Early Success for Patient and Therapist Alike: A Case Study of an Optimal Theory-Inspired Collaboration
Background and Purpose: Patient-centered care and a recovery emphasis are imperative for rehabilitation success. The OPTIMAL theory of motor learning can be integrated with primary interventions to facilitate a positive rehabilitation trajectory. OPTIMAL utilizes autonomy support. AS; enhanced expectancies, EE, and an external focus of attention, EF) to create a context that encourages not only effective motor performance and learning, but a desirable collaborative patient-therapist relationship. This case study describes a novice clinician’s use of OPTIMAL to facilitate patient success, and grow in her clinical confidence and skill.
Case Description: KH began practicing as a PT and neurologic resident in a hospital setting. One year after graduating, she was introduced to OPTIMAL through a 1-day continuing education course and immediately began implementing strategies into her practice. KH had 2 months of self-practice of OPTIMAL and 2 focused mentor sessions prior to her work with patient MB. MB was a 61 year-old active grandmother. She enjoyed caring for her grandchildren, planning family gatherings, and dancing. She experienced a left ischemic MCA stroke with a thrombectomy and hemorrhagic conversion. At admission to inpatient rehabilitation, her balance, strength, sensation, endurance, and confidence were impaired. OPTIMAL interventions were integrated into daily treatment and included: collaboration to set goals and identify movement problems/solutions, and therapy activities such as dancing with her husband to music, simulation of family gathering preparation and caring for grandchildren (AS); identification of assets, quantitative metrics to make progress measurable, and celebration of successes (EE); and minimal reference to body parts (EF).
Outcomes: MB discharged home at a modified independent level after a 10 day optimized program. Significant improvements were seen in multiple outcome measures. MB reported confidence returning home and resuming valued activities and roles. KH reflected: “The OPTIMAL theory influenced my practice immediately. The 3 pillars offer unique opportunities to build an effective therapist-patient relationship, enhance patient-centered care, encourage patients to collaborate and become active drivers of their recovery, and build confidence. ... I was better able to understand who the individual was as a person. My focus changed to goals that would make a real difference for that individual. ...I was able to quickly see improvements in patient motivation and excitement. These improvements happened within and between sessions. These quick changes enhanced my own personal confidence as a clinician.”
Discussion: Beyond admonitions for evidence-based and patient-centered practice, roadmaps to accomplish these goals may seem unclear or divergent to new professionals. The OPTIMAL theory, though focused on strategies to enhance patients’ motor learning, may provide critical early success in therapists’ skill development, as well as satisfaction of their fundamental psychological needs.