A CASE STUDY ON THE EFFECT OF EMBODIMENT APPROACHES ON REHABILITATION AND SOCIAL INTERACTION IN A PATIENT WITH RECURRENT STROKE

Background: Previous studies have found that embodiment theory acknowledges the integral connection between “Self” and patient’s subjective experience of stroke. Stott (2019) has demonstrated that stroke causes a sense of disembodiment, which results in altered body perception, physical and bio-psycho-social discomfort. The changes in muscle function and sensation are the obvious changes seen after stroke, but a person’s perception of his/her body and change in sociability is often ignored which hampers the physical rehabilitation. This can lead to a psycho-social problem in the life of a patient with stroke after termination of Physiotherapy rehabilitation.

Purpose: To understand how incorporating embodiment approaches from Dance Movement Therapy (DMT) with physiotherapy treatment affects rehabilitation and social interaction of a patient with stroke.

Methods: The subject of the case study was selected by convenience sampling. The subject was a 65-year-old male, retired engineer living with his family, with four episodes of stroke which resulted in physical deficits assessed by Functional Independence Measure (FIM) and severe cognitive and psychological deficits which were assessed using the Mini Mental scale examination (MMSE) and the Montgomery-Åsberg Depression Rating Scale (MADRS) respectively. Subject’s medical history showed Diabetes Mellitus, Hypertension, Ischemic Heart Disease and anterograde amnesia after recurrent stroke. After the first stroke, the usual rehabilitation protocol (Upper and lower limb exercises, Functional training, gait training) was followed for the physical deficits. The cognitive and psycho-social deficits after the second stroke, affected his participation in rehabilitation protocol.
Authentic Movement (AM) and Laban Movement Analysis (LMA) from Dance Movement Therapy (DMT) was incorporated in the rehabilitation plan and were done three times a week for 45 minutes for 12 sessions. All the exercises were accompanied with the patient’s favorite music and songs. The patient was encouraged to sing along and move all limbs using free movements. The physiotherapist guided the movements in all directions following the planes and axes which is common for both PT and LMA.
MMSE, MADRS, FIM scores were assessed before Session 1 and after Session 12. Weekly narrative interviews of the caregiver were taken to find out the psycho-social changes in the patient. These scores and interview notes were later analysed for emergent themes and correlated with relevant literature.

Results: Interviews revealed that the patient had become more compliant to follow the rehabilitation protocol and enjoyed better interaction with his family and friends but was struggling with cognition. The FIM and MADRS score improved from 59 to 88 and 31 to 16 respectively. The MMSE score declined from 14 to 9.

Conclusion(s): Embodiment approaches in conjunction with rehabilitation protocol was beneficial for this patient’s biopsychosocial symptoms which affected the patient’s image of “Self” and his rehabilitation outcomes. An association between depression and self-consciousness is well established.

Implications: Physiotherapy is aimed at the functional and physical impairments. This case gives hope that as physiotherapists, being cognizant of the embodiment approaches may ensure a better post-rehabilitation life to patients of stroke by improving the person’s perception of his/her body. To generalize the results, further experimental studies are needed.

Funding, acknowledgements: None

Keywords: Recurrent Stroke, Embodiment approach, Rehabilitation

Topic: Older people

Did this work require ethics approval? No

Institution: The Neotia University

Committee: R & D Committee, Neotia University

Reason: It was a single case study. Informed consent of the patient and caregiver was taken.