Shanon Phelan

Introducing a Critical Analysis of the Figured World of Occupation

This critical analysis of occupational science examines the figured world of occupation. Figured worlds are ‘typical’ representations of a particular construct based on taken-for-granted theories and stories developed through experience and “guided, shaped, and normed” though social interactions (Gee, 2011, p. 76). Drawing on theoretical articles published primarily in the Journal of Occupational Science, a discussion regarding the values and assumptions underlying occupational science is presented. It is proposed that there are tendencies to identify occupations as “positive” and to focus on the relationship of occupational engagement to enhanced health and well-being. At the same time, there may be an implicit exclusion of activities that are considered ‘negative,’ ‘unhealthy’ or ‘deviant’ from the figured world of occupation, which has the potential to stigmatise and marginalise individuals or collectives. It is suggested that occupational science may have a significant role to play in developing critical understandings of the social construction of occupations as moral or immoral, deviant or normal, and healthy or unhealthy. The role of occupational science in (re-)presenting occupations is framed as a social justice issue that contributes to the social construction of ways of acting and ways of being.

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.

Directions for advancing the study of work transitions in the 21st century

OBJECTIVES The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Ethical Tensions Related to Systemic Constraints: Occupational Alienation in Occupational Therapy Practice.

Ethical tensions arise daily in health care practice and are frequently related to health care system structures or policies. Collective case study methodology was adopted to examine ethical tensions reported by occupational therapists practicing in different settings in Southwestern Ontario, Canada. Inductive analysis involving multiple layers of coding was conducted. This article focuses on tensions related to systemic constraints. Participants reported ethical tensions related to balancing client priorities with those of health care services. Four themes related to systemic constraints were identified including imposed practices, ineffective processes, resource limitations, and lack of services. Therapists’ aims could be seen to align with an “ethic of care” and were seen to be in tension in light of systemic constraints. The findings raise issues related to occupational justice, particularly related to occupational alienation in occupational therapy practice, and open conversations related to neoliberalist health care agendas.

Representations of disability and normality in rehabilitation technology promotional materials

Abstract Purpose: To explore the ways in which promotional materials for two rehabilitation technologies reproduce commonly held perspectives about disability and rehabilitation. Method: Our analysis was informed by critical disability studies using techniques from discourse analysis to examine texts (words and images) and their relation to social practices and power. Using this approach, promotional materials for (a) hearing aid and (b) robotic gait training technologies were interrogated using three central questions: (1) Who are represented? (2) What is promised? and (3) Who has authority? Results: Messages of normalization pervaded representations of disabled children and their families, and the promises offered by the technologies. The latter included efficiency and effectiveness, progress and improvement, success and inclusion, and opportunities for a normal life. Conclusions: Normalization discourses construct childhood disability through texts and images. These discourses reinforce pervasive negative messages about disability that are taken up by children and families and have ethical implications for clinical practice. Rehabilitation has largely focused on “fixing” the individual, whereas broadening the clinical gaze to the social dimensions of disablement may lead to a more sensitive and informed approach within family-clinician discussions surrounding these advanced technologies and the use they make of promotional materials. Implications for Rehabilitation Awareness of the potential effects of implicit and explicit messages about disability in promotional materials may lead to a more sensitive and informed approach within family-clinician discussions surrounding rehabilitation technologies. In practice, it is important for rehabilitation professionals to remember that parents’ and children’s values and beliefs are shaped over time, and parents’ and professionals’ perspectives on disability strongly influence how disabled children internalize what disability means to them.

What is it like to walk with the help of a robot? Children’s perspectives on robotic gait training technology

Abstract Purpose: Robotic gait training is an emerging intervention that holds great therapeutic promise in the rehabilitation of children with neuromotor disorders such as cerebral palsy (CP). Little is known about children and parents’ views on this new technology. The purpose of this qualitative study was to investigate the expectations and experiences of children with CP in relation to robotic gait training using the Lokomat®Pro. Method: An interpretivist qualitative design was employed in which perspectives of children and parents were elicited through separate semi-structured interviews to examine expectations of and experiences with the Lokomat. Results: Four themes related to children’s expectations and experiences using the Lokomat were identified: (1) Not sure what to expect, but okay, I will do it; (2) It’s more than just the Lokomat, it’s the people that make the difference; (3) Having mixed impressions about the Lokomat; and (4) It’s probably helping me, but I don’t really know. Conclusions: Rehabilitation professionals, researchers and parents are encouraged to reflect on why and how one might engage children in gait-related rehabilitation in ways that appeal to children’s desires and expectations. This may shape how interventions are presented to children and how goals and outcomes are framed. Implications for Rehabilitation Children in this study did not consistently feel excited about, have a wish to use, or have a sustained interest in the use of a robotic technology, and at times experienced some anxiety in relation to their participation in the intervention. Contrary to assumptions that disabled children value walking “normally”, children in this study did not express a desire to walk in typical (non-disabled) gait patterns, and equated so-called “normal” walking with their usual walking styles. Thus, we encourage clinicians, researchers and parents to reflect on why, when and how best to engage children in gait-related rehabilitation in ways that appeal to and align with children’s desires and expectations.

A Case Review: Reframing School-Based Practices Using a Critical Perspective

ABSTRACT It is well established in the literature that school-based practice is fraught with challenges such as acquisition of appropriate and sufficient resources, communication barriers among professionals, parental burden, and redundancies and gaps in services. The purpose of this perspective paper is to reframe potentially problematic school-based practices using a critical social science perspective, suggesting a vision and strategies for therapists working in the context of school-based practice. We illustrate our approach with a case example. To reframe school-based practices, we begin with Jills case, exploring it through a critical lens to identify potential issues and opportunities for change. We then trace these findings to our larger dataset from an ongoing program of research to ensure relevance to the broader context of school-based practice. Reframing of three school-based practice issues is discussed from: (a) advocacy by proxy to collaborative dialogue, (b) governing texts to guiding texts, and (c) playing the “right” part to having a voice. Although this is a perspective paper based on a case exemplar, we posit how we may reframe and rethink school-based practices in pediatric rehabilitation. We suggest that only with a genuine shift in our professional values will we see the enactment of collaborative practice in school-based settings.

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient‐Clinician Interactions

Background: Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients’ needs, and attentive to societys influence. Purpose: The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. “Connected” refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. Research Design: The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. Study Sample: The qualitative sampling methods employed were case sampling, purposive within‐case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. Data Collection and Analysis: The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. Results: The clinician case highlighted clinicians’ heuristic‐based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed patients’ perceptions of themselves as technologically competent or incompetent, and descriptions of how they learned to use the new technology. Between cases, the study found a difference in the response to how the connected hearing aid changed the clinician‐patient relationship. While clinicians valued the increased time they spent “getting to know” their patients, patients experienced some frustration specific to the additional troubleshooting related to Bluetooth connectivity. Across cases, there was a resounding theme of “normalization” of hearing aids via their integration with a “normal” technology (mobile phones) and general lack of concern about privacy in relation to the smartphone application and its tracking and geotagging features. Both audiologists and patients credited the connected hearing aids with increased opportunities to participate more fully in everyday life. Conclusions: The introduction of smartphone‐connected hearing aids influenced the identities and candidate profiles of hearing aid users, and the nature of time spent in clinical interactions, in important and interesting ways. The influence of connected hearing aids on patient experience and audiology practice calls for continued research and clinical consideration, with implications for clinical decision‐making regarding hearing aid candidacy. Further study should look critically at normalization and possible unintended stigmatizing effects of making hearing aids increasingly discreet.

Silences around occupations framed as unhealthy, illegal, and deviant

ABSTRACT Occupational science has made tremendous strides in establishing a theoretical and empirical knowledge base grounded in the study of occupation. Yet given its origins in occupational therapy, a health profession aimed at enhancing health and well-being through engagement in meaningful and purposeful occupation, there has been sustained focus on the health-enhancing qualities of occupation. This has effectively silenced a significant realm of human experience: namely, occupations that are considered within dominant worldviews and societal groups to be unhealthy, illegal, and/or deviant. Our intent in this paper is to both explicate why attention to non-sanctioned occupations is an important means to diversify perspectives on occupation, and point to key framing concepts, such as deviance, hegemony, and resistance, for such scholarship. We emphasize that examinations of this nature evoke critical reflection on underlying disciplinary assumptions, enactments of social power, and values and moral standpoints that inform knowledge production in occupational science, helping to diversify understandings of occupation itself.

Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review

Objectives: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. Methods: The scoping review process described by Arksey and O’Malley was used to guide article selection and data extraction. Results: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies (n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families (n = 49). Conclusion: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.