One woman's story about her everyday life after a spinal cord injury

Influences on Participation in Life After Spinal Cord Injury: Qualitative Inquiry Reveals Interaction of Context and Moderators

Background

Greater understanding of the influences on participation in life after spinal cord injury (SCI) can inform rehabilitation theory and practice. Careful qualitative inquiry can reveal subjective meanings associated with the relevant experiences, strategies, and perceptions of those with lived experience of SCI. A search of literature, followed by a thematic synthesis of qualitative studies, was undertaken to bring together these insights in a meaningful way.

Methods

The research question guiding the literature review and synthesis was, What do people with SCI perceive to be the influences on their participation in life? Three critical databases were searched for qualitative studies examining influences on participation in life after SCI. Peer-reviewed studies published after 2006, involving adults with SCI living in countries with advanced economies, were included. Data were extracted from 24 articles and subjected to three-level thematic synthesis—the coding of primary data from the studies, the development of descriptive themes based on an organization of those codes, and the generation of analytical themes.

Results

The synthesis yielded five analytical themes, supported by 17 descriptive themes. The analytical themes were (1) external contextual influences, (2) personal physical context, (3) personal psychological context, (4) potential moderators of participation outcomes, and (5) temporal dimensions of participating in life after SCI.

Interpretation

These themes highlight the complex interactions that shape participation from the perspective of people with SCI. Closer examination of the potential moderators may provide insights into effective rehabilitation interventions.

Conclusions

Synthesis of qualitative inquiry provides valuable insights into the perceptions of influences on participation in life from the point of view of people with SCI. The findings of this synthesis are instructive for rehabilitation theory and practice. It can complement what we learn from using the ICF to understand participation.

"Living with a fragmented body": a qualitative study on perceptions about body changes after a spinal cord injury

STUDY DESIGN

A qualitative study analyzed using Grounded Theory.

OBJECTIVES

To explore perceived bodily changes in people with acquired spinal cord injury of both genders and with different levels of injury.

SETTING

The National Paraplegic Hospital in Toledo, Spain, a national reference center for the treatment of spinal cord injury.

METHODS

A qualitative study designed and analyzed from the perspective of Grounded Theory. Semi-structured interviews were conducted in a triangulated sample of 32 people with acquired spinal cord injury. The analysis was based on the constant comparative method and an open, axial, and selective coding process.

RESULTS

The perceptions regarding bodily changes in people with spinal cord injury were grouped into two broad categories: changes in body schema (a fragmented body, a blurred body, body as a burden, non-muscular body, the wheelchair as an extension of the body, and body normalization) and increased bodily awareness (an uncontrollable body and retraining the body). The amount of time since the injury, positive life behaviors and attitudes, youth, male gender, and having flexible beliefs, values, and habits were considered facilitators for coping with body changes after a spinal cord injury.

CONCLUSIONS

Suffering a spinal cord injury implies a new body schema and a change in body awareness. When healthcare professionals are aware of the changes affecting the body after a spinal cord injury, they display more favorable attitudes and are more involved in promoting the patients' adaptation to their new body schema.

Thriving after pediatric spinal cord injury: two life stories

INTRODUCTION

The primary objective of this qualitative study was to explore the lived experience of spinal cord injury (SCI) as described by life story interviews with two adults who sustained SCI as children.

CASE PRESENTATION

Data were collected by conducting 15 life story interviews with two individuals with SCI. Atkinson's Life Story Interview approach along with open-ended questions was utilized to capture the narrative data. Polkinghorne's narrative analysis of eventful data approach was used to configure the data elements into a story with the purpose of understanding the lived experience of SCI of these two individuals. Four themes relevant to the experience of living with a chronic condition emerged: adjustment to life with SCI, hardiness, interdependence, and post-traumatic growth.

DISCUSSION

This study illustrated how the two participants' personal development and life trajectories were deeply shaped by pediatric-onset SCI. The life story interview process proved to be an effective approach to understanding the lived experience of SCI as told by two adults with pediatric-onset SCI. While the two participants represented unique contexts, their stories conveyed several cohesive, transcendent themes relevant to the experience of living with a chronic condition. Future narrative inquiry research in individuals with pediatric-onset SCI is necessary to build a representation of this population's lived experiences.

"To Work Just Like Anyone Else"-A Narrative from a Man Aging with Spinal Cord Injury

People aging with spinal cord injury (SCI) develop medical problems commonly associated with the aging process at a younger age than the general population. However, research about how the life story changes and how meaning will be experienced in occupations is lacking. The aim was to describe and offer an explanation of how a man experienced meaning in everyday occupations while aging with an SCI. Four narrative interviews were performed over a four-year period, with a man in his fifties, who lived with SCI for 39 years. The narrative analysis generated an overall plot, named “To Work Just Like Anyone Else,” and gives a picture of his experiences, thoughts, and reflections about meaning in occupations, from when he became injured to the present, and in relation to his future. His life story is characterized by secondary health complications, and his experiences of negotiating with the aging body and making choices to continue working. Further, how occupational risk factors, e.g., imbalance, alienation, and deprivation, occur as a result of lack of rehabilitation and support from social systems is addressed. Future research should explore how rehabilitation and social systems can support people aging with SCI to experience meaning in everyday occupations and to have balance in everyday life.

Spousal caregivers' experiences of participation in everyday life when living in shifting contexts

BACKGROUND

To promote health and well-being, and to meet the desires of the growing elderly population to age in place, elderly spousal caregivers need adequate support such as respite care services. More knowledge is needed about elderly spousal caregivers' experiences in relation to participation, which is an aspect of health that remains relatively unexplored for this group.

AIM

To explore and describe how elderly spousal caregivers experience and discuss participation in everyday life when living in shifting contexts due to the use of respite care.

METHOD

A grounded theory approach was used during data generation and analysis, which involved repeated focus group interviews with 12 spousal caregivers.

RESULTS

Complexity and ambiguity was understood to imbue participation in everyday life. Being in charge of everyday life was challenging for spousal caregivers, and created a need for personal time. Respite care and home care service gave them time, although when interacting with social contexts other issues arose that influenced their own recovery.

CONCLUSIONS

A holistic 'situation centered' approach that focuses on the elderly couple's life story and needs might capture a wider perspective and enable adequate support that influences their health, well-being, and participation in everyday life.

Leisure repertoire among persons with a spinal cord injury: interests, performance, and well-being

OBJECTIVE

To explore and describe the leisure repertoire of persons with traumatic spinal cord injury (SCI) and how the repertoire is related to interest, performance, and well-being.

DESIGN

Cross-sectional study.

SETTING

A total of 97 persons with traumatic SCI were recruited from the non-profit national organization, RG Active Rehabilitation in Sweden.

OUTCOME MEASURE

Data were collected through a two-part postal survey. The first comprised of questions investigating socio-demographic variables and injury characteristics; the second part included an interest checklist with 20 areas of leisure activities.

RESULTS

The participants were mostly interested in, performed, and experienced well-being from social and culture activities and TV/DVD/movies. The areas of leisure activities in which they had most likely experienced changes after the SCI were outdoor activities, exercise, and gardening. Sex, age, and to some extent, time since injury were related to interest, performance, well-being, and changed performance.

CONCLUSIONS

The results provided an explanation and limited description of a changed leisure repertoire among persons after a traumatic SCI. The study showed that sex, age, and time since injury were more closely related to the choice of leisure activities to include in the leisure repertoire than the level of injury. This knowledge can be of importance when professionals in the field of rehabilitation are planning and implementing interventions concerning leisure activities for persons with SCI.