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  • Karen K. Yoshida, BSc.PT, MSc. PhD, Professor (tenured), Department of Physical Therapy, Rehabilitation Science Insti... moreedit
Purpose: Research on fiscal implications of the bundled care (BC) model exist; however, patient-perceived experiences are less well known. As BC expands in Ontario, this study aims to examine these experiences with physiotherapy care... more
Purpose: Research on fiscal implications of the bundled care (BC) model exist; however, patient-perceived experiences are less well known. As BC expands in Ontario, this study aims to examine these experiences with physiotherapy care within the total knee replacement (TKR) BC programme. Methods: Qualitative cross-sectional study design. Semi-structured one-on-one telephone interviews were conducted with eight patients four to six weeks post-TKR. Thematic analysis was used. Results: This exploratory study identified three themes across the care journey that patients perceived as influencing their physiotherapy experiences: timely access to physiotherapy care, quality of physiotherapy care, and patient outcomes. Communication, clinical support, and social support were sub-themes. Conclusions: Patients’ overall experiences with BC physiotherapy were positive. Areas for improvement included coordination of postoperative physiotherapy and return-to-work support. Patients valued group settings and were interested in meeting previous TKR patients. Health system planners are advised to consider incorporating patient experiences when evaluating and developing BC programmes to achieve patient-centred outcomes.
Aims: Since the introduction of both cervical and breast screening programmes in Aotearoa New Zealand, mortality rates have dropped. Both screening programmes track women's engagement, but neither capture the level of engagement of Deaf... more
Aims: Since the introduction of both cervical and breast screening programmes in Aotearoa New Zealand, mortality rates have dropped. Both screening programmes track women's engagement, but neither capture the level of engagement of Deaf women who are New Zealand Sign Language users or their experiences in these screening programmes. Our paper addresses this knowledge deficit and provides insights that will benefit health practitioners when providing screening services to Deaf women. Methods: We used qualitative interpretive descriptive methodology to investigate the experiences of Deaf women who are New Zealand Sign Language users. A total of 18 self-identified Deaf women were recruited to the study through advertisements in key Auckland Deaf organisations. The focus group interviews were audiotaped and transcribed. The data was then analysed using thematic analysis. Results: Our analysis indicated that a woman's first screening experience may be made more comfortable when staff are Deaf aware and a New Zealand Sign Language interpreter is used. Our findings also showed that when an interpreter is present, extra time is required for effective communication, and that the woman's privacy needs to be ensured. Conclusion: This paper provides insights, as well as some communication guidelines and strategies, which may be useful to health providers when engaging with Deaf women who use New Zealand Sign Language to communicate. The use of New Zealand Sign Language interpreters in health settings is regarded as best practice, however their presence needs to be negotiated with each woman.
Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence... more
Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence adopting CPET in a stroke rehabilitation setting. Method: A qualitative descriptive study was conducted. Physiotherapists (n = 6) participated in a focus group to discuss the use of CPET in practice. Patients (n = 8) who had completed CPET during stroke rehabilitation participated in a semi-structured interview to explore their experiences. Thematic analysis was performed. Results: CPET increased the physiotherapists’ confidence in prescribing exercise, especially for medically complex patients. Ongoing medical management early post-stroke was a barrier to referral. Physiotherapists expressed decreased confidence in interpreting test results. Consultation with local experts facilitated the use of CPET. Patients described how CPET increased their confidence to participate in exercise. They desired more information before and after CPET to better understand the purpose and results and their relation to their rehabilitation goals. Conclusions: Both physiotherapists and patients described the benefit of having CPET available to support them as they participated in exercise in a stroke rehabilitation setting. Physiotherapists would benefit from having educational tools to support their interpretation and application of test results, and patients would benefit from improved communication and education to support their understanding of the relevance of CPET to their rehabilitation goals. Future research should explore these findings in other stroke rehabilitation settings.
IntroductionFalls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of... more
IntroductionFalls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors that influence fall risk would guide the development of effective fall prevention strategies.ObjectivesTo gain a comprehensive understanding of the factors that influenced the risk of falling as perceived by wheelchair users with SCI.DesignA qualitative study using photo-elicitation interviews.SettingA Canadian SCI rehabilitation hospital and the participants’ home/community environments.ParticipantsTwelve wheelchair users living in the community with chronic SCI.MethodsParticipants captured photographs of situations, places or things that they perceived increased and decreased their risk of falling. Semistructured photo-elicitation interviews were conducted to discuss...
Background Individuals living with chronic spinal cord injury or disease (SCI/D) are at an increased risk of falling. However, little is known about the impact of falls and fall risk in the subacute phase of SCI/D, despite this being a... more
Background Individuals living with chronic spinal cord injury or disease (SCI/D) are at an increased risk of falling. However, little is known about the impact of falls and fall risk in the subacute phase of SCI/D, despite this being a time when fall prevention initiatives are delivered. Hence, we explored the impact of falls and fall risk in individuals with subacute SCI/D as they transitioned from inpatient rehabilitation to community living. Methods This qualitative photo-elicitation study used an inductive thematic analysis. Eight individuals (7 male) undergoing inpatient rehabilitation at a Canadian tertiary rehabilitation hospital due to a new SCI/D participated. Six months following discharge, photo-elicitation interviewing was used to understand the impact of falls and fall risk. Over 7–14 days, participants completed a photo-assignment that involved taking photographs in response to questions, such as what increases/decreases your likelihood of falling? A semi-structured in...
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Purpose: To examine the CBC’s television coverage of two highlighted Canadian Paralympic athletes who participated at the 2004 Summer Paralympic Games held in Athens, Greece. This analysis focuses on representations of ability and gender... more
Purpose: To examine the CBC’s television coverage of two highlighted Canadian Paralympic athletes who participated at the 2004 Summer Paralympic Games held in Athens, Greece. This analysis focuses on representations of ability and gender and to consider the repercussions of these representations for Paralympians, people living with physical difference, and spectators. Methods: Informed by disability studies theory and Garland-Thomson’s (2000) work, qualitative research methods were used to analyze segments of CBC’s television coverage of two Canadian Paralympians, one male and one female, for dominant and recurring themes. Results: Multiple positive representations of athletes were presented in the data. The dominant theme was the athletic.  Though a positive alternative to negative stereotypes of ability this representation is used solely for the female athlete in this case study. The analysis of the male athlete revealed a more nuanced, complex representation.  Within this analysi...
We identify the key social and political forces that brought about the Self Managed Attendant Service Direct Funding Pilot (SMAS-DFP). Attendant Services are services for people with physical disabilities (PWD) to assist with daily... more
We identify the key social and political forces that brought about the Self Managed Attendant Service Direct Funding Pilot (SMAS-DFP). Attendant Services are services for people with physical disabilities (PWD) to assist with daily activities. Direct Funding means that individuals obtain funds through direct funding mechanisms and/or through third parties. Self-direction refers to consumers who know their attendant service needs and can instruct workers to meet these needs. Self-management refers to (PWD) who are employers under the law and are legally responsible for hiring, training, scheduling and paying their attendants. Our analysis of the success of the SMAS-DFP is based on pre-conditions and facilitating elements. The pre-conditions were the: (1) existence of social movements; (2) precedents to direct funding programs; (3) prior experience with the governance of attendant services; and (4) government health reform. Five elements facilitated the SMASD-FP: (1) a clear vision by the community; (2) a core group of leaders; (3) supporters of the SMAS-DFP came from inside and outside of the community; and (4) supporters provided key resources to be used and to deal with barriers. PWD successfully led the pilot (1994–1997) and continue to administer the expanded government program (began 1998).
This paper describes how four ‘helping’ professionals came to embrace and teach critical disability studies (CDS) perspectives rather than biomedical approaches to impairment and disability that traditionally inform those professions... more
This paper describes how four ‘helping’ professionals came to embrace and teach critical disability studies (CDS) perspectives rather than biomedical approaches to impairment and disability that traditionally inform those professions (occupational therapy, physiotherapy, social work, and speech-language pathology). Sharing examples from our experiences, we describe how we came to question the normative, ableist assumptions of our professional disciplines. We then briefly outline literature demonstrating how critical approaches have been incorporated into professional research and practice and discuss possible obstacles and tensions in adopting more widespread critical approaches into professional spaces. We conclude by suggesting that continued development of connections among scholars and activists within CDS, rehabilitation and social work, and the community, is necessary to ensure that intersectional critical perspectives in relation to disability become a core component of profe...
In this paper, we describe a methodology of access developed and applied during a three-year project in the Niagara region focused on cultivating the next generation of disability leaders. We describe the theoretical approach to the... more
In this paper, we describe a methodology of access developed and applied during a three-year project in the Niagara region focused on cultivating the next generation of disability leaders. We describe the theoretical approach to the project and highlight the significance of doing this work in Niagara. A literature review of adult, transformative, and community-based learning scholarship revealed that little research or writing has focused on describing a thorough approach to access in transformative projects in community-based settings. Writing with two participants from the study, we elaborate on the five dimensions of our approach: 1) funding; 2) local and focused; 3) intimate, relational, and interdependent; 4) curating access, and 5) welcoming disruption. We also describe the tensions in taking on this work. We conclude with an invitation to scholars, community groups, and organizations to consider integrating our methodology in their next research project.
In this article we provide a critical reflection on the integrated use of solicited audio diaries, photography, and interviews in a study with disabled young men transitioning to adulthood. In the study, we developed a methodological... more
In this article we provide a critical reflection on the integrated use of solicited audio diaries, photography, and interviews in a study with disabled young men transitioning to adulthood. In the study, we developed a methodological approach for illuminating the intersectionality of gender, disability, and generation (life stage) identities. Drawing from a critical Bourdieusian perspective, we suggest that rather than producing single or “true” accounts, the combination of methods can be used to elucidate how participants establish, maintain, and reform their identities in everyday practices. Furthermore, we discuss how participants' acts of data creation are analyzable events in themselves, wherein participants do work to establish, maintain, and reform their identities. We conclude with some lessons learned and future directions.
ABSTRACT Purposes: (1) To determine the availability, use and factors associated with the use of electrophysical agents (EPAs) in the management of patients with musculoskeletal impairments in physical therapy (PT) outpatient clinics in... more
ABSTRACT Purposes: (1) To determine the availability, use and factors associated with the use of electrophysical agents (EPAs) in the management of patients with musculoskeletal impairments in physical therapy (PT) outpatient clinics in Metro Toronto and (2) to determine sources ...
This article reports on a study conducted for the Canadian International Development Agency by The International Centre for Disability and Rehabilitation at the University of Toronto. We critically examined the broad literature in the... more
This article reports on a study conducted for the Canadian International Development Agency by The International Centre for Disability and Rehabilitation at the University of Toronto. We critically examined the broad literature in the area of disability and development and in this article we identify the key issues which emerged. Most of the data were collected from existing literature in the academic and practice settings and from the publications of key NGOs and governments. We first, examine disability in the context of low-income countries, and then discuss key critical issues: disability and poverty, disability and health, disability and education, disability and gender, disability and children/youth, disability and conflict/natural disasters and disability and human rights. In all these areas we find reports of discrimination, stigmatisation and marginalisation. We conclude that, as we address issues of multi-cultural disability services in developed countries, it is important to bear in mind the various issues that many people with disabilities and their families bring with them as the result of immigrating from a developing country. Although we address these issues within our own countries, we must bear in mind the changes that are occurring due to globalisation.
Children and youth with progressive conditions are living longer, and there is increased interest in designing programs that will assist them with “transitioning” to adulthood. Almost none of the transitions research to date, however, has... more
Children and youth with progressive conditions are living longer, and there is increased interest in designing programs that will assist them with “transitioning” to adulthood. Almost none of the transitions research to date, however, has attended to the experiences of disabled boys in “becoming men,” nor has there been critical conceptual work problematizing notions of “normal” adulthood or theorizing the complex, diverse, and gendered experiences of transitioning. In this Canadian study, we investigated the intersectionality of gender, disability, and emerging adulthood with 15 young men with Duchenne muscular dystrophy. Participants created audio diaries and photographs that were explored in in-depth interviews. Using a Bourdieusian lens and Arthur Frank’s notion of the narrative habitus, we examined how participants re/negotiated identities in everyday practices. Our analysis suggested that disability, masculinities, and generational (life stage) identities intersected through “...
Although there is a great deal of interest in women's health,... more
Although there is a great deal of interest in women's health, research on the health and well being of women with disabilities has not increased. In this article we present internal and structural barriers to wellness activities experienced by women with disabilities. We also discuss women's actual and recommended strategies to address these barriers. Data were collected in six focus groups in urban and rural Ontario, Canada. The participants represented a diversity of disability, age, and ethnoracial backgrounds. Our findings suggest that individual and structural barriers exist for the women, with structural barriers (physical, informational, and systemic access) being predominant. Barriers prevented women from engaging in desired wellness activities. Women discussed actual strategies to address these barriers, such as collective efforts to buy nutritious foods and recommendations to create greater access (e.g., increase health professionals' training in disability issues).
The purpose of this article is to describe the changing nature, process and structure of an international non-governmental organisation (NGO) in response to internal and external factors. This article is based on the interview data... more
The purpose of this article is to describe the changing nature, process and structure of an international non-governmental organisation (NGO) in response to internal and external factors. This article is based on the interview data collected for the study which focussed on the experiences and perception of key informants on trends related to official development assistance, local governments' perspective of the NGO as a development partner and the NGO's perception of corporate and foundation support. Qualitative descriptive data analysis was used. Three main themes were developed with the interview data. Our analysis indicated shifts in the: (1) vision/nature (single to cross disability focus), (2) structure (building internal and external relationships) and (3) process (from ad hoc to systemic evaluations). These broader issues of vision, structure (relationships) and evaluation within and outside of the organisation, needs to be addressed to provide a foundation upon which funding initiatives can be developed. A closer relationship between funders and projects/programmes would do much to enhance the partnership and would ensure that the projects are able to measure and report results in a manner that is conducive to increasing support.
Background: Women with a disability are often characterised as a homogenous social group consigned to a cultural stereotype with assumptions of dependence, asexuality and gender neutrality. Furthermore, there is a void of research about... more
Background: Women with a disability are often characterised as a homogenous social group consigned to a cultural stereotype with assumptions of dependence, asexuality and gender neutrality. Furthermore, there is a void of research about the experience of people with disabilities following diagnosis with HIV. Little is known about how HIV diagnosis intersects with disability and gender and how it shapes the experiences of intimacy and gender roles of those negotiating this intersection.Objective: The objective of this study was to explore how HIV, disability and gender shape the perspectives of HIV-positive women with disabilities regarding intimacy and gender roles.Methods: Twelve women in Lusaka, Zambia were recruited for in-depth semi-structured interviews to explore their experiences of having a disability and living with HIV. Interviews were conducted in English, Bemba, Nyanja and Zambian sign language. Descriptive and thematic analyses were conducted, followed by in-depth gende...
Research shows a decline in physical activity levels during adolescence, particularly among girls. This study explored perceived barriers to participation in moderate and vigorous physical activity among adolescent girls who live in a... more
Research shows a decline in physical activity levels during adolescence, particularly among girls. This study explored perceived barriers to participation in moderate and vigorous physical activity among adolescent girls who live in a large ethnoracially and socioeconomically diverse city. A total of 73 adolescent girls in Toronto participated in 1 of 7 focus group sessions which were audiotaped and transcribed verbatim, and qualitative software was used to facilitate data analysis. A constant comparison approach was used to inductively develop themes. Participants' perceived barriers to participating in physical activity included: lack of time; involvement in technology-related activities; influence peers, parents and teachers; concern about safety; inaccessibility of facilities and cost of using them; competition; and body-centered issues. The results suggest that strategies to address specific intrapersonal, social-environmental, and physical-environmental barriers to physica...
We recast a toy figure as a cultural agent of various interlocking and hegemonic discourses, and in particular, explore how normative discourses are reflected in material objects. We suggest that the Toy Gymnast represents and reinforces... more
We recast a toy figure as a cultural agent of various interlocking and hegemonic discourses, and in particular, explore how normative discourses are reflected in material objects. We suggest that the Toy Gymnast represents and reinforces these discourses and therefore influences how children learn that normative bodies are desirable. Playing with Normalcy: A Disability Material Culture Analysis by Fady Shanouda & Karen K. Yoshida is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at https://rdsjournal.org. Permissions beyond the scope of this license may be available at https://www.rds.hawaii.edu.
In this paper, we describe a methodology of access developed and applied during a three-year project in the Niagara region focused on cultivating the next generation of disability leaders. We describe the theoretical approach to the... more
In this paper, we describe a methodology of access developed and applied during a three-year project in the Niagara region focused on cultivating the next generation of disability leaders. We describe the theoretical approach to the project and highlight the significance of doing this work in Niagara. A literature review of adult, transformative, and community-based learning scholarship revealed that little research or writing has focused on describing a thorough approach to access in transformative projects in community-based settings. Writing with two participants from the study, we elaborate on the five dimensions of our approach: 1) funding; 2) local and focused; 3) intimate, relational, and interdependent; 4) curating access, and 5) welcoming disruption. We also describe the tensions in taking on this work. We conclude with an invitation to scholars, community groups, and organizations to consider integrating our methodology in their next research project.
Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to... more
Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to identify how individuals living with a spinal cord injury (SCI) viewed and/or used their disability positively, and what contextual influences facilitated this positive approach. This study was a secondary analysis of qualitative data from a larger study. The findings revealed three levels at which disability was viewed and/or used positively by people with SCI: self, peers, and disability community. In addition, several aspects of the participants' situations were found to facilitate this positive view and/or use of disability: personality, spirituality, support systems, and acceptance of one's disability. The findings reveal that individuals with SCI are viewing and/or using their disabilities positively in many different ways. This study has significant implications for the direction of future research and for health care professionals who need to increase their advocacy and facilitating roles.
The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to... more
The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to identify why performance assessment discussions are valuable, explore the role of each participant throughout the discussion, identify the challenges associated with these discussions, and explore the effect of the standardized assessment tool on the discussion. This study used a qualitative descriptive design, consisting of student and CI focus groups in the Greater Toronto Area from January to June 2016. All participants (=29) recognized the importance of having face-to-face performance assessment discussions in a quiet and private space. Students and CIs agreed that the Canadian Physiotherapy Assessment of Clinical Performance helped to structure and focus the discussions. Valuable discussions occurred when students were open minded and self-reflec...
The 2005 South Asian earthquake led to large-scale injuries and disabilities in northern Pakistan, which were dealt with using various approaches. In this regard, a community-based rehabilitation approach was initiated in the Muzaffarabad... more
The 2005 South Asian earthquake led to large-scale injuries and disabilities in northern Pakistan, which were dealt with using various approaches. In this regard, a community-based rehabilitation approach was initiated in the Muzaffarabad district of Pakistan in early 2006, focused on preventing complications among persons with Spinal Cord Injury. This case study briefly describes its development, aims and service provision components, in addition to the distribution of injuries from the disaster. Pressure ulcer prevention education, its recall and decrease in prevalence over a year are presented as key outcomes and illuminate the process of implementing rehabilitation in this context. This case study presents findings from a larger internal program evaluation in 2010-11. The study design was cross-sectional, to elicit recall of education components and the resulting prevalence of pressure ulcers over the year, in 33 randomly selected persons with Spinal Cord Injury. Outcomes includ...
We examined the relationship between the amount of physical activity and level of fatigue in adults with cystic fibrosis (CF).Participants were recruited from the Toronto Adult Cystic Fibrosis Centre at St.... more
We examined the relationship between the amount of physical activity and level of fatigue in adults with cystic fibrosis (CF).Participants were recruited from the Toronto Adult Cystic Fibrosis Centre at St. Michael's Hospital. Participants completed the Habitual Activity Estimation Scale, the Multidimensional Fatigue Inventory, and the Depression subscale of the Hospital Anxiety and Depression Scale, in that order. Descriptive statistics and linear and multiple regressions were computed.Over a 6-month period, 51 individuals were approached, and 22 (10 men, 12 women) participated in this study. The participants' median age was 33, and forced expiratory volume in 1 second (FEV) was 64% predicted. When holding both FEVand depression constant, a significant negative correlation was found between total active hours per weekday and general fatigue (β=-0.735,=0.03); there was a negative trend between total active hours per weekday and physical fatigue (β=-0.579,=0.09).This study is the first to demonstrate that among adults with CF, a higher level of physical activity is associated with a lower level of general and physical fatigue when controlling for lung function and level of depression. Physical activity may be used as a means of mitigating the levels of general and physical fatigue in people with CF.
... Teaching Disability Studies in Canada and the USA DAVID PFEIFFER & KAREN YOSHIDA Department of Public Management, Suffolk University, Boston, MA 02108 770, USA and Department of Physical Therapy, University of Toronto,... more
... Teaching Disability Studies in Canada and the USA DAVID PFEIFFER & KAREN YOSHIDA Department of Public Management, Suffolk University, Boston, MA 02108 770, USA and Department of Physical Therapy, University of Toronto, Toronto, Ontario M5T 1W5, Canada ...
When in public places, many individuals with physical disabilities experience staring. Although staring is typically seen as uncomplicated and something to be "ignored," it has consequences for the person being stared and the... more
When in public places, many individuals with physical disabilities experience staring. Although staring is typically seen as uncomplicated and something to be "ignored," it has consequences for the person being stared and the staree. Few studies have focused on staring experienced by men following spinal cord injury (SCI). Accordingly, this study explored how adult men with SCI give meaning to the staring from others, the consequences for them, and their responses to the staring and to the starer. Principles of modified grounded theory methods were used to conduct a secondary analysis of interview data for 30 male participants from a larger study of community-dwelling individuals with SCI. Themes revealed through analysis related to context-dependent meanings of staring, negative consequences of staring for some men, and positive opportunities for self-growth and interaction with the public. These findings contribute to a more complex understanding of staring and the relat...

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