Redefining health and disability
[img_inline align=”right” src=”http://padnws01.mcmaster.ca/images/Petrenchik edited.jpg” caption=”Terry Petrenchik, assistant professor in McMaster University’s School of Rehabilitation Science. Photo courtesy Faculty of Health Sciences.”]Rehabilitation is in the midst of a revolution, changing the definition of good health for people with disabilities to a measure of their participation in society rather than just how well they can get weak limbs and sick bodies to work better.
Terry Petrenchik, assistant professor in McMaster University's School of Rehabilitation Science, calls it a paradigm shift in rehabilitation services and described its implications while giving the 8th annual Helen Saarinen Lectureship, named in honour of the school's co-founder and first chair of the university's undergraduate program in physiotherapy.
With this shift, Petrenchik said the words “disability” and “handicap” have been replaced by “activity limitation” and “participation restriction.” The potential exists to remake rehabilitation science, with major implications for medicine as well, she said.
“For example, it doesn't matter if I'm in a wheelchair, on a respirator, or have a chronic disease,” Petrenchik said. “If all that is being managed well, and I'm able to participate in society the way that I want to, then I'm in good health.”
She said people with disabilities were instrumental in helping the world community and medical professionals understand that disability is not a medical problem to be fixed, but a political, societal and attitudinal issue.
This shift in perspective was embodied by the World Health Organization in 2001 when it introduced its new International Classification of Functioning, Disability and Health (ICF).
Petrenchik said the old medical model looked at people with disabilities and chronic diseases according to how well their limbs functioned, and their biology.
A child with cerebral palsy, for example, who needed to learn how to put on his coat in order to go out and play would be taken to the gym by therapists and taught normal movement patterns over and over again. With the new way of thinking, the child would simply be given a bigger coat with Velcro so that he could easily put his coat on by himself and participate right away with less emphasis on the quality of his movements.
“There is more emphasis on what can be done to the environment and the activity than what can you do to the child,” Petrenchik said. “For us, it means we don't wait to give the gift of participation until we think the client is ready, but we give it immediately.”
The big pay-off, she said, is the improvement in the ability of people with disabilities to quickly participate in activities and society in ways that are meaningful to them.
“In the past, interventions have focused on correcting impairments and building a client's readiness for participation,” Petrenchik explained. “More recently, particularly since the introduction of the ICF, interventions are becoming a chess game of fitting a person with the environment until we achieve a negotiated level of participation rather than an optimal level of functioning and performance. It is a question of intention and focus. The end goal is health through, and for, participation.”
The title of Petrenchik's lectureship was Honouring The Past, Celebrating The Present, Embracing The Future: Expanding Horizons in Rehabilitation Sciences. It was well received by the researchers, educators, students, clinicians and community researchers who attended.
Petrenchik brought a diverse professional background which includes business, marketing, therapeutic massage and occupational therapy to her selection as this year's recipient of the Helen Saarinen Lectureship.
Her clinical areas of expertise include community practice with vulnerable populations, and the agencies that serve them. Her current research activities include the study of childhood participation, head injury and disability among adults who are homeless, and the ecology of health-participation relationships for children with special needs.
Petrenchik has acquired a deep knowledge of resilience and vulnerability in the context of life adversities through her work with families and youth coping with poverty, homelessness, and social emotional difficulties. During Hurricane Katrina, she was a Red Cross Disaster Mental Health Team volunteer.
