Psychosocial Aspects of Physical Rehabilitation

Disability and Adjustment

Disability can be likened to the proverbial iceberg: the onlooker can only see the tip, whereas the entity itself contains more hidden aspects of its being than are revealed on the surface. An expression of physical pain or the absence of normal sense experiences, the lack of sensory input or motor output, a missing or dysfunctional limb or structure, and other such reflections of loss are just the surface structure of physical disability.

Yet, these are the major domains that traditionally have been addressed when dealing with physical disability. All of the uniquely combined thoughts and feelings that the individual has gathered during a lifetime of personal experiences shape that individual’s perception of disablement.

The factors that shape individual reactions include the set of values, directions, and prohibitions taken on by the individual. These combine with innate and acquired drives, needs, and experiences to create an individual unique perceptual mode and form an individualized cognitive base. It is through this that the individual has learned to see the self and the surrounding world.

The resultant self-image, whether conscious or unconscious, organizes the stage and creates a set of values and expectations by which one measures oneself and one’s worth. It becomes the compass with which one steers through life and guides relationships, and the framework that structures the goals and foundations of one’s individualized world.

Through this process, a method of coping and functioning emerges – the style of coping through which one recognized the self. Then suddenly, or gradually, depending on the nature and extent of a disablement, the lifelong foundation and structure of that “self” become damaged and weakened by the impact of the disability, oftentimes to the point of total collapse.

The disabling condition as well as the perception of it disrupts the structure that had been so carefully erected. Rules and roles change; relative independence and the ability to perform the essential tasks of living are gone, or perceived as such. The ability to give and take love, care, affection, and support is diminished or lost. Relative financial stability and security may vaporize into thin air.

Intellectually, orthopedic specialists and other healthcare personnel can understand the trauma and may even be sensitive enough to feel some of it. They may associate the patients’ suffering with recollections of some pain or loss experiences they have personally experienced. The physical therapist, for instance, working towards the goal of rehabilitating a client, needs to be cognizant of the possibility that adjustment to the actual physical disability may not be the most difficult adjustment for the patient.

The individual will most likely have a more difficult task adjusting to new perceptions about him or herself and the societal attitudes toward the disability. These factors and the individual’s reactions to the new situation will most likely impact on the overall adjustment, the rehabilitation treatment process, and its outcome.

Ignoring this probability may lead to a serious level of interference with or complication of the therapeutic outcome. An awareness of these issues can prevent or minimize their interference and enable the clinician to mobilize the very same factors in the service of the rehabilitative effort.

Adaptation: A Survival Modality

Living is a constant ongoing adjustment and adaptation process encompassing different operating levels of an organism and its life space. This process is active at the physiologic, physical, psychologic, and social levels. Although there are indeed significant differences among these aspects of functioning, we should keep in mind that they are but part of an entity that functions as an integrated whole. Any separation between levels and parts of an individual’s system is an artificial convenience, because no part within the person is independent of the rest of that individual.

Psychologic adjustment is accordingly part and parcel of overall adjustment in general, rather than a separate independent entity. There are many aspects of the dynamic, interactive, and ongoing process of an individual’s adaptation within the context of total life space. This life space includes, among others

  1. the body total with its various genetic, electrochemical, hormonal, and neurologic configurations,
  2. innate instinctual drives, as well as conditioned mental mechanisms,
  3. sociocultural, spiritual, and ethnic beliefs and value systems as well as socioeconomic realities of the time and place in which a person interacts, and
  4. the historic-mythologic, philosophic-ideologic, or even imagined-delusional image that one feels part of and is influenced by.

Lastly, a person’s disability is to a large extent directly related to the way that he or she perceives the condition. The extent of a disability will increase if the focus is on deficiencies rather than assets. Much of such focusing depends on the premorbid makeup of an individual, his or her coping repertoire, and on the cultural perception of the disabling situation.

The interaction of these factors will determine the adjustment to the disablement.

Cedric Loiselle is an experienced writer who enjoys imparting useful information to many readers. The topics he usually writes about include business and finance, health, and home improvement.