A tough-love pedagogy in rehabilitation: integration of rehabilitation ideology with local cultures

Institutional contexts contribute to the low priority given to developing self-care independence in a rehabilitation ward: a qualitative study

OBJECTIVES

To examine the institutional contexts that contribute to the low priority given to the development of self-care independence in a rehabilitation ward.

DESIGN

Research was guided by ethnographic principles of Martyn Hammersley and Paul Atkinson (2007). Individual in-depth interviews were completed. Participant observation was done daily during the rehabilitation stay of the patients.

PATIENTS

Six men and three women with neurological impairments and their caregivers.

RESULTS

Patients' daily routines on a rehabilitation ward in Taiwan are described. Four prominent themes emerged from the data: (1) the attitudes of patients, caregivers, and staff facilitated extended rehabilitation stays within the first year after disability, (2) attending therapy sessions was the most important activity, (3) pragmatic considerations, such as 'faster and easier', outweighed the value of developing self-care independence, and (4) strategic organization of daily routines to keep therapy the priority was critical for daily activity.

CONCLUSION

Multiple institutional factors jeopardize the development of self-care independence in a rehabilitation ward. The factors include the primacy of biomedical-oriented rehabilitation ideology, insurance reimbursement policies, and cultural values associated with family caregiving. They legitimize the low priority given to developing self-care independence. Therapists need to include a critical review of daily routines (what and how activities are carried out inside and outside of therapy clinics) as part of therapy regime to identify opportunities and institutional constraints to the development of self-care independence.

Older adult perceptions of the physicians' role in promoting physical activity

PURPOSE

The purpose of this research was to explore the perceptions of independent living older adults regarding their physicians' role in promoting physical activity (PA).

METHODS

A qualitative inductive analysis was undertaken using focus group discussions of independent living adults over age 60. Thirty-one participants were placed into focus groups based on their current level of PA (three focus groups of physically active persons, and three focus groups of physically inactive persons). Discussions were audiotaped and transcribed verbatim. Qualitative data were open and axially coded and independently analysed by two researchers for emergent themes. Inter-rater reliability was established (κ = 0.89).

RESULTS

Themes for physically active and physically inactive groups included limited or inadequate discussions with their physician regarding PA, and the use of PA as a secondary prevention method. The physician as an extrinsic motivator of PA emerged only in the physically active group discussions. Some participants believed that their physician was uncomfortable discussing PA or that their physician was unable to provide them with sufficient PA guidelines. When PA counseling occurred, it was usually in relation to a preexisting illness.

DISCUSSION AND CONCLUSION

Although participants were looking to their physician for PA counseling, physicians were not initiating a regular PA dialogue. Possible reasons may include lack of physician knowledge or skill. Further research is needed to explore physicians' knowledge and comfort when prescribing exercise or PA for their patients.

Bodies completed: On the physical rehabilitation of lower limb amputees

This ethnographic study, based on empirical work carried out in an Israeli rehabilitation hospital, discusses the physical rehabilitation of lower limb amputees, during which body normalcy is re-constructed. Throughout the process, physiotherapists serve as social agents who teach pragmatic and discursive practices to manage the body as well as the prosthesis in the re-cultivation of body techniques. The findings, portraying four spheres of meaning, show that the mere use of prosthesis is insufficient since it stigmatizes the body as absent a limb. To avoid such stigmatization, the staff teach compensatory and discursive skills which enable incorporation of the prosthesis in body techniques while referring to it as a biological leg. Constructed as a ‘social organ’, the device is gradually transformed from an extension to an integral part of the body. Disability and its remedies, thereby concealed, facilitate able-bodied performance. Paradoxically, the prosthesis, though meant to benefit patients, induces pain and discomfort, a fact that challenges the acceptance of its conventionality as a medical aid for amputees. Yet, physical rehabilitation by means of prosthetics remains one of the many medical practices in Israel that ensure a disability-free society, together with the promotion of rights to accessibility and anti-discrimination regulation. The study contributes to the theoretical debate regarding the relationship between the biological and the social in disability studies. The findings indicate the need to encompass the cultural and the corporeal when exploring disability. The ethnography of disability, I suggest, should be viewed as a juncture of socio-cultural perceptions of the body, embedded in its own corporeal constraints.