To examine issues of continuity and transition facing clients as they return to life in the community following stroke and the role of rehabilitation in this process.
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The sudden onset of disability following a stroke represents a major disruption to the continuity of a person’s life experience. Rehabilitation has an important role in the transition from the non-disabled to the disabled state; however, current rehabilitation services and outcomes post-stroke focus on functional recovery rather than on a return to meaningful roles and activities and pay little attention to the transition from the non-disabled to the disabled self. Although some current rehabilitation models address the importance of involvement in a life situation, they do not adequately address issues of the role of the environment, the nature of community, the importance of meaning and choice when thinking about life situations, and change in abilities across the life course.
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Models of rehabilitation service delivery need to move to a chronic disease management model that incorporates outcomes that are meaningful to clients, and not the assumed needs or outcomes as defined by rehabilitation professionals.
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| Element | Contribution |
|---|---|
| Importance of environment | Participation is variable and modifiable because of the role of the physical and social environment including the immediate physical social setting, contextual factors, and environmental societal variables. |
| Nature of community | Consider the meaning of “community” for clients in order to better consider the context in which they are participating and its influence on participation. |
| Client-centredness | Consider issues of meaningfulness and choice. |
| Determinants other than the health condition | Consider participation within a health condition framework but recognize that there are other broad determinants that may not be affected by rehabilitation interventions. |
| Aging with disability | Consider the impact of onset of secondary conditions or functional changes on participation as one ages with a disability. |
| Interdependence | Emphasize interdependence and social networks rather than independence when considering participation. |
The findings from this paper emphasize the importance of broadening our notions of rehabilitation outcomes beyond functional outcomes to include issues of participation as defined by the ICF but incorporating important concepts identified from the Disability Creation Process Model, the Consumer Model of Community Integration, and the Canadian Model of Occupational Performance. Table 1 summarizes the important elements from these models that need to be integrated into notions of participation in order to enhance our understanding of life in the community for persons post-stroke. Unless we incorporate these considerations into our theoretical models, we will continue to give them short shrift in research and practice.
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