Embodiment, tailoring, and trust are important for co-construction of meaning in physiotherapy after stroke: A qualitative study.

Background and Purpose: Physiotherapy, with an emphasis on high intensity, individually tailored, and person-centered treatment, is an effective route for recovery after a stroke. No single approach, however, has been deemed paramount, and there is limited knowledge about the patient experience of assessment, goal-setting, and treatment in physiotherapy. In this study, we seek to report patient experiences of I-CoreDIST-a new physiotherapy intervention that targets recovery-and those of usual care. The purpose is to investigate how individuals with stroke experience the bodily and interactive course of physiotherapy during their recovery process. Methods: A qualitative study, nested within a randomized controlled trial, consisting of in-depth interviews with 19 stroke survivors who received either I-CoreDIST or usual care. Data were analyzed using systematic text condensation, and this analysis was informed by enactive theory. Results: Interaction with the physiotherapist, which was guided by perceived bodily changes, fluctuated between being, on the one hand, formal/explicit and, on the other, tacit/implicit. The experiences of participants in the intervention group and the usual care group differed predominantly with regards to the content of therapy sessions and the means of measuring progress; divergences in levels of satisfaction with the treatment were less pronounced. The perception of positive bodily changes, as well as the tailoring of difficulty and intensity, were common and essential features in generating meaning and motivation. An embodied approach seemed to facilitate sense-making in therapy situations. In the interaction between the participants and their physiotherapists, trust and engagement were important but also multifaceted, involving both interpersonal skills and professional expertise. Conclusion: The embodied nature of physiotherapy practice is a source for sense-making and meaning-construction for patients after a stroke. Trust in the physiotherapist, along with emotional support, is considered essential. Experiencing progress and individualizing approaches are decisive motivators.The study was funded by the Northern Norway Regional Health Authority

Social interaction rhythm and participatory sense-making : an embodied, interactional approach to social understanding, with some implications for autism

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Making Sense in Participation: An Enactive Approach to Social Cognition

Most research on social understanding, in such diverse fields as developmental psychology, neuroscience, philosophy of mind, cognitive science, anthropology, linguistics and robotics, seems to have fallen into one of two categories: the one in which the interaction process (in its social and cultural aspects) is central, and the one in which individual capacities are at the focus. Even dialogue analysis and cognitive science, which intersect between the above disciplines, have most often focused on only one of these two angles: on the interaction or on the individual respectively. We argue that these two lines of approach to the question above need to be brought into correspondence with each other. We criticise existing approaches to social cognition on the basis that interactionist approaches tend to see social processes as having too much of a life of their own, while individualism sees social encounters as problems to be solved by a cogniser. A fruitful approach to the complexities of social cognition will, however, need to explore the relation between individual actions and social processes and bring them together in an integrated framework. We suggest that a story that succeeds in taking both the interaction process and the individuals involved seriously and in making progress on understanding their relationship, can be delivered by extending the enactive approach to cognition in general to the realm of social cognition. More specifically, we extend the enactive notion of sense-making into the social domain. Our argument runs like this. Enactivists characterise cognition as sense-making (Varela 1991; Thompson 2004; Di Paolo 2005), which is the active engagement with a world by a cogniser who imbues his environment with meaning and value because of this active engagement with it. Sense-making is an embodied and embedded activity, and if this is true, then movements are its tools and expressions. It is well-established that individuals can coordinate their movements intra-individually (Thelen 1981; Kelso and Clark 1982; Turvey 1990), and that such coordination is a non-mysterious and ubiquitous phenomenon in nature (Strogatz and Stewart 1993; Clayton, Sager and Will 2004). It has also been found that coordination can happen inter-individually. People can coordinate, for instance, their heartbeats (Neugebauer and Aldridge 1998) and their movements and utterances (see Kendon 1990, among others) in social settings. Interindividual coordination, moreover, seems to be a phenomenon that can be hard to avoid (Kelso 1995). Until now, no principled account of this coordination in social interaction has been put forward. We introduce a set of concepts that serves to unpack the workings of coordination in social interactions and get a better grip on it. We describe how the proposed notions can guide and inform interdisciplinary empirical research. This groundwork in the understanding of how interactors coordinate underlies our proposal regarding social understanding. We argue that, if movements are the tools and expressions of sense-making activities, and movements can be coordinated inter-individually, sense-making activities can also be coordinated. We call such coordination of sense-making participatory sense-making. Participatory sense-making is the active engagement of social agents in making and transforming meaning together (De Jaegher 2006). This approach combines the individual and interactional aspects of social understanding in that the interaction process plays a fundamental and indispensable role in the meanings generated and transformed by individuals in interaction. The individual and interactional levels emerge as having complex synchronic and diachronic relationships: social processes and individual actions in the same timescale become mutually constraining, and a developmental history of interactions changes us as individuals and makes us more prone to certain expectations and interactions

Horizons for the enactive mind: Values, social interaction, and play

What is the enactive approach to cognition? Over the last 15 years this banner has grown to become a respectable alternative to traditional frameworks in cognitive science. It is at the same time a label with different interpretations and upon which different doubts have been cast. This paper elaborates on the core ideas that define the enactive approach and their implications: autonomy, sensemaking, emergence, embodiment, and experience. These are coherent, radical and very powerful concepts that establish clear methodological guidelines for research. The paper also looks at the problems that arise from taking these ideas seriously. The enactive approach has plenty of room for elaboration in many different areas and many challenges to respond to. In particular, we concentrate on the problems surrounding several theories of value-appraisal and valuegeneration. The enactive view takes the task of understanding meaning and value very seriously and elaborates a proper scientific alternative to reductionist attempts to tackle these issues by functional localization. Another area where the enactive framework can make a significant contribution is social interaction an