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In my experience in the United States, I see a blend of the medical and social models of disability. I see the medical model mostly in acute onset of disability, particularly one with high rehabilitation potential. For example, a child who has an arterio-venous malformation in the brain, presenting as a stroke patient, is very much treated through a medical lens. Children have high levels of neural plasticity and often make robust improvement. The underlying “problem list” impacting the patient’s status would be specifically addressed, and rehab goals formed to meet each “deficit.” A good rehab program would recognize the child as an individual with unique home environment – do they live in a one story building? An elevator building? A 3 story walk up building? Do they have siblings? Parents at home who can help? Etc… But the underlying rehab plan is based on the medical model. I tend to see more social models in application of long term rehab needs, chronic or even degenerative conditions. Examples that come to mind are fully cognitively intact, employed adults with professional and family responsibilities who also have rehab needs such as adults with lasting side effects from polio, or spinal cord injuries, or long term diseases such as multiple sclerosis. These individuals may have maximized the rehab potential that can be derived through the medical model and must have social model applications to minimize barriers to society and allow them to exercise their best potential.
It’s a difficult question to ask what I think of when I see someone with a disability. I’d like to believe my impression and thoughts are purely altruistic, but I have taken classes addressing bias in health care and am aware that I need to check my biases and privileges as an able bodied person before engaging in any judgemental thoughts. That said, working in NYC, when I see someone with disabilities I usually scan the environment to be sure it is safe. There are a lot of uneven surfaces to manage, potholes in the street, curbs of varying heights. Sometimes the elevator in the subway can be broken. I try my best to be aware of the environment. I think I was raised in a combination of the medical and social models. I come from a very large extended family, and as such have loved ones with varying degrees of ability – disability. I was raised with the attitude of “there but for the Grace of God, go I”, suggesting it’s somewhat the luck of the draw who has what body and capability, to maintain humility, empathy and try to even the playing field for all.