Improving Engagement and Occupational Participation

in Couples Coping with Stroke

Brieanna Allen, BS, Meghan Berry, BS, Alec Burke, BS, Sarah Giles, BS, Lauren Lundstrom, BS, Artemis Sefandonakis, Jackie Einerson, MOT, OTR/L, Alexandra L. Terrill, PhD
Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA

Introduction Results Table 2. Positive Psychology Activities

Stroke affects occupational participation for people with
stroke and their care-partners. We developed a positive-
psychology intervention (PPI) for couples coping with
stroke to promote well-being and activity engagement.
Objectives
The purpose of this study was to explore changes in
occupational participation and engagement experienced by
stroke survivors and their care-partners following stroke
and to identify potential clinical implications.
Methods
• Intervention: Couples were trained in a PPI, which they
implemented at home for 8-weeks individually and as a
couple. See Table 2 for intervention activity information.
• Measures: Qualitative data were collected through
surveys and individual feedback interviews following the
intervention. Participants were asked to rate on a scale of
0 to 4 (none to extreme) any positive or negative effects
and their satisfaction with the intervention. An interview
was then conducted to allow participants to elaborate on
the questionnaire and to identify themes around
occupational re-engagement.
Design
Cross-sectional, descriptive mixed-methods data were
collected on couples coping with stroke as part of a
behavioral intervention pilot study. Participants, recruited
from University-affiliated clinics, included 20 community
dwelling, cohabitating couples that were at least three
months post-stroke. See Table 1 for demographic
information.
• Survey results indicate high perceived benefit, positive effects, and
satisfaction with the intervention across participants.
• Several themes arose from the feedback interviews, including increased
awareness of occupational capacity, gratitude, increased social
engagement as a couple and as individuals, and increased mindfulness.
See Table 3 for sample participant quotes for each theme.
Table 3. Feedback Interview Themes and Quotes
• "These 8 weeks have told us: well that doesn’t mean we can’t go
on a hike around Liberty Park, or it doesn’t mean we can’t go up
north around a pond." - Care-partner
Occupational • "It made me think about the stuff that I was doing on, like, a routine
Capacity & basis. I know I didn’t do the best overall, because what I wanted to
Engagement do was to try new things like try to branch out and I didn’t do as
well but I thought it was positive still to at least have a sense of
what I was doing in my routine rather than just going through the
routine." - Care-partner
• "It was a time of real peace, and I don’t have much peace in my
life. I don’t take the chance to enjoy peace...And that was strictly
because I’ve been inspired by the exercises." - Care-partner
Mindfulness • "The part about myself was that a lot of these things I did naturally.
So reading through them and picking through them for a certain
activity made me more focused on what I was doing and why I was
doing it." - Stroke survivor
• "It just made us more conscious I think not just the relationship
Social with each other but the relationship with family and friends, kind of
Engagement & be more conscious ‘cause I think sometimes again you fall in a rut
Relationships and you don’t reach out to friends and I think friends and
relationships are really important." - Care-partner
Expressing gratitude: Appreciation of life circumstances and
gratitude towards persons (thanking someone).
Practicing acts of kindness: Performing good deeds for other
people.
Fostering relationships: Strengthening relationships by
making time for people and being supportive.
Focusing on the positive: Self-monitoring and replaying
positive experiences (e.g., listing three good things).
Savoring: Finding beauty, relishing ordinary experiences, and
savoring those experiences with others.
Working toward a goal: Devoting time and effort to pursuing a
significant, meaningful goal.
Spirituality: Seeking meaning and purpose, finding the sacred
in ordinary life, and meditating.
Conclusion
This study suggests that positive psychology-based
activities may lead to increased occupational
participation and well-being in couples coping with
stroke. Preliminary data are promising, but the small
sample size of this study limits its generalizability.
Clinical implications: Using positive psychology-based
activities could be a useful tool to promote occupational
engagement for survivors and partners post- stroke.

• "I just walked around and said, you know, the grass is green, the sky is
blue, and the creek is running, and the birds are singing, and
Table 1. Participant Survivor Care-partner everything is really great, you know? That’s actually been a positive,
Characteristics (n=20) (n=20) because when I’m golfing when I’m playing crappy, I just say the grass
Female, n (%) 10 10 is green don’t throw this club." - Stroke survivor

Age, mean years (SD) 53.4 Gratitude • "Just because I think that the act of expressing gratitude really helps
Age range years 27-77 me stay more centered on how far I’ve come instead of focusing on the
negative stuff so much. Being able to be thankful for what I’ve got and
what has happened and, uhm, looking at it from another perspective....I
really felt a turn-around in my disposition for one thing." - Stroke
Contact email: alex.terrill@hsc.utah.edu survivor Acknowledgement of financial support: NIH NCMRR #1R03HD091432-01
Utah StrokeNet Research Training & Career Development Program (NIH
Phone: (801) 581-5951 NINDS #5U10NS086606-03) & University of Utah Consortium for Families &
Health Research (C-FAHR)