The paradox of normalization through rehabilitation: growing up and growing older with cerebral palsy.
OBJECTIVE
To examine the experience of normalization through rehabilitation for persons growing up & growing older with lifelong physical impairment (cerebral palsy [CP]).


METHODS
A qualitative methodology consisting of narrative inquiry informed by the Life Course Perspective. Multiple (3-4), in-depth interviews were completed with each participant in order to co-construct their life stories. Data were systematically compared for themes and categories, as well as the central plot that weaves the participants' experiences together.


RESULTS
Nine community-dwelling individuals (three men; six women), aged 26-70, with mild to severe CP participated. Their common narrative involved intensive rehabilitation in childhood that focused on "normalizing" movement, particularly walking. In adolescence they were deemed to have achieved their functional potentials and "nothing further could be done". After transitioning out of pediatric health services many start to lose the gains they achieved in rehabilitation (particularly around walking). In their 30's and 40's they begin to slow down and lose functional abilities but no longer have access to rehabilitation to help them manage their aging bodies.


CONCLUSIONS
Many of the assumptions that underlie the organization and delivery of rehabilitation services for people with long term impairments may contribute to difficulties encountered in adulthood and old age by focusing on normalizing physical function at the expense of learning to manage their bodies across the life course.


CONCLUSIONS
• The way that rehabilitation services are organized and delivered for people with lifelong impairments needs to be re-considered. • Frontloading rehabilitation in childhood does not meet the long term needs of children growing up and growing older with physical impairments. As they grow up and grow older, they lose many of the gains they achieved in rehabilitation yet they have nowhere to turn to receive rehabilitation for their aging bodies. • The focus on normalizing function in childhood may only serve to emphasize the child’s lack of ablebodiedness to the detriment of their sense of self and wellbeing.
Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. lrmoll@gmail.com
Laura R
LR
Moll
Cheryl A
CA
Cott
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology* / Q000523:psychology; D002547:Cerebral Palsy / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D033262:Narration; D010549:Personal Satisfaction; D036301:Qualitative Research; D011788:Quality of Life; D012046:Rehabilitation; D012720:Severity of Illness Index