Table 1 Capability, Opportunity, Motivation, Behaviour Model Components of the intervention
What needs to happen so that the affected arm is used? | Methods to address components |
|---|---|
Capability: Physical | |
Person needs to have enough arm function to be able to use the limb in a helpful way | • GRASP Exercise Program |
Capability: Psychological | |
• Understands the evidence related to experience-driven neuroplasticity • Understands the importance of “use it or lose it”; • Understands the importance of challenge and practice • Has emotional resilience to practice despite frustration • Has ability to problem solve when encountering problems using the limb • Has ability to monitor how and how much they are using limb • Knows how to advance task practice • Patient has sufficient memory/attention/executive function to develop and adhere to practice schedule | • Education of link between challenging practice and neuroplasticity • Feedback from TENZR • Action planning • Goal setting • Barrier identification and problem solving |
Opportunity: Physical | |
• Patient has time to use upper limb as tasks will take longer • Patient has appropriate items in the house or community to enable task practice • Patient has external reminders to use the limb | • Problem solving • Feedback from TENZR |
Opportunity: Social | |
• Has a person who will support patient while he/she is less efficient in accomplishing tasks during and after intervention • Patients not entirely driven to accomplish tasks independently no matter what • Social pressure to perform activities as before the stroke | • Social support from therapist • Social support from family |
Motivation: Reflective | |
• Believe that incorporation of their arm into daily activities will improve their function • Believe that practicing using their arm is important • Believe that temporary frustration will lead to positive gains • Be confident that their affected arm can accomplish required task • People have goals for using their limb (i.e. tasks they wish to change or start doing) • Have intentions to increase practice or use in daily activities | • Education of link between challenging practice and neuroplasticity |
Motivation: Automatic | |
• Have established routines and habits for using limb • Experience emotional benefits from using their limb | • Problem solving and planning |