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UBC Theses and Dissertations

The experience of spinal cord injury as transformative learning Carpenter, Christine


The purpose of this study is to explore individual conceptions of the experience of traumatic spinal cord injury from the perspective of adult learning. A qualitative research approach was chosen as the most appropriate to explore these meanings. The methodology for this study was both descriptive and interpretive. Data collection took the form of semi-structured in-depth interviews. The research was essentially exploratory. Commonalities of meaning attributed to the injury were revealed through analysis of the data and grouped into three thematic categories; rediscovery of self, redefining disability and establishing a new identity. These themes, whilst representing commonalities, revealed the complex and multidimensional nature of each individual's experience. The disability and overall sense of loss were initially symbolized by the physical changes or the external experience of disability. These are separate from the internal concept of 'self ' which was perceived by the individuals as being the same as pre-injury. The findings suggest that an inner conflict between the external or public 'self ' and the internal or private 'self ' develops which can best be described as an experiential split. The theme of rediscovering self is concerned with those components of the post-injury experience which inhibit or facilitate a reintegration of the internal and external selves. The inhibiting factors identified included the loss of control over physical functioning and capabilities, alienation from the 'real world,' the restrictive environment and instructional limitations of the rehabilitation facility and the attitudes of health professionals. The process was found to be facilitated by the continuity of their sense of self, a gradual build-up of a new framework of experience and personal resources accrued from their pre-injury history and social context. The theme of redefining disability was achieved by challenging the attitudes and stereotypes espoused by health professionals and society, and an assimilation of a new sense of coherence. The latter was seen as occurring through attributing meaning to the cause of the injury, expanding the range of available options and developing new value priorities. The third theme of the establishment of a new identity was found to be associated with making comparisons with others by which self-esteem can be enhanced, by association and dialogue with a peer minority, by creating intimacy with significant others and new ways of interacting with society. These themes bear little relationship to the instructional content of current rehabilitation programs, and defy explanation through the traditional learning perspective of skill acquisition and behavioral change which has dominated rehabilitation practice, and to which research is primarily directed. The data yielded a way of understanding the experience of spinal cord injury which is not adequately expressed in the literature. It became apparent that these individuals were engaged upon a complex learning process. A theory of transformative learning proposed by Mezirow was introduced as a possible alternative, or adjunct to, the educational model of rehabilitation service provision. Central to this theory are two dimensions of meaning described as meaning schemes and meaning perspectives and the unique adult characteristic of critical reflection. The subjects in this study recognized the learning involved in questioning old meaning perspectives and creating new ones. By reflecting and acting on these new meaning perspectives the facts and implications of disability became integrated into a chosen lifestyle. Implications for rehabilitation practice are that the target of an educational intervention may not, in fact, be the clients but the health professionals involved in providing instruction and care. A greater understanding of the experience of traumatic spinal cord injury over time, and the uniquely individual learning process involved, would facilitate a more client centred and relevant approach to instruction.

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