"We Live Our Life Normal": A Qualitative Analysis of Nigerian Women's Health-Seeking Behavior during the COVID-19 Pandemic.

BACKGROUND: This study examined where women sought healthcare during the COVID-19 pandemic and their reasons for doing so. We aim to understand further how women accessed care during the COVID-19 pandemic to inform future preparedness and response efforts. This knowledge gained from this study can inform strategies to address existing gaps in access and ensure that women's health needs are adequately considered during emergencies. METHODS: This study used an interpretive phenomenological-analysis approach to analyze data on women's experiences with healthcare in Nigeria as the COVID-19 pandemic progressed. Semi-structured interviews were conducted with 24 women aged 15 to 49 between August and November 2022 and were supplemented with three focus-group discussions. RESULTS: Following our analysis, three superordinate themes emerged: (i) barriers to seeking timely and appropriate healthcare care, (ii) the influence of diverse health practices and beliefs on health-seeking behavior, and (iii) gendered notions of responsibility and of coping with financial challenges. CONCLUSIONS: This paper examined women's decision to seek or not seek care, the type of care they received, and where they went for care. Women felt that the COVID-19 pandemic affected their decision to seek or not seek care.

"She was finally mine": the moral experience of families in the context of trisomy 13 and 18- a scoping review with thematic analysis.

INTRODUCTION: The value of a short life characterized by disability has been hotly debated in the literature on fetal and neonatal outcomes. METHODS: We conducted a scoping review to summarize the available empirical literature on the experiences of families in the context of trisomy 13 and 18 (T13/18) with subsequent thematic analysis of the 17 included articles. FINDINGS: Themes constructed include (1) Pride as Resistance, (2) Negotiating Normalcy and (3) The Significance of Time. INTERPRETATION: Our thematic analysis was guided by the moral experience framework conceived by Hunt and Carnevale (2011) in association with the VOICE (Views On Interdisciplinary Childhood Ethics) collaborative research group. RELEVANCE: This article will be of interest and value to healthcare professionals and bioethicists who support families navigating the medically and ethically complex landscape of T13/18.

Composing adult lives with a ventilator at the intersection of developmental and neoliberal discourses of time.

This paper explores temporalities and experiences of time drawn from an analysis of interview data from a critical narrative inquiry of the experiences of young adults living with home mechanical ventilation (HMV). The analysis centers the ideological effects of dominant discourses that shape understandings of time in the Euro-Western world and the ways in which young adults' stories prompt a rethinking of time in health research and praxis. Data generation involved interviews and photo-elicitation with five young adults (ages 18-40). A critical narrative analysis of participants' stories surfaced the influence of ableist, developmentalist, and neoliberal discourses of time and the creative resistance that points to the potential of crip orientations to time in opening up possibilities for living. Implications for practice and research are offered.

The Uses and Effectiveness of Occupational Therapy Physical Activity Interventions in Young Children with Developmental Disabilities: A Systematic Review.

BACKGROUND: Physical activity (PA) is often used to support the development of young children (<5 years) with disabilities. The effectiveness of PA as an occupational therapy (OT) treatment approach in this population has not yet been systematically examined. AIMS: This research aimed to explore the uses and effectiveness of OT PA interventions on developmental indicators in young children with developmental disabilities. METHODS: A systematic review of peer-reviewed publications (from 2000 onward) across six electronic databases was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess study quality. Narrative synthesis (vote counting and structured reporting of effects) was employed to summarize the findings. RESULTS: Eight studies with heterogenous interventions were included. Evidence demonstrated positive trends of participation in the PA interventions on physical, cognitive, and social-emotional indicators, with significance varying. There was no association between interventions and communication indicators or negative effects related to participation in the interventions. Overall, the studies were low-quality when judged by GRADE. CONCLUSIONS: PA may be a promising avenue for OT interventions among young children with developmental disabilities. Rigorous research is needed to determine the magnitude of effect PA has on developmental indicators.

Critiquing representations of intellectual disability in occupation-based literature.

BACKGROUND: Within and beyond occupation-based scholarship, concerns abound regarding the pervasiveness of discourses that promote a negative, deficit-based view of intellectual disability and associated consequences for disabled people's lives. Such representations risk reducing the complexities of human doing and being and can limit the occupational possibilities of this group. Yet, there is a lack of critically reflexive research exploring how disability is discursively constructed in occupation-based literature. AIMS/OBJECTIVES: This paper critically analyses representations of intellectual disability within occupation-based literature. It considers the influence of such representations on the occupational possibilities of people labelled intellectually disabled. METHODS: This review employed a critical interpretive synthesis of 21 peer-reviewed articles from occupational therapy and occupational science that focused on intellectual disability. RESULTS: Three analytic threads were identified as contributing to how intellectual disability was represented across the reviewed literature: habilitating expected doings, becoming productive citizens, and activated, but insufficient. CONCLUSION & SIGNIFICANCE: Occupation-based discourses have powerful influence within society, particularly within occupational therapy, regarding understandings of intellectual disability and how these shape occupational possibilities for persons labelled intellectually disabled. Drawing attention to taken-for-granted representations of intellectual disability is essential to promote transformative occupational therapy practice and enhance occupational possibilities for this population.

From reflection to phronesis in 'good' physiotherapy practice.

BACKGROUND: Reflection is promoted in health professional education as a way to learn in and on practice. 'Being reflective' is considered important to 'good' and 'expert' physiotherapy practice, yet there is limited research on reflective practices of experienced physiotherapists. For Aristotle, a good person reasons and acts in ways to promote human flourishing. Physiotherapists' perspectives on the place of reflection in good practice has the potential to advance professional understandings of how it may be enacted. Such knowledge may inform health professions education, regulatory guidelines, professional practices, and patient interactions. PURPOSE: The purpose of this research was to examine experienced musculoskeletal (MSK) practitioners' perceptions of reflection in the practice of a 'good' physiotherapist. METHODS: A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of the qualities and practices that constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on ways of 'being reflective', which emerged as a major theme in the original study. FINDINGS: Six themes were identified related to 'being reflective' in a 'good' physiotherapist: 1) learning from experience; 2) integrating multiple perspectives; 3) navigating indeterminate zones; 4) developing embodied knowledge; 5) questioning assumptions; and 6) cultivating wisdom. CONCLUSIONS: Findings support the notion that 'good' physiotherapy involves a disposition toward making wise judgments through reflection. This practice-based knowledge can inform educational initiatives that nurture practices that foster attention to reflective processes that inform phronesis in professional life. Through reflexivity on what the profession takes for granted, physiotherapists may be better prepared when navigating the indeterminate zones of practice.

Representations of parenting autistic children: A critical interpretive synthesis.

BACKGROUND: Many taken-for-granted expectations for parents in Western societies are situated in normative assumptions. Social constructions of 'good' parenting may be a poor fit for parents whose children's development varies from a so-called typical trajectory. Normative assumptions about parenting can have harmful effects for parents of autistic children. AIMS/OBJECTIVES: This paper examines representations of parenting autistic children in contemporary research and considers the potential effects of these representations on these parents' occupational possibilities. METHODS: Informed by a critical occupational perspective, a critical interpretive synthesis (CIS) of 27 research articles focussed on parenting autistic children was conducted. FINDINGS: Three major discursive threads were identified regarding how parents of autistic children are represented in research: gendered assumptions, caregiving as all-consuming, and disruption of normative expectations of parenting. CONCLUSIONS AND SIGNIFICANCE: Normative discourses about parenting were (re)produced within this body of research which may perpetuate limitations in the occupational possibilities of parents of autistic children. Critical investigation into contemporary research is necessary to challenge taken for granted expectations for parents of children with autism, to mitigate harmful effects for parents, to inform transformative OT practices and policies, and to promote equitable service provision.

Mindfulness and therapeutic relationships: A phenomenological inquiry into paediatric occupational therapists' practices.

BACKGROUND: A growing body of literature points to the potential of mindfulness to support therapeutic relationships, and the importance of the therapeutic relationship when working with children and youth, yet little attention has been paid to this topic in occupational therapy. AIMS/OBJECTIVES: The aim of this study was to inquire into occupational therapists' experiences of mindfulness in the therapeutic relationship with children and youth. MATERIALS AND METHODS: Hermeneutic phenomenology was the methodological approach, with Heidegger's concepts of being-with and care as theoretical underpinnings of the study. Eight North American occupational therapists participated in semi-structured interviews that elicited first-hand accounts of mindfulness in the therapeutic relationship with children and youth. Interviews were transcribed verbatim and analysed using a phenomenological approach. RESULTS: Four key themes were identified: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. CONCLUSIONS AND SIGNIFICANCE: The findings offer insights regarding the potential affordances of mindfulness to support clinicians in the development of therapeutic relationships with children and youth. Further, this study highlights research priorities for future inquiry.

Mindfulness in paediatric occupational therapy practice: a phenomenological inquiry.

PURPOSE: While research into mindfulness practices is on the rise across populations, there is evidence to suggest that clinical practice has outpaced the literature with regard to mindfulness in pediatric rehabilitation. The aim of this study was to explore the perceptions of occupational therapists who opt to incorporate mindfulness into their clinical practices with children and youth. METHODS: Hermeneutic phenomenology was the methodology of the study. The theoretical framework employed a Heideggerian-informed phenomenology of practice. Eight occupational therapists practicing in Canada and the United States participated in 90-120 min semi-structured interviews that elicited first-hand accounts of mindfulness in pediatric occupational therapy practice. Interviews were transcribed verbatim and analyzed using Finlay's four-step approach. RESULTS: Six salient themes were identified in the data: drawing from personal practice, enhancing participation, fostering healthy habits, adapting for children, keeping it playful, and doing with. CONCLUSION: The findings of this study offer insights for therapists who are considering incorporating mindfulness into their practices with children and youth. Further, this research highlights a number of research priorities that require further inquiry.IMPLICATIONS FOR REHABILITATIONMindfulness is growing in popularity and may support occupational engagement in children and youth receiving rehabilitation services.Mindfulness practices may support rehabilitation providers in approaching their work with children and youth from a critical perspective.Further development of the child- and youth-centred mindfulness approaches may be warranted to enhance engagement and appropriateness for a range of ages and conditions.

Transforming normative, ableist, and biomedical orientations to living well and quality of life in nursing: Reimagining what a ventilated body can do.

A goal of living as well as possible is central to practice and research with young adults living with home mechanical ventilation (HMV). Significant effort has been put into conceptualizing and measuring the quality of life (QOL) as a proxy for living well. Yet, dominant understandings of QOL have been influenced by normative, ableist, and biomedical discourses about what constitutes a good life that, when applied in practice and systems with those living with HMV, can contribute to exclusion and constrain opportunities to live well. Inquiry into what certain understandings of living well can do is critical to opening up possibilities to reimagine living well with HMV. This paper draws on findings from a critical narrative inquiry that explored the experiences of five young adults (ages 18-40 years) living with HMV. Data were co-constructed virtually through an initial interview and photo-elicitation using participant-generated photographs. A critical narrative analysis of participants' stories made visible the ideological effects of ableist, biomedical, and individualist discourses and how the young adults reproduced and resisted these dominant discourses. Their stories further opened up possibilities for nurses and other healthcare providers to see living well and QOL differently.

The 'responsive' practitioner: physiotherapists' reflections on the 'good' in physiotherapy practice.

BACKGROUND: Being 'responsive' is named as an element of ethic of care theories, yet how it is enacted is not clearly described in health professional practice. Being 'responsive' is implied within patient-centered approaches and promoted as important to health care practices, including physiotherapy. However, ways of being a responsive practitioner have not been explicitly examined. Practitioners' perspectives about how a 'good' physiotherapist enacts responsiveness have potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, and patient interactions. PURPOSE: The purpose of this research was to explore experienced musculoskeletal (MSK) practitioners' perceptions of 'responsiveness' in the practice of a 'good' physiotherapist. METHODS: A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of what constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on 'responsiveness,' which emerged as a major theme in the original study. FINDINGS: Six themes were identified related to 'Being responsive' in a 'good' physiotherapist: Being person-centered, Being attentive, Being open, Being a listener, Being validating, and Being positive. CONCLUSIONS: As a relational way of practicing, being responsive may facilitate person-centered approaches including a relational understanding of autonomy, inviting dialogue, and sharing power and decision-making with patients. Pivotal to the practice of a 'good' physiotherapist, being responsive in the ways underscored by participants suggests researchers, educators, and practitioners consider relational ways of practicing as a balance to the technical aspects of physiotherapy.

An integrative review of the qualities of a 'good' physiotherapist.

INTRODUCTION: Qualities of a physiotherapist may influence the therapeutic alliance and physiotherapy outcomes. Understanding what qualities constitute a 'good' physiotherapist has yet to be systematically reviewed notwithstanding potentially profound implications for the future practice of physiotherapy. PURPOSE: The primary purpose of this review was to critically examine how physiotherapists and their patients describe the qualities of a 'good' musculoskeletal physiotherapist as depicted in peer-reviewed literature. The secondary aim was to synthesize qualities represented in the literature, and to compare patient and physiotherapist perspectives. METHODS: An integrative review methodology was used to undertake a comprehensive literature search, quality appraisal of studies, and thematic analysis of findings. An electronic search of CINAHL, EMBASE, Nursing and Allied Health, PsycINFO, PubMed, and Scopus databases was conducted within a time range from database inception to June 14, 2019. RESULTS: Twenty-seven studies met the inclusion criteria. Six qualities of a 'good' musculoskeletal physiotherapist were identified as: responsive, ethical, communicative, caring, competent, and collaborative. CONCLUSIONS: The qualities of a 'good' physiotherapist identified in the review emphasize the human interaction between physiotherapists and patients and point to the centrality of balancing technical competence with a relational way of being.

Beyond inclusion: collective social spaces of safety, communion, and recognition / Além da inclusão: espaços sociais coletivos de segurança, comunhão e reconhecimento

Abstract This paper unsettles taken-for-granted understandings of social inclusion in the field of occupational therapy and links with the concept of radical inclusion developed in social occupational therapy. It traces the ways that, over time, inclusion has been reduced to a position within the inclusion/exclusion binary. Pierre Bourdieu's reflexive theory of practice is introduced to expand understandings of how the negative value accorded to disability is reproduced through exclusionary social conditions and relations. Drawing on the results of a qualitative study that examined the everyday lives, practices and occupations of 13 Canadian youth who used augmentative and alternative communication (AAC) modes as a result of physical impairments, three elements of more inclusive social spaces - safety, communion, and recognition - are presented alongside implications of each for occupational therapy. These alternative approaches for thinking beyond inclusion are grounded by narratives illustrating elements of social spaces that can foster a sense of belonging and connection. The perspectives shared by youth in the study add complex insights into how they made 'practical sense' of prevailing calls for social inclusion. Their stories show how even as they struggled for inclusion, they were subject to and internalized negative valuations of disability. Importantly, the paper highlights strategies employed by youth to reformulate inclusion on their own terms. These reformulations go beyond over-simplified conceptions of inclusion and hold potential to inform the ways that occupational therapists work alongside individuals and collectives to improve life chances, expand occupational possibilities, and support flourishing for disabled children and youth.

Resumo Este artigo desestabiliza os entendimentos aceitos sobre a inclusão social no campo da terapia ocupacional e relaciona-os com o conceito de inclusão radical desenvolvido na terapia ocupacional social. Traça as maneiras pelas quais, ao longo do tempo, a inclusão foi reduzida a uma posição simplificada dentro do binário inclusão/exclusão. A teoria reflexiva da prática de Pierre Bourdieu é introduzida para expandir a compreensão de como o valor negativo atribuído à deficiência é reproduzido por meio de condições e relações sociais excludentes. Com base nos resultados de um estudo qualitativo que examinou a vida cotidiana, práticas e ocupações de 13 jovens canadenses que usam modos de comunicação aumentativa e alternativa (AAC), em decorrência de suas deficiências físicas, três elementos de espaços sociais mais inclusivos são apresentados juntamente com as suas implicações para a terapia ocupacional: segurança, comunhão e reconhecimento. Essas abordagens para pensar além da inclusão são fundamentadas em narrativas que ilustram elementos dos espaços sociais que podem promover um sentimento de pertencimento e conexão. As perspectivas compartilhadas pelos jovens acrescentam percepções complexas sobre como eles deram "sentido prático" aos apelos predominantes por inclusão social. Suas histórias mostram como, mesmo enquanto lutavam pela inclusão, foram submetidos e internalizaram avaliações negativas sobre a deficiência. Importante ressaltar as estratégias empregadas pelos jovens para reformular a inclusão em seus próprios termos, que vão além de concepções simplificadas de inclusão e têm potencial para informar as maneiras pelas quais os terapeutas ocupacionais trabalham com indivíduos e coletivos para melhorar as oportunidades de vida, expandir a ocupação.

"Passion to do the right thing": searching for the 'good' in physiotherapist practice.

BACKGROUND: Practitioners' perspectives of what constitutes a 'good' physiotherapist have not been explicitly examined despite their potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions. PURPOSE: The purpose of this research was to examine physiotherapists' perceptions of what constitutes a 'good' physiotherapist. The context of the study was musculoskeletal practice (MSK). METHODS: A hermeneutic phenomenological investigation was undertaken. Semi-structured interviews were conducted with twelve experienced MSK physiotherapists to examine their perceptions of what constitutes a 'good' physiotherapist. FINDINGS: Seven themes were identified. Good physiotherapists were depicted as: 1) oriented to care; 2) integrating knowledge sources; 3) competent; 4) responsive; 5) reflective; 6) communicative; and 7) reasoning. To deepen the understanding of these themes, we discuss the findings in relation to Joan Tronto's ethic of care theory. CONCLUSIONS: Physiotherapists' perceptions of what constitutes a 'good' physiotherapist highlight practices that may underpin an ethic of care including the pivotal role of person-centered and relational dimensions of practice. The findings call into question the profession's emphasis on a technical rationalist approach to education and clinical practice and invites conversation about future directions that balance technical competence with relational dimensions of practice.

"The Strength to Leave": Women With Disabilities Navigating Violent Relationships and Occupational Identities.

IMPORTANCE: Being in an intimate relationship is a desired occupation for many people, in particular for women living in low- and middle-income countries (LMICs), where relationships can provide material support, intimacy, and social integration and increase chances of survival. OBJECTIVE: To explore accounts of navigating intimate relationships from women with disabilities in Sierra Leone. DESIGN: A qualitative study was conducted, guided by a critical occupational approach and informed by feminist disability scholarship. Data were generated through interviews and analyzed using reflexive thematic analysis. SETTING: Community-based across four districts of Sierra Leone. PARTICIPANTS: Thirteen women with disabilities were recruited by means of snowball and purposive sampling. RESULTS: Four themes were generated that illuminated the women's experiences of intimate relationships as viewed through the lens of gender and disability dimensions. The overarching theme, "violence in intimate relationships," describes the incidences of violence and abuse they experienced. "Becoming a wife" explores the women's occupational identity wishes. "Leaving as an occupational rupture" illuminates the actions the women took to end the relationship. "Mothering as an occupational identity and resource" focuses on the women's role as mothers and transitions in their occupations. CONCLUSIONS AND RELEVANCE: Taking their unique narratives into account draws attention to how the women have met their occupational needs and resisted occupational injustices, enabled by social and structural supports, including their children, disability social benefits, and their engagement in the disability rights movement. Implications are directed at socially committed occupational therapists to address systemic issues of disability- and gender-based violence. What This Article Adds: This study adds much-needed knowledge in an area in which there is a paucity of research: the experiences of women with disabilities being in an intimate relationship as a social occupation in an LMIC. The results illuminate the importance of considering the systemic issues that affect the social occupations of women with disabilities, particularly in light of the shift within occupational therapy practice toward developing a socially transformative focus.

Interrogating inclusion with youths who use augmentative and alternative communication.

Even as the goal of social inclusion underpins health and social services for disabled youths, those with communication impairments continue to lead narrowly circumscribed lives. In this Canadian study, we combined visual methods and interviews with 13 Canadian youths who use augmentative and alternative communication (AAC) to understand how they make 'practical sense' of discourses of inclusion. Drawing on Bourdieu's theory of practice, we suggest: (i) participants' narratives reveal habitus - a socially constituted set of dispositions - that predispose them to accommodate the devalued social positions and constricted conditions of existence imposed on them; (ii) some forms of 'inclusion' perpetuate symbolic violence, as youths who use AAC internalise, as seemingly 'natural', dominant social norms and values that privilege 'normal' bodies; and (iii) although their practices primarily reproduced the status quo, youths in the study also worked at the margins to create locally produced forms of inclusion that attempted to transform the 'rules of the game'. We argue these results suggest a need for systemic shifts past reified notions of inclusion towards fostering social spaces where alternative ways of being in the world are positively valued.

Problematizing 'productive citizenship' within rehabilitation services: insights from three studies.

Background: The idea that everyone should strive to be a 'productive citizen' is a dominant societal discourse. However, critiques highlight that common definitions of productive citizenship focus on forms of participation and contribution that many people experiencing disability find difficult or impossible to realize, resulting in marginalization. Since rehabilitation services strive for enablement, social participation, and inclusiveness, it is important to question whether these things are achieved within the realities of practice. Our aim was to do this by examining specific examples of how 'productive citizenship' appears in rehabilitation services.Methods: This article draws examples from three research studies in two countries to highlight instances in which narrow understandings of productive citizenship employed in rehabilitation services can have unintended marginalizing effects. Each example is presented as a vignette.Discussion: The vignettes help us reflect on marginalization at the level of individual, community and society that arises from narrow interpretations of 'productive citizenship' in rehabilitation services. They also provide clues as to how productive citizenship could be envisaged differently. We argue that rehabilitation services, because of their influence at critical junctures in peoples' lives, could be an effective site of social change regarding how productive citizenship is understood in wider society.Implications for rehabilitation'Productive citizenship', or the interpretation of which activities count as contributions to society, has a very restrictive definition within rehabilitation services.This restrictive definition is reflected in both policy and practices, and influences what counts as 'legitimate' rehabilitation and support, marginalizing options for a 'good life' that fall outside of it.Rehabilitation can be a site for social change; one way forward involves advocating for broader understandings of what counts as 'productive citizenship'.

Expanding beyond individualism: Engaging critical perspectives on occupation.

BACKGROUND: Perspectives that individualize occupation are poorly aligned with socially responsive and transformative occupation-focused research, education, and practice. Their predominant use in occupational therapy risks the perpetuation, rather than resolution, of occupational inequities. AIM: In this paper, we problematize taken-for-granted individualistic analyses of occupation and illustrate how critical theoretical perspectives can reveal the ways in which structural factors beyond an individual's immediate control and environment shape occupational possibilities and occupational engagement. METHOD: Using a critically reflexive approach, we draw on three distinct qualitative research studies to examine the potential of critical theorizing for expanding beyond a reliance on individualistic analyses and practices. RESULTS: Our studies highlight the importance of addressing the socio-historical and political contexts of occupation and demonstrate the contribution of critical perspectives to socially responsive occupational therapy. CONCLUSION AND SIGNIFICANCE: In expanding beyond individualistic analyses of occupation, critical perspectives advance research and practices towards addressing socio-political mediators of occupational engagement and equity.

A Relational Ethics Framework for Advancing Practice with Children with Complex Health Care Needs and Their Parents.

Children with complex health care needs are an emerging population that commonly requires long-term supportive services. A growing body of evidence has highlighted that these children and their families experience significant challenges. Many of these challenges involve ethical concerns that have been under-recognized. In this article, we (a) outline ethical concerns that arise in clinical practice with children with complex health care needs and their families (e.g.: exclusion of children's voices in discussions and decisions that affect them; difficulties in defining their best interests; clashes across the array of social roles that parents manage; limited recognition of the ethical significance of parents' and other family members' interests) and (b) propose a relational ethics framework for addressing these concerns. Our framework draws on hermeneutical interpretation and moral experience as foundational orientations, recognizing children with complex health care needs as relationally embedded agents, who while dependent and entitled to protection, are simultaneously agential. Children's and parents' interests are relationally intertwined and interdependent. Families are recognized as significant social microcosms for the cultivation and transmission of intergenerational cultural heritage, narratives, and outlooks. We describe strategies for (a) conducting a relational ethics inquiry and (b) reconciliation of identified ethical concerns through a process of rapprochement. A relational ethics framework can promote clinical practices that are ethically attuned to the complexity of this population's needs.

Assembling activity/setting participation with disabled young people.

Rehabilitation research investigating activity participation has been largely conducted in a realist tradition that under-theorises the relationship between persons, technologies, and socio-material places. In this Canadian study we used a post-critical approach to explore activity/setting participation with 19 young people aged 14 to 23 years with complex communication and/or mobility impairments. Methods included integrated photo-elicitation, interviews, and participant observations of community-based activities. We present our results using the conceptual lens of assemblages to surface how different combinations of bodies, social meanings, and technologies enabled or constrained particular activities. Assemblages were analysed in terms of how they organised what was possible and practical for participants and their families in different contexts. The results illuminate how young people negotiated activity needs and desires in particular 'spacings' each with its own material, temporal, and social constraints and affordances. The focus on assemblages provides a dynamic analysis of how dis/abilities are enacted in and across geotemporal spaces, and avoids a reductive focus on evaluating the accessibility of static environmental features. In doing so the study reveals possible 'lines of flight' for healthcare, rehabilitation, and social care practices.