Dance and Somatic-Informed Movement in an Acute Inpatient Stroke Unit
Abstract
1. Introduction
2. Materials and Methods
2.1. Qualitative Research
2.2. Data Collection and Analysis
2.3. Intervention Procedures
3. Results
3.1. Mr. K
Session 1—14 January (50 min) | ||
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Immediate and embodied experiences | Self-critical theoretical reflection | Themes and categories |
After a brief introduction, I tell Mr. K [who is] lying in bed that what we are going to do together “is to put some movement back into his body” and that I am going to put my hand on his head to roll it very gently from side to side, which I did, humming a gentle rhythm. I notice a little movement to the left and a lot of resistance to the right. | I stand to his left and lower the bedpost to make sure that he can see and hear me, and that he understands my instructions. I pace the action because I know the cognitive benefits of rhythm for the brain [35]. | (K) Somatics, stroke (H) Inductive and supportive touch, passive and assisted movement, rhythm, gentleness, verbal information (F) Range of motion |
I ask him to do the movement with me. At first, he moves fast, puts in a lot of effort, and his head barely rolls to the right. I tell him that we will repeat more slowly and gently to feel the movement better and use only the minimum muscular effort required. Gradually, he slows down, and my hand can feel that he is not overly contracting his muscles. | Both the sound and cadence of my voice, and the touch of my hand on his forehead, encourage gentleness and slowness. The FM is based, among other things, on Weber–Fechner’s law [36], which refers to the minimum intensity of a stimulus required for one to detect its presence. | (K) Neuroscience, somatics (H) Supportive touch, active movement, repetition, slowness, gentleness, rhythm, effortless, verbal information, and instruction (F) Tension release |
I invite Helen, his partner, to stand on the right side of the bed, and ask Mr. K to slowly and rhythmically pronounce her first name with me and her when he tries to turn his head to the right, and my first name when he turns his head to the left (I support the rolling movement with my hand on his forehead). Mr. K cannot speak, but I invite him to say our names in his head as his head moves from side to side. His eyes are blurry when he turns to the right. I then ask Helen to position herself at an angle that allows good eye contact. We continue in this way for several repetitions. Gradually, he succeeds in establishing clear eye contact with his head rolling more easily to the plegic side. He relaxes. He smiles at us. | On the spur of the moment, I asked Mr. K’s partner to participate because every bodily movement is motivated by desire. Mr. K became motivated by a meaningful visual and sound stimulus. I perceived this proposal as helping, at both an affective and a motor level. I chose this movement to start with because “eye movements affect muscular tone of the neck and the rest of the body” [36] (p. 200). It is often used in the FM, which relies on motor development principles. | (K) Neuroscience, somatics (H) Supportive touch, active movement, repetition, gaze, rhythm (R) Collaboration (F) Tension release, body part coordination, motivation |
Session 6—21 January (45 min) | ||
We go into the physiotherapy room. Through the window, we can see a splendid sunset. I mention, “It’s so beautiful; let’s take two minutes to appreciate the many shades of pink”. His partner joins us, puts a hand on his shoulder. We all feel moved as we admire the sunset in silence. | One of the benefits of dance as an aesthetic activity in health is that it helps to regulate emotions [37]. In the FM, taking time to create an atmosphere conducive to perceptual learning is foremost. Doidge [24] explains that with the FM, the injured brain, which has been in the sympathetic fight-or-flight response mode, enters into the calm and healing state of the parasympathetic system. Then, the people can pay attention and differentiate movements to learn the best option for making them. | (K) Dance, neuroscience, somatics (H) Aesthetic environment (F) Calmness |
Next, I ask him, in a sitting position, to turn his head to the left and then back, noticing which other parts of his body are moving, even minimally. Then, I ask him to move his left shoulder backwards at the same time as he turns his head to the left. I first demonstrate this movement alone, then do it with him, and finally let him do it by himself, with and without my hand on his scapula to help him feel the movement. The sequence continues with the addition of a rotation of the torso to the left and finally the inclusion of the pelvis. | Starting to move on the functional side of the body is typical of the FM so that the primary motor cortex, responsible for movements, has a functional experience, a brain map of the movement that might be recruited when moving or visualizing the movement on the plegic side [24]. Also typical of the FM is the progression that consists of gradually including all the body parts that participate in turning. I thought that increasing the range of motion of the entire body toward the left would help overcome lack of movement in the spastic side. However, it is atypical for the FM to demonstrate the movement. I was progressively shifting from a somatic approach to a dance pedagogy. | (K) Neuroscience, somatics (H) Reflective touch, active and progressive movement, verbal instruction, visual demonstration (F) Range of motion, body part coordination |
At first, I guide these movements verbally and gently with my hands, so that Mr. K can become aware of the movement of the vertebrae in the areas I mention. I ask if he can feel the movement under my fingers. Without hesitation, he answers “yes”. After a few repetitions, I ask him to add a circle (circumduction) with his left arm, keeping eye contact with his hand as his whole body turns to the left. Using my voice, I set a rhythm that I feel matches his capacities. When my hands feel the transmission of movement from one region to another, or my eyes note the fluidity of the movement, I ask, “Do you feel the movement here in this region?” He answers “yes” with a smile as his speech improves from day to day. | For Moshe Feldenkrais, sensory motor learning requires self-perception within the course of action, including sensitivity to the differentiated segments one at a time before integrating them into a whole. My precise but gentle touch was providing him with feedback to help develop his awareness. My action then showed an appropriate distribution of movement throughout his whole body without too much emphasis at one place, which is one of the aims of the FM [36]. | (K) Somatics (H) Inductive and reflective touch, active and progressive movement, repetition, rhythm, verbal instruction and questioning, visual demonstration (F) Range of motion, quality of movement |
We then repeat each step on his plegic side. When he is unable to execute the movement as such in space, I invite him to visualize it slowly. At one point, when he is trying to visualize his right arm circling to the right while actually doing the head, torso, and pelvis movements, he starts laughing and says, “Oops, I was only doing my head”. I start to laugh also, saying, “You’re quite frank, thank you”. | Visualizing a movement is used in both the FM and dance since it engages the same motor and sensory engrams that are involved in actually performing the movement [38]. What strikes me is how Mr. K trusts my approach to overcome movement restrictions by not forcing or pushing, which complements the work of the physiotherapists. I admire him for his open-mindedness. | (K) Somatics, dance, neuroscience (H) Visualization, effortless (R) Open-mindedness, trust |
I then put on some Western music (his partner had told me he likes this type of music) and ask him to perform the movements (head, torso, pelvis, and arms) alternately on the left and right sides, visualizing them on the plegic arm. After a few repetitions, I notice that he is getting into the swing of things, as he is kicking his feet. This prompts me to say, “Now you improvise. You do what you want to move: your head, shoulder, torso, pelvis, arms, from one side to the other”. He begins to move to the rhythm of the music, his foot beating time. When he moves his left arm, the impulse is transmitted to his right side, which doesn’t move as such, but somehow comes alive in resonance with the left side. His partner, the two intern physiotherapists also present, and I are amazed and delighted. We end the session with this amazing moment, as if the movement of the left side combined with the visualization of the plegic side brought life to the plegic side in a way that was palpable for everyone present. Afterwards, one of the physiotherapists says to me, “Music changes everything. It’s what makes it work”. | Bearing in mind the hope that this project will continue, I wish it had been the two full-time physiotherapists working at the hospital who had witnessed this scene rather than two physiotherapist interns. All the same, during the weekly meeting with the whole treatment team a few days later, the interns mentioned the great cooperation and complementarity we had. The music certainly helped, but it was also the combination of the atmosphere created at the beginning of the class, the progression of the movements chosen, the somatic pedagogy, the quality of the human relationship and the invitation to dance freely without judgement that generated this result. Jarrett [39], reporting a SIMP in a stroke rehabilitation context, mentions “the significance of being able to feel free when confined to a hospital bound by rules and regulations” (p. 21). | (K) Somatics (H) Aesthetic environment, rhythm, visualization, active and progressive movement, repetition, verbal instruction (R) Open-mindedness, collaboration (F) Body part coordination, quality of movement, motivation |
On our way back to his bedroom, I ask him what work he did before retirement. Helen tells me that he had been a boxer and had a boxing school. I exclaim, “That explains everything; you already know how all the joints move together”. He laughed as if he’d played a trick on me. I left, telling him that his boxing was helping his rehabilitation. | Sööt and Viskus [40] mentioned that a “holistic dance teacher approaches teaching through human aspects by taking the distinctive features of students as human beings into account, and by introducing their personal human plan” (p. 292). For Jarrett [39], the results of SIMP are clear: “Dance raised the energy levels of people who participated, contributed to optimism and hope after the trauma of a stroke, and helped people remember who they were” (p. 18). | (K) Dance, somatics, stroke (H) Verbal questioning (R) Trust |
Session 11—29 January (40 min) | ||
We repeat the progressive rotation of the spine to the music. For each movement stage, I ask him to move slowly to feel what the shoulder, then the torso, and finally the pelvis are doing. I prompt him to listen to the connections within his body. Then, I ask him to take the time to visualize the plegic side stage by stage. Coming back to his functional side, we slowly move to dancing, with me counting the movement first on a slow rhythm of four beats, then on two beats as he gradually becomes able to move faster with ease. He really enjoys accelerating gradually. I had never seen Mr. K moving like that with his pelvis participating. | I could have used this opportunity to add the movement of the foot to the action of turning. There is so much we could do. I prioritize as we go along based on my observations of Mr. K’s physical and emotional state. Surprisingly, I feel comfortable making quick choices supported by my knowledge, although not always clearly formulated in my mind, because I see Mr. K improving. | (K) Dance (H) Visualization, rhythm, aesthetic environment, slowness, active and progressive movement (F) Body part coordination, quality of movement, motivation |
Session 12—30 January (60 min) | ||
The vascular neurologist tells me that Mr. K is leaving the hospital in three days. I then take a moment to speak with Helen in the hall, while Mr. K is having dinner. She finds our meetings extraordinary. She can see the progress and says her partner likes it, because he’s smiling. When we return to the room, he is upset to learn that he is going to a rehabilitation hospital. He says he has not done anything good since he arrived. This is very surprising for Helen and me. I tell him that the other hospital is better suited to his rehabilitation. Suddenly, he asks Helen insistently for a piece of paper and asks me to write down the activities. He wants homework. I write and demonstrate. He asks me if I will come to the rehabilitation hospital. I say it is impossible because I will be away on a trip, but I will have time to visit him there once before I leave. | Visiting Mr. K in the rehabilitation hospital was not part of the research as initially planned. Being aware of professional boundaries in health settings, I nevertheless decided to do so because it felt right according to my ethical values. Like Korthagen [41], I question the rationale for segmenting our life domains: “[…] to what end the teacher wants to do his or her work, or even what he or she sees as his or her personal calling” (p. 291). My professional life is, in a way, an outgrowth of my personal life. Values such as relationships are central in both. Mr. K and I had developed mutual respect; I cared for him, and I thought that it could increase his motivation to keep going with his rehabilitation. In the same vein, as argued by Elmslie et al. [42], “Dance harnesses humanity” (p. 1). | (K) Dance (R) Dialogue, trust (F) Motivation |
3.2. Mrs. T
Session 1—22 January (45 min) | ||
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Immediate and embodied experiences | Self-critical theoretical reflection | Themes and categories |
She has just been put back to bed, having been placed in a wheelchair earlier today for her first physiotherapy session. Upon my arrival, her breathing seems difficult, and she has a lot of spasms in her left leg. Her toes are clenched, and her left foot is slightly dorsiflexed. Her left heel tends towards her right ankle (adduction), and her knee is slightly bent. I make eye contact with Mrs. T as I introduce myself, but she then closes her eyes for what turns out to be most of the session. | I wonder if it’s relevant to intervene in this context. Insisting appears to contradict the somatic principle of learning through raising awareness, but on the other hand, in a stroke context, stimulating patients is crucial for their recovery. Our presence at the hospital aligns precisely with the quest for an enriched and stimulating environment for patients [43]. I am wondering how to navigate with my somatic posture in this medically oriented environment. | (K) Neuroscience, somatics, stroke |
I start with background music to stimulate the patient. After attempting to wake Mrs. T by gently squeezing one of her hands, which proves ineffective, I stop and observe her attentively. I notice impulsive movements in her left foot and leg, which sometimes result in sudden small flexions at the knee with external rotation. It seems to me that her feet offer an entry point for a ‘conversation’ in motion, to ‘tell’ her left leg to calm down. | FI is a ‘conversation’ [34] between the practitioner and the ‘student’ through various qualities of touch (e.g., reflective, inductive, directive). For Tufnell [7], it is a “communication through movement and the body” (p. 105). This type of non-verbal conversation might provide Mrs. T with an opportunity for learning, even though it should normally be based on a conscious exploration of movement. | (K) Somatics, dance (H) Aesthetic environment |
After rubbing my hands together to warm them up and placing them on her feet, I apply gentle pressure to different areas under her feet, one foot at a time, to see if there is a response in the ankle, knee, and hip. The heel-ischium connection is observable on the left side but not on the right. I focus on the position of the left foot and rotate the leg slightly externally (so as to match the knee’s orientation), then I alternate moving the leg inward and outward. After numerous repetitions, slowly her ankle relaxes and her heel aligns more with her leg, although her toes remain clenched. Her breathing slows down. | Initially disconcerted by Mrs. T’s ‘non-participation,’ I now have the feeling that I have somehow initiated a conversation through movement, guided by the quality of her breathing movement. That said, I’ll check with the vascular neurologist whether it’s medically inadvisable to intervene in such a context, even though I remember hearing her say during a team meeting that patients sometimes need to be woken up so that they don’t sleep all the time. Excessive daytime sleepiness in stroke patients can have neurocognitive, functional, and health impacts [44]. | (K) Stroke, somatics (H) Inductive touch, passive movement, slowness, gentleness (R) Collaboration (F) Tension release, calmness, body part coordination |
Session 2—23 January (15 min) | ||
Mrs. T is breathing better, but she is still drowsy, and I am told by a nurse that no therapist has been able to work with her today. My attempts at verbal interaction remain difficult, but I go ahead with the vascular neurologist’s approval. She still moves her left foot and leg involuntarily. I start with movements inspired by the ones she is already making. I go a little further today by gently turning her foot outward to initiate a bending movement at the knee and then the hip. I then press under her foot to bring about knee flexion, with the heel sliding towards the pelvis on the bed. Despite her drowsy state, she seems to participate in the knee-bending movement, allowing me to slide her foot close to her pelvis and then to come back and extend her leg, offering less resistance than yesterday. She occasionally relaxes her foot, and her toes gradually become less clenched under my fingers. I then guide the same type of movements on the right (plegic) side, although this leg responds like a puppet. | My patience is beginning to bear fruit. A form of trust has been established through the slow and repetitive movements. It is reasonable to assume that Mrs. T is in an altered state of consciousness rather than unconsciousness [45,46]. It encourages me to keep going with these typical Feldenkrais movements of the leg since learning seems plausible. Starting tomorrow, I am also going to talk to her a bit during the sessions, as she may be partially conscious despite her drowsiness. Because her left leg sometimes responds in spasms, at times I doubt the relevance of what I am patiently trying to do. I also wonder if too much stimulation can exacerbate the patient’s fatigue [47]. I will check with the vascular neurologist and decide to shorten the session for today. | (K) Neuroscience, somatics, stroke (H) Inductive and supportive touch, passive and progressive movement, slowness, repetition (R) Trust, collaboration (F) Tension release, voluntary movement control |
Session 5—28 January (45 min) | ||
Upon my arrival, two physiotherapists are mobilizing Mrs. T to sit on the edge of her bed, with her arms resting on a side table in front of her. I observe them working. The patient’s tendency to flex her left leg in external rotation in bed is also visible in a seated position, even if with less tonus. She constantly brings her left leg to the right to cross it over her lower right leg, with her left knee slightly turned to the left, causing her to tilt to her left side. One of the physiotherapists is firmly attempting to ‘place’ the patient’s foot on the ground in a parallel position. The foot just does not stay there. | It seems to me to be a habit, no matter whether she is lying or sitting. Even though the neurological accident could explain in part what I am observing, I assume that there may have been such a propensity in the body organization before the stroke, an assumption based on my readings of Feldenkrais [48] and Hanna [49]. | (K) Stroke, somatics (R) Collaboration |
After ten minutes of unsuccessful work with the drowsy patient, the physiotherapists reposition her in bed before I take over. Having noticed that she reproduced the same body organization in the sitting position as in the lying position, I repeat what I have done in the past sessions: slow, gentle rotations of the left leg, both externally and internally, gradually increasing the range of motion in external rotation to further flex the knee. Today, the patient offers less resistance, and the movement is more accessible. I take this opportunity to gently move her left leg from a flex hip and external hip position (‘frog position’) to position her left foot flat on the bed, with her knee pointing towards the ceiling. It works! | This seems positive since the physiotherapists were unable to establish contact between her foot and the ground. Every time they released the pressure applied to her foot, it would lift off the ground and float in the air. The FM approach helped me to circumvent the difficulty encountered by the physiotherapists. My observation of her movements—both when she was sitting and lying—enabled me to adjust my intervention on the spur of the moment. | (K) Somatics (H) Inductive touch, passive and progressive movement, slowness, gentleness (F) Tension release, body part coordination, range of motion |
On three occasions during this session, I perceive voluntary controlled movements by Mrs. T with her spastic left leg: (1) a knee flexion after pressing on her left heel, (2) a knee adduction while guiding it towards the ceiling, and (3) a leg extension midway in the frog position, as I am subtly guiding her leg to extend fully. | She is less passive. She participates at times and is more available in the movements, as I can move her left leg without her contracting her muscles. For Rywerant [34], in FI, a proposed movement “should never startle the pupil but rather emerge easily, out of secure patterns established earlier in life or even reflex reactions of the neuro-motor system. The pupil is expected to allow the movements, if possible, without helping or resisting” (p. 27). The use of somatic pedagogy seems to have defused her parasitic inefficient ‘frog’ leg organization lying down, which did not seem to be the case with the directive and corrective approach of the physiotherapists while she was sitting. | (K) Somatics (H) Inductive and supportive touch, passive and assisted movement (F) Voluntary movement control over involuntary movement, tension release, quality of movement |
Session 6—29 January (65 min) | ||
Mrs. T is still in bed, drowsy. I pick up where I left off yesterday, but proceed even more slowly. The repeated movements contribute to the relaxation of her left leg and its alignment with the hip. Instead of constantly folding her leg into a ‘frog’ position in response to any external stimuli (as observed by the nursing staff and clinicians), she manages to keep it calmer and even extends it herself after folding it. As I speak with the vascular neurologist who came to visit her, Mrs. T opens and fully extends her leg on her own, parallel to the other leg, several times. We are witnessing a first, which moves us. Having noticed that I was using background music with the patient, the vascular neurologist confirmed that Mrs. T’s hemorrhagic stroke had not affected the ‘musical’ area of her brain. | Up until now, I have been using music more as background, but from now on, I will use it to rhythmically guide movement sequences. Music is not used as such in FM, but combining movement with music will enable me to gradually move towards a dance-like approach. Speaking of approach, it turns out that patience, continuity, and gradual variations are pedagogical keys to unlocking Mrs. T’s learning potential despite her drowsiness. | (K) Somatics (H) Inductive and supportive touch, passive and active movement, slowness, repetition, aesthetic environment, rhythm (R) Dialogue, collaboration (F) Calmness, body part connection |
Staff members have probably noticed changes since they are more curious today, asking questions about my work and what is going on in our sessions. They tell me that music is soothing in the neurology unit. | I realize that my way of talking and guiding the patient’s movements while she appears to be asleep may seem odd to them, as may my use of music. My sessions are quite different from the usual therapy sessions. Collinson [5] reports that SIMP is generally misunderstood by the medical team. | (K) Neuroscience, somatics (H) Aesthetic environment (R) Curiosity, dialogue |
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ATM | Awareness through movement |
FI | Functional integration |
FM | Feldenkrais method |
SIMP | Somatic-informed movement practice |
Appendix A
Codes | Mr. K | Mrs. T | Categories | Themes | Research Key Words |
---|---|---|---|---|---|
Fostering the letting go of unnecessary muscle contractions | X | X | Somatic principles and modalities | Somatics | Knowledge base used for intervention |
Fostering ease vs. effort | X | X | |||
Fostering gentle movement | X | X | |||
Fostering slow movement | X | X | |||
Fostering sensory learning | X | X | |||
Initiating movement with the functional side | X | X | |||
Sensory communication through movement/the body | X | X | |||
Combining music and movement | X | Musicality | Dance | ||
Fostering one’s own movement | X | Expressivity | |||
Fostering emotional expression | X | ||||
Inducing rhythm | X | Cognition/Brain | Neuroscience and Stroke | ||
Directing eye movement | X | Muscular tone | |||
Stimulating senses | X | X | Neuroplasticity | ||
Engaging imagination | X | ||||
Enriched environment | |||||
Fostering a calm state | X | X | Parasympathetic system | ||
Inducing movement by touch | X | X | Inductive touch | Tactile inputs | Helping the intervention |
Leading a movement by touch | X | X | |||
Directing attention to a body part through touch | X | X | Reflective touch | ||
Reflecting on one’s movement by touch | X | ||||
Assisting movement execution through touch | X | X | Supportive touch | ||
Describing what we do | X | Information | Verbal inputs | ||
Explaining why we do something | X | ||||
Instructing what/how to do | X | Instructions | |||
Asking questions about patients’ sensation/perception | X | Questions | |||
Showing what/how to do | X | Visual demonstration | Visual inputs | ||
Patients (Relative) | Team | ||||
Welcoming new perspectives | X (X), X | X | Open- mindedness | Interactions with stakeholders | Relationships |
Welcoming complementarity | X (X) | X | |||
Asking questions, showing interest | X (X) | X | Curiosity | ||
Willingness to learn | X, X | X | |||
Confidence in the practitioner | X (X), X | X | Trust | ||
Mutual respect | X (X) | X |
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1. Help/Hinder | Describe a moment when what I said/did gave me the impression of helping/hindering the patient’s condition. Describe exactly what I did/said in detail, so that someone can visualize the gestures and hear the words. |
2. Why | In my perception, what aspects of this intervention help/hinder? Why? |
3. Logic of action | What was the logic of action? The rationale or intuition that led me to do what I did and to perceive it as helping/hindering? |
4. Context | What is my perception of my integration into the interdisciplinary team? What have I done/said to contribute to my integration? |
5. Wish list | What could improve the intervention context? How should the next session unfold/be improved? |
Categories | Themes | Research Key Words |
---|---|---|
Musicality Expressivity | Dance | Knowledge (K) |
Somatic principles Somatic modalities | Somatics | |
Cognition/brain Muscular tone Neuroplasticity Parasympathetic system | Neuroscience and Stroke | |
Information | Verbal inputs | Help (H) |
Instructions | ||
Questions | ||
Inductive touch | Tactile inputs | |
Reflective touch | ||
Supportive touch | ||
Demonstration | Visual inputs | |
Eye contact | ||
Visualization | Imaginary inputs | |
Active movement | Movements | |
Assisted movement Passive movement | ||
Effortless movement Gentle movement Progressive movement Repetitive movement Rhythmic movement Slow movement | Movement qualities | |
Music Qualitative/affective experience | Aesthetic environment | |
Open-mindedness Curiosity Trust Dialogue Collaboration | Interactions with stakeholders | Relationships (R) |
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© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Beaudry, L.; Odier, C.; Fortin, S. Dance and Somatic-Informed Movement in an Acute Inpatient Stroke Unit. Medicina 2025, 61, 966. https://doi.org/10.3390/medicina61060966
Beaudry L, Odier C, Fortin S. Dance and Somatic-Informed Movement in an Acute Inpatient Stroke Unit. Medicina. 2025; 61(6):966. https://doi.org/10.3390/medicina61060966
Chicago/Turabian StyleBeaudry, Lucie, Céline Odier, and Sylvie Fortin. 2025. "Dance and Somatic-Informed Movement in an Acute Inpatient Stroke Unit" Medicina 61, no. 6: 966. https://doi.org/10.3390/medicina61060966
APA StyleBeaudry, L., Odier, C., & Fortin, S. (2025). Dance and Somatic-Informed Movement in an Acute Inpatient Stroke Unit. Medicina, 61(6), 966. https://doi.org/10.3390/medicina61060966