Young widowhood, conceptualized as the loss of one’s spouse before the age of 50, is a profoundly painful and distressing loss (Den Elzen, 2017, 2018). The literature on young widowhood shows the death of a partner generally causes a fragmentation of the self, as it violates expectations of the normal life cycle, namely growing old together (Haase and Johnston, 2012; Levinson, 1997). Premature loss of one’s spouse tends to be experienced by the surviving partner as distressing or traumatizing, such as having witnessed their suffering in illness or through accident (Den Elzen, 2018) or in struggling with unfinished business (Holland et al, 2020). Whilst post-traumatic stress is well-known and has been widely researched across various disciplines, the concept of post-traumatic growth is much newer and by contrast has received less attention. PTG was introduced as a scholarly concept by Tedeschi and Calhoun in the mid-1990s and is defined as a positive psychological change as a result of the struggle with highly challenging life events (2004). Calhoun and Tedeschi’s notion of PTG has been backed by a recent systematic review. In the first meta-analysis of moderate-to-high PTG, Wu et al. found that of the 10,181 subjects, about 50% experienced PTG (2019). They also reported that women, young people and victims of trauma experienced higher levels of PTG than men, the elderly and those who experienced indirect trauma. PTG has attracted some controversy, with some researchers questioning its scientific validity (Jayawickreme and Blackie, 2014). Others caution against the minimization of people’s suffering. Hayward is a trauma counsellor who advises approaching PTG carefully, highlighting that if it is introduced with clients too early it can "often be construed as minimizing someone's pain and suffering and minimizing the impact of the loss" (cited in Collier, 2016, n.p.). In addressing the critique of PTG, Calhoun and Tedeschi (2006) emphasize that the focus on investigating positive psychological change following trauma does not deny the common and well-documented negative psychological responses and distress following severe life stresses: “Negative events tend to produce, for most persons, consequences that are negative” (p.4). They argue however, and their research supports this finding, that for many people distressful events can foster positive psychological changes. We view PTG as a possibility following (profound) loss, and emphasize that PTG may continue to co-exist with painful and/or unresolved emotions regarding the loss itself. We conceptualize PTG as a continuum and not as an either/or binary with grief. Further, we wish to highlight that PTG is a highly individual process that depends on many factors, and we are not suggesting that the absence of PTG is to be seen as a failure. This chapter intends to contribute to the study of PTG through a person-centered approach. The most used method to assess PTG is the 21-item posttraumatic growth inventory developed by Calhoun and Tedeschi in 1996 (Jayawickreme & Blackie, 2014). Self-reported posttraumatic growth has been the foundation of PTG research, which has aimed to identify to what extent PTG evokes improved psychological and physical health. In discussing our own creative narrative processes of PTG, our practice-led-research lens aims to contribute to research on how PTG might be fostered. We propose a Writing-for-wellbeing approach in this context and explore what it offered us both as writers and widows and what it might offer the field of Writing-for-wellbeing and by extension clinical and scholarly practice.
Movement is an essential part of our lives. Throughout our lifetime, we acquire many different motor skills that are necessary to take care of ourselves (e.g., eating, dressing), to work (e.g., typing, using tools, care for others) and to pursue our hobbies (e.g., running, dancing, painting). However, as a consequence of aging, trauma or chronic disease, motor skills may deteriorate or become “lost”. Learning, relearning, and improving motor skills may then be essential to maintain or regain independence. There are many different ways in which the process of learning a motor skill can be shaped in practice. The conceptual basis for this thesis was the broad distinction between implicit and explicit forms of motor learning. Physiotherapists and occupational therapists are specialized to provide therapy that is tailored to facilitate the process of motor learning of patients with a wide range of pathologies. In addition to motor impairments, patients suffering from neurological disorders often also experience problems with cognition and communication. These problems may hinder the process of learning at a didactic level, and make motor learning especially challenging for those with neurological disorders. This thesis focused on the theory and application of motor learning during rehabilitation of patients with neurological disorders. The overall aim of this thesis was to provide therapists in neurological rehabilitation with knowledge and tools to support the justified and tailored use of motor learning in daily clinical practice. The thesis is divided into two parts. The aim of the first part (Chapters 2‐5) was to develop a theoretical basis to apply motor learning in clinical practice, using the implicit‐explicit distinction as a conceptual basis. Results of this first part were used to develop a framework for the application of motor learning within neurological rehabilitation (Chapter 6). Afterwards, in the second part, strategies identified in first part were tested for feasibility and potential effects in people with stroke (Chapters 7 and 8). Chapters 5-8 are non-final versions of an article published in final form in: Chapter 5: Kleynen M, Moser A, Haarsma FA, Beurskens AJ, Braun SM. Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study. Disabil Rehabil. 2017 Aug;39(17):1729-1737. doi: 10.1080/09638288.2016.1207111. Chapter 6: Kleynen M, Beurskens A, Olijve H, Kamphuis J, Braun S. Application of motor learning in neurorehabilitation: a framework for health-care professionals. Physiother Theory Pract. 2018 Jun 19:1-20. doi: 10.1080/09593985.2018.1483987 Chapter 7: Kleynen M, Wilson MR, Jie LJ, te Lintel Hekkert F, Goodwin VA, Braun SM. Exploring the utility of analogies in motor learning after stroke: a feasibility study. Int J Rehabil Res. 2014 Sep;37(3):277-80. doi: 10.1097/MRR.0000000000000058. Chapter 8: Kleynen M, Jie LJ, Theunissen K, Rasquin SM, Masters RS, Meijer K, Beurskens AJ, Braun SM. The immediate influence of implicit motor learning strategies on spatiotemporal gait parameters in stroke patients: a randomized within-subjects design. Clin Rehabil. 2019 Apr;33(4):619-630. doi: 10.1177/0269215518816359.
BACKGROUND: Itching (pruritus) following burns is a well-known clinical problem. However, there are no long-term prospective studies that document the course and the extent of the problem. Studies on risk factors are anecdotal.OBJECTIVES: To study self-reported itching in a multicentre cohort among adults with burns at 3, 12 and 24 months postburn. Further, to examine psychological and injury characteristics in relation to itching at these three points in time.METHODS: Itching was assessed as part of a self-report scar complaint list in a prospective longitudinal cohort study. Injury characteristics, demographics and self-reported post-traumatic stress symptoms were examined as possible risk factors in three linear regression models.RESULTS: A total of 510 persons participated. The reported prevalence rates of mild to severe itching were as high as 87%, 70% and 67% at the three respective points in time. Significant predictors of itching at all three points in time were deep dermal injury and early post-traumatic stress symptoms. Along with these, total burned surface area and female gender were predictors at 3 months postburn.CONCLUSIONS: Itching remains a significant problem over a 2-year period. Individuals having undergone surgical procedures and experiencing early post-traumatic distress are more likely to suffer from long-term and persistent itching. Implications regarding practice and research are discussed.
