Wenche Schrøder Bjorbækmo

Assessment of everyday functioning in young children with disabilities: an ICF-based analysis of concepts and content of the Pediatric Evaluation of Disability Inventory (PEDI).

Background. Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements. Purpose. To examine the conceptual basis and the content of the PEDI using the ICF. Method. Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached. Results. The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment. Conclusions. Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.

‘I am almost like a fish’: an investigation of how children with congenital heart disease experience and perform movement in daily life

BACKGROUND Because of dramatic medical improvements, most children with congenital heart disease (CHD) survive into adulthood. Nevertheless, they remain in need of long-term health care. Living with CHD implies having diminished aerobic capacity. As far as we know, no previous study within healthcare research has focused on how children with CHD experience movement and activity in daily life. METHODS In order to examine this topic, a qualitative approach was employed that combined both interviews and observation of 11 children between 7 and 12 years of age and interviews with their parents. The theoretical base of the article is inspired by the philosopher Maurice Merleau-Ponty and his theory of movement. We use his descriptions of movement as intentional expressions to illuminate how children with CHD move in daily life. RESULTS The study shows how the children use different strategies to participate in play and that they move to fulfill their first priority: to be together with other children. Despite having limited physical endurance, the children perceive themselves as having the same capabilities as other children and as acting as they do. At the same time, they are not unaware of their own limitations. They adjust and respond to the challenges they face in the different situations to which they are exposed. On one hand, they want others to take their limitations into consideration, while, on the other hand, they do not want others to know about these limitations. CONCLUSIONS In our analysis, we interpret that living with CHD creates situations where the children constantly face their limitations, the gazes of others and their own wish to participate.

Experiences of being tested: a critical discussion of the knowledge involved and produced in the practice of testing in children's rehabilitation.

Intensive professional testing of children with disabilities is becoming increasingly prominent within the field of children’s rehabilitation. In this paper we question the high quality ascribed to standardized assessment procedures. We explore testing practices using a hermeneutic-phenomenological approach analyzing data from interviews and participant observations among 20 children with disabilities and their parents. All the participating children have extensive experience from being tested. This study reveals that the practices of testing have certain limitations when confronted with the lived experience of those who are being tested. Testing seems to transmit the experts’ view of what is important, correct and admirable, and the way in which an individual child fulfills such requirements and fits in with the predetermined standard. Regular testing may result in insecurity on the part of the tested individual, and possibly to a lack of confidence in their body and the way it functions. For the individual being tested the meaning of testing is primarily related to passing or not passing the test requirements. Given the meaning of testing, children with disabilities may experience repeated testing as an ordeal that they are expected to put up with. By illuminating the experiences of the ones exposed to testing, this paper offers new insight for professionals to gauge more accurately the quality of contemporary testing practice.

“A touch of physiotherapy” — the significance and meaning of touch in the practice of physiotherapy

ABSTRACT Touch, while ubiquitous and ever present in the practice of physiotherapy, is conspicuously absent from physiotherapy-related research. Based on a theoretical perspective inspired by phenomenology, this article explores and elaborates on the meaning and significance of touch in the practice of physiotherapy. The research data were generated through 16 close observations conducted in primary care clinics, and through interviews with 9 physiotherapists and with 9 patients suffering from chronic neck problems. The findings revealed how the use of touch in the practice of physiotherapy brings people into proximity in ways more complex than simple skin-to-skin contact. Through nontouch, touch, and movements, physiotherapists invite their patients to participate in the process of creating and performing therapy; dialogue through touch and movement is vital. Touch in physiotherapy depends on the physiotherapist’s embodied skills; those they cultivate in order to respectfully listen to their patients and guide them to explore their own bodily capacity, limits and possibilities. The findings also suggest that observing therapy from outside and from participating in it offer significant different experiences, information, understanding, and meanings. The differences between physiotherapy as observed expression and as lived experience would seem to have important implications for understanding the practice of physiotherapy.

Connectivity: An emerging concept for physiotherapy practice

ABSTRACT Having spent their first century anchored to a biomedical model of practice, physiotherapists have been increasingly interested in exploring new models and concepts that will better equip them for serving the health-care needs of 21st century clients/patients. Connectivity offers one such model. With an extensive philosophical background in phenomenology, symbolic interactionism, structuralism, and postmodern research, connectivity resists the prevailing western biomedical view that health professionals should aim to increase people’s independence and autonomy, preferring instead to identify and amplify opportunities for collaboration and co-dependence. Connectivity critiques the normalization that underpins modern health care, arguing that our constant search for deviance is building stigma and discrimination into our everyday practice. It offers provocative opportunities for physiotherapists to rethink some of the fundamental tenets of their profession and better align physiotherapy with 21st century societal expectations. In this paper, we provide a background to the place connectivity may play in future health care, and most especially future physiotherapy practice. The paper examines some of the philosophical antecedents that have made connectivity an increasingly interesting and challenging concept in health care today.

Clinical reasoning—embodied meaning-making in physiotherapy

ABSTRACT This article examines physiotherapists’ lived experience of practicing physiotherapy in primary care, focusing on clinical reasoning and decision-making in the case of a patient we call Eva. The material presented derives from a larger study involving two women participants, both with a protracted history of neck and shoulder pain. A total of eight sessions, all of them conducted by the first author, a professional physiotherapist, in his own practice room, were videotaped, after which the first author transcribed the sessions and added reflective notes. One session emerged as particularly stressful for both parties and is explored in detail in this article. In our analysis, we seek to be attentive to the experiences of physiotherapy displayed and to explore their meaning, significance and uniqueness from a phenomenological perspective. Our research reveals the complexity of integrating multiple theoretical perspectives of practice in clinical decision-making and suggests that a phenomenological perspective can provide insights into clinical encounters through its recognition of embodied knowledge. We argue that good physiotherapy practice demands tactfulness, sensitivity, and the desire to build a cooperative patient–therapist relationship. Informed by theoretical and practical knowledge from multiple disciplines, patient management can evolve and unfold beyond rehearsed routines and theoretical principles.

Manipulating practices: A critical physiotherapy reader

Physiotherapy with horses and rider-patients builds on communication and interaction through groundwork and mounted work. This chapter discusses outdoor equine-facilitated physiotherapy on green care farms with three patients representing ideal types from the author’s clinical practice. The practice of co-creation and improvisation, i.e. devising, is used to discuss how the triad of physiotherapist, rider and horse, work together to support the rider’s step-by-step changes towards better health. Being with horses facilitates exploration of communicative strategies and embodied ways of being, whilst nature and physical activities add value to the therapeutic benefits. Horses represent risk and desire, as does the facing of bodily constraints or habits. Physiotherapy equinefacil itated phys iother apy 195 aims to facilitate a purposefully created change by playing with daring (out-of-the-ordinary experiences when usual boundaries are pushed) and compassion. Therapist, rider and horse face dares and desire together by experimenting, improvising, and testing new modes of co-being and becoming. The ideas and tools from applied drama (i.e. collaborative creation and contact improvisation) tune human and horse bodies to communication and action. Outdoor practice and devising equip physiotherapists with a larger toolbox for a playful practice.

Which knowledge? An examination of the knowledge at play in physiotherapy with children

ABSTRACT This article explores how knowledge is expressed and enacted in the practice of physiotherapy with children. The empirical material was generated through close observation of seven physiotherapy treatment sessions involving 7 children between 6 and 11 years old and 5 physiotherapists. Observations were undertaken by the first author, whose post-session written notes, along with comments and questions, constitute the database of this article. Through processing and analysis of data, we have written and present three experiential anecdotes as basis for further analysis and discussion. The article shows how children take initiative during therapy and display playful knowledge both of their body, moving capacity and of the equipment and tasks introduced. The physiotherapists seem to tend to emphasize physiological knowledge relating to the body, its functions and the “dangers” of pathological movement patterns. As a result, physiotherapists and child clients appear caught in a kind of stagnant co-existence where their connection and contact are at a standstill and there is little exchange of knowledge between them. We argue that, for therapy with children to develop along qualitative and creative lines, physiotherapists need to explicitly recognize children as humans of knowledge and embrace their playful contributions as significant to therapy.

Long term sick leave, subjective health complaints and sense of coherence, a cross-sectional study

Abstract Background: Long-term work absence is increasing in Western countries. More people suffer from subjective health complaints, such as musculoskeletal pain and depression-like symptoms. Social rights and benefits are based on medical diagnoses; hence large resources are used to identify the biological causes. An alternative approach towards medicalization and diagnosis, like Salutogenesis, with the key factor “Sense of coherence” (SOC) should be approved. Purpose: To explore the level of SOC, anxiety and depression, as well as the associations between SOC and general resistance resources (GRRs) and deficits, in people with subjective health complaints on long term sick leave. Material and methods: Cross-sectional study, including data from 892 participants from the Friskgården (Norwegian health promotion center) database. The questionnaire included the SOC-13, the Hospital Anxiety and Depression Scale and questions about demographics and sick leave. Multivariable linear regression models were used. Results: Participants’ mean (SD) age was 49 (10) years, 70% were women. Mean SOC was 59.4 (13.3). The mean anxiety and depression for all participants were 8.7 (4.4) and 6.2 (3.8) respectively. No difference was found in SOC in participants on sick leave less than, compared with more than one year (p = 0.07). Conclusions: People on long-term sick leave have lower SOC and higher level of anxiety and depression than previously shown in general populations. Large parts of the SOC variation are explained by GRRs and deficits, indicating potentials for improvement by for instance participation in Salutogenic/resource oriented therapy.