University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Embodied Knowledge

Do you remember learning to brush your teeth? Maybe you watched your parents brushing their teeth; maybe they held the brush in your hand and guided you through the motions. Pretty soon, you were on your own, and probably didn't think very much about the actions of brushing. It felt natural to brush your teeth daily, maybe more than once during the day. You may even have added your own special way of doing it, like maybe starting with your back teeth, or brushing your tongue for a few strokes, too. Perhaps after your spinal cord injury, you needed to learn a new way of brushing your teeth, whether it was doing it yourself or finding a way to work with a care attendant to get your teeth cleaned effectively. Whatever your method of brushing your teeth, it's very likely this process became a habit, internalized or what we might call embodied, that is, it became automatic, being done daily without thinking and in a style that is unique to you. When an action or idea becomes embodied, it feels natural to you, an easy habit to continue because you believe in it. This applies to practices to prevent pressure ulcers (which means the same thing as "pressure sores" or "bedsores"): you might hear about the dangers of pressure ulcers or see pictures of infected ulcers, but until the knowledge about them becomes embodied - until it becomes truly personal or real to you - it's just words or pictures that have little meaning. And once the participants in our study took pressure ulcers seriously, then knowledge about pressure ulcer prevention became embodied, and prevention became a habit they were motivated to follow.

At least two-thirds of the participants in our study changed their minds about pressure ulcers after they actually went through getting one. They may have been taught about preventing pressure ulcers before actually developing one, but didn't feel it was urgent to do anything about them. This shouldn't be very surprising; it's simply human nature not to take something seriously until a personal experience makes it "real" to them. For example, Alley, who participated in our study, enjoyed working long hours in her brother's bed-and-breakfast inn and didn't think much of the "blister" that was forming on her bottom. After that ulcer became infected and led to coming down with pneumonia - which almost killed her - Alley then became very careful about pressure ulcer prevention, and didn't get another pressure ulcer for another 30 years! Helen, another study participant, went through years of alcohol and drug abuse, during which she got a number of pressure ulcers, but her failing health and the support of her boyfriend finally convinced her to get clean and sober, and, once she did, to get real about pressure ulcer prevention. Judy used some pressure ulcer prevention techniques, but when she had demands to work overtime at her job, she preferred to keep working instead of watching out for her health. Once she had to go through surgery and a month recuperating in the hospital to deal with the pressure ulcer that formed from spending such long hours up in her wheelchair while at the office, Judy decided that whenever she saw redness in the future, she would immediately stay in bed until the redness cleared up; she has stayed free of pressure ulcers in the years since that incident. Robert reported that he learned more about pressure ulcer prevention from his own experience than from the lessons he had while in the rehabilitation facility. After he recovered from surgery for a pressure ulcer, Frank began habits of twice-daily skin checks, eating a high-protein diet and using the alarm in his watch to remind him to do pressure reliefs every 15 minutes, because now he takes pressure ulcer prevention much more seriously.

While part of "embodied knowledge" is letting something "soak in" and become a natural part of your beliefs or habits, another aspect is shaping those habits to fit your unique life. For example, Odel explained that the staff at the hospital taught him to do pressure reliefs every 15 minutes, but he tested his own tolerance and found that about once an hour was more appropriate for him. Another study participant, Mitch, commented that "if you do everything that you were taught to do in the hospital, you wouldn't have time to do anything else.... You try to fit certain things into the way you are livin.'" Chris also stated that he spends more time up in his wheelchair than is recommended in order to remain active and involved in life, but he and his care attendant engage in a number of techniques, including careful skin checks, to help make sure this doesn't create pressure ulcers. Alma has found that what works best for her is to get out of her chair and lie down for a half-hour to 45 minutes every 4 to 5 hours. By embodying the knowledge about pressure ulcers, these study participants and others were able to pick the prevention techniques that worked for them. They didn't worry about trying so many different practices that they might have felt overwhelmed; they just stuck with the techniques that had been personally successful.

There is one other sense in which knowledge can become "embodied." This is the sense in which what you have learned starts to feel like an instinct or internal sense. A few of our participants talked about "listening to their body". To understand what is meant by "listening to your body," think about how you decide when to eat lunch: some people eat because the clock says noon (that is, they use external or outward signals), but some people eat lunch when they feel hungry (that is, they listen to their bodies). Although they may not have traditional sensations since their spinal cord injuries, study participants including Helen, Ken and Odel all reported that they clearly felt when it was time to move to relieve pressure. They didn't just think about pressure ulcer prevention, or do it as a habit; they did it because their bodies sent them a message to do it.

Odel summed up the three forms of "embodied knowledge" - allowing something to become a natural part of your beliefs, finding your own way to make it part of your daily life, and having a sense or instinct about it - when he said, "Sometime you can't go by the book. You've got to listen to your own body. So, I mean, it is good what they are talking about, but then, gradually, like I said, you are going to write your own book and go by your own rules...because it is not in the book on how the person is feeling and what they can tolerate." The value of letting knowledge about pressure ulcers become embodied is that it will then be truly important to you to prevent them, it will be easy to find which techniques work best for you as part of your regular daily activities, and it will be natural for you to "feel" or sense when to do them.

Perhaps the best way to learn more about how embodied knowledge works is to read the personal stories of people with spinal cord injuries, and see how they have created daily routines for themselves, or how they handle the challenges life presents. On the website for the Palo Alto Weekly newspaper, in My life as a quadriplegic, Harry Lewenstein tells the detailed story of how he got a spinal cord injury at the age of 70 while bicycling on vacation in Portugal, and describes the routines he has devised to take care of himself and have access to his community.