"Functional electrical stimulation (FES) impacted on important aspects of my life" - A qualitative exploration of chronic stroke patients' and carers' perceptions of FES in the management of dropped foot.

Our purpose was to explore the impact of functional electrical stimulation (FES), as applied in the management of dropped foot, on patients with chronic stroke and their carers. A qualitative phenomenological study was undertaken. Participants were recruited from the Lothian FES clinic. Data were collected by using semistructured face-to-face interviews and analysed by using the framework of interpretative phenomenological analysis (IPA). Thirteen patients and nine carers consented to participate in the study. The overarching theme that emerged from the data was that "FES impacted on important aspects of my life." Four subthemes were identified: 1) "Walking with FES is much better"; 2) "FES helped regain control of life"; 3) "Feeling good comes with using FES"; and 4) "FES is not perfect but it is of value." This study provides insights into the perceptions of patients and carers of the impact of FES. These results have implications for clinicians delivering an FES service for the management of dropped foot after stroke. © Informa Healthcare. USA, Inc

Containment, delay, mitigation: waiting and care in the time of a pandemic

In this paper we take up three terms – containment, delay, mitigation – that have been used by the UK Government to describe their phased response to the COVID-19 pandemic. Although the terms refer to a political and public health strategy – contain the virus, flatten the peak of the epidemic, mitigate its effects – we offer a psychosocial reading that draws attention to the relation between time and care embedded in each term. We do so to call for the development of a form of care-ful attention under conditions that tend to prompt action rather than reflection, closing down time for thinking. Using Adriana Cavarero’s notion of ‘horrorism’, in which violence is enacted at precisely the point that care is most needed, we discuss the ever-present possibility of failures within acts of care. We argue that dwelling in the temporality of delay can be understood as an act of care if delaying allows us to pay care-ful attention to violence. We then circle back to a point in twentieth-century history – World War II – that was also concerned with an existential threat requiring a response from a whole population. Our purpose is not to invoke a fantasised narrative of ‘Blitz spirit’, but to suggest that the British psychoanalytic tradition born of that moment offers resources for understanding how to keep thinking while ‘under fire’ through containing unbearable anxiety and the capacity for violence in the intersubjective space and time between people. In conditions of lockdown and what will be a long and drawn-out ‘after life’ of COVID-19, this commitment to thinking in and with delay and containment might help to inhabit this time of waiting – waiting that is the management and mitigation of a future threat, but also a time of care in and for the present

Chapter 5 Depressing time

The Time of Anthropology provides a series of compelling anthropological case studies that explore the different temporalities at play in the scientific discourses, governmental techniques and policy practices through which modern life is shaped. Together they constitute a novel analysis of contemporary chronopolitics. The contributions focus on state power, citizenship, and ecologies of time to reveal the scalar properties of chronopolitics as it shifts between everyday lived realities and the macro-institutional work of nation states. The collection charts important new directions for chronopolitical thinking in the future of anthropological research

Exercise rehabilitation for recovery from critical illness (Protocol)

Queen Margaret University, Edinburgh, UK. As part of an ongoing research education programme.This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this systematic review is to assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, on improving functional exercise capacity and quality of life in adult ICU survivors who have been mechanically ventilated for more than 24 hours. We will compare an exercise intervention to any other intervention or a control or 'usual care' programme. Exercise includes any structured or taught programmes. Respiratory or inspiratory muscle training is excluded due to it being initiated within the ICU environment, for example with weaning from a ventilator, and not as post-discharge rehabilitation as required for this review.sch_phyAngus 1997 Angus, DC. Understanding the incidence and long-term outcomes of ARDS. In: Gullo, A editor(s). Anaesthesia, pain, intensive care and emergency medicine: a scientific report. Berlin Heidelberg New York: Springer, 1997:289-98. Angus 2003 Angus DC, Carlet J, Brussels Roundtable 2002 Participants. Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Medicine 2003;29(3):368-77. [PUBMED: 12536269 ] Baumgartner 1999 Baumgartner WA,Walinsky PL, Salazar JD, Tseng EE, Brock MV, Doty JR, et al.Assessing the impact of cerebral injury after cardiac surgery: will determining the mechanism reduce the injury?. The Annals of Thoracic Surgery 1999;67(6):1871-3. [PUBMED: 10391329] Brown 1990 Brown AB, McCartney N, Sale DG. Positive adaptation to weightlifting in the elderly. Journal of Applied Physiology 1990;69(5): 1725-33. [PUBMED: 2272965] Burtin 2009 Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al.Early exercise in critically ill patients enhances short-term functional recovery. Critical Care Medicine 2009;37(9): 2499-505. [PUBMED: 19623052] Chaboyer 2003 Chaboyer W, Grace J. Following the path of ICU survivors: a quality improvement activity. Nursing in Critical Care 2003;8(4): 149-55. [PUBMED: 12940690] Eddleston 2000 Eddleston J, White P, Guthrie E. Survival, morbidity, and quality of life after discharge from intensive care. Critical Care Medicine 2000; 28(7):2293-9. [PUBMED: 10921555] Elliott 2006 Elliott D, McKinley S, Alison J, Aitken L, King M. Study protocol: Home-based rehabilitation for survivors of a critical illness. Critical Care 2006;10(3):R90. [PUBMED: 16792792 ] Fiatarone 1994 Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al.Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 1994;330(25):1769-75. [PUBMED: 8190152] Fletcher 2003 Fletcher S, Kennedy D, Ghosh I, Misra V, Kiff K, et al.Persistant neuromuscular and neurophysiological abnormalities in long-term survivors of prolonged critical illness. Critical Care Medicine 2003; 31(4):1012-6. [PUBMED: 12682465] Frank 2000 Frank M, Schlapfer H, Otte B, Yasikoff N, Conzelmann M. Results of neurorehabilitation. An outcome study 20 months after stroke. Praxis 2000;89(44):1799-808. [PUBMED: 11109917] Gill 2002 Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine 2002; 347(14):1068-74. [PUBMED: 12362007] Grimby 1986 Grimby G. Physical activity and muscle training in the elderly. Acta Medica Scandinavica. Supplementum. 1986;711:233-7. [PUBMED: 3535411] Guyatt 2008 Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, et al.What is quality of evidence- and why is it important to clinicians?. BMJ 2008;336:995-8. [PUBMED: 18456631] Higgins 2008 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. Available from www.cochrane-handbook.org: The Cochrane Collaboration, 2008. Iversen 2003 Iversen MD, Fossel AH, Katz JN. Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Archives of Physical Medicine and Rehabilitation 2003;84 (9):1324-31. [PUBMED: 13680569] Jolliffe 2001 Jolliffe J, Rees K, Taylor RRS, Thompson DR, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001800.] King 1998 King J, Crowe J. Mobilisation practices in Canadian critical care units. Physiotherapy Canada 1998;50(3):206-11. [MEDLINE: 0346574] Kouidi 2002 Kouidi E. Exercise training in dialysis patients: why, when, and how?. Artificial Organs 2002;26(12):1009-13. [PUBMED: 12460377] Krishnan 2002 Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, et al.Comorbidity of depression with other medical diseases in the elderly. Biological Psychiatry 2002;52(6):559-88. [PUBMED: 12361669] Lavie 2009 Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clinic Proceedings 2009; 84(4):373-83. [PUBMED: 19339657] Lewis 2003 Lewis M. Intensive care unit rehabilitation within the United Kingdom: a review. Physiotherapy 2003;89(9):531-8. [DOI: 10.1016/S0031-9406(05)60179-4] Martin 2005 Martin M, Salim A, Murray J, Demetriades D, Belzberg H, Rhee P. The decreasing incidence and mortality of acute respiratory distress syndrome after injury: a 5-year observational study. Journal of Trauma 2005;50(5):1107-13. [PUBMED: 16385287] Mazzeo 2001 Mazzeo RS, Tanaka H. Exercise prescription for the elderly: current recommendations. Sports Medicine 2001;31(11):809-18. [PUBMED: 11583105] Miller 2002 Miller MD, Crotty M, Giles LC, Bannerman E, Whitehead C, Cobiac L, et al.Corrected arm muscle area: an independent predictor of long-term mortality in community dwelling older adults?. Journal of the America Geriatrics Society 2002;50(7): 1272-7. [PUBMED: 12133024] Paffenbarger 1986 Paffenbarger RS, Hyde RT, Wing AL, Hseih CC. Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine 1986;314(10):605-13. [PUBMED: 3945246] Puhan 2006 Puhan MA, Busching G, Schunemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial. Annals of Internal Medicine 2006;145(11):816-25. [PUBMED: 17146066] Rantanen 2000 Rantanen T, Harris T, Leveille SG, Visser M, Foley D, et al.Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. Journal of Gerontology. Series A: Biological Sciences and Medical Sciences 2000;55(3):M168-73. [PUBMED: 10795731] RevMan 5.0 The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Schweickert 2009 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al.Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(epub):1874-82. [PUBMED: 19446324] Smith 2006 Smith TP, Kennedy SL, Smith M, Orent S, Fleshner M. Physiological improvements and health benefits during an exercisebased comprehensive rehabilitation program in medically complex patients. Exercise Immunology Review 2006;12:86-96. [PUBMED: 17201074] Stiller 2000 Stiller K. Physiotherapy in intensive care: toward an evidence-based practice. Chest 2000;118(6):1801-13. [PUBMED: 11115476] Storch 2008 Storch EK, Kruszynski DM. From rehabilitation to optimal function: role of clinical exercise therapy. Current Opinion in Critcal Care 2008;14(4):451-5. [PUBMED: 18614911] Wiles 2009 Wiles L, Stiller K. Passive limb movements for patients in an intensive care unit: A survey of physiotherapy practice in Australia. Journal of Critical Care 2009;epub:ahead of print. [PUBMED: 19819105] Yoshida 1999 Yoshida T, Kohzuki M, Yoshida K, Hiwatari M, Kamimoto M, Yamamoto C, et al.Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Nursing & Health Sciences 1999;1(3):163-70. [PUBMED: 10894639] Indicates the major publication for the study8pub1756pubArt.

Chapter 5 Depressing time

The Time of Anthropology provides a series of compelling anthropological case studies that explore the different temporalities at play in the scientific discourses, governmental techniques and policy practices through which modern life is shaped. Together they constitute a novel analysis of contemporary chronopolitics. The contributions focus on state power, citizenship, and ecologies of time to reveal the scalar properties of chronopolitics as it shifts between everyday lived realities and the macro-institutional work of nation states. The collection charts important new directions for chronopolitical thinking in the future of anthropological research

Carer experiences of life after stroke - a qualitative analysis

Aims and objectives. Carers' experiences of caring for a stroke survivor were explored, including reactions and changes in their lives. Method. A phenomenological approach was taken to the collection and analysis of data. Semi-structured interviews lasting an average of 43 min were carried out with nine informal carers in their own homes. All were married to someone who had survived a stroke. Results. An overarching theme emerged, entitled: 'lives turned upside-down'. It took time for participants to understand the long-term impacts of stroke. Carers experienced increased caring and domestic workloads alongside reduced participation and altered expectations of life. They found emotional and cognitive changes in their partners particularly distressing, and would have valued more information and help with adjusting to the increased emotional, physical and cognitive workload of caring. Conclusions. It is important to support carers of people who have survived a stroke in adjusting to their changed lifestyles. This may affect their quality of life as well as sustainability of caring, and requires further research

User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke

Objectives: To explore experiences, preferences and choices relating to the use of ankle foot orthoses (AFOs) and functional electrical stimulation (FES) for foot-drop by people who have suffered a stroke and their carers, with the aim of informing clinical decision-making. Design: Semi-structured interviews explored individual experiences through a phenomenological approach. The Interpretative Phenomenological Analysis framework was used to enable organisation and interpretation of qualitative interview data. Setting: Participants who had used both transcutaneous FES and one of several types of AFO were recruited from a single FES clinic. Participants: Nine people who had suffered a stroke and four carers were recruited purposively, including people between 2 and 9 years post stroke, with different degrees of difficulty in walking. Results: Participants described experiences, preferences and choices relating to AFO and FES use. All but one person expressed a preference for FES use and related this to being able to move the ankle more freely; walk more normally, safely and independently; and greater comfort. Several people also used AFOs when the FES equipment failed, when travelling and near water. One person rationed their use of FES on a daily basis due to allergic reactions. Conclusions: The consensus in this sample demonstrated positive and negative experiences of both FES and AFO use. Participants weighed up the pros and cons, and despite predominant preferences for FES, many also used AFOs due to some drawbacks of FES. Further research and development are required to reduce drawbacks and further explore users' experiences. © 2010 Chartered Society of Physiotherapy