroke each year, and 33% of them have a kick in the event of a stroke. Most studies on stroke expectations and treatment are conducted in the growing countries, but more than 85% of strokes occur in those countries. In the study conducted by Kulshrestha A., population-based studies from South Asia have stroke prevalence in the range of 45-471 per 100,000. The age-adjusted incidence rate varied from approximately 145 per 100,000 to 262 per 100,000. Rural parts of South Asia have a lower stroke prevalence compared with urban areas
Stroke remains one of the leading causes of disability and death worldwide and has a significant socioeconomic burden. Foltey, Norine, et.al. claims that stroke in elderly patients poses a major public health concern, due to its strong association with multiple medical complications, poorer functional outcomes, and substantial healthcare cost. Plant S. found out that despite goal-setting being widely used and recommended in clinical guidelines for stroke, evidence suggests it is often poorly carried out, particularly in the hospital setting. There is no specific tool to assist therapists and patients in goal-setting together. The result shows for physical therapists, participation in an active multi-component knowledge translation intervention resulted in improved evidence-based knowledge and practice behaviors compared with passive dissemination strategies. These gains did not translate into change in clinicians’ attitudes towards best practices. For occupational therapists, no studies have examined the use of multi-component interventions; studies of single interventions suggest limited evidence of effectiveness for all outcomes measured (M. Anita, K. Brtensky et.al). Additionally, C. Lang, J. MacDonald et.al. confirms that the amount of practice provided during post-stroke rehabilitation is small compared with animal models. It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function post-stroke optimally.
The researchers have gathered an ample amount of related literatures to gain an overview of how motivation affects the result of rehabilitation process. There are also supporting statements from the caregivers. In contrary, they also obtained discouraging facts about stroke rehabilitation, which can lead to low motivation. Some studies brings emphasis on how a patient’s motivation is a great predictor of the success in the rehabilitation processes. While some studies, came up with no unified idea on how to be recover successfully, thus, having a confusion on what to do in rehabilitation. The articles found here are focused on the motivational factors, therefore disregarding other factors that affect the results. There is a need for further research in order to complete these other factors and come up with an effective technique in rehabilitation and in order to give the best approaches in conducting a stroke rehabilitation. The studies differ, maybe because of the subjectivity of the people who are studied. They have different experiences and motivation.
Chapter 3
RESEARCH METHODOLOGY
Research Design
This study will use a phenomenological design to discover the different perspective of the respondents about their stroke experience. The researchers will conduct a semi-structured interview to know the kinds of rehabilitation programs stroke patients participated in and the factors that drove them to adhere to the clinical advice about practicing exercises frequently and intensively.
Research Environment
The research environment is in Malate, Manila, specifically on the respective houses of the respondents. Their houses are mostly the main place of their recovery, so this will provide a more natural setting fo this study. Aside from this, the respondents are more comfortable in their houses, therefore they are more relaxed and they can easily answer questions.
Research Respondents
The respondents for this study will be patients in the Malate area, who participated in the rehabilitation programs and recovered.
Research Instrument
The following instruments will be used in the study:
Interview Guide
This will be used to know the rehabilitation program stroke patients participate in and the motivational factors that affect rehabilitation.
Audio Recorder
This will be used to record the answers of the respondents during the interview. This will help in the process of transcribing the interview.
Data Gathering Procedure
The researchers will first conduct a survey in Malate area to identify the stroke patients. After doing so, the researchers will then ask for their consent to be interviewed. Once consent is given, the researchers will discuss the purpose of the study and gove the participants a copy of the interview questions a week before the actual interview. During the interview, the researchers will record the whole interview and take note of the important points that will be essential to the study.
Data Analysis
The content analysis is used to analyze data, gathered from personal interview. First the researchers will identify common ideas on the different answers of different participants. Those answers will then be classified and assessed according to themes. This will enable the researcher to easily examine the answers. Using all of those answers, they will come up with a conclusion.
Sampling Procedure
Purposeful sampling will be used in this study. Participants are purposively chosen through a survey.