The social organization in constraint-induced movement therapy.

Ethnographic data were collected at two rehabilitation facilities conducting ongoing research to evaluate functional and neurological outcomes of constraint-induced movement therapy (CIMT). Our findings indicate that several patterns of behavior occur during participant/therapist interaction in therapy sessions: coaching, cheerleading, reminding, changing, and contemplating. These interaction patterns indicate that learned nonuse of an affected limb does not exist in social isolation and that people who participate in CIMT routinely consider the balance of any improvement against the costs of using an affected limb that is still not fully functional. These patterns of social interaction that occur during therapy--which often influence a participant's hope for future physical progress--are an important part of CIMT that may not be fully acknowledged in the clinical training of therapists.

Constructing the stroke: sudden-onset narratives of stroke survivors.

In this article, the authors explore the narrative production of stroke from the perspectives of survivors, that is, the stroke itself, not its implications for the individual poststroke. In the vast amount of literature on both sudden onset and chronic illness, the narrative construction of the onset of the illness, for the most part, has been ignored by social scientists, most notably in qualitative research. This is certainly true of stroke. Drawing on existing literature in both chronic illness and the body, the authors extend this to explore the phenomenological construction of stroke onset. Using data gathered from in-depth interviews with 111 stroke survivors postdischarge, they suggest three narrative mechanisms are used in the construct of the sudden-onset event itself: the use of typifications to construct the body during stroke, stroke as an internal communicative act, and stroke as a physical sensation and the mechanisms used to minimize bodily concerns.

The experience of time in the transition from hospital to home following stroke.

This paper reports findings related to the transition from hospital to home during the first month after discharge following acute stroke. Qualitative data were obtained from in-depth, semistructured interviews with 51 male stroke survivors and their caregivers. Data were analyzed with the N6 software application, designed to assist with qualitative data analysis. Stroke survivors described experiences related to changes in the temporal order of life, disruptions in sense of self, and strategies used to manage time. Findings indicate that changes in the temporal order of life are related to functional impairments and disruption in the taken-for-granted body. At 1 month post-discharge, survivors are struggling with establishing routines in their day and coping with an increased amount of idle time. In conclusion, strategies for managing increased idle time are "passing time," "waiting on time," and "killing time."

Sudden illness and biographical flow in narratives of stroke recovery.

The conceptual framework of biographical disruption has dominated studies into the everyday experience of chronic illness. Biographical disruption assumes that the illness presents the person with an intense crisis, regardless of other mitigating factors. However, our data suggests that the lives of people who have a particular illness that is notably marked by sudden onset are not inevitably disrupted. Extensive qualitative interviews were conducted with a sample of veteran non-Hispanic white, African-American, and Puerto Rican Hispanic stroke survivors, at one month, six months and twelve months after being discharged home from hospital. Narrative excerpts are presented to describe specific discursive resources these people use that offset the disrupting connotations of stroke. Our findings suggest a biographical flow more than a biographical disruption to specific chronic illnesses once certain social indicators such as age, other health concerns and previous knowledge of the illness experience, are taken into account. This difference in biographical construction of the lived self has been largely ignored in the literature. Treating all survivor experiences as universal glosses over some important aspects of the survival experience, resulting in poorly designed interventions, and in turn, low outcomes for particular people.

Benchmarking as everyday functional assessment in stroke recovery.

OBJECTIVES: Functional assessment in stroke recovery extends beyond formal testing and evaluation. Stroke survivors themselves continuously engage in the process of reckoning their functional capacities as they go about their everyday lives. This process is called benchmarking. The aim of this article is to discuss and illustrate how it operates in three areas of experience--self-definition, comorbidity and age, and the tasks of daily life. METHODS: Benchmarking data are drawn from in-depth qualitative interviews with male stroke survivors of various ages and from three ethnic groups (Hispanic, African American, and non-Hispanic White). RESULTS: The results show that the benchmarking process is evident in all social categories in which survivors fall, but specific kinds of benchmarks may be more prominent in some categories than others. DISCUSSION: The lessons provided by everyday functional assessment for understanding the stroke experience, as well as directions for further study, are discussed in the conclusion.

The underlife of behavior modification.

The practice of behavior modification in a residential treatment center for emotionally disturbed children is described, based on the author's observations over 18 months. Particular attention is given to the influence of context and situation as staff members count units of behavior, report their findings, and meet with colleagues to evaluate their data. It is suggested that these data reflect a mixture of client behavior and tacit staff practices, although they are presented officially as being only about clients.