Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This mixed-methods case study examines use of a harness system in a community garden for persons poststroke.No studies exist on this topic. Two persons participated.Multiple pretest–posttest measures, observations, and poststudy interviews were conducted. Both showed improvement in balance and mobility, and Person 2's spirituality improved. Persons described enhanced confidence in functional mobility, ability to problem solve, and use of the hemiplegic upper extremity. Research in natural environments is needed.
Primary Author and Speaker: Beth Ekelman
Contributing Authors: Kelly Bishop, Erica Hughes, Allison Kienzle, Alicia Loreta, Marissa Melaragno, Shay Smallman, Jason Uth, Morgan Vaughn, and Jessica Zdanowicz
PURPOSE: This study examines the efficacy of the use of a harness system within a natural context of a community garden for persons post-stroke who have balance challenges and learned non-use of their hemiplegic UE. Harnesses provide safety against the potential for falls, enhance mobility confidence, and positively impact balance (Castro et al., 2019). Waddell et al. (2014) found that repeated tasks with high amounts of repetitions can help improve UE functional outcomes in the participant (P) post-stroke. Community gardening offers opportunities for establishing environments that allow for participation in occupations and social participation/inclusion (Whatley et al., 2015). No studies exist that examine the therapeutic use of a harness system in relation to gardening or within a natural environment.
DESIGN: This study employs a mixed methods case series design (Creswell & Poth, 2018).
METHODS: Using convenience and snowball sampling, the Ps met inclusion criteria: 18 years or older; an interest in gardening; the ability to achieve sit to stand; and the ability to safely garden under supervision. Ps engaged in the study at different times. After obtaining informed consent, Ps participated in two hours of pre-testing and three hours of post-testing. Pre/post-test measures: the Canadian Occupational Performance Measure (COPM), Fatigue Severity Scale (FSS), Falls Efficacy Scale (FES), Timed Up and Go (TUG), Berg Balance Scale (BERG), Five Times Sit-to-Stand Test (5XSTS), Mini Balance Evaluation Systems Test (Mini BESTest), and Activities-Specific Balance Confidence Scale (ABC scale). The Quality of Life Profile for Adults with Physical Disabilities (QOLP-PD) and Action Research Arm Test (ARAT) were also used for P2. The OT conducted a preliminary semi-structured interview using the COPM and completed an occupational profile. Ps attended 7-8 gardening sessions, 1-2 times per week, and each session lasted 1-2 hours depending on the participant's activity tolerance and weather. During the gardening sessions, researchers provided skilled interventions, took observation notes, and completed three structured occupational analyses at the beginning, middle, and end of the program. In the post-study audio-recorded interview, Ps explained the post-test COPM ratings, described the meaning of the gardening experience, and how the experience influenced his/her physical, mental, and social well-being. The interview was transcribed verbatim.
DATA ANALYSIS: The researchers examined whether changes in pre/post-test measures were clinically significant for each P. Qualitative data were analyzed using strategies described by Creswell (2013). Three researchers completed a direct interpretation of the data by looking at single instances within the described data, categorizing these, then identifying overarching themes. Researchers identified similarities and differences between the Ps. Trustworthiness of findings were obtained through triangulation of data, audit trails, and peer debriefings.
RESULTS AND FINDINGS: P1 was one year post-stroke and P2 was 10 years post-stroke. Both showed improvements per the COPM. P1 also showed improvements in the FSS, mini-BESTtest, and the TUG. P2 showed an improvement in the spirituality measure of the QOLP-PD.Qualitative analysis across cases revealed enhanced confidence in functional mobility within the garden, home, and community environments, improved ability to problem solve within the garden and at home, and enhanced use of the hemiplegic UE.
CONCLUSION: The results suggest that using a safety harness within the natural context of a community garden can significantly impact spirituality, mobility confidence, the ability to apply compensatory techniques to enhance participation in gardening, and carry over to other meaningful occupations.
References
Castro, P., Kaski, D., Schieppati, M., Furman, M., Arshad, Q., & Bronstein, A. (2019). Subjective stability perception is related to postural anxiety in older subjects. Gait and Posture, 68, 538–544. https://doi.org/10.1016/j.gaitpost.2018.12.043
Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry & research design: Choosing among five approaches (4th ed.). Los Angeles, Calif.: Sage
Waddell, K., Strube, M., Bailey, R., Klaesner, J., Birkenmeier, R., Dromerick, A., & Lang, C. (2017). Does task-specific training improve upper limb performance in daily life poststroke? Neurorehabilitation & Neural Repair, 31(3), 290–300. https://doi.org/10.1177/1545968316680493
Whatley, E., Fortune, T., & Williams, A. (2015). Enabling occupational participation and social inclusion for people recovering from mental ill-health through community gardening. Australian Occupational Therapy Journal, 62(6), 428-437.
