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DEFINING DISABILITY — ITS IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE : RECONCILING THE DIFFERENCES
The relationship between disabled people and health professionals has never been an easy one, for it is an unequal relationship with the professional holding most of the power. Traditionally the professional worker has defined, planned and delivered the services, while the disabled person has been a passive recipient with little if any opportunity to exercise control. As noted above the disabled person's definition of his problems and the appropriate solutions to them, are generally given insufficient weight, thereby seriously hampering the rehabilitation process; for if there is no consensus little real progress can be made.
Over the last decade or so disabled people have become increasingly organized and politically active. Centres for integrated living, coalitions of disabled people and international disability organizations, all controlled by disabled people themselves, now flourish. There are radio and television programmes promoting the views of disabled people, and an increasing number of conferences, courses, journals and books on disability issues, organized and produced by disabled academics. All of this amounts to a 'disability movement' as disabled people press for control in decision-making and for their perspectives and rights to be acknowledged and acted upon. Though still young, the movement has brought about considerable change in attitudes and practices. The pace of change has no doubt been helped by similar social movements such as those promoting 'gender equality', 'racial equality', 'consumerism' and 'equal opportunities'.
Professionals understandably tend to find these developments threatening as their status, power, role and even their jobs no longer seem secure. It has to be admitted that there are many disabled people who, disillusioned with the help they have received in the past, reject any professional involvement in the new services they are developing. However, many believe that partnership and collaboration with professional workers is important, and professionals are already assisting disabled people in developing services appropriate to their needs as they define them. Professionals in such a situation serve as a resource to disabled people as they strive to reach their own goals. They do not attempt to dominate, to take control or to 'manage' disabled people but rather to act as 'supportive enablers', actively sharing their expertise and knowledge while recognizing and learning from their disabled associates — the term 'patient' is no longer appropriate.
Silburn (1990) explains the work of the Integrated Living Team in North Derbyshire where a physiotherapist, a speech therapist and an occupational therapist work with severely disabled people under their direction. In this situation the experiences and perceptions of disabled people are given precedence over the perceptions and judgements of the professional workers. The therapists have had to learn many new skills in order to provide a truly integrated service and have had to accept an enormous broadening of their roles and erosion of role boundaries.
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