Disability dilemmas and rehabilitation tensions: a twentieth century inheritance.

Although disability has gradually become part of the social justice concept in Western nations since the seventeenth century, and is a current world-wide social concern, it is no way as readily definable or determinable as race, gender, age or even poverty, other issues of social justice. It remains a relative term despite efforts to contain it. The World Health Organization's definition for disability is a restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being, arising as a consequence of physiological, psychological or anatomical impairment. Under the impairment/disability paradigm, rehabilitation interventions aim for the restoration of maximum functional activity or independence. The consequences of impairment and disability can, but do not necessarily, lead to handicaps or conditions of disadvantage, the composite result of individual functional limitations and faults in physical, cultural, social, economic and political environments. Rehabilitation for handicapping conditions then implies not necessarily the restoration of maximum functional activity or independence, but the restoration of maximum social function, including work and family roles. Recent literature on disability and rehabilitation research and policy reflects the complex and expanding context, but the relativity of the concepts involved, particularly the slippage between disability and handicap, create problems of consistently determining and communicating need. For the literature, certain dilemmas are evident in determining and providing for the needs of disabled persons: self-perceived and self-defined need vs bureaucratic standards and statistical definition; resource compensation vs resource enhancement; urban vs rural needs. Closely related to these perplexing problems are tensions in rehabilitation approaches: institutional and community approaches; individual functional improvement and environmental improvement. This paper considers the dilemmas and tensions as reported, and on that basis certain policy issues are tabulated and presented.