Upper-limb Exercise Research Articles

Efficacy of a Virtual Reality Commercial Gaming Device in Upper Limb Recovery after Stroke: A Randomized, Controlled Study

Objective: To compare the efficacy of a virtual reality commercial gaming device, Nintendo wii (NW) with conventional therapy and customary care in facilitating upper limb recovery after stroke.Design: Randomized, controlled, single-blinded study. Setting: Tertiary rehabilitation center.Participants: 105 subjects admitted to in inpatient rehabilitation program within 6 weeks of stroke onset.Interventions: Subjects were randomly assigned to one of three groups of upper limb exercises: (1) NW gaming; (2) conventional therapy; (3) control. NW gaming and conventional therapy were provided fourtimes a week for 3 weeks.Main outcome measure(s): The main outcome measure was Fugl-Meyer assessment (FMA) of upper limb function. Secondary outcome measures included Action Research Arm Test, Functional Independence Measure, and Stroke Impact Scale. These measures were assessed at baseline, completion of intervention (week 3) and at 4 weeks and 8 weeks after completion of intervention. The primary outcome measure was the change in FMA scores at completion of intervention.Results: The mean age was 57.5±9.8 years, and subjects were enrolled at a mean of 13.7±8.9 days after stroke. The mean baseline FMA score was 16.4±14.2. There was no difference in FMA scores between all 3 groups at the end of intervention, and at 4 and 8 weeks after completion of intervention. Similar findings were also noted for the secondary outcome measures.Conclusion(s): Twelve sessions of augmented upper limb exercises via NW gaming or conventional therapy over a 3-week period was not effective in enhancing upper limb motor recovery compared to control.

A COMPARATIVE ANALYSIS BETWEEN THE RECOVERY RESULTS OF PATIENTS WITH HIP JOINT REPLACEMENT IN THE PERIOD OF EARLY REHABILITATION AT HOME (13-45 DAYS AFTER SURGERY)

Rehabilitation of the patients with Hip Joint Arthroplasthy is an indispensable part of the functional recovery. The purpose of this report is to track and measure the results of an applied complex rehabilitation program during the early post-surgery period in home setting (13-45 days after surgery) and to make a comparative analysis between the recovery results of patients who conducted a comprehensive rehabilitation treatment, and a control group of patients who conducted only early physical therapy and occupational therapy in the hospitalization in the Department of Orthopedics and Traumatology. Methods and materials: 152 patients (107 female and 45 male) aged between 22 and 84 with Hip Joint Arthroplasthy due to osteoarthritis or femoral neck fracture participated in the study, divided into two groups, according to postoperative behavior. The rehabilitation program consists of: kinesitherapy (positional therapy, isometric exercises, movement of the artificial hip joint within the allowed volumes, exercises for upper limbs and the healthy lower limb) and ergotherapy (ergonomic home environment adjusted to performing the daily activities of life). Patients in the second control group have conducted kinesitherapy and occupational therapy only in the early postoperative period in orthopedic clinic. Results: Locomotion test and DAL test measurements were taken and the results for each patient were stored in a special patient file. Conclusion: Ensuring an ergonomic home environment and independent practice of kinesitherapeutic and ergotherapeutic stimulate the recovery of the patients’ selfreliance significantly improve the psycho-emotional balance and self-respect, and serves as an important basis for the latter stages of rehabilitation.

Respiratory Response to BiPAP Aided Upper Limb Exercise in Hypercapanic COPD Patients

Study design: Experimental study design Background: Application of inspiratory support, through proportional assisted ventilation, or continuous positive airways pressure ventilation, may potentially lead to enhanced training intensity. Therapies that are aimed to enhance physical activity levels have the potential to benefit patient group. However, beneficial effects of BiPAP aided performance of upper limb activities have been poorly documented. Purpose of the study: To investigate the beneficial effects of BiPAP aided performance of upper limb activities along with oxygen therapy in improving gas exchange, fatigue and dyspnoea in Hypercapnic COPD patients. Method: 30 Hypercapanic COPD patients were selected for both groups. Subjects in group A performed 20 minutes upper limb activity regimen without BiPAP where as subjects in group B performed the same regimen with BiPAP. Subjects underwent ABG analysis before and immediately after intervention. Results: Within Groups analysis showed that there was a significant rise in dyspnoea, fatigue and Pa CO2 scores in both groups (p<0.001). PaO2 and pH scores showed significant reduction in group A whereas there was a significant increase in PaO2 score and a decrease in pH scores in group B. Between groups analysis showed significantly higher rise in dyspnoea, fatigue, PaCO2 in Group A as compared to that in Group B (p ? 0.05). pH scores showed significant reduction in group A as compared to that in Group B (p? 0.001).There was significantly higher rise in PaO2 score in Group B as compared to Group A (p? 0.001). Conclusion: The results yielded a clinically significant improvement in patients’ blood gas exchange parameters and less increase in dyspnoea and fatigue in BiPAP aided Hypercapanic patients.

Respiratory Response to BiPAP Aided Upper Limb Exercise in Hypercapanic COPD Patients

Respiratory Response to BiPAP Aided Upper Limb Exercise in Hypercapanic COPD Patients

Depression diagnosed by the mini international neuropsychiatric interview plus (MINI) in patients with chronic obstructive pulmonary disease: relationship with functional capacity and quality of life.

BackgroundThe prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) is associated with a worsening of prognosis. Most studies classify COPD patients as depressive or non-depressive based on symptoms, rather than on a diagnosis using specific tools. Thus, the aim of this study was to determine the impact of depression, as diagnosed by the Mini International Neuropsychiatric Interview Plus (MINI), on functional capacity estimated by the 6-minute walk test (6MWT) and unsupported upper-limb exercise test, and quality of life estimated by Saint George’s Respiratory Questionnaire (SGRQ), among patients with COPD.ResultsUsing the MINI as a diagnostic tool, 22.2 % of all patients (6.6 % of all men and 41.6 % of all women) were diagnosed with depression. No significant differences were found between depressive and non-depressive patients with regard to anthropometric measurements, lung function, functional capacity, or quality of life variables. The best models for the dependent variables representing functional capacity and quality of life revealed that the covariates SGRQTOTAL and gender (R2 = 16.7 %) were significant in explaining the response variable for functional capacity of the upper limbs. Results also showed that age, monthly income, insomnia, and the results of a 6MWT were significant in explaining overall quality of life (R2 = 46 %), and that the percentage of the predicted forced expiratory volume in the first second post-bronchodilator and gender were significant in explaining walking distance (R2 = 22 %). Depression, as diagnosed by the MINI, was not significant in explaining any of the dependent variables.ConclusionsDespite a high prevalence of depression in COPD patients, especially in women, depression, as diagnosed by the MINI, was not correlated with functional capacity tests or quality of life in patients with moderate to very severe COPD in the present study. This suggests that depression identified by this diagnostic test may be more accurate than depression diagnosed by tests that evaluate symptoms, as they may be influenced by the perceptions of the patient in relation to their health.

The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation.

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes.

Influences of different expiration diameters on ventilator parameters during unsupported upper limb exercise

Influences of different expiration diameters on ventilator parameters during unsupported upper limb exercise

Integrating Upper- and Lower-Limb Exercises in Virtual Reality Video Games: A Novel Approach in Pediatric Clinical Exercise Rehabilitation for Duchenne Muscular Dystrophy

In clinical exercise rehabilitation, training of the lower extremities is recognized as a key contributor in delaying the decline in functional status and the onset of disability in children with Duchenne muscular dystrophy. Recent evidence revealing the importance of upper-limb exercise as an adjunct intervention has led to the evaluation of clinical trials regarding the integration of exercise modalities involving the upper and lower extremities. One method to integrate both modalities of exercise is through the use of interactive video game (exergaming) technology, which is currently an active area of research to improve neurorehabilitation outcomes in children with developmental disabilities. We propose that a novel approach involving clinical exercises of the upper and lower extremities in virtual reality video games can lead to marked enhancements in the functional status of children with Duchenne muscular dystrophy.

Cognitive-linguistic effort in multidisciplinary stroke rehabilitation: Decreasing vs. increasing cues for word retrieval

Approximately 24% of stroke survivors experience co-occurring aphasia and hemiparesis. These individuals typically attend back-to-back therapy sessions. However, sequentially scheduled therapy may trigger physical and mental fatigue and have an adverse impact on treatment outcomes. The current study tested a hypothesis that exerting less effort during a therapy session would reduce overall fatigue and enhance functional recovery. Two stroke survivors chronically challenged by non-fluent aphasia and right hemiparesis sequentially completed verbal naming and upper-limb tasks on their home computers. The level of cognitive-linguistic effort in speech/language practice was manipulated by presenting verbal naming tasks in two conditions: Decreasing cues (i.e., most-to-least support for word retrieval), and Increasing cues (i.e., least-to-most support). The participants completed the same upper-limb exercises throughout the study periods. Both individuals showed a statistically significant advantage of decreasing cues over increasing cues in word retrieval during the practice period, but not at the end of the practice period or thereafter. The participant with moderate aphasia and hemiparesis achieved clinically meaningful gains in upper-limb functions following the decreasing cues condition, but not after the increasing cues condition. Preliminary findings from the current study suggest a positive impact of decreasing cues in the context of multidisciplinary stroke rehabilitation.

Measurement of body joint angles for physical therapy based on mean shift tracking using two low cost Kinect images.

Range of motion (ROM) is commonly used to assess a patient's joint function in physical therapy. Because motion capture systems are generally very expensive, physical therapists mostly use simple rulers to measure patients' joint angles in clinical diagnosis, which will suffer from low accuracy, low reliability, and subjective. In this study we used color and depth image feature from two sets of low-cost Microsoft Kinect to reconstruct 3D joint positions, and then calculate moveable joint angles to assess the ROM. A Gaussian background model is first used to segment the human body from the depth images. The 3D coordinates of the joints are reconstructed from both color and depth images. To track the location of joints throughout the sequence more precisely, we adopt the mean shift algorithm to find out the center of voxels upon the joints. The two sets of Kinect are placed three meters away from each other and facing to the subject. The joint moveable angles and the motion data are calculated from the position of joints frame by frame. To verify the results of our system, we take the results from a motion capture system called VICON as golden standard. Our 150 test results showed that the deviation of joint moveable angles between those obtained by VICON and our system is about 4 to 8 degree in six different upper limb exercises, which are acceptable in clinical environment.

Effect of muscular fatigue on fractal upper limb coordination dynamics and muscle synergies.

Rehabilitation exercises cause fatigue because tasks are repetitive. Therefore, inevitable human motion performance changes occur during the therapy. Although traditionally fatigue is considered an event that occurs in the musculoskeletal level, this paper studies whether fatigue can be regarded as context that influences lower-dimensional motor control organization and coordination at neural level. Non Negative Factorization Matrix (NNFM) and Detrended Fluctuations Analysis (DFA) are the tools used to analyze the changes in the coordination of motor function when someone is affected by fatigue. The study establishes that synergies remain fairly stable with the onset of fatigue, but the fatigue affects the dynamical coordination understood as a cognitive process. These results have been validated with 9 healthy subjects for three representative exercises for upper limb: biceps, triceps and deltoid.

Plasma cytokine and exertional responses in relation to exercise intensity and volume of exercising muscle mass during arm-crank ergometry.

This original study investigated the effect of submaximal exercise intensity and volume of contracting muscle mass on plasma inflammation-mediating cytokine and perceived exertional responses to acute arm-crank ergometry (ACE). Twelve recreationally active but upper limb untrained males performed 30 min of (i) low-intensity (40% peak oxygen uptake) ACE (LOW); (ii) moderate-intensity (60% peak oxygen uptake) ACE (MOD); and (iii) concurrent low-intensity (40% peak oxygen uptake) ACE plus lower limb cycle ergometry to match total power output in MOD (HYB). Plasma concentrations of interleukin (IL)-6, IL-10, IL-1ra, adrenaline, and cortisol were determined at rest, immediately postexercise, and 1 h and 2 h postexercise. Heart rate (HR) and differentiated ratings of perceived exertion (RPE) were also recorded. Plasma IL-6 concentrations were elevated (p < 0.05) immediately postexercise and 1 h postexercise (∼ 2.5-fold) in all trials and 2 h postexercise in MOD (3-fold). Plasma IL-1ra concentrations were elevated (p < 0.05) 2 h postexercise in MOD only (2-fold). No plasma IL-10, cortisol, and adrenaline responses were observed. HR and differentiated RPE were significantly higher during MOD than HYB and LOW. Peripheral RPE were significantly higher than central and overall RPE in each trial. Thirty minutes of moderate intensity ACE initiated a plasma cytokine response associated with the protective effect of regular exercise against cardiovascular and metabolic disease risk. Further work is required to establish an optimal intensity and duration of upper limb exercise to maximise the anti-inflammatory potential whilst managing the risk of over-use injury.

Effects of a Single Hand–Exercise Session on Manual Dexterity and Strength in Persons with Parkinson Disease: A Randomized Controlled Trial

ObjectiveTo evaluate the effects on manual dexterity, hand grip, and pinch strength of a single intervention focused on hand exercises. DesignRandomized, controlled, blinded study. PatientsSixty people with Parkinson disease (PD) were recruited; 30 participants were allocated to a brief exercise session and 30 to a control group. InterventionsParticipants randomized to the experimental group received a 15-minute exercise session focused on hand training using therapeutic putty. Participants allocated to the control group performed active upper limb exercises. Main Outcome MeasurementsMeasures of manual dexterity (assessed by the Purdue Pegboard Test and the Chessington Occupational Therapy Neurologic Assessment Battery dexterity task) and strength (hand grip and pinch strength) were recorded at baseline and after the intervention. ResultsParticipants had significantly improved manual dexterity values (P < .05) after the intervention. They also had increased hand grip (P < .001) and pinch strength (P < .05). ConclusionsA single hand–exercise session showed an improvement in manual dexterity and strength in persons with PD.

The Effects of Upper Limb Exercise Through Yoga on Limb Swelling in Chinese Breast Cancer Survivors – A Pilot Study

Breast cancer is the most common female cancer. The aim of this study was to assess the impact of yoga on lymphedema in breast cancer survivors. Repeated measures before and after the intervention. We enrolled 15 women with breast cancer who had not previously worn elastic clothing to treat lymphedema. The program was led by a certified trainer and consisted of 60-minute sessions, three times a week for 12 weeks. The volumes of the affected and normal limbs were measured. A self-assessed edema score was also recorded. Fifteen patients completed the program, none of whom suffered from complications related to exercise. There was no significant edema after exercise. No significant differences were noted in subgroup analysis by age or the affected arm. Yoga does not induce lymphedema. Lymphedema is usually treated with uncomfortable elastic clothing, and high-resistance exercise may induce edema. Yoga may be suitable for these patients.

Muscular and functional effects of partitioning exercising muscle mass in patients with chronic obstructive pulmonary disease - a study protocol for a randomized controlled trial.

BackgroundLow-load, high-repetitive single-limb resistance training may increase limb muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD) while minimizing the occurrence of limiting exertional symptoms. Whether high-repetitive single-limb resistance training would perform better than high-repetitive two-limb resistance training is unknown. In addition, the mechanisms underlying possible benefits of high-repetitive resistance training has not been investigated. The aims of this study are to compare single versus two-limb high-repetitive resistance training in patients with COPD and to investigate mechanisms of action of these training modalities.Methods/DesignThis trial is a prospective, assessor-blind, randomized controlled trial. The participants are patients with stable severe to very severe COPD who are older than 40 years of age and healthy controls. The intervention is single-limb, high-repetitive, resistance training with elastic bands, three times/week for 8 weeks.The control is two-limb high-repetitive resistance training with elastic bands, three times/week for 8 weeks.The primary outcomes is change in the 6-min walking distance after 8 weeks of single-limb or two-limb high-repetitive resistance training.The secondary outcomes are changes in limb muscle strength and endurance capacity, key protein involved in quadriceps anabolic/catabolic signalization, fiber-type distribution and capillarization, subjective dyspnea and muscle fatigue, muscle oxygenation, cardiorespiratory demand and health-related quality-of-life after 8 weeks of single-limb or two-limb high-repetitive resistance training.The acute effects of single-limb versus two-limb high-repetitive resistance training on contractile fatigue, exercise stimulus (the product of number of repetition and load), subjective dyspnea and muscle fatigue, muscle oxygenation, and cardiorespiratory demand during upper and lower limb exercises will also be investigated in patients with COPD and healthy controls.Randomization will be performed using a random number generator by a person independent of the recruitment process, using 1:1 allocation to the intervention and the control group using random block sizes.Blinding: All outcome assessors will be blinded to group assignment.DiscussionThe results of this project will provide important information to help developing and implementing customized exercise training programs for patients with COPD.Trial registrationClinicalTrials.gov Identifier NCT02283580 Registration date: 4 November 2014. First participant randomized: 10 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0698-x) contains supplementary material, which is available to authorized users.

I31. Economic Evaluation of a Brief Education, Self-Management and Upper Limb Exercise Training Programme in People With Rheumatoid Arthritis

Lindsay M. Bearne, Billingsley Kaambwa, Julie Ratcliffe, Ernest Choy, David L. Scott, Michael V. Hurley and Victoria L. Manning Division of Health and Social Care Research, King’s College London, London, UK, Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, Australia, Institute of Infection & Immunity, Cardiff University, Cardiff, Department of Rheumatology, Faculty of Life Sciences and Medicine, King’s College London and School of Rehabilitation Sciences, St George’s, University of London and Kingston University, London, UK

Lower limb conduit artery endothelial responses to acute upper limb exercise in spinal cord injured and able-bodied men.

Vascular improvements in the nonactive regions during exercise are likely primarily mediated by increased shear rate (SR). Individuals with spinal cord injury (SCI) experience sublesional vascular deconditioning and could potentially benefit from upper body exercise-induced increases in lower body SR. The present study utilized a single bout of incremental arm-crank exercise to generate exercise-induced SR changes in the superficial femoral artery in an effort to evaluate the acute postexercise impact on superficial femoral artery endothelial function via flow-mediated dilation (FMD), and determine regulatory factors in the nonactive legs of individuals with and without SCI. Eight individuals with SCI and eight age, sex, and waist-circumference-matched able-bodied (AB) controls participated. Nine minutes of incremental arm-crank exercise increased superficial femoral artery anterograde SR (P = 0.02 and P < 0.01), retrograde SR (P < 0.01 and P < 0.01), and oscillatory shear index (OSI) (P < 0.001 and P < 0.001) in both SCI and AB, respectively. However, these SR alterations resulted in acute postexercise increases in FMD in the AB group only (SCI 6.0 ± 1.2% to 6.3 ± 2.7%, P = 0.74; AB 7.5 ± 1.4% to 11.2 ± 1.4%, P = 0.03). While arm exercise has many cardiovascular benefits and results in changes in SR patterns in the nonactive legs, these changes are not sufficient to induce acute changes in FMD among individuals with SCI, and therefore are less likely to stimulate exercise training-associated improvements in nonactive limb endothelial function. Understanding the role of SR patterns on FMD brings us closer to designing effective strategies to combat impaired vascular function in both healthy and clinical populations.

Multi-dimensional balance training programme improves balance and gait performance in people with Parkinson's disease: A pragmatic randomized controlled trial with 12-month follow-up.

Previous studies have demonstrated that exercise interventions can improve balance and gait performance in people with Parkinson's disease (PD), but most training did not targetall balance domains and was conducted mainly indoors. To investigate the short- and long-term effects of a multi-dimensional indoor and outdoor exercise programme on balance, balance confidence and gait performance in people with PD. Eligible subjects with PD were randomly assigned to an eight-week indoor and outdoor balance training (EXP, N=41) group or upper limb exercise (CON, N=43) group. Outcome measures included BESTest total and subsection scores, gait speed, dual-task timed-up-and-go (dual-task TUG) time and Activities-specific Balance Confidence (ABC) score. All outcomes were assessed before training (Pre), immediately after intervention (Post) and at six-month (FU6m) and twelve-month (FU12m) follow-ups. Immediately after training, EXP group showed more significant improvements than CON group in BESTest total and subsection scores, gait speed and dual-task TUG time (p<0.05). At both FU6m and FU12m, EXP group showed significantly greater gains than CON group in BESTest total and subsection scores and dual-task TUG time (p<0.05). EXP group also showed significantly greater increase in the gait speed than CON group at FU6m (p<0.05). The positive findings of this study provide evidence that this multi-dimensional balance training programme can enhance balance and dual-task gait performance up to 12-month follow-up in people with PD.

The effects of acute arm crank ergometry and cycle ergometry on postural sway and attentional demands during quiet bipedal standing.

Current evidence suggests that acute bouts of lower limb exercise elicits a number of adverse effects on both sensory and motor components of postural control. The effects of acute exercise on quiet standing balance while concurrently performing an attentional task remains equivocal. This study aimed to compare the alterations in postural control and attentional demands elicited by upper and lower limb exercise. Twelve healthy young males (mean ± SD age, 22.2 ± 3.2 years) were examined on six separate occasions. The first two visits determined maximal aerobic fitness on an arm crank ergometer (ACE) and cycle ergometer (CYC). Subsequently, participant's postural sway was assessed during single- (ST) and dual-task (DT) conditions before and immediately after moderate- and high-intensity exercise engaging the upper or lower body musculature. The order of the four exercise tests was counterbalanced. The centre of pressure displacement in the anteroposterior (COPAP) and mediolateral (COPML) directions and the COP path length (COPL) were computed using a force platform. A time × mode interaction was observed for COPAP (ST; p = 0.011, DT; p = 0.018) and COPML (ST; p = 0.001). CYC elicited large (ES; 1.6-2.0) increases in COPAP and COPML, but there were no differences between aerobic and anaerobic tests (p > 0.05). The effect of cognitive load appeared to increase sway in the frontal plane following anaerobic CYC (p = 0.001) but not ACE (p < 0.05). Exercise has different effects on frontal and sagittal plane sway following different cognitive loads. In particular, COPML was increased at the cost of maintaining attentional performance following exercise.

Development of a behaviour change intervention to increase upper limb exercise in stroke rehabilitation.

BackgroundTwo thirds of survivors will achieve independent ambulation after a stroke, but less than half will recover upper limb function. There is strong evidence to support intensive repetitive task-oriented training for recovery after stroke. The number of repetitions needed is suggested to be in the order of hundreds, but this is not currently being achieved in clinical practice. In an effort to bridge this evidence-practice gap, we have developed a behaviour change intervention that aims to increase provision of upper limb repetitive task-oriented training in stroke rehabilitation. This paper aims to describe the systematic processes that took place in collaboratively developing the behaviour change intervention.MethodsThe methods used in this study were not defined a priori but were guided by the Behaviour Change Wheel. The process was collaborative and iterative with four stages of development emerging (i) establishing an intervention development group; (ii) structured discussions to understand the problem, prioritise target behaviours and analyse target behaviours; (iii) collaborative design of theoretically underpinned intervention components and (iv) piloting and refining of intervention components.ResultsThe intervention development group consisted of the research team and stroke therapy team at a local stroke rehabilitation unit. The group prioritised four target behaviours at the therapist level: (i) identifying suitable patients for exercises, (ii) provision of exercises, (iii) communicating exercises to family/visitors and (iv) monitoring and reviewing exercises. It also provides a method for self-monitoring performance in order to measure fidelity. The developed intervention, PRACTISE (Promoting Recovery of the Arm: Clinical Tools for Intensive Stroke Exercise), consists of team meetings and the PRACTISE Toolkit (screening tool and upper limb exercise plan, PRACTISE exercise pack and an audit tool).ConclusionsThis paper provides an example of how the Behaviour Change Wheel may be applied in the collaborative development of a behaviour change intervention for health professionals. The process involved was resource-intensive, and the iterative process was difficult to capture. The use of a published behaviour change framework and taxonomy will assist replication in future research and clinical use. The feasibility and acceptability of PRACTISE is currently being explored in two other stroke rehabilitation units.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0223-3) contains supplementary material, which is available to authorized users.