insightt 3 Flashcards
In the uk, every … hours is someone paralysed by spinal cord injury
8
There are …. amputations a year in the UK
5000-6000
Over …. people in the world are disabled, and of these, ….encounter significant difficulties in their daily lives (…)
one billion…110-190 million …..WHO report
Who said “How this (disability definition) is explained and understood is vital for individuals working with disabled people in any context
(Smith & Bundon, 2015)
Two key models:
Medical model
Social model
What is the medical model (reference)
The inability to perform a task considered normal for any person due to impairment (Thomas, 2007).
According to the medical model, disability is described as…
Disability is described as “caused” by parts of the body that do not work “properly” (Smith & Perrier, 2014).
Understanding of disability shaped as a biological product.
What is the social model
Disability as a consequence and problem of society.
Views disabled people as socially oppressed – improvements gained from removing social barriers.
Influenced anti-discrimination legislation – Disability Discrimination Acts
What is the social model
Disability as a consequence and problem of society.
Views disabled people as socially oppressed – improvements gained from removing social barriers.
Influenced anti-discrimination legislation – Disability Discrimination Acts
Issue with tubes for disabled individuals
Either bot accessible at all or roughly 1 in 6 stations
Relates to social model due to people being disabled by society and infrastrutcure
Clean separation between 2 models
Medical model:
The individual is the problem
Social model:
Society is the barriers
People with
a Disability vs Disabled
People
People with a Disability:
Medical model - Promotes the idea that people are disabled by their medical condition
Disabled People:
Social model - People are disabled by the barriers to their full participation in society
What is a Supercrip?
Someone who overcomes their disability in ways that are seen by the public as inspiring
Issue with the term supercrip
Presents disability as a challenge that can be overcome with perseverance
Purportedly positive representation becomes in fact quite problematic in that (most importantly for me) it continues to circulate the discourse of negativity surrounding disability; precisely through the language it uses to appear “positive
Societical expectations - the superscrip
Reinforces low societal expectations for people with disabilities and sets the standard that all people with disabilities should be able to attain similar feat as that of the disabled hero; failing to acknowledge the diverse ways that disability is experienced
Supercrip narratives may have a negative impact on the physical and social development of disabled individuals by reinforcing what could be termed “achievement syndrome” - the impaired are successfulin spiteof their disability
This type of representation may be seen by the able bodied majority as enlightened.
Using “Inspiration” in rehab
(Wadey and Day, 2018)
Inspiration came from:
Looking down to others who were less able yet still living an active life
Witnessing others who are positive, authentic and represent another way of life
However, some found this difficult - comparing themselves who is struggling to a superhero
Inspirational figure issue
Burnout from having to tell inspiring story, always having to smile, put on a positive persona, always having to continually listen toothed peoples negative story
Lower limb amputation level
Transtibial - most common (calf)
Transfemoral - 2nd common (quad)
Double lower amputation i.e. amputation of both lower limbs 3.9% of all amputations
Types of amputation and associated difficulties (physical demands of disability)
Transtibial amputee
Transfemoral amputee
Transtibial amputee
Requires about 30% more energy to walk, compared with a non-amputee.
Retain the knee joint, which enables them to walk more efficiently, with limb strength and proprioception below the knee being retained
Transfemoral amputee
Uses over 70% more energy to walk.
The stump is more difficult to fit comfortably and the resulting gait is less cosmetic, requiring a mechanical knee joint, as well as a prosthetic foot
Physical barrier - Pain/Phantom
Pain from the residual limb or phantom limb (pain experienced as arising from the limb which has been amputated)
Phantom pain occurs in about 30%-50% of amputees.
The pain can manifest as an occasional stab of mild pain or any degree up to severe, intractable, excruciating, continuous pain.
The term ‘phantom’ can be misleading - very real sensation of pain.
Physical barriers
Blistering Phantom limb pain Poorly fitting prosthetic Chronic nature of pain – constant Rest-activity cycle Painkillers causing drowsiness
Potential physical issues with wheelchairs
- Arms and shoulders are constantly taxed
- Over exertion &
pain in the shoulders – the most common problem - Soft tissue injuries, pressure sores
- For those with high Injuries - inability to regulate body temperature
Psychosocial challenges of being an amputee
Loss of independence and control over one’s life, the fear of being a burden to others, and a concern for the future
(Murray & Forshaw, 2013)
Giving up work and activities that were previously enjoyed
Beginning to use a prosthesis - emotionally ambivalent experience - often unprepared for the difference in capabilities they experienced in comparison to their abilities prior to limb loss
Feeling like a different person - expressing a reluctance to see friends and family
Sporting Challenges
Wadey & Day (2018) Focus groups (2) Fieldwork observations (225 hours) Formal interviews (44)
What are the barriers, facilitators, and benefits of Leisure Time Physical Activity among people with an amputation in England
Lack of wellbeing - Wadey & Day (2018)
More bad days than good following discharge from hospital
Bad days – isolated, depressed, fearful, embarrassed, fragile, unattractive…
Difficulty transitioning from hospital environment, particularly if influenced by societal pressure to act and feel in certain ways.
Lack of wellbeing - Wadey & Day (2018)
More bad days than good following discharge from hospital
Bad days – isolated, depressed, fearful, embarrassed, fragile, unattractive…
Difficulty transitioning from hospital environment, particularly if influenced by societal pressure to act and feel in certain ways.
Lack of social well-being - Government Wadey & Day (2018)
Government policies (i.e., Personal Independence Payment, Employment and Support Allowance) impacted and restricted physical activity -
Who can get PIP?
To get PIP, you must:
need help with everyday tasks or getting around, or both
have needed this help for at least 3 months and expect to need it for at least another 9 months
When you try and go for a benefit it’s all about telling people how shit your life is. It’s not trying to see the best in things. In order to get anything you have got to paint your blackest picture of your blackest day in your blackest hour! And then you begin to live it. And then you think, how can I applying for a benefit that says I am not allowed to climb hills or go on a bike again.
Lack of social well-being - Government
Government policies (i.e., Personal Independence Payment, Employment and Support Allowance) impacted and restricted physical activity -
Who can get PIP?
To get PIP, you must:
need help with everyday tasks or getting around, or both
have needed this help for at least 3 months and expect to need it for at least another 9 months
When you try and go for a benefit it’s all about telling people how shit your life is. It’s not trying to see the best in things. In order to get anything you have got to paint your blackest picture of your blackest day in your blackest hour! And then you begin to live it. And then you think, how can I applying for a benefit that says I am not allowed to climb hills or go on a bike again.
Self-presentation concerns Wadey & Day (2018)
Individuals used disengagement strategies including:
- covering prosthesis in public
Spending more time at home
Not engaging with public (e.g., avoiding eye contact, closed body language)
Not challenging disablism
Self-presentation concerns Wadey & Day (2018)
Individuals used disengagement strategies including:
- covering prosthesis in public
Spending more time at home
Not engaging with public (e.g., avoiding eye contact, closed body language)
Not challenging disablism
Experience of LTPA - Leisure time physical activity Wadey & Day (2018)
Prior experiences as a barrier to participation
“For some people, going back to something they were good at before can be really disheartening. So, for me, it’s good to try sports I wasn’t doing before so I have nothing to compare it to. You can only ever achieve.”
Experience of LTPA - Leisure time physical activity Wadey & Day (2018)
Prior experiences as a barrier to participation
“For some people, going back to something they were good at before can be really disheartening. So, for me, it’s good to try sports I wasn’t doing before so I have nothing to compare it to. You can only ever achieve.”
Experience of LTPA Wadey & Day (2018)
Lacking knowledge about what is LTPA, including:
- What is ‘good’ and ‘bad’ LTPA?
- What LTPA they would enjoy?
- How to lead an active life?
Institutions (e.g., hospitals, charities, and limb-centres) and others (e.g., Health Care Professionals, gym instructors, coaches) either lacked LTPA knowledge and resources (e.g., opportunities, barriers, facilitators, benefits, how to tailor exercises for amputees, advise on the ‘right’ equipment to use) and/or that knowledge was disseminated in a patronising manner or devoid of care and compassion.
Health care professionals - know about routes to expertise and capabilities of the different disabilities
Organisational Functionning - Wadey & Day (2018)
Governing bodies in sport and charities often had a performance agenda –focused on winning and competing.
Social and Financial capital - how can charities host local/regional events with access to social (e.g., volunteers) and financial (e.g., donations)
Key question
How could we help to bridge the gap between hospital based rehabilitation and participation in sport?
Jaarsma et al. (2014)
Most people with disabilities don’t participate in sport regularly - which could increase chances of developing secondary health conditions.
Personal barriers and environmental barriers - important to think of both when advertising participation
Barriers need to be distinguished for each disability
Stephens et al. (2012)
Found there are many benefits for participation:
Socialisation, self worth, physical challenge, emotional
Many barriers:
Organisational, medical, emotional( confidence), lack of relevant information, views held by others (patronising)
Stephens et al. (2012) pt.2
NDA (2014)
5 main factors
Strong leadership
Improved and inclusive community facilities
The provision of adequate pe experience in schools and community
Adequate and accessible information services
Comprehensive coaching and teaching programs
Wilhite and Shank (2009)
Sport benefits included enhanced functional capacity, health promotion, relationship development, increased optimism, and inclusion in meaningful life activities
Health professionals were vital in introducing and encouraging people with disabilities to participate in sport
Uses the ICF framework to enhance sport participation
What is ICF
3 interconnecting parts
If you influence one part, all the other parts change to adapt
Body structure and function - explains how body parts work
Activity and participation - explains what people do, how they engage with the world
Contextual factors - environmental and personal factors, help people function
Using the ICF approach to view a child’s health might help you to..
Understand child strengths and challenges and help to see a broader picture of their development
Communicate better about child’s functional needs to health care professionals and community
Make informed decisions and engage activity in child’s health care
