Shared-Decision Making
The Vehicle for Partnership
What is Shared Decision-Making?
Bridging the inactivity gap in inpatient rehab involves moving beyond the traditional biomedical model where the clinician is the sole director of care.
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To make this transition, you can intentionally use Shared Decision-Making, a collaborative process where your clinical expertise and the survivor’s lived experience are exchanged to reach a consensus on rehabilitation goals (Stiggelbout et al., 2012). This approach centers the survivor in goal setting and treatment planning to the fullest extent of their capacity.
By mastering this collaborative approach, you move beyond the "clinician-as-expert" role and ensure that individual patient values drive the self-directed training plan (Armstrong, 2017).​​
Why is collaboration crucial for Self-Directed Training?
Self-directed training relies on the survivor’s ability to manage their own practice when a therapist is not present. This transition is only possible when the clinician moves from a clinician-led approach to a collaborative partnership.
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Moving from compliance to ownership: In a clinician-led approach, the survivor is often a passive recipient of a plan. This leads to passive compliance, where the survivor follows instructions but lacks the control needed to own their recovery (Armstrong, 2017). A collaborative partnership gives the survivor the choice and control they need to stay engaged even when therapy is over.
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Developing safety and problem-solving: When you share the lead, you are teaching the survivor how to monitor their own performance. By identifying barriers together, the survivor learns to spot risks and troubleshoot their own movements. This awareness is what allows them to practice safely without needing you there to correct them (Wulf & Lewthwaite, 2016).
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Sustaining recovery dosage: The goal of self-directed training is to increase the amount of practice a survivor gets during their hospital stay (Krakauer & Marshall, 2015). If a survivor doesn't help build the plan, they are far less likely to initiate practice on their own. The partnership ensures the training continuesand the repetitions happen long after the therapy hour ends.
The Clinician's Internal Shift
Principles from Self-Determination Theory can guide your transition from a traditional expert role to a collaborative partner, establishing the foundational knowledge for the partnerships introduced in the next step of the toolkit (Ryan & Deci, 2000).
This resource supports your shift by fostering professional agency, allowing you to intentionally move away from directive roles and prioritize survivor values as a deliberate clinical choice.
Your clinical confidence is built through the mastery of specific skills, such as navigating candidate selection and environmental setup, which helps establish the internal readiness to safely integrate self-directed training into a busy inpatient schedule.
This collaborative approach fosters the mutual commitment required for the survivor to stay engaged with their training program when practicing independently.
Strategies for Patient Engagement
While the previous section focuses on your internal mindset shift, the OPTIMAL Theory of Motor Learning guides the specific communication and instructional style used to support the partnership (Wulf & Lewthwaite, 2016).
This toolkit uses this framework to prioritize how you provide choices and build confidence as the primary facilitators for self-directed practice. By integrating simple choices, such as allowing a survivor to select the order of their activities or the specific objects they use, you encourage them to take active ownership of their recovery.
To further support this engagement, your communication can focus on highlighting successful repetitions rather than errors during the setup process. This approach helps the survivor believe in their own ability to succeed, building the internal confidence they need to practice effectively when you are not directly present to supervise.
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Ready to move on?
Now that we’ve established the mindset and communication strategies for partnership, we can look at the actual environment where inpatient stroke recovery happens.
Understanding the foundation of a partnership is essential, but we also have to recognize the unique pressures and systemic factors that influence how that partnership functions in a real-world hospital setting.