Transformative Physical Rehabilitation: Thriving After a Major Health Event

By Claire-Jehanne Dubouloz Wilner

Dans la réadaptation physique adulte, la théorie d’apprentissage transformateur permet le développement d’un modèle détaillé du processus de transformation des perspectives de sens en réadaptation physique basé sur des indices de recherche, des exemples et des cas, et propose des conseils pour des applications cliniques.

Transformative Physical Rehabilitation: Thriving After a Major Health Event s’inspire du contexte théorique et de l’apprentissage transformateur dans l’éducation des adultes (Mezirow) pour discuter du développement et du transfert des connaissances dans les interventions reliées au domaine de la réadaptation physique et communautaire.

Il présente aussi les découvertes novatrices d’un projet de recherche mené pendant quinze ans sur le processus de transformation des perspectives de sens majeures avec des groupes de clients ou de patients. Ce projet a engendré le premier modèle de transformations importantes dans le champ de la réadaptation physique. Ce processus émerge de la construction de nombreuses théories substantives (Glaser & Strauss), financées à l’externe, et complétées pour la première fois auprès de populations de clients variées traités en ergothérapie, en physiothérapie et dans d’autres disciplines de réadaptation de la santé physique.

Ce livre s’adresse aux cliniciens, éducateurs et étudiants en réadaptation physique, ainsi qu’à ceux qui accompagnent un proche qui traverse un important changement personnel.

Publié en anglais.

• Language: English
• Publisher: University of Ottawa Press
• Release date: Sep 8, 2020
• ISBN: 9780776629025

Claire-Jehanne Dubouloz Wilner

Claire-Jehanne Dubouloz Wilner has been a professor of occupational therapy at the School of Rehabilitation Sciences at the University of Ottawa for more than thirty years. Previously, she enjoyed a ten-year career as a clinical therapist at Montreal’s Gingras-Lindsay Rehabilitation Institute. She has been a key player in the development of rehabilitation sciences education at the University of Ottawa, and has received many external research funds and prizes and awards, including the prestigious Muriel Driver Award (2014).

Book preview

TRANSFORMATIVE

PHYSICAL

REHABILITATION

TRANSFORMATIVE

PHYSICAL

REHABILITATION

THRIVING AFTER A MAJOR

HEALTH EVENT

CLAIRE-JEHANNE

DUBOULOZ

University of Ottawa Press

2020

The University of Ottawa Press (UOP) is proud to be the oldest of the francophone university presses in Canada as well as the oldest bilingual university publisher in North America. Since 1936, UOP has been enriching intellectual and cultural discourse by producing peer-reviewed and award-winning books in the humanities and social sciences, in French and in English.

www.press.uOttawa.ca

Library and Archives Canada Cataloguing in Publication

Title: Transformative physical rehabilitation : thriving after a major health event / Claire-Jehanne Dubouloz Wilner.

Names: Dubouloz Wilner, Claire-Jehanne, 1951- author.

Description: Series statement: Collection 101

Identifiers: Canadiana (print) 20200206664 | Canadiana (ebook) 20200206672 | ISBN 9780776629001 (softcover) | ISBN 9780776629049 (hardcover) | ISBN 9780776629018 (PDF) | ISBN 9780776629025 (EPUB) | ISBN 9780776629032 (Kindle)

Subjects: LCSH: Physical therapy.

Classification: LCC RM700 .D83 2020 | DDC 615.8/2—dc23

The University of Ottawa Press gratefully acknowledges the support extended to its publishing list by the Government of Canada, the Canada Council for the Arts, the Ontario Arts Council, the Social Sciences and Humanities Research Council and the Canadian Federation for the Humanities and Social Sciences through the Awards to Scholarly Publications Program, and by the University of Ottawa.

Contents

Preface

Acknowledgments

Introduction

An Illustrative Case: Lisa

1.  The Theory of the Transformative Learning Process

Sources

Definition

General Description of the Theory

Central Concepts

Transformation

Meaning Perspectives or Frames of Reference

Habits of Mind

Meaning Schemes or Points of View

Critical Reflection

Back to Lisa

2.  Understanding of Meaning Perspective Transformation: Research Evidence

The Grounded Theory Approach and Research Questions

The Rehabilitation Studies

1. Clients with Spinal Cord Injury

Clinical Context

Core Meaning Perspectives

Research Connections

2. Clients with Spinal Cord Injury (2)

Clinical Context

Core Meaning Perspectives

Research Connections

3. Clients with Multiple Sclerosis

Clinical Context

Core Meaning Perspectives

Additional Comments

Research Connections

4. Clients in Rehabilitation Following a Cardiac Event

Clinical Context

Core Meaning Perspectives

Research Connections

5. Clients with Rheumatoid Arthritis (2)

Clinical Context

Core Meaning Perspectives

Research Connections

6. Clients with Rheumatoid Arthritis

Clinical Context

Core Meaning Perspectives

Contextual Factors That Delayed Meaning Perspective Transformation

Meaning Perspective Distortions

Research Connections

Further Note on Distortions

7. Arthritis Health Education Groups and Meaning Perspective Transformation

Clinical Context

Core Meaning Perspectives

Research Connections

8. Meaning Perspective Transformation in a Stroke Support Group

Context of Care

Clinical Context

Core Meaning Perspectives

The Process of Meaning Perspective Transformation

3.  The Model

Description of the Model

The Trigger Phase

Readiness for Change

The Changing Phase

The Outcome Phase

4.  Clinical Use of the Model

Identifying Where Clients Are in the Transformation Continuum

And the Upshot is…

References

Preface

My fascination with how people survive, adapt, and thrive after a major health event—a fascination that has become a career-long passion and research focus—began when I was beginning my clinical practice as an occupational therapist. Prior to my academic years, I was a practitioner in occupational therapy and was always moved by the heroic changes that clients and significant others mastered after a rehabilitation effort. I started in the 1970s in Switzerland, in an acute adult mental-health hospital where individuals confronted their personal realities and tried to make sense of them through meaning-making in activities offered in occupational therapy. I continued my professional journey in Canada in community-based adult mental-health services, where individuals attempted to create a new occupational engagement with their community surroundings (work, family, self-care) to develop a power to act.¹ I then moved to, and remained part of for more than 10 years, a fascinating adult physical rehabilitation centre, the Gingras-Lindsay Rehabilitation Institute, in Montreal. There, I had the occasion and privilege to meet and engage with incredible individuals who, in spite of their major traumas and grave illnesses, were looking for meaning in their lives. The new understandings they developed were often generated by experiencing bio-psycho-social challenges, such as developing physical independence and autonomy through assistance, and achieving engagement in productive activities with meaning and purpose. Since 1998, as professor at the School of Rehabilitation Sciences at the University of Ottawa, I have continually conducted research in personal reflection and change among various health-challenged groups. In 2007, I presented a key early reflective observation at the University of Toronto’s annual Thelma Cardwell Research Day:

Early in my practice, as an in-training occupational therapist at the Institute of Rehabilitation in Montréal, I witnessed a situation that I learned later was frequent and at the same time unique to each individual and context.

A client of perhaps 25 years of age, who had suffered a high-level spinal cord injury, was being pushed in a wheel chair to the entrance way of the department of occupational therapy by an assistant nurse. While the chair was still moving on its own, the nurse quickly turned toward an occupational therapist colleague of mine who was in charge of the department and said: Paul is starting rehab today, I will pick him up in an hour, see you later!

I felt apprehensive at the sudden connection that had just been created between Paul and the therapist. It seemed to me at that time, that this young man’s life had been completely shattered and he was abandoned by all. After having sustained a major motorcycle accident, he presented no active movement below his shoulders. He was sort of, lying down, slouched in a wheel chair too wide for him, filled with cushions, staring up from below at his future therapist, with a mix of tremendous fear, hope and expec­tation. I questioned myself: How is this man going to find a new life? How is he going to face, manage, and succeed at this tremendous life challenge? What a courageous man, what faith!

Time passed. Many weeks later, I saw him again. After intensive rehabilitation treatment, after having experienced occupational limitations and after having searched for and found adaptive solutions, after having learned with various therapists in different contexts of living, the image of helplessness that this young client had presented at first, had been transformed. Now in front of me was an individual driving his powered wheelchair, deciding where to go and when; a cheerful and reflective young man, who, when I spoke to him, told me about himself and his short-term personal living plans. He demonstrated the signs of a successful rehabilitation process. How this apparently miraculous change could be explained, I wondered. What was the secret of such a dramatic shift in a person’s life? I was curious and fascinated by this man’s transformation process that gave him a sense of belonging and social participation. I felt that it had to be explored to be better understood and understanding it could serve as a backdrop for future successful rehabilitative interventions.²

And what about less successful interventions? I wondered. Why some results were less transformational than others, and what could we learn from them? So, faced with these intriguing questions, what better path to follow than to plunge head-first into a 20-year research program to study this process, to explore what has been observed over and over again by many rehabilitation therapists in both clinical and community settings­­—the process of personal transformation during physical rehabilitation! How did Paul transform the vision of his life? Was there a trigger, a turning point for such a shift? If there were one, what was it? How did it work? How does an individual give new meaning to his or her life after such a traumatic event? Does this new meaning facilitate learning?

This is the experiential background of this book. Of course, not all of us have encountered such an event, but many of us know or know of someone who has experienced a traumatic health event. Many of you may be health professionals or future health professionals. All of us can read further to explore and understand how transformative learning plays a key role in successful adult physical rehabilitation.

Acknowledgments

This book is dedicated to those who have undergone some measure of transformation during their physical rehabilitation journey, and to those who will. All of you are champions.

Introduction

At the time of publication, in 2020, this book is the only of its kind devoted to the topic of transformative learning theory in adult physical rehabilitation sciences. The book is written for clinicians, educators, and students in the field of physical rehabilitation, and in health care in general, as well as for the general reader with an interest in delving below the surface. The book provides an understanding and usage of