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2. Embodiment, altered perception and comfort after stroke

Author

Stott, Hannah

Subjects
Body perception, embodiment, stroke, comfort, phenomenology, assessment, digital technology
Abstract

After stroke, changes to body perception are common. However, little is known about what these disturbed perceptions feel like to the stroke survivor. This programme of work used embodiment theory to explore stroke survivors' experiences of altered body perception and whether these perceptions were uncomfortable from a biopsychosocial perspective. It explored whether participants indicated a need for clinical interventions and the feasibility of using assessment tools to collate information about the body. A range of methodologies were used. A scoping review of the literature identified 28 studies exploring first-person accounts of altered body perception. Stroke survivors described the body across conditions as strange and unfamiliar; reflecting a changed awareness and means of relating to the body. Concurrently, a phenomenological study was conducted. A purposive sample of 16 stroke survivors able to communicate verbally, at least six-months post-stroke and experiencing motor and sensory impairments, were selected. Semi-structured interviews were conducted and analysed using interpretative phenomenological analysis. Participants described uncomfortable altered perceptions. The body did not exist, was hindered by strange perceptions and uncontrollable. The body was isolated, but participants were hopeful for improvement. Altered perceptions were difficult to comprehend and describe. From this, a feasibility and acceptability study explored the use of three assessment tools to communicate the altered body. Ten participants experiencing including a proportion with communication problems, were purposively selected. Participants wanted to communicate the experience of altered body perception and discomfort to health professionals and their preferred visual tools to achieve this. Stroke causes a complex sense of physical and psychosocial disembodiment, which is uncomfortable and of concern to survivors. Embodiment research suggests these domains may interact with one another. Clinical recognition and support to communicate altered body perception and discomfort from a holistic perspective may elucidate the multimodal experience of altered perceptions and foster new approaches for rehabilitation.

Published
2019

5. First contact physiotherapy: an evaluation of clinical effectiveness and costs.

Author

Walsh, Nicola E, Halls, Serena, Thomas, Rachel, Berry, Alice, Liddiard, Cathy, Cupples, Margaret E, Gage, Heather, Jackson, Daniel, Cramp, Fiona, Stott, Hannah, Kersten, Paula, Jagosh, Justin, Foster, Dave, and Williams, Peter

Subjects
MEDICAL care, PHYSICAL mobility, COST effectiveness, MUSCULOSKELETAL system diseases, DESIGN services
Abstract

Background: First contact physiotherapy practitioners (FCPPs) are embedded within general practice, providing expert assessment, diagnosis, and management plans for patients with musculoskeletal disorders (MSKDs), without the prior need for GP consultation. Aim: To determine the clinical effectiveness and costs of FCPP models compared with GP-led models of care. Design and setting: Multiple site case-study design of general practices in the UK. Method: General practice sites were recruited representing the following three models: 1) GP-led care; 2) FCPPs who could not prescribe or inject (FCPPs-standard [St]); and 3) FCPPs who could prescribe and/or inject (FCPPs-additional qualifications [AQ]). Patient participants from each site completed outcome data at baseline, 3 months, and 6 months. The primary outcome was the SF-36 Physical Component Summary (PCS) score. Healthcare usage was collected for 6 months. Results: In total, 426 adults were recruited from 46 practices across the UK. Non-inferiority analysis showed no significant difference in physical function (SF-36 PCS) across all three arms at 6 months (P = 0.667). At 3 months, a significant difference in numbers improving was seen between arms: 54.7% (n = 47) GP consultees, 72.4% (n = 71) FCPP-St, and 66.4% (n = 101) FCPP-AQ (P = 0.037). No safety issues were identified. Following initial consultation, a greater proportion of patients received medication (including opioids) in the GP-led arm (44.7%, n = 42), compared with FCPP-St (18.4%, n = 21) and FCPP-AQ (24.7%, n = 40) (P<0.001). NHS costs (initial consultation and over 6-month follow-up) were significantly higher in the GP-led model (median £105.5 per patient) versus FCPP-St (£41.0 per patient) and FCPP-AQ (£44.0 per patient) (P<0.001). Conclusion: FCPP-led models of care provide safe, clinically effective patient management, with cost-benefits and reduced opioid use in this cohort. [ABSTRACT FROM AUTHOR]

Published
2024
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9. sj-pdf-2-cre-10.1177_02692155211000740 – Supplemental material for ‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Author

Stott, Hannah, Cramp, Mary, McClean, Stuart, and Turton, Ailie

Subjects
body regions, FOS: Clinical medicine, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental material, sj-pdf-2-cre-10.1177_02692155211000740 for ‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke by Hannah Stott, Mary Cramp, Stuart McClean and Ailie Turton in Clinical Rehabilitation

Published
2021
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10. sj-pdf-1-cre-10.1177_02692155211000740 – Supplemental material for ‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Author

Stott, Hannah, Cramp, Mary, McClean, Stuart, and Turton, Ailie

Subjects
body regions, FOS: Clinical medicine, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental material, sj-pdf-1-cre-10.1177_02692155211000740 for ‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke by Hannah Stott, Mary Cramp, Stuart McClean and Ailie Turton in Clinical Rehabilitation

Published
2021
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12. Exploring altered body perception and comfort after stroke: An interpretive phenomenological analysis

Author

Stott, Hannah, Cramp, Mary, McClean, Stuart, and Turton, Ailie

Subjects
stroke, body perception, embodiment, comfort, phenomenology, Centre for Health and Clinical Research
Abstract

Background: After stroke, changes to body perception are common. However, little is known about what these disturbed perceptions feel like to the stroke survivor. This study took a phenomenological approach to explore experiences ofaltered body perception, whether these perceptions were uncomfortable, and whether participants indicated a need for clinical interventions.Method: A purposive sample of 16 stroke survivors were predominantly recruited from community support groups for stroke. All participants were at least six months post-stroke, experiencing motor and sensory impairments and able to communicate verbally. In-depth, semi-structured interviews were conducted in participants’ homes. Interviews were audio-recorded, transcribed verbatim, and analysed alongside reflexive notes using an interpretativephenomenological approach. Ethical approval was obtained from University of the West of England.Results/Findings: Four themes emerged. Participants described a body which did not exist; a body hindered by strange sensations and distorted perceptions; an uncontrollable body; and a body isolated from health professionals and clinical interventions. Participants expressed discomfort and feelings of conflict towards the body. They found their experiences difficult to understandand hard to describe.Discussion: Altered body perceptions left survivors feeling disembodied: their bodies perceived as strange, uncooperative, uncomfortable, and isolated from support. This is the first study to look at altered body perceptions in terms of patient comfort.Conclusion: These findings highlight the need for health professionals to recognize and support the communication of stroke survivors’ experiences of altered body perceptions and discomfort. Further research is needed to determine new ways to communicate about altered body perception and develop interventions to improve body comfort.

Published
2018

14. Outcomes for children and young people affected by modern slavery: An analysis of Independent Child Trafficking Guardianship service support in England and Wales

Author

Skeels, Anna, Huxley, Katy, Stott, Hannah, Skeels, Anna, Huxley, Katy, and Stott, Hannah

Abstract

This report summarises research commissioned through a UKRI funded Fellowship from the Modern Slavery and Human Rights Policy and Evidence Centre (Modern Slavery PEC) on ‘Support for children1 with lived experience of modern slavery’. It explores the benefits and limitations of the Barnardo’s delivered Independent Child Trafficking Guardianship (ICTG) service on children and young people’s outcomes, situates this amidst the nature of modern slavery affecting children in England and Wales and sets out what this might mean for policy and practice.

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