Discourse analytic study of counseling sessions in stroke physiotherapy

Studies on the interaction between physiotherapists and patients during treatment sessions have found low levels of communicative participation by patients and lack of direct influence by patients on the content of their treatment. This article reports the results of 7 counseling sessions in which physiotherapists and patients with stroke and their caregivers discussed the patients' postural control and balance, which had been tested and videotaped at different stages of the rehabilitation process. The physiotherapists' discourses relating to the videotaped test performances were either brief comments on the patient's performance or critical appraisals with references to difficulties encountered during performance. Performances of the easier tasks were treated by the physiotherapists with rhetorical questions. The second type of discourse consisted of the physiotherapists directing the patients' attention to their problems, and of the patients' and caregivers' initiatives leading to conversation about the patients' problems. The patients understood the significance of the test performance for their life at home in varying ways. The results of this study showed that successful counseling calls for physiotherapists to develop dialogic communication skills to help patients in coconstructing their home exercise together with their social network.