SCI participation Flashcards
define participation
Encompasses and includes some or all of the following: Major role in life: parent, spouse, child, profession / occupation Using transportation / driving Acquiring, keeping and terminating a job Education Recreation and leisure Economic self-sufficiency Community life Human rights
models of disability
medical
social
Disability is a feature of the person, directly caused by disease, trauma or other health condition
Requires medical care provided in the form of individual treatment by professionals
Aim to ‘correct’ the problem with the
individual
Disability is a socially-created problem
Not at all an attribute of an individual
Disability demands a political response, since the problem is created by an unaccommodating physical environment brought about by attitudes and other features of the social environment
barriers to services
examples
Barriers to services and environments restrict participation and undermine quality of life
Examples:
Inadequate policy and provision Lack of funding
Physical access barriers
Negative attitudes, unconscious bias Lack of knowledge
“Don’t save me then leave me”
Community integration depends on overcoming environmental barriers
Housing barriers: stairs, small space, entrance
Transportation barriers: Absent ramps, lifts, safety lock-down system, lack of training for transport personnel, availability of wheelchair taxis, toilets on aeroplanes are often inaccessible
Driving barriers: Funding for adapted cars, availability of disabled parking spaces
Public buildings: parking, routes to public buildings, ramps, entrances and toilets
Laws, policies and standards have to be enforced
education and employment
Education is about becoming an active member of society, not just simple learning
Work is about belonging, not just about income
People with disabilities are entitled to participate in education and employment on an equal basis with others
UN Convention on the Rights of Persons with Disabilities (UNCRPD)
SCI and return to work
Return to work is higher in SCI survivors injured at a younger age, who had less severe injuries and higher functional independence (Lidal et al, 2007)
Estimated 30% of people with SCI are working at any given time (Hilton et al, 2018)
21-67% of SCI survivors who were working at the time of injury return to paid employment
Few return to their pre-injury job
SCI survivors stop working at a younger age (often in their 40s)
paid employment
Productive work is a cornerstone of adulthood and an ingredient of a successful and meaningful life
Being employed influences life satisfaction and well-being
positively, with fewer symptoms of depression
Employment is associated with a higher level of activity, fewer medical treatments and a better overall adjustment
Systematic review by Hilton et al (2018): myriad factors influencing RTW
Can you think of any factors that might facilitate return to work?
What, do you think, are the barriers?
participation hobbies and sports
recreation and leisure wheelchair sports NRH annual spinal games IWA accessible gym in clontarf paralympics inter spinal unit games fishing airsoft, adaptive biking powerboat diving
wlaking with iSCI
50% would have like to have been segregated from the non-walkers because ‘then you’d have something in common with other people with what you are experiencing sort of thing…that would be beneficial’
‘I don’t use public transport because with the jolt of the buses, with trains just all those people going up and down the stairs and the busyness – I just wasn’t comfortable’
‘Walking too long, sitting too long, no good.’
‘One of the biggest drawbacks about being a walking paraplegic is it is so slow, its very frustrating and it’s much quicker for me to be in my wheelchair…’
‘This is not being ungrateful for anything that I have accomplished with my recovery: but it is very sad existence compared to what it used to be’
resilience
Themes participants considered as important contributors to their ability to
adapt:
Psychological strength (positive attitude, adaptability, determination, overcoming adversity, independence, proactive behaviour, assertiveness)
Social support (from family, friends, caregivers, rehab staff)
Adaptive coping (seeking education, sense of humour, music, journaling)
Spirituality (faith, fate and making meaning)
Perspective (the “big picture”)
Being a role model / inspiring others (helped in the ability to bounce back)
sense of purpose
“Sometimes we choose our own challenges; spinal cord injury is one of those challenges that chooses us. It’s what we decide to do about it that counts” -Mark Pollock
“I always asked myself: ‘What is the reason why you are on Earth?’ Maybe this is it. Why not? It’s nice when you can believe that what you are doing is for something bigger. That you can do something on Earth to make it better for others” -Kristina Vogel
role of physio in enabling participation for people with SCI
Listen
Provide support, and signpost to the supports beyond your scope
Don’t judge
Know about assistance services and create networks
Change attitudes to disability
Foster research
WHO recommendations for SCI
Improve health sector response to SCI
Empower people with SCI and their families
Challenge negative attitudes to people with SCI
Ensure that buildings, transport and information are accessible
Support employment and self-employment
Promote appropriate research and data collection
Implement recommendations
