Disability Paradigms and Models and Rehabilitation Practice

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Disability Paradigms and Models and
Rehabilitation Practice

• Lesley Jordan
• School of Health and Social Sciences
• Middlesex University

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Issue and Aims

• Issue
• Engaging social model with rehabilitation
  services
• Aims
• Provide a framework for analysis (illustrated by
  aphasia therapy)
• Raise questions about-
• - Distinction between individual and
  social
• model services
• - Social aspects of rehabilitation services
• - Application of social model values within
• services concerned with impairment

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Individual and Social Models of Disability
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Applying disability paradigms to aphasia therapy
activities

1. BODY Therapies to improve functional
   communication
2. PSYCHOLOGY/IDENTITY Dealing with psychological
   aspects of aphasia affecting 1 above
   
   Self-advocacy courses Identity projects (Connect
   website)
3. SOCIAL STRUCTUREAdvocacy/facilitation to enable
   a man with severe aphasia to give evidence in
   court (Hovard, 1997) 
4. CULTURETraining in strategies/techniques to
   facilitate interaction for
   Care workers (e.g.
   Jordan, 1998a) Volunteers (e.g. Kagan Gailey,
   1993)

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Applying the paradigms to therapy activities

• Activities can be analysed in terms of
• (a) Their specific content
• (b) Their meaning/emotional tone
• - messages conveyed to person with
  aphasia / others
• Both affected by therapists underlying values

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1i Body activities / Individual model
values

• Focus on
• (a) Impairment rather than the whole person
• OR
• (b) Client as a disabled person
• Therapist as best assessor of clients needs
• Professional powerful
• Client subordinate

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1s Body activities / Social model
values

• Client a person with a life to live and multiple
  roles
• Professional expertise used to aid clients in
  achieving their goals
• Problem-solving approach, led by the client
• Balanced partnership between therapist and client

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2i Psychology activities /
Individual model values

• Assist client in accepting their impairment and
  coming to terms with themselves / their position
  as a disabled person
• Emphasis on client being realistic about
  themselves and their limitations
• Sympathetic to carers burden

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2s Psychology activities / Social Model values

• Assist clients in developing a positive identity
  as a person with aphasia
• Self-advocacy courses for people with aphasia
• Educating communication partners about
  facilitating communication
• Training volunteers to facilitate communication
  with specific client

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3i/3s Social structure

• Therapists activities
• Professional opinion / advocacy / facilitation in
  relation to e.g. benefits / courts / education /
  employment
• Independent living provisions (adaptations /
  aids, etc) and information about them
• Individual model values
• General assumption that the disabled person is
  the problem. Rationale humanitarian
• Social model values
• Assumption that society is the problem, so
  expectation of adjustments, modifications of
  procedures, etc. Rationale citizenship

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4i/4s Culture

• Therapists Activities
• Influencing media representations of people with
  aphasia
• Providing education via publications and mass
  media
• Increasing awareness of aphasia (e.g. Corker
  French, eds, 1999 Swain et al, eds, 2004)
• Training other service providers and members of
  general population in facilitation
• Provider Values
• Content and delivery likely to reinforce
  individual model of disability unless explicit
  exposition of social model at every stage

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Conclusions and Further Issues

• Potential for social model rehabilitation?
• (Possibly) increasing compatibility between
  professional values and social model of
  disability (RCSLT, 1991, 1996)
• Examples of NHS aphasia therapists working in
  partnership with clients
• Some professional education takes social model on
  board (e.g. City University Birmingham
  University)
• Voluntary sector practice and courses informed by
  the social model (e.g. Connect)
• Social model of disability in aphasia therapy
  literature (Jordan, 1998b Jordan Kaiser, 1996
  Parr et al, 2003 Pound et al, 2000)

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Conclusions and Further Issues

• Problems for the social model in rehabilitation
• Dominance of individual model of disability in
  society
• Possible reinforcement from patients and their
  families/friends of individual approach
• Lack of clear distinction between illness and
  disability
• NHS culture
• Scarce resources
• Issues
• How can NHS therapists be encouraged to base
  their impairment level activities on social
  model values?
• How to ensure that therapists disability level
  activities are based on social model?
• Appropriateness of framework for rehabilitation?

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Gearing the Framework to Rehabilitation
Activities
Practicalities Meanings
BODY PSYCHOLOGY
SOCIAL STRUCTURE CULTURE
Personal Change
Environmental Change
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References

• Connect The Communication Disability Network
  www.ukconnect.org
• Hovard, L. (1997) The speech therapists
  experience as facilitator, In Action for
  Dysphasic Adults Legal/Medical Advocacy Day, Full
  Transcript, ADA, London
• Jordan, L. (1998a) Carers as Conversation
  Partners Training for Carers of Communicatively
  Impaired People, Care The Journal of Practice
  and Development, 6(3), May, 45-59
• Jordan, L. (1998b) Diversity in Aphasiology A
  Social Science Perspective Aphasiology, 12(6),
  June, 474-480
• Jordan, L Kaiser, W (1996) Aphasia A Social
  Approach, Stanley Thornes, Cheltenham
• Kagan, A Gailey, P (1993) Functional is not
  enough Training of conversation partners for
  aphasic adults, in A L Holland M M Forbes,
  eds, Aphasia Treatment World Perspectives,
  Chapman Hall, London

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References continued

• Parr S et al eds (2003) Aphasia Inside Out, Open
  University Press, Maidenhead
• Pound C et al (2000) Beyond Aphasia Therapies
  for Living with Communication Disability,
  Speechmark, Bicester
• Priestly, M (1998) Constructions and creations
  idealism, materialism and disability theory,
  Disability Society, 13, 75-94
• Priestley M (2003) Disability A Life Course
  Approach, Polity, Oxford
• Royal College of Speech Language Therapists
  (1991, 1996) Communicating Quality, RCSLT, London
• Thomas, C (1999) Female Forms Experiencing and
  Understanding Disability, Open University Press,
  Buckingham