In this study Kulnik and Nikoletou (2017) discuss two opposing ways of viewing disability- the social model of disability and the individual-medical model. The former sees the restrictions of the environment and society as the barrier to performance, whereas the latter regards the physical impairments of the person as causing the limitations in performance.
They propose that whichever model a therapist most aligns with will shape the treatment they provide, through the clinical reasoning and goals they set encourage the client to set. From interviews with disabled clients, they found four key themes. These were
- talking about the term ‘disability’
- clients were uncomfortable using the label of disabled, and described the term in a third person way rather than as relevant to themselves
- it was described as… the inability to do things for yourself and therefore reliance on others
- clients’ views of disability aligned with the individual-medical model
- experience of disability and ageing
- these were generally viewed as frightening and negative experiences
- difficulties with the social model way of thinking
- clients did not interpret their situation in a political/social model way
- they often viewed health professionals as acting out of self-interest and not helping the disabled people they are meant to serve
- they described inadequate resources and systems (eg adaptive equipment and reductions in personal care assistance) as making their disabled situation worse
- expectations of clients from community rehab programs
- clients had limited general knowledge of what to expect from community rehab, and any knowledge was based on previous personal experience
- rehabilitation was associated with institutional settings
Factors influencing these themes are that the government is shifting towards the client being an empowered consumer rather than a passive patient, in which case community rehab (including any OT services!) would need to raise its profile so the ‘consumers’ were aware of it as a potential choice.
Criticisms of the study
With this study it should be noted the subjects were all older adults with acquired disabilities although they were from a variety of cultures and types of disability (mental and physical) which is good. The sample size was small at 10 people, however with phenomenology a smaller sample is needed “quality over quantity” since each person’s narrative is studied in such depth. If people had disabilities from birth eg CP they may view themselves as more aligned with the social model of disability and not feel the need to justify having assistance provided to them. Another criticism is that in the introduction the authors discuss how the disability models would affect OTs’ practice but this is not addressed again in the rest of the study- would be an area for future research investigation.