Client Perspectives on Reclaiming Participation After a Traumatic Spinal Cord Injury in South Africa

Abstract

Client perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors.

Factors Influencing Participation in Daily Activities by Persons With Spinal Cord Injury: Lessons Learned From an International Scoping Review

“…[36][37][38][39][40] Equally, transitioning from hospital to home and lack of support for mental health issues were reported as constraining participation in daily activities. 30,31,41 However, studies of HICs presented measures for enhancing mental health that facilitated participation, such as motivational counseling that encourages persons with SCI to develop a balanced repertoire of occupations. 22 Physical health was also linked to promoting participation through enhancing mental strength.…”

“…30,[43][44][45][46][47] These constraints appeared to be greater in LMICs given the prevalence of health complications, severely limited short-and long-term survival of persons with SCI, 10 and limited outdoor mobility and poor functional capacity leading to sedentary indoor living. 10,31,40,48 Physical exercise, wheelchair mobility, and transferring skills practice were identified as assisting in the prevention of health complications in HICs. 42,49 3 Availability of cost-effective adaptive equipment.…”

“…Impact of natural and physical environments -Resources (finance, public transport system) 18,27,81 -Environmental accessibility (public outdoor spaces, shopping centres, pavement, 18 accessibility in home) 20,51 -Wheelchair-friendly home environment ensured safety, 49,58 wheelchair-friendly work environment ensured job, 84 and facilitates access to community resources 21 -Inaccessibility in private or public infrastructure, such as in vehicle parking, 52,54 petrol pump, public buildings, 18,52 high curbs, stairs, lack of automatic doors, and inaccessible restaurant, transportation 20,27,51,53,88,89 -Inaccessibility in others/friends home 49,53 -Inaccessible lake or park and natural environment/ terrain 53,76 -Geographical distance 47 -Unfavorable climate conditions (eg, weather, season, temperature, humidity) 20,27,45 Living in urban areas 10 Inaccessible home: eg, toilet, entrance, water source, and road access to home 10,57 -Inaccessible public space, eg, defective accessibility, no ramp, no wheelchair access (toilet of shopping center, bank and public spaces) 31 -Lack of accessible transportation 40,57 Social relations based on social skills and mutual understanding -Basic manner, communication skills, 30,56 relationship skills, and self-control in actual social context 39 -Social skill such as "social engineering" that is feeling comfortable within oneself and in society 49…”

“…-Positive relationship and attitude with neighbors 47 partner, family members 56,68,81,87,90 -Intimate relationship, multiple relationships, and supports from family members, friends, and SCI peers 45,58,59 -Availability of social support 70 -Avoid interactions, negative assumption about disabilities, negative comments, discrimination 51 -Social stigma 49 -Poor social support networks 37,91 Maintaining relationship with neighbors, health professionals, and family members -Criticism, negative attitudes, and insulted by other people 31,57 -Exclusion from society (even family members' negative attitude acts as barrier) 40,57 -Struggle with social relation and acceptance 48 (Continued) -Occupational story making (therapist and client make a visionary story of meaningful future) 21 -Freedom to restructure occupational identity 22,59 -Availability of home-or community-based adaptation services 49 -Reciprocity in dealing with community, improving own community, sharing ones' life story, doing volunteer work, or educating each other 51 Lack of freedom of choice in community life 56 -Unemployment and lack of opportunities 10,31,57 -Limited resources in community-based rehabilitation 10…”

“…27 As the medical model has limitations, it is important for providers to incorporate the social and human rights models of understanding disability into their services. 4,28 Second, there is knowledge on how rehabilitation follow-up service, accessible transportation, community networks of people with SCI, and disability acts and legislation facilitate participation in high-income countries (HICs), 29,30 but these are far and few between in LMICs, 31 where disability acts might exist but remain unenforced. 4 Also, few studies exist of facilitators and constraints to participation.…”