Oral Presentation Smart Strokes Annual Scientific Meeting 2025

“I Think, They Think”: Unpacking the Personal, Implicit, and Relational Nature of Task Challenge in Stroke Rehabilitation Using Video-Reflexive Ethnography. (127636)

Emeline M Gomes 1 , Gemma Alder 1 , Felicity AS Bright 2 , Nada Signal 1
  1. Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
  2. Centre for Person Centred Research, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand

Introduction

Task challenge is a dynamic and multidimensional element of stroke rehabilitation1, 2. However, the ways in which challenge is set, monitored, and progressed in clinical practice is poorly understood. To advance theory and practice, this study explored how people with stroke and rehabilitation therapists’ understandings and experiences of challenge underpinned its use in stroke rehabilitation. 

Methods

Video-reflexive ethnography3 was used to explore participants’ ‘insider knowledge’ and unpack the implicit assumptions, interactions, and contexts shaping challenge. Purposively sampled patient-therapist dyads were observed and video-recorded during usual rehabilitation. Selected video clips supported participant's reflections during interviews. Audio-visual data were analysed using conventional content analysis.  

Results

Seven patient-therapist dyads and one triad (n=17) representing diverse stroke experiences and rehabilitation contexts participated. Four inter-related themes emerged: (i) challenge is an interpretive lens, (ii) the terms and conditions of challenge, (iii) making challenge make sense, and (iv) meeting (or leaving) each other in the challenge. While patients and therapists held different understandings, meaningful engagement with challenge was facilitated by trust, emotional safety, recognition of expertise, and shared decision-making, which in turn, strengthened the therapeutic relationship. In contrast, when shared decision-making did not take place, this risked disengagement, disconnection and misaligned expectations of rehabilitation.  

Conclusion

People with stroke and therapists held distinct understandings of challenge, shaped by unique insights, roles, and the evolving therapeutic relationship. Responding to these nuanced perspectives is essential for the constructive use of challenge, which in turn, may enhance the therapeutic relationship, and the person’s experience and outcomes of stroke rehabilitation.  

Relevance to clinical practice 

Recognising personal, implicit, and relational dynamics may promote more collaborative approaches to optimising challenge which are both responsive to the person’s experience and the complexities of stroke rehabilitation practice. 

  1. 1 Hayward KS, Churilov L, Dalton EJ, et al. Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose. Stroke. 2021;52(2):761-769. doi:10.1161/STROKEAHA.120.032496
  2. 2 Gomes E, Alder G, Bright FAS, Signal N. Understanding Task "Challenge" in Stroke Rehabilitation: An Interdisciplinary Concept Analysis. Disabil Rehabil. 2025;47(3):560-570. doi:10.1080/09638288.2024.2356010
  3. 3 Iedema R, Carroll K, Collier A, et al. Video-Reflexive Ethnography in Health Research and Healthcare Improvement: Theory and Application. 1st ed. CRC Press; 2018.