Made available in DSpace on 2015-05-08T14:47:40Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1042215 bytes, checksum: 5a288f1af2a8d293145f46e75bcc68f0 (MD5) Previous issue date: 2014-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The physical and cognitive sequelae caused by CVA compromise the functional capacity, and the independence and autonomy of the person affected by the CVA, causing changes in the dynamics of life not only of the individual affected, but also the family, especially for the main caregiver. Objectives: evaluating the health-related quality of life of family caregivers of patients with sequelae with CVA. Methods: the research was descriptive, transversal type, with a quantitative approach, held at the domicile of patients with sequelae by AVE, in the city of João Pessoa-Paraíba, in the period between the months of February and April 2013. The population of the study consisted of 136 family caregivers of patients affected by stroke. For data collection, there was used a structured instrument, contemplating closed issues relating to variables of the study and the specific measures to assess, respectively, the physical capacity of individuals with sequel by CVA, the overload and health-related quality of life among caregivers: Barthel index, Burden Interview Scale and Short Form-36. The analysis was performed using three techniques: statistical descriptive analysis and exploratory data analysis and Association through the Chi-square test and the T-test and F for comparisons of the averages. The project was submitted to the ethics committee of the Centre for Health Sciences, Federal University of Paraíba Health and approved under protocol number 0279/13 and CAAE: 13778313.3.0000.5188. Results: commitment was evidenced in almost all domains of quality of life of family caregivers, among them, those who were presented with lower average were: Pain (40.16), Mental Health (53.62) and Social Aspects (54.12). Characteristics of individuals with sequel by CVA, which is related with the domains of quality of life, one can find out that those who were below the age of 65, were married and had highest level of schooling, major averages, respectively, in the fields of Social Aspect, Emotional and Mental Health Aspects. Caregivers of people with higher level of dependency to the basic activities of daily living had lower average in the mental health field. Regarding the characteristics of the caregiver, major averages were caregivers under the age of 40 years old and married in the field, Functional Capacity, those who had a profession, on emotional aspects and those who had higher income, in the areas of mental health and vitality. There was also an association between overload and worse health-related quality of life in the areas of functional capacity, physical aspects, emotional aspects and Pain. Conclusion: the results of the study allowed understanding the different dimensions and specificities in the context of the health-related quality of life, evidencing the need for redirection of the look to public spheres for the recognition of the problems faced by the family when individuals are affected by a disabling disease, such as CVA. / Introdução: As sequelas físicas e cognitivas provocadas pelo AVE comprometem a capacidade funcional, a independência e a autonomia da pessoa acometida e acarreta alterações na dinâmica de vida não só do indivíduo acometido, mas também da família, sobretudo na do cuidador principal. Objetivos: Avaliar a qualidade de vida relacionada à saúde de cuidadores familiares de pacientes com sequelas com AVE. Metodologia: A pesquisa foi do tipo descritivo, transversal, com abordagem quantitativa, realizada no domicílio dos pacientes com sequela de AVE, no município de João Pessoa PB, no período de fevereiro a abril de 2013. A população do estudo foi composta por 136 cuidadores familiares de pacientes acometidos por acidente vascular. Para a coleta dos dados, foi utilizado um instrumento estruturado, contemplando questões fechadas relativas às variáveis do estudo e às medidas específicas para avaliar, respectivamente, a capacidade física dos indivíduos com sequela de AVE, a sobrecarga e a qualidade de vida relacionada à saúde entre os cuidadores: índice Barthel, Burden Interview Scale e o Short-Form-36. A análise foi realizada através de três técnicas: estatísticas: Análise Descritiva e Exploratória de Dados e Análise de Associação por meio do Teste de qui-quadrado e o Teste T e F para comparações das médias. O projeto foi encaminhado ao comitê de ética do Centro de Ciências da Saúde da Universidade Federal da Paraíba e aprovado sob o protocolo n 0279/13 e CAAE: 13778313.3.0000.5188 Resultados: Foi evidenciado comprometimento em quase todos os domínios da qualidade de vida dos cuidadores familiares. Entre eles, os que se apresentaram com menor média foram: Dor (40,16), Saúde mental (53,62) e Aspectos sociais (54,12). Quanto às características dos indivíduos com sequela de AVE, que se relacionaram com os domínios de qualidade de vida, conclui-se que os que tinham idade inferior a 65 anos eram casados e tinham um nível mais alto de escolaridade, obtiveram maiores médias, respectivamente, nos domínios Aspecto sociais , Aspectos emocionais e Saúde mental . Os cuidadores de pessoas com nível mais alto de dependência para as atividades básicas de vida diária tiveram menor média no domínio Saúde mental . No concernente às características do próprio cuidador, as maiores médias foram relativas aos cuidadores com menos de 40 anos e os casados, no domínio Capacidade funcional , os que tinham uma profissão, no domínio Aspectos emocionais , e os que apresentavam maior renda, nos domínios Saúde mental e Vitalidade . Constatou-se também uma associação entre a sobrecarga e pior qualidade de vida relacionada à saúde nos domínios Capacidade funcional , Aspectos físicos , Aspectos emocionais e Dor . Conclusão: Os resultados do estudo permitiram compreender as diferentes dimensões e especificidades no contexto da qualidade de vida relacionada à saúde e evidenciou que as esferas públicas precisam redirecionar o olhar para reconhecer os problemas enfrentados pela família quando indivíduos são acometidos por uma doença incapacitante como o AVE.

The Occupational Therapist's Intervention for Adult Patients with Neurogenic Dysphagia Abstract of the Thesis: Dysphagia is a serious disorder, often caused by a cerebrovascular accident; in many cases it may be its only or primary symptom, and even the cause of death. The main objective of this thesis is to raise awareness of swallowing disorders among occupational therapists. Despite the fact that the occupational therapist's intervention for patients with swallowing disorder is common practice among occupational therapists abroad, this issue still is not well known among occupational therapists in the Czech Republic. There is also a considerable lack of Czech literature dealing with swallowing disorders from the occupational therapy point of view. This thesis therefore not only presents theoretical findings in this field but also recommends practical procedures for occupational therapists. The theoretical part of the thesis describes functional anatomy of the swallowing structures and swallowing physiology and pathophysiology. It analyses different causes of dysphagia with a focus on neurological disorders, defines the term dysphagia and other related terms, and briefly explains several classification methods of dysphagia. While the first part of the thesis looks primarily into the diagnostics and...

Orientador: Gastão Wagner de Sousa Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T17:31:05Z (GMT). No. of bitstreams: 1 Nascimento_RobertaSoares_D.pdf: 1746323 bytes, checksum: c99f33ea2452bdbaaa3f70d60f291f19 (MD5) Previous issue date: 2010 / Resumo: A Hipertensão Arterial (HA) e o Acidente Vascular Cerebral (AVC) como analisadores da atenção básica no SUS em Campinas. No Brasil o AVC é uma das primeiras causas de morte e importante fonte de incapacidade permanente entre adultos. Utilizaremos este agravo como analisador da atenção básica e sua relação com o diagnóstico e tratamento da HA. Descrevemos o perfil das vítimas de AVC e seu atendimento hospitalar no período de abril de 2006 a março de 2007. Descrevemos a ocorrência do agravo como indicador indireto de acesso de pacientes crônicos ao SUS, uma vez que o principal precursor do AVC é a HA que é um problema com prioridade de abordagem na rede básica. Analisamos narrativas produzidas a partir de grupos focais entre usuários e trabalhadores das Unidades Básicas de Saúde (UBS) sobre a amplitude de sua intervenção clínica. Consultamos as fichas familiares dos referidos pacientes na UBS e entrevistamos gerentes locais sobre a organização dos serviços. Agrupamos 06 UBS em três diferentes graus de implantação dos arranjos organizacionais e diretrizes do projeto Paidéia de saúde da Família, como o vínculo e adscrição de clientela por equipe de referência, a institucionalização do trabalho em equipe, atividades assistenciais coletivas e estratégias de intervenção no território. Analisamos as UBS com SUS dependência alta mas ao mesmo tempo com um grau de organização e cobertura assistencial maior ou igual a 50% Observamos a organização do processo de trabalho, agendas individuais, grupos, outras ações de promoção em saúde e atendimento domiciliar / Abstract: Arterial Hypertension and Cerebrovascular Accident as analyzers of primary care in the health care system in Campinas. In Brazil, the stroke is one of the leading causes of death and a major source of permanent disability among adults. We will use this harm as the primary analyzer of the basic attention and its relationship with diagnosis and treatment of hypertension. We describe the victims' profile of stroke and their hospital care from April 2006 to March 2007. We describe the occurrence of the disease as an indirect indicator of chronic patients' access to SUS since the main precursor of stroke is hypertension, which is a problem with priority in the basic approach. We analyzed narratives produced from focus groups among users and employees of the Basic Health Units (UBS) on the extent of their clinical intervention; consulted the records of those patients' family in the UBS and interviewed local managers on the organization of services. 06 UBS were grouped into three different degrees of implementation of organizational arrangements - Paideia Health Family Project's guidelines - as the bond and assignment of customers for reference team, the institutionalization of work, the teamwork, the collective welfare activities and the strategies of intervention on territory. We analyzed UBS with similar characteristics and with high dependence for the population by the Unified Health System (SUS) but, at the same time, with a degree of organization installed and welfare coverage greater than or equal to 50%. We observed the organization of the work process, individual agendas, educational groups on health and other actions to promote health and home care / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

O Brasil é um país em que o número de idosos tem crescido vertiginosamente e com isso ocorrem mudanças no perfil demográfico, socioeconômico e epidemiológico. As doenças crônicas assumem posição de destaque, dentre elas o Acidente Vascular Cerebral - AVC. O objetivo foi determinar a incidência de sintomas depressivos em idosos que foram hospitalizados por AVC, após a alta hospitalar. Trata-se de um estudo observacional e prospectivo com abordagem quantitativa. Foram entrevistados 48 idosos (60 anos ou mais) residentes na comunidade de cidades do interior paulista, que sofreram AVC e foram internados em um hospital terciário. A coleta dos dados foi realizada através de visitas domiciliares em duas etapas (após três e seis meses do AVC), no período de maio de 2010 a março de 2011. O instrumento de coleta de dados foi composto por dados demográficos e socioeconômicos, Mini-Exame do Estado Mental (MEEM), Atividades Instrumentais da Vida Diária (AIVD), Medida de Independência Funcional (MIF), presença de comorbidades e Escala de Depressão Geriátrica (GDS). A média de idade foi de 72,4 (±7,5) anos, com predominância do sexo masculino (56,2%). A maioria era composta por idosos casados, com média de 3,4 anos de estudo, 75% tinham renda familiar maior que um salário mínimo, 89,6% moravam acompanhados e 56,3% possuíam cinco ou mais morbidades. O tipo de AVC mais prevalente foi o isquêmico (81,2%), com maior comprometimento do lado esquerdo do cérebro. Com relação à Capacidade Funcional (CF), houve um aumento da média da MIF do terceiro para o sexto mês, ou seja, os idosos se tornaram mais independentes nesse quesito. Com as AIVD ocorre o contrário, os idosos se tornam mais dependentes na segunda avaliação. Os idosos do sexo masculino se tornaram menos depressivos, enquanto as idosas sofreram mais desses sintomas após seis meses do AVC. Embora o AVC seja a primeira causa de morte no país e também o grande responsável pelas incapacidades (físicas e emocionais) e internações hospitalares, estudos sobre a morbidade ainda é escasso. O intuito desse trabalho é o de apresentar essas consequências e os sintomas depressivos, os quais podem ser prevenidos com avaliação e intervenção de equipe interdisciplinar. / Brazil is a country in which the number of elderly people has displayed a steep growth, entailing changes in the demographic, socioeconomic and epidemiological profile. Chronic conditions stand out, including Cerebrovascular Accident - CVA. The aim was to determine the incidence of depressive symptoms in elderly people hospitalized due to CVA, after discharge from hospital. An observational and prospective study with a quantitative approach was carried out. Forty-eight elderly people (aged 60 years or older) were interviewed who lived in the community in interior cities in São Paulo State, had been victims of a CVA and were hospitalized at a tertiary-care hospital. Data were collected through home visits in two phases (three and six months after the CVA), between May 2010 and March 2011. The data collection instrument comprises demographic and socioeconomic data, the Mini-Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL), Functional Independent Measure (FIM), presence of co-morbidities and the Geriatric Depression Scale (GDS). The mean age was 72.4 (±7.5) years and the male gender predominated (56.2%). Most elderly were married, the mean education time was 3.4 years, 75% gained a family income of more than one minimum wage, 89.6% lived with another person and 56.3% suffered from five or more co-morbidities. The most prevalent type of CVA was ischemic (81,2%), which more strongly affects the left side of the brain. Regarding Functional Capacity (FC), the mean FIM score increased between the third and sixth month, that is, the elderly became more independent in this regard. The opposite occurred with the IADL, as the elderly become increasingly dependent on the second assessment. Male elderly became less depressed, while these symptoms were more present among female elderly six months after the CVA. Although CVA is the first cause of death in the country and also the main responsible for (physical and emotional) disabilities and hospitalizations, studies on this morbidity remain scarce. This research aims to present these consequences and depressive symptoms, which can be prevented through multidisciplinary team assessment and intervention.

Purpose. The use of antiplatelet agents in patients hospitalized with ischemic stroke was studied. Methods. Patients with a primary or secondary diagnosis of noncardiogenic, thrombotic ischemic stroke from January 2002 through December 2004 were included in the analysis. Patients were then subdivided into four treatment groups and one no-treatment group based on whether they were charged for any of four antiplatelet regimens (low-dose aspirin [≤325 mg daily], extended-release dipyridamole 200 mg with aspirin 25 mg, clopidogrel 75 mg, and clopidogrel 75 mg [as the bisulfate] plus low-dose aspirin) at any time during hospitalization. Patients who did not receive any of these medications during hospitalization were defined as the no-treatment group. A patient's illness severity was measured and compared with other patients in the data set. Results. A total of 44,108 patients were assigned to the treatment group, and 14,255 patients were assigned to the no-treatment group. In general, longer lengths of stay and higher institutional costs were associated with the no-treatment group. Patients in the no-treatment group consistently displayed more comorbid conditions than did patients in the treatment group. The no-treatment group exhibited higher usage rates of both fibrinolytic agents and vitamin K. More patients in the treatment group were discharged to home or rehabilitation, while more patients in the no-treatment group were either discharged to another nursing facility or died before discharge. Conclusion. A retrospective analysis of a large national hospital database revealed that one quarter of patients who suffered an acute stroke did not receive antiplatelet drugs during their patient stay. Outcomes for such patients were poorer than for patients who had received antiplatelet therapy.

No description available.

Jönsson, J & Persson, TAfasi. En litteraturstudie om kommunikation vid afasi orsakad av stroke.Examensarbete i omvårdnad 10 poäng. Malmö högskola: Hälsa och samhälle, utbildningsområde omvårdnad, 2007.Afasi är ett samlingsnamn för språkliga skador och kan drabba människor i alla åldrar. Cirka 12 000 personer drabbas årligen i Sverige av afasi vilket är en vanlig åkomma efter stroke. Individen med afasi och dennes anhöriga känner en frustration då de inte kan kommunicera med varandra, sjuksköterskan går här in och stöttar både patient och anhöriga. Syftet med denna litteraturstudie var att belysa kommunikationen mellan sjuksköterska och patient med afasi. Frågeställningarna var: vilka metoder använder sjuksköterskan för att kommunicera med patienten? Hur upplever sjuksköterskan kommunikationen med patienter med afasi? Hur upplever patienten sin situation vid kommunikationssvårigheter? Litteraturstudien omfattar både kvalitativa och kvantitativa studier. Resultatet visade att sjuksköterskans kommunikations -metoder består av att skapa en relation med patienten, visa empati, använda fysisk beröring, kroppsspråk samt humor. Sjuksköterskan känner empati för patienten och hon upplever patientens situation som tragisk och stöttar honom genom att visa uppmärksamhet och uppmuntran. Patienten kan känna sig frustrerad och deprimerad av att inte kunna uttrycka sig verbalt. Resultatet diskuteras utifrån Virginia Hendersons omvårdnadsteori. En konversation behöver inte innehålla ord, utan en förståelse kan även nås genom att använda kroppsspråk och fysisk beröring. Nyckelord: afasi, kommunikation, patient, relation, sjuksköterska, stroke, upplevelser. / Jönsson, J & Persson, TAphasia. A literature review about communication at aphasia caused by a cerebrovascular accident.Degree Projekt, 10 Credit Points. Nursing Programme, Malmö University: Health and society, Department of Nursing, 2007. Aphasia is a common name for several speech disabilities and this can affect people in all ages. Approximately 12 000 people develop aphasia every year in Sweden and it is a common sequel after a cerebrovascular event. The patients and their relatives feel a frustration when they can not communicate with each other, and the nurse needs to support both parties. The aim of this review-study was to illuminate the communication between the nurse and the patient with aphasia. The questions at issue were: which methods does the nurse use when communicating with the patient? How does the nurse experience the communication with patients who have aphasia? How does the patient experience the situation when having difficulties to communicate? This literature study is based on qualitative and quantitative studies. The results show; that methods used by the nurse to communicate include the ability to create a relationship with the patient, show empathy, use physical touch, body language and humour. The nurse experience sympathy for the patient and find the situation most tragic. She or he supports the patient by showing attention and encourage. The patient can be frustrated and depressed by not being able to verbally express himself/herself. The results are discussed on the basis of Virginia Henderson’s theory. A conversation does not necessarily need words, comprehension might also be achieved by using body language and physical touch. Keywords: aphasia, cerebrovascular accident, communication, experience, nurse, patient, relation.

This thesis is occupied with the issues of development of the fine motor skills and graphomotorics of an individual suffering from the central mobility disorder. The main aim of the thesis is to discover and describe what development possibilities of these abilities and skills are. The theoretical part deals with basic terms related to diagnosis of Cerebrovascular accident (CVA) and its rehabilitation options. There are also described the fine motor skills, graphomotorics, grasping process, classification of grasps and their development. There is a separate chapter that is engaged only with development of the fine motor skills and graphomotorics. The thesis also contains evaluation surveys that are applied in practice and that are important for comparison before and after a therapeutic intervention. The practical part is based on qualitative oriented methodology and it operates with data gained from five case studies. Based on comparison of values gained from the entry and control examinations, particular data have been elaborated. It was discovered from the performed research that it had come up to improvement of the fine motor skills as well as graphomotorics by use of various therapeutic methods. Each method had been chosen in accordance with the client's current condition and their individual...

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-08-10T12:08:37Z No. of bitstreams: 1 ANA CLÁUDIA MAGALHÃES MATOS.pdf: 3267899 bytes, checksum: 2d2b25e1956255ea5beaaf63fb6ba19e (MD5) / Made available in DSpace on 2017-08-10T12:08:37Z (GMT). No. of bitstreams: 1 ANA CLÁUDIA MAGALHÃES MATOS.pdf: 3267899 bytes, checksum: 2d2b25e1956255ea5beaaf63fb6ba19e (MD5) Previous issue date: 2017-03-10 / Oropharyngeal dysphagia is a common disorder in people that survived a cerebrovascular accident (CVA). It is a disability that contributes to the lack of functionality and dependency to eat. These eating limitations lead to clinical risks and adaptation needs to deal with the restrictions. The objective of the present dissertation, a qualitative case study, was to describe the experience of living with oropharyngeal dysphagia after a CVA from the patients‟ and their relative caregivers‟ perspectives. The dissertation reports seven cases of people who survived a CVA; these patients live in the southwest of Bahia and were discharged from hospital presenting signs and symptoms of dysphagia between October 2015 and July 2016. Data were collected through semi-structured interviews at the patients‟ homes. Five patients and seven relative caregivers were interviewed individually or in pairs. By applying an interpretative thematic analysis, the following thematic topics were identified: changes in preparing, handling and offering food; difficulties and feelings of the patients and relative caregivers before dysphagia; and social support. Confrontation of the signs and symptoms of dysphagia occurred with little orientation, mainly in the transition from hospital to home care, and little formal support. It was observed that the signs and symptoms of this disorder, such as cough and choking, are frequent, especially during the postdischarge period, and cause dissatisfaction and reveal a lack of preparation to deal with difficulties. The relative caregivers that did not receive orientations and help to manage the eating routine of the patients faced a greater difficulty to prepare, handle and offer food. The results show the importance of interdisciplinary team work, mainly to prepare the family for hospital discharge, and the relatives‟ commitment in the care process regarding the application of educational practices and training to achieve humanized care and a higher quality of life for patients. In addition to these measures, the findings confirm the need for speech therapy interventions focused on the evaluation of patients with CVA and follow-up of their eating patterns throughout the rehabilitation process. / A disfagia orofaríngea é um distúrbio observado frequentemente em pessoas que sobrevivem ao acidente vascular cerebral (AVC). Trata-se de uma incapacidade que contribui para a perda da funcionalidade e da independência para se alimentar. As limitações para a alimentação levam a riscos clínicos e necessidades de adaptação para enfrentar as dificuldades existentes. O objetivo desta pesquisa, do tipo estudo de caso qualitativo, foi descrever a experiência de vivenciar a disfagia orofaríngea após o acidente vascular cerebral na perspectiva do paciente e de cuidadores familiares. Foram descritos os casos de sete sobreviventes ao AVC, residentes em um município do Sudoeste da Bahia e que receberam alta hospitalar com sinais e sintomas de disfagia, no período de outubro de 2015 a julho de 2016. Os dados foram coletados por meio de entrevistas semiestruturadas realizadas em domicílio. Foram entrevistados cinco pacientes e sete cuidadores familiares, de modo individual, ou em díades. Por meio da análise temática interpretativa, foram identificados os seguintes núcleos temáticos: mudanças no preparo, manejo e oferta da dieta; dificuldades e sentimentos dos pacientes e cuidadores familiares no enfrentamento da disfagia e o apoio social. O enfrentamento dos sinais e sintomas da disfagia ocorreu com poucas orientações, principalmente no processo de transição do cuidado hospitalar para o domicílio, e pouco apoio formal. Observou-se que os sinais e sintomas deste distúrbio como tosse e engasgos são frequentes, sobretudo na fase pós alta hospitalar, e trazem sentimentos de insatisfação, bem como demonstram o despreparo dos cuidadores para lidar com as dificuldades. Os cuidadores familiares que não tiveram orientações e auxílios nas condutas durante alimentação se depararam com maior dificuldade no preparo, manejo e oferta da dieta. Os resultados evidenciam, além da necessidade de intervenções fonoaudiológicas focadas na avaliação do paciente com AVC e no acompanhamento de seu padrão de alimentação no decorrer do processo de reabilitação, a importância da atuação de equipes interdisciplinares, principalmente no preparo para alta hospitalar, e do envolvimento da família no processo do cuidar, com vistas ao desenvolvimento de ações educativas e treinamento prático para a busca constante da humanização e melhor qualidade de vida.

Le temps et la mémoire chez la personne « cérébro-lésée » Le temps et la mémoire participent au fondement de notre humanité. Les personnes atteintes de pathologies neurologiques interrogent de façon particulière les liens que les hommes tissent avec leur temporalité et leur mémoire. Au cours de ce travail, nous avons tenté de dégager ce qui était spécifique du temps vécu et de l’atteinte mémorielle dans la clinique neurologique. Temps disloqué des patients « déments », temps déchiré des patients atteints d’un accident vasculaire, ces deux modalités temporelles seront étudiées sous l’angle de l’éprouvé temporel. Nous avons également tenté de réfléchir autour des questions de la durée et du changement. Que devient l’identité de ces personnes touchées au coeur de leur être ? En précisant ce qui anime le rapport dialectique qui s’articule entre le temps et la mémoire, et qui est l’oeuvre de l’esprit, nous évoquons ce qui atteste de la continuité de la vie psychique, au-delà de l’apparaître et des potentialités « rationnelles ». L’accompagnement de ces patients requiert une présence, un don du temps / Time and memory are at the root for our humanity. People suffering from neurological illnesses greatly question the links men have with their temporality and their memory. In this essay, I have tried to bring out what is specific to time that has been experienced and to the effects of memory illnesses in the neurological clinic. I have studied two temporal modalities, the ‘demented” patient ‘s dislocated time, the patient who has suffered a stroke’s ripped time, as the time-proven person. I have also tried to consider questions of time, duration and change. What becomes the identity of those people who have suffered in their being? I have mentioned what testifies the continuity of the psychic life, beyond seemingness and “rational” potentialities by clarifying what prompts the dialectic relationship between time and memory. Being with those patients requires a presence, a gift of time