title: Improving practice with integration of patient directed activity during inpatient rehabilitation.
abstract: BACKGROUND
  Early initiation of rehabilitation following stroke promotes better long-term outcomes than delayed onset, emphasizing the importance of inpatient therapy. However, literature indicates that following stroke individuals in inpatient rehabilitation spend the majority of their day in their bedroom and inactive. Consequently, since amount of functional activity is posited to relate to outcomes, the current rehabilitation model needs to be challenged with innovative solutions to maximize recovery.
  
  
  BACKGROUND
  In an attempt to promote greater activity and higher doses of therapy during inpatient rehabilitation, we implemented the "Patient Directed Activity Program" to facilitate specific movement and improve outcomes for patients post stroke. Our interdisciplinary activity program was conceptualized on a theoretical model for stroke recovery and principles of experience-dependent neural plasticity.
  
  
  METHODS
  The "Patient Directed Activity Program" includes distinct activity stations designed to increase repetition, stimulation, attention, and activity of the affected upper extremities, lower extremities, and trunk. Each task-specific activity was easily graded to achieve moderate- to high-intensity. The activity program prescribed individuals up to three additional 30-minute bouts of activities daily that were to be completed independently, and in addition to standard of care. Clinical application: After implementing this program in our facility for one year as a quality improvement project, the intervention has been delivered as an Institutional Review Board approved randomized controlled trial (Clinical Trial #NCT02446197). Challenges with people and facilities have been overcome, resulting in a feasible program that can be delivered in an inpatient setting. High satisfaction has been reported by patients and clinicians.
authors.affiliation: 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Trammell
authors.affiliation: 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Kapoor
authors.affiliation: 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA.|2 Department of Physical Therapy, Texas Woman's University, TX, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Swank
authors.affiliation: 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Driver
mesh_terms: D000203:Activities of Daily Living; D006760:Hospitalization; D006801:Humans; D010358:Patient Participation; D000071939:Stroke Rehabilitation
keywords: Stroke; implementation; increasing activity; self-management