Training therapists to coach individuals with a neurological condition to use the SMART Arm.

The intervention to be developed and evaluated is is a SMART Arm train-the-trainer course, for Occupational Therapists, Physiotherapists and Rehab Assistants. The SMART Arm is a device designed for individuals with upper limb paresis as a result of stroke or other neurological conditions to enable them to undertake task-oriented practice and to achieve the intensity of practice required to promote recovery The train-the-trainer course will be focused on teaching clinicians how to coach individuals with a neurological condition to use the SMART Arm independently in order to drive their own recovery in the long term. In small groups (~4-8) the clinician will learn to coach the individual with a neurological condition to set-up, practice and progress optimally, either independently, or with only a significant other to help them. The ultimate goal of SMART Arm training is for stroke survivors to practice without a clinician present. The steps towards developing the train-the-trainer course are as follows: 1. Determine requirements for a SMART Arm train-the trainer course 2. Develop a SMART Arm train-the trainer course and corresponding Capabilities Assessment Tool 3. Pilot the SMART Arm train-the trainer course with clinicians who use the SMART Arm at CRnQ 4. Evaluate the SMART Arm train-the trainer course and make recommendations for refinement. Phase 1: Participating clinicians will attend train-the-trainer courses, practice coaching with individuals with a neurological condition and provide feedback on their coaching skills and capabilities. Participating individuals with a neurological condition will act as models during the training courses, will undertake SMART Arm training to allow clinicians to practice coaching and will provide feedback on clinicians coaching capabilities through a survey questionnaire, focus group and individual interviews and through completion of the capabilities assessment tool. On commencement of the trial, all participating clinicians at the trial site (Community Rehab nQ) will have completed one standard 90 minute group coaching session with an accompanying manual, on operation of the device and delivery of basic coaching for the stroke survivor. The session will be conducted by Ruth Barker who is the Lead Inventor or the SMART Arm and a Master trainer. The standard group coaching session will consist of 30 minutes introduction to the device, a 30 minutes demonstration with a stroke survivor; and a 30 minutes Q & A session. From that point onwards, participating clinicians will coach individuals with a neurological condition to undertake SMART Arm training. As per standard practice, the clinician will determine the number of sessions and the specific SMART Arm training elements (e.g. set-up, load, elevation, hand position and involvement) in order to match each individuals' goals and upper limb deficits. At the end of their rehabilitation program, each individual with a neurological condition will provide feedback on clinician's skills in coaching by completing a survey questionnaire and if they wish, attending a focus group or individual interview with the researcher, This feedback will be coupled with the best available evidence to guide development of a 'Train-the-trainer' course and corresponding capability assessment tool. Phase II: Participating clinicians will attend the newly developed train-the-trainer course and complete the capability assessment tool at three time-points (Post training, 3 months and 6 months). Participating individuals with a neurological condition will once again, act as models during the train-the- trainer courses, allow clinicians to practice coaching by participating in SMART Arm training and provide feedback on clinicians coaching capabilities through completion of the capabilities assessment tool. The train-the-trainer course will be conducted in a small group format (~4-8 clinicians) by Ruth Barker. It is anticipated to run for a full day (or two half days) and to consist of the following: i) Operation of the SMART Arm device ii) SMART Arm training incorporating and progressing all essential training elements to drive upper limb recovery for a person with a neurological condition iii) Coaching individuals with a neurological condition to undertake and progress SMART Arm training so that they can drive their own recovery iv) Training new /rotating clinicians in i), ii), and iii). A register of attendance at all training sessions will be completed.