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INSTITUTIONAL OR COMMUNITY LIVING?WORKING WITH ILL AND DISABLED PEOPLE
Physiotherapists work with ill and disabled people in a variety of institutional and community settings. It is important that they are aware of the full range of options possible and the advantages and disadvantages of each for any particular client, they must think and act broadly and flexibly, outside the medical model, to avoid inadvertently restricting and alienating the very people they are trying to assist. It is important that physiotherapists become fully acquainted with illness and disability from the perspective of the client and should think very carefully about the ideas and wishes of ill and disabled people before proclaiming them unrealistic or impossible. This can only be achieved by consultation and cooperation with clients themselves, as well as their carers and the organizations which represent them.
Physiotherapists should have a full understanding of the process of institutionalization. Bearing the wishes of individual clients in mind, Tully's (1986) advice concerning 'normalization' and 'the least restrictive alternative' are good principles to follow. The civil rights of ill and disabled people, including their right to take risks and live unconventional life-styles, should not be forgotten. Physiotherapists must take care that their own attitudes and practices are not adversely influenced by the institutional environment or based on erroneous stereotypes. Physiotherapists should be prepared to act as advocates and attempt to bring about change in management and policy if this would improve their clients' lives. Such an approach is a far cry from the traditional role of the physiotherapist and requires courage, especially of junior physiotherapists and students who lack influence and status themselves. Managers should support them, for people new to the profession sometimes have a clearer perception of the situation than those who have worked within the system for many years.
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