GHD Blog: Exploring the Paradox of Physical Therapy

September, 2022
by: Gloria Di Iorio, McGill School of Physical and Occupational Therapy, M2

Physical therapy is about getting people back to function… or is it? How might this commonly held perception reinforce ableism within PT? How does our perception of cure impact the profession – who we treat, what interventions we offer, and when we discharge patients?

PT is often strongly aligned with the medical model of disability, where the primary aim is to get people “back” to a certain functional level by “fixing” physical impairments. Despite the adoption of more holistic models of care, such as the International Classification of Functioning (ICF), this goal of achieving normality through the resolution of impairment is still embedded within PT training and practice. Common goals and end-points of rehabilitation are to return to work and to live independently. This narrow understanding of normality and what it means to be a “productive citizen” can have marginalizing effects on persons with disabilities. These perceptions also influence what counts as rehabilitation services and who has access to those services (Fadyl et al., 2020).

The paradox of physical therapy is that it simultaneously works to ameliorate disability while celebrating it as diversity (Roush et al., 2011). We want people to gain function, autonomy, and independence, and we also want to accept and celebrate people for who they are. Going forward, the role of rehabilitation professionals must expand beyond “fixing” impairments. Our conceptualizations of disability must extend beyond the individual level and we must consider the environment in which people live (Roush et al., 2011). We need to advocate for a broader understanding of what we value as being a “productive citizen” (Fadyl et al., 2020). We must become advocates for disability awareness and reframe our ideas of function and cure to ensure that persons with disabilities are treated equitably (Roush et al., 2011).

As rehabilitation professionals, practicing disability allyship can take many forms and is not a set of boxes to check. In clinical practice, this may involve listening and respecting people’s goals, unlearning ableist ideas and language, and advocating for improved accessibility. As rehabilitation curriculum educators, this may involve exposing students to disability studies by working closely with persons with disabilities to ensure all folks are well represented in clinical case studies and practical scenarios. A tangible example within education of a space aiming to engage rehabilitation providers in disability studies was the McGill Summer Institutes in Global Health Course in June 2022 entitled “Global Considerations of Disability for Rehabilitation Providers.”

Resources to learn more about disability:

• Justice Rehab Posts on Disability Justice
• Resource Guide for Training Disability Competence in Physical Therapy
• 21-Day Challenge: Disability Justice

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References

Susan E. Roush, Nancy Sharby, Disability Reconsidered: The Paradox of Physical Therapy, Physical Therapy, Volume 91, Issue 12, 1 December 2011, Pages 1715–1727, https://doi.org/10.2522/ptj.20100389.

Joanna K. Fadyl, Gail Teachman & Yani Hamdani (2020) Problematizing ‘productive citizenship’ within rehabilitation services: insights from three studies, Disability and Rehabilitation, 42:20, 2959-2966, DOI: 10.1080/09638288.2019.1573935.