Understanding Body Image in Women with Disabilities can help tailor Rehab accordingly

Women with disabilities bring a range of experiences, attitudes and feelings about their bodies all of which shape the rehab process. The more we understand about a woman’s image of her own body with all the feelings and history underlying it the better we can tailor a therapy program that meets her physical and emotional needs.

Many women with disabilities who are referred to physical therapy have been in therapy before. This is particularly true for women who have been disabled since childhood. I have been a therapist for many years and have treated children in the past. I have often heard about positive childhood experiences, but also discovered that many women recalled negative childhood experiences of therapy. I was interested in hearing the recollections of these women to help me understand how childhood experiences might affect their attitudes toward physical therapy as adults. K, who has cerebral palsy and came to rehab to deal with back pain, says, "I had physical therapy when I was a child, and my emotional and physical memories about that time are mixed. Therapists used to own body. I remember myself as a child crying when they were stretching my legs with force. However, I also remember the smell of the vinyl from the exercise mat when I was allowed to be playful, crawl freely and explore my own bodily movements." L, who also has cerebral palsy, does not have any positive memories about therapy. "All I remember as a child is pain. The physical therapist was very nasty with me". In reaction to my need to rest, she would say "Oh, you are just lazy." When I said I was tired and unable to climb the stairs, she would say, "Yes you can," without any sympathy or supporting emotions to my own personal struggle. Therapists used to have [so much control over my desires and my body. Such histories teach me that women with disabilities must be equal partners in the rehab process. To that end, they must actively participate in setting goals and designing the program. In fact, this is the underlying philosophy in all the work I do. Each woman needs to feel in control of her body and what happens to it in the therapy room. To address these issues, I tell a woman beforehand how I will be moving or positioning her body and ask her permission. While she may experience some discomfort (it is inevitable with certain types of stretching), she is at least prepared for it. Therefore, the experience may not feel as invasive and unpleasant. Regardless of whether women with disabilities have had physical therapy before, certain parts of the body raise strong feelings and emotions in them. Such feelings need to be recognized and respected.

For example, the pelvis and hips are often the prime focus of therapy, particularly for women. Yet, they are quite interconnected with sexuality and personal hygiene, as well as walking and standing. Sometimes, the legs need to be placed apart at the hips, which can cause a heightened sense of exposure and vulnerability.

As a physical therapist, I advocate for body symmetry. But this sometimes is misinterpreted by a woman as one more demand for normalcy. It is not. Rather, asymmetry brings health-related consequences I seek to mitigate. For instance, asymmetrical postures in wheelchairs may lead to pain and scoliosis, among other things. Similarly, asymmetrical walking patterns may lead to uneven stress on joints, resulting in pain and premature arthritis.

  B describes some of the benefits of these positions.  "The accumulative experience of my disability sometimes drains me. There is physical discomfort, frustration and fear of the long-term effects on my reserves. It takes more determination to get anything done, which discourages me from doing more and creates an almost bottomless, insatiable sense of need. But the passive restorative postures restore my equilibrium and stretch me in many ways, which dissolve my inertia and replenish me."

Original article was published Advance for directors in Rehabilitation March 2003 VOL. 12 NO. 3

It had images Images:

By artist Ellen Clark

and by artist Melina

And line drawing by  Dalia Zwick

E-mail me to get the completed article: yogarehab@gmail.com