Clinicians' Sense-Making When Working With Patients in Disordered States of Consciousness Following Brain Injury
We presented this poster on clinical reasoning at the American Congress of Rehabilitation Medicine International Conference at the HILTON ANATOLE, 2201 North Stemmons Fwy, Dallas, TX 75207.
To obtain a pdf copy of this poster, please click on the link below.
All the best, Christina Papadimitriou.
Poster currently on display at the 2018 international ACRM conference in Dallas Texas
Our poster on Clinicians’ Sense-Making will be on display from now until October 3, at the 2018 American Congress of Rehabilitation Medicine International Conference in Dallas Texas. We thank the academic institutions and hospitals that have supported our research.
We will make the poster available for you to view shortly and will provide a PDF to download. Keep you posted!
I am very proud to share with you this article with co-authors Nick Caddick and David A Stone. In this article we use analytic pluralism to analyze a data excerpt from the medical rehabilitation of an inpatient with spinal cord injury and his physical therapist to examine how the concept of motivation is used in clinical practice. We employ three theoretical perspectives to explore ways of understanding this concept: social determination theory, phenomenology, and narrative inquiry. We present and argue for multiple ontologies as a new forward to understanding complex human phenomena such as motivation.
Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From Improvement Publications From 2010 to 2016
Objective: To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.
Data Sources: Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.
Study Selection: Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.
DataExtraction: Reported study characteristics including sutdy focus, study setting, use of inferential staistics, stated limitations, and use of improvememt clcles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.
Data Synthesis: Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.
Conclusions: The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.
© Archives of Physical Medicine and Rehabilitation 2018;99:1141-8
"You managed to take me to a place I could never have imagined or considered or experienced. Truly enlightening journey." (Audience comment, Tiger Dublin Fringe)
I had the privilege of being part of an experiential, immersive audio-based artwork/training based on Shannon Yee’s experience with acquired brain injury (ABI). This is artwork that is also medical training like no other.
Shannon fell critically ill with a rare brain infection and experienced multiple brain surgeries, coma, and was eventually able to re-integrate into the world with her disability. The artwork/training allows participants to experience these life changing events not as a simple spectator, but rather as immersed in a new world of unknowns.
The experience starts by being affixed with a medical wrist band and laid down on a hospital bed assigned just for me. Shoes off, covered with a light blanket, eye mask and headphones on. Shannon, as my nurse, ensures I am comfortable. She is gentle, soft spoken, neither friendly nor distant. And so the auditory experience begins.
Sounds enter through the headphones. Not too loud, but intense nonetheless. The sound is complex: at any one moment it is voices of people talking, babies crying, doors closing, sounds of crowds, and the quiet talking of Shannon’s emotions, perceptions, quandaries and noise.
At other moments, the sound is of the rehabilitation hospital in the early phases of recovery, and so it’s hospital noises of machine and cords and people entering and leaving rooms, of therapists’ jumbled voices asking the same questions again and again and not waiting for the answers, there are voices that appear to be close but unclear, and far away but whispering.
And then there are the silent sounds of internal thoughts; the sounds of frustrations at a body failing to collaborate with one’s inner wishes. No single sound happens alone; no single moment in this 50 minute experience is simply of one thing, of one feeling, of one thought, of one easy-to-identify human experience.
And though this is an auditory based artwork experience, it is my whole body that feels the sounds and the emotions. That didn’t surprise me. Our bodies are connected viscerally and in ways we don’t rationally understand.
I traveled in this auditory world that Shannon gave me permission to be in as I was still in the comforts of my world. And when it was done, 50 minutes later, my world was no longer the same. My world was enriched; it was now fuller and forever changed. That surprised me.
Why feel what it’s like to experience ABI?
Because you are allowed access to what is often understood as a private experience. And private experiences are challenging to describe. We have stories and accounts of living with ABI; and they are impactful and powerful. The power of Reassembled is its felt sense: one’s emotional and emotive body is impacted via sonic arts technology. This felt sense means that we are not just spectators, involved comfortably from a distance, where we listen, attend and cognitively appraise. Instead, we are an immersed audience, and though safely able to leave at any moment (by removing the eye mask and headphones and reassuming our sense of our world), we are virtually transposed into a world other than our own.
What surprised me is that the artwork reaches our sense of being without any rational decision making ever happening. It just happens. And then our world is forever changed. And trust me, you wouldn’t want to go back to your world before Reassembled. You want to be with Shannon in the world after. And you want this because you are able to understand, appreciate and relate to Shannon and to the experience of ABI in a more compassionate, direct and affective way. Because you can now see that your life is like Shannon’s; and that Shannon’s life has something to say to yours. Because you now experienced her world in the ways she wanted you to, unmediated by your ideas of ‘what ABI is’ or ‘this is how I should act when I meet someone with ABI’, etc.
In my case, I felt joy after 50 minutes of being immersed in Shannon’s life. For one, there is a happy ending in Reassembled. Shannon is, after all, alright. She is able/capable. She is reassembled, slightly askew, as she lives with an invisible disability in a world that is not made for people with disabilities. But she lives it: She works, is a mom, partner, artist, public speaker; engaged, present and mobile.
Via Reassembled one can now appreciate anew one’s own life changes that may be occurring such as aging, caring for a loved one, experiencing loss, being tired, or one’s own mental health. I identified with Shannon’s ways of experiencing her situations in spite of having never experienced ABI myself. Her artwork brought me closer to my own life changes as I came closer to hers. In that way, our commonalities superseded any differences, and Shannon allowed me to focus on the common humanity that we share. In that way, Shannon’s artwork is joyful: it is a hopeful reminder that we can understand each other even if we have tremendously different and uniquely private life experiences. After Reassembled, it is possible to feel that humans are more similar than different. And that is a joyous experience.
Look at www.reassembled.co.uk for a showing near you. You will not regret it.
I am Christina Papadimitriou, an Associate Professor of Interdisciplinary Health Sciences and Sociology at Oakland University in Rochester, MI USA. My research focuses on understanding the experience of disability in society, especially related to rehabilitation services and access. All of my work is inter-professional.