1. The Competitive Edge: A dyad approach to upper limb group therapy across the continuum of care Toni Heinemann & Deanne Doggett Stroke Services - Senior Occupational Therapists Sir Charles Gairdner and Osborne Park Health Care Group: Committed staff, clever researchers – caring for patients

2. Background:  Dyad approach involves working in pairs or partnership with people with similar functional goals  Intensity of repetitions  Motor Learning literature  Social Interaction  Motivation  Cognition  Fatigue management

3. Aims and Inclusion Criteria:  To review the feasibility of adopting a dyad or paired approach to group therapy for the upper limb for stroke recovery  Inclusion Criteria:  Stroke  UL Goals  Appropriate group environment  Attend to 45 minute group (sustained attention, fatigue)

4. Methods:  Referrals – 3 services  Timing  Facilitators  Group Structure  Pairing  Task specific focus

5. Group Description:  Outcome Measures:  Box and Block  FIM  Qualitative feedback  Personal goal based reviews

6. Patient Demographics:  Commenced July 2015  32 participants (to date)  28 completed program  Majority mild to moderate UL deficits (66%)  46% Males; 54% Females  63% L UL affected; 37% R UL affected  Age range: 65 - 91 years (average 75 yrs)

7. Results:  Average of 150 repetitions  Raw data have demonstrated improvements in FIM scores and Box and Block scores  Formal analysis will be completed at the completion of the trial

8. Qualitative Feedback: Common Themes:  Motivated to perform the task within a group setting  Assisted with social interaction between stroke survivors  Elevation of mood  “Didn't want to let the team down”

9. Qualitative Feedback:  “Got you out of your room and you got to meet some people whilst helping my arm work better”  “I sometimes think my struggles are mine, but it was good to see others had the same struggles and I realise that I am not alone”  “I don't normally enjoy physical exercise though I am really enjoying the group. It feels like we (the participants) are sharing the load. Time really flies in the group. Before I know it the group is over”  “The exercises were really tough some days, I feel like my arm has had a good work out”

10. Reflection & Future Direction:  Beneficial for inpatients  Difficulty matching partnerships (with similar level of function and goals)  Managing therapist expectation- especially in regards to movement quality  Resource preparation required  Introduction of educational component  Bonus cognitive therapeutic benefit (especially attentional skills)  Introduction planned for COPM

11. References: Adey – Wakeling, Z & Crotty, M. (2013). Upper Limb Rehabilitation following stroke: current evidence and future perspectives. Aging Health, 9(6), 629 – 647. Lee, T, D., & Wishart, L, R. (2005). Motor Learning Conundrums (and Possible solutions). Quest, 57(1), 67 78. McNevin, N, H., Wulf, G., & Carlson, C. (2000). Effects of Attentional focus, Self-control and Dyad training on Motor Learning. Implications for Physical Rehabilitation. Physical Therapy, 80, 373 – 385. Waddell, K, J., Birkenmeier, R, L., Moore, J, L., Hornby, T, G & Lang, C, E. (2014). Feasibilty of high- repitition, task-specific training for individuals with upper-extremity paresis. American Journal of Occupational Therapy, 68, 444-453. Wulf, G., Shea, C, & Lewthwaite, R. (2010). Motor Skill learning and performance: a review of influential factors. Medical Education, 44, 75 – 84.

12. Questions:  Deanne.Doggett@health.wa.gov.au Deanne.Doggett@health.wa.gov.au  Toni.Heinemann@health.wa.gov.au Toni.Heinemann@health.wa.gov.au