Models of disability shift attention to how institutionalized forms of misrecognition are as debilitating as disease processes or diagnostic categories. Drawing from an ethnography of clinical practice, this article focuses on the poetic process — visible in fleeting, bodily-sensing images, gestures or nonsensical utterances like "apple-apple-ike" — that structures the interactions between a child diagnosed with autism and an occupational therapist. Microanalysis of moments of bodily attunement reveal how the emergence of embodied pleasures leads to a mutual healing of regard; that is, how techniques of bodily-sensing interventions work equally to restore the health of social relatedness. The tight entanglement between intercorporeality and intersubjectivity — embodied pleasure and recognition of the Other — foregrounds that the healing of regard must be mutual. Reframing rehabilitation research in terms of aesthetics and folk neurology considers what is at stake in developing a language to grasp what constitutes evidence of healing beyond a calculus of discrete, measureable outcomes.
Leo Kanner's (1943/1985) depiction of autistic "aloneness" characterized a psychiatric disorder, setting the frame for subsequent pathological portrayals that have pervaded popular belief. For example, even when outsider metaphors of autism, such as psychologist Bettelheim's (1972) "empty fortress," are rewritten as inhabited by human life — such as Clara Claiborne Park's (1972) biography of her daughter's life as "laying siege to the citadel" — separation is framed in terms of embattled isolation. Healing entails, as in Clara Park's (2001) second memoir Exiting Nirvana, a type of existential border crossing — a recognition of and movement towards the Other.1 Insider perspectives, such as Temple Grandin's much cited phrase describing her experience as an Anthropologist from Mars (Sacks 1995) or Sainsbury's (2000) Martian in the Playground, shift attention to those gaps between experiential worlds. How, that is, a different bodily-sense of gravity lends itself to experiences of alienation of galactic proportion. Certainly, isolation-alienation metaphors provide an indispensible means to understand what really matters (Kleinman 2006) for individuals diagnosed with autism and their families (Biklen 2005; Savarese 2007; Prince-Hughes 2002; Bagatell 2007). However, this article takes a slightly different tack, asking what is also gained when those more mundane narrative bits and pieces — registered in fleeting bodily-sensing images or momentarily visible in gestures or nonsensical utterances like "apple-apple-apple-ike" that emerge between insider-outsider perspectives — are held to a more vigorous inspection.2
Shifting focus to those more ineffable and ambiguous moments of experience (Throop 2005; Crapanzano 2006) within institutionalized practices offers an intriguing corrective to calculated or positivist measures of efficacy.3 Micro-descriptions of gesture, tone, expression, and rhythm unveil how bodily-sensing lies at the heart of transforming institutional misrecognition into moments of recognizing socially occupied beings — the doing something with someone else that matters (Lawlor 2003). Drawing attention to emergent moments of sociality has practical implications for those diagnosed with autism as well as for research methods. To do so has relevance for how research can inform practice; that is, how a focus of intersubjectivity redresses a theoretical gap that is present in both biomedical and disability research where such ephemeral moments of transformative processes may be rendered invisible by institutionalized cultural values.
Beyond a Calculus of Power
Arguably, the metaphor of living in a "world apart" has not supported the shift towards examining "intersubjectivity" as the key unit of analysis for research. Despite recent developments in neuroscience that support the reframing of autistic aloneness as a problem of intersubjectivity (Aitken 2008), the institutional structure of biomedicine — as evidenced in the long list of the Psychiatric Diagnostic Manual's (APA 1994) criteria — continues to locate deficits solely within the individual. For example, recent research on mirror neuron systems shows how the same neural structures involved in processing and controlling actions, felt sensations and emotions are also involved in the perception and imagination of those actions, felt sensations and emotions in others; that is, a neurological basis of a shared manifold of intersubjectivity (Gallese 2003, 2004). Thus, a neurological basis for being able to attune to someone else's actions and emotions (i.e. intentional attunement) locates problems of intersubjectivity in the mirror neuron system of individuals (Gallese 2006; Gallese et al. 2009). Although this theoretical view also points to how social cognition is linked to actions or sensory-motor processing (Gallese et al. 2009), laboratory-based findings that individuals with autism have "broken" mirror neuron systems (Dapretto, et al. 2006; Ramachandran and Oberman 2006) only continue the biomedical legacy of isolating deficits to components within particular bodies. Granting hegemony to biomedical terms — psychosocial components, neurological systems or sensory-motor movements — in either research or practice only reaffirms the body-as-territory-to-be-conquered metaphor; that is, where the "medical colonization of the body" (Frank 1995) ends up producing treatment interventions and measurement outcomes that are about the "discipline of the body" (Foucault 1975/1995).
The social model of disability provides an alternative framework by recognizing the abilities of those identified with certain diagnoses. However, by foregrounding group identity, the social model ignores intra-group heterogeneity,4 often enforcing a kind of we-against-them struggle for power that may ultimately be detrimental (Danermark and Gellerstedt 2004). The philosopher Nancy Fraser (2001, 2000) emphasizes that too tight a focus on the social model also ignores the very real and unequal distribution of resources. Although a formal model of social justice promotes the equal distribution of resources, it erases the equally real need to recognize the status of individuals necessary for full social inclusion. Thus, Fraser (2001) has argued for a status model of disability that defines misrecognition of the individual as a form of status subordination. Status subordination originates in how cultural values are institutionalized:
To be misrecognized, accordingly, is not simply to be thought ill of, looked down upon or devalued in others' attitudes, beliefs or representations. It is rather to be denied the status of a full partner in social interaction, as a consequence of institutionalized patterns of cultural value that constitute one as comparatively unworthy of respect or esteem. When such patterns of disrespect and disesteem are institutionalized, they impede parity of participation, just as surely as do distributive inequities [italics added].(27)
A status model of disability, then, provides the conceptual grounds for the value of clinical research that focuses on how individuals succeed in recognizing the identity of Other that leads to a "parity of participation." Locating the problem of misrecognition in how values are institutionalized provides a means to move beyond a calculus of power that dominates biomedical research or the problematic outcome of a we-against-them stakes of a social model of disability. However, such a shift in focus from subjectivity to intersubjectivity requires a method to examine, in detail, the process by which therapeutic protocols unfold between therapists and clients within institutional contexts.
Drawing from an ethnography that utilizes an acted narrative methodology to examine what emerges in those experiential "gaps between" children with autism and occupational therapists in a sensory-integration based clinic,5 we will follow the bodily-sensing interactions of five-year-old Timur diagnosed with severe autism and his therapist Eva as they ultimately confound the isolation-alienation metaphor of "autistic aloneness" through the creation of healing, and what I am calling embodied pleasures. Such an analysis suggests that embodied pleasures — to be more fully defined in the conclusion — may be central to experiences of a parity of participation during interventions and can be a resource for individuals to more fully realize outside of clinical contexts.
Ethnographic method presumes that understanding particular lives in particular places hinges on thick descriptions (Geertz 1973) of embodied actions with others; that is, on participant observations documented in detailed field notes of shared experiences with others.
[T]he task of the ethnography is not to know the Other in any final sense, nor even to know the self through the other. Nor is it to change the lives of others, or even critique one's own culture. Its warrant and worth lies in its power to describe in depth and detail, the dynamics of intersubjective life under a variety of cultural conditions in the hope that one may thereby be led to an understanding of those rare moments of erasure and effacement that occur when self and other are constituted in mutuality and acceptance rather then violence and contempt (Jackson 1998: 208).
In this ethnographic study, microanalysis of bodily attunement (i.e. gaze, gesture, tonality of voice and the like) was deepened through a hermeneutic cycling between digitally recorded interactions of clinical sessions of children with autism and occupational therapists, narrative interviews with the therapists and adult caregivers, and field notes.6 The unit of analysis focused on what emerged between individuals; that is, to borrow from anthropologist Jackson (1998), how what is in potentia comes to be realized in action. Further, an acted narrative method — following anthropologist Mattingly's (1998, 2000) hypothesis that there is a homology between the structure of lived experience and the structure of narrative — brackets the analysis of actions and events that rise up or give shape to everyday clinical interaction in the form of significant experiences. Analysis also drew upon the literary critic Burke's (1931/1968) description of the poetic process where the appeal of the form (i.e. crescendo, syncopation, rhythm) lies in its embodied nature (i.e. the beat of the heart beats, rise and fall of footsteps, falling). An acted narrative method, then, doesn't just put up for analysis the retrospective storytelling or narrative reasoning by which therapist and adults come to create experiences for others or make sense of dilemmas. It also focuses on the actions by which individuals in therapeutic settings create the types of experiences that rise up to provide something worth talking about, that give a certain memorable, even poetic, shape to lived experience.
This article considers what is at stake in moving both the methods for, and research of, a clinical intervention beyond a calculus of discrete, measureable outcomes towards those more ephemeral moments in bodily-sensing in clinical interaction that reveal also the aesthetics of transformative processes. First, I will describe and situate how an aesthetic framework emerged from this research setting of a sensory integration clinic.
The local aesthetics
Set in an anonymous business park on the outskirts of a large metropolitan city, this pediatric clinic's nondescript façade houses the types of tools considered useful for the re-wiring of nervous systems: matted floors, large padded slides, ball pools, inner tubes, and trampolines. Large cardboard tunnels — actual forms for the cement pillars of freeway overpasses — like the various nets, ramps, rope ladders, and glider wires hanging at 45-180 degree trajectories or bolster platforms that tilt and sway — appear less like a playground than a stage for a traffic flow that can travel in any direction and on multiple levels. In fact, a myriad of swings known in the vernacular as "frog, bolster, moon, hammock" can be hung with bungee cords, rotator joints (or both) to elicit the up-down, back-forth, side-to-side, or centrifugal forces that lend themselves to traveling. Light wands, sound toys, beanie babies, shaving cream, clothespins, playdough, small to large 4-foot balls, and the like are instrumental for the practice framework of sensory integration (Ayres 1979, 1989), which cultivates a clinical gaze on how the integration of auditory, vestibular (i.e. movement through space), proprioceptive (i.e. deep pressure or feedback from muscles and joints), tactile, and visual processing systems impact on learning, behavior, and emotions.
Sensory integration, as a practice framework for occupational therapy — a rehabilitation practice that uses everyday activities as a therapeutic medium — guides practitioners to examine the sensory qualities of activities and specific environments and use this sensory input to support a child's intentional engagement in activities. For example, some sensory qualities can be either organizing or disorganizing, depending on how an individual's nervous system registers, processes and modulates the information from the environment. Individuals diagnosed with autism have long reported how different sensory input can be perceived as overwhelming (see, for example, Grandin 1995; Mukhopadhyay and Biklen 2005; Prince-Hughes 2004). In Ayres' theory, engagement in slightly more challenging activities supports the useful integration of the senses. In short, the equipment and materials typically found in sensory-integration based clinics provide a place where bodily sensing can refigure calculations of "the good," where problems of intersubjectivity are inextricably entangled with ones of intercorporeality.
In such a setting, the definition of aesthetics illuminates the at-stakeness of grounding (1) any appreciation, or criticism, of the beautiful, in (2) the sensuousness of multi-modal experiences (O.E.D. 1989). In turn, a framework of aesthetics foregrounds the possible "goods" of the cultural forms structuring the sensuousness of bodily-sensing of rhythm, movement, tactility, hues of light and color, and nuances of sound that organize intersubjective and joint actions. A focus on aesthetics, then, reframes the psychosocial, neurological and sensorimotor terms that measure the outcome of biomedical interventions towards those more sensorial and ephemeral outcomes inherent in social relatedness itself.
A folk neurology of unbearable lightness
In the outer room where their session begins, the blue industrial carpet is marked by the remains of a hopscotch grid outlined by masking tape, like faint hieroglyphics. Timur enters, step-kicking out of his sandals. Eva greets him with a "Hi!" "Ike," he responds without looking up. "What?" asks Eva. His mom, Julia, following closely at his heels, laughs and matter-of-factly repeats, "huuu — Ike." Timur adds a "Ughaaaahhhduggadooo," followed by a throaty, "uck, uck," and rapid repetitions of "Ooebabueao, ooebabueao." The vowel-rough consonant clusters are accentuated by Timur's continual movements over the remains of the hopscotch game: Two steps forward, pivot, pulling arms back, swinging them forward as he takes a huge leap-hop, jumps three times in rapid succession, swinging arms their full trajectory back-and-forth at the same time.
According to the language of the DSM-IV, Timur's movements would tally up into a kind of pathology of rhythm: "marked impairment in the use of multiple nonverbal behaviors, repetitive motor manners; and delay in spoken language." In the vernacular of a sensory integration-based clinic, however, therapists — and thus, parents — reframe such behavior into a type of folk neurology.7 Folk neurology, as I am calling it, borrows from Bruner's (2002) conception of narrative as a type of folk psychology, the everyday way in which we make sense of dilemmas or others' actions through telling stories. For example, according to the sensory integration framework, aversive sensory input — such as certain tactile, auditory or visual information in the environment — may be overly arousing, causing inattention, excess or repetitive movement or "shutting down." Arousal is often talked about in terms ranging from low to high. In this clinic, then, children are often described as being "too high" or "too low." This translation is also a way that "makes sense" of the different bodily-sensing or experiences of gravity that individuals with autism have expressed in metaphors of outer space, like being astronauts or Martians (Grandin 1995; Sainsbury 2000). Folk neurology, not unlike folk psychology, shifts the focus to the work being done by parents, or caregivers and therapists alike, to bring the terms of biomedicine and neuroscience down to human terms.
Other types of sensory input, such as rate and rhythm of vestibular input (e.g. swinging) or proprioceptive input (e.g. pushing/pulling) are indicated as ways to help the nervous system modulate or regulate those sensations. Thus, Timur's mother, Julia, associates sensory information with getting him "back to earth":
But, you know, when he's tired and doing his sensory stuff and he's seeking all that vestibular and all that input, it really does bring him down a bit. But I guess you've got to know when he's up and when he's down [or] he goes so off into—, you know, the vocal stims or the verbal stims or he's doing all that stuff with his eyes….
As the session begins, in the following transcription of a video recording of the session, Eva and Julia will speak in these folk neurological terms — trying to make sense out of Timur's increasing repetitive movements that continue to keep him from engaging with others at home, his avoidance of the swing (which had previously helped him focus and stay engaged with others), and whether what they see in the clinic is the same as what is happening at home:
Timur's continuous movement — recalling the hovering, darting, blur of constant wing movements, slight pause on branch, back into air whirring of hummingbird or butterfly flight patterns — represents the dilemma that they need me to understand.
eva: How's he been? The same at home?
julia: Yeah…[the same].
As they finish each other's sentences, their thoughts flow into one continuous stream:
eva: I [was telling Melissa] about—
julia: Not wanting to swing [and all that any more.
eva: [About just kind of…walking around and—
julia: Ahh, like just doing this a lot—, all this sort of stuff a lot, just sort of—
Figuring out "when he's up and when he's down" is not easy. So, even as Julia, his mother, has learned a folk neurology that reframes her son's actions in terms of being "too high" or "too low," her struggle to meet him on common ground is an existential one. "Some days" she recounts in a later interview, "I'm like really strong, and some days I'm just like crying my eyes out, you know?" This is an existential dilemma demarcated by sensory border zones that separate experiential worlds. For Eva, Timur's being "too high" or "too low" interrupts his ability to be in the same world:
And I really feel that it's interrupting his ability to do lots of things. I mean, if he's not walking back and forth and he's not stimming visually, he's doing something else with his hands or he's complaining or he's—, I feel like he's this little boy that's trapped and doesn't know how to get out."8
From a perspective of folk neurology, Timur's constant movement also represents a desire to be grounded, where vestibular-proprioceptive input can modulate an over- or under-aroused nervous system, bring him back from being "too low" or "too high":
I feel like he doesn't know how to—, there's something inside him where he can't really connect with the outside world, and I feel like he's trying. I feel like he so wants to interact … but I also see a child who cannot stop moving who needs to be in constant movement all the time.
This need for movement is echoed in insider Tito Rajarshi Mukhopadhyay's (Mukhopadhyay and Biklen 2005: 113) apologetic explanations for the movements that he feels might be interfering in his conversation, "I cannot. I'm sorry but I cannot help it, I need it [the rocking] to feel my body." Yet, if such movement may create a type of sensory border zone that demarcates different experiential worlds, insider Amanda Baggs (2007) also describes the pure pleasure in bodily-sensing in a quote that accompanies the first part of her film entitled, "In My Own Language":
Far from being purposeless, the way that I move is an ongoing response to what is around me. Ironically the way that I move when responding to everything around me is described as being in a world of my own. Whereas if I interact with a much more limited set of responses and only react to a much more limited part of my surroundings, people have claimed that I am opening up to "true interaction" with the world.
This portion of the film depicts the rhythmic movement of objects accompanied by sounds she hum-sings. If outsiders perceive only the distance to the Other created by such movements, Amanda Baggs describes this as her "native language." In part, her joy in the sensuality of experience of movement as a response "to everything around me" that is posted on a public website points to how clinical narratives of not being able to "really connect with the outside" may be a form of institutionalized misrecognition. In part, this juxtaposition of outsider and insider perspectives underlines the potency of bodily-sensing experiences in isolating or bridging experiential worlds.
Returning to re-view Timur's movements at the opening of the session over the remains of the hopscotch grid shows that his movements were not aimless but purposeful. The numerous views taken to transcribe the opening moments of the session show that his movements were, in actuality, highly ordered by the two ends of the masking-taped hopscotch game. Each foot-tilt, ground-strike by aligning foot-to-tape pivot, like the signal of a grand staff, marked a new musical bar for the sound of his nubby carpet impact-draaaaag of toe-walk, rapid-jumps, looooong-strided full-arm swing hop-slams of syncopated improvisation.
Three steps towards Eva and Julia, pivot, six toe-steps forward, pivot, full trajectory arms-swing run-hops forward, five steps, pivot. Briefly glancing up at his mother, but without pause, he takes seven steps back in the other direction, pivoting, two toe-steps, settling down to flat-feet five steps back, and rapid-hop-hop-hop-ping from one leg to the other, before pivoting, eight strides back. As he jumps up-down in rapid succession, on each upward full-arm swing, his right hand raised peripheral in his field of vision, moves his fingers rapidly, then shakes-down them as if wet towels. Occasionally, he croons out a long "shoooooew," or rapid fire, "buggadoweooo." Eva turns to open a cupboard, which holds weighted vests,9 and pulls one out.
For Eva, however, Timur's world — hovering just within reach — accentuates the anticipation of reaching common ground — of the pleasure of intersubjectivity — and equally so, the derivative pain of disconnect. In a later interview, Eva's efforts trying to get me to feel this experience were underlined by her accentuation of certain phrases:
When he makes that connection? When he wants to make that connection with me and he looks at me? I feel like I—, he's so with me. For that minute. But then again, there are other times where I can look at him and—, and—, he's not there. [long pause] So, it's kind of sad in a way. It makes you sad.
This is an existential sadness — a sadness of disconnect — for Eva of unbearable lightness where making connections across the isolation-alienation border zone takes on a certain sense of gravity. The weighted vest that Eva pulls out for him to put on speaks equally to the guidelines of a sensory integration framework that indicate this helps individual nervous systems modulate sensations and give proprioceptive feedback to orient one in space. In folk neurological terms, "weight" could practically as well as metaphorically ground Timur, and close the gap between experiential worlds. In the following moments of the session, Eva repeatedly (and literally) will begin throwing out bodily-sensing invitations to ground Timur in that space in-between.
The seduction of bodily sensing rhythms
According to insider Dawn Prince-Hughes (2004:25), there's a certain seduction to rhythm — a cutting down of the types of extraneous sensory information that create pain — a kind of bodily sense-making. In her memoir, "Songs of a Gorilla Nation," she writes:
Most autistic people need order and ritual and will find ways to make order where they feel chaos. [They] instinctively reach for order and symmetry…. [For example] they rock back and forth, cutting a deluge of stimulation into smaller bits with the repetition of their bodies' movements.
So, Eva hangs up a moon swing,10 before moving to her right to open up space for him to take her invitation. Timur, keeping her watchful face in his visual periphery, merely jump-armswing-armswing-jump-walks in a large half-moon circle to his right. When she reverses and moves to her left, he cuts back like a scythe to retrace his steps to his left. Not unlike a planet in orbit, he maintains an equal distance of separation. Before the session, Eva had communicated her dilemma:
It's hard for me right now, because I'm lost when the child doesn't want to interact. Yet he does. I know you can see it. We're interacting the whole time. When he finally wants to let me in, it's almost all on his—, when he wants it.
They circle each other again. This scene demonstrates anthropologist Jackson's (1998:18) point that in crossing boundaries, "…the critical issue is always whether a person is in control of this switching and oscillation between his or her own particular world and the world considered not-self or other."
Eva makes another invitation, by bouncing a large 3-foot diameter green therapy ball on the cement floor like a basketball, "BOUNK, BounCK," before sending it rhythmically, "KaBoMP, KaBoump, kabomp, kaboumping," towards Timur. On the first BOUNK, he drops his hand, fingers running rapidly down from little to index, then looks up, returns to watching his fingers in their undulating movement, and merely sidesteps the ball. If Eva moves forward towards him, he moves back. If she moves slightly to her right, he moves slightly to his right. Several more times will they circle again locked in a kind of game that includes a "space between" which neither can enter. Again, Eva turns her back, fetches a larger blue therapy ball (approximately 4 feet in diameter), turns, and bounces it with both hands in front of her — watching him as he walks back-forth back-forth perpendicular to her stance about five feet away. BOUNCE-BOUNCE, BoUnce, BOUNCE, before sending this invitation across the room in seven rhythmic "Kabump, kabump, kabump, kabump, kabump, kabump, kabumps" towards Timur.
Eva described her process after this session:
I'm trying to work with whatever he's going through and not try to push too hard, and, you know, let him do his own thing. And try and just get him that way to interact, like throw things in his way, and then have him come to me more. And I think it worked.
For if Timur first side-steps the blue ball, as he did the green one, and moves away from her as she moves to retrieve it, he eventually does come over and with both hands rising and falling, drums out an answering, "FLackK, Flacke, Flackc!" Eva gently takes his moving arms and places them onto the blue ball, tilting him forward over it in a kind of invitation to be rolled forward on his stomach. He feels the curvature against his stomach, before standing up, once more abandoning the ball and his proximity to her. He retreats to a large tilted platform bolster and sits, examining the movement of his fingers. Yet, Eva knows that Timur is not really "in his own world," but rather that he was, indeed, his own person. After the session, reasoning through his distance but not distant positioning, she reflects:
I mean, he was with me the whole time. He knew where I was the whole time and I really think that he's just going through a period right now where he's like, "I want to do what I want to do."
Without any actual words having passed between them, Eva sensed the critical issue of control in intersubjective relations (Jackson 1998).
What emerges next, suggests that this recognition of other as a human being and not as a sign or symptom of a diagnostic label is a necessary prerequisite for an intersubjectivity — the "giving for" and "receiving of" — pleasure. For if he abandons his seat on the tilted bolster, it is Timur who will now invite Eva.
They stand facing each other as Timur reaches into a large cardboard tunnel dangling from a net and pulls out the green ball. "Ubachewuuu," he croons, looking up at Eva. The ball comes up to his chest. Timur leans over the ball on his elbow. Eva smiles, but without closing the distance between them, takes one exaggerated step to the right — both of her hands now shoved into the back pockets of her jeans. Timur, legs supporting him and elbows crunched up underneath his torso, gently pushes himself forward and is momentarily weightless before the roll of the ball sets him back down. He bounces lightly a couple of times, then up at Eva. She takes one step closer. Again, he leans down, bounces on his belly — this time bending his knees and raising his feet entirely off the ground. Bouncing a bit harder, he rolls to the left, catches himself, stands up. Right hand touching the ball, he raises his head to locate Eva, then leans-bounces back down rolling himself forward, weightless for a second. He tries it again with more force, rolling himself forward enough so that he must catch himself with his palms flat against the ground. As he tries to push himself back up, he tilts. He sticks out his leg, but his torso is already sliding off the ball. Catching himself with his hand, he lets out a quiet, "Ohhewoo."
Eva steps into his line of vision — hands still in her back pockets — but does not come closer. Timur looks up at her, stands quickly, his hands still lightly touching the ball. "Uooodpeoo," he says, leaning down on the ball and rolling himself forward. Too much force, and he immediately tilts over. Making a small sound of complaint, Timur rights himself. Eva takes two steps forward. They watch each other intently — bodies mirroring each other. Timur's head and body tilted sideways to the left, while Eva's head tilted slightly, body leaning slightly on a slide structure to her right. Timur again rolls himself forward, bouncing several times, tilt-slipping off, before extending — just in time — his hand out to catch himself. He is frowning. He gets to his knees, then stands, hand steadying the ball. Eva, watchful, has not moved. Timur throws himself forward, his body bounces a little before it again starts to tilt and roll, just managing to catch himself by pushing up with his leg. Too late. He rolls forward so fast, tumbling to his right and flipping over so that he ends up right at Eva's feet, smiling broadly and laughing.
From a sensory-integration perspective, Timur's falls indicate challenges with balance, and negotiating where his body is in space (i.e. vestibular) without a sense of being grounded (i.e. proprioceptive); but in this dance of gaze, as we will see next — he has also seduced Eva into that space-between.
Turning his back, he stands up, complaining, "ohhweeeoo," and bounces back down onto his torso, but immediately runs into the same problem. His body tilts off—, but he stands before falling, takes two quick steps back and rolls the ball right in front of him, so he's directly in front of Eva, then bounces forward, tilts, manages to catch himself, again overcompensating. He stands and looks directly at Eva, "Ohhhweoeudo." As he leans and bounces lightly on the ball, still looking intently up at her, she takes one small step forward, and asks, "Timur, do you need help?"
eva: Do you need help?
timur: (clearer) Help.
Eva takes three rapid steps forward, slides into a kneeling position in front of Timur — their heads now at the same level — and takes both of his hands in hers. "Watch." She gently pulls him forward so that he's lying with the front of his torso curved over the ball, and then moving to his side, she rests her forearms and open palms across his lower back and hips.
The emergence of embodied pleasures
In the next moments, Eva and Timur will begin an improvisatory dance that takes on a dramatic structure. Timur's shifts in heightened affect, increased language and gaze build from a mutually built rhythm punctuated by beats and pauses. Their emergent and mutual pleasure signals the types of transformations central to developing a recognition necessary for a parity of participation.
Eva's flat palms and forearms act like broad canvas straps as she begins bouncing him in rhythm and cadence to her numbering: "One-two-three-four," bouncing him again in rhythm with "one-two-three-" then, without warning, Eva propels him rushing head-first forward, "Hands out!" with a barely perceptible slowing of his body that gives Timur that necessary moment to throw-hinge his arms forward and stop his forward momentum with his palms, his head only inches from the carpet.
This is a theme that Eva will vary in the following moments — a kind of bodily-sensing game of rhythm — as she slowly adds more and more challenging shifts in tempo and pattern, while adding in spaces that invite Timur to participate by either physically pausing the movements or verbally giving him warnings to get his hands up before she slings him forward…
eva: One (bounce), two (bounce), three (bounce), four (bounce)—, one (bounce), two (bounce), hands out! (rushroll-forward) Hands out!
Ready this time, Timur's palm impact >thunk< as Eva smiles. She underlines her draw-rolling him back up with a long drawn-out, "Goooood!" that is underlined by Timur's palms-dragging-on-nubby carpet, before he folds up his arms so that his entire front is contoured around the curve of the ball.
eva: One (bounce), two (bounce), three (bounce), four (bounce)—, Hands out!
Timur's palms impact the ground a bit too close to the ball, so he compensates by walking his left arm/palm forward. Eva, noticing, slows down the force of her push-thrust then raises her arms as if releasing safety restraints. He hovers just a moment, before tilting and rolling >clump< off.
Eva rises to her knees to see his face. "Hhhu-I-ike!" he says with a grin and rolls to sitting. Eva smiles. Timur stands, pulls the ball back towards him, pats it a couple of times, picks it up in both hands, sets it down, turns his body towards Eva, and falls forward — Eva steadying the ball — as he tilt-rolls >clump!< to the left.
eva: Uh ohh. Do you need help?
With his gaze on Eva's face, Timur extends his left hand, touches the ball, gets to his knees, and says into the space in front of him, "Help."
eva: Look (pointing to her chin) at me. (gesturing with her left arm) Help
timur: (looking directly at her) Help me.
Eva in an upbeat tone, "Ohhh, okay!" Her entire face lights up into a smile and her left arm fully extended and open, curves around his back as he leans forward…
eva: (brightly) Get on! One (bounce), two (bounce), three (bounce), four (bounce)—, one (bounce), two (bounce), three (bounce), four (bounce), hands out! Hands-out!!!
She sings out the last "Hands out!" with a bit of urgency as she is already tilt-rolling the ball forward with some force. In fact, she has to pause the momentum slightly, waiting until he has his arms up before she completes the arc. >thunk< go his palms on the carpet as her laugh and Timur's high squeal of delight sound simultaneously. Their voices overlap…
eva: More plea[se.
timur: [More please.
eva: One (bounce), two (bounce), three (bounce), four (bounce)—, one (bounce), two (bounce), three (bounce)—, and OUT!—
Eva draws out the "and," underlining the trajectory forward so that on the "OUT!" Timur's palms hit the ground at exactly the same time. She rolls him back and then push-slings him forward, saying again, "Out!" Palms striking ground in perfect sync with "out!" Timur breaks into giggles. Eva smiles broadly. She pulls him back, sling-rolls him forward, in their syncopated dance of "and…out!" Then she stops. Holds him poised above the ground, fingers slightly extended, waiting. He vocalizes, a sound mixed between complaint and statement.
Sensation of body ordered numerically. "1-2." "1-2-3- aaaaaaannnnnd (warning) Hands out!" Sudden release and roll forward of freedom, repeated in various forms, "1-hands out!-2-hands out!-3-hands out!-4-hands out! From a sensory integrative perspective, the "bounce-bounce," "bounce-bounce-bounce" establishes a sense of where one's body is in space by providing intense vestibular and proprioceptive feedback. While the quick thrust forward is a moment of suspension in space, weightless, before, "splat" palms hit ground force echoing up through the shoulder-joints before Timur is rolled back, while dragging >shhhheeessss< his palms against the rough nubs of carpet.11
She looks at him. He looks at the ground, "Mmmmgaooouah." She bend-tilts her head so that their gaze is at the same level. He turns his head to look directly at her, each word a rush of air, "un-uhoo-hree-huuor." The intent is clear enough to Eva who smiles and prompts…
eva: More please.
timur: (repeats) One-two (and returns gaze to the floor)
eva: (bending her head down further so her gaze intercepts his) Look at me. More [please
timur: [More please
eva: (immediately) Oh! Okay. Here we go. One (bounce-bounce), two (bounce-bounce), (bounce), three (bounce-bounce), and out!
Eva takes in a long drawn out expectant breath before "And out!" Timur's palms impact the ground at just the tip of the trajectory. "Good!" she exclaims. Before his head passes through the horizontal plane, his arms rise forward and up. As soon as he is back in prone, she push-thrusts him forward — underlining the movement with "Ewwwwwhoaaa." >Chunk!< his palms strike the ground. He laughs, Eva smiles. She takes a deep breath while rolling him back as he drags palms against carpet >shhheeeesh<, then "Ewwwwhoaa" forward-thrust into space >clump< palms strike ground >sheeessshhh< pull-drag back on carpet. Stillness. Balanced prone over the ball, he waits. She bounces him, waits, then says, "one." She waits. She bounces his torso slightly, waits…
timur: two (head-bob)
Eva bounces him, waits.
timur: three (head-bob)—,
Eva bounces him, waits. Until the new sequence begins, this time as if each bounce pushes out a number in a huff of air…
timur: one (head-bob), two (head-bob), three (head-bob)—
Eva does not bounce him. Without missing a beat, or a head bob, Timur turns his head towards Eva, and still bobbin his head in a sideways fashion, says…
timur: one (head-bob), two (head-bob), five (head-bob), six (head-bob), seven (head-bob)—
Eva and Timur have their heads aligned on the horizontal plane, gazing at each other. Eva bobs her head to his rhythm, then places her right forefinger on his chin lightly. He pauses his head bobbing as she says, "Look at me." And then before she has finished saying "More," he has finished it for her…
Eva brightens her voice, forewarning him with a "Hands-out, hands-out!" before she thrust-rolls him forward, underlining this movement with an exaggerated indrawn breath.
eva: Okay. Here we go. One (bounce), two (bounce)-, one (bounce), two (bounce), three (bounce), and (quickly) hands out, hands out! (indrawn breath)
timur: (grunt) Ou[t.
Eva rolls him back and then forward quickly. Timur's palms meet the floor on her "Out!" She rolls him back, each forward thrust underlined by his widening smile and pleasured squeal of "Eewhoa!" as his palms impact carpet. On the second impact they both laugh and giggle, the timing of impact and her sound perfectly in sync.
Underlined numerically by Eva, the regulated bounce-bounce-bounce, bounce-suspended pause-bounce-suspended pause-bounce-suspended pause, bounce-bounce-bounce-bounce is also an embodied pleasure of a poetic calling:
[T]he appeal of form as exemplified in rhythm [that] enjoys a special advantage in that rhythm is more closely allied with "bodily" processes. Systole and diastole, alternation of the feet in walking, inhalation and exhalation, up and down, in and out, back and forth, such are the types of distinctly motor experiences "tapped" by rhythm (Burke 1931/1968:46).
The quick weightless rush forward, Timur's simultaneous "Eewhoa!" squeal of delight of his palms impact the ground, followed by the shhhhhheeeeesh of dragging palms against nubby carpet, and repetition of the weightless rush forward-impact-Eewhoa!- shhhhhheeeeesh, weightless rush forward-impact-Eewhoa!-shhhhhheeeeesh also contours an emotional experience, what psychoanalytic theorist Stern (2004) termed the "feeling flow shapes" of proto-narrative envelopes for action. Just excerpting the bodily-sensing phrase of the quick weightless rush forward-impact speaks to what the anthropologist Desjarlais (1996:155) in his ethnography of Yolmo healing practices called the "wild images" that lead to the pleasures of rejuvenation:
[I]t is precisely the type of poetic calling whose images "divert" and "interrupt" that we encounter time and again and that, I contend, work most to rejuvenate bodies.
To sense Timur's movements along with him suggests how the sharp thrust weightless rush forward-impact of bodily force running up palms-wrists-elbows-shoulder joints are also a bodily-sensing poetic calling towards oneself. In Yolmo healing practices, the "wild images" are spoken images like a particular stone or pathway drawn from actual places of the patient's everyday life that call him or her back to everyday life. In this healing practice, the sequencing of the quick weightless rush forward-impact creates bodily-sensing images where the wildness lies in its DISruption of "the deluge of stimulation" (Prince-Hughes 2004) that overwhelms and distracts from everyday life. However, in contrast to the Prince-Hughes example of solitary rocking back and forth to cut through the deluge of stimulation, this is a wild image created in the shared context of laughter and pleasure — and therefore, also, a poetic re-calling of self in relation to Other.
Reframing a rehabilitation framework of sensory integration as a healing practice, this is a poetic calling to the materiality and bodily-sense of moving through (i.e. thrust forward as vestibular input) and being in (i.e. impact on ground and securely formed to ball as proprioceptive input) space. Timur and Eva's repetitions of a repeated, yet improvisatory sequence (>bounce-bounce-bounce<, >bounce-suspended pause-bounce-etc.) readies him to throw his hands forward to keep from hitting his head on the carpet while the weightless rush forward supports his anticipatory action (i.e. feet forward) by simultaneously heightening Timur's attention to his body self and visual attention to Eva.12 Drawing from neurophysiologist Gallese's (2004, 2006) theoretical hypothesis of the neurological basis of social cognition, these sequences prepare Timur's bodily-sensing for intentional attunement to Eva;13 that is, the rhythm and sequence of their bodily-sensing, improvisatory game mutually attunes them — via visual attending — to each other's actions and is necessary for learning, the fruition of which follows in the next section.
Eva is breathing more heavily, and sits back onto her knees, her hands still on his back and waits. Timur also waits, expectant. Two seconds pass. Timur turns his head towards Eva — his head angled to mirror hers — and says, "want (head-bob) more (head-bob) please (head-bob)." Eva nod-bobs opening her mouth wide to insert the missing…
eva: want m[ore—
Extending her leg out to brace herself, she gets ready to sling-push him forward through space…
eva: (brightly) Oh, okay! Here we go! Here (bounce) we (bounce) go (bounce). Here (bounce) we (bounce) go—, (exaggerated urgency) hands out, hands out, hands out! (thrust-forward) And go!
Both are laughing as Timur's palms impact-roll back-thrust forward three more times before Eva slowly guides him back to level, then releases her arms so that he roll-tilts over and into sitting on the other side of the ball. Timur stands, looks directly at her, and giggles.
Timur leans forward over the ball, attempts to balance — but as in the beginning — tilt-rolls off, right into Eva's lap. Eva, laughing, raises her arms in a kind of questioning gesture…
eva: Uh oh, craaash!
timur: (laughs as stands)
timur: (picks up ball, lets it bounce-drop) Uhhhchewbaaaa!
Timur is not turned towards Eva. She waits. Timur bounceS himself forward onto the ball, rolls slightly to right. Catches himself. Bounce-falls back onto his torso, tilt-rolls off, and ends up sitting down.
timur: (surprised) Ike!
Sitting, ball in front of him, he looks for Eva who rises to kneeling so her smiling face is visible, "Hi!" Timur smiles, stands, touches the ball, looks up at the lights, then bounceS self down onto his torso, tilt-rolls to his left, barely catching himself on a nearby blue bolster. As he struggles to push himself back into standing, Eva steadies the ball with a soft >slap<. Timur pushes himself up, turns to Eva, and head bobbing starts, "I—"
She gazes at him expectantly, smiling. He moves directly in front of her and says very clearly:
timur: I (body bob) want (body bob) more (body bob) please.
The unprompted clarity of Timur's "I-want-more-please" marks the poetic apex of the session. Timur's desire communicated and received for — more please — bodily-sensing syncopation of weightless rush forward-groundedness, weightless rush forward-groundedness, weightless rush forward-groundedness underlines this rhythm as a poetic process (Burke 1931/1968: 46) where the "potentiality for being interested by certain processes or arrangements," experientially results in the "feeling or such arrangements of subject-matter as produce crescendo, contrast, comparison, balance, repetition, disclosure, reversal, contraction, expansion, magnification, series, and so on."
eva: Oh, okay! You want more. Here we go. Here we go, ready? One (bounce) two (bounce)-, one (bounce), two (bounce), three (bounce), go (thrust forward)-, hands out! (palms-impact) Eiiiiiewww!
eva: (roll back-thrust forward) Hands out!
timur: (excited) Eeewwwiiiiee!
eva: Hands out! (thrust forward-palms impact) One (bounce), two (bounce)-, one (bounce), two (bounce), three (bounce), and (thrust-forward) hands out! (palms impact-roll back).
Eva changes the rhythm. Already perfectly in sync, now he no longer needs pauses or verbal warnings…
eva: One (palms-impact). Two (palms-impact).
eva: Three (palms-impact)! Four (palms-impact)!
timur: ([high squeal of excitement)
eva: [Five (palm-impact, sheeesh-back)! Six (palm-impact, sheeesh-back)! Seven (palm-impact, sheeesh-back)!
eva: [(laughs) Eight (palm-impact, sheeesh-back)! Nine (palm-impact, sheeesh-back)! Aaannd-
Eva lets him tilt-roll off to the left, as she eases-lets go gradually. Timur stands immediately, turns to face her, and, very clearly, "I — want — more — please." Eva, her head tilted up to him with an open and expectant face, stabilizes the ball with one extended arm as Timur fall-forwards onto it. Looking directly at her, each word underlined with a head bob (in case, she doesn't get it), "More. I (head-nod) want (head-nod) more (head-nod) please (head-nod)." Eva chuckles, and says, "Oh, okay. Let's do it again, let's count to ten!" Timur makes a sound of expectation…
This is embodied pleasure in which a gaze of vulnerability (Behar 1996) and respect (Lawrence-Lightfoot 1999) transform a biomedical discourse enumerating deficits into a rhythm that cannot be calculated.14
A healing of regard
Drawn from the opening moments of a singular treatment session, thick description afforded an analysis of how the emergence of embodied pleasures led to a healing of regard; that is, the movement from a place of relative invisibility or misrecognition in an institutional setting (i.e., where a biomedical discourse foregrounds impairments) to a place of visibility and recognition as an individual (Park 2008). Pleasure, as it was used here, conjoins its Latin etymology of "plaisir" or "to give pleasure" and its archaic form, "jouissance" or "the use of something affording advantage, enjoyment, delight" (O.E.D. 1989) that implies the presence of other (Ponzio 2004). To give pleasure or joy connotes the intersubjectivity of giving or receiving. The particular focus on the senses and the particular emphasis on the shared experiences of sensory-saturated activities in this local setting (i.e. touch, auditory, pressure, movement and the like) also lent themselves to the potency of simple bodily-sensing pleasures. In my working definition, then, embodied pleasures are novel associations between multi-modal, affectively laden, bodily-sensing actions and experiences that emerge with others in dramatically structured experiences in ways that afford mutual recognition of the Other. Further, dramatically structured experiences, for the purposes of this article, were contoured by the type of "feeling flow shapes" of proto-narrative envelopes (Stern 2004) or the "poetic process" itself (Burke 1931/1968). Mutual recognition of other, in turn, can be best described by redressing the language of mirror neuron research in light of the Husserlian view of intersubjectivity; that is, how one's own bodily-sensing "natural standpoint" is simultaneously a "trading places" with the Other (Duranti 2008) that can be seen in the closing moments of this session between Timur and Eva as they sit, in chairs that are back-to-back in the waiting room.
Timur looks towards the windowed doors, awaiting his mother while Eva sits facing me, narratively reasoning15 about the previous session. If, at the beginning, she lamented that Timur's lack of engagement with her was just a sign of his "wanting to do what he wants to do," she now feels that the session actually was "…pretty good—, considering how he's been? It was a pretty good session. I feel really good about it." She begins to talk of "the good" of the session in a calculus of power; that is, what she is able to get him to do that would be measured as favorable in biomedical and educational terms, "I got him to say, "More." I got him to count…." Her voice drifts off as she pauses, then changes her terms mid-sentence, continuing, "I just got the—, the interact—, a lot more interaction. He stayed with the activity." An unstated thought hovers: He stayed with me. The emphasis, though, has fallen not on his isolated actions, but on their shared interaction, their social relatedness. Then, with barely a moment between her finishing the above sentence, Timur — whether asserting presence or taking his turn in, as he did during their bodily-sensing rhythm on ball — takes up his thread of the dialogue by asserting, "Apple, apple, apple."
timur: Apple, ike?
timur: (indrawn breath-sigh)
eva: We have to wait for Mommy, though, right?
Timur reaches behind him, cup-caresses her chin with the palm of his hand…
This is a conversation of mutual recognition of the Other as an equal partner. It is not what is said, but the mutuality of unfolding gestures, despite what words are spoken. Timur's "apple, apple, apple, ike" no longer evokes a disability, but a partner in conversational flow. It can be located in Eva's recognition of, and response to Timur's intentions before he speaks and equally so in Timur's gesture, the reaching out to also include Eva, that underlines a "parity of participation" (Fraser, 2000) that is more typically absent from biomedical discourse and social science theory and research. Such mundane narratives deepen on inspection to contain rhythms, cadence, repetitions integral to the deep structures of poetic form, where flight-and-groundedness, weightlessness-and-impact of embodied pleasures close the gap between experiential words when intersubjectivity is tightly intertwined with intercorporeal mutuality.
The outcomes of such interactions in clinical contexts may never develop fully into a redistribution of resources or the aims of a status model to "de-institutionalize patterns of cultural value that impede parity of participation and to replace them with patterns that foster it" (Fraser 2000: 25). Recognition of embodied pleasures in clinical contexts may, however, hint at what needs to be of equal focus in measuring treatment outcomes. Insomuch as simple bodily-sensing pleasures and other ephemeral moments lead to a mutual healing of regard — the movement from institutionalized cultural values in biomedical contexts to recognition of the Other as full and equal partners — the embodiment of such experiences, for both the individuals with a diagnosis and their therapists, opens up the possibility of adding to the canon of what is considered legitimate, and morally necessary, outcome measures for therapeutic interventions.
I would like to thank the families and therapists in this study for their open willingness to share their experiences, and acknowledge my dissertation chair Mary Lawlor along with Cheryl Mattingly. Additionally, this article could never have been realized without the collegial dialogue and multiple forms of support from Nancy Bagatell, Lone Grön, Michael Jackson, Ann Neville-Jan, Karin Johansson, Staffan Josephsson, Teresa Kuan, Leonardo Menegola, Steven Rousso-Schindler, and the editor of this special edition, Ralph Savarese. Any mistakes should to be taken to be my own. Previous versions of this article were presented with the support of the Division of Occupational Therapy, Karolinska Institutet at the American Anthropological Conference in San Francisco of 2008 and the Feminist Conference in Stockholm of 2009.
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This article frames "healing" as the restoration of the health or soundness of social relationships as facilitated through what I call "bodily-sensing"; that is, through working through bodily-sensing to reach a literal and metaphorical common ground. This is a deliberate shift away from definitions of "healing" that focus on the cure of disease or ailment of an individual accentuated in biomedical contexts. Rather, "healing" is conceptualized as a transformation of relatedness that can be facilitated through the bodily ways of being in the world.
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The focus, then, is less on the bodily-sensing or acted narratives of or by individuals (see, for example, Baggs 2007). Rather, this narrative inquiry focuses on the fleeting shapes and images — what nears the poetic — that emerge from bodily-sensing interactions between individuals.
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I use "corrective" here in terms of Burke's (1937/1984) "comic corrective" of an audience seeing two perspectives at once to remedy a flattened, one-perspective of experience.
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Insider Sue Rubin (2005: 105) insightfully expands this notion of intra-group heterogeneity to one of self, "every autistic person is heterogeneous."
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The original proposal of this dissertation was entitled, "The gaps between," in order to re-situate the unit of analysis to those interactions that unfold between individuals who represent different local cultures defined by differences in age, education, social status, ethnic background and the like.
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Data collection consisted of over 27 hours of digitally taped treatment sessions in sensory-integration based treatment sessions, narrative interviews with parents or primary caregivers, participant observations and field notes over the course of the children's academic year. Ethics were reviewed and approved by an Institutional Review Board.
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Suggesting that sensory integration is interpreted as a kind of folk neurology (along the lines of Bruner's idea of folk psychology) is meant to underline how therapists take up and must situate the language of an intervention framework in the everyday lives of their clients. This article does not speak to biomedical or psychosocial outcomes of this intervention. Rather, the term of "folk neurology" intends to excavate the underground work that therapists and families do translating clinical language into terms that can address the particular needs and desires.
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Eva and Julia's comments underline their interpretation of Timur's bodily-sensing actions as an act of existential border crossing. Other individuals diagnosed with autism — although their physical actions may appear vastly different — have documented similar experiences of bodily entrapment (Biklen 2005). For example, Alberto Frugone (2005: 187, 193) described how he feels when he wants and knows how to roll down the car window on a hot day, but cannot: "…while I try to put together the sequences to go through the action. I mentally review all of the necessary steps, but the first one simply doesn't come out. I'm trapped." And later, "I really believed that inside me there was a personal world of my own." As a young adult, Richard Attfield (2005: 198) published in his journalistic award winning essay, "Crying Inside," a childhood experience where he could not reciprocate hand holding, "Autism takes total control of a child and one becomes a prisoner in one's own body."
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"Being grounded," although not a technical term, is exactly what they are after. Weighted vests support awareness of body in space, as the added weights is considered a form of giving increased feedback to the muscles and joints while a child is in movement.
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A moon swing is like an inverted mushroom. One grabs the "stem" that extends up, while sitting with one's legs wrapped around the "cap" at the bottom such that one must use a variety of muscles and postural responses to stay on as the swing moves. Thus, this is a swing requiring an active holding on, flexion, and full body response that could also provide more proprioceptive feedback while moving through space then, say, a platform swing.
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From a sensory integration framework, vestibular-proprioceptive activities, such as being bounced and then moving quickly forward through space while stopping the flow of motion with one's hands, can potentially integrate the sensory information of (1) moving through space (i.e. vestibular), with a (2) sense of one's body in space that is the foundation for ocular motor control, extension against gravity, and bilateral motor coordination. The stimulation to the vestibular system caused by a rush forward in space typically should be enough for an automatic protective response that can be delayed for some individuals who present with inefficient vestibular processing. Note how Eva slows down her thrust forward of Timur through space at the initiation of their mutually created game.
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According to the sensory integration framework, certain types of vestibular input heighten arousal and influence ocular-motor control. In addition, the "quickness" of the movement forward could also provide the added input to trigger the protective extension response or throwing one's hands out to protect one's head from hitting the ground.
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Gallese's argument that embodied simulation is the root of challenges facing autism shifts attention to how there may be a neurological basis that includes the related sensorimotor processing challenges of individuals diagnosed with autism. This view significantly redirects attention, as he has argued, to a more comprehensive view of a neurological basis to social cognitive challenges facing individuals with autism. However, autism as an exemplar of deficits is not grounded in the experiences of particular individuals with particular others and remains theoretical. The theory of embodied simulation, however, provides a useful starting point to re-examine the benefits of sensory and motor focused interventions that take place with others in intentional activities. The thick description of the unfolding moments of this session suggests how Eva provides the types of bodily-sensing movements, influenced by her interpretation of the sensory integration framework shaped by her experience, that support Timur's ability to attend to or attune to her intentions.
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In a recent CNN broadcast, Dr. Gupta is interviewing DJ Savarese who is diagnosed with autism, "Is autism something that should be treated?" DJ quickly reponds, "Yes, treated with respect" (Cooper 2008).
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Narrative reasoning, in contrast to the procedural reasoning guided by a biomedical framework and protocol, is a mode of clinical reasoning that deliberates what's at stake, a mode of making sense of another's actions by situating them within a larger storyline (Mattingly 1998; Mattingly and Fleming 1994).
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