Recovery of Body Awareness After Stroke: An Observational Study

Abstract

Background: Body awareness (BA) is a process that involves sensory awareness originating from the body's physiological states, processes and actions, and is shaped by one's attitudes, perceptions, beliefs and experience of social and cultural context. Impairments in body awareness after stroke are believed to be common and may be an important influence on recovery outcomes. However, recovery of body awareness is poorly understood and receives little consideration in rehabilitation.Aims: To investigate if body awareness changes over time following stroke; and identify if body awareness after stroke is associated with sensation, motor impairment, self-efficacy and quality of life.Methods: An exploratory longitudinal observational study was performed. Participants with a stroke diagnosis and associated motor impairment were recruited from an acute stroke unit. An assessment battery consisting of sensory and motor impairment and function, body awareness, self-efficacy and quality of life measures were used at baseline, 1, 3 and 6 months.Results: A total of 105 people with stroke were recruited. Most recovery in sensation and body awareness occurred within the first month after stroke (all p < 0.01). Sensation and body awareness were correlated with other clinical outcomes (motor impairment, self-efficacy and quality of life), demographics, and stroke specific clinical characteristics (all p < 0.01).Conclusions: This is the first study to track recovery of body awareness after stroke and investigate the relationship it may have in recovery of sensation, motor impairment and function, self-efficacy and quality of life. Further research is now warranted to continue investigation of body awareness and to develop effective stroke-specific assessment and intervention strategies.

Preliminary Rasch analysis of the Multidimensional Assessment of Interoceptive Awareness in adults with stroke

“…to the potential of the questions being "too distressing for someone in the acute stroke phase" and because their authors posited that neglect and hypo-vigilance would be more common after stroke than hypervigilance [35]. Serrada et al (2021) proposed that the development of a measure of body awareness that is appropriate for use after acute stroke is necessary, and we agree. We did not encounter distress when acquiring the MAIA in our sample, but we recruited only adults with chronic stroke.…”

“…Their participants were enrolled 1 to 14 days post-stroke, so consequently participants only filled out the MAIA at 1 and 6 months post-stroke. Serrada et al (2021) did not recommend using the MAIA in adults after stroke due to the potential of the questions being “too distressing for someone in the acute stroke phase” and because their authors posited that neglect and hypo-vigilance would be more common after stroke than hypervigilance [35].…”

“…To the best of our knowledge, only one other previous study utilized the MAIA in adults with stroke, specifically to measure recovery of body awareness impairments after acute stroke recovery, and to identify the associations between body awareness impairments and "sensation, motor impairment, self-efficacy, and quality of life" after stroke [35]. to the potential of the questions being "too distressing for someone in the acute stroke phase" and because their authors posited that neglect and hypo-vigilance would be more common after stroke than hypervigilance [35]. Serrada et al (2021) proposed that the development of a measure of body awareness that is appropriate for use after acute stroke is necessary, and we agree.…”

“…Worldwide, approximately 15 million people suffer a stroke each year. Roughly, half are left with permanent disabilities impeding upper limb use in daily activities, balance, and ambulation as well as influencing mental health and coping strategies [27][28][29][30][31][32][33][34][35]. As part of the ongoing body of research, it is essential to use outcome measures that support accurate assessment of body awareness, especially when body awareness is assessed in studies with interventions aimed at training body awareness in this population.…”

“…The MAIA was intended to differentiate between experienced and inexperienced mind-body practitioners, to measure changes in participants’ outcomes after mind-body therapies, and to differentiate between anxiety-driven hypervigilance and mindful attention styles [6,11,40]. As such, the MAIA has been heavily utilized for body awareness training measurement in varied populations, but to the best of the authors knowledge it has been used in only one previous observational study with adults with stroke [35, 39]. At the time of publication, it has been translated into over 24 distinct languages [41].…”