How strength training reshapes body schema in women with severe cerebral palsy: a mixed-methods phenomenological study

PURPOSE: This mixed-methods phenomenological study examined how systematic strength training reshapes body schema in women with severe cerebral palsy (CP). MATERIALS AND METHODS: Five women with severe CP (aged 18-65) participated in a year-long, community-based strength training program using an intervention-withdrawal-intervention design. Quantitative outcomes were assessed using the Gross Motor Function Measure (GMFM). Qualitative data were collected through interviews and field notes and analyzed using Merleau-Ponty's theory of body schema to explore participants' lived experiences. RESULTS: Across four assessment points, GMFM scores increased during intervention phases, showed slight regression during withdrawal, and reached the highest levels at the final assessment, indicating cumulative benefits of sustained training. Thematic analysis revealed three interconnected transformations: (1) embodied confidence, reflecting a shift from "I cannot" to "I can"; (2) expanding spatial agency, as participants engaged more independently in domestic and daily activities; and (3) enhanced self-determination, marked by proactive continuation of physical activity and redefined bodily agency. CONCLUSIONS: Integrating quantitative improvements with phenomenological insights demonstrates that strength training not only enhances motor capacity but also reorganizes body schema. These findings support inclusive, community-based rehabilitation approaches that foster embodied capability and agency in women with severe CP.