Last week, the WCPT unveiled its latest briefing paper titled Access to physical therapist entry level education and practice for persons with disabilities. This paper and supporting resources are significant, not only for their critical and radical statements on the relationship between physiotherapists and people with disabilities, but also because they situate one of the profession’s leading advocacy organisations in the position of critiquing physiotherapy’s longstanding atheism towards disability rights.
Physiotherapists have long paid lip-service to the idea that they advocate for the rights of disabled people, but have systematically excluded disabled people from training (with the exception, perhaps of blind therapists and injured ex-servicemen), and have even been accused of being parasitic towards disability by creating new categories of illness and injury that they are, themselves, particularly well suited to remedy (Swain, French & Cameron, 2003).
Read in this context, the WCPT’s briefing paper represents an innovative, well-executed, well-considered project, that isn’t afraid of identifying entrenched apathy and intransigence, or for suggesting that we could do more than we have done before.
Recently, a number of physiotherapists have offered new critical insights into the role disability plays in rehabilitation. Barbara Gibson, for example, recently argued that;
Disability as ‘a problem to be fixed’ remains a dominant idea in rehabilitation despite increased emphasis on ‘biopsychosocial’ models of care (Chapter 2). Advocates working in disability studies have a long tradition of rejecting biomedical approaches to disability, and the field is replete with sophisticated research and scholarship debating the complex relations that intersect to produce disabled bodies. While it may be argued that rehabilitation has made great strides in moving away from the so-called medical model of practice through an increased interest in enabling activity and participation, it still largely constructs disability as an individual deficit that is addressed through individual interventions (Hammell 2006, Magasi 2008b, French and Swain 2001). Helping persons is not in and of itself a problem, but the focus on individual bodies decontextualizes disability and offloads responsibility for change onto disabled people… In rehabilitation, a biomedical focus on individual deficits (whether at the level of body structures, activity, or participation) orients what counts as a ‘problem’ to be fixed. The interdisciplinary lens of critical disability studies provides an avenue to integrate bioscientific and sociopolitical approaches to rehabilitation without privileging one over the other (Gibson, 2016; pp.11-12)
Furthermore, there persists a longstanding view physiotherapists need to possess normal visual, auditory and tactile acuity if they are to practice effectively. This point was exemplified recently by Inherent Requirements for training to be a physiotherapist that were adopted by a number of Australian university programmes (see, for example, this). These requirements state that applicants must have:
- Sufficient visual acuity to demonstrate the required range of skills, tasks and assessments to maintain consistent, accurate and safe care of self and to others
- Sufficient auditory ability is necessary to monitor, assess and manage an individual’s health needs consistently and accurately
- Sufficient tactile ability is necessary to monitor, assess and detect patients’ physical characteristics and act on any abnormalities detected to provide appropriate physiotherapy management
By definition, these inherent requirements represent a barrier to disabled people’s training and practice as physiotherapists. Consequently, physiotherapy has become a profession significantly at odds with the population it often serves.
In preparing this post, we asked an OT colleague with spina bifida to comment on the problems faced by disabled practitioners. She said that;
The rehab world is particularly difficult to work within because the concept of accommodation and flexible work environment is not as accepted and approved of as much as we’d like to think it is. So far, in my adult life, I have been normalized, perhaps assimilated into rehabilitation, as a successful disabled person, who’s made it; who’s overcome all obstacles to get to where she is; someone who “could” function within this environment. But this constant pressure to function at this level is just not sustainable for me.
The quote reminds us that we have a lot to learn from disabled students and colleagues. For example, while in the WCPT document (point 11) it says “think broadly about disability and how it might affect practice as a physical therapist; applying principles learnt in the context of patients/clients to the situation of peers” we might suggest that it is also important to reverse this thinking i.e. to “think broadly about physiotherapy and how it might affect practice as a disabled physical therapist”. We might also suggest that rather than “applying principles learnt in the context of patient/clients” uncritically, it would be more important to “be cautious applying principles learnt in the context of patient/clients to the situation of peers”. First these are colleagues, not patients and second, because we can’t always assume that the way physios work with disabled people is good!
We asked one of the authors of the report to provide a bit of context for the paper. Their comments reinforce the significance of the report for the profession:
As one of the authors, it is not appropriate for me to comment. But as a person with a disability, I am partially deaf, and a parent of a son with a disability and as a person who has worked in the disability sector as a physiotherapist, physical therapist educator and public servant (disability policy and data) I believe I can.
This report raises awareness about the capacity of people with disability to enter the profession as students, to take part in the profession and to return to the profession following illness or injury. Accepting and well-informed colleagues and employers are key and suitable (reasonable) accommodations important. With the current global focus on ‘No one left behind’ physical therapist educators and employers can take the guidance in the document and apply it so that as profession we are not left behind. Accreditation and regulatory bodies also need to ensure that their practices accommodate people with disabilities.
The Chartered Society of Physiotherapy has been a leader in enabling access to the profession and is acknowledged for bringing the motion to the WCPT general meeting. I have seen comments to the contrary so I hope that this paper will provide a rebuttal to the idea that PTs need to meet the generally portrayed model (fit, young, slim, and manual handling) and the expectation that the WCPT member organisations will work towards better acceptance of people with disabilities in the profession.
I hope that the report results in many more people with disabilities being physiotherapists. A profession that aims to enable others should aim to enable its own.
The final sentence here is, I think, particularly striking.
The WCPT should be congratulated for tackling an issue that has too long remained under-discussed and under-examined. Physiotherapists are far too quick to assume that just because they often work with disabled people, that they have insights into the ways that disabled people experience physiotherapy, as students and as consumers. The profession’s relative lack of acceptance of disabled people into its ranks suggests that we have had a longstanding antipathy to the contribution that disabled people may make to health care practice, and by extension, everyday work and perhaps even life in general. These historical biases will be overturned much faster when we have a large cohort of disabled students in our educational programmes. Let us hope that all educators take this report seriously and consider how they might implement change in their own workplaces.
Gibson, BE. Rehabilitation: A post-critical approach. Boca Raton (United States): CRC Press; 2016.
Swain, J., French, S., & Cameron, C. (2003). Practice: Are professionals parasites? In Controversial issues in a disabling society (pp. 131-140). Buckingham: Open University Press.
Thanks to Barbara Gibson and Jenny Setchell for their help in co-authoring this post.