Caregivers' lived experience in trying to read slight movements in a child with severe brain injury: A phenomenological study.

AIMS AND OBJECTIVES: To explore caregivers' lived experience of reading slight movements of a child with severe brain injury. BACKGROUND: Despite increased need, the development of individual care for children with severe brain injuries has been prevented by their severe physical state and the poor reproducibility of their movements. In addition to a lack of evidence on the motor characteristics of patients with severe brain injury with multiple disabilities, their own development contributes to increasing variability in their states. Thus, caregivers are compelled to rely on their experiences, which have not been academically explored. DESIGN: A qualitative study based on van Manen's method of hermeneutic phenomenology. METHODS: Data were obtained through twenty-one 3-hr observation sessions and five 15- to 45-min group interviews. We observed a child (called AK) with severe brain injury and his 61 caregivers, and conducted group interviews with 28 caregivers. We focused on caregivers' experiences of reading AK's slight movements. The data were interpreted based on van Manen's hermeneutic phenomenological approach. RESULTS: Four themes emerged as caregivers' experience in trying to read AK's slight movements. By considering "AK's physical state and his slight movements" and discovering "caregivers' 'sense of uncertainty' about AK's slight movements," caregivers could decipher "AK's multiple slight movements." "Sharing" was found as a necessary aspect of these other three themes of reading AK's slight movements. CONCLUSIONS: We presented caregivers' experiences as related to these four themes in their efforts to read the slight movements of AK. Due to AK's slight movements with poor reproducibility, "sharing" was necessary to read AK's slight movements, as it exposes caregivers' lived experience to the interpretation of multiple caregivers. RELEVANCE TO CLINICAL PRACTICE: These four themes may be useful for assessing, guiding and promoting caregivers' use of sharing when reading the slight movements of children with severe brain injury.

The effect of L-citrulline ingestion on ECG QT interval and autonomic nervous system activity.

The purpose of this study was to investigate the effect of L-citrulline ingestion on ECG QT interval. To accomplish this purpose, nine male subjects (age: 23.4±0.5 years, weight: 57.7±5.6 kg) participated, who had no history of cardiovascular or respiratory function disorders. Each subject performed two tests (L-citrulline and placebo ingestion) on a separate day. ECG was taken before, and 60 min and 90 min after L-citrulline ingestion. The heart-rate-corrected QT interval (QTc) decreased significantly 60 min (p=0.0004) and 90 min (p=0.011) after L-citrulline ingestion. However, there were no significant changes after placebo ingestion. In addition, the interaction between L-citrulline ingestion and placebo was significant (two-way ANOVA: interaction, p=0.010). Our major finding was that L-citrulline ingestion decreases the QT interval in healthy subjects. This result suggests that transient L-citrulline ingestion may shorten the time required to complete myocardial depolarization and repolarization.

Impact of phase difference between cardiac systole and skeletal muscle contraction on hemodynamic response during electrically-induced muscle contractions.

Percutaneous low-frequency electrical muscle stimulation (LF-ES) is a new alternative exercise prescription for individuals who cannot adequately perform voluntary exercise. However, substantial undesirable elevation of both systolic blood pressure (SBP) and cardiac afterload occurs during LF-ES and must be resolved. Therefore, this study examined whether or not the synchrony between cardiac systole and skeletal muscle contraction affects instantaneous blood pressure and cardiac afterload during intermittent evoked muscle contractions. In eight subjects, the quadriceps and biceps femoris muscles of each limb were simultaneously stimulated at 20 Hz with a duty cycle of 0.3s stimulation and 0.7s pause for 15 min. The phase difference between the ECG R-peak and the onset of muscle contraction (tau(c-s)) was measured for all heartbeats. Then, instantaneous SBP, tension-time index (TTI), and peripheral vascular resistance (PVR) associated with each heartbeat were plotted as functions of tau(c-s). The results showed that SBP, TTI, and PVR were significantly lowered at positive tau(c-s) (i.e., the moment at which a muscle contraction started during the cardiac recovery phase). These results suggest that a well-designed stimulator, one that induces muscle contractions coupled with heartbeats with appropriate phase difference, would effectively attenuate the elevation of SBP and cardiac afterload during LF-ES.

Caffeine acutely activates 5'adenosine monophosphate-activated protein kinase and increases insulin-independent glucose transport in rat skeletal muscles.

Caffeine (1,3,7-trimethylxanthine) has been implicated in the regulation of glucose and lipid metabolism including actions such as insulin-independent glucose transport, glucose transporter 4 expression, and fatty acid utilization in skeletal muscle. These effects are similar to the exercise-induced and 5'adenosine monophosphate-activated protein kinase (AMPK)-mediated metabolic changes in skeletal muscle, suggesting that caffeine is involved in the regulation of muscle metabolism through AMPK activation. We explored whether caffeine acts on skeletal muscle to stimulate AMPK. Incubation of rat epitrochlearis and soleus muscles with Krebs buffer containing caffeine (> or =3 mmol/L, > or =15 minutes) increased the phosphorylation of AMPKalpha Thr(172), an essential step for full kinase activation, and acetyl-coenzyme A carboxylase Ser(79), a downstream target of AMPK, in dose- and time-dependent manners. Analysis of isoform-specific AMPK activity revealed that both AMPKalpha1 and alpha2 activities increased significantly. This enzyme activation was associated with a reduction in phosphocreatine content and an increased rate of 3-O-methyl-d-glucose transport activity in the absence of insulin. These results suggest that caffeine has similar actions to exercise by acutely stimulating skeletal muscle AMPK activity and insulin-independent glucose transport with a reduction of the intracellular energy status.