[Thesis] Clinicians’ Perspectives on Cross-Education in Stroke Rehabilitation – Full Text PDF


Purpose: Cross-education is a neural phenomenon where an untrained limb improves after unilateral training of the opposite homologous limb. It has been extensively studied in the healthy population and shows promise for post-stroke rehabilitation. Despite this promise, cross-education has not been adopted into clinical rehabilitation practice. Cross-education is contrary to current best practice for upper extremity post-stroke rehabilitation which is focused on training the affected limb. The objective of this study was to understand: current post-stroke upper extremity rehabilitation practice, clinician’s perspectives on cross-education, and facilitators and barriers to implementation of a cross-education intervention.

Methods: An Interpretive Description framework guided this study. Twenty- two occupational therapists and 2 physiotherapists were interviewed in 4 focus groups and 1 individual interview in a rehabilitation hospital and 3 acute care hospitals. After transcription, line-by-line coding was done by 2 investigators. A third investigator, who was not part of data collection, reviewed the process and agreed on the primary categories.

Results: Cross-education is antithetical yet promising was the lone theme which was reiterated in every data collection session. The primary theme was captured in 3 descriptive categories. The therapists described working in a (1) forced-use paradigm, yet they also described how that paradigm did not meet the needs of all of their patients. They recognized this as a (2) gap in current practice. They also hypothesized that (3) cross-education used as an adjunct could be quite effective within their current practice for specific patients. The primary theme weaves between the 3 categories.

Conclusions: Therapists perceived that cross-education would be most appropriate for patients with a severely impaired upper extremity. They suggested that educational materials for clinicians, patients, and patient families would be essential to the success of cross-education in order to explain training the less affected limb. This study provides important foundational information about clinician perspectives that will help transition cross-education into clinical stroke rehabilitation research and eventually practice.

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