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Barbara E Gibson, PhD, Department of Physical Therapy, Termerty Faculty of Medicine, University of Toronto

Barbara Gibson (she/her) is a Professor in the Department of Physical Therapy at the University of Toronto, Canada. Her research and scholarship examine the intersections of social, cultural, and institutional practices in producing health, inclusion/exclusion, and identity with disabled young people.

Barbara Gibson conducts critical research and scholarship that aims to infuse disability studies into rehabilitation and the health sciences. Her work investigates the intersections of societal, cultural, and institutional practices in producing health, inclusion/exclusion, and identity with disabled young people. The work is interdisciplinary and intersectional, drawing upon sociological studies of health, bioethics, posthumanism, and critical disability studies. Barbara has over 100 peer reviewed publications and has authored three books - Rethinking Rehabilitation Theory and Practice, Rehabilitation: A Post-critical Approach, and Manipulating Practices: A Critical Physiotherapy Reader. She holds cross-appointments to Bloorview Research Institute in Toronto and the Auckland University of Technology in New Zealand.

For the video recording of this presentation, please see the online symposia page.

What if rehabilitation was grounded in critical disability studies (CDS)? I was trained as a physiotherapist and my scholarship is oriented to bringing CDS into rehabilitation practice, theory, and research. Rehabilitation (rehab) has often been vilified in CDS because of its adherence to the medical model of disability and its practices of normalization. There is a history of harm associated with rehab that perhaps is most unsettling in relation to my field of children’s rehabilitation. Children have been and still are subjected to hours of therapy, week after week, year after year, aimed at correcting their bodies and promoting so-called ‘normal’ physical and social development. Through immersion in rehab and other social spaces they learn to see their bodies and selves as problems to be fixed (Mosleh & Gibson, 2022, Gibson et al, 2015). Normalization goals are not limited to children and pervade all rehab spaces. These serious issues are slowly being addressed as CDS makes its way into rehab teaching, research, and scholarship. Urgent change is needed but will not come about by dismissing the entire field (Shakespeare et al., 2018). Rehabilitation can and does provide useful services for disabled people. Providing a new approach that is oriented to radical change is the aim of an emerging field of scholarship: Critical Rehabilitation Studies. 

Critical Rehabilitation Studies (CRS) invites radical change in how rehab thinks and operates. First and foremost, it demands criticality. Criticality is something new for healthcare professionals and is further muddled by confusion with ‘critical thinking’ which teaches them skills in biomedical ‘evidence-based’ practice. The dominant knowledge in health care is Euro-American, techno-scientific, and positivist in orientation. These ideas masquerade as universal truths which displace and dismiss alternative epistemologies (ways of knowing) such as those from the Global South. CRS challenges these ideas by investigating the taken for granted, attending to power, and critiquing the dominance of bioscience. Moreover, it explicitly works to identify how ableism operates within rehab practices and the (unintended but real) violence such practices perpetrate on disabled people. Moreover, CRS recognizes and promotes the imperative for disabled people to lead and/or partner in reforming rehab. 

In its current practice, rehab reproduces ableism even while striving to support disabled people. This is because ableism operates systemically in healthcare. It is embedded in everything that rehab does – its programs, policies, principles, training programs, organization, funding mechanisms, assessment measures, and the research questions that are deemed relevant. Everything. Solutions are thus only possible when the systemic nature of the problem is recognized and addressed. Rehab practitioners (including educators and researchers) are embedded in the same disability discourses that pervade societies and contribute to processes like internalized ableism. What is needed is to expose and address entrenched systems of thought and how they are operationalized at the programmatic and micro levels of practice.  

There are multiple assumptions that pervade rehab, but perhaps the most damaging is the assumption that disability is a problem that needs to be fixed through normalization. Rehab is not oriented to cure but rather to re-establishing physical and social function. Following injury this represents a return to previous function, or the closest possible approximation. For those with life-long impairments it is also an approximation towards something. That something is normality: normal bodies, normal activities, and/or normal social roles (Gibson, 2014; Gibson, 2016). 

Normality as a goal in rehab is positioned in opposition to disability which is constructed as the problem requiring intervention. Of note, normalization has multiple meanings and varied practices and as such may not always or necessarily be problematic. As Bezmez and colleagues (2021) have demonstrated, normality is ambiguous and constantly negotiated amongst actors in rehabilitation spaces. It is however dangerous to assume that normalcy is always preferable to difference, or that sameness is better than diversity. A key task of CRS is to reject the binary of normal/abnormal and embrace diversity, complexity, uncertainty, and new possibilities. A CRS approach thus partners with disabled ‘clients’, scholars, and advocates to, continually and creatively, reimagine what counts as a positive outcome.

CRS is a transdisciplinary field that deliberately resists definition to allow for innovation and inclusion of diverse perspectives (Setchell et al., 2018). As an open-ended enterprise, it is nevertheless closely aligned with CDS. Its core aim is to end ableism and other axes of oppression by identifying and addressing how they operate in healthcare spaces. My title refers to a manifesto. A manifesto is a declaration of an intention to change the world and it provides a road map to its realization. In that spirit, I call for the following actions to advance CRS and change the world of rehab: 

• Training in disability studies, anti-oppression, and CRS for rehab students, educators, researchers, and practitioners
• Questioning medical(ized) outcomes and measures in policy, practice, and research
• Exposing and addressing ingrained structures and systems in health and rehabilitation, including systematised and intersecting oppressions
• Retheorizing disabled childhoods and developmentalism and their applications
• Research with an explicit focus on identifying and ending ableism in rehab
• Promotion of cross disciplinary scholarship and alternative modes of knowledge production
• Partnerships to bridge CDS and CRS in both disciplines

Importantly, and perhaps especially given the aims of the Disability Matters Symposia, this work cannot only be done from within rehabilitation spaces. I encourage my colleagues working in CDS to move beyond dismissal of rehab, to lead and partner in this work, and to help create rehab services and practices that work for disabled people. This is already happening. How can we help it to grow and thrive?  

Viva la revolución!

References

Bezmez D, Shakespeare T, Lee K. Theorising rehabilitation: Actors and parameters shaping normality, liminality and depersonalisation in a UK hospital. Sociology of Health & Illness. 2021 Mar;43(3):713-31.

Gibson, BE. Rehabilitation: A post-critical approach. Boca Raton (United States): CRC Press; 2016

Gibson BE, Teachman G, Hamdani Y. Rethinking ‘Normal Development’ in Children’s Rehabilitation. In: McPherson, KM, Gibson BE, Leplege A, editor(s). Rethinking Rehabilitation: Theory and Practice. Boca Raton (United States): CRC Press; 2015.

Gibson BE. Parallels and problems of normalization in rehabilitation and universal design: enabling connectivities. Disability and Rehabilitation. Special Issue: Designing Inclusive Environments: Shaping Transitions from Theory into Practice. 2014 Mar; 36(16):1328-33.

Mosleh, D, Gibson B.E. Abnormal-Becoming-Normal: Conceptualizations of Childhood Disability in Children's Rehabilitation Textbooks. Scandinavian Journal of Disability Research.2022 April: 24(1), 122–135. 

Setchell J, Nicholls DA, Wilson N, Gibson BE. Infusing rehabilitation with critical research and scholarship: A call to action. Physiotherapy Canada. 2018 Dec; 70 (4).

Shakespeare, T., Cooper, H., Bezmez, D., & Poland, F. (2018). Rehabilitation as a disability equality issue: A conceptual shift for disability studies? Social Inclusion, 6(1), 61-72.