Rochette Annie, Korner-Bitensky Nicol, Levasseur Melanie
School of Rehabilitation, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, Québec, Canada H3C 3J7.
Disabil Rehabil. 2006 Oct 15;28(19):1231-5. doi: 10.1080/09638280600554827.
There is mounting interest by professionals working in the rehabilitation sciences related to the concept of participation, especially given the increasing numbers of individuals worldwide living with chronic illnesses. It is now internationally agreed that participation level is influenced by both personal and environmental factors. The question arises as to the meaning of 'optimal' participation. The main objective of this article is to provide a reflective look at the concept of participation and the meaning of 'optimality' for individuals with and without disability and to explore both in relation to response shift.
Similarities in definitions of participation are first examined. Normal participation level is discussed leading to an 'optimal' level based on normality. Cases are used to illustrate normality as well as how 'optimal' participation can be achieved through a transition period despite disabilities caused by a health condition such as a stroke.
'Optimal' participation would rely on a perfect fit between an individual's reality (how activities and roles are actually realised) and expectations of how activities and roles should be accomplished. A transition period, including a response shift, following an acute event or onset of a chronic condition can lead to an optimal participation level despite persisting disabilities.
A better understanding of the meaning of optimal participation and its association to response shift is important to clinical practice. Interventions aimed at optimizing participation through assisting clients who are experiencing a response shift can then be designed to maximize participation and concomitantly, quality of life in those with chronic health conditions.
康复科学领域的专业人员对参与概念的兴趣日益浓厚，尤其是考虑到全球慢性病患者人数不断增加的情况。目前国际上一致认为，参与水平受个人和环境因素的影响。“最佳”参与的含义问题随之而来。本文的主要目的是对参与概念以及“最佳状态”对于残疾人和非残疾人的意义进行反思性探讨，并结合反应转移来进行研究。
首先考察参与定义中的相似之处。讨论正常参与水平，进而得出基于常态的“最佳”水平。通过案例来说明常态以及尽管因中风等健康状况导致残疾，但如何在过渡期实现“最佳”参与。
“最佳”参与依赖于个人现实（活动和角色实际实现的方式）与对活动和角色应如何完成的期望之间的完美契合。急性事件或慢性病发作后的过渡期，包括反应转移，尽管存在持续残疾，仍可导致达到最佳参与水平。
更好地理解最佳参与的含义及其与反应转移的关联对临床实践很重要。旨在通过帮助经历反应转移的患者优化参与的干预措施，可设计用于最大限度地提高慢性健康状况患者的参与度，并随之提高其生活质量。
