Taking back a little of what you have lost: the meaning of using an Environmental Control System (ECS) for people with high cervical spinal cord injury.

PURPOSE: Assistive technologies have deep and personal meanings for people with disabilities. This study sought to provide an in-depth exploration of the subjective meaning of Environmental Control System (ECS) use for people with high cervical spinal cord injury. MATERIALS AND METHOD: Interpretative Phenomenological Analysis (IPA) was used to explore the personal meaning of ECS. In-depth interviews with five participants were analyzed according to recommended IPA guidelines to produce a rich phenomenological account of lived experience. RESULTS: This study identified two overarching themes, one of which was the subject of an earlier publication. This paper focuses on the second theme "taking back a little of what you have lost" and its two main components "reclaiming a little doing" and "feeling enabled". Doing everyday things, being less dependent on others and feeling safer and less needy all contributed to participants experience of regaining something important of what had been lost. CONCLUSIONS: A nuanced range of meanings, demonstrating how "a little can mean a lot" emerged from this study. For those with high cervical spinal cord injury, "reclaiming a little doing" resulted in subtle, but subjectively significant, improvements in identity, relationships and well-being, while "feeling enabled" was both enjoyable and empowering and led to an increased sense of safety and reduced neediness. The potentially powerful impact on individuals with life-altering injuries of reclaiming a little of what they had lost, supports the value of more widespread access to and provision of ECS. Implications for rehabilitation While ECS use produces only a "little" objective change in activity levels, it subjectively means "a lot" to people with high level injuries. ECS enable people to "do" everyday things as well help in supporting them to "feel" less dependent and needy. Using ECS facilitates much more than functional tasks and a sense of security. It helps promote positive self-perception and continuity of being. It is important for those with high cervical spinal cord injuries to have access to ECS to ensure they can enjoy both psychological and physical benefits.

Experiences of using an Environmental Control System (ECS) for persons with high cervical spinal cord injury: the interplay between hassle and engagement.

PURPOSE: Environmental Control Systems (ECS) have many benefits; however studies of personal experience of ECS use are scarce. This qualitative study explored the insiders' experience of using an ECS. METHOD: An ECS starter-pack was compiled and trialled for an eight-week period with six persons with high spinal cord injuries (SCI) living in Ireland. Semi-structured interviews were subsequently completed with each person and analysed using Interpretative Phenomenological Analysis (IPA). FINDINGS: Two major themes emerged: "Taking back a little of what has been lost", and "Getting used to ECS" which is the focus of the current paper. This theme captured a dynamic interplay between the experience of "hassle" and "engagement" for new users of ECS. "Hassle" resulted from technological frustrations and the challenge of breaking familiar habits, while "Engagement" resulted from feeling good, having fun and being surprised. CONCLUSIONS: The complex interweaving of hassle and engagement experienced by new ECS users reflects the clinical experience of rehabilitation providers. The importance of overcoming initial hassle needs to be understood by clinicians and users in order to maximise the potential benefit of ECS. Non-use must be considered one reasonable outcome if based on realistic ECS trials.

Electronic aids to daily living: be able to do what you want.

PURPOSE: This study explores the experiences of Irish people with high cervical spinal cord injuries living with electronic aids to daily living (EADL) and the meaning attributed to such systems in the context of participation in everyday life. METHOD: Qualitative methodology using a phenomenological approach was used to explore the phenomenon of living with EADL. Data were collected using four focus groups of users and nonusers of EADL (n = 15). All participants had high cervical spinal cord injuries (C3-5). Groups were video recorded, transcribed verbatim and analysed using descriptive phenomenological analysis. FINDINGS: Findings revealed key elements of the meaning of living with EADL. Two key themes, time alone and changed relationships are described. These contribute to the super ordinate theme of autonomy. Findings suggest that participants perceived improvements in both anticipated and actual lived experiences with EADL. Themes are interrelated and together represent a summary of the experience of living with environmental controls. The themes described are similar to those found in other spinal injury studies relating to quality of life. CONCLUSIONS: Findings highlight differences in life experiences for those with and without EADL and provides motivation to address this difference. Such insights are valuable for both users and providers of EADL.

An exploration of participation in leisure activities post-stroke.

AIM: The purpose of this study was to illuminate the experiences of older adults' return to leisure activities, following rehabilitation, post-stroke. METHOD: A phenomenological approach was used to explore the experiences of re-engaging in leisure occupations post-stroke. In-depth interviews were conducted with five community-dwelling individuals (three men, two women) aged 68-74 years who had experienced a stroke in the past year. Data were analysed using thematic analysis. FINDINGS: Four themes emerged: (i) Re-engaging in leisure activities, (ii) acceptance of physical limitations post-stroke, (iii) gratitude for help and support and (iv) looking forward to the future. CONCLUSION: Implications revealed that post-stroke interventions need a more occupation-focussed approach, including return to leisure at an earlier stage of stroke rehabilitation.

How do employees and managers perceive depression: a worksite case study.

BACKGROUND: The impact of depression in the workplace is significant. If managers and employees understood depression better they could assist those with depression to achieve optimal work performance. METHOD: The case study was a medium-sized, privately owned forest products company located in western Canada. Individual interviews were used to explore the views of employees and managers about depression and its impact on work performance. FINDINGS: Suggest that how one perceives workplace support for depression is influenced by the interaction of the following factors: a) knowledge and understanding of depression, b) roles and responsibilities within the work environment, and c) perceptions of work role boundaries. CONCLUSION: Better links are needed between employees and managers to enhance workplace collaborations and achieve optimal work performance. The implementation of mental health support programs and the vocational role of occupational therapy in addressing the impact of depression in the workplace are discussed.