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What is Rehabilitation?
‘Restoration of an individual to optimal physical, cognitive, psychological and social function following injury’ (p.12)
The Department of Health (2007)
‘Through rehabilitation, involving engagement in physical, psychological and social processes, people can learn how to live a life that is not dominated by their disability’ (p.155)
Ellis-Hill et al. (2008)
What is Disability?‘Physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities’
The Equality Act (2010)
‘It is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives’
World Health Organisation (2014)
Disability is based on the ideology of ‘normality’ imposed by a medical model, with the pressure to conform to ‘normality’ leading to oppression and alienation rather than the impairment itself
Oliver and Barnes (2012)
Bio-Psychosocial Model
‘Considers disability not only from a physical, but also from an individual and societal perspective, and importantly includes the environmental and personal context of the individual’ (p.12)
International Classification of Functioning, Disability and Health (Dean et al., 2012)
Power
Biomedical Model:
1.14 ‘The physiotherapist, as part of the MDT, should be involved in making the decision to refer the patient for a prosthetic limb’ (p.18)
(Broomhead et al., 2006)
Why? Justify health provision
(French and Swain, 2001)
Professional altruism (Whalley Hammell, 2006)
Juxtaposition: efficiency, specialist knowledge and improved services Vs relinquishing the idea that knowledge gives them power to ‘define problems and solutions for others’
(Finlay, 2000, p.92)
Why?...Rationing or gatekeeping of resources and services
(Allen et al., 2004, Lipsky, 2010)
Concept of ‘imposed powerlessness’ for patients, due to a lack of ‘condition’ education, mistrust in professionals following failure of treatment options and a lack of empathy of professionals who fail to recognise this state
(Livingstone et al., 2011)
Where’s the ‘Hope’ in that?
4.2.2 ‘Patients/carers should be made aware that they will experience lower levels of function than bipedal subjects’ (p.25)
(Broomhead et al., 2006)
HopeImportance of developing a new sense of self
(Ellis-Hill et al., 2008, Cotter, 2009, Livingstone et al., 2011, Kortte et al., 2012, Soundy et al., 2012, Boaz and Morgan, 2013)
Progression from defiance, a process of active resistance to a situation fortified by external hope, acceptance and hopelessness, and to the re-establishment of a sense of purpose and hope
(Soundy et al., 2012)
Maintaining normality, adjustment and coping strategies, reconstruction of selfhood and remaining engaged with a social network which reduces feelings of hopelessness
(Cotter, 2009)
Why Hope?
Several studies have documented feelings of hopelessness post amputation, especially in diabetes populations
(Livingstone et al., 2011, Murray and Forshaw, 2013, Spiess et al., 2014)
Kortte et al., 2012A cohort study of 174 patients undergoing inpatient rehabilitation for a number of conditions including amputation (n=22) by measured Hope (Hope Scale), positive affect and functional ability and participation at the start of the programme and 3 months post discharge
They found that the level of hope at the acute phase was predictive of the level of functional skill, role participation and engagement in occupational activities, including social integration at follow-up, and that, while positive affect does not contribute to participation levels, it is shown to significantly improve physical independence and mobility
Bright et al. (2011)
Association between persistent hopelessness, lower survival rates and depression
Health professionals may also be responsible for both building and destroying hope
Three interrelated attributes of hope: hope as an internal state of being, being outcome orientated and also an active process
A final thought…
Are all your hopes ‘realistic’?
So do you stop hoping?
References
Allen, D., Griffiths, L. and Lyne, P. (2004) ‘Accommodating health and social care needs: routine resource allocation in stroke
rehabilitation’. Sociology of Health and Illness, 26(4), pp. 411–432.
Boaz, A. and Morgan, M. (2013) ‘Working to Establish ‘Normality’ Post-Transplant: A Qualitative Study of Kidney Transplant
Patients’. Chronic Illness, 0(0), pp. 1-12.
Bright, F., Kayes, N., McCann, C. and McPherson, K. (2011) ‘Understanding Hope After Stroke: A Systematic Review of the
Literature Using Concept Analysis’. Topics in Stroke Rehabilitation, 18(5), pp. 490–508.
Broomhead, P., Dawes, D., Hancock, A., Unia, P., Blundell, A. and Davies V (2006) Clinical Guidelines for the Pre and Post-
Operative Physiotherapy Management of Adults with Lower Limb Amputation’. British Association of Chartered
Physiotherapists in Amputee Rehabilitation. Available at: http://bacpar.csp.org.uk/publications/clinical-guidelines-pre-post-
operative-physiotherapy-management-adults-lower-li (Accessed: 15 December 2014)
Cotter, V. (2009) ‘Hope in Early-Stage Dementia: A Concept Analysis’. Holistic Nursing Practice, 23(5), pp. 297–301.
Dean, S., Siegert, R. and Taylor, W. (2012) Interprofessional rehabilitation: A person-centred approach. Chichester: Wiley-
Blackwell
Department of Health (2007) Specialised Services National Definition Set: 7 Complex specialised rehabilitation for brain
injury and complex disability (adult). Available at:
http://webarchive.nationalarchives.gov.uk/20080814090248/dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/S
pecialisedservicesdefinition/DH_4001834 (Accessed: 15 December 2014)
Equality Act (2010) c.15. Available at: http://www.legislation.gov.uk/ukpga/2010/15/section/6 (Accessed: 15 December
2014).
Ellis-Hill, C., Payne, S., and Ward, C. (2008) ‘Using stroke to explore the Life Thread Model: An alternative approach to
understanding rehabilitation following an acquired disability’. Disability and Rehabilitation; 30(2), pp. 150–159.
Finlay, L. (2000) ‘The Challenge of Professionalism’. Critical Practice in Health and Social Care. Edited by Brechin, A., Brown,
H. and Eby, M. London: The Open University. Sage Publications. pp. 73-95.
French, S. and Swain, J. (2001) ‘The Relationship Between Disabled People and Health and Welfare Professionals’.
Handbook of Disability Studies. Edited by Albrecht, G., Seelman, K. and Bury, M. California: Sage Publications. pp. 734-753.
Kortte, K., Stevenson, J., Hosey, M., Castillo, R. and Wegener, S. (2012) ‘Hope Predicts Positive Functional Role Outcomes in
Acute Rehabilitation Populations’. Rehabilitation Psychology, 57(3), pp. 248–255.
Lipsky, M. (2010) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. (2nd edn) New York: Russell Sage
Foundation
Livingstone, W., Van De Mortel, T. and Taylor, B. (2011) ‘A path of perpetual resilience: Exploring the experience of a
diabetes-related amputation through grounded theory’. Contemporary Nurse, 39(1), pp. 20–30.
Murray, C. and Forshaw, M. (2013) ‘The Experience of Amputation and Prosthesis Use for Adults: A Metasynthesis’.
Disability & Rehabilitation, 35(14), pp. 1133–1142.
Nieuwenhuijsen, E. (2009) ‘An insider’s view on person-centred rehabilitation: A case study’, Disability and Rehabilitation;
31(18), pp. 1529–1539
Oliver, M., and Barnes, C. (2012) The New Politics of Disablement. Basingstoke: Palgrave Macmillan.
Soundy, A., Benson, J., Dawes, H., Smith, B., Collett, J. and Meaney, A. (2012) ‘Understanding Hope in Multiple Sclerosis’.
Physiotherapy, 98 (2012), pp. 344-350.
Spiess, K., McLemore, A., Zinyemba, P., Ortiz, N. and Meyr, A. (2014) ‘Application of the Five Stages of Grief to Diabetic Limb
Loss and Amputation’. The Journal of Foot and Ankle Surgery, 53(2014), pp. 735-739.
Whalley Hammell, K. (2006) Perspectives on Disability and Rehabilitation. Contesting Assumptions; Challenging practice.
Philadelphia: Churchill Livingstone Elsevier.
World Health Organization (2014) Health Topics: Disabilities. Available at: http://www.who.int/topics/disabilities/en/
(Accessed: 15 December 2014)
Thank You
