Engagement and learning: an exploratory study of situated practice in multi-disciplinary stroke rehabilitation.
OBJECTIVE
Active participation is considered to be a key factor in stroke rehabilitation. Patient engagement in learning is an important part of this process. This study sets out to explore how active participation and engagement are 'produced' in the course of day-to-day multi-disciplinary stroke rehabilitation.


METHODS
Ethnographic observation, analytic concepts drawn from discourse analysis (DA) and the perspective and methods of conversation analysis (CA) were applied to videotaped data from three sessions of rehabilitation therapy each for two patients with communication impairments (dysarthria, aphasia).


RESULTS
Engagement was facilitated (and hindered) through the interactional work of patients and healthcare professionals. An institutional ethos of 'right practice' was evidenced in the working practices of therapists and aligned with or resisted by patients; therapeutic activity type (impairment, activity or functional focus) impacted on the ways in which patient engagement was developed and sustained.


CONCLUSIONS
This exploration of multi-disciplinary rehabilitation practice adds a new dimension to our understanding of the barriers and facilitators to patient engagement in the learning process and provides scope for further research. Harmonising the rehabilitation process across disciplines through more focused attention to ways in which patient participation is enhanced may help improve the consistency and quality of patient engagement.
Health and Social Sciences Research Institute, Faculty of Health, University of East Anglia, Norwich, UK. s.horton@uea.ac.uk
Simon
S
Horton
Alison
A
Howell
Kate
K
Humby
Alexandra
A
Ross
D001037:Aphasia / Q000209:etiology / Q000534:rehabilitation; D003142:Communication; D004401:Dysarthria / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D009788:Occupational Therapy / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D010358:Patient Participation; D026741:Physical Therapy Modalities; D011369:Professional-Patient Relations; D012494:Sampling Studies; D013070:Speech Therapy / Q000379:methods; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014741:Video Recording