An uncertain future for disabled physiotherapy students?

Karen Atkinson's comment on the "Opening doors to disability' blogpost a few days ago (link) really struck a cord with me coming at a time when there are some odd things happening in the profession.

Physiotherapy has always had a difficult relationship with disability.  While this sounds an odd thing to say, think about how few disabled people are practitioners.  Then step out of yourself as a physiotherapist and imagine how this might be perceived by the disabled community.

Physiotherapists, it seems, are quite happy being the practitioners, but not so happy enabling disabled people to become therapists.

While blind masseurs and physiotherapists have been long established in the profession (Barclay, 1996), it has been rare for the profession to embrace the potential of disabled practitioners.  A few cases are used to suggest progress is being made (see here, for example), but these are the exception rather than the rule.

In my experience, many able-bodied physiotherapists simply cannot conceive of how someone can fulfil the full duties of a registered physiotherapist if they have a significant physical or mental handicap*.

Recent moves across some of the Australian schools of physiotherapy to establish 'Inherent Requirements' for students entering professions including physiotherapy highlight this point. According to Curtin University, Inherent Requirements are those which are necessary for a person to:

• perform the tasks or functions which are a necessary part of the job productivity and quality requirements

• work effectively in the team or other type of work organisation concerned

• work safely (source)

These requirements are in addition to the registration requirements mandated by various regulatory authorities.

The requirements have been operationalised in a number of ways by universities - some offering quite detailed interpretations, others less so.  The University of Western Sydney provides one of the clearest explanations.  Here students must meet eight Inherent Requirements:

• Ethical behaviour

• Behavioural stability

• Legal

• Communication

• Cognition

• Sensory abilities

• Strength & mobility

• Sustainable performance

Some of these are relatively uncontroversial (e.g. "Student demonstrates knowledge of, and engages in ethical behaviour in practice."), while others are more problematic. Mandating that "Behavioural stability is required to function and adapt effectively and sensitively in a demanding role" without defining what 'behavioural stability' means opens this up to significant discrimination against those that don't conform to some people's perceptions of normal behaviour.

But it is in the domain of Sensory abilities and Strength & Mobility that things become particularly problematic.  UWS suggests that the:

• Student demonstrates sufficient visual acuity to perform a range of skills

• Student demonstrates sufficient aural function to undertake the required range of skills

• Student demonstrates sufficient tactile function to undertake a range of skills and assessments

• Student demonstrates the ability to perform gross motor skills to function within the scope of practice

• Student demonstrated ability to use fine motor skills to provide safe effective care

• And that the student demonstrates: » Consistent and sustained level of physical energy to complete a specific task in a timely manner and over time » The ability to perform repetitive activities with a level of concentration that ensures a capacity to focus on the activity until it is completed appropriately » The capacity to maintain consistency and quality of performance throughout the designated period of duty (source)

These requirements all but remove the possibility of disabled people entering the profession.  Certainly students like the young tetraplegic man we are about to graduate would not find a place as a therapist. This is deeply troubling to me.

Notwithstanding the questions of whether this breaches the UN declaration of the rights of disabled people (see here), it also says some rather disturbing things about our profession.  How can we claim to work alongside, advocate for and support disabled people if we cannot find a way to include them in our ranks?

At a recent meeting, I was talking about our young tetraplegic graduand and one of my colleagues looked at me incredulously and asked how he could possibly practice?  This isn't an uncommon question from within the profession.  I said that he uses mediating technologies to help him fulfil his duties: just like how I might use a pulse oximeter to measure someone's SaO2.  I don't physically leap into the blood stream and count the oxyhaemoglobin molecules myself.  Sometimes he uses another person, sometimes an adapted technology.

The only thing we haven't been able to find a way around has been spinal manipulation, but this is not a necessary skill for registered physiotherapy practice anyway. Curtin University provides an important interpretation on inherent requirements that would be worth attending to.

They state that:

...an essential activity or "inherent requirement" for a Receptionist's job is the ability to communicate by telephone. But it is not an "inherent requirement' to hold the phone in the hand. Accordingly an accommodation of providing a headset to a Receptionist would enable them to perform the duties required. Example 1: A nurse who has a hearing impairment experiences difficulty in measuring patient’s heartbeats, this is an inherent requirement of the job. The nurse is provided with an electronic stethoscope that permits her to set volume levels, thereby allowing her to accurately measure a patient’s heartbeat as required. The accommodation of providing an electronic stethoscope enables her to perform the essential requirement of the job (my emphasis, source).

This suggests that inherent requirements need not restrict people's right to work in professions like ours.  Clearly this is an important issue for the profession.

There is a danger that our restricted view of (dis)ability comes across as discrimination based on paternalism towards disabled people.  Inherent Requirements like this need to be contested.  Perhaps some of our recent writing on connectivity can point to a way forward?

References

Barclay, J. (1994).  In good hands: The history of the Chartered Society of Physiotherapy.  London, Butterworth Heinemann.

Bialocerkowski, A., Johnson, A., Allan, T. & Phillips, K. (2013).  Development of physiotherapy inherent requirement statements – an Australian experience.  BMC Medical Education; 13(54).  doi: 10.1186/1472-6920-13-54.

*I use this word unashamedly, ironically and pointedly here to refer to what I believe are very 'old fashioned' values.