Where is my body? : re-establishing first-person body perception among young and pre-elderly stroke survivors through expressive arts-based intervention

Abstract

Stroke is a severe cerebrovascular disease which can cause long-lasting physical, cognitive, and psychosocial impairments. These sequelae alter the body and the original daily life routine, causing stroke survivors to have a new perception toward their bodies and altered embodied experiences. Since current practices mainly focus on curing physical dysfunctions and symptoms, how stroke survivors perceive their altered bodies, their first-person body perceptions, are rarely discussed. Understanding these subjective experiences may help facilitate the recovery process and enhance the post-stroke psychosocial well-being and quality of life. Expressive arts-based intervention was proposed to help stroke survivors to attune to their post-stroke bodies. This approach may help stroke survivors revisit and express the stroke-related thoughts and emotions through non-verbal means.

Study 1 investigated the embodied experiences, the lived experiences of being in the post-stroke bodies of the young and pre-elderly stroke survivors. It was a qualitative study and adopted the Interpretative Phenomenological Approach (IPA) for data analysis. Ten young and pre-elderly stroke survivors were interviewed. Three main themes emerged and demonstrated that stroke survivors experienced dissonant embodied experiences engendered by the post-stroke impairments at the intrapersonal, interpersonal, and environmental levels. Nonetheless, with appropriate adjustments, reharmonization with the body could be experienced which could be called "re-embodiment." As physical restraints still existed, the perception of their post-stroke bodies played a critical role in re-embodying the post-stroke body.

Study 2 explored whether the first-person body perception was changed after participation in the Expressive arts-based intervention. It also investigated how the first-person body perception was altered by the Expressive arts-based intervention. It further investigated how the first-person body perception related to post-stroke psychosocial well-being and quality of life. Sixty-two young and pre-elderly stroke survivors were recruited from a randomized controlled trial. Half of them participated in the Expressive arts-based intervention while the other half did not and continued their normal routines. Quantitative and qualitative assessments were conducted at baseline and after the intervention (i.e., eight weeks after the baseline assessments). Qualitative findings demonstrated that the intervention supported positive interactions within oneself and with others, which promoted the re-establishment of the positive first-person body perception and thereby might help build the ground for reaching "re-embodiment." These experiences supported the enhancement of psychosocial well-being and might boost the quality of life of the stroke survivors. Quantitative results displayed that stroke survivors had improvements in self-esteem, perceived social support, interoceptive awareness, and psychosocial aspect of quality of life, and lower anxiety after participating in the intervention.

In conclusion, this thesis advocates the importance of understanding the stroke survivors' perception of the body in the trajectory of recovery. The embodied experiences could be changed by adjusting how stroke survivors perceive their post-stroke bodies. Their body perceptions are also related to their psychosocial well-being and may affect their post-stroke quality of life. This thesis also demonstrated the application of a body drawing task to assess the first-person body perception and contributed to the application of Expressive arts-based intervention on stroke survivors.