A question I sometimes have as a Physical Therapy student is how do I motivate my clients to reach their fullest potential without implicitly promoting ableism? What does fullest potential even mean in this ableist society we live in? Physical Therapy and Occupational Therapy have long been part of a disabled child’s life; but if it is done ignorantly it has the potential to send messages that promote ableism. For example, the idea that a child’s value depends on how “normal” they are able to move and go through life.
For the longest time I believed that specialized services such as Occupational Therapy, Physical Therapy and ABA were essential, mandatory services that a disabled child should receive. I believed that these services would help them gain function, independence and promote normal development. But through my classes, I realized that my belief was based on a very ableist mindset. Why is it that we are trying to change disabled children to be more “normal”? Shouldn’t we be changing the system to be more welcoming of neurodiverse individuals instead? For example, if every building was equipped and designed with disabled people in mind, the time disabled children spent on learning how to walk “properly” in physical therapy could be spent on something else that is more important to them.
(Image above: a man in a wheelchair reaching for a book on an accessible bookshelf)
Looking back at my curriculum, I now see how parts of Physical Therapy are rooted in ableism. For example, we learn about the different motor milestones that a child should have but why do we have the goal of getting children to move to these milestones? Does it serve a purpose for the child? Does it align with their goals? Does it improve their quality of life? In an interview with Norman Kunc, a self- advocate and disability rights activist, he talks about how a lot of therapists focus on better functioning, but they often do not realize that a child’s functioning level does not equate to their quality of life. An example he gave was how when he was in therapy as child, he lost the opportunity to socialize and make friends, which negatively affected his quality of life. Better functioning is important for ease of living but Kunc believes that there is a huge difference between ease of living and quality of life. Therapy services often focus on the ease of living aspect, where therapists focus on reducing physical energy spent in daily task and increasing independence. But if we think about what quality of life is, we don’t think about how far we are able to walk or whether we are able to live alone, we think about our relationships, having fun and feeling like we belong.
So, what can we do as therapists living in an ableist world? First, we must be advocates for disabled people. We can do so by listening. We can and should tailor our services to the goals of our clients. We should talk with our clients and figure out what it is they want to achieve. For example, if the goal of a client is to work in a yogurt shop, some of the goals we can work on could be learning how to use a cash register or proper mechanics for lifting bags of yogurt toppings. Furthermore, as therapists, we should also accept and know that our clients know what is best for them, no matter what age they are. If they believe that therapy is no longer beneficial or that their time would be better spent elsewhere, we need to accept and support their decision. Because the truth is, there is a lot more to life than being in therapy. We need to start seeing our clients as more than their disability and use these specialized services to enhance the strengths they already have and work on what is important to them.
(Image above: A colorful pediatric physical therapy gym with a tricycle, parallel bars and balls)
