Oops, not following Dale Carnegie, 'How to Win Friends and Influence People'.
http://www.mdpi.com/2075-4698/6/2/14/htm
1
Department of Human Ecology, University of Alberta, 302 Human Ecology Building, Edmonton, AB T6G 2N1, Canada
2
Department of Medicine, University of Alberta, Edmonton, AB T6G 2N1, Canada
3
School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montréal, QC H3G 1Y5, Canada
*
Correspondence: Tel.: +1-780-953-5541; Fax: +1-780-492-4821
†
These authors contributed equally to this work.
Academic Editor:
Gregor Wolbring
Received: 24 December 2015 / Accepted: 14 April 2016 / Published: 19 April 2016
Abstract
:
This paper reports on a project that looked at
the meaning stroke survivors assigned to assistive devices. Material
culture theory served as a framework to help stroke survivors explicitly
consider [dis]ability as a discursive object with a socially
constructed meaning that influenced how they thought about themselves
with impairment. Material culture theory informed the design (taking and
talking to their peers about photos of anything that assisted) and
analysis of the meaning of the assistive devices project. In our
analysis of the narratives, survivors assigned three types of meanings
to the assistive devices: markers of progress, symbolic objects of
disability, and the possibility of independent participation. Notably,
the meaning of assistive devices as progress, [dis]ability, and
[poss]ability was equally evident as participants talked about mobility,
everyday activities, and services. We discuss how considering
[dis]ability as a discursive object in the situation might have enabled
stroke survivors to participate.
Keywords:
disability; material culture; stroke; assistive devices1. Introduction
We live in a material culture [1].
Peoples’ clothing, furniture, transportation, music, art, and
technology are chosen to perform a wide range of practical functions,
but they also express an individual’s desired identity, as well as the
individual’s position and class in society [2,3].
Objects have symbolic authority: “it is difficult to imagine a king
without a throne, a judge without a bench… they are literally clothed
with the vestment of the positions (p. 15)” [4]. As well, the meaning of all material and discursive objects are continually being created discursively through interactions [5].
In other words, the meaning of the king and the judge has changed with
time and as the culture has changed. Meaning (material, social,
cultural, linguistic) is a process, not a static product [1,5].
Accordingly, [dis]ability is constantly being defined through the
bodily, social, and material cultural experiences of persons within
their contexts [6,7].
External
objects such as assistive devices can become vestments of self-image
for people with bodily impairments ([dis]abilities). Assistive devices
are the products, tools, or devices that facilitate participation in
desired activities [8,9].
At their best, specialized assistive devices should increase ability by
increasing independence, improving quality of life, and reducing the
physical and attitudinal barriers between people with and without
impairments [10,11].
Correspondingly, assistive devices can contribute to [dis]ability by
setting people apart from others and making them feel different [12,13].
People with impairments are subjected to disabling societal attitudes
that view them as less valuable, lazy, and/or objects of pity [14,15].
Assistive devices can become part of a person’s self-image, in effect
increasing embarrassment, their felt stigma, and exerting a negative
impact on one’s self-image [16,17].
While participation may be demanding or even impossible without assistive devices [18],
consumers will abandon assistive devices prescribed by health
professionals. Abandonment or non-use rates range from 30% in a study of
227 people with a variety of impairments [19]
to 76.7% of 126 adults with neurological, lower extremity orthopedic,
or complex medical conditions discharged from inpatient-rehabilitation [20].
Abandonment has been attributed to changes in needs (recovery or
additional impairment), devices that are not suited to needs (heavy,
awkward) [17,21,22] or because the device draws unwanted attention or increases stigma [16].
Only the person using assistive devices can estimate the capacity of
those assistive devices to enhance their ability or increase disability.
Consumer involvement, i.e.,
actively seeking consumers’ experience and opinions, is recommended as
the route to a better match between assistive technology and users [18,19,20,23].
Consumers are more likely to use assistive devices if: (1) their
opinion is included in the selection of their devices; (2) the device is
easy to obtain, reliable, comfortable, and easy to use; (3) the device
contributes to personally meaningful activity or self-image; and (4) the
device continues to meet consumers’ needs [19,23].
When people with disabilities are given the opportunity to assess their
own needs and determine what assistive devices would work best for
them, they are less likely to abandon their assistive devices. Involving
people in the design, selection, and evaluation of adaptive devices can
also be empowering [9].
Health literacy (knowledge about condition, treatments),
self-confidence, ability to communicate, and participation in society
(activities outside the home, e.g., volunteering) all increase when
people are engaged [24,25,26].
The
purpose of this paper is to report on employing material culture theory
as a framework to help stroke survivors explicitly consider
[dis]ability as a discursive object with socially constructed meaning
that influences how they think about themselves with impairment.
Discursive objects, i.e., words in
conversations or texts, have cultural meanings that make a particular
response contingently relevant in the situation [27].
Frequently, stroke survivors are unaware of the constructedness of this
meaning and the possibilities of thinking about themselves and their
environmental contexts in other ways. In specific terms, we report on a
project that looked at the meaning stroke survivors assigned to
assistive devices. The paper is organized into four sections. First, we
situate this meaning of the assistive devices project into the “Getting
on With the Rest of Your Life after a Stroke” intervention. Second, we
describe material culture as an approach to enable stroke survivors to
clearly understand how the meaning they attach to [dis]ability has
consequences for how they “got on” with their post-stroke lives. Third,
we proceed with the study’s methodology; report on the project in which
participants discussed the meanings they attach to assistive devices;
and outline participants’ evaluations of the project. Finally, we
discuss how considering [dis]ability as a discursive object in the
situation might have enabled stroke survivors to participate.
Full paper at the link. Only 40 references so your doctor should know about all of them
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