The bodily experience of apraxia in everyday activities: a phenomenological study

Abstract

Purpose: The aim of this study is to explore apraxia as a phenomenon in everyday activities, as experienced by a group of stroke patients. Some consequences for clinical practice are suggested. Method: In this phenomenological hermeneutical study, six persons with apraxia were followed from 2 to 6 months, from the early phase of stroke rehabilitation. ADL-situations and interactions with therapists were observed and videotaped repeatedly during the rehabilitation trajectory, to provide access to and familiarity with the participant’s apractic difficulties over time. Two in-depth interviews were conducted with each participant. Interviews and video observations were analyzed together, taking Merleau-Ponty’s concept of bodily intentionality as basis for analysis and his phenomenology as the main theoretical perspective of the study. Results: Five types of altered bodily intentionality were described by the participants []: Gap between intention and bodily action [], Fragmented awareness in action [], Peculiar actions and odd bodies [], Intentionality on the loose, and [] Fighting against tools. These were recognized as characteristics typical of the apraxia experience. Conclusion: The phenomenology of Merleau-Ponty, and his concept of bodily intentionality in particular, elucidate the way specific apractic difficulties come into being and may thus render apraxia less incomprehensible. The apraxia phenomenon appears as characteristic fragmentations of anticipation inherent in action performance, thereby “slackening” the bodily intentionality. Identifying apractic changes of intentionality may help health professionals to adjust and individualize therapy, and facilitate patients’ acting competence in everyday life.Implications for RehabilitationFew studies have explored how apraxia appears in everyday life activities, e.g. during rehabilitation practice.The study explores apraxia as a phenomenon in everyday activities, as experienced by a group of stroke patients. Merleau-Ponty’s concept of bodily intentionality constitutes the analytic focus.Reflection upon changes of intentionality in illness may help professionals focus on patients’ experiences and their struggles.Findings support the necessity of the user perspective, with a more adapted, individualized and contextualized occupational therapy.