Abstract
The aim of the study is to investigate how time and uncertainties of clinical action and decision-making plays out in the practical work of early neurorehabilitation in order to present new analytical ways to understand the underlying logics and dynamic social processes that take place during professional treatment of patients with severe acquired brain injury. Drawing on ethnographic fieldwork in a Danish neuro-intensive step-down unit (NISU) specialising in early neurorehabilitation, we found that negotiation of futures takes place in the modern ICU in the present by strategically building upon past experiences. We have argued that the clinical programme therefore cannot be understood only from a "here and now perspective", since the early neurorehabilitation practice is embedded in overlapping temporalities of the past, the present, and desired futures. The study discusses the underlying logics-often hidden or unnoticed-that impact clinical practice of early neurorehabilitation, in what we have termed a logic of clinical reenactment, a logic of future negotiation and a logic of paradox.
Highlights
A 58-year-old man is pruning a tree in his garden
The ethnographic fieldwork was conducted as an open-ended emergent learning process in which Principle Investigator (PI), an anthropologist who had never been in an intensive care unit (ICU), over time discovered the social rules and meanings of importance within the cultural system of the intensive health care facility
This brings us to the logic related to the relationship between agency and time in early neurorehabilitation, given that the neuro-intensive step-down unit (NISU)-therapists actively seem to reconstruct the past in the present by bringing in previously known senses, knowledge, and personal artefacts in the rehabilitation sessions in order for the patients to remember or “re-live what use to be” in the present moment
Summary
A 58-year-old man is pruning a tree in his garden. The branch holding him snaps and the man falls to the ground, landing on the left side of his head. A clock begins from the health provider perspective, during which many believe an early window exists in which the brain’s dynamic response to injury is heightened and rehabilitation is assumed to be effective. Evidencebased research has not been able to identify this “early window of enhanced neuroplasticity,” the optimal time to begin rehabilitation is still not known [4]. Neurorehabilitation refers in general to rehabilitation interventions and mobilisation activities that begin immediately after the stabilisation of physiologic derangement in the intensive care unit (ICU), often before the patient is weaned from mechanical ventilation and vasopressor medication [5,6,7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
