Living with Physical Disability

.................................................................................................................1 ORIGINAL PAPERS....................................................................................................3 INTRODUCTION......................................................................................................4 BACKGROUND .........................................................................................................6 Different perspectives on disability .............................................................................6 Possible consequences of disabilities with a focus on engagement in occupations .......7 Conditions influencing the engagement of persons with disabilities in occupations..11 The rehabilitation service in general and occupational therapy .................................13 Rehabilitation and occupational therapy based on a holistic perspective................13 Social service support for the participation of persons with disabilities ..................15 The rehabilitation process.........................................................................................16 Clients’ participation in planning their rehabilitation services ...............................16 The clients’ needs in relation to the rehabilitation services provided over time ......18 AIMS OF THE THESIS ............................................................................................21 METHODS................................................................................................................22 Selection of informants.............................................................................................23 Informants in Study I............................................................................................24 Informants in Study II ..........................................................................................25 Informants in study III..........................................................................................25 Informants in Study IV .........................................................................................25 Informants in Study V ..........................................................................................26 Data collection methods...........................................................................................27 Interviews..............................................................................................................27 Questionnaire........................................................................................................28 Data analysis methods ..............................................................................................29 Content analysis ....................................................................................................29 The constant comparative method ........................................................................29 A hermeneutic approach to analysis.......................................................................30 Statistical analysis ..................................................................................................31 ETHICAL CONSIDERATIONS...............................................................................32 MAIN FINDINGS.....................................................................................................33 Clients’ perceptions of their participation in the planning of their rehabilitation and professionals’ view of the strategies they adopt to encourage it (Study I)..................33 The experiences that persons with disabilities have of their rehabilitation process (Study II) .................................................................................................................33 The experiences persons with disabilities have of their occupational lives in their homes (Study III) .....................................................................................................34 The experiences persons with disabilities have of the meaning of their assistive devices (Study IV) ................................................................................................................34 The perceptions of persons with spinal cord injury on their participation in life situations (Study V)..................................................................................................35 GENERAL DISCUSSION.........................................................................................36 The vital role of societal and social environments for enabling occupations..............36 Overall consequences of environmental influences for the future design of services36 The influence of social interactions on the experience of engaging in occupations.38 Adapting rehabilitation services to meet clients’ needs over time ...........................40 Adapting the planning of rehabilitation to clients’ desire to participate .................42 The influence of engaging in occupations on the meaning experienced of disability .42 The influence of autonomy in everyday occupations on participation in life situations...............................................................................................................43 The influence of occupational engagement on autonomy......................................43 The influence of engaging in occupations on the meaning of the home and on the personal identification ...........................................................................................44 METHODOLOGICAL CONSIDERATIONS.........................................................46 Studies I-IV..............................................................................................................46 Study V ....................................................................................................................48 CONCLUSIONS .......................................................................................................50 SAMMANFATTNING (SUMMARY IN SWEDISH) ..............................................51 ACKNOWLEDGEMENTS.......................................................................................53 REFERENCES ...........................................................................................................55