Disability Orientation of Occupational Therapy Practitioners in Physical Rehabilitation Settings: Tension Between Medical and Social Models in Theory and Practice

Inclusion, Participation, Belonging = Surviving, Thriving, Flourishing

PURPOSE

To share my perspectives on how pediatric physical therapists support children with disabilities and their families to maximize their potential to flourish.

KEY POINTS

Best practice supports the inclusion of people with disabilities in all aspects of society. Policy statements from governmental agencies, research universities, advocacy, and non-governmental organizations all support inclusion. The concept of belonging and how pediatric physical therapists can promote belonging is less familiar to pediatric physical therapists than inclusion and participation. Essential elements necessary to bring about a sense of belonging in young children will be presented, leading to a discussion on the role of the pediatric physical therapist and key implications for the early childhood system of care.

CONCLUSIONS

Pediatric physical therapists support children with disabilities and their families to maximize the potential of every child. I propose that to do this, we must focus our interventions to promote a child's active participation in community life and build programs and relationships that promote belonging.

CLINICAL RELEVANCE

Interventions for children with disabilities will be successful by focusing on the outcomes that promote inclusion, participation, and belonging.

Developing Client Self-Advocacy in Occupational Therapy: Are We Practicing What We Preach?

Background

Developing client self-advocacy is in occupational therapy's (OT) scope of practice; however, there is limited understanding of if, or how, occupational therapists learn about self-advocacy interventions as well as implement self-advocacy into clinical practice.

Objective

This study sought to identify if and how therapists learn about self-advocacy intervention approaches and identify if and how therapists implement self-advocacy into their work with clients.

Method

A survey was distributed via email to academic and professional listservs in the United States, and data were collected using REDCap survey software. Descriptive statistics were analyzed data using REDCap/SPSS. Comparative statistics, Kruskal-Wallis's tests, Chi-square tests for independence, and Pearson's correlation tests analyzed differences across groups of respondents.

Results

Practicing and licensed occupational therapists (n = 138) across the United States completed the survey. Findings indicate a majority (59.5%) of occupational therapists not learning strategies for addressing or developing client self-advocacy. Of significance, 21.7% of participants had never been exposed to concepts of client self-advocacy in academic or clinical education. Practitioners who did address self-advocacy did so indirectly through teaching-related skills (76.6%).

Conclusion

Many clients of OT will need self-advocacy skills in order to address issues of exclusion and discrimination that prohibit full participation in society. Occupational therapists must prioritize incorporating client self-advocacy into curricula and clinical practice.

Drawing on critical disability and universal design perspectives within occupational therapy

BACKGROUND

Critical perspectives which focus on socio-political influences on occupation have gained increased attention within the occupational therapy profession. Critical disability studies (CDS) question prevailing assumptions about disability and how disabling ideologies and practices are perpetuated in society. Universal Design (UD) is a design approach that aims to operationalise issues of inclusion and justice.

AIM

To identify and discuss how the tenets of CDS and UD can contribute to occupational therapy practice and research.

METHODS AND RESULTS

Drawing on the writings of leading scholars within CDS, UD and occupational therapy, we demonstrate the intertwined barriers faced by disabled children, youth, and adults who have participated in our studies and provide ideas on how practice can be guided by the tenets of CDS and UD to promote social equity.

CONCLUSIONS

Incorporating CDS and UD perspectives in occupational therapy practice and research requires a change in mindset and ways of working. Occupational therapy knowledge needs to be expanded to scrutinise disabling hindrances hidden within social and structural spaces, and implemented in services. We recommend working with disability communities to raise awareness and combat disabling barriers at various level of society, as mandated by policy.

Value-consistent rehabilitation is associated with long-term psychological flexibility and quality of life after traumatic brain injury

Meaningful steps have been taken toward using holistic approaches in outpatient rehabilitation for traumatic brain injury (TBI) (i.e., treating the whole individual); however, research and practice continue to disproportionately focus on adapting to physical and cognitive changes. Research suggests treatment focusing on individual values may be important for psychological adjustment after TBI. The current study sought to explore individual values across multiple life domains in those with TBI as well as what values outpatient rehabilitation was helpful for, and to examine discrepancies between these factors (i.e., value-consistent rehabilitation) in relation to important long-term treatment outcomes. 215 adults with a history of TBI who had participated in outpatient rehabilitation completed online surveys assessing how consistent outpatient rehabilitation was with individual values, psychological flexibility, and quality of life. The life domains with the greatest discrepancies between individual importance and rehabilitation helpfulness were spirituality, intimate relations, and family relations. Greater value-consistent rehabilitation was associated with higher levels of psychological flexibility and quality of life beyond demographics and injury characteristics. Our findings provide further support in favour of holistic, client-centred approaches that are facilitated by neurological rehabilitation programs.

Finding Our Strengths: Recognizing Professional Bias and Interrogating Systems

No one builds their lives on remediated weaknesses. No one. Who does a deficits-based approach benefit? Those we serve, or the professional community? Do our current models of practice support flourishing? Our professional biases make it hard for us to see not only how our practice may be getting it wrong today but is also perpetuating systems that prevent us from getting it right tomorrow. A paradigm shift to a strengths-based model that interrogates the educational, research, and practice systems we work in is proposed. It is a shift that we must see, speak, and act on. Our vulnerability and willingness to rethink is our strength, which will meet the changing needs of society. This lecture will draw on literature from positive psychology, disability justice, well-being, and research that centers the voice of self-advocates.

Float to grow: nurturing the roots of socially inclusive and just practice in occupational therapy students

Abstract Models of practice and theoretical frameworks that seek to deemphasize impairment and focus on the implications of societal attitudes, norms, and culture are significant and relevant to the practice of occupational therapy. As an underpinning of client-centered practice, there is a need to highlight and embrace the intersection of impairment-deemphasizing theories and move from conceptual understanding to true application of those theoretical models in practice. This article describes the inclusion of the Salamander Workshop; an experiential learning activity designed to facilitate the development of students’ therapeutic self-awareness and initiate a starting point for incorporating social frameworks into authentic practice. Student reflections conceptualize the discussion about professional growth and development against the backdrop of disability experiences, social change, and empowerment. The article begins with an introduction to how the profession of occupational therapy and disability studies interconnect. This is followed by a description of both the occupational therapy education program where the experiential learning activity took place, and details of the workshop itself. The final two sections of the article articulate and discuss student reflections of the experiential learning exercise and conclude by framing the discussion within the larger context of occupational therapy pedagogy. The Salamander Workshop facilitated an opportunity for students to immerse themselves in the lived experience of others, while enhancing their own self-awareness, which in turn may translate to their growth and development as inclusive practitioners.

Disability Studies and Occupational Therapy: Renewing the Call for Change

Disability studies (DS) is an interdisciplinary field grounded in a minority studies philosophy that approaches disability as a socially constructed phenomenon. The first special issue of the American Journal of Occupational Therapy on DS was published in 2005. The present issue serves as a follow-up to highlight opportunities for and examples of DS integration into occupational therapy education, research, and practice. Studies in this special issue reflect a DS approach to research that prioritizes lived experiences, critical approaches, and participatory methodologies. Reported interventions focus on changing societal barriers rather than remediating individual impairments and acknowledge instrumental activities of daily living often neglected by traditional research. Studies on educational practices in occupational therapy have found persistent issues around negative attitudes toward disability and many opportunities to better infuse disabilities studies into curricula. Revisiting DS as it applies to occupational therapy has shown that many of the issues and considerations raised in 2005 remain in the field today. Recommendations across articles in this special issue highlight that advocacy and working for broader social change are essential for occupational therapy practitioners, given ongoing occupational injustices for people with disabilities. Infusing DS ideas into occupational therapy can promote greater alignment with priorities of disability communities and spur professional change to dismantle oppressive structures and ideologies.