Article

PURPOSE: Following stroke,
re-engagement in personally valued activities requires
some experience of risk. Risk, therefore, must be seen as having positive as well
as negative aspects in rehabilitation. Our aim was to identify the dominant
understanding of risk in stroke rehabilitation and the assumptions underpinning
these understandings, determine how these understandings affect research and
practise, and if necessary, propose alternate ways to conceptualise risk in
research and practise. METHOD: Alvesson and Sandberg's method of problematisation
was used. We began with a historical overview of stroke rehabilitation, and
proceeded through five steps undertaken in an iterative fashion: literature
search and selection; data extraction; syntheses across texts; identification of
assumptions informing the literature and; generation of alternatives. RESULTS:
Discussion of risk in stroke rehabilitation is largely implicit. However, two
prominent conceptualisations of risk underpin both knowledge development and
clinical practise: the risk to the individual stroke survivor of remaining
dependent in activities of daily living and the risk that the health care system
will be overwhelmed by the costs of providing stroke rehabilitation. CONCLUSIONS:
Conceptualisation of risk in stroke rehabilitation, while implicit, drives both
research and practise in ways that reinforce a focus on impairment and a generic,
decontextualised approach to rehabilitation. Implications for rehabilitation Much
of stroke rehabilitation practise and research seems to centre implicitly on two
risks: risk to the patient of remaining dependent in ADL and risk to the health
care system of bankruptcy due to the provision of stroke rehabilitation. The
implicit focus on ADL dependence limits the ability of clinicians and researchers
to address other goals supportive of a good life following stroke. The implicit
focus on financial risk to the health care system may limit access to
rehabilitation for people who have experienced either milder or more severe
stroke. Viewing individuals affected by stroke as possessing a range of
independence and diverse personally valued activities that exist within a network
of relations offers wider possibilities for action in rehabilitation.

Langue : ANGLAIS