Lost in Space: Redevelopment of the Sense of Self following Stroke using the Feldenkrais Method
Stroke directly affects the functioning of the brain, and impairment of the self image is a common sequela. In a cortical stroke there has been disruption of body schema representations in the brain at an organic level. This may manifest as sensory, spatial and/or motor ‘inattention’, as well as difficulties with movement. The relationship of ‘inattention’ to the return of function in the upper limb is being investigated within a rehabilitation hospital using the Feldenkrais Method. The Feldenkrais Method uses touch, movement and directed attention to improve function.
A pilot program commenced in February 2004 and involved 3 x1 hour sessions/week, conducted by a Feldenkrais practitioner and 1-2 assistants (physiotherapists, occupational therapists and students were rostered to participate). The sessions involved movement lessons led by the Feldenkrais practitioner. Participants had an Upper Arm Function MAS score of less than 3 and were current inpatients in the Rehabilitation Hospital.
Outcome measures include the Motor Assessment Scale (MAS) Upper Arm Function item, 3 items of the Behavioural Inattention Test (BIT) and, in collaboration with an art therapist, drawing to assess change in self image.
Preliminary data consists of a case study. 58 year old Mr B suffered an extensive right frontal haemorrhage on 2/2/04. On 15/4/04 he scored: MAS:0 on the Upper Arm Function Item, BIT:26/36 for line crossing, 11/40 for letter cancellation and 24/54 for star cancellation. On 20/5/04, after participation in the program for 4 weeks, he scored: MAS of 0 on Upper Arm Function, 36/36 for line crossing, 30/40 for letter cancellation and 41/54 for star cancellation. He drew pictures demonstrating a disturbed self image, which became more complete over time(examples to be shown on poster).
Results, of both the BIT and the drawings,indicate some improved spatial awareness on the left, which was not reflected in improved motor scores. Further research is needed to establish if there is a relationship between these measures. Collaboration with the art therapist opens new domains for exploring the redevelopment of self image following stroke.