Interoceptive Awareness Improvements After Body Awareness Training in Adults with Spinal Cord Injury

Research Objectives: The Multidimensional Assessment of Interoceptive Awareness, Version-2 (MAIA-2) is a self-report measure of interoceptive sensibility. MAIA-2 is reported in healthy adults or adults with mental disorders. Yet, interoceptive awareness is also important in adults with spinal cord injury (SCI), because recognizing subtle body cues can help them avoid pressure sores by repositioning, treat urinary tract infections quicker. However, studies identifying interoceptive awareness deficits in adults with SCI are lacking.

Moreover, we investigated whether interoceptive awareness in adults with SCI could be improved with body awareness training, such as Qigong or cognitive multisensory rehabilitation (CMR). Our aims were to (1) establish differences in MAIA-2 between community-dwelling healthy adults and adults with SCI; (2) evaluate changes in MAIA-2 from baseline to post-body awareness interventions, and to follow-up.

Design: Observational (comparison baseline data healthy vs adults with SCI) and quasi-experimental intervention design (pre-post-body awareness intervention + follow-up assessments in adults with SCI).

Setting: General community + university setting.

Participants: We recruited community-dwelling healthy adults and adults with SCI ≥1year prior to testing. We recruited 554 healthy adults (H), average age, 51±17 years, 354 women, two women with non-binary gender identification, one agender person; 8 Hispanic; and 11.19% of diverse race. We recruited 56 adults with SCI (S), average age 54±12 years, 24 women, one Hispanic; 17.86% of diverse race; 11±10 years post-SCI; 23.21% with complete SCI. Of those, 18 practiced Qigong and 16 completed CMR.

Interventions: Adults with SCI practiced Spring Forest Qigong (online video) for 12 weeks (3x/week, 45min/session) + 6-week follow-up; or in-person CMR for 8 weeks (3x/week, 45min/session) + 3-month follow-up.

Main Outcome Measures: MAIA-2 was assessed at baseline in both groups, and post-intervention + follow-up in the SCI group. We used t-tests to compare MAIA-2 in healthy vs SCI groups at baseline, and repeated-measure ANOVA in adults with SCI.

Results: At baseline, adults with SCI were better at noticing (average MAIA-2, S:3.42±1.22; H:3.12±1.01, p=0.04) and attention regulation (S:3.44±0.95; H:2.75±0.97, p< 0.0001). Healthy adults were better at not being distracted than adults with SCI (S:1.75±1.14; H: 2.38±0.99, p< 0.0001).
Compared to baseline, self-regulation (p=0.02), and trusting (p=0.004) improved after body awareness training. Not-worrying (p=0.009), self-regulation (p < 0.0001), body listening (p=0.004), and trusting (p=0.002) improved between baseline and follow-up.

Conclusions: Body awareness training such as Qigong and CMR can improve interoceptive awareness, in particular, not-worrying, self-regulation, body listening, and trusting. Validation in a larger SCI sample is needed.

Author(s) Disclosures: The authors declare having no conflict of interest.