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Adult educators’ role in the rehabilitation of physically disabled adults 1974

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ADULT EDUCATORS' ROLE IN THE REHABILITATION OF PHYSICALLY DISABLED ADULTS by MARIE-LOUISE HOLDEN B . S c , U n i v e r s i t y of B r i t i s h Columbia, 1968 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n the Facu l t y of Educat ion We accept t h i s t h e s i s as conforming to the requ i red standard THE UNIVERSITY OF BRITISH COLUMBIA June, 1974 In presenting t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s understood that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission. Department of Educat ion Facu l ty o f Educat ion The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8 , Canada J u l y 3 1 , 1974 i ABSTRACT The purposes o f t h i s study were to i n v e s t i g a t e the psychosoc ia l needs o f the c h r o n i c a l l y d i sab led and t o determine the ex tent t o which the a d u l t educator could f u r t h e r expand the educa t iona l o p p o r t u n i t i e s which could p a r t i a l l y f u l f i l l these needs. Due t o l i m i t e d research by a d u l t educators i n t h i s f i e l d , most of the l i t e r a t u r e i n v e s t i g a t e d and c o n s u l t a t i o n s conducted were i n o ther d i s c i p l i n e s . I n the chron ic care f i e l d , medical personnel were v i s i t e d , extended care and r e h a b i l i t a t i o n cent res were i n s p e c t e d , d i sab led persons were i n t e r v i e w e d , and f a c i l i t i e s f o r the d i s a b l e d at u n i v e r s i t i e s i n Vancouver, B.C. were s t u d i e d . F i n a l l y , a four -month f i e l d study was undertaken a t an extended care h o s p i t a l i n V i c t o r i a , B.C. The f i e l d s tudy fo l l owed "A Model f o r Research and E v a l u a t i o n on R e h a b i l i t a t i o n " proposed by Suchman. The l i t e r a t u r e revealed t h a t the number o f p h y s i c a l l y d isab led has increased i n t h i s century w i t h a cor responding r i s e i n t h e i r psychosoc ia l needs. I n prev ious c e n t u r i e s the numbers o f c h r o n i c a l l y d i s a b l e d were few and the medical o r i e n t a t i o n was towards the p h y s i c a l aspect o f d isease. This p r a c t i c e has p e r s i s t e d to the present day. Owing to these increases and to the f a c t t h a t t h e r e appears t o be i n s u f f i c i e n t t ime f o r the complete care o f the p a t i e n t , both p h y s i c a l and p s y c h o s o c i a l , the psychosoc ia l needs cannot be adequately met by phys ic ians and nurses. These needs are now recogn ized , and they appear t o be predominate ly s o c i a l . S o c i o l o g i s t s and a d u l t educators should p a r t i c i p a t e to prevent these needs f rom becoming p s y c h o l o g i c a l . i i Three f a c t o r s t h a t may determine the outcome o f r e h a b i l i t a t i o n a r e : M o t i v a t i o n , goals and i n t e g r a t i o n and these aspects are i l l u s t r a t e d i n the case h i s t o r i e s s t u d i e d . The a d u l t educators must recognize the importance of t h e i r r o l e i n ach iev ing these f a c t o r s w i t h the d i s a b l e d . Un l i ke Sweden, no comprehensive e f f o r t has been made i n Nor th America t o p rov ide educat ion f o r the d i s a b l e d . Some u n i v e r s i t i e s and a d u l t educa t iona l f a c i l i t i e s have been mod i f i ed and serv ices supp l ied to the d isab led but few a d u l t educators o f f e r se rv ices t o these people ou ts ide of i n s t i t u t i o n s and yet the va lue of educa t i on , whether i t be f o r se l f -en r i chmen t or v o c a t i o n a l r e h a b i l i t a t i o n , cannot be overemphasized. Even i n the b r i e f f i e l d study a t S t . Mary 's Extended Care H o s p i t a l the b e n e f i t s o f adu l t educat ion i n a i d i n g r e h a b i l i t a t i o n were demonstrated. I t i s concluded t h a t t he re might be two main causes f o r t h i s o v e r s i g h t by a d u l t educators . The f i r s t i s t h a t t he re i s no i n c l u s i v e r e g i s t r y o f d i s a b l e d , t h e r e f o r e , the ex ten t o f the problem might not be apparent . The second i s t h a t t h e r e are no courses f o r a d u l t educators on the medical problems o f the d isab led and a d u l t educators are thereby i l l - p r e p a r e d to a s s i s t i n r e h a b i l i t a t i o n . I t i s recommended t h a t the P r o v i n c i a l Government r e g i s t e r a l l the d i s a b l e d ; t ha t the Canadian Adu l t Educat ion A s s o c i a t i o n f a m i l i a r i z e i t s members w i t h t h i s problem; and t h a t i t suggest f u r t h e r research and study i n t h i s a rea . Courses should be organized by Cont inu ing Educat ion Departments a t U n i v e r s i t i e s , Co l leges , Adu l t Educat ion Centres o r by Correspondence. i i i Adu l t Educat ion Research Centres should f u r t h e r exp lo re the r o l e of adu l t educators i n the f i e l d . Adu l t Educat ion Departments should s t ress the removal of a l l p h y s i c a l b a r r i e r s f rom e d u c a t i o n a l f a c i l i t i e s . Correspondence courses and personal con tac ts should be i n i t i a t e d and main ta ined i n the home by the a d u l t educator o r v o l u n t e e r . Counse l l i ng i n regard t o a d u l t educa t ion should a lso be a v a i l a b l e . The above recommendations would make i t p o s s i b l e f o r a d u l t educators to c o n t r i b u t e t o the r e h a b i l i t a t i o n o f the d i s a b l e d . i v ACKNOWLEDGEMENT S In appreciation for the guidance given by Dr. James E. Thornton, for the in t e r e s t shown and assistance given by Miss Marilyn Dutton and Mr. Paul Thiele and to Mrs. Vera Mclver R.N., Miss Margaret Hood, Doctor Peter Bunton and a l l personnel i n the health care f i e l d who contributed to my further understanding of the problems of the ph y s i c a l l y disabled. And p a r t i c u l a r appreciation to a l l those p h y s i c a l l y disabled who pa r t i c i p a t e d i n t h i s study and whose patient and cheerful responses made the wr i t i n g of t h i s thesis a most rewarding experience; DEDICATION v i TABLE OF CONTENTS PAGE ABSTRACT i ACKNOWLEDGEMENTS i v DEDICATION v CHAPTER I. INTRODUCTION 1 A. Problem under Study 2 B. How the Problem Developed 3 C. The Purpose of the Study 6 D. Li m i t a t i o n of the Study 6 E. D e f i n i t i o n of Terms . 7 F. Methodology 8 G. Plan of the Study 8 Footnotes 10 II . PSYCHOSOCIAL NEEDS OF THE PHYSICALLY DISABLED 11 A. The Needs of a Patient with a Chronic D i s a b i l i t y 11 B. The Relationship of Physicians i n the Care of the Chronic 13 C. The Relationship of Nursing Personnel i n the Care of the Chronic 15 D. The Involvement of So c i a l S c i e n t i s t s i n the Care of the Chronic 17 E. Summary 19 Footnotes 21 v i i CHAPTER PAGE I I I . FACTORS IN THE REHABILITATION OF THE PHYSICALLY DISABLED 23 A. Motivation i n the Disabled 23 B. Goals for the Disabled 25 C. Integration f o r the Disabled 29 D. Summary 34 Footnotes 36 CHAPTER IV. EDUCATIONAL PROGRAMMES FOR THE PHYSICALLY DISABLED 38 A. Post Secondary Education Programmes 39 1 . U n i v e r s i t i e s and Colleges i n Sweden 39 2. U n i v e r s i t i e s i n the U.S.A 39 U n i v e r s i t y of Missouri at Columbia 39 U n i v e r s i t y of I l l i n o i s and Southern I l l i n o i s U n iversity 40 U n i v e r s i t y of C a l i f o r n i a at Berkeley 41 3. U n i v e r s i t i e s i n Canada 41 University of Alberta, Edmonton, Alberta 41 Simon Fraser U n i v e r s i t y Burnaby, B.C 41 U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B.C 42 43 B. Adult Education Programmes 43 1 . North America 2. England 46 3. Sweden 48 v i i i C. Summary 49 Footnotes 51 CHAPTER PAGE V. CHRONIC CARE PHILOSOPHY IN PRACTICE 54 A. F i r s t Study i n 1969 i- 55 B. Second Study i n 1973 55 1. Use of Educational Process 55 2. Use of a Model for Assessment 58 3. D i v i s i o n of Study into Four Phases .. 58 4. Report On Hospital i n Phase I 59 5. Report on Residents Assigned i n Phases I I , I I I & IV 62 6. Follow-up Report on Residents Assigned 68 7. Conclusion of the Study 68 C. Summary 70 Footnotes 74 VI. CONCLUSIONS AND RECOMMENDATIONS 76 A. Conclusions 76 B. Recommendations 80 1. P r o v i n c i a l Government 80 2. Canadian Adult Education Association 80 3. Adult Education Departments 80 4. University of B r i t i s h Columbia ... 81 Footnotes 83 i x PAGE B ib l i og raphy 84 CHAPTER I INTRODUCTION P r i o r to the twentieth century, the physical needs of the i l l were emphasized but a f t e r the turn of the century, other needs of the i l l were given increased attention, r e s u l t i n g i n s o c i a l s c i e n t i s t s becoming ac t i v e i n the health care f i e l d . During the f i r s t h a l f of t h i s century, t h e i r e f f o r t s concentrated on s a n i t a t i o n and contagious disease c o n t r o l . As these conditions have l a r g e l y been brought under c o n t r o l , s o c i a l s c i e n t i s t s have dire c t e d t h e i r a ttention from the physical to psychosocial aspects of disease."*" Ling and O'Malley point out that t h i s psychosocial concept of disease i s not new, having i t s o r i g i n with Hippocrates, and that i t 2 has been a l t e r n a t i v e l y emphasized and neglected. It appears never to have been emphasized as much as i n t h i s century because of the growing number of disabled r e q u i r i n g long term care. Along with the increase i n research i n the psychosocial aspects of disease by s o c i o l o g i s t s , psychologists and s o c i a l anthropologists, the emergence of adult educators i s noted among the s o c i a l s c i e n t i s t s interested i n the health care f i e l d . At some u n i v e r s i t i e s physical modifications and s p e c i a l f a c i l i t i e s , have made i t possible f o r wheel-chair students and b l i n d students to attend. At the University of B r i t i s h Columbia, for example, a s p e c i a l l i b r a r y for students with sight defects and perceptual d i f f i c u l t i e s makes i t unique i n North America. - 2 - Although some educational f a c i l i t i e s are av a i l a b l e i n chronic care h o s p i t a l s and two minor f i e l d studies i n adult education have been undertaken i n one, there does not appear to be a co-ordinated programme by adult educators to p a r t i c i p a t e i n the education of the disabled i n North America. A. PROBLEM UNDER STUDY The physical needs of the c h r o n i c a l l y disabled appear, f o r the most part, to be recognized and adequately met by the medical profession but the psychosocial are not. "Even the p r a c t i t i o n e r ' s t r a d i t i o n a l o r i e n t a t i o n and involvement with the patient and h i s professional reward system may require considerable r e s t r u c t u r i n g as treatment extends not only temporally, but sociopsychologically as 3 w e l l " , Litman states. Also, the government programmes concentrate on vocational r e h a b i l i t a t i o n and employability. Therefore, the psychosocial needs of the c h r o n i c a l l y disabled appear to be overlooked and educational opportunities are not being extended, on an equal basis to a l l who are disabled. "In short, unless a handicapped person i s capable of leaving h i s home, has some means of transportation, can attend a school with no a r c h i t e c t u r a l b a r r i e r s to h i s mobili t y , has no great p h y s i c a l problems which render him 'undesirable' i n the classroom, has no major problem i n communication and has unusual drive and motivation, he i s not very 4 l i k e l y , at present, to be educated." - 3 - B. HOW THE PROBLEM DEVELOPED I n t h i s century we are conf ron ted w i t h growing numbers o f i n j u r i e s i n c u r r e d i n war, i n d u s t r y and t r a f f i c . Advances i n medicine have made i t poss ib le t o su rv i ve many>e acc idents and i l l n e s s e s . Th is i s exemp l i f i ed i n the s t a t i s t i c s t h a t the Uni ted States p o p u l a t i o n has grown by about 2 . 5 - f o l d s ince the t u r n o f the century but the p o p u l a t i o n o f o lde r persons has grown by 7 - f o l d i n the same t ime and i s a c c e l e r a t i n g . Among these s u r v i v i n g acc idents and i l l n e s s e s are m i l l i o n s of people who s u f f e r d i s a b i l i t y . I n the Un i ted S t a t e s , i t i s es t imated t h a t the re are 25,620,000 d i s a b l e d 6 and i n Canada, 2 , 5 0 0 , 0 0 0 . 7 The t rend i s e x e m p l i f i e d by the t o t a l number of members (See F igure 1 ) , the number o f new i n j u r i e s r e s u l t i n g i n d i s a b i l i t y (See Figure 2) and a char t of new i n j u r i e s (See F igure 3 ) , showing major causes, i n the 1972 Annual Report of the Canadian Parap leg ic A s s o c i a t i o n , B r i t i s h Columbia D i v i s i o n . I t i s t o be noted t h a t the b u l k o f new cases were the r e s u l t o f motor v e h i c l e and i n d u s t r i a l a c c i d e n t s , the former p redominat ing . Among the members l i s t e d i n 1971 were 230 non d i sab led and 927 d i s a b l e d . Thus a f f l u e n t s o c i e t i e s o f t e n not on ly produce a h igh l e v e l of w e l f a r e r e s u l t i n g i n improved medical and s o c i a l b e n e f i t s , but a lso an increased f l o w o f t r a f f i c r e s u l t i n g 8 i n more d i sab led people. Figure 1 A Membership Graph Canadian Parap leg ic A s s o c i a t i o n B. C. D i v i s i o n Number o f Members NO 00 ON O rH CM co < t LO NO 00 ON O rH CM m LO u-i NO NO NO NO NO NO NO NO \D NO ON ON ON O l ON ON ON ON ON ON ON ON ON ON ON ON ON rH T—1 rH rH H H rH rH rH rH rH rH rH rH rH rH rH Year Number o f Persons *Source: Canadian Paraplegic A s s o c i a t i o n B r i t i s h Columbia Annual Report 1972 Figure 2 New I n j u r y Growth Year Parap leg ics and Quadr ip leg ics i n B r i t i s h Columbia CM CO < f LO NO 00 ON O rH CM NO NO NO NO vO NO NO NO ON ON ON ON ON ON ON ON ON ON ON rH rH rH rH rH rH rH rH rH rH rH - 5 - FIGURE 3 New Inj u r i e s Chart 1972 Paraplegics and Quadriplegics i n B r i t i s h Columbia CD TYPES o rH CD cd a OF CD •H r4 CD cfl rH i—i 4J CD CO rH rH rH u o CO 4J CO cfl CD DISABILITY cfl CU O -H 3 5-1 rH 0) o 4-1 rH 4-> XI O rH CO CO O O CD C P< n) •H •H H fx< S > M C/3 Pn Q PARAPLEGICS 54 45 9 19 15 1 6 4 8 QUADRIPLEGICS 25 22 3 13 6 4 3 - - TOTAL 79 67 12 32 211 5 9 4 8 Source: Canadian Paraplegic Association B r i t i s h Columbia D i v i s i o n Annual Report 1972 - 6 - C. THE PURPOSE OF THE STUDY The purposes o f t h i s study are t o i n v e s t i g a t e the psychosoc ia l needs of the c h r o n i c a l l y d isab led and t o determine the ex ten t t o which the a d u l t educator can f u r t h e r expand the educa t iona l o p p o r t u n i t i e s which w i l l p a r t i a l l y f u l f i l l these needs. The study w i l l p o i n t out how psychosoc ia l needs o f t e n become predominant over p h y s i c a l and are o f t e n inadequate ly d e a l t h w i t h i n the l o n g - t e r m d i sab led p a t i e n t s . I t w i l l i l l u s t r a t e how a d u l t educators can a s s i s t and have ass i s ted the d i sab led i n educa t iona l f a c i l i t i e s , a t home or i n h e a l t h care f a c i l i t i e s i n Nor th Amer ica, England and Sweden. I t w i l l i n d i c a t e t h a t i f a d u l t educators are to a s s i s t competent ly i n the r e h a b i l i t a t i o n f i e l d , they must undertake s tud ies d i r e c t e d by exper ts such as p s y c h i a t r i s t s , medical s o c i o l o g i s t s and occupa t iona l t h e r a p i s t s . And i t w i l l i l l u s t r a t e the va lue o f f i e l d s tud ies f o r a d u l t educators i n order t h a t they can apply the t h e o r e t i c a l knowledge rece ived and ga in the exper ience necessary to understand and a i d the d i s a b l e d . D. LIMITATION OF THE STUDY There has been l i t t l e research by a d u l t educators w i t h the d i s a b l e d , t h e r e f o r e most of the l i t e r a t u r e i n v e s t i g a t e d and i n t e r v i e w s conducted were i n o ther d i s c i p l i n e s . Often the va lue o f educat ion i n the r e h a b i l i t a t i o n o f the d isab led i s recognized but the v iewpo in t o f educators , i n t h i s p a r t i c u l a r a r e a , i s l a c k i n g . - 7 - E. DEFINITION OF TERMS The f o l l o w i n g d e f i n i t i o n s are s p e c i f i e d f o r t h i s s tudy as d i f f e r e n t connota t ions are suggested i n the l i t e r a t u r e . D i s a b i l i t y : Handicap: Psychosocia l Factors A d i s a b i l i t y i s any p h y s i c a l impairment wh ich , though i t may impede, w i l l not be an obs tac le t o an i n d i v i d u a l ' s achievement o f a s p e c i f i c goal or goa l s ; A handicap i s a p h y s i c a l impairment which i s an obs tac le to an i n d i v i d u a l ' s achievement o f a s p e c i f i c goal or goa ls . The term psychosoc ia l i nc ludes p s y c h o l o g i c a l and s o c i o l o g i c a l f a c t o r s as a s i n g l e e n t i t y which are i n e x t r i c a b l y in te rwoven. R e a l i t y o r i e n t a t i o n i s a technique designed to re-educate a person who shows s igns o f memory l oss and con fus ion f o l l o w i n g an acc ident or an i l l n e s s . At i t s s imples t fo rm, i t uses c e r e b r a l f u n c t i o n s t h a t are s t i l l 9 i n t a c t . R e h a b i l i t a t i o n : R e h a b i l i t a t i o n takes p lace when there i s recovery t o the maximum t o which a person i s capable of f u n c t i o n i n g . R e a l i t y O r i e n t a t i o n : - 8 - F. METHODOLOGY Personnel and d isab led persons at extended care h o s p i t a l s , r e h a b i l i t a t i o n cent res and u n i v e r s i t i e s , and at home and work were i n t e r v i e w e d . F a c i l i t i e s f o r the d i sab led a t u n i v e r s i t i e s i n Vancouver, B.C. were s t u d i e d . A four month f i e l d study was undertaken a t an extended care h o s p i t a l i n V i c t o r i a , B.C. There were f i v e sub jec ts i nvo lved i n the study and th ree d i f f e r e n t educa t iona l processes were used as i n t e r v e n i n g v a r i a b l e s i n t h e i r r e h a b i l i t a t i o n . There were two o f these people t a k i n g correspondence courses, two p a i n t i n g and one p r a c t i c i n g bas ic p r i n t i n g , coun t ing and r e a d i n g . The study fo l l owed "A Model f o r Research and Eva lua t i on on R e h a b i l i t a t i o n " proposed by Suchman. G. PLAN OF THE STUDY The needs of the c h r o n i c a l l y i l l , the a t t i t u d e of phys ic ians and n u r s i n g pe rsonne l , and the i nc reas ing involvement o f s o c i a l s c i e n t i s t s i n the care of the c h r o n i c a l l y i l l are discussed i n Chapter I I . I n Chapter I I I , the study then cons iders some key f a c t o r s and the r o l e of educat ion i n the r e h a b i l i t a t i o n of the d i s a b l e d . The importance o f m o t i v a t i o n , goals and i n t e g r a t i o n are discussed and case h i s t o r i e s are o u t l i n e d . I n Chapter I V , u n i v e r s i t y e f f o r t s of some u n i v e r s i t i e s which have mod i f i ed campuses to overcome p h y s i c a l b a r r i e r s and which have - 9 - supp l ied necessary se rv ices f o r the d i sab led are considered and a d u l t educa to rs ' c o n t r i b u t i o n and p r e p a r a t i o n i n the r e h a b i l i t a t i o n o f the d isab led are assessed. F i e l d s tud ies at an extended care h o s p i t a l are discussed i n Chapter V. Case s tud ies about educa t iona l e f f o r t s w i t h p a t i e n t s are presented. I n Chapter V I , f i n a l l y , conc lus ions and recommendations are submit ted about the a d u l t educators ' r o l e i n the r e h a b i l i t a t i o n o f the c h r o n i c a l l y d i s a b l e d . - 10 - CHAPTER I FOOTNOTES "'"Gerald Gordon et a l . , Disease, the Individual and Society, (New Haven, Conn.: College and University Press, 1968), pp. 10-89. 2 Thomas M. Ling and C.J.S. O'Malley, R e h a b i l i t a t i o n a f t e r I l l n e s s and Accident, (London: B a l l i e r e , T i n d a l l and Cox, 1958), pp. 5-9. 3 Theodor J . Litman, "Introduction", i n The Sociology and So c i a l Psychology of D i s a b i l i t y and R e h a b i l i t a t i o n , (New York: Random House, 1970), Constantine S a f i l i o s - R o t h s c h i l d , pp. x - x l . 4 L o u i s F. Saylor, "Residential Care Needs: A Report to the C a l i f o r n i a State L e g i s l a t u r e " , ERIC Research i n Education, Vol. 6, No. 1 (January 1971) : 43. "*C. E i s d o r f e r , "A Philosophy for Extended Care", Seminar on Extended Care. (Vancouver, B.C.: B r i t i s h Columbia Hospitals' Association, 26-27 February 1973), p. 4. President's Task Force on the P h y s i c a l l y Handicapped, "A National E f f o r t for the P h y s i c a l l y Handicapped", ERIC Research i n Education, Vol. 6, No. 7 (July 1971): 30. 7Voluntary Association f o r Health and Welfare of B r i t i s h Columbia, Report of the Committee on A r c h i t e c t u r a l B a r r i e r s i n Respect to Building Standards for the Handicapped 1970. Supplement No. 5 to the National Building Code of Canada, p. 10. Q Bengt Mollstedt, Public Health i n Sweden, (Stockholm: The Swedish I n s t i t u t e , 1972), p. 31. American P s y c h i a t r i c Association, R e a l i t y Orientation (Washington, D.C.: American.Psychiatric Association, 1969), p. 2. "^Edward A. Suchman, "A Model for Research and Evaluation on R e h a b i l i t a t i o n " , i n Marvin B. Sussman (ed.), Sociology and R e h a b i l i t a t i o n ; (Washington, D.C. : American S o c i o l o g i c a l Association, 1965), pp. 52-70. CHAPTER I I PSYCHOSOCIAL NEEDS OF THE PHYSICALLY DISABLED The needs of a person w i t h a ch ron ic d i s a b i l i t y o f t e n d i f f e r f rom those o f a person w i t h an acute i l l n e s s . Usua l l y the same p h y s i c a l and psychosoc ia l needs are p resen t , however, the emphasis i s changed. I n the care of the c h r o n i c a l l y i l l the psychosoc ia l needs are o f t e n predominant. Phys ic ians and nurses are main ly occupied w i t h c a r i n g f o r the p h y s i c a l needs of the p a t i e n t , however, as a r e s u l t , the psychosoc ia l needs, p a r t i c u l a r l y of the l ong - te rm d i s a b l e d , are o f t e n not met. Therefore s o c i a l s c i e n t i s t s are becoming more invo lved i n the h e a l t h care f i e l d . A. THE NEEDS OF A PATIENT WITH A CHRONIC DISABILITY When a person s u f f e r s an i l l n e s s or i n j u r y which i s o f comparat ive ly shor t d u r a t i o n and has few, i f any, r e s i d u a l e f f e c t s , t he re i s l i t t l e adjustment necessary. A l though the d i s a b l i n g f a c t o r may be p a i n f u l , cause expense and w o r r y , and d i s l o c a t i o n f rom f a m i l y , f r i e n d s and work, i t w i l l u s u a l l y be o f temporary d u r a t i o n and the person can f o r e s e e , w i t h a reasonable degree o f s u r e t y , h i s r e t u r n to h i s former way of l i v i n g . Th is i s h i s goal and a lso t h a t o f the medical team c a r i n g f o r h im. The c l a s s i c h o s p i t a l model o f care has i t s emphasis on the acute phase of an i l l n e s s , on shor t term acute care where the p a t i e n t ' s s e l f r e l i a n c e i s not encouraged."*" Th is i s the acute care phi losophy (See Phase 1 of F igure 4 ) • I t recognizes t h a t psychosoc ia l needs are always present i n a l l people and increase i n t imes o f s t r e s s , such as i l l n e s s or i n j u r y . But i n t h i s phase they u s u a l l y do not a t t a i n the s i g n i f i c a n c e o f p h y s i c a l needs. For example, a t t h i s s tage , the psychosoc ia l needs are met by v i s i t s of r e l a t i v e s and f r i e n d s , by the knowledge he w i l l be r e t u r n i n g t o h i s home and t o h i s work. He views h i s present p l i g h t as on ly a temporary inconvenience. An i l l n e s s t h a t i s of longer d u r a t i o n may be approaching a chron ic or t e r m i n a l phase and psychosoc ia l and p h y s i c a l needs w i l l o f t e n v i e f o r impor tance; an awareness o f l o s s and p h y s i c a l d i scomfor t w i l l n e c e s s i t a t e an ad- jus tment to b o t h . This r e q u i r e s a long term acute care ph i losophy (See Phase 2 of F igure 147) . F i n a l l y , an i l l n e s s o f long d u r a t i o n enters the chron ic phase. Except f o r t e r m i n a l i l l n e s s , Wesson exp la ins t h a t as the chron ic phase o f an i l l n e s s man i fes ts i t s e l f the emphasis should be on r e h a b i l i t a t i v e care where m o t i v a t i o n to master d i s a b i l i t i e s must be mob i l i zed and where the p a t i e n t takes an a c t i v e p a r t i n a j o i n t endeavour 2 w i t h the s t a f f . This i s the chron ic care ph i losophy (See Phase 3 o f F igure A1)- For the p a t i e n t f u r t h e r adjustment i s necessary and psy- chosoc ia l needs may become predominant as he recognizes t h e r e w i l l be no r e t u r n to the s t a t u s quo of h i s l i f e p r i o r to d i s a b i l i t y . - -13 - FIGURE 4-? PHASE 1 HEALTH CARE* PHASE 2 PHASE 3 Acute Care Philosophy PHYSICAL CARE Psychosocial Care Long Term Acute Care Philosophy PHYSICAL CARE PSYCHOSOCIAL CARE Care _̂  Chronic Care Philosophy PSYCHOSOCIAL CARE Physical Care Categories are r e v e r s i b l e , for an acute i l l n e s s may develop into a chronic phase and chronic i l l n e s s may develop an acute phase, chronic phas If we are to achieve a balanced environment when developing psychosocial care programmes for the disabled, the emphasis must be on the s o c i a l needs. Although between 34.6%and 43.7 percent of male and female claimants f o r d i s a b i l i t y b enefits i n a sample of phy s i c a l d i s a b i l i t y benefits i n the United States showed an elevation i n the neurotic t r i a d (hypochondriasis, depression and hysteria) and had 3 moderate to severe psychoneuroses or personality disorders , Wright states that the disabled do not present as many psychological problems as believed. The problems are of s o c i a l o r i g i n a f f e c t i n g the psycholo- 4 g i c a l adjustment of the i n d i v i d u a l . . B. THE RELATIONSHIP OF PHYSICIANS IN THE CARE OF THE CHRONIC For the decade 1963-1973, Dr. Szasz, the Director of the - 14 - D i v i s i o n o f I n t e r p r o f e s s i o n a l Educat ion o f the U n i v e r s i t y o f B r i t i s h Columbia, s ta ted t h a t the psychosoc ia l needs were being recognized more by the medical p r o f e s s i o n . yButh<al<t%otfgtf'the'f'e laftfeam©ieaMU«siib:l'ed*'pe'rsons and improved r e h a b i l i t a t i o n techniques f o r them, most phys ic ians are t r a i n e d i n the p h y s i c a l environment. And, i n regard to p a t i e n t s , phys ic ians are drawn to acute care p a t i e n t s , r a t h e r than c h r o n i c , i n which the re i s more l i k e l y to be monetary reward and persona l s a t i s f a c t i o n . There fo re , i t would appear t h a t t he re i s s t i l l a cons iderab le l a g i n f u l f i l l i n g the psychosoc ia l needs o f p a t i e n t s . I n the case of the a c u t e l y i l l t he re may hot be as many psychosoc ia l needs as i n the case o f the c h r o n i c a l l y i l l . I n the Uni ted States i t was found t h a t the c h r o n i c a l l y d i sab led fa red b e t t e r p h y s i c a l l y than men ta l l y and man's incompetence i n d e a l i n g w i t h human na tu re was con t ras ted w i t h h i s a b i l i t y i n d e a l i n g w i t h p h y s i c a l a s p e c t s . 7 This may account f o r the l a c k of s u f f i c i e n t t ime of most phys ic ians and by the a t t i t u d e o f some. The p a t t e r n s o f p r a c t i c e have been changed by s o c i a l changes w i t h i n our s o c i e t y over which the p h y s i c i a n has l i t t l e c o n t r o l , and by medical advances w i t h which he must keep up. I n the f i r s t case, medical insurance f o r a l l i n B r i t i s h Columbia has r e s u l t e d i n an increased demand f o r h o s p i t a l s ' and p h y s i c i a n s ' s e r v i c e s . Fur thermore, medical advances have r e s u l t e d i n a g rea te r p o r t i o n o f the p h y s i c i a n s ' t ime spent i n study and a lso i n the care o f the c h r o n i c a l l y i l l who su rv i ve i n i n c r e a s i n g numbers. Simply - 15 - s t a t e d , t o d a y ' s phys ic ians bear an i n c r e a s i n g p ressu re , t h a t o f se rv ing a l a r g e r p o p u l a t i o n which i s more o f t e n seeking h i s adv i ce , and t h a t o f keeping abreast o f medical advances and he must o f t e n p lace p r i o r i t i e s on the needs o f h i s p a t i e n t s . These w i l l most o f t e n be the p h y s i c a l over psychosoc ia l . I n a d d i t i o n , the a t t i t u d e o f some phys ic ians must change f rom t h a t o f a benign p a t e r n a l image, to t h a t of a respected adu l t image and, i n so d o i n g , to a l l o w the p a t i e n t t o accept a d u l t r e s p o n s i b i l i t y f o r and p a r t i c i p a t e i n h i s own r e h a b i l i t a t i o n . C. THE RELATIONSHIP OF NURSING PERSONNEL IN THE CARE OF THE CHRONIC Most nurses , l i k e p h y s i c i a n s , are a t t r a c t e d t o the care of the acute p a t i e n t and a l a r g e percentage of t h e i r t r a i n i n g i s i n the acute h o s p i t a l . Here psychosoc ia l needs are not as s i g n i f i c a n t as the p h y s i c a l needs and, t h e r e f o r e , they are o f t e n over looked i n the nurses ' t r a i n i n g w i t h the consequence t h a t the complete care o f the p a t i e n t i s not r e a l i z e d . I n the acu te l y i l l , psychosoc ia l needs are u s u a l l y not as ev ident as i n the c h r o n i c a l l y i l l and the l ack of s a t i s f a c t i o n by nu rs ing s t a f f not as damaging. However, t he re appears t o be l ess persona l a t t e n t i o n pa id t o p a t i e n t s i n the l a s t decade and t h i s aspect of care should not be neg lec ted . For example, i n 1964, a t the Vancouver 9 General H o s p i t a l , the head neurosurgery v i s i t e d each p a t i e n t every morning she was on du ty . A l l p a t i e n t s knew her and her a s s i s t a n t - 16 - and the re was good communication. They knew t h a t sen io r nurses were aware o f them and t h e i r needs. Observat ions i n 1970-1972 d i s c l o s e d t h a t few p a t i e n t s even knew the names o f the sen ior nurses on the ward; some f e l t the reverse must a lso be true."*"^ This d e f i c i e n c y has been recognized by the nu rs ing p r o f e s s i o n i n some areas and steps have been made t o r e c t i f y i t . A two year programme was i n i t i a t e d at an American v e t e r a n s ' h o s p i t a l i n 1969 d i r e c t e d a t improving communications among p h y s i c i a n s , nurses and p a t i e n t s and to r e t u r n i n g nurses to n u r s i n g r e s p o n s i b i l i t i e s r a t h e r than a d m i n i s t r a t i v e . ^ I n t h I n the c h r o n i c a l l y i l l , psychosoc ia l needs are s i g n i f i c a n t and nurses r e f l e c t by t h e i r a t t i t u d e s , t h a t they do not always perce ive t h i s f a c t . I n a recent s tudy , i t was observed t h a t an o r i e n t a t i o n i s needed f o r acute care h o s p i t a l nurses to f o l l o w up i n the care o f ca rd iovascu la r acc ident p a t i e n t s . I t s t a t e s t h a t nurses o f t e n do not 12 t r a i n the p a t i e n t i n s e l f - c a r e and do not communicate w i t h the p a t i e n t . I n i t i a l l y , i t takes longer t o t r a i n a p a t i e n t i n the a c t i v i t i e s of d a i l y l i v i n g than t o do them f o r him and, i t may be t ime consuming t o t r y to understand and be understood i n communicating w i t h some p a t i e n t s . Yet t r a i n i n g the p a t i e n t t o care f o r h imse l f and communicate w i t h Others , even i n a smal l way, w i l l increase h i s sense o f wor th to h imse l f and those around him and take him another step toward h i s r e h a b i l i t a t i o n . I t i s noted t h a t no mention was made o f p h y s i o t h e r a p i s t s or occupa t iona l t h e r a p i s t s i n t h i s a r t i c l e . - 17 - Another study done i n London by a nurse with twenty years experience, t e l l s how a nurse rewards her favourite patients and treat s the unpopular with scorn, impatience, i r r i t a t i o n and r i d i c u l e . Among the unpopular were the unpleasant, the long-term, the mentally i l l , 13 the hypochondriacs and the dying. It i s evident that a l l these might require an increased degree of psychosocial care and that the nurse, f a m i l i a r with the p h y s i c a l , does not recognize t h i s and turns away from the unfamiliar, blaming the patient for h i s behaviour when i t might be that h i s needs are not being s a t i s f i e d . Vera Mclver maintains for twenty-five years nurses have given psychosocial care l i p service 14 but have been unable to put i t into p r a c t i c e . D. THE INVOLVEMENT OF SOCIAL SCIENTISTS As has been stated, the psychosocial needs of the c h r o n i c a l l y disabled are pr i m a r i l y s o c i a l and i f s o c i a l needs are supplied, psychological maladjustments may not occur. But these needs are often outside the scope of services that medical personnel can supply, f o r example, those needs that involve s o c i a l i z i n g with others, i n t e l l e c t u a l pursuits and hobbies. Occupational therapists are engaged i n many aspects of r e h a b i l i t a t i v e programmes to meet these needs, however, with the growing numbers of disabled to care f o r i t would appear others might a s s i s t them. Occupational therapists must examine the patient's problem from every aspect, for example, f i n d out h i s c a p a b i l i t i e s , a i d i n the se l e c t i o n of occupation and adapt h i s l i v i n g habits.'''"' It i s commented - 18 - t h a t v o c a t i o n a l e v a l u a t i o n and the a c t i v i t i e s o f d a i l y l i v i n g should increase i n importance f o r the occupa t iona l t h e r a p i s t s and because of these f a c t o r s concern i s expressed by an occupa t iona l t h e r a p i s t t h a t 16 o ther d i s c i p l i n e s may enter the f i e l d . And ye t these o the rs should c o n t r i b u t e t h e i r s k i l l s . The i n c r e a s i n g involvement of s o c i a l s c i e n t i s t s i n the medical f i e l d , f rom the i n i t i a l sparce r e p o r t s o f the e igh teen th and n i n e t e e n t h c e n t u r i e s on d isease, s o c i a l and economic c o n d i t i o n s t o the r e p o r t s o f the t w e n t i e t h are documented. I t was not u n t i l the 1940's t h a t major research was repor ted by s o c i o l o g i s t s , s o c i a l a n t h r o p o l o g i s t s and psycho log i s t s i n the h e a l t h care f i e l d . By the 1950's a t t e n t i o n was turned f rom the p h y s i c a l and s o c i a l environment to the p s y c h o l o g i c a l and s o c i a l env i ronment . ^ 7 Wi th t h i s l a t t e r concern the psychosoc ia l needs of the p h y s i c a l l y d i sab led were brought i n t o focus by medical s o c i o l o g i s t s . I n 1960, a conference on "Psycho log ica l Research and R e h a b i l i t a t i o n " was h e l d . M o d i f i c a t i o n s of behaviour r e s u l t i n g f rom the c o n d i t i o n of d i s a b i l i t y , i t s i m p l i c a t i o n s f o r new l e a r n i n g , and r e l e a r n i n g were d iscussed. Fo l low ing t h i s , i n 1965, a conference on " S o c i o l o g i c a l Theory, Research and R e h a b i l i t a t i o n " was assembled i n Carmel, C a l i f o r n i a , and cu r ren t s o c i o l o g i c a l theory and research i n the f i e l d of r e h a b i l i t a t i o n were i n v e s t i g a t e d . I t was repor ted t h a t r e h a b i l i t a t i o n , because i t i s a s o c i a l problem, u s u a l l y takes p lace i n 18 an uns t ruc tu red environment. By 1968, an Ad Hoc Committee on D i s a b i l i t y was e s t a b l i s h e d and arrangements were made w i t h the American S o c i o l o g i c a l A s s o c i a t i o n ' s s e c t i o n on medical soc io logy t o sponsor a s p e c i a l sess ion on the "Soc io logy of D i s a b i l i t y " at the A s s o c i a t i o n ' s meetings i n San Francisco 19 i n 1969. There are now over e igh t hundred s o c i a l s c i e n t i s t s engaged 20 i n research i n the h e a l t h f i e l d and the number i s i n c r e a s i n g . Thus, s o c i a l s c i e n t i s t s , both s o c i o l o g i s t s and a d u l t educators may be an impor tant ad junc t t o the e f f o r t s o f occupa t iona l t h e r a p i s t s . I n the f i r s t case, needs i n r e l a t i o n to the s o c i a l aspect may be recognized and f u l f i l l e d ; i n the second, many areas of educat ion such as commercial , t e c h n i c a l and academic as w e l l as r e c r e a t i o n a l may be s u p p l i e d . Adu l t educators would a lso be u s e f u l i n v o c a t i o n a l assessment. E. SUMMARY As a person passes f rom the acute phase of an i l l n e s s i n t o a chron ic phase, h i s needs may d i f f e r d r a m a t i c a l l y . Most o f the t r a i n i n g t h a t phys ic ians and nurses rece ive focuses on those a c u t e l y i l l which i s u s u a l l y p h y s i c a l care o f shor t d u r a t i o n . As a r e s u l t , when medical personnel are con f ron ted w i t h those c h r o n i c a l l y i l l , where psychosoc ia l care i s predominant and o f long d u r a t i o n , t h e i r needs are not adequately met. Soc ia l s c i e n t i s t s are now s tudy ing the psychosoc ia l needs of the c h r o n i c a l l y d i s a b l e d . The papers presented a t the Carmel Conference - 20 - stater* t h a t most of the r e h a b i l i t a t i o n of the d isab led takes p lace 2 ou ts ide o f the r e h a b i l i t a t i o n system and, as such, i s a s o c i a l problem. I t may be theo r i zed t h a t i f more s o c i a l s c i e n t i s t s were invo lved d i r e c t l y i n the r e h a b i l i t a t i o n system i t s e l f more p o s i t i v e r e s u l t s would be ach ieved. I n the f u t u r e , s o c i o l o g i s t s and a d u l t educators should he lp t o f u l f i l l the psychosoc ia l needs of the d i s a b l e d . - 21 - FOOTNOTES CHAPTER I I A l b e r t Wessen, "The Apparatus o f R e h a b i l i t a t i o n : An O r g a n i z a t i o n a l A n a l y s i s " , i n Marvin B. Sussman ( e d . ) , Socio logy and R e h a b i l i t a t i o n (Washington, D.C. , American S o c i o l o g i c a l A s s o c i a t i o n , 1965) , pp. 148-78. 2 I b i d . John W. Shaf fe r and Kur t Nussbaum, " P r o f i l e s o f D i s a b i l i t y Insurance C la iman ts , " American Journa l o f P s y c h i a t r y , 129 (1972) : 403-07. 4 Bea t r i ce A. W r i g h t , Phys ica l D i s a b i l i t y - A Psycho log ica l Approach, (New York; Harper and Row, 1960) , p. 3. ^ I n t e r v i e w w i t h George Szasz, M.D., D i r e c t o r , D i v i s i o n o f I n t e r - p r o f e s s i o n a l Educat ion , U n i v e r s i t y o f B r i t i s h Columbia, 15 October 1973. Howard D. Young, "A Study o f R e h a b i l i t a t i o n of P h y s i c a l l y Handicapped Adu l t s L i v i n g i n Foster Homes, Soc ia l Work I n t e r v e n t i o n i n the Adapta t ion t o Family Environment, F i n a l Repor ts " , ERIC Research i n Educat ion , V o l . 5, No. 1 (January, 1970) : 222. 7Saad Z. Nag i , "The P r a c t i t i o n e r as a Par tner i n Research", R e h a b i l i t a t i o n Record, V o l . 6, No. 4 ( Ju l y -Augus t , 1965) : 2. Constant ine S a f i l i o s - R o t h s c h i l d , The Socio logy and Soc ia l Psychology of D i s a b i l i t y and R e h a b i l i t a t i o n (New York', Random House, 1970) , p. 158. 9 Observat ions by the w r i t e r a t Vancouver General H o s p i t a l , Department of Neurosurgery, Head Nurse I rene Dennis, R .N. , June-September 1964, "^Observat ions by the w r i t e r a t Vancouver General H o s p i t a l , Department of Neurosurgery, February, March, 1970, June, August, December 1971 and A p r i l 1972. - 22 - Cather ine D. Santor ium and V i r g i n i a M. S e l l , "A P a t i e n t - Centered Nurs ing S e r v i c e , " Journa l o f Nurs ing A d m i n i s t r a t i o n ( J u l y - August 1973) : 32-7 . i o Gerald ine P a t r i c k , R.N. , M.Sc.N. , "Fo rgo t ten P a t i e n t s on the Medical Ward", The Canadian Nurse (March 1972) : 3 1 . 13 Barbara Koval Nelson, " t he unpopular p a t i e n t " , Modern H o s p i t a l (August, 1973): 70-3. "^Vera Mc lve r , R.N. , Notes from a Speech made at the Canadian Nurses' A s s o c i a t i o n Convent ion, Edmonton, A l b e r t a , June 26-28, 1972. 1 5Thomas M. L ing and C.J .S. O'Mal ley ( e d . ) , R e h a b i l i t a t i o n a f t e r I l l n e s s and Accident (London: B a l l i e r e , T i n d a l l and Cox, 1958) , p. 85. 1 ft Josephine C. Moore, "Changing Methods i n the Treatment o f Phys i ca l D y s f u n c t i o n " , The American Journa l of Occupat ional Therapy, V o l . 2 1 , No. 1 (1967): 20. "'"''Gerald Gordon et a l . , Disease, the I n d i v i d u a l and Soc ie ty (New Haven, Conn.: Col lege and U n i v e r s i t y Press, 1968) , pp. 1-89. 18 Marvin B. Sussman, (ed . ) Socio logy and R e h a b i l i t a t i o n (Washington, D.C. : American S o c i o l o g i c a l A s s o c i a t i o n , 1965) , pp. 1-265. 19 Theodor J . L i tman, I n t r o d u c t i o n , The Sociology and Soc ia l Psychology o f D i s a b i l i t y and R e h a b i l i t a t i o n , Constant ine S a f i l i o s - R o t h s c h i l d (New York: Random House, 1970) , X I I . 20 Gordon, Disease, the I n d i v i d u a l and Soc ie t y , p. 74. 21 Sussman, ( e d . ) , Socio logy and R e h a b i l i t a t i o n , p. 236. - 23 - CHAPTER III FACTORS IN THE REHABILITATION OF THE PHYSICALLY DISABLED As the numbers of disabled grow many factors are discerned among the psychosocial needs. Three of these factors are motivation, goals and i n t e g r a t i o n . By recognizing the importance of these f a c t o r s , the adult educator may be the means of i n i t i a t i n g or sustaining some or a l l factors by educational endeavors which w i l l aid i n the r e h a b i l i t a t i o n of the p h y s i c a l l y disabled. A. MOTIVATION IN THE DISABLED Motivation i s necessary f o r the disabled to be r e h a b i l i t a t e d and the s o c i a l s c i e n t i s t should assess that which i s present i n the person whom he wishes to a s s i s t . For some, motivation w i l l be high, for others i t may vary from moderate to low, or even be non-existent. Where motivation i s high, adult educators may have only to counsel as to what i s a v a i l a b l e , what aids can be obtained, what d i f f i c u l t i e s he may encounter and what assistance he may require i n obtaining the a c t i v i t y of h i s choice. Where motivation i s low the adult educator, i f p o s s i b l e , w i l l have to win the confidence of the disabled, stimulate his i n t e r e s t and encourage him i n order that he may attempt a task that i s new to him. Studies on the disabled showed that a s p i r a t i o n , learning and a c t i v i t y are e s s e n t i a l to socialization."'" The adult educator - 24 - should be an impor tant ad junct i n t h i s area of r e h a b i l i t a t i o n . Case H i s t o r y of a Disabled Person Lacking M o t i v a t i o n CASE I He i s a man i n h i s l a t e f i f t i e s and was employed as a milkman i n 1966 when pa in i n h i s neck became severe. His p h y s i c i a n r e f e r r e d him to an or thopaedic surgeon who performed a s e r i e s o f o p e r a t i o n s . He rece ives monthly payments f o r d i s a b i l i t y . The surgeon s t a t e d he was able to work but could not do any heavy l i f t i n g * The government o f f e r e d r e t r a i n i n g , however, the p a t i e n t re fused t o b e l i e v e the surgeon was c o r r e c t i n h i s assessment and sought another o p i n i o n which a f f i r m e d the f i n d i n g s o f the o r i g i n a l surgeon. He seems to have assumed the r o l e of the i n v a l i d , having the mobi le l i b r a r y b r i n g books t o him and spending the days read ing o r l i s t e n i n g to the r a d i o . I t would appear t ha t he can do more. When the government requested t h a t he undergo t e s t s i n V i c t o r i a , he went by bus and f e r r y from Vancouver, and re tu rned the same day by h i m s e l f . He s t i l l does n o t h i n g . His background shows l i t t l e educa t ion . His w i f e does not encourage any a c t i v i t y on h i s p a r t but agrees w i t h him tha t the doctors consp i re i n order t o h ide the f a c t t h e i r e f f o r t s have not been s u c c e s s f u l . Case H i s t o r i e s o f D isab led Persons Having M o t i v a t i o n CASEIII He i s a man under t h i r t y years o f age and graduated i n Economics i n 1973 from the U n i v e r s i t y o f B r i t i s h Columbia. He i s a parap leg ic who was i n j u r e d p l a y i n g i c e hockey w h i l e i n Grade X I . He sa id t h a t he was ab le to manage f a i r l y w e l l a t u n i v e r s i t y overcoming p h y s i c a l b a r r i e r s and t h a t f e l l o w s tudents were a v a i l a b l e when he r e q u i r e d h e l p . F i n a n c i a l l y , he rece ived a pension andlinl iaTi l i afld2l97i2 ^rangr^nfrnff_bm fiheo0pp-6rt"unities f o r Youth" fund to study p h y s i c a l b a r r i e r s f o r d i sab led s tudents at post secondary i n s t i t u t i o n s . As a r e s u l t , t he re were some improvements a t h i s own u n i v e r s i t y , such as s p e c i a l washroom f a c i l i t i e s , ramps and one te lephone were i n s t a l l e d . Th is man i s now employed as a counse l l o r f o r p a r a p l e g i c s . CASE I I I He i s a man under t h i r t y years o f age. A f t e r becoming a q u a d r i p l e g i c - 25 - when he was i n j u r e d w h i l e s k i i n g du r i ng h i s f i n a l year at h i g h schoo l , he completed Grade X I I then at tended the B r i t i s h Columbia I n s t i t u t e of Technology f o r two years . Having rece ived h i s c e r t i f i c a t e , he was employed as a r e h a b i l i t a t i o n c o u n s e l l o r . Comments on M o t i v a t i o n I n these case h i s t o r i e s , i t i s noted t h a t people c lose to them played a prominent r o l e . Where the re was no encouragement the re was no m o t i v a t i o n . The w i f e i n Case I cou ld see no b e n e f i t f rom courses her husband was advised t o take and he re fused t o f u r t h e r h i s r e h a b i l i t a t i o n . A l s o , the age at which d i s a b i l i t y i n t e r r u p t e d educat ion was s i g n i f i c a n t . For those whose d i s a b i l i t y d id not i n t e r f e r e w i t h the c o n t i n u i t y of t h e i r educa t ion , such as the b l i n d , or had completed much of t h e i r educa t ion , the d i s a b i l i t y presented a d i f f i c u l t y but not a t e r m i n a t i o n to t h e i r a s p i r a t i o n s . The r e h a b i l i t a t i o n counse l lo r at the B.C. Parap leg ic A s s o c i a t i o n conf i rms the f a c t t ha t i n t h i s r e g a r d , 2 t h e r e f o r e , t he re are more impediments f o r c h i l d r e n than f o r a d u l t s . B. GOALS FOR THE DISABLED Meaningfu l goals are necessary i n programmes f o r the d i s a b l e d . The occupa t iona l t h e r a p i s t or a d u l t educator must be c a r e f u l not to ass ign a task because he b e l i e v e s the task i t s e l f w i l l a i d the p a t i e n t to improve muscular s t r e n g t h , c o - o r d i n a t i o n or c o n c e n t r a t i o n . The r e s u l t s o f the task must g ive him a sense of f u l f i l l m e n t and must not - 26 - be demeaning. Ear l y programmes f o r the d isab led inc luded such a c t i v i t i e s as weaving and c h a i r caning and s t i l l e x i s t i n some programmes today. To some d isab led such programmes might be u s e f u l but to o thers they might be h a r m f u l , as negat ive aspects could predominate. A fo rmer l y ab le -bod ied i n d i v i d u a l having to face up t o d i s a b i l i t y and then having to engage i n a c t i v i t i e s t h a t are p o s s i b l y ego damaging i n e f f o r t s to r e h a b i l i t a t e h imse l f w i l l obv ious l y not have h i s psychosoc ia l needs met. As much as p o s s i b l e , most a c t i v i t i e s should be s i m i l a r to those i n which ab le -bod ied persons might p a r t i c i p a t e . Other a c t i v i t i e s not on ly adverse ly a f f e c t the d i s a b l e d ' s own image of h imse l f but a lso i n f l u e n c e the "normal " persons ' concept o f the d i s a b l e d . Because o f t h i s , equipment resembl ing t h a t used i n 3 i n d u s t r y i s p r e f e r r e d over t h a t used i n occupa t iona l therapy p r o j e c t s . A i d s , such as car s imu la to rs used by D r i v i n g Schools to teach new d r i v e r s , could be used to p r a c t i s e and t e s t c o - o r d i n a t i o n , p e r c e p t i o n , r e f l e x and c o n c e n t r a t i o n . S i m i l a r l y , another t e s t i n g machine t h a t could be adapted i s one s i m i l a r t o t h a t which can be i n s t a l l e d i n a car to t e s t the degree o f s o b r i e t y o f a person be fo re d r i v i n g . The necessary numbers i n c o r r e c t order must be punched be fo re i g n i t i o n i s t u r n e d . This could be a t tached to a b a t t e r y operated mechanism t o sound a buzzer when c o r r e c t r a t h e r than the i g n i t i o n o f a ca r . Some long-ca re h o s p i t a l s are us ing methods to increase the sense o f wor th o f the p a t i e n t s w h i l e they are engaged i n t h e r a p e u t i c - 27 - procedures. For example, i n some a c t i v i t i e s at L ions Gate Extended Care H o s p i t a l , Nor th Vancouver, B.C. the p a t i e n t s may make i tems to s e l l a t a bazaar. At S t . Mary 's P r i o r y Extended Care H o s p i t a l , V i c t o r i a , B.C. , they may make toys t o g ive to the c h i l d r e n at the Solar ium. Academic endeavours w i l l a lso vary but again goals must be r e a l i z e d . For i n s t a n c e , p a t i e n t s might study a f o r e i g n language or p a i n t f o r p leasure or p r o f i t or s imply a t tend a course i n a d u l t educat ion i n order to s o c i a l i z e . Whenever s u i t a b l e goals do not m a t e r i a l i z e , m o t i v a t i o n i s i n h i b i t e d . Case H i s t o r y o f a Disabled. Person Lacking Goals CASE IV He i s a man under t h i r t y years of age and had j u s t graduated f rom h igh school when he was thrown o f f a horse. His balance i s impa i red , h i s r i g h t s ide i s p a r t i a l l y para lyzed and he has a double v i s i o n problem. He gets around f a i r l y w e l l w i t h the he lp o f canes. His mother wrote t h a t her son was a t the s c h o o l , Counc i l f o r Cr ipp led Ch i ld ren and Adu l t s at Saskatoon f o r two months. According to her l e t t e r , t h e i r a c t i v i t i e s cons is ted o f packaging p l a s t i c bags, c u t t i n g w i res and work ing ceramic a r t i c l e s . He would have l i k e d ceramics but thought he was too unsteady and re tu rned home because he d i d n ' t l i k e to l i v e w i t h s t rangers and f e l t h e l p l e s s . I n c o n c l u s i o n , h i s mother w r i t e s , "What can a person do i f he c a n ' t wa lk , read or w r i t e ? We w i l l have to accept h i s c o n d i t i o n f o r what i t i s and make the best o f an imposs ib le s i t u a t i o n . " He d i c t a t e d a l e t t e r t o me and s a i d , " I have too much t ime on my hands, t h e r e ' s s imply no th ing I can d o . " Case H i s t o r i e s o f D isabled Persons Having Goals CASE V A U n i v e r s i t y o f B r i t i s h Columbia s tuden t , under t h i r t y years of - 28 - age, took f i r s t year A r t s l a s t year but i s now c o n t i n u i n g on i n Commerce as he f e e l s t ha t t h i s w i l l be more p r a c t i c a l . He i s a p a r a p l e g i c who was i n j u r e d p l a y i n g rugby a t the age o f s i x t e e n . L i ke Case I I he manages to get around the campus q u i t e w e l l owing t o remodel led f a c i l i t i e s and f i n d s h i s f e l l o w s tudents most h e l p f u l . He plans h i s t i m e t a b l e w i t h ca re , choosing t ime and p lace of scheduled l e c t u r e s which are most s u i t a b l e . F i n a n c i a l l y , he rece ives f r e e t u i t i o n , books, and the d isab led pension f rom the government and, hand c o n t r o l s f o r h i s car and a scho la rsh ip f rom the Parap leg ic A s s o c i a t i o n . Along w i t h Case I I , he a lso rece ived $90.00 per week f o r s i x t e e n weeks and f i f t e e n weeks, r e s p e c t i v e l y , i n 1971 and 1972 f rom the O p p o r t u n i t i e s f o r Youth Programme. CASE VI Th is man i s a p a t i e n t i n the Pearson H o s p i t a l , Vancouver, B.C. and i s under t h i r t y years o f age. He i s a c e r e b r a l pa lsy p a t i e n t and cannot s i t u p r i g h t or c o n t r o l movement i n h i s hands or f e e t . Wi th the encouragement of an aunt and the he lp of the occupa t iona l t h e r a p i s t , he i s now w r i t i n g shor t a r t i c l e s . He does t h i s by the use o f a s t i c k fas tened t o a headband and an e l e c t r i c t y p e w r i t e r . He at tended school a t the C h i l d r e n ' s H o s p i t a l i n Vancouver, B.C. ^ and went as f a r as Grade X. He i s determined to become a w r i t e r . CASE V I I Th is man i s a p a t i e n t i n the Pearson H o s p i t a l , Vancouver, B.C. and i s under f o r t y years o f age. He s t a t e d he had l i t t l e fo rma l educat ion as he worked as a logger and f isherman u n t i l he con t rac ted p o l i o i n 1955. He was ve ry depressed i n the e a r l y p a r t s o f h i s i l l n e s s as he i s a severe q u a d r i p l e g i c and r e q u i r e s an e l e c t r i c wheelchai r f o r h i s on ly s e l f locomot ion . His on ly accomplishments had been of a p h y s i c a l n a t u r e . A member o f the s t a f f , who had a doc to ra te i n ph i losophy , i n t e r e s t e d him i n p a i n t i n g by mouth. He had never done any p a i n t i n g be fore and decided t o t r y i t , by l e a r n i n g f rom those around h im, e s p e c i a l l y the doc tor who had i n i t i a t e d h i s i n t e r e s t and the occupa t iona l t h e r a p i s t . He s e l l s h i s p a i n t i n g s and says i t i s now s t a r t i n g to pay. He teaches p a i n t i n g a t n i g h t school at Vancouver C i t y Col lege f o r one or two n i g h t s a week, s e l l s 90% of what he p a i n t s , and pays f o r a l l h i s own s u p p l i e s . This p a t i e n t s a i d he r e a l i z e d t h a t people w i t h h i s type o f d i s a b i l i t y , can now l i v e many y e a r s , owing to advances i n med ic ine , and he i s p leased he can p a i n t and teach so s u c c e s s f u l l y . - 29 - Comments on Goals Meaningfu l goals appeared not to have been e s t a b l i s h e d when Case IV at tended r e h a b i l i t a t i o n schoo l , t h e r e f o r e h i s m o t i v a t i o n was not s t imu la ted and he d i d not remain. He seems to have g iven up. Fraser s t a t e s the d i sab led must concent ra te on the t h i n g s they can do t h a t , t h e r e f o r e , the "Acceptance of the f a c t s of a d i s a b i l i t y i s the p re -cu rso r o f a l l progress towards conquering i t ; not acceptance and r e s i g n a t i o n , but acceptance and r e s o l v e . " " ' Meaningfu l goals appeared to have been e s t a b l i s h e d f o r o the r cases i n va r ious ways. Whether they were v o c a t i o n a l or persona l s a t i s f a c t i o n , they were p e r s i s t i n g i n t h e i r p u r s u i t s . There fo re , the c h r o n i c a l l y d i sab led r e q u i r e a p o s i t i v e reason f o r l i v i n g t h a t i s not n e c e s s a r i l y l i n k e d to monetary ga in i n order to be s u c c e s s f u l l y r e h a b i l i t a t e d . C. INT-EGRAT-"I0N.TEOR THE DISABLED I n t e g r a t i o n w i t h the "normal " p o p u l a t i o n i s i n v a l u a b l e f o r the d i s a b l e d . I n our s o c i e t y , we have been g u i l t y of segregat ing many d i s a b l e d , e i t h e r because o f the d isab i l i tey lo ryo f rphys&caQi ibar r ' ie rs i n the environment. Sometimes good i n t e n t i o n s may be the cause as i n the move f o r some d i sab led f rom the Marpole I n f i r m a r y , Vancouver, B.C. to Pearson H o s p i t a l , Vancouver, B.C. The surroundings a t Marpole appeared inadequate, f o r t h i s was an o l d h o t e l - t y p e b u i l d i n g , b u i l t to the s idewalks w i t h no grass and no v iew. They were subsequent ly moved t o Pearson H o s p i t a l , back from the main thoroughfare w i t h lawns - 30 - around the b u i l d i n g s . I t seemed to be an i d e a l s e t t i n g . However, some o f the d isab led missed s i t t i n g on the s idewalk , seeing the t r a f f i c and c h a t t i n g w i t h people passing by and were l o n e l y i n t h e i r new sur round ings . A l though , i n t h i s case, the move appeared t o be necessary, i t brought forward f o r c i b l y the p o i n t t h a t what the non- d isab led f e e l to be an improvement i s not always what the d isab led f e e l . 7 The p r o t e c t i v e i n f l u e n c e of segregat ion i s repo r ted by the I n t e r n a t i o n a l Soc ie ty f o r the R e h a b i l i t a t i o n of the Disab led on the decade 1970-1980 - t h a t we must get away f rom the f e e l i n g t h a t the d isab led are " d i f f e r e n t " and g ive more thought f o r the educat ion o f g handicapped c h i l d r e n w i t h i n o r d i n a r y schoo ls . T h i e l e , the l i b r a r i a n f o r v i s u a l d i s a b i l i t i e s a t the U n i v e r s i t y of B r i t i s h Columbia, s t a t e s t h a t i f c h i l d r e n are educated i n a b l i n d school they develop " b l i n d i s m s " , such h a b i t s as r o c k i n g and jumping , which become r e - i n f o r c e d when grouped toge ther but seldom occur i f they are educated i n o r d i n a r y schoo ls . He s t a t e s t h a t we have some b l i n d c h i l d r e n going to o r d i n a r y schools where s p e c i a l equipment i s s u p p l i e d . At u n i v e r s i t y he f o l l o w s through h i s i n t e g r a t i o n p o l i c y by a l l o w i n g the use o f the Crane L i b r a r y f o r l i b r a r y purposes o n l y , thereby encouraging s o c i a l i z i n g a t r e g u l a r 9 student c e n t r e s . I t i s a lso observed t h a t w i t h d i s a b i l i t i e s , no mat ter at what age they occur , the sooner i n t e g r a t i o n i s accompl ished, the eas ie r i t i s f o r the d i s a b l e d . Thus, when i t occurs w i t h c h i l d r e n , they should - 31 - be i n a r e g u l a r school when p o s s i b l e , and when i t occurs w i t h a d u l t s they should be re tu rned to the r e g u l a r s o c i e t y when p o s s i b l e . I f kept i n a p r o t e c t e d environment too l o n g , sometimes a person w i l l f e a r l e a v i n g i t . A c o l l e c t i o n of d i s a b l e d s ' a u t o b i o g r a p h i c a l essays p r o t e s t s against the segregat ion o f the d i s a b l e d . They wish to lessen the s o c i a l d is tance between the d isab led and non d i s a b l e d . Aga in , i t i s recommended t h a t a s t a r t be made w i t h d i sab led c h i l d r e n to a t tend school w i t h the "normal"." '"^ I n t h i s r e p o r t , d i sab led people expressed concern w i t h what the wor ld c a l l s c r i p p l e s and the manner i n which the "normal " sometimes p a t r o n i z e or w r i t e o f f the people who do not p h y s i c a l l y measure up, as use less . One was g iven the impression t h a t many people equate mental d e f i c i e n c y to p h y s i c a l d e f i c i e n c y and appear embarrassed i n h i s presence. Swedish e f f o r t s are d i r e c t e d to the d i sab led l i v i n g a l i f e as c lose to normal as poss ib le and thus i n t e g r a t i n g w i t h the members o f the genera l community.''""*' The "normal " must be made more f a m i l i a r w i t h the d i sab led i n our p o p u l a t i o n . We must see them, work w i t h them, and l i v e w i t h them, from the t ime we are c h i l d r e n . We must r e a l i z e t h a t almost twenty percent o f our p o p u l a t i o n s u f f e r s some form o f d i s a b i l i t y and the chance o f becoming d i sab led i n our l i f e t i m e i s increased as the complex i ty o f our l i f e inc reases . We should be f a m i l i a r and accept the d i sab led as p a r t o f our r e g u l a r c u l t u r e , not as a s u b c u l t u r e . I n our s o c i e t y , d i sab led a d u l t s appear to have d i f f i c u l t y - 32 - i n t e g r a t i n g unless the d i s a b i l i t y can be d isgu ised o r can be worn as a badge of honour, such as t h a t i n c u r r e d i n the se rv ices of h i s coun t ry . I n the Uni ted S t a t e s , c i v i l r i g h t s p r o t e c t d i f f e r e n t races 12 f rom seg rega t i on . There i s l i t t l e p r o t e c t i o n f o r the d i s a b l e d . Case H i s t o r y of a Disabled Person Lacking I n t e g r a t i o n CASE V I I I A man, under t h i r t y years o f age, was d i sab led as the r e s u l t of an a c c i d e n t . He r e q u i r e d ass is tance i n a c t i v i t i e s o f d a i l y l i v i n g and h i s f a m i l y wished him t o l i v e i n a f r a t e r n i t y type of home w h i l e at c o l l e g e so they sought guidance and funds to e s t a b l i s h t h i s f o r t h e i r son and o ther d i sab led men on the campus. However, these o ther men d i d not w ish t o leave the s e c u r i t y o f t h e i r s h e l t e r e d accomodation and the campus res idence f o r them d id not ma te r i a l i ze . " ' " 3 Case H i s t o r i e s o f Disabled Persons Obta in ing I n t e g r a t i o n CASE IX A man, under t h i r t y years of age, has c e r e b r a l p a l s y . Because he had l i m i t e d p h y s i c a l powers, h i s parents encouraged him t o use h i s mental a b i l i t i e s . He graduated f rom c o l l e g e w i t h a degree i n j o u r n a l i s m . Leg braces made i t poss ib le f o r him to d r i v e a s p e c i a l l y equipped car and, a f t e r t a k i n g a course i n computer programming, he was ab le to o b t a i n a f u l l - t i m e employment.-'- 4 CASE X A woman, under t h i r t y years o f age, has cereba l p a l s y . She wants to l i v e an a d u l t l i f e independent o f her p a r e n t s . The Handicapped Persons' P i l o t P r o j e c t i n C a l i f o r n i a found her a s u i t a b l e apartment . With a d d i t i o n a l educa t iona l and s o c i a l involvement she expects to keep h e r s e l f men ta l l y o c c u p i e d . - ^ CASE X I A b l i n d U n i v e r s i t y o f B r i t i s h Columbia student graduated i n 1973 w i t h - 33 - a B.A. degree. I t i s noted t h a t she has a s t rong sense of independence and a need to be t r e a t e d as j u s t another s tuden t . CASE X I I Another b l i n d student at the U n i v e r s i t y of B r i t i s h Columbia f i n i s h e d her t h i r d year i n music i n 1973. She l e f t the s p e c i a l environment o f Je r i cho School f o r the Deaf and B l i n d i n Vancouver, B.C. a f t e r Grade I I I and went t o p u b l i c schoo ls . At t h a t t ime the re were on ly two b l i n d s tudents a t t e n d i n g c lasses i n the r e g u l a r schoo ls . T h i e l e , the l i b r a r i a n f o r the b l i n d , s t a t e s t ha t B r i t i s h Columbia i s g e t t i n g away f rom the idea of s p e c i a l schools.- ' " 7 CASE X I I I A man, under t h i r t y years of age, i s a p a t i e n t a t the Pearson H o s p i t a l , Vancouver, B.C. He was s t r i c k e n w i t h p o l i o i n 1953 and i s a q u a d r i p l e g i c . He sa id he f e l t d iscouraged and f r u s t r a t e d and had no d e s i r e t o take any courses u n t i l a group o f employees f rom Canadian P a c i f i c A i r set up an amateur r a d i o s t a t i o n "HAM" at the h o s p i t a l . This p a t i e n t , w i t h o t h e r s , took a s i x months morse code and r a d i o theory to o b t a i n an amateur t i c k e t . He uses apst-ick ihehisdmouth to operate the r a d i o and te lephone. He then took another s i x months study and rece ived h i s advanced amateur t i c k e t which meant he could operate w i t h both morse and microphone. His wor ld had been enlarged by h i s con tac ts w i t h o thers on the rad io b u t , a f t e r complet ion of h i s courses, he r e a l i z e d how much they had meant to h im. Now he f e l t he was o p e r a t i n g the "HAM" f o r r e c r e a t i o n a l purposes o n l y , hav ing completed the fo rma l i n s t r u c t i o n , and f e l t a v o i d . He s t a r t e d to t h i n k o f the educat ion he had missed and feared he was i n danger of v e g e t a t i n g . A f t e r a l l these y e a r s , h i s a t t e n t i o n was t u r n i n g to educa t ion . He took correspondence B io logy X I . A l though he thought he had missed the most i n t e r e s t i n g p o r t i o n of the course, the f i e l d t r i p s and l a b o r a t o r i e s , he stayed w i t h i t and, i n s p i t e of the obs tac les presented by h i s c o n d i t i o n , he completed the course i n e ighteen months. He i s now t a k i n g Eng l i sh X I and Soc ia l Studies X I . Last summer he took a course on read ing and study s k i l l s at the Centre f o r Cont inu ing Educat ion a t the U n i v e r s i t y o f B r i t i s h Columbia. C u r r e n t l y , he has been chosen as a candidate f o r a contemplated computer science course. As Case I I I po in ted o u t , i t i s d i f f i c u l t f o r people who have been d i sab led s ince chi ldhood-i to undertake educa t iona l endeavours. This man has shown h igh m o t i v a t i o n and d e t e r m i n a t i o n i n comple t ing courses to d a t e , bu t he obv ious l y f e l t insecure when o f f e r e d the o p p o r t u n i t y o f s tudy ing computer science because he requested psycho log i ca l t e s t i n g to determine i f he would be competent. - 34 - CASE XIV Th is man i s a c e r e b r a l pa lsy case under the age o f t h i r t y and a p t l y demonstrates what some d i sab led may accompl ish, g iven the o p p o r t u n i t y and m o t i v a t i o n . For t e n years he at tended T o r o n t o ' s Sunnyview School and c la ims t h a t the people i n t h i s school were not i n t e r e s t e d i n f i n d i n g out a handicapped person 's p o t e n t i a l . From there he went to a s h e l t e r e d workshop where he d i d such t h i n g s as f o l d i n g boxes and separa t ing nuts f rom b o l t s . E v e n t u a l l y , he s t r u c k out on h i s own, e n r o l l e d at McMaster U n i v e r s i t y , got h i s B.A. and became a j o u r n a l i s t . Subsequently! he hashwotftfa*-- a $5,000.00 award on a p lay based on the d isab led and has w r i t t e n another which i s be ing produced.-'- 8 Comments on I n t e g r a t i o n Mix ing w i t h the "normal " p o p u l a t i o n i s an impor tant phase o f r e h a b i l i t a t i o n . One man was unable t o a t t a i n i n t e g r a t i o n f o r h imse l f and o ther d i sab led on h i s campus because of a l ong de lay . I n d i f f e r e n t c i rcumstances, o ther cases were able to i n t e g r a t e . Sequent ia l and concurrent development of the t h r e e f a c t o r s , goa ls , m o t i v a t i o n and i n t e g r a t i o n , are exemp l i f i ed i n Cases X I I I and XIV. D. SUMMARY I n r e l a t i o n to educa t ion , case h i s t o r i e s o f the d isab led i l l u s t r a t e t h a t th ree f a c t o r s , m o t i v a t i o n , goals and i n t e g r a t i o n may determine the outcome o f r e h a b i l i t a t i o n . The th ree f a c t o r s may be in terwoven and o f equal impor tance, o r one f a c t o r may be i s o l a t e d and a t t a i n o v e r a l l impor tance. Other - 35 - times, they may be i n sequence. For example, motivation may be the means of seeking a goal or the goal recognized may be the means of stimulating motivation. Both may a t t a i n the in t e g r a t i o n or s o c i a l i z a t i o n of the i n d i v i d u a l . It i s noted that where there was encouragement, there was motivation i n i t i a t e d by s t a f f , r e l a t i v e s and outside interested p a r t i e s and i n t e g r a t i o n appears to be the most s i g n i f i c a n t . Yet, f o r the disabled, i t presents many problems i n our society, p h y s i c a l obstacles being only one. Although t h e i r p h y s i c a l needs may be cared f o r , the disabled are often placed away from the stream of "normal" l i v i n g where they can be grouped together and "looked a f t e r " . Without in t e g r a t i o n , motivation and goals lose much of t h e i r meaning. FOOTNOTES CHAPTER I I I Gary L. A l b r e c h t , "Adu l t S o c i a l i z a t i o n : The E f f e c t s o f A s p i r a t i o n upon Role Performance i n R e h a b i l i t a t i o n S e t t i n g s , " ERIC Research i n Educat ion , V o l . 6 No. 1 (January 1971) : 10. 2 I n t e r v i e w w i t h Tom Parker , R e h a b i l i t a t i o n Counse l lo r , Canadian Parap leg ic A s s o c i a t i o n , B.C. D i v i s i o n , 10 May 1973. 3 Josephine C. Moore, "Changing Methods i n the Treatment o f Phys ica l D y s f u n c t i o n " . The American Journa l o f Occupat ional Therapy, V o l . 2 1 , No. 1 , (1967) : 19. 4 He len Bateson, "Break ing out o f the p r i s o n " , Vancouver Prov ince , 19 May 1973, p. 55. ~*Sir Ian F raser , e d . , Conquest o f D i s a b i l i t y , (London: Odhams Press L i m i t e d , Long Acre , 1956), p. 8 - 1 1 . J . F. Ga r re t t and Edna S. Lev ine , e d . , Psycho log ica l P r a c t i c e s w i t h the P h y s i c a l l y D isab led , (New York: Columbia Press , 1962) , p. 416. ^Constant ine S a f i l i o s - R o t h s c h i l d , The Socio logy and Soc ia l Psychology of D i s a b i l i t y and R e h a b i l i t a t i o n , (New York: Random House, I n c . , 1970) , p. 118. g Dorothy Warms and Susan Hammerman, "P lann ing f o r the Decade o f R e h a b i l i t a t i o n 1970-1980, New Pat te rns of I n t e r n a t i o n a l Se rv i ce , F i n a l Repor t " , ERIC Research i n Educa t ion , V o l . 6, No. 4 ( A p r i l 1971) : 39. 9 I n t e r v i e w w i t h Paul T h i e l e , L i b r a r i a n , Crane Memorial L i b r a r y , U n i v e r s i t y of B r i t i s h Columbia, June 1973. "^Pau l Hunt , e d . , "S t igma: The Experience of D i s a b i l i t y " London, Chapman, 1966, c i t e d i n The Socio logy and Soc ia l Psychology o f D i s a b i l i t y and R e h a b i l i t a t i o n , Constant ine S a f i l i o s - R o t h s c h i l d , (New York: Random House, I n c . , 1970) , p. 118. - 37 - "'""'"Richard S te rne r , Services f o r the Handicapped i n Sweden, (Stockholm: The Swedish I n s t i t u t e , 1972) , pp. 1-2. 12 Ruth Lauder, The Goal I s : M o b i l i t y ! N a t i o n a l C i t i z e n s Conference (Washington, D.C. : U.S. Department of H e a l t h , Educa t ion , and Wel fa re , Soc ia l and R e h a b i l i t a t i o n Serv ice , 1969) , pp. 51-2 . 13 Louis F. Say lo r , " R e s i d e n t i a l Care Needs: A Report to the C a l i f o r n i a State L e g i s l a t u r e " , ERIC Research i n Educat ion V o l . 6, No. 1 , (January 1971): Appendix E2-3. 14 I b i d . , p. 29. 1 5 I b i d . , p. 29. 1 ft Murray McMi l lan , "We S h a l l Overcome", U.B.C. Alumni C h r o n i c l e , V o l . 27, No.'* 2 (Summer 1973) : 5. " * " 7 I b i d . , pp. 5 -6 . 18 Audrey M. Ash ley , "Timmy campaign c a l l e d obscene", Vancouver Prov ince , 5 August, 1971, p. 36. - 38 - CHAPTER IV EDUCATIONAL PROGRAMMES FOR THE DISABLED The psychosoc ia l needs o f the c h r o n i c a l l y d i sab led are ev ident and educat ion may be one means o f p a r t i a l l y f u l f i l l i n g them. U n f o r t u n a t e l y , many programmes on ly o f f e r educat ion to those d isab led who have a chance o f v o c a t i o n a l r e h a b i l i t a t i o n . For example, i n Newfoundland, f i n a n c i a l ass is tance f o r t u i t i o n , books, f e e s , maintenance and t r a n s p o r t a t i o n i s a v a i l a b l e , but emphasis i s p laced on t r a i n i n g o r r e - t r a i n i n g of d isab led persons t o prepare them f o r the labour market."'" However, the va lue of educat ion i n r e h a b i l i t a t i o n i s ga in ing more r e c o g n i t i o n and some programmes are a v a i l a b l e now t o a l l d i s a b l e d , regard less o f f u t u r e employment. I n Nor th Amer ica, f o l l o w i n g the Second World War, the need was perce ived t o supply educa t iona l b e n e f i t s to the d i s a b l e d . Some u n i v e r s i t y and c o l l e g e campuses were mod i f ied and serv ices s u p p l i e d . However l i t t l e a t t e n t i o n was pa id t o adu l t educa t iona l f a c i l i t i e s . I n England, a d u l t educators have been p a r t i c i p a t i n g i n the h e a l t h care f i e l d by co -opera t i ng w i t h the medical a u t h o r i t i e s to supply educa t iona l s e r v i c e s . One o f the most advanced cent res i s f o r the r e h a b i l i t a t i o n o f s p i n a l i n j u r i e s at the Stoke-Mandevi l le H o s p i t a l i n Ay lesbury . - 39 - I n Sweden, a l though they b e l i e v e resources can s t i l l be improved, much progress has been made i n the educat ion of the d i s a b l e d . F a c i l i t i e s and serv ices are a v a i l a b l e at both u n i v e r s i t y and a d u l t educat ion cent res or th rough correspondence study f o r people of a l l ages. A. POST SECONDARY EDUCATION PROGRAMMES 1 . U n i v e r s i t i e s and Col leges i n Sweden I n Sweden, the same serv ices o f f e r e d to d i sab led s tudents at the Folk High Schools are g iven at every u n i v e r s i t y , school of economics or u n i v e r s i t y l e v e l i n s t i t u t e of technology and pa id f o r by the Government. Specia l f l a t s or rooms, which are adapted f o r s tudents w i t h d i s a b i l i t i e s , are b u i l t i n the res idences , personal a s s i s t a n t s are supp l ied when r e q u i r e d and t r a n s p o r t i s ar ranged. The Government i s respons ib le f o r p r o v i d i n g serv ices such as persona l he lp to c a r r y books or read t e x t s , and supply t e c h n i c a l a i d s , f o r example, t y p e w r i t e r s , 2 tape recorders or whee lcha i rs . 2, U n i v e r s i t i e s i n the U.S.A. U n i v e r s i t y o f M i s s o u r i a t Columbia I n the Uni ted S ta tes , i n 1959, the U n i v e r s i t y of M i s s o u r i s t a r t e d a programme to modify i t s p h y s i c a l f a c i l i t i e s and supply personnel to a i d the p h y s i c a l l y d i sab led who wished to a t t e n d . The research and demonstra t ion p r o j e c t was completed i n October, 1966, but m o d i f i c a t i o n s are s t i l l c a r r i e d on as needs a r i s e . The t o t a l cost over - 40 - the s i x years of the grant was $980,642.00;" There are now over f i f t y severe ly d i sab led s tudents i n a t tendance. The p h y s i c a l f e a t u r e s t h a t were mod i f i ed i nc luded doorways, e l e v a t o r s , res t rooms, te lephones, desks and c h a i r s . Housing on campus i s arranged by p l a c i n g one d isab led person w i t h f i v e ab le -bod ied people because the m a j o r i t y o f d i sab led p r e f e r r e d t o l i v e w i t h non d i s a b l e d . T r a n s p o r t a t i o n i s arranged by s p e c i a l buses. A s e c t i o n o f the l i b r a r y , complete w i t h e l e c t r i c t y p e w r i t e r , d i c t a t i n g machine and tape recorder i s set as ide f o r the d i s a b l e d . A b lock model o f the campus i s prov ided f o r the b l i n d and l i b r a r y s t a f f a s s i s t w i t h o b t a i n i n g books. Spec ia l c o u n s e l l i n g se rv ices are a v a i l a b l e but once a d i sab led student has completed r e g i s t r a t i o n , he i s t r e a t e d l i k e any o ther s tudent and i s expected t o meet the same academic requirements as o ther u n i v e r s i t y s t u d e n t s . 3 U n i v e r s i t y o f I l l i n o i s and Southern I l l i n o i s U n i v e r s i t y At these u n i v e r s i t i e s , t h e r e are over 750 p h y s i c a l l y d i s a b l e d . A r c h i t e c t u r a l b a r r i e r s have been removed here but not on o ther campuses i n the State and i t i s poss ib le t h a t many a t t e n d i n g u n i v e r s i t y might be b e t t e r served i f t e c h n i c a l and occupa t iona l programmes had 4 f a c i l i t i e s a v a i l a b l e . - 41 - The U n i v e r s i t y of C a l i f o r n i a at Berkeley A f i v e year p r o j e c t , February 1 , 1968 to January 3 1 , 1973, was i n s t i t u t e d t o make a r e s i d e n t i a l u n i t a v a i l a b l e f o r severe ly d i sab led q u a d r i p l e g i c , t r i p l e g i c and pa rap leg ic s tudents a t the u n i v e r s i t y . There are e leven q u a d r i p l e g i c s i n the p r o j e c t , one spends s i x t e e n hours a day i n an i r o n l u n g . They r e q u i r e a r e g i s t e r e d nurse and an o r d e r l y to a s s i s t them. N ine ty percent o f the costs are funded by the Federal Soc ia l and R e h a b i l i t a t i o n Serv ices . At p resen t , two of these s tudents have entered graduate schoo l . ^ 3. U n i v e r s i t i e s i n Canada U n i v e r s i t y o f A l b e r t a , Edmonton, A l b e r t a I n 1967, a computer programming course was s t a r t e d at the U n i v e r s i t y of A l b e r t a Computer Centre f o r q u a d r i p l e g i c s i n the U n i v e r s i t y of A l b e r t a H o s p i t a l . A keypunch was placed i n the p o l i o ward. A f t e r va r ious c o n t r a c t j o b s , they formed t h e i r own company "Pro-Data Services L t d . " ^ Simon Fraser U n i v e r s i t y , Vancouver, B.C. At Simon Fraser U n i v e r s i t y p h y s i c a l f a c i l i t i e s appear adequate. F ive s tudents i n wheelcha i rs rand "oneiMandi student are r e g i s t e r e d . 7 The p r o j e c t p lanner s t a t e s t h a t a l l b u i l d i n g s must comply w i t h the - 42 - mun ic ipa l code and new b u i l d i n g s must conform to the code and accomodate the d i s a b l e d . Older b u i l d i n g s have been redesigned when g necessary. I t i s to be noted t h a t the women's res idences do not 9 conform to the b u i l d i n g code. The planner conf i rmed t h i s f a c t but sa id he knew o f no request f o r changes. There i s a p r o j e c t e d p lan f o r the d isab led f rom Pearson H o s p i t a l t o study computer science and use f a c i l i t i e s at the u n i v e r s i t y and hospital."'""'" U n i v e r s i t y o f B r i t i s h Columbia, Vancouver, B.C. At t h i s u n i v e r s i t y , p h y s i c a l f a c i l i t i e s f o r the d i sab led do not appear to be w e l l developed. New b u i l d i n g s f o l l o w the N a t i o n a l B u i l d i n g Code, B u i l d i n g Standards f o r the Handicapped, but most o l d e r b u i l d i n g s are not e a s i l y access ib le f o r whee lcha i r s . There i s no demand to modify the campus to be acceptab le f o r the d i sab led and p r i o r i t i e s f o r c a p i t a l expend i tu re go to o the r needed f a c i l i t i e s which 12 serve the g rea te r p o p u l a t i o n . When a d d i t i o n s were made to the Woodward L i b r a r y , they conformed to the B u i l d i n g Standards f o r the handicapped. Some modi f iedcaccomodat ion, a s p e c i a l te lephone and washrooms have been i n s t a l l e d i n o ther areas o f the campus. However, t he re i s not much encouragement f o r the d i sab led w i t h one excep t ion . The Crane Memorial L i b r a r y on t h i s campus i s the on ly l i b r a r y i n Nor th America t h a t i s p u r e l y academic, pa r t of an e s t a b l i s h e d u n i v e r s i t y system and s p e c i a l l y designed f o r those who are b l i n d or - 43 - have pe rcep tua l d i f f i c u l t i e s . This l i b r a r y supp l ies bo th re fe rences and a q u a l i f i e d l i b r a r i a n and conta ins 18,000 t e x t s i n B r a i l l e and 5,000 on tape. S i x t y - f i v e persons used the l i b r a r y i n 1973. The Crane Memorial L i b r a r y has been recognized by the L i b r a r y of Congress, Washington, D.C. and has e s t a b l i s h e d wor ld -w ide a f f i l i a t i o n s , supp ly ing books t o European c o u n t r i e s and the Un i ted S ta tes . Besides the books i n B r a i l l e or on tapes , o ther se rv i ces are p r o v i d e d . For example, t he re are seven pa id readers and seventy v o l u n t e e r readers , t he re i s a model o f the campus on which b l i n d s tudents can f e e l t h e i r way around and get to know the geography of the campus, and a ramp i s l o c a t e d a t the back o f the b u i l d i n g f o r easy access. Of f u r t h e r i n t e r e s t i s the f a c t t h a t a l l m a t e r i a l s i n the l i b r a r y can be obta ined through a p u b l i c l i b r a r y and there are p r o j e c t e d 13 p lans f o r these t o be d i s t r i b u t e d through the r e g u l a r mobi le u n i t . B. ADULT EDUCATION PROGRAMMES 1 . Nor th America P a r t i c i p a t i o n by Adu l t Educat ion Assoc ia t i ons appears t o be i n - s i g n i f i c a n t i n the h e a l t h care f i e l d i n Nor th America. Review of the l i t e r a t u r e f a i l e d t o revea l any unique e f f o r t s f o r the d i sab led by a d u l t educators , i n s p i t e o f the l a r g e numbers o f d i s a b l e d . I n one a d u l t educat ion p u b l i c a t i o n , i t mentions t h a t t he re are mental and - 44 - p h y s i c a l obs tac les to reach ing a d u l t educat ion a c t i v i t i e s , such b a r r i e r s as f a t i g u e , weather , p lace to park the c a r , i n e r t i a , f a m i l y r e s p o n s i - 14 b i l i t i e s and s o c i a l demands. A p h y s i c a l d i s a b i l i t y may encompass these and more and yet the re i s no mention of the b a r r i e r o f d i s a b i l i t y or of any a i d o f f e r e d the d i s a b l e d . I t cou ld be t h a t a d u l t educat ion has tu rned t o p r a c t i c a l r a t h e r than i d e a l i s t i c purposes, t h a t i t i s now a u t i l i t a r i a n t r a i n i n g more than an education."*"^ Or i t could be t h a t adu l t educators are not aware of the l a c k o f educa t iona l o p p o r t u n i t i e s f o r the d i sab led or the l a r g e numbers i n v o l v e d . I n our s o c i e t y we tend to h ide d i s a b i l i t i e s and o f t e n the needs o f chron ic p a t i e n t s on ly come to the a t t e n t i o n of agencies such 16 as those t h a t are a f f l i c t i o n - l i n k e d ; t h e r e f o r e r e s u l t s are p iecemeal . Some d i s a b i l i t i e s are w e l l recorded. For example, the Canadian N a t i o n a l I n s t i t u t e f o r the B l i n d , keep t h e i r records updated when a r e p o r t i s rece ived f rom an opthamologis t and computer ize them each year . There were 3,573 r e g i s t e r e d i n the B.C. r e g i o n as o f January, 1 9 7 4 . T h e Canadian Parap leg ic A s s o c i a t i o n , B.C. D i v i s i o n , 18 a lso main ta ins an accurate record and has a membership of 1 ,241 . Al though the A r t h r i t i s and Rheumatism Socie ty has f i l e s on a l l who are t r e a t e d , because many cases are not t r e a t e d or diagnosed and some tha t are do not w ish to be r e g i s t e r e d , on ly an es t imate o f cases i s p o s s i b l e . I n B.C. , t h i s i s one i n twen ty : I n the U.S.A. one i n 19 twe lve . This would make approx imate ly 100,000 cases i n B r i t i s h Columbia. - 45 - I f the need has not been recogn ized , i t i s understandable t h a t , a t adu l t educat ion c e n t r e s , l i t t l e concern i s shown f o r the d i s a b l e d . There are many f a c i l i t i e s which haveiphy.s±ca*l*ibarxi'erls and se rv i ces are l i m i t e d . Spec ia l t r a n s p o r t a t i o n i s expensive and not ob ta inab le i n many areas. Counse l l ing i s not a v a i l a b l e . Most a d u l t educators are not knowledgeable o f the medical aspect o f d i s a b i l i t y and would f i n d i t d i f f i c u l t to meet the requirements o f the d i s a b l e d . Away f rom a d u l t educat ion c e n t r e s , a d u l t educators do not contact the d isab led as they are hard t o l o c a t e ou ts ide o l e i n s t i t u t i o n s . There fo re , i t appears t h a t few educa t iona l o p p o r t u n i t i e s are a v a i l a b l e f o r the d isab led and t h a t l i t t l e encouragement i s g iven t o them i f no v o c a t i o n a l r e h a b i l i t a t i o n i s p o s s i b l e . However, two examples o f a i d to the d i sab led are o u t l i n e d , these are both i n Vancouver, B.C. One i s at a chron ic h o s p i t a l , the o ther at a r e h a b i l i t a t i o n c e n t r e . I n both cases, the goal i s r e h a b i l i t a t i o n i n i t s broad c o n t e x t , v o c a t i o n a l r e h a b i l i t a t i o n , a l though i t may be p o s s i b l e , i s not the c r i t e r i o n f o r e n t e r i n g i n t o any programme. At the Pearson H o s p i t a l , the re i s a t u t o r supp l ied and a smal l s p e c i a l l i b r a r y c o n t a i n i n g t e x t books and an encyc lopaedia . Correspondence courses are taken and an amateur r a d i o o p e r a t i o n was set up by some i n t e r e s t e d c i t i z e n s f rom Canadian P a c i f i c A i r a long w i t h courses g iven to the p a t i e n t s t o operate i t . The rad io room i s l i n e d w i t h badges f rom d i f f e r e n t opera tors w i t h whom they have been i n c o n t a c t . - 4 6 - Some other courses are taken ou ts ide of the h o s p i t a l . For example, one p a t i e n t has completed a year at Vancouver C i t y Col lege and p lans t o con t i nue , another i s t a k i n g a C e r t i f i e d General Accountan t ' s 20 course. At the G.F. Strong R e h a b i l i t a t i o n Centre, the emphasis i s on the p h y s i c a l and the average s tay f o r p a t i e n t s i s i n d e f i n i t e — f r o m a few weeks to over a year . When r e h a b i l i t a t i o n se rv i ces are complete, the p a t i e n t i s moved t o an app rop r ia te res idence. Dur ing t h e i r s tay a t the c e n t r e , they can be taught the use of many a i d s , such as h o l d i n g devices f o r p repar ing vegetables w i t h the use o f on ly one arm, a head s t i c k f o r t y p i n g w i t h o u t the use of arms and the "possum" ( p a t i e n t operated s e l e c t o r mechanism). Th is l a t t e r a i d appears most u s e f u l as i t makes i t poss ib le f o r the p a t i e n t to operate many dev ices , t y p e w r i t e r , t e l e v i s i o n , l i g h t sw i tches , e t c . , but the t h e r a p i s t exp la ined i t s d isadvantages. The mechanism i s not e a s i l y o b t a i n a b l e , t he re i s no maintenance se rv i ce i n Vancouver, i t i s expensive and i t i s d i f f i c u l t f o r many people t o cope w i t h the s o p h i s t i c a t i o n o f the "possum". The p a t i e n t must a lso be ab le to manipulate h i s mouth to operate the device by s u c t i o n and t h i s i s d i f f i c u l t f o r some p a t i e n t s w i t h neuro- l o g i c a l d i s o r d e r s . An a l t e r n a t i v e i s the " p i l o t " ) p a t i e n t i n i t i a t e d l i g h t operated t e l e c o n t r o l d e v i c e ) , which operates w i t h a minimum amount of head movement. For educa t iona l purposes, a s t i c k fastened to a head band can be used f o r persons w i t h o u t the proper use o f arms. Th is has the advantages of s i m p l i c i t y , a v a i l a b i l i t y and economy to the p a t i e n t but i t i s slow and 21 22 can be used on ly f o r t y p i n g . ' For those t h a t can, they may a lso use a s t i c k i n t h e i r mouths f o r t y p i n g . 2. England Adul t educat ion a u t h o r i t i e s appear f a i r l y a c t i v e i n England - 47 - i n the h e a l t h care f i e l d . They supply f a c i l i t i e s f o r p r e - v o c a t i o n a l work, a d v i c e , superv ised study or p r a c t i c a l work and t u i t i o n i s a v a i l a b l e f o r them. I f the p a t i e n t i s to b e n e f i t f rom such h e l p , he must be i d e n t i f i e d e a r l y and the occupa t iona l t h e r a p i s t w i l l not n e c e s s a r i l y be i n v o l v e d . I n a h o s p i t a l w i t h o u t complete f a c i l i t i e s the occupa t iona l t h e r a p i s t and s o c i a l worker take the i n i t i a t i v e and arrange f o r t u i t i o n through the Adu l t Educat ion A u t h o r i t y or through the Prepara tory T r a i n i n g Bureau o f the B r i t i s h Counc i l f o r the 23 R e h a b i l i t a t i o n o f the D isab led . A noteworthy e f f o r t i s made at the s p i n a l - c o r d i n j u r y cent re at the Stoke-Mandevi l le H o s p i t a l i n Ay lesbury . The founder o f the c e n t r e , Dr. Ludwig Guttman, was a l e a d i n g n e u r o l o g i s t and neurosurgeon i n Bres lau be fo re l e a v i n g Nazi Germany i n 1939. I n 1944, the B r i t i s h Government asked him to set up the u n i t to r e h a b i l i t a t e s p i n a l - c o r d war c a s u a l i t i e s o f the B r i t i s h Forces. This has s ince become the l a r g e s t and most famous s p i n a l cord i n j u r y cen t re i n the B r i t i s h Commonwealth and Europe. I t was the f i r s t p lace t o t r e a t t h i s type of i n j u r y which has been one o f the most depressing and most neg lec ted i n medicine and 24 s o c i a l sc ience. One r e p o r t s t a t e s t h a t i n the Un i ted S ta tes , i t i s s t i l l neg lec ted and because of a t t i t u d e s o f some members o f the medical p r o f e s s i o n and the general p u b l i c , the count ry i s the most backward and neg l i gen t of the major c i v i l i z e d c o u n t r i e s i n c a r i n g f o r c i v i l i a n s w i t h 25 s p i n a l cord i n j u r i e s . At S toke-Mandev i l le , the complete person i s t r e a t e d , t h e r e f o r e , t r a i n e d personnel on the r e h a b i l i t a t i o n team i n c l u d e , - 48 - s p e c i a l l y t r a i n e d nurses , p h y s i o t h e r a p i s t s , and o r d e r l i e s , s o c i a l workers and teachers . Radica l changes and a p s y c h o l o g i c a l approach to the problem o f pa rap leg ia were in t roduced as Guttman says " . . . t o rescue these men and women from the human scrap heap." Educat ion p lays a l a r g e p a r t . Employment s t a t i s t i c s show t h a t , o f 2,012 p a t i e n t s , 85.4 percent were e m p l o y e d . ^ 3. Sweden I n Sweden, a d u l t educators are very a c t i v e w i t h a l l ages o f d i s a b l e d . Some o f the a c t i v i t i e s are o u t l i n e d and our e f f o r t s i n Nor th America, by comparison, would appear t o be f a r below adequate. Hobby a c t i v i t i e s i nc lude courses i n weaving, sewing, book- b i n d i n g , p o t t e r y , p a i n t i n g c h i n a , p a i n t i n g and mode l l i ng i n c l a y . Othe a c t i v i t i e s i nc lude language courses, and courses i n l i t e r a t u r e , soc io lo genealogy, a d m i n i s t r a t i o n and numerous o ther s u b j e c t s . The pensioners a lso have groups f o r drama, s i n g i n g and music. I n c a p a c i t a t e d pensioners and younger handicapped persons can use a s p e c i a l t r a n s p o r t se rv i ce to get t o the l i b r a r y , or to go on p r i v a t e v i s i t s , t h e a t r e , e t c . They a lso have a mobi le l i b r a r y i n M a l m o . ^ A l l ages o f a d u l t d i sab led are served by study c i r c l e s organized by a d u l t educat ion a s s o c i a t i o n s , by an i nc reas ing number o f " f o l k h igh schoo ls" (board ing schools f o r a d u l t e d u c a t i o n ) , by va r ious - 49 - mun ic ipa l schools and by courses f o r a d u l t educa t ion . There i s a l i b r a r y f o r the b l i n d and books i n B r a i l l e or " t a l k i n g books" and books i n l a r g e type or i n s i m p l i f i e d language are p rov ided as w e l l as i n t e r p r e t e r s f o r the deaf and s p e c i a l consu l tan ts work ing w i t h a d u l t 29 educat ion a s s o c i a t i o n s and o r g a n i z a t i o n s o f the handicapped. C. SUMMARY I n Nor th America, some post secondary i n s t i t u t i o n s are being mod i f i ed t o overcome p h y s i c a l b a r r i e r s . A l s o , o ther se rv ices make i t poss ib le f o r many d isab led to a t t e n d , regard less of v o c a t i o n a l goa ls . However, more i s be ing done i n o ther c o u n t r i e s , f o r example, Sweden. The d i sab led must be g iven a mot ive f o r l i v i n g not r e l a t e d , 30 n e c e s s a r i l y , t o f i n a n c i a l g a i n , and now more are seen to f o l l o w 31 i n t e l l e c t u a l p u r s u i t s i n order to compensate f o r p h y s i c a l l o s s e s . Some educa t iona l endeavours may not be c u r t a i l e d by the boundar ies of p h y s i c a l d i s a b i l i t y and the c r e a t i v i t y they employ may a l l o w an o u t l e t by which a person may escape t e m p o r a r i l y f rom h i s d i s a b i l i t y . A l s o , an i n d i v i d u a l may engage i n educat ion and o f t e n ga in the g r a t i f i c a t i o n o f s u c c e s s f u l l y competing w i t h those who are not d i s a b l e d . I n t h i s f i e l d t h e r e would be numerous o p p o r t u n i t i e s i n a d u l t 32 educat ion because t h e r e i s something a v a i l a b l e f o r a l l i n t e r e s t s . As these may be the on ly sources f rom which the d isab led can draw t o en large h i s environment, the importance o f a d u l t educat ion cannot be - 50 - overemphasized f o r t h i s group. Encouragement and f a c i l i t i e s must be 33 made a v a i l a b l e f o r a d u l t educa t ion . Th is i s be ing recognized and some steps taken i n Nor th America but t h e r e i s s t i l l much t o be done. I t appears a d u l t educators are not yet f u l l y aware of the c o n t r i b u t i o n they could be making on beha l f o f the d i s a b l e d . - 51 - FOOTNOTES CHAPTER IV S. F. C u l l e n , P r o v i n c i a l Co-Ord inator o f R e h a b i l i t a t i o n , Government of Newfoundland and Labrador , Department of H e a l t h , R e h a b i l i - t a t i o n D i v i s i o n , personal l e t t e r , 11 A p r i l 1971. 2 Sven-Olaf B r a t t g a r d , M.D., Pres ident o f Fokus Soc ie ty and Professor a t the U n i v e r s i t y o f Goteborg, Sweden, personal l e t t e r , 3 January 1973. John F. McGowan and Tim Gust, "P repar ing Higher Educat ion F a c i l i t i e s f o r Handicapped S tuden ts " , ERIC Research i n Educat ion , V o l . 6, No. 3 (March 1971) : 1-107. 4 P a u l C. M a l l , " F e a s i b i l i t y Study f o r the P h y s i c a l l y Handicapped, 1970-1971" , ERIC Research i n Educat ion , V o l . 6, No. 7 ( Ju ly 1971) : 1-37. "TJuc'i'ihenE. Wi th ing ton and Michael T. Savine, " V o c a t i o n a l R e h a b i l i t a t i o n of the Severely. Disabled i n a U n i v e r s i t y S e t t i n g " , ERIC Research i n Educat ion , V o l . 6, No. 4 ( A p r i l 1971) : 1-9. D. Fenna, Ph .D . , U n i v e r s i t y o f A l b e r t a H o s p i t a l , Edmonton, A l b e r t a , personal l e t t e r , 18 May 1973. 7 Ida C u r t i s , Resource Person f o r the Handicapped, Simon Fraser U n i v e r s i t y , Vancouver, B .C. , personal l e t t e r , 18 October 1973. R. McKay, P r o j e c t P lanner , Phys i ca l P l a n n i n g , Simon Fraser U n i v e r s i t y , te lephone communication, 15 January 1974. 9 Vo lun ta ry A s s o c i a t i o n f o r Hea l th and Wel fare of B r i t i s h Columbia, B u i l d i n g Standards f o r the Handicapped 1970, Supplement No. 5, March 1971, p. 5. 1 0 R . McKay, 12 February 1974. - 52 - "''"'"Interview w i t h Tom Parker , Counse l lo r , Parap leg ic A s s o c i a t i o n Vancouver, B.C. , 10 May 1973. 12 Robert S. Houston, A s s i s t a n t to the Super intendent of Design D i v i s i o n , Phys ica l P l a n t , U n i v e r s i t y o f B r i t i s h Columbia, te lephone communication, 8 January 1974. 13 I n t e r v i e w w i t h Paul T h i e l e , L i b r a r i a n , Crane Memorial L i b r a r y , U n i v e r s i t y of B r i t i s h Columbia, 18 June 1973. 14 V i r g i n i a B. Warren, ed.,- A Treasury of Techniques f o r Teaching Adu l ts (Washington, D.C. : N a t i o n a l A s s o c i a t i o n f o r Pub l i c School Adu l t Educat ion , N a t i o n a l Educat ion A s s o c i a t i o n , 1964) , p. 35. "'"^Webster E. Co t ton , "a new d i r e c t i o n f o r adu l t e d u c a t i o n " , Educat iona l Horizons (Summer 1968) : 152. 1 6 I n t e r v i e w w i t h Peter Bunton, M.B., B .S . , F .R.C.P. , Soc ia l P s y c h i a t r i s t , U n i v e r s i t y of B r i t i s h Columbia, J u l y 1971. "*" 7Edith York, Pub l i c Re la t ions O f f i c e r , Canadian N a t i o n a l I n s t i t u t e f o r the B l i n d , B r i t i s h Columbia, te lephone communicat ion, 14 May 1973. 18 Annual Repor t , Canadian Parap leg ic A s s o c i a t i o n , B.C. D i v i s i o n , 1972. 19 J . F. Dewhurst, Pub l i c Re la t ions O f f i c e r , A r t h r i t i s and Rheumatism Soc ie t y , B r i t i s h Columbia, te lephone communicat ion, 8 May 1973. 20 S. Fos te r , H o s p i t a l T u t o r , Pearson H o s p i t a l , Vancouver, B.C. , te lephone communication, 16 A p r i l 1973. 21 I n t e r v i e w w i t h S y l v i a Home, Superv isor , Occupat ional Therapy Adu l t Sec t ion , G.F. Strong R e h a b i l i t a t i o n Centre , Vancouver, B .C. , 13 A p r i l 1973. 22 I n t e r v i e w w i t h A. R. Smith, Pub l i c Re la t ions O f f i c e r , G.F. Strong R e h a b i l i t a t i o n Cent re , Vancouver, B .C. , 3 May 1973. - 53 - 23 E. M. MacDonald, G. MacCaul, L. M i r ray et a l . , e d . , Occupat ional Therapy i n R e h a b i l i t a t i o n (London: B a l l i e r e , T i n d a l l and Casse l l L t d . , 1970) , p. 117. 24 S i r I an Fraser , e d . , Conquest of D i s a b i l i t y , (London: Odhams Press L i m i t e d , Long Acre , 1956) , pp. 59-79. 25 Paul C. Bucy, " P a r a p l e g i a : The Neglected Prob lem", Phys ica l Therapy, V o l . 49, No. 3 (1968) : 269. 26 L. Guttman, "Our Paralysed Fellowmen a t Work", R e h a b i l i t a t i o n 43 (October-December 1962) : 9. 27 Bucy, op. c i t . , p. 269. 28 Yngve Tidman, "Towards a Real I n t e g r a t i o n o f the Aged i n S o c i e t y " , New L ives f o r O ld , t r a n s l a t e d by K e i t h B r a d f i e l d (Stockholm: Swedish I n s t i t u t e , 1969) , pp. 6-7. 29 Richard S te rner , Serv ices f o r the Handicapped i n Sweden, Stockholm: Swedish I n s t i t u t e , 1972) , p. 15. 30 Garret and Lev ine , op. c i t . , p. 416. 31 R. E. A. Gable and P. J . R. N i c h o l s , Eva lua t ion o f a Disabled L i v i n g Un i t (Bath , Great B r i t a i n : Pitman Press , 1971) , pp. 226-227. 32 Ernest E. McMahon, Robert H. Coates and Alan B. Knox, "Common Concerns: The P o s i t i o n of the Adu l t Educat ion A s s o c i a t i o n of the U.S.A. " , Adu l t Educat ion J o u r n a l , V o l . 18, November 3 (1968): 197. 33 Canadian a s s o c i a t i o n f o r a d u l t educat ion (1964) , A wh i te paper on the educat ion o f a d u l t s i n Canada, (Toronto : Thorn Press , 1964) . - 54 - CHAPTER'V CHRONIC CARE PHILOSOPHY IN PRACTICE Studies a t S t . Mary 's P r i o r y Extended Care H o s p i t a l Th is t h e s i s has discussed the problem t h a t the psychosoc ia l needs of the c h r o n i c a l l y d i sab led are o f t e n not met, but at S t . Mary 's P r i o r y Extended Care H o s p i t a l , V i c t o r i a , B .C. , apparen t l y the re i s an awareness o f these needs and s incere e f f o r t to s a t i s f y them. At a seminar on extended care i t was s ta ted t h a t t h i s h o s p i t a l and Mount St . Mary 's i n V i c t o r i a , B.C. were the p ioneers i n t h i s p rov ince on extended care and have set an example of what could be accompl ished. The standards f o r extended care were developed w i t h the a i d o f severa l h o s p i t a l s such as these."'" From 1970, a l l l i t e r a t u r e about and from St . Mary 's P r i o r y H o s p i t a l was s t u d i e d , four persona l i n t e r v i e w s were conducted and numerous correspondence was rece ived from the D i r e c t o r of H o s p i t a l Serv ices , c u l m i n a t i n g i n a fou r month f i e l d study a t the h o s p i t a l . A rev iew was made of a b r i e f study done i n 1969 which used d i scuss ion groups i n St . Mary 's r e a c t i v a t i o n programme. The c u r r e n t shor t study i n 1973 was d i v i d e d i n t o f o u r phases, the f i r s t , an overv iew of the h o s p i t a l , second, f a m i l i a r i z a t i o n of r e s i d e n t s ass igned, t h i r d , an educa t iona l process to be used i n - 55 - r e h a b i l i t a t i o n and f o u r t h , r e - i n t e g r a t i o n o f the study group of r e s i d e n t s w i t h the p o p u l a t i o n of the h o s p i t a l . A. FIRST STUDY IN 1969 2 This shor t study was conducted t o f u r t h e r the r e a c t i v a t i o n programme at t h i s h o s p i t a l . S i s t e r B e r t i l l a had taken a course on " E f f e c t i v e Leadership and Communications" and e i g h t p a t i e n t s were chosen, rang ing i n age f rom s i x t y - f o u r to n i n e t y - f o u r y e a r s , to par take i n d i scuss ion groups o f such t o p i c s as the news of the day, the B i b l e , or shor t s t o r i e s . She was a s s i s t e d by a s tudent i n order t o m a i n t a i n i n t e r e s t and g ive adequate coaching. A c t u a l p a r t i c i p a t i o n was encouraged and conf idence and t r u s t were i n s t i l l e d by showing i n t e r e s t , concern and respec t . The S i s t e r spent some t ime i n i n q u i r i n g about hobb ies , i n t e r e s t s and v o c a t i o n s . Dur ing t h i s p e r i o d , some progress was noted i n the p a t i e n t s and i t would i n d i c a t e t h i s type o f therapy would be o f b e n e f i t i n the r e a c t i v a t i o n n programme. B. SECOND STUDY IN 1973 3 The second study was conducted between June 1 , 1973 and September 30, 1973 and a t o t a l of f i v e r e s i d e n t s p a r t i c i p a t e d . 1 . Use o f Educat iona l Process The educa t iona l process was used as a means o f r e p l a c i n g - 56 - a p o r t i o n of l o s t a c t i v i t i e s and i t s e f f e c t i v e n e s s was observed i n d e a l i n g w i t h symptoms o f w i thd rawa l i n the l o n g - t e r m d i s a b l e d . I n the case o f one res iden t i t was used s imply as a d i v e r s i o n but w i t h o thers i t became a t o o l t o s t i m u l a t e awareness. Because most or a l l former a s s o c i a t i o n s , may be l o s t f o r the d i s a b l e d , a p a r t i a l or complete w i thd rawa l f rom the wor ld o f r e a l i t y may take p lace . I n t r o - spec t ion enlarges to engu l f many o f the conscious e f f o r t s o f the person and a comatose appearance may f o l l o w . I t i s t heo r i zed t h a t educat ion may be a wedge to combat w i thd rawa l and rep lace some a c t i v i t i e s which are l o s t . I t may enlarge hor izons by fo rming new a s s o c i a t i o n s and new purposes o r by r e a c t i v a t i n g former s k i l l s . (See F igure 5 ) . F r i e n d s >\ / ' * • R e l a t i v e s >r S o c i a l ' / A c t i v i t i e s , . Home \ t o o d Healttt \ / Job T r a v e l \ > / 7 \ FIGURE 5 T h e o r i z e d P r o g r e s s i o n from " N o r m a l " L i f e to D i s a b l e d w i t h P o s s i b l e Complete Withdrawal and the Role Educators may P l a y to Prevent o r A l l e v i a t e W i t h d r a w a l . y\ .*;Th't rpV..'.' • * '•' * r\ Frji,ehds...'JA. i>,:Re 1 at i ve s_v _ \ v ,'Ae t i v i t i e s/;;- i :Hqra4v'... •• '-.y^'v.''! ;-x e o 6 a , - x , V i - i N^/'rJobV4-' T.ra-ve'i^-'.^:^y' X _'. I n t r o s p e c t i o n ' ' - • Complete_Withd,rawal ,.*'•'•' Fantasy . * / ' * . : ' • ' - 58 - 2. Use of a Model f o r Assessment A model f o r research and e v a l u a t i o n on r e h a b i l i t a t i o n by Suchman was used, however, the p r e c o n d i t i o n i n g v a r i a b l e was not i nco rpo ra ted owing to the f a c t t h a t i t was not poss ib le to o b t a i n 4 enough i n f o r m a t i o n p r i o r to d i s a b i l i t y on t h i s group o f peop le . (See F igure v6"~) FIGURE &1 MODEL FOR ASSESSMENT P r e c o n d i t i o n i n g Independent Va r i ab le V a r i a b l e PRE-EXISTING CONDITIONS _V DISABILITY I n t e r v e n i n g Va r iab le Dependent V a r i a b l e -i REHABILITATION ~* CONSEQUENCES 3. D i v i s i o n o f Study i n t o Four phases. Phase I Overview o f the h o s p i t a l , t h r e e weeks, June 1-22 1 . General Phi losophy of the H o s p i t a l 2. Residents and S t a f f 3. Methods o f Car ing f o r the P a t i e n t s - 59 - Phase II F a m i l i a r i z a t i o n of residents assigned, seven weeks, June 25 - August 10 1. Study of Medical History 2. Recreation - Car Rides, Bowling, Planters, etc. 3. R e a l i t y Therapy 4. Mealtime i n Separate Dining Room Phase III Educational process to be added to those a c t i v i t i e s i n Phase I I , complying with a b i l i t i e s and i n t e r e s t s of the resident, f i v e weeks, August 13 - September 14. 1. Short Correspondence Course on B.Cg^ 2. Correspondence Course on Painting. 3. P r a c t i c e on re-learning to p r i n t , read and count. Phase IV Re-integration with population of the h o s p i t a l , two weeks, September 17-30. 1. Recreation 2. Mealtime 3. Continuation of Correspondence Courses D. Report on Hospital i n Phase I. General Overview of the Hospital At the P r i o r y Hospital an e f f o r t i s made to have as "homey" an atmosphere as possible. Nursing personnel do not wear uniforms, v i s i t i n g hours are not regulated, c h i l d r e n and animals are allowed to v i s i t and the residents are dressed i n adaptable regular c l o t h i n g and i n the lounge or a c t i v i t y room as much as possible. Mental stimulation i s encouraged. A l l rooms have calendars and clocks and d i f f e r e n t colours are used on doors i n order that the resident may i d e n t i f y her room. The day s t a r t s e a r l y , the resident i s washed and dressed and given f r u i t j u i c e . She then goes into the dining room for breakfast, followed by exercise and r e a l i t y o r i e n t a t i o n - 60 - i n a s u i t a b l e group. I n the summer the re are such a c t i v i t i e s as bus r i d e s , barbecues and bow l ing . At o ther t i m e s , those who are able make hobby i t ems , decora t ions f o r Christmas and presents f o r c r i p p l e d c h i l d r e n . Community involvement i s encouraged, f o r example, the P r i o r y has a m i n i a t u r e rodeo, hot dogs and s o f t d r i n k s are served and the members o f the community are i n v i t e d . The r e s i d e n t s are a lso taken out t o the highway t o watch the l o c a l parade and were o b v i o u s l y d e l i g h t e d when the sen io r R.C.M.P. o f f i c e r sa lu ted them; thus they i n t e r a c t w i t h the community. I n a l l these a c t i v i t i e s the re i s an e f f o r t to f u l f i l l the th ree ca tegor ies o u t l i n e d i n Chapter I I I , t h a t o f s t i m u l a t i n g m o t i v a t i o n , se rv ing a purpose f o r a c t i v i t i e s , and making e f f o r t s at i n t e g r a t i o n . Bu t , even w i t h these e f f o r t s , t h e r e i s some s e g r e t a t i o n . The h o s p i t a l i s e i g h t mi les from the c i t y and set back f rom the highway. A l s o , a l l r e s i d e n t s are women, t h e r e f o r e i t i s not a "no rma l " p o p u l a t i o n . Even husband and w i f e may be separated owing to the f a c t t h a t sexes are separated o r d i f f e r e n t l e v e l s of care are r e q u i r e d . They are then p laced i n " a p p r o p r i a t e " accomodation. For example, one n i n e t y - t w o year o l d husband was at a board ing home across the road w h i l e h i s e i g h t - e i g h t year o l d w i f e was at the extended care h o s p i t a l . Residents could a lso be ou ts ide more o f t e n . At the present t i m e , a l l o u t s i d e areas are access ib le on ly by ramp but as some r e s i d e n t s cannot be l e f t unattended o u t s i d e , t h e r e were many f i n e days - 61 - when they were i n s i d e . I f the l a r g e p a t i o w i t h umbrel las and t a b l e s were made l e v e l w i t h t h e i n s i d e f l o o r , r e s i d e n t s cou ld be o u t s i d e and ye t remain i n f u l l v iew from i n s i d e . Th is would make i t easy to wheel them i n t o a t tend to personal needs and back out aga in . A l s o , i n t e r a c t i o n between r e s i d e n t s was not encouraged as much as i t might have been. This i s most impor tant as s t a f f and v o l u n t e e r s change and the r e s i d e n t s form the s t a b l e p o p u l a t i o n . The r e s i d e n t s were d i v i d e d i n t o two groups the f i r s t , apparen t l y s u f f e r e d l i t t l e r e t r o g r e s s i o n or w i t h d r a w a l . They a te i n a smal l d i n i n g room which a l lowed some contac t du r i ng a c t i v i t i e s and mealt imes but each day they had a "happy hour" which was conducted by a vo lun tee r or a member o f the s t a f f , read ing f rom newspapers, conduct ing d i s c u s s i o n s , b a k i n g , e t c . The r e s i d e n t s were arranged i n a s e m i - c i r c l e around the person conduct ing the sess ion . Nothing was done t o break up the group and have d iscuss ions among the peers so n e a r l y a l l conversa t ion was d i r e c t e d t o he r ; the shyer ones never had much chance to p a r t i c i p a t e . The second group was main ly composed of r e s i d e n t s who were s u f f e r i n g v a r y i n g degrees o f r e t r o g r e s s i o n , w i thd rawa l and c o n f u s i o n . There were two t a b l e s i n t h e i r a c t i v i t y room on which e i g h t were able to have meals. The o thers were placed around the pe r iphe ry of the room w i t h i n d i v i d u a l t r a y s and t h e r e f o r e l i t t l e chance f o r i n t e r a c t i o n , f o r the persons i n t h e i r l i n e of v i s i o n were too f a r away. A l though i t - 62 - would be l e s s convenient to look a f t e r t h e i r needs, i f the chairs were placed i n small groups there would have been more c o n v i v i a l i t y and more chance for s o c i a b i l i t y even when conversation made l i t t l e sense. In summary, the p o s i t i v e aspects f a r outweighed the negative i n these general observations of the f i r s t two weeks. 5. Report on Residents Assigned i n Phases I I , III & IV a. General Means of R e h a b i l i t a t i o n The report i s made on an i n d i v i d u a l b a s i s . The means of r e h a b i l i t a t i o n which were common to a l l are l i s t e d . ( i ) The selected residents were seated i n t h e i r own dining room for a l l meals, the group with i t s own table set with a table c l o t h and s i l v e r . ( i i ) They were taken on such outings as car r i d e s , "walks", i n the garden, barbecues, bowling, they set up planters with the gardener and v i s i t e d at the home for the r e t i r e d nearby. ( i i i ) They attended general a c t i v i t i e s of the h o s p i t a l which were of i n t e r e s t to them. (iv) Each day each member had a personalized o r i e n t a t i o n session. These could not be given as a group because of the d i s p a r i t y i n l e v e l s of function and i n t e r e s t . (v) They were often given sensory stimulation. T a c t i l e was sometimes the only means of communication. Besides t a c t i l e , such as holding hands, putting an arm around t h e i r shoulders or giving them plants and s o i l to f e e l when arranging planters, v i s u a l and auditory means were used. It was found that speaking to them and s i t t i n g i n front of them were more h e l p f u l than t e l e v i s i o n or movies where they would often doze when not c a l l e d upon to respond. - 63 - b. I n d i v i d u a l Means o f R e h a b i l i t a t i o n Phase I I , I I I & IV (F igure 6) Resident No. 1 H i s t o r y D i s a b i l i t y Rehab i l i t a t i o n Goal: Means: Consequences: Born i n 1905. Resident o f the h o s p i t a l s ince 1968. Park inson 's Disease, w e l l managed on the med ica t ion o f L-Dopa. Able to walk but subj ect to f a i n t n e s s and spasms o f the eyes. Gets f i t s of depress ion . Restore s e l f esteem, a s , accord ing to s t a f f r e p o r t s , t h i s r e s i d e n t had two changes i n her environment i n the l a s t few years . Her r e l a t i o n s w i t h her f a m i l y had been s t r a i n e d and her p o s i t i o n i n the h o s p i t a l had been changed. I n p r i o r years she had been prominent owing t o her progress and c a p a b i l i t y but now was inconspicuous owing t o the change i n p o p u l a t i o n . A s s i s t w i t h the r e s t o f the group assigned who were obv ious ly not as capable . Take correspondence course on B r i t i s h Columbia f o r which she would rece ive a d ip loma. Her s e l f esteem was r e - i n f o r c e d i n the group as she was capable of a i d i n g the o t h e r s , s e t t i n g the t a b l e , h e l p i n g them eat and j o i n i n g them i n a c t i v i t i e s , i n a l l o f which she was obv ious l y s u p e r i o r . She completed the correspondence course and rece ived her diploma b u t , a long w i t h her o ther d u t i e s , i t was d i f f i c u l t to ass ign any p o s i t i v e gains a t t r i b u t a b l e to a d e f i n i t e v a r i a b l e , however, persona l assessment would favour the f i r s t , her p o s i t i o n as leader i n the group. - 64 - F i n a l l y , she was able to re-integrate well at the end of the summer. Resident No. 2 History D i s a b i l i t y Born i n 1883. Resident of the h o s p i t a l since A p r i l , 1973. A r t e r i o s c l e r o s i s . Disoriented and extremely agitated much of the time. R e h a b i l i t a t i o n Goal: To improve s o c i a l i z a t i o n with s t a f f and peers. To c o n t r o l a g i t a t i o n and improve r e c o l l e c t i o n of r e l a t i v e s . Means: by he Consequences: Besides the general means of r e h a b i l i t a t i o n l i s t e d , she had many pictures of friends and r e l a t i v e s shown to her and discussed with her. A pi c t u r e of her farm was placed by her bed. Her s o c i a l i z a t i o n was improved as evidenced by the fac t that many of her s o c i a l graces returned. At f i r s t , at the dining table, she would take the food from others and use any u t e n s i l s but at the end of two weeks, she was keeping her place t i d y , f o l d i n g her s e r v i e t t e and never touching others' food. She offered her desserts to others, enjoyed going for rid e s i n the car and out i n the garden and talked with others. Over a few weeks, i n r e a l i t y therapy sessions, she remembered her dead husband, asked about s i b l i n g s and spoke of her ch i l d r e n , but did not remember when the l a t t e r saw her. She recognized photographs of friends and r e l a t i v e s and a picture of her farm. She remembered her name and wished to be ca l l e d by a "nickname". It i s mentioned that progress i n r e h a b i l i t a t i o n i s made when the person assumes h i s i d e n t i t y by remembering his name.7 Although her mental improvement was noticeable under the personal therapy she s t i l l became extremely agitated and usually, by l a t e afternoon, could not be consoled. At the end of July, she died from pneumonia. - 65 - Resident No. 3 H i s t o r y Born i n 1885. Resident of the h o s p i t a l s ince 1971. D i s a b i l i t y Unable t o walk because of the e f f e c t s of a s t r o k e . Spoke on ly g i b b e r i s h . Had days when she could not be aroused. R e h a b i l i t a t i o n Goal: To improve s o c i a l i z a t i o n . To be able t o communicate i n t e l l i g i b l y . To be ab le t o use u t e n s i l s w i t h which t o read and w r i t e . To s t i m u l a t e her i n o rder t h a t she stayed awake each day. To i n t e r a c t p l e a s i n g l y w i t h peers and s t a f f . Means: Besides the general means o f r e h a b i l i t a t i o n l i s t e d , a r e - e d u c a t i o n a l process was used, t h a t of r e a d i n g , w r i t i n g and c o u n t i n g . Consequences: I n the second phase of the s tudy , as a r e s u l t o f s t i m u l a t i o n i n the form of personal a t t e n t i o n , car r i d e s , "wa lks " i n the garden and o t h e r s , t h i s r e s i d e n t became a l e r t most o f the t i m e . She p r o g r e s s i v e l y improved i n her speech, f rom the g i b b e r i s h she spoke i n i t i a l l y , t o sens ib le and p l a i n words, f o r example, by J u l y 6, she c a l l e d " n u r s e " . The f o l l o w i n g week she spoke s e n s i b l y a l l the t ime I had her out w i t h the group f o r a car r i d e but re fused t o say any th ing when she re tu rned to the h o s p i t a l . By J u l y 20, she was speaking many i n t e l l i g i b l e sentences and expanding her environment by t a l k i n g w i t h o ther r e s i d e n t s , t h e i r f r i e n d s and r e l a t i v e s . I n the t h i r d phase, she cont inued to be a l e r t and t a l k a t i v e a l though much was s t i l l g i b b e r i s h . She was never un res - pons ive . She at tended movies, c h o r a l groups and church s e r v i c e s . She - 66 - commented when another member of the group appeared to be s u f f e r i n g and even n o t i c e d a change i n h a i r s t y l e of another . She has been read ing her name, p r i n t i n g , count ing and even c o r r e c t e d me on the p ronounc ia t i on of her name. I n r e c o g n i z i n g her name she evidenced the f i r s t step i n her r e h a b i l i t a t i o n 8 but i n coming back t o r e a l i t y , the unpleasant as w e l l as the p l e a s a n t , are r e c a l l e d . At t imes she would remember - ' her l i f e l o n g companion, a s i s t e r who was dead, and would cry and c a l l her name. I n the f o u r t h phase, she appears to be i n t e g r a t i n g w e l l . Resident No. 4 H i s t o r y D i s a b i l i t y Born i n 1901. Resident o f the h o s p i t a l s ince 1968. Stroke r e s u l t i n g i n r i g h t s ided hemip leg ia and aphas ia . Heart c o n d i t i o n . Signs of w i t h d r a w a l . R e h a b i l i t a t i o n Goals: Means: I n t e r a c t i o n w i t h s t a f f , peers and o t h e r s . Hold head u p r i g h t . Improve speech. A t tend group a c t i v i t i e s . Besides the genera l means o f r e h a b i l i t a t i o n l i s t e d , s p e c i a l a t t e n t i o n was g iven i n an at tempt t o ga in conf idence and encourage i n t e r a c t i o n , fFor example, she was spoken t o o f t e n and ample t ime a l lowed f o r r e p l y and r e p e t i t i o n of r e p l y i f not unders tood. A h a l t e r was designed t o f i t over her head and used f o r t h ree minutes th ree t imes a day to help her t o ho ld her head i n the c o r r e c t p o s i t i o n . She was taken out around grounds and h o s p i t a l where she would meet o thers r a t h e r than remain i n the T.V. room by h e r s e l f . - 67 - She was moved to more c h e e r f u l surroundings as a l l the p a t i e n t s i n t h i s ward were very i l l . A vo lun tee r was approached t o make r e g u l a r v i s i t s to he r . A correspondence course was arranged w i t h her pe rm iss ion . Consequences: I n the second phase, s ince j o i n i n g the group and be ing g iven l o t s o f encouragement, she was t r y i n g to s i t w i t h her head up. She had i n i t i a t e d smi les and s t a r t e d a conversa t ion w i t h the nurse i n which she t o l d her a l l about a bus t r i p she had taken on the p r i o r day. She a lso spoke of her husband, s t a t i n g t h a t he was dead. She had re fused to admit t h i s i n a p r i o r conve rsa t i on . I n the t h i r d phase, she completed the course on B r i t i s h Columbia. I t appeared p a r t i c u l a r l y u s e f u l to t h i s l a d y , not because o f the course c o n t e n t , but f o r the f a c t i t drew o thers i n t o conversa t ion w h i l e we went over the lessons i n the a c t i v i t y room, i n the ward o r ou ts ide i n the garden. Fel low r e s i d e n t s , nurses and v i s i t o r s i n q u i r e d what we were do ing . I n t e r e s t i n g conversat ions f o l l o w e d and o f t e n the lesson was f o r g o t t e n . I n the f o u r t h phase, she appears to be i n t e g r a t i n g w e l l . She has shown some improvement, o f t e n s m i l i n g and speaking w i t h me. However, i t i s n o t i c e d t h a t she does not i n t e r a c t w i t h peers and she very r a r e l y i n i t i a t e s conversa t ion w i t h nurses. Resident No. 5 H i s t o r y : Born i n 1885. Resident of the h o s p i t a l s ince J u l y 26, 1973. D i s a b i l i t y : Post f r a c t u r e d femur. P a r t i a l l y deaf . - 68 - R e h a b i l i t a t i o n Goals: Means: Consequences: As she does n o t h i n g , encourage her to use her l a t e n t a b i l i t i e s , p a i n t i n g and p l a y i n g the p iano . Have her p lay the piano i n the a c t i v i t y room f o r shor t sessions a few t imes a day. Have her take a correspondence course on p a i n t i n g f o r p leasu re , j o i n e d by another who a lso used to water co lour as a hobby. She was not w i t h the group l o n g , having come to the h o s p i t a l at the end o f J u l y . She appeared t o have p leasure w i t h her piano p l a y i n g and to enjoy her p a i n t i n g f o r shor te r per iods of t ime . Of the two, the piano p l a y i n g appeared the more b e n e f i c i a l . 6. Fol low-up Report on Residents Assigned. A Report on Residents i n the Study was obta ined on 14 December 1973. Resident No. 5 had broken her h ip aga in i n October, 1973 and had been removed to another h o s p i t a l . However, Vera Mclver repor ted t h a t the o the rs appeared t o have main ta ined much of the improvement evidenced du r ing the s tudy . 7. Conclusion o f the Second Study There are some d i f f i c u l t i e s i n a r r i v i n g at a s c i e n t i f i c assessment f o r any study of t h i s t y p e . F i r s t l y , i t i s d i f f i c u l t t o measure behavior i n t imes o f i l l n e s s , t h e r e f o r e the study has been t h e o r e t i c a l and d e s c r i p t i v e , but - 69 - not a n a l y t i c a l . Conclusions were ob ta ined f rom the w r i t e r ' s observa t ions r e - i n f o r c e d by members of the h o s p i t a l s t a f f . Secondly , . i n i t i a l l y t he re was not s u f f i c i e n t t ime or o p p o r t u n i t y t o study the r e s i d e n t s assigned be fo re new r e h a b i l i t a t i o n measures were under taken. T h i r d l y , i t was not p o s s i b l e to determine the pre-morb id c o n d i t i o n o f the r e s i d e n t s as the re i s l i t t l e record p r i o r t o d i s a b i l i t y ; t h e r e f o r e the p r e c o n d i t i o n i n g v a r i a b l e was omi t ted f rom Suchman's model f o r assessment. F o u r t h l y , i t was not f e a s i b l e to i s o l a t e any p o s i t i v e ga in and a t t r i b u t e i t to any s p e c i f i c a c t i v i t y , such as educa t ion , as many o ther i n t e r v e n i n g v a r i a b l e s were a lso i nvo l ved such as the in tense persona l i n t e r e s t shown t o these r e s i d e n t s who were p a r t of the s tudy . I n c o n c l u s i o n , the r e s i d e n t s appeared to b e n e f i t f rom the s p e c i a l care they rece ived and not to form any dependency which would have to be te rmina ted at the end o f the s tudy . A l though they had to be t r e a t e d w i t h some concessions owing t o t h e i r s t a t e o f h e a l t h , t h i s was accomplished by r e s p e c t i n g them and r e l a t i n g t o them as mature peop le . The d isc repanc ies i n t h i s type o f study are apparent , f o r example, the smal l sample chosen f o r the study and the shor t t ime engaged i n the study but the p o s i t i v e r e s u l t s obta ined would i n d i c a t e the va lue of more leng thy and i n t e n s i v e i n v e s t i g a t i o n . - 70 - An observa t ion was made of o t h e r s , i n the area of psychology, who at tempted a study here w i t h o u t the necessary medical background. As s t a t e d by Dr. S z a s z , e d u c a t o r s are not u t i l i z e d i n the D i v i s i o n of I n t e r p r o f e s s i o n a l Educat ion at U n i v e r s i t y of B r i t i s h Columbia because they u s u a l l y l a c k the medical background. This could a lso app ly to psycho log i s t s and s o c i o l o g i s t s , f o r i n any medical f i e l d i t i s necessary t o have some unders tanding o f the medical aspects i n order t o f u n c t i o n i n a p o s i t i v e manner. Observat ions here r e i n f o r c e d h i s s ta tement , f o r example, one student m i s i n t e r p r e t e d the hand l ing of h i s cases as being p rogress ive ins tead o f ev idenc ing dependency and depress ion . As a r e s u l t t h e r e was r e t r o g r e s s i o n i n the p a t i e n t s under h i s c a r e . I I I . Summary Knowing t h a t many s tud ies have shown tha t h igher m o r b i d i t y and 12 m o r t a l i t y ra tes occur when the e l d e r l y enter i n s t i t u t i o n s , e f f o r t s are made here to s o f t e n the trauma of d i s l o c a t i o n . However, no s tud ies were l oca ted comparing the l e n g t h of s tay o f the e l d e r l y i n v a r i o u s types of i n s t i t u t i o n s , reasons f o r t e r m i n a t i o n and i n d i c a t i o n s of the k ind of care which appears t o r e s u l t i n happier and longer l i v e s . The summer of 1973 study was d i r e c t e d at the r e a c t i v a t i o n programme of the P r i o r y and the va lue of psychosoc ia l care f o r long term cases was e x e m p l i f i e d by these peop le . Educat ion was one v a r i a b l e used 13 as the re i s a need f o r d i v e r s i o n a l a c t i v i t i e s i n the f i e l d o f g e r i a t r i c s and educat ion and r e - e d u c a t i o n can be among them. Government programmes - 71 - i n the States are sa id to have been designed to meet v o c a t i o n a l needs and the re i s need t o improve and ma in ta in the p h y s i c a l c o n d i t i o n o f 14 e l d e r l y s t roke p a t i e n t s . This may apply t o any d i s a b i l i t y . The P r i o r y H o s p i t a l does much to a c t i v a t e the r e s i d e n t s and to meet t h e i r psychosoc ia l needs. However, some d e f i c i e n c i e s i n extended h o s p i t a l care were no ted . For i n s t a n c e , each h o s p i t a l should have a l l l e v e l s o f care and bo th sexes, more c l o s e l y approx imat ing the ou ts ide community. I f a t a l l p o s s i b l e , husbands and wives should not be separated. Couples who have l i v e d toge ther many years f i n d themselves alone when o f t e n they need each o ther the most. An e l d e r l y couple v i s i t i n g at the h o s p i t a l sa id they feared some i l l n e s s t h a t would separate them. Death i s i n e v i t a b l e but premature s e p a r a t i o n , i n the name o f e f f i c i e n c y or economy, can be d e t r i m e n t a l . A l s o , h o s p i t a l s should be p laced where the a c t i v i t i e s o f the community may be observed by the r e s i d e n t s , day by day, not as an excurs ion t r e a t . W i t h i n t h i s h o s p i t a l , t h e r e should a lso be an area reserved f o r r e s i d e n t s to be alone i f they wished sec lus ion f o r a shor t t i m e . Now they are always w i t h o t h e r s , t he re i s no p lace t o d i s p l a y emotions or f o r peace fu l s o l i t u d e , even t h e i r rooms are shared w i t h o t h e r s . There used t o be a chapel f o r r e f u g e , but even t h i s space has been u t i l i z e d f o r d i n i n g and a c t i v i t y a rea . - 72 - As f a r as the s t a f f i s concerned, t h e r e was a tendency and evidence t h a t s t e r e o t y p i n g takes p l a c e , w i t h r e s u l t a n t expectancies t h a t a d e f i n i t e response was to be expected f rom c e r t a i n types o f i l l n e s s . For example, one woman was i n t e a r s and bo th the nurse and a c t i v i t i e s c o - o r d i n a t o r s t a t e d t h a t the reason was she was a s t roke case. When spoken t o , her depress ion a t t h i s t ime was due to the f a c t her husband, who was i n a board ing home, had been taken to h o s p i t a l . There fo re , t h e r e should be g rea te r understanding t h a t many r e a c t i o n s are "normal " i n any s t r e s s f u l s i t u a t i o n , depress ion may be caused by the r e s u l t s o f d i s a b i l i t y , f o r example, by the f a c t of separa t i on f rom loved ones, worry over them and f r u s t r a t i o n at p h y s i c a l d i s a b i l i t y and not n e c e s s a r i l y a t t r i b u t e d t o the cause o f d i s a b i l i t y . A l s o , the s t a f f should t r e a t the d isab led l i k e the "normal " p o p u l a t i o n . They should accept some o f the r e s p o n s i b i l i t y f o r t h e i r ac t i ons and not be over indu lged but does t h i s a lso mean t h a t they are not to rece ive l i t t l e personal a t t e n t i o n s which would be g iven ou ts ide an i n s t i t u t i o n , take l i t t l e t ime and make the a t tendant a f r i e n d r a t h e r than a custodian? For example, when a r e s i d e n t i n the main d i n i n g room had a spasm i n her eyes which made i t imposs ib le f o r her t o e a t , a wet c l o t was g iven to her to p lace over her eyes, then she was l e f t a lone . I t was not long before she removed i t , put on her glasses and f i n i s h e d her d i n n e r . The nurses be l i eved she was be ing s p o i l e d , ye t she was on ly g iven a l i t t l e c o n s i d e r a t i o n and r e c o g n i t i o n t h a t she had a d i f f i c u l t y and t h a t someone cared . - 73 - Nurses should a lso take care not to i n i t i a t e a s i t u a t i o n t h a t cannot be ma in ta ined . As has been exp la ined i n the case h i s t o r i e s , Resident No. 1 , had been the ob jec t o f s p e c i a l a t t e n t i o n u n t i l the a r r i v a l of more r e s i d e n t s w i t h equal c a p a b i l i t i e s d ispersed t h i s a t t e n t i o n among o thers and had a d e l e t e r i o u s e f f e c t on her . A s o c i o l o g i s t aware of medical problems might be u s e f u l i n c l a r i f y i n g these issues and a i d i n g nurses to a t t a i n a more s e n s i t i v e approach and s t i l l to avo id indu lgence. I n regard to the care o f r e s i d e n t s , Vera Mclver"*"^ b e l i e v e s t h a t nurses should use judgment and accept r e s p o n s i b i l i t y , a t t imes , whether j u s t i f i e d or n o t , f o r any nega t i ve behaviour o f r e s i d e n t s . By her example, she does much t o preserve the d i g n i t y o f the r e s i d e n t s and ma in ta in e q u i l i b r i u m among t h i s ve ry f r a g i l e p o p u l a t i o n . She has nurses aides a t t h i s h o s p i t a l t r a i n e d i n t h e i r ph i losophy and, d e s p i t e the few d e f i c i e n c i e s no ted , they d i s p l a y an understanding of many of the problems o f the c h r o n i c a l l y i l l . This i s most impor tant as the problems o f the e l d e r l y are o f t e n s o c i a l and p s y c h o l o g i c a l r a t h e r than medical and t e c h n i c a l " ^ as has been demonstrated i n t h i s t h e s i s f o r a l l l o n g - term d i s a b l e d , regard less of age. - 74 - FOOTNOTES CHAPTER V E. G. Q. Van T i l b u r g , Review o f B.C.H.A. Report on Extended Care, T r a n s c r i p t of Seminar on Extended Care, (Vancouver, B.C. : February 26-27, 1973) , pp. 86 and 88. 2 Vera Mc lver , R.N. , D i r e c t o r o f H o s p i t a l Serv ices , S t . Mary 's P r i o r y H o s p i t a l , V i c t o r i a , B.C. , " R e b i r t h o f an I d e n t i t y " , unpubl ished r e p o r t o f a study done a t the h o s p i t a l , February 1969, pp. 1-9. Mar ie-Lou ise Holden, Graduate Student , Adu l t Educat ion Research Cent re , U n i v e r s i t y o f B r i t i s h Columbia, F i e l d Study, S t . Mary 's P r i o r y H o s p i t a l , V i c t o r i a , B.C. , June 1 - September 30, 1973. 4 Edward A. Suchman, "A Model f o r Research and E v a l u a t i o n on R e h a b i l i t a t i o n " , i n Sociology and R e h a b i l i t a t i o n , e d i t e d by Marv in B. Sussman, (Washington, D.C. : S o c i o l o g i c a l A s s o c i a t i o n , 1965) , pp. 52-70. ^B.C. Correspondence Educat ion , V i c t o r i a , B .C. , " B r i t i s h Columbia, Canada's P a c i f i c P r o v i n c e " . I b i d . , " P a i n t i n g f o r P leasu re " . M u r i e l Ober leder , "Res to r ing the Aged Men ta l l y I I I Through R e a l i t y O r i e n t a t i o n " , R e a l i t y O r i e n t a t i o n , (Washington, D.C. : The H o s p i t a l and Community P s y c h i a t r i c Se rv i ce , American P s y c h i a t r i c A s s o c i a t i o n , compiled by Louise P. Stephens, August 1969) , p. 7. 8 Loc. c i t . Vera Mc lver , R.N. , D i r e c t o r of H o s p i t a l Serv ices , S t . Mary 's P r i o r y H o s p i t a l , V i c t o r i a , B.C. Telephone Communication 16, December, 1973. Theodor J . L i tman, " I n t r o d u c t i o n " , The Sociology and Soc ia l Psychology of D i s a b i l i t y and R e h a b i l i t a t i o n , Constant ine S a f i l i o s - R o t h s c h i l d , (New York: Random House, 1970) p. v i i i . - 75 - I n t e r v i e w s w i t h George Szasz, M.D., D i r e c t o r , D i v i s i o n o f I n t e r p r o f e s s i o n a l Educat ion , U n i v e r s i t y of B r i t i s h Columbia, June 1971 and 15 October 1973. 12 Barbara T. Turner , Sheldon S. Tobin and Morton A. Lieberman, " P e r s o n a l i t y T r a i t s as P r e d i c t o r s of I n s t i t u t i o n a l Adap ta t ion Among the Aged", Journa l o f Geronto logy, V o l . 27, No. 1 (1972): 61-8 . 13 Helen S. W i l l a r d and Clare S. Spackman, Occupat ional Therapy, ( P h i l a d e l p h i a : J . P. L i p p i n c o t t Company, 1971) , p. 10. 1 4 J . B. Haese, A. B. T r o t t e r and R. T. F l ynn , " A t t i t u d e s o f Stroke P a t i e n t s toward R e h a b i l i t a t i o n and Recovery" , The American Jou rna l o f Occupat ional Therapy, V o l . 24, No. 4 (May-June 1970) : 289. "^Vera Mc lver , R.N. , I n t e r v i e w August, 1973. 16 Benjamin B. We l l s , "The Long Term I m p l i c a t i o n s o f R e a l i t y O r i e n t a t i o n " , R e a l i t y O r i e n t a t i o n , (Washington, D.C. : American P s y c h i a t r i c A s s o c i a t i o n , compiled by Louise P. Stephens, August 1969) , p. 10. - 76 - CHAPTER V I CONCLUSIONS AND RECOMMENDATIONS A. CONCLUSIONS As the d isab led increase i n numbers, i t f o l l o w s t h a t t h e i r needs increase and o f t e n psychosoc ia l needs predominate over p h y s i c a l . I t i s necessary t o f u r t h e r d i f f e r e n t i a t e the psychosoc ia l i n t o psycho log i ca l and s o c i o l o g i c a l as i t i s t h e o r i z e d t h a t t he re i s more immediate necess i t y f o r the s o c i a l needs to be met; t h e r e f o r e , the emphasis on s o c i a l s c i e n t i s t s i n the chron ic care f i e l d i s f o r s o c i o l o g i s t s and a d u l t educators . F u r t h e r , they shoulddbe a p a r t of the r e h a b i l i t a t i o n team and should have courses a v a i l a b l e i n order to increase t h e i r competence i n t h i s a rea . W i t h i n the r e h a b i l i t a t i o n team, they could f u n c t i o n t o s t i m u l a t e m o t i v a t i o n , f u r n i s h goals and a i d i n the s o c i a l i z a t i o n o f the d i s a b l e d . I n order to do t h i s they would have to contac t the d i s a b l e d . Y e t , there i s no comprehensive r e g i s t r y o f the d i s a b l e d . As a r e s u l t , the p res iden t o f the Canadian Medical A s s o c i a t i o n s t a t e s t h a t P r o v i n c i a l governments do not know the number o f para lyzed p a t i e n t s o r the ex ten t of the prob lem.^ Before e s t a b l i s h i n g such a r e g i s t r y an educa t iona l campaign would have to be d i r e c t e d to the p o p u l a t i o n as a whole, f o r s t i l l today t h e r e appears to be an ou t -da ted a t t i t u d e a s s o c i a t i n g d i s a b i l i t y w i t h s t igma. - 77 - The va lue o f educat ion f o r the d i s a b l e d , whether f o r monetary ga in or personal enr ichment , i s an impor tan t ad junc t i n r e h a b i l i t a t i o n . I t may supply s o c i a l i z i n g i n f l u e n c e s ou ts ide the scope o f the content of the a c t i v i t y i t s e l f , f o r example, the study at S t . Mary 's P r i o r y H o s p i t a l i l l u s t r a t e d how educat ion encouraged i n t e r a c t i o n i n a p a t i e n t who was showing s igns o f w i t h d r a w a l . I n t h i s regard educators must look at the o v e r a l l b e n e f i t o f a l e a r n i n g endeavour and r e a l i z e t ha t any p o s i t i v e by-product may be of more va lue than the l e a r n i n g exper ience 2 i t s e l f and they must not overemphasize the m a t e r i a l p resented. With many a d u l t educa to rs , course content r a t h e r than s o c i a l involvement i s impor tant ye t i t i s o f t e n on ly the l a t t e r t h a t w i l l enhance the r e h a b i l i t a t i v e va lue o f educat ion f o r the d i s a b l e d . I t i s exper ience gained i n f i e l d s tud ies t h a t w i l l he lp to c l a r i f y t h i s i s s u e . Educators should a lso be p e r s i s t e n t i n hav ing b u i l d i n g s mod i f ied and serv ices s u p p l i e d . t o f u r t h e r . t h e i n t e g r a t i o n of the d i s a b l e d . For example,. t he re has been no concerted e f f o r t here as the re has been Sweclren3en. I n Nor th America, some u n i v e r s i t i e s have been mod i f i ed and a few a d u l t educat ion cent res but l i t t l e comprehensive e f f o r t has been made t o communicate w i t h the d i s a b l e d and supply educat ion i f d e s i r e d . I n summary, the study has i n d i c a t e d the s i g n i f i c a n c e of psychosoc ia l needs as the numbers o f c h r o n i c a l l y d i sab led increase i n t h i s century and, as these needs appear p r i m a r i l y s o c i a l , t h e i r s a t i s f a c t i o n may be p a r t i a l l y f u l f i l l e d by a d u l t educators . The - 78 - p rogress ion of these needs and the p o s i t i o n of educators are i l l u s t r a t e d (See Figure 7 ) . I t may be noted t h a t , p r i o r to the t w e n t i e t h c e n t u r y , most care was not requ i red past the acute care s tage .and , t o d a t e , i t i s noted t h a t psychosoc ia l needs of the c h r o n i c a l l y d i sab led appear to be g rea te r than acknowledged by the medical p r o f e s s i o n and the 3 medical method, t h e r e f o r e does not ho ld t h i s v iew. C u r r e n t l y , the r o l e o f the a d u l t educator should be f i r s t l y , to e s t a b l i s h the d e s i r e f o r educat ion among the d i s a b l e d , secondly , to o b t a i n the t r a i n i n g necessary to understand the medical aspects and t h i r d l y , t o supply the s e r v i c e . - 79 - FIGURE 7 PROGRESSION OF NEEDS IN THE LONG-TERM DISABLED - THE POSITION OF EDUCATORS IN THE PLAN MAKES ADEQUATE RECOVERY REMAINS INCAPACITATED I P-HYSTCAlv- Psycho Soc ia l Long Term Acute Care I Chronic Care P H Y S ^ A £ : - PSYCHO SOCIAL PSYCHOSOCIAL Psycho- l o g i c a l ! SOCIAL 77T |Educa t ion Academic : Non Academic - 80 - B. RECOMMENDATIONS 1 . PROVINCIAL GOVERNMENT That a l l d i sab led be r e g i s t e r e d by the P r o v i n c i a l Government and i n f o r m a t i o n on the d i sab led t a b u l a t e d and made a v a i l a b l e t o o r g a n i z a t i o n s i n the h e a l t h care f i e l d . I n f o r m a t i o n such as med ica l , e d u c a t i o n a l , s o c i a l and f i n a n c i a l would be i n c l u d e d . 2. CANADIAN ADULT EDUCATION ASSOCIATION That the a s s o c i a t i o n f a m i l i a r i z e adu l t educators w i t h the l a c k o f educa t iona l o p p o r t u n i t i e s f o r the d i sab led a d u l t and suggest t h a t they research the problems o f the d isab led f o r the purpose of f u r n i s h i n g educa t iona l a c t i v i t i e s to t h i s segment o f our p o p u l a t i o n . 3. ADULT EDUCATION DEPARTMENTS a) That p h y s i c a l b a r r i e r s be removed to enable attendance of d i sab led a t adu l t educat ion f a c i l i t i e s . b) That correspondence courses be made a v a i l a b l e at home, n u r s i n g homes, h o s p i t a l s , e t c . and a persona l con tac t such as an a d u l t educator or v o l u n t e e r be s u p p l i e d . c) That v o l u n t e e r s , such as r e t i r e d school teachers be organized f o r academic p u r s u i t s and l a y people f o r hobbies and s p e c i a l a c t i v i t i e s . A r e g i s t r y of such vo lun tee rs should be set up, s t a t i n g background, i n t e r e s t , l o c a t i o n , t r a n s p o r t a t i o n , t imes - 81 - a v a i l a b l e , number of persons they would be able to a s s i s t and number o f hours they would be v o l u n t e e r i n g per week. Also any pre ference i n the type o f person they would be a s s i s t i n g . d) That c o u n s e l l i n g be g iven i n regard to educa t ion . 4. UNIVERSITY OF BRITISH COLUMBIA a) That the Centre f o r Cont inu ing Educat ion organ ize a course on campus, by correspondence or at educat ion cent res f o r a d u l t educators and vo lun tee rs engaged i n the educat ion o f d i sab led a d u l t s . This course could a lso be o f use to s o c i o l o g i s t s and psycho log i s t s who are contemplat ing or are invo lved i n the medical f i e l d . For example, courses i n medical soc io logy are 4 not a v a i l a b l e at U.B.C. The courses would be an overv iew o f the needs o f the d isab led and obs tac les encountered by them as w e l l as a ids and serv ices a v a i l a b l e . I t would be designed t o i n t e r e s t the l a r g e s t number o f people i n t h i s a r e a , not t o be an i n depth study and the m a t e r i a l would be presented by a d u l t educators , s o c i o l o g i s t s , p s y c h i a t r i s t s , phys ic ians i n general p r a c t i c e , occupa t iona l t h e r a p i s t s and c o u n s e l l o r s . This course would be f e a s i b l e i f the need were es tab l i shed. " * b) That a d u l t educators contempla t ing work w i t h the d i sab led should engage i n f i e l d s tud ies at the U n i v e r s i t y o f B r i t i s h Columbia. - 82 - c) That the Adu l t Educat ion Research Centre at the U n i v e r s i t y of B r i t i s h Columbia should f u r t h e r research the r o l e t h a t a d u l t educators may p lay i n the educat ion o f the d i s a b l e d . The above recommendations would make i t p o s s i b l e f o r a d u l t educators t o engage, w i t h i n t h e i r e x p e r t i s e , i n the r e h a b i l i t a t i o n of the d i s a b l e d , bo th f rom the o r g a n i z a t i o n a l and educa t iona l s t a n d p o i n t . - 83 - FOOTNOTES CHAPTER VI "'"John Braddock, "C.M.A. head lambastes gov's, h o s p i t a l s " , Vancouver Province, 19 May 1973, p. 55. 2 Ernest E. McMahon, Robert H. Coates and Alan B. Knox, "Common Concerns: The P o s i t i o n of the Adult Education Association of the U.S.A.", Adult Education Journal, Vol. 18 (November 3, 1968): 200. 3 Interview with Peter Bunton, M.B., B.S., F.R.C.P., So c i a l P s y c h i a t r i s t , University of B r i t i s h Columbia, 22 May 1974. 4 Pat Merchak, Assistant Professor, Department of Sociology, U.B.C., telephone communication, 30 A p r i l 1974'. ^Interview with Miss M. 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Personal Communication a. Correspondence B r a t t g a r d , Sven-Olaf , M.D. Pres ident o f Fokus Soc ie ty and Pro fessor o f the U n i v e r s i t y of Goteborg, Sweden. 3 January 1973. C u l l e n , S.F. P r o v i n c i a l Co-Ordinator of R e h a b i l i t a t i o n , Government of Newfoundland and Labrador , Department o f H e a l t h , R e h a b i l i t a t i o n D i v i s i o n . 11 A p r i l 1971. C u r t i s , I d a . Resource Person f o r the Handicapped, Simon Fraser U n i v e r s i t y , Vancouver, B.C. 18 October 1973. Fenna, D. , Ph.D. U n i v e r s i t y o f A l b e r t a H o s p i t a l , Edmonton, A l b e r t a . 18 May 1973. b. Telephone Communication Dewhurst, J . F . Pub l i c Re la t ions O f f i c e r , A r t h r i t i s and Rheumatism Soc ie ty . 8 May 1973. F o s t e r , S. Tu tor Pearson H o s p i t a l , Vancouver, B.C. 12 March 1973. Houston, Robert S. A s s i s t a n t t o the Super intendent o f Design D i v i s i o n , Phys ica l P lan t^ .Un ivers i t y of B r i t i s h Columbia, Vancouver, B.C. 8 January 1974. Mc lver , Vera. D i r e c t o r o f H o s p i t a l Serv ices , S t . Mary 's P r i o r y H o s p i t a l , V i c t o r i a , B.C. 16 December 1973. - 89 - McKay, R. Project Planner, Physical Planning Plant, Simon Fraser University, Vancouver, B.C. 15, January 1974. Merchak, Pat. Assistant Professor, Department of Sociology, University of B r i t i s h Columbia, Vancouver, B.C. Telephone communication, 30 A p r i l 1974. York, Edith. Public Relations O f f i c e r , Canadian National I n s t i t u t e for the B l i n d , B r i t i s h Columbia. 14 May 1973. c. Interview Bunton, Peter. M.B., B.S., F.R.C.P. S o c i a l P s y c h i a t r i s t , University of B r i t i s h Columbia. July 1973 and 8 A p r i l 1974. Home, S y l v i a , Supervisor, Occupational Therapy, Adult Section, G.F. Strong R e h a b i l i t a t i o n Centre, Vancouver, B.C. 13 A p r i l 1973. Parker, Tonw Counsellor, Canadian Paraplegic Association, B r i t i s h Columbia D i v i s i o n , Vancouver, B.C. 10 May 1973. Smith, A. R. Public Relations O f f i c e r , G.F. Strong R e h a b i l i t a t i o n Centre, Vancouver, B.C. 3 May 1973. Smith, M. Centre for Continuing Education, Un i v e r s i t y of B r i t i s h Columbia. 15 February 1974. Szasz, George, M.D. Director, D i v i s i o n of Interprofessional Education and Associate Professor, Department of Health Care and Epidemiology, Un i v e r s i t y of B r i t i s h Columbia, July 1971 and 16 October 1973. T h i e l e , Paul. L i b r a r i a n , Crane Memorial Library, U n i v e r s i t y of B r i t i s h Columbia. June 1973 and 17 May 1974. 6. Observations by writer Vancouver General Ho s p i t a l , Department of Neurosurgery. Irene Dennis R.N. Head Nurse. June - September 1964. Vancouver General Hospital, Department of Neurosurgery, February, March, 1970, June, August, December 1971, and A p r i l , 1972. - 90 - 7. F i e l d Study by w r i t e r S t . Mary 's P r i o r y Extended Care H o s p i t a l , V i c t o r i a , B.C. 1 June 1973 - 30 September 1973.

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