Transitions in the Embodied Experience After Stroke: Grounded Theory Study

Background. The body is central to the practice of physical therapy, but clinical theory largely neglects the body as a concept. A better understanding of the embodied experience could enhance delivery of physical therapy. Objectives. The purpose of this study was to gain an in-depth understanding of embodiment for people after stroke while transitioning from the hospital to the home. Design and Methods. Seven people with stroke, aged 66 to 89 years, were interviewed 1 month after discharge from a stroke rehabilitation unit. Interviews were analyzed using grounded theory methods, and a theoretical model was developed. Results. Two main themes in the embodied experience of stroke were: (1) "a divergent body-self," where participants referred to an objective physical body, separate from their sense of self, and (2) "a cohesive body-self," reflecting a sense that "it's all me." The theme "a divergent body-self" included subthemes of a body that was "strange," "unpredictable," and "effortful." In contrast, the theme "a cohesive body-self" comprised the subthemes "freedom," "control," and "self-identity," reflecting experiences of bodily movement, personal independence, and self-identity. Participants fluxed between these perspectives, within moments and over time, with these perspectives influenced by "anchors," including their environment, knowledge, and attitude. Conclusions. The bodily experience of stroke is intimately connected with a person's sense of self. A person's social and physical environment, as well as his or her personal attributes, can serve to "anchor" that person more comfortably within his or her embodied experience of stroke. Theory that acknowledges the integral connection between body and self could enhance physical therapist practice. This study supports the need for physical therapists to be adequately informed to integrate the embodied experience in their practice when working with people after stroke.