Exploring occupational therapists’ perspectives on motor recovery interventions in neurorehabilitation for stroke and traumatic brain injury

Abstract

Background: Stroke and traumatic brain injury can significantly affect motor function, independence, occupational performance, and participation in daily life (Langhorne et al., 2011). Occupational therapists play an important role in neurorehabilitation by providing clientcentred and occupation-focused interventions that support functional recovery and meaningful engagement (AOTA, 2020). Although various motor recovery interventions are described in international literature, no research has explored how occupational therapists select, combine, and justify these approaches in practice, particularly within the Maltese context. Aims: This study aimed to explore how occupational therapists perceive, apply, and evaluate motor recovery interventions within neurorehabilitation for individuals with stroke and traumatic brain injury. It also aimed to identify the barriers, contextual factors, professional identity issues, and training needs that influence clinical practice. Method: A qualitative research design was adopted for this study. Participants were recruited through purposive sampling and had to be registered occupational therapists working in neurorehabilitation with individuals with stroke or traumatic brain injury within Maltese public healthcare settings. Data was gathered through semi-structured interviews with ten occupational therapists working across community, outpatient, ward-based, and long-term care services. This data was then analysed using Braun and Clarke’s (2006) thematic analysis. Findings: Four main themes were identified: “Clinical Reasoning Behind Intervention Selection”, “Challenges and Barriers Shaping Clinical Practice”, “Professional Identity and Role Overlap in Neurorehabilitation”, and “Professional Development and Personal Professional Enhancement”. Participants selected interventions according to client goals, motivation, abilities, cognitive status, recovery stage, and setting. They used restorative, compensatory, occupation-based, impairment-focused, and adjunctive approaches. Practice was influenced by limited resources, caseloads, time pressures, environmental barriers, family expectations, role overlap, limited specialised training, and the need for ongoing professional development. Discussion: The findings highlight that occupational therapy neurorehabilitation practice in Malta is shaped by client needs and local service realities. Intervention selection involved balancing motor recovery techniques with occupation-focused goals to support independence, daily function, and meaningful participation. Resource limitations, service pressures, training access, role overlap, and misconceptions about occupational therapy influenced practice. These findings emphasise the need for improved resources, practical continuing professional development, and clearer communication of the occupational therapy role within interdisciplinary teams.