Rules of relevance after a stroke.

In line with the WHO, rehabilitation after a stroke can be viewed as a process of interaction and negotiation between the patient and the health care system about realistic goals and relevant activities. So a relevant question is "Whose understandings and rules of relevance determine the rehabilitation process?" In order to answer the above question the aim of this study was twofold. One aim was to explore how stroke survivors under 65 understand and deal with the activities of the rehabilitation process and how they experience having had a stroke. The second aim was to explore how the same patients and their rehabilitation processes were described in medical records, and ultimately to compare the two results. Ten patients were studied during the first 3 months after their strokes. Data consists of transcripts from interviews with the patients and notes from medical documents. Discourse analysis was used as a methodological approach, and in the analysis the focus was upon the discourse, rather than upon the message itself. The discourse of stroke survivors and health care personnel overlap each other to a great extent. The discourse is a biomedical one and both focus on the physical disabilities of the stroke survivors. The subordinate position of the patients and the authoritative position of the health care providers are also valid for both groups. However, there are also differences. While the stroke survivors portray themselves as individuals having had a position in the society, which they want to recapture, they are portrayed as fragmented male or female bodies of a certain age with certain impairments and dysfunction in the medical records. There is no answer to the question; What is of most importance for the stroke survivors?