Disability and "The Paradox of Physical Therapy"

Last weekend, I had the opportunity to volunteer with the organization Life Rolls On. It was started by a surfer after he experienced a spinal cord injury, and the main purpose is to provide adaptive surfing experiences (and now skateboarding experiences too!) for people with physical disabilities. The participating surfers spanned a wide age range and a wider range of physical abilities. It was a gorgeous day outside, and the surfers’ joy and excitement were contagious. I personally had a blast, the surfers had a blast, and the joy of the day was evident in the pictures that came through from various photographers at the event.

As someone who has chosen to work with people who have physical disabilities as a career, and someone who has people with physical disabilities in my close family circle, I expected to have a great time volunteering. Even so, I was surprised by the extent to which my feelings about Life Rolls On were different from my feelings of being at work. Mainly, I relished the freedom of participating in a fun activity with my client population WITHOUT having to talk about medical things. I didn’t have to know which surfer had missed an appointment for Botox injections because of illness in the family, or which surfer was denied by insurance for a new wheelchair. I didn’t have to ask about pain levels, and I didn’t have to encourage the surfers to keep trying their best in the name of making functional progress. We got to be present in the moment together, enjoying the ocean and the beautiful day, sharing jokes, laughs, and silly poses on the surf board.

This article [1], “Disability Reconsidered: The Paradox of Physical Therapy”, illustrates a lot of the ideas that have been swirling in my head since last weekend’s event. In PT school, we focus (necessarily) on medical issues involved in disability. We spend extensive time learning how to help people with disabilities gain more independence, prevent complications, and gain strength/mobility. But, because of the medical nature of our education and practice, we don’t spend enough time learning about things that aren’t medical. We don’t learn as much about what it is like to navigate the world with a physical disability. People with disabilities come to our classes to demonstrate how they perform mobility tasks, but they don’t often get to stay and share their experiences of being treated differently because of their physical capabilities.

I have one patient who, every time he begins a story about being treated differently because of his disability, says, “remember, I’m in a wheelchair, so automatically you should talk louder and slower to me – I clearly can’t understand because I can’t walk”. What he says rings true. There is latent (or sometimes blatant) ablism present in physical therapy attitudes and in the set up of physical therapy practices. We forget to ask patients about their top goals for therapy because we get so wrapped up in making the apparently dysfunctional more functional. We assume the worst about patients when they miss appointments due to transportation issues, forgetting that people in wheelchairs often face discrimination finding employment or are unable to afford to modify a vehicle to transport themselves. We assume they are noncompliant when they don’t buy into therapy programs that fail to consider their goals instead of ours.

The article cited above calls for better integration of the biopsychosocial model of medical care into the care of people who have disabilities. Research demonstrates that pervasive negative attitudes or paternalistic attitudes from medical providers have a strong negative impact on the successful treatment of people with disabilities. This should be common sense, since negative provider attitudes impact the recovery and treatment of people with EVERY type of diagnosis. The difference is that negative attitudes and biases toward people with disabilities are so pervasive, and baked into not only medical culture, but global culture at large.

The article above suggests that, in physical therapy education, we could combat this “medicalized” view of people with disabilities and the ablism present in our culture by emphasizing lived experiences of people with disabilities AND providing opportunities where students could engage with people with disabilities as peers rather than as patients. I would go one step further to add that, as a clinician, interacting with a differently abled person outside the clinic is critical not only for keeping my biases in check and retaining my biopsychosocial outlook, but also for fighting burnout/compassion fatigue. Sometimes, in clinical care, we see the hardest situations. We know when people aren’t able to get what they need because of insurance, and we see the ways in which society perpetuates ablism. We often are involved in writing letters of medical necessity, in which we go into extreme detail listing out a person’s impairments and potential health dangers. It’s not often enough that we get to see the other side of things – people with disabilities participating in typical activities and sharing fun rather than difficult times.

Through my personal life, I know that people with disabilities have fulfilling jobs, meaningful social groups like book clubs and bible studies, and can perform on stage for a standing ovation. Through my patients, I know that people with disabilities can enjoy international travel and ride motorcycles. Through my experience last weekend, I was reminded that we can participate in joyful, fun, playful activities together. That’s the paradox of physical therapy – to see a person’s impairments while also seeing an already whole person.

[1] https://academic.oup.com/ptj/article/91/12/1715/2735085?login=false