Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care

Rehabilitation trials and post-acute care to lessen impairments and disability after stroke, spinal cord injury, and traumatic brain injury almost never include training to promote long-term self-management of skills practice, strengthening and fitness. Behavioral theories about self-management and self-efficacy for physical activity have been successfully incorporated into interventions for chronic diseases, but rarely for neurologic rehabilitation. Motivation, sense of responsibility and confidence to practice and exercise in the home can be trained to increase adherence to skills practice and exercise both during and after formal rehabilitation.

• 1
  Persons who need inpatient stroke rehabilitation do little walking 6-12 months later.
• 2
  A meta-analysis of walking interventions carried out in the home and community after stroke suggested that exercise combined with at least one behavioral technique was more effective than task-oriented exercise training alone.
• 3
  Behavioral change strategies that lead to self-management require education, ongoing contact, tailored information, goal setting, monitoring, feedback, and motivational enhancement.