Full Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=iptp20

Download by: [Auckland University of Technology] Date: 07 April 2016, At: 14:13

Physiotherapy Theory and PracticeAn International Journal of Physiotherapy

ISSN: 0959-3985 (Print) 1532-5040 (Online) Journal homepage: http://www.tandfonline.com/loi/iptp20

Connectivity: An emerging concept forphysiotherapy practice

David A. Nicholls GradDip, MA, PhD, Karen Atkinson GradDip, MSc, PFHEA,Wenche S. Bjorbækmo PT, MA, PhD, Barbara E. Gibson MSc, PhD, JulieLatchem BSc, MSc, MCSP, Jens Olesen MEd, Jenny Ralls MSc, MCSP & JenniferSetchell BSc(Pty), GradCert(ClinPty)

To cite this article: David A. Nicholls GradDip, MA, PhD, Karen Atkinson GradDip, MSc, PFHEA,Wenche S. Bjorbækmo PT, MA, PhD, Barbara E. Gibson MSc, PhD, Julie Latchem BSc, MSc,MCSP, Jens Olesen MEd, Jenny Ralls MSc, MCSP & Jennifer Setchell BSc(Pty), GradCert(ClinPty)(2016): Connectivity: An emerging concept for physiotherapy practice, Physiotherapy Theoryand Practice

To link to this article: http://dx.doi.org/10.3109/09593985.2015.1137665

Published online: 06 Apr 2016.

Submit your article to this journal

View related articles

View Crossmark data

DESCRIPTIVE REPORT

Connectivity: An emerging concept for physiotherapy practiceDavid A. Nicholls, GradDip, MA, PhDa, Karen Atkinson, GradDip, MSc, PFHEAb, Wenche S. Bjorbækmo, PT, MA,PhDc, Barbara E. Gibson, MSc, PhDd, Julie Latchem, BSc, MSc, MCSPe, Jens Olesen, MEdf, Jenny Ralls, MSc, MCSPg,and Jennifer Setchell, BSc(Pty), GradCert(ClinPty)h

aSchool of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand; bDepartment of Allied Health Professions andMidwifery, University of Hertfordshire, Hatfield, UK; cDepartment of Health Sciences, Institute of Health and Society, Blindern, Oslo, Norway;dDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; eSchool of Social Sciences, Cardiff University, Cardiff, UK;fNeurorehabiliteringen Regionshospitalet Skive, Hammel Neurocenter, Skive, Denmark; gRehabWorks Ltd, Bury St Edmunds, Suffolk, UK;hSchool of Psychology, Department of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia

ABSTRACTHaving spent their first century anchored to a biomedical model of practice, physiotherapists havebeen increasingly interested in exploring new models and concepts that will better equip themfor serving the health-care needs of 21st century clients/patients. Connectivity offers one suchmodel. With an extensive philosophical background in phenomenology, symbolic interactionism,structuralism, and postmodern research, connectivity resists the prevailing western biomedicalview that health professionals should aim to increase people’s independence and autonomy,preferring instead to identify and amplify opportunities for collaboration and co-dependence.Connectivity critiques the normalization that underpins modern health care, arguing that ourconstant search for deviance is building stigma and discrimination into our everyday practice. Itoffers provocative opportunities for physiotherapists to rethink some of the fundamental tenets oftheir profession and better align physiotherapy with 21st century societal expectations. In thispaper, we provide a background to the place connectivity may play in future health care, andmost especially future physiotherapy practice. The paper examines some of the philosophicalantecedents that have made connectivity an increasingly interesting and challenging concept inhealth care today.

ARTICLE HISTORYReceived 27 February 2015Revised 5 July 2015Accepted 9 July 2015

KEYWORDSConnectivity;phenomenology;physiotherapy;postmodernism;structuralism; symbolicinteractionism

There is no need to fear or hope, but only to look for newweapons (Deleuze, 1992, p. 4).

Introduction

Having spent their first century anchored to a bio-medical model of practice, physiotherapists havebeen increasingly interested in exploring new mod-els and concepts that will better equip them forserving the health care needs of 21st century cli-ents/patients.1 Connectivity offers one such concept(Aguilar, Stupans, Scutter, and King, 2013;Praestegaard, Gard, and Glasdam, 2014; Schoebet al, 2014; Shaw and DeForge, 2012; Wikström-Grotell, Broberg, Ahonen, and Eriksson, 2013;Wikström-Grotell and Eriksson, 2012).Connectivity centers around a radical alternative tothe traditional medical and social models of health.It critiques the way that people are labeled as

abnormal and “other” in orthodox medicine, butalso the perpetuation of these distinctions in societyat large. Connectivity builds on a philosophicalbackground in phenomenology, symbolic interac-tionism, structuralism, and postmodern research topropose that it is people’s connections with otherentities (people, technologies, objects, environments,ideas, etc.), that define their abilities, not putativemedical or socially-constructed norms. Acceptingthis alternative notion of embodied engagement inthe world to that offered by biomedicine has impor-tant implications for physiotherapists, who haveexpressed dissatisfaction with the currently availablepractice models (Bullington, 2009b; Nicholls andGibson, 2010; Standal and Engelsrud, 2013). In thispaper, we examine some of the principles thatunderpin the concept, and propose some ways inwhich it may offer critical insights into physiother-apy practice.

CONTACT David A. Nicholls david.nicholls@aut.ac.nz School of Public Health and Psychosocial Studies, AUT University, 90 Akoranga Drive,Northcote, Auckland, 0627, New Zealand.

PHYSIOTHERAPY THEORY AND PRACTICEhttp://dx.doi.org/10.3109/09593985.2015.1137665

© 2016 Taylor & Francis

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

Background

Physiotherapy has been influenced by biomedicinethroughout much of its history, and this affinity has con-tributed greatly to the profession’s position as the pre-eminent provider of orthodox physical rehabilitation. Inrecent years, however, biomedical reasoning has beenheavily criticized for its elitism and professional closure,its readiness to be the arbiter of normality, and its histor-ical affinity with the Victorian notion of the body-as-machine (Clarke and Shim, 2011; Freidson, 2001;Keshet, 2009; Lupton and McLean, 1998; Slatman,2014). Criticism has come from a wide range of healthservice users, most notably, women, disabled people, andindigenous communities.2 But, criticism has also comefrom medical sociologists, practitioners, and academicswithin the medical community itself. Much of this criti-cism has been leveled at the traditional “medical model”which has long governed the organization, delivery, andevaluation of health care in developed countries (Buryand Gabe, 2013; Clarke, 2010; Morrall, 2009; Petersenand Bunton, 1997). The model centers around seven keyprinciples outlined in Table 1.

These principles have, individually and collectively,been vital in many of the remarkable achievements of

western medicine, but they are also divisive, with criticsarguing that they can be used to discriminate andmarginalize the very populations they are designed toserve. Normalization, the principle most relevant to thispaper, functions to separate those who do not conformto socially-defined norms in order that we may cure,remedy, or rehabilitate them. Abnormality or othernessbecomes intolerable, and it is the role of medicine toreturn the ill, mad, sick, handicapped, malformed, anddeficient to “normality.” Resistance to the power thatcame with the medical profession’s ability to be thearbiter of abnormality began in the middle of the 20thcentury, and has been sustained ever since, most nota-bly from disability rights activists, who argued that itwas not impairment that disabled people, but the crea-tion of disabling attitudes and environments (Hughesand Paterson, 2010; Owens, 2015; Shuttleworth andMeekosha, 2013). The social models of health, alongwith other counter-narratives that emerged after WorldWar II, sought to give voice to people who had pre-viously been marginalized and silenced, especially chil-dren, disabled people, elderly, indigenous communities,mental health service users, and people in poverty(Marmot et al, 2008). But, in recent years, social modelshave also come in for criticism because they also relyon the identification of people as “other” in order thatwe can advocate for them, thus perpetuating discrimi-nation, marginalization, and stigma at all levels ofsociety rather than ameliorating it.

In recent years, we have seen the emergence of newapproaches to the traditional medical and social binarythat are opening up radically different ways of engagingin health-care practice. These approaches are particu-larly exciting for physiotherapists, because they centeraround the body and the ways we are challengingtraditional beliefs about what our bodies can do,where bodies begin and end, and how we might relateto other people, objects, technologies, and ideas in thefuture. The development of new touch-based technolo-gies, consumer robotics, adaptive bioengineering, andhuman-computer networks, alongside the emergingfield of trans-humanism, all point to a radically differ-ent conception of the traditional limits of human formoffered by biomedicine and the social sciences.

Connectivity is one such approach. An amalgam ofphilosophical sources, including the phenomenology ofMerleau-Ponty (2002); the symbolic interactionism ofthe Chicago School (Blumer, 1986; Mead and Morris,1934); Actor Network Theory (Latour, 2005); the post-modern writings of Gilles Deleuze, Felix Guattari andManuel De Landa (DeLanda, 2006; Deleuze andGuattari, 1987); and the post-structural feminism ofDonna Haraway (Haraway, 2006), connectivity

Table 1. Seven key principles of biomedicine.Principle Brief description

Reductionism Dividing the body up into discrete systems andparts. This can be at a microscopic level (i.e.cellular structure), at the level of the organ (theheart), an organ system (the cardiovascularsystem), or even the organization of a discretebranch of medicine (cardiothoracics)

Cartesian Dualism From Rene Descartes. The belief that the bodyand mind are separate. The mind is pure, God-like, the seat of the soul, and thus the concern ofThe Church, and the body is profane, prone tofailure and, therefore, the province of medicine.

Specific aetiology That the primary goal of medical science is tolocate the specific cause of illness and to focus onremedying this cause rather than the signs andsymptoms that are its outward expression.

Germ theory The belief that germs (bacteria, viruses, fungi,protozoa) are the case of disease, not foul air(miasma theory), malign gods and evil spirits(superstition), or unbalanced humors.

Normalization A scientific but also political and social distinctionbetween what is normal and abnormal. Includesthe difference between madness and sanity,ability and disability, health and sickness, evenalive and dead.

Objectivity andexperimentation

Also from Descartes, the belief that we cannottrust our senses, so rely on multiple sources ofempirical (observable) evidence, ideally fromrationally-conducted experimentation, to verifywhat we believe to be true.

Body-as-machine The belief that the structure, function andorganization of the body can be understoodmetaphorically in the same way we understandthe workings of simple and complex machines.

Adapted from Lupton (2012), Scott and Morgan (2004), Shilling (2012), andTurner (2008).

2 D. A. NICHOLLS ET AL.

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

explores how we become embodied through our con-nections with other human and non-human entities.

Various expressions of connectivity have emerged inthe literature in recent years including: economics(Stromquist, 2002); environmentalism (Crooks andSanjayan, 2006); gender studies (Hawthorne andKlein, 1999); information technology (Webb, 2007);media studies (Van Dijck, 2013); metaphysics (Laszlo,2003); and organization and management (Unhelkar,2009). Each of these shares a common concern for thecomplexity of contemporary life and a desire to findnew ways to connect human and non-human agents.

Key principles of connectivity

Connectivity refers to any assemblage, interaction, orlinkage between one’s “self” and another (or others)(Gibson, 2006). The “other” referred to in connectivityneed not be another person. Animals, other people,tools, technologies, even ideas, and concepts are allrecognized as “others,” and all entities are consideredto be equal.

This is a vital distinction, because in the past, peo-ple’s utilization of other entities has been one of theways in which we have labeled people as abnormal,deviant or disabled. For example, if a man uses aguide dog to help him navigate around town, he isconsidered to be disabled under the medical modelbecause he has an impairment requiring an adaptivetechnology. Under the social model, the man is disabledby an environment that is not universally accessible.But, with connectivity, he is no more disabled than theshepherd who uses a sheep dog to herd his flock. Bothuse a mediating technology (in this case a dog) toengage meaningfully in the world.

This distinction is not frivolous. Under traditionalhealth care, the man might be given a label (blind,disabled, handicapped even); he may experience socialisolation and judgment about his ability based on pre-judice and misunderstanding; and he could be expectedto conform, willingly or otherwise, to a medical systemdesigned to diagnose and fix physical deviations, withthe societally-acceptable goal of returning him to “nor-mal.” Many other arbitrary distinctions are made aboutpeople in health care today, and many of these arecontributing to stigmatizing judgments of people’s abil-ities, ratcheting costs of potentially unnecessary care,and many are putting unnecessary constraints on prac-titioners who might be able to serve their clients/patients better if they were less constrained in theirpractice ideologies.

Many other examples exist in health care and the socialworld at large. Arbitrary distinctions are made between

people who employ home-help and those who rely onfamily and friends; people who listen to music throughheadphones and people who use a hearing aid; peoplewho use a therapist to improve their balance and thosewho use a coach to improve their swimming technique.Connectivity challenges not only our normative assump-tions about when someone is healthy and sick, mad orsane, able bodied or disabled, but also, therefore, our roleas “therapists.” Before exploring how connectivity may dothis, we will briefly discuss how this paper came about,before examining some of the fundamental philosophicalprinciples that underpin this emerging concept.

Background to this article

In mid-2014, an international collaborative network ofphysiotherapists was formed to advance critical debatewithin the profession (www.criticalphysio.me). InNovember, the group undertook a month-long exerciseto establish its priorities for the coming year, participantsagreed that an important role for the group involvedhelping to explain philosophical ideas to physiothera-pists. Connectivity was already a concept that somemembers of the group had grappled with. It has providedpurchase for critical questioning of the profession’s past,present and future, and we had used it to debate how wemight think otherwise about physiotherapy (http://criticalphysio.me/2014/10/08/ results-from-30-days-of-sep-tember/). Consequently, an invitation went out to mem-bers to engage in their own act of connectivity, andcollaborate on a paper. Eight members of the groupsubmitted content that drew on a wide range of philoso-phical ideas used in their work as academics, clinicians,researchers, and students. The paper was compiled andedited collaboratively throughout.

What follows is the sum of these collaborativeefforts. We believe that connectivity offers some pro-vocative and potentially significant opportunities forphysiotherapists. Many of the ideas explored in thispaper will be familiar to readers, but the radicallydifferent way connectivity envisages the self (the reader,the therapist) and the other (the human or non-humanentity with which we, or our clients/patients connect),may provide readers with the stimulus to rethink manyof the fundamental tenets of their present practice.

Philosophical basis of connectivity

Phenomenology, embodiment, and intersubjectivity

The idea that we develop an understanding of ourselvesand others through inter-subjective connections is afeature of phenomenology, a philosophy that predates

PHYSIOTHERAPY THEORY AND PRACTICE 3

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

modern medicine and has been a foundation of philo-sophy for nearly two centuries. Drawing on the writingsof philosophers like Edmund Husserl (1859–1938),Martin Heidegger (1889–1976), and Maurice Merleau-Ponty (1908–1961), phenomenology has been a power-ful influence in health care, and latterly on physiother-apy (Abrams, 2014; Bjorbaekmo and Engelsrud, 2011;Groven and Engelsrud, 2013; Shaw and Connelly, 2012;Standal and Engelsrud, 2013).

As an example, Bjorbækmo and Engelsrud (2011)developed and implemented a year-long movementimprovisation program in which 12 children with dif-ferent movement capabilities participated in weeklysessions under the practical leadership of two danceteachers and the researcher. The applied phenomeno-logical perspective made it possible to emphasize move-ment as both personal, expressive, and at the sametime, relational and contextual phenomenon, andencouraged the children to move in their own way.When the children’s way of moving was welcomedand regarded as significant, they found satisfaction inmoving, and were inspired to keep on moving. Thestudy shows that a phenomenological perspective andan improvisational approach may create an attitude andcontext where people can come to trust that theirperforming movements regardless of age, ability orcircumstance.

Merleau-Ponty’s work, especially, has drawn thefocus of physiotherapists interested in the nature ofconsciousness and perception, embodiment, identity,meaning, subjectivity, and touch (Bullington, 2009a;Bullington, 2009b; Bullington, 2013).

Phenomenology is prefaced on the belief that theworld is not an external reality, independent of ourconsciousness, but rather a product of our “being-in-the-world.” Thus, what is “real” is that which aperson turns their consciousness toward (intention-ality). This notion of intentionality is fundamentallydifferent to the objective reality offered by westernscience, not least because it argues that we come toknow the world through our bodies, through oursenses; becoming “embodied” in the process.Emphasizing the individual’s being as a bodily-being is one of Merleau-Ponty’s revolutionary con-tributions (Abram, 1996).

Richard Shusterman (2005) described Merleau-Ponty’s work as defining the “body”s primacy inhuman experience and meaning’, and therefore thecrucial source of all perception and all action, as wellas the basis of all expression, language and meaning.Merleau-Ponty (cite 1962) argued that there is a certainambiguity inherent in having a body (in the physicalsense of the word), and being embodied, since we are

both subject and object in a world in which we interactwith other people and things to give meaning to ourexistence.

Through acts of touching and moving, for example,the bodies of the physiotherapist and the client/patientinter-relate, and we experience ourselves and othersthrough this inter-corporeal connection. Physicalexperiences, emotional linkages, and environmentalinfluences all factor into the ways we experience theconnection with others and develop our professionalrelationships. Physiotherapists develop embodiedknowledge and corporeal experience through theirpractice. This kind of knowledge builds and relies onbodily experiences; experiences that are both personaland relational; and always contextual. Our bodies knowand understand at a pre-experiential level before wereflect on the experiences.

Merleau-Ponty (2002, p. 94) argued that theambiguity that exists between “having” a body and“being” embodied stimulates us to continually iden-tify with and commit ourselves to certain projectsthat might reconcile this uncertainty. This desire isat the heart of our intentionality – the consciousnesswe have of who we are and how we experience theworld. It is this ambiguity that brings about theunity of the senses, of intelligence, of sensibility,and motility.

For phenomenologists, particularly those informedby the work of Merleau-Ponty, intersubjectivity is onepart of our always situated existence. For Merleau-Ponty, we are always ourselves, but being ourselvesinvolves a mutual inter-relatedness with the world,our surroundings, nature and culture: We are notonly in the world, we are always of the world weinhabit. Our bodies are intertwined with a world thatis around us and fuses with us, and this intertwining isan embodied position in continual flux; an ongoingshift of inside-out and outside-in experiences thatenvelop two solids and makes them adhere to oneanother; “To be a body, is to be tied to a certainworld. . .[O]ur body is not primarily in space: it is ofit” (Merleau-Ponty, 2002, p. 162).

Clinical practitioners experience phenomenologyin practice every day and it can be seen in the waythey constantly look for opportunities to offer carethat recognize the other’s wishes dreams and hopes,and supports their dignity. This is the “lifeworld”that lies at the heart of phenomenology, and asMerleau-Ponty (2002, p. 123) points out, leads us tosee that “illness is a complete form of existence”. Assuch, it cannot be seen only as a limited way ofliving, but must also be understood as the existenceof opportunities.

4 D. A. NICHOLLS ET AL.

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

Symbolic interactionism and our meaningfulconnections with the world

Phenomenology is not the only philosophical positionto explore how we come to know ourselves through therelationship between self and other. Symbolic interac-tionism is a theoretical perspective and ontologicalposition which takes, as its central concern, the rela-tionship between individual action and social organiza-tion, and has its origins in the work of The ChicagoSchool. Based around Chicago University in the 1930s,and pioneered by George Herbert Mead (1863–1931)and one of his students, Herbert Blumer (1900–1986),symbolic interactionism gave rise to methodologicalapproaches that are now commonly used in health-care research, including grounded theory andethnomethodology.

Symbolic interactionists were critical of the way earlysociologists had concentrated on grand theories ofsocial action, preferring instead to concentrate on“much fuller depictions of actual conduct in real cir-cumstances” (Cuff, Sharrock, Dennis, and Francis,2006, p. 127). Mead argued that we come to understandour “selves” through our interaction with others, posit-ing that symbols and the construction of commonmeanings play a key role in organizing social action(s)and reality. This included other people, but alsoallowed for our interaction with other objects in thesocial world. The human capacity for reflection,thought and memory, he argued, allowed us to appreci-ate the symbolism of events, and this symbolic capacitymake it possible for us to represent ourselves as our-selves, as another entity in a distributed network ofinter-related entities (Blumer, 1986).

In his pioneering work summarizing the key princi-ples of Symbolic Interactionism, Herbert Blumer devel-oped three basic principles that form the basis of thisapproach: (1) Human beings act toward things on thebasis of the meanings that the things have for them; (2)the meaning of things is derived from, or arises out of,the social interaction that one has with one’s fellows;and (3) meanings are handled in, and modifiedthrough, an interpretive process used by the person indealing with the things he [sic] encounters (1986, p. 2).

Symbolic interactionists believe that human beingsdo not “respond directly to objects but attach meaningto them” (Handberg et al, 2015, p. 2). For them, theworld is not therefore made up of objects “which carryintrinsic meaning” (Denzin, 1969, p. 923), but is cre-ated by people constructing and giving objects meaning(Blumer, 1980). The meaning is created through inter-action with others and through the symbolic value weplace on our collective understanding of the world. The

process of meaning making through interaction is notstatic, however; it is a fluid and malleable process, beingcontinually created and modified through what sym-bolic interactionists call an “interpretive process.”Moving away from seeing the development of the selfas rational and linear allows us to reflect the everchanging, complex, modifiable, and always incompletenature of one’s health with greater clarity.

In his book Mind, Self and Society (Mead andMorris, 1934), Mead highlights that neither the indivi-dual nor the world can be understood in isolation, as“the self” is continually being developed and refinedthrough interaction with others and through participa-tion in society. Mead argued that “the self” is undercontinual construction rather than being fixed or fullyformed. Both the existence and creation of meaning-making through interaction with others has at its heart,the idea of connectivity; the process of constant con-nections being made and the role their making, unmak-ing and remaking has in developing “self,” our realityand social world. How this is done is the focus ofsymbolic interactionism which concentrates on theway that group actions and social organizations aregenerated through these interactions, and the routi-nized and repeatable nature in which this takes place.In physiotherapy, we see this in the present debatesamong practitioners about best practice or the futureof the profession; in the way we educate our students inshared groups; in inter-professional practice and sharedgroup work with patients and communities.

Structural embodiment, marginalization, and socialchange

Health sociologists have had a longstanding interest inhuman interaction and the social organization of healthand illness. In the mid-19th century, researchers wereconcerned with the differences in health status betweenmen and women, the poor and the wealthy, indigenouspeoples and migrants. Social scientists and philosopherslike Charles Wright Mills (1916–1962), Rudolph Virchow(1821–1902), John Snow (1813–1858), and FriedrichEngels (1820–1895) wrote extensively about the connec-tions between people and their environment, particularlythe conditions of urban living and public health. During aperiod dominated by biological, and later psychologicalexplanations for people’s living conditions, these healthsociologists provided robust social theories to explain theconnection between “the intimate realities of ourselves . . .[and] larger social realities” (Mills, 2000, p. 15).

Structuralism emerged as one branch of this emer-ging sociology of life in the early 1900s, and it posited

PHYSIOTHERAPY THEORY AND PRACTICE 5

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

that we cannot understand our existence unless weunderstand the societal structures that make it possiblefor us to exist, survive, and prosper. Structuralists arguethat there are conditions that people are born into orlive with that are largely out of their control, and thesestructures produce conditions of poverty, ill health,powerlessness and apathy. Income, gender, and racialinequality, for example, are not things that peoplechoose, but are conditions into which they are born,and in which they live their daily lives and whichstructure their choices, opportunities and desires. Agreater engagement of physiotherapy education inunderstanding social justice issues and resultant diver-sity of life experiences would help physiotherapistsintegrate these issues to achieve meaningful outcomeswith people they work with.

Structuralism is a broad field however and includesbranches of linguistics, Marxist and feminist scholar-ship, post-colonial philosophies and disability theory,and the influence of structuralism is evident in socialmovements that critique and seek to change the struc-ture of society. Of particular relevance to physiotherapyis the early disability rights movement and it articula-tion of the social model of disability that locates dis-ability in the environment rather than the individual.The movement came to prominence in the 1960s as apowerful response to the medical model of disabilitythat viewed disability as primarily residing within theindividual (Hughes and Paterson, 2010).

With its focus on disabling social environments andattitudes, many disability rights advocates have chal-lenged a prevailing trend in qualitative health researchto focus on the individual subjective, phenomenologicalexperiences while ignoring the conditions that give riseto marginalization (Scotch, 1989). Where phenomenol-ogists argue that a person’s “being in the world” is afundamental feature of our cognitive or perceptual life,many structuralists believe that our experiences of theworld are framed by external forces that cause us to actand think in certain ways. Like symbolic interactionists,their focus is on the material reality of people’s exis-tence, but the focus is overtly political, with a strongemphasis on power asymmetries, and attempts toemancipate those who are oppressed or marginalized.

Using these approaches, disability rights activistshave been successful in raising people’s consciousawareness of overt and subtle discriminations directedat disabled people, the need for anti-discriminationlaws and accessibility requirements for public buildings,and other societal changes. Structuralists have high-lighted how our connections with entities in theworld; other people, objects, laws and policies, environ-ments, and attitudes are far from politically neutral.

Unlike phenomenology and symbolic interactionism,structuralists are concerned with the powers thatmake consciousness possible, and draw our attentionto the world in which we live as a contested spacewhere some are afforded more opportunities thanothers. A structuralist perspective challenges phy-siotherapists to acknowledge the political and socialcircumstances of the people we work with and integratethis into the way we work.

In much of the biomedical theories and practicaleducation that physiotherapists are exposed to, thereis an unspoken assumption that able bodied identitiesand perspectives are preferable and should be aspiredto (McRuer, 2013). These “ableist” discourses are dee-ply embedded within Western culture and so the illu-sory notion of a corporeal standard, the perfectiblebody, is something against which many health-careprofessionals measure their clients. Structuralists pointto these discourses and offer a different perspective thatis less hierarchical, less stigmatizing, more empathicand empowering. They argue that it is possible to takea different view of the body’s variability and encouragehealth professionals to open themselves to knowledgethat may be unfamiliar, but enables them to betterunderstand how disabled people express their autono-mous subjectivities in everyday life.

In the United Kingdom, for example, there aremoves to shift the power base of health professionals,via co-production projects, to enable clients to be incontrol of the services that they access. The aim is toimprove health and well-being by enhancing the qualityof relationships and helping to achieve the outcomesthat matter most to people. There are also elements ofdeveloping better connections with communities. Theseprojects serve as an ideal vehicle through which tointroduce physiotherapists to philosophical ideas thatunderpin connectivity and emancipatory practice(Hutcheon and Wolbring, 2013).

Postmodernism, assemblages, and multiplicity

Although positive changes have clearly come out ofsurfacing the structural mediators of disability, struc-turalist thinking, as a whole, has faced considerablecritique in recent years. The continued identificationof marginalized peoples has led some critics to wonderif we will ever rid ourselves of the stigma of these kindsof discriminatory labelling (McRuer, 2003). Thedilemma of structuralism is that it reifies the identitiesthat it seeks to extinguish, and critics have argued thatstructuralism has a positivist ontology (the idea thatthere is one knowable reality) that lacks socio-historicalreference or flexibility (Crotty, 1998; Lupton, 2012). In

6 D. A. NICHOLLS ET AL.

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

the case of disability, this means that from a structur-alist perspective one either is “disabled” or not. Thisnecessarily means that some people will be excludedfrom this definition. People who consider themselvesdisabled due to their HIV status (McRuer, 2002), orobesity (Cooper, 2010), for example, have felt excludedfrom this definition of disability, because they do not fita standard medical or social definition. As a result ofthese kinds of criticisms, in the latter decades of the20th century postmodern and poststructural philoso-phers emerged to challenge interpretive and structuralunderstandings of human existence, and these havebegun to be widely adopted in the health sciences(Bauman, 2000; Bury, 1998; Featherstone andHepworth, 1991; Fox, 1999; Mol, 2002; Nettleton,2005; Shildrick, 1997).

Postmodern approaches have been a prominent fea-ture of continental philosophy (deriving primarily fromFrench and German academics, rather than the analyticphilosophy common to the UK and America).Postmodern approaches fundamentally challenge thebelief that we can understand the world as an expres-sion of conscious experience, and/or as a series ofhidden social structures. Instead, they argue for amuch greater recognition of the complexity, diversityand multiplicity of human connectedness, and the end-less transition, or “becoming” rather than the “being”that animates our subjectivities. Postmodernism pro-blematizes the way we think about persons as separate,stable and self-contained “individuals” that movethrough the world in parallel with other individuals,things and ideas. They propose that all elements of theworld are profoundly connected and move in and outof various temporary “assemblages” of human and non-human elements. Assemblages are temporary, fluid,and mobile connections.

Assemblages are everywhere in physiotherapy. Forexample, a type of assemblage is formed between abody and a prosthetic leg (body-prosthesis). A phy-siotherapist may be helping to enable this assemblageto function and in doing so becomes part of it (body-prosthesis-PT). None of these elements are howeverpermanently connected, and each element on its ownis another assemblage that could have been named indifferent ways. For example, the physiotherapist is aparticular assemblage of body-knowledge-techniquesthat forms different assemblages with other bodiesand technologies in other contexts (e.g. as a parent,reader, or cyclist). Similarly the “patient” is connectedin multiple other ways to other bodies, technologies,social roles, and places. Each body-subject is continu-ally in flux. An obvious example is the interchangea-bilty of the prosthetic-body that may include different

legs for walking or rock climbing. The elements in theassemblage come together and then break apart to formother assemblages that do different things in the world,each of which has its own functions and effects.

Turning conventional thinking about the primacy ofhuman subjectivity on its head, Gilles Deleuze and FélixGuattari, who along with Michel Foucault, JacquesDerrida and Jean-François Lyotard represent the mostprominent postmodernists of the last 50 years use themetaphor of machinery to explain how humans formassemblages with other entities; “You have constructedyour own little machine, ready when needed to beplugged into other collective machines” (Deleuze andGuattari, 1987, p. 151). In a move typical of postmo-dernism, Deleuze and Guattari challenge our beliefsthat it is our consciousness and social relations thatset us apart from other sensate and insensate beings,preferring instead to place humans on the same registeras plants and animals, manufactured objects and allother entities. In doing so, they destabilize our deepestassumptions about where the body begins and ends, thedivision between mind and body, and what constitutesa person in relation to the world. Bodies and personsbecome irreducibly connected to the world, not dis-tinct, rationally conscious and superior.

Postmodernists do not share the view, held by phi-losophers since the Enlightenment that human con-sciousness sets us apart from others and the worldaround us. Nor do they agree that we can understandpeople by interrogating the systems and structures thatgovern their actions. Postmodernists believe that allentities form assemblages with other entities, and thatthese are alike. A rock forms an assemblage with thesun when it absorbs and then gives off its heat, in thesame way as my hand forms an assemblage with aclient/patient’s skin when I practice massage.Assemblages, then, are the stuff of everyday life.Everything we “do” is an act of assemblage. But cru-cially, where some would look to make artificial nor-malizing judgments about certain kinds of assemblage,postmodernists resist these moral judgments.

Assemblages reveal the profound connectedness thatcharacterizes human existence, recasting “dependence”as neither “good” nor “bad” but unavoidably present.The task for physiotherapists thus moves away fromfacilitating independence to enabling fruitful connec-tions. If we return to the example of the body-prosthe-sis assemblage, the physiotherapist works towardenabling different dependencies that work or not indifferent contexts. This may include the abandonmentof the prostheses in some contexts where crutches or awheelchair are better options. The goal is not indepen-dence but enabling connectivities with the body-

PHYSIOTHERAPY THEORY AND PRACTICE 7

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

prosthesis as one of many possible fluid assemblagesthat can support human flourishing. In such a scenario,wheelchair “dependency” would not necessarily be seenas a poorer outcome compared to walking but rather asanother, morally neutral, way of being and doing in theworld that works or not for individuals in the contextof their lives.

Discussion

Connectivity is a broad term increasingly being used inthe health literature and elsewhere to refer to intersub-jectivity, connectedness and assemblage. Some philoso-phies retain the individual’s pre-eminence(phenomenology, existentialism, and realism), othersprivilege the social structures and systems that governour conduct (structuralism and symbolic interaction-ism). Still others situate human beings on the sameregister as all other universal entities (postmodernism).Our purpose here is not to promote one philosophicalposition over another, but rather to present some of thecommon principles of connectivity to physiotherapistsbecause it is our belief that it holds some distinct possi-bilities for profound change in the nature of our practice.

Physiotherapy remains closely anchored to thepowerful discourse of positivism that is the hallmarkof biomedicine, and this affords many privileges to theprofession. But, this discourse also forces physiothera-pists to accept certain dogmas that sometimes clashwith the real-world experiences of their practice andchallenges how they view their work with clients/patients and communities. For example, many phy-siotherapy clinical and research practices rely on adeeply held principle of independence; the notion thatquality of life is necessarily related to the degree ofassistance one requires. These assumptions are builtinto measures of function and quality of life that ratepeople according to their needs for human or technicalassistance, and trigger interventions to amelioratedependencies. Connectivity rejects the assumptionthat dependency reduces the quality of life because itasserts that everyone and everything is unavoidablyconnected. Such notions challenge preconceived ideasof right and proper lives and the pursuit of autonomy(Gibson, 2006). Instead, recognition of the intimateconnections between everything; places, people, ideas,nature, and technologies provides a way to shift prac-tices away from enabling independence to assessingpossibilities for connecting in new and varied ways(Gibson, 2006; Gibson, 2014).

Ironically, this is very much the direction being takenby governments and policy-makers who have long sincerealized that it is only through collaboration and

partnership that we canmake progress in the 21st century.The old days of “the doctor knows best” are long sincebehind us. There aremoves withinmany developed coun-tries to shift the power base of health professionals, toenable clients/patients to be in control of the services thatthey access through increased “lay” representation, theacknowledgement of the expert client/patient, and thegrowth of qualitative “user-centred” research, for example(Foot et al, 2014). The aim is to improve health and well-being by enhancing the quality of relationships betweencommunities and the professionals that they connectwith, in the hope that this helps them to achieve outcomesthat are most meaningful to them. In many ways, this isthe message of primary health care and underpins manyof the structural shifts that are taking place in the organi-zation of care; moving services closer to communities,away from specialist centers (where physiotherapistshave traditionally congregated), the growth of personalhealth budgets, and developing better locality-based ser-vices (Forder et al, 2012; The Health Foundation, 2010).

Connectivity-oriented physiotherapy practiceswould operate differently to current ideas of best prac-tice. Beginning with the education of graduates, thefocus would be on the practitioner’s ability to examinethe various assemblages utilized by persons seekingtreatment; asking how these assemblages enable or dis-able them; how they enhance a person’s ability and inwhat ways might they further restrict their meaningfulactivities; what possibilities they open up, and what dothey foreclose. The physiotherapist would work withothers, including the family-assemblage, to discoverwhat connections are possible and their various effects.The key question, “what does this assemblage do?”would be considered broadly. As Timmermans andBerg argued (2003), each of these technologies connectsme to the world of places, people, and things. Forexample, an assemblage of man-wheelchair-woman,wherein a man sitting in a wheelchair is pushed bythe woman, has multiple effects. It may achieve mobi-lity, but it may also be disabling for the woman who isnot free to make other connections and achieve othertasks. Moreover, in some contexts the assemblage maylimit the man’s mobility if the woman is not availableor the space is inaccessible. At the same time, there maybe other social effects including discrimination andexclusion of the wheelchair-body.

Critically, independence is not the goal in this sce-nario, rather practice is oriented to collaboratively iden-tifying alternative enabling dependencies. These mightinclude bodily-interventions aimed at increasing theman’s abilities; traditional physical therapies directedat increasing strength, or balance, or coordination, forexample. Or the therapy may involve introducing a

8 D. A. NICHOLLS ET AL.

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

powered wheelchair or identifying others to push thechair. None of these possibilities are considered a prioripreferable to the others, nor is there a need to chooseamong them. Instead multiple connections are triedout, adjusted and modified over time (Winance,2006). One collective machine is plugged into anotherto open doors for activity, movement, and meaningfulengagement in the world.

In many ways, physiotherapists have been practicingconnectivity for years, since assemblages have beenoccurring spontaneously at every therapeutic encoun-ter. Biomedicine has been a powerfully dominant con-straint on our thinking here and some would say it hasimposed unnecessary and increasingly limiting dogmaon what might be possible in the future. As phy-siotherapists, we have established ourselves as havinga particular expertise in managing movement dysfunc-tion; specializing in the use of objectivity, logic andreason to define normal and abnormal (dysfunctional).This has become a basis for our professional status,enabling us to “defend and demarcate the territory ofphysiotherapy as a valued profession in contemporaryhealth care” (Shaw and DeForge, 2012, p. 420). Whatmight be gained if we overturned our long history ofvalorizing independence, and moved instead to privi-lege connections and enabling dependencies? Whatmight we achieve if we dispensed with normalizationand the language of pathology and deficit (Renshaw,Choo, and Emerald, 2014), and embraced diversity andinclusiveness? What might be the response if we prior-itized assemblages with other people and communities?

Connectivity offers a number of interesting possibi-lities for physiotherapists. Firstly, it is concerned withpeople’s “doing” in the world, and therefore capitalizeson people’s functional capacities (Gibson, 2014).Secondly, it challenges the traditional distinctionbetween healthy and sick, able-bodied and disabled, soallows physiotherapists to apply their knowledge andskills to the whole population, not just those diagnosedwith an existing pathology. Thirdly, it resonates withmany of the modern approaches to person-centeredcare and shared care, and so reflects the profession’sneed to adapt to the changing economy of health care.And finally, it is a practical concept that incorporatesqualitative and quantitative dimensions, and supports awide range of approaches to research. It is as BarbaraGibson states “an active potential for connecting acrossmultiple dimensions” (Gibson, 2006, p. 2).

The idea of connectivity is not unquestionably betterthan what it purports to challenge or replace. It is avery different approach to health-care practice and onethat rejects many of the assumptions offered by biome-dicine, and so there will naturally be some things lost in

moving away from a medical model and toward a moreconnected view of health. Many people, for example,have absorbed the long history of biomedical discourseand will find it hard to relinquish what they understandabout the body, movement, function, and activity. Ithas also given orthodox health professionals significantmarket advantage, lent them social status, professionallegitimacy and power, and so some physiotherapistswill be understandably reticent about changing some-thing that has been to their advantage for so long. Someclients/patients may also find a shift difficult. For manypeople the desire to be cured, rehabilitated, or returnedto “normal” is very strong, and there are many timeswhen people prefer to be passive in the face of over-whelming pain or illness. These powerful discoursesremind us that connectivity is not necessarily “better”than biomedicine, but could work in harmony withmore tradiational biomedical approaches. It is merelyanother way to view health, but one that offers realpossibilities for the 21st century.

These are clearly early days for this discussion,and the topic of connectivity is only beginning tofind purchase within health care. At the momentbiomedicine holds sway in the western world and itis unlikely to be subverted by a radically new idealike connectivity. Powerful discourses like the socialmodel of health have been important in challengingthe dominant model of biomedicine, but theseapproaches still rely on the idea that there is devia-tion from the norm. Connectivity fundamentallychallenges this assumption, arguing that these nor-mative judgments need to be replaced with a philo-sophy that is less arbitrary, discriminatory andstigmatizing. Connectivity offers a possible way for-ward because it emphasizes the principle that weexist in connection with other entities in the world,and these things examine our subjectivity in newways that may overcome some of the limitations ofexisting thinking and practice.

What is particularly exciting about connectivity forphysiotherapists is that there is a clear role for us inhelping people find ways to engage meaningfully in theworld. Using our existing knowledge of the body, ourability to understand people’s needs and desires, andassess their physical engagement in the world, phy-siotherapists could be the profession, par excellence,to take the idea of connectivity forward. The world ofhealth care is clearly changing, and people are demand-ing more from their health service than biomedicinealone can provide. Connectivity offers some contem-porary responses to this challenge, grounded in a longhistory of ideas related to intersubjectivity, enablingdependence and assemblage.

PHYSIOTHERAPY THEORY AND PRACTICE 9

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

Conclusion

In this paper, we have explored the newly emergingfield of connectivity. Having established a rationalefor considering connectivity in physiotherapy, weexamined how the concept had been represented infour overlapping philosophies: (1) phenomenology;(2) symbolic interactionism; (3) structuralism; and(4) postmodernism. We argue in this paper thatconnectivity offers some innovative and contempor-ary approaches to health care that offer physiothera-pists the opportunity to challenge their establishedways of thinking and practicing, and align the pro-fession better with the changing economy of healthcare in the 21st century.

Declaration of interests

The authors report no conflicts of interest. The authors aloneare responsible for the content and writing of the article.

Notes

1. We have used the generic term clients/patients through-out the text as a convenient device to refer to our clients,consumers, patients and service users. We are aware thateach term carries particularly loaded meaning, but it isnot our purpose to debate these here. For a discussion ofissues of naming, see McLaughlin (2009).

2. We have used the term “disabled people” in preferenceto “people with disability” throughout the text to bereflect the convention within the disability rights sec-tor, which argues that people are disabled by physicalenvironments and entrenched social attitudes ratherthan by the presence of an impairment (Hughes, 2007).

References

Abram D 1996 Sansenes magi – Å se mer enn du ser (TheSpell of the Sensuous – Perception and Language in aMore-than-Human World). Oslo, Flux Forlag, p. 54.

Abrams T 2014 Flawed by Dasein? Phenomenology, ethno-methodology, and the personal experience of physiother-apy. Human Studies 37: 431–446.

Aguilar A, Stupans I, Scutter S, King S 2013 Exploring theprofessional values of Australian physiotherapists.Physiotherapy Research International 18: 27–36.

Bauman Z 2000 Liquid Modernity. Cambridge, Polity Press.Bjorbaekmo WS, Engelsrud GH 2011 “My own way of mov-

ing” – Movement improvisation in children’s rehabilita-tion. Phenomenology and Practice 5: 27–47.

Blumer H 1980 Mead and Blumer: The convergent metho-dological perspectives of social behaviorism and symbolicinteractionism. American Sociological Review 45: 409–419.

Blumer H 1986 Symbolic Interactionism: Perspective andMethod. Berkeley, University of California Press.

Bullington J 2009a Being body: The dignity of human embo-diment. In: Nordenfelt L (ed) Dignity in Care for OlderPeople, pp 54–76. Chichester, Wiley-Blackwell.

Bullington J 2009b Embodiment and chronic pain:Implications for rehabilitation practice. Health CareAnalysis 17: 100–109.

Bullington J 2013 The Expression of the Psychosomatic Bodyfrom a Phenomenological Perspective. Dortrecht, Springer.

Bury M 1998 Postmodernity and health. In: Scrambler G andHiggs P (eds) Modernity, Medicine and Health: MedicalSociology Towards 2000, pp 1–28. Abingdon, Routledge.

Bury M, Gabe J 2013 The Sociology of Health: A Reader.Abingdon, Routledge.

Clarke AE, Shim J 2011 Medicalization and biomedicalizationrevisited: Technoscience and transformations of health,illness and American medicine. In: Pescosolido BA,Martin JK, McLeod JD, Rogers A (eds) Handbook of theSociology of Health, Illness, and Healing, pp 173–199.London, Springer.

Clarke A 2010 The Sociology of Healthcare. Abingdon,Routledge.

Cooper C 2010 Can a fat woman call herself disabled?Disability and Society 12: 31–42.

Crooks KR, Sanjayan M 2006 Connectivity Conservation.Cambridge, Cambridge University Press.

Crotty M 1998 The Foundations of Social Research: Meaningand Perspective in the Research Process. London, Sage.

Cuff EC, Sharrock WW, Dennis AJ, Francis DW 2006Perspectives in Sociology, p. 127. Abingdon, Routledge.

DeLanda M 2006 A New Philosophy of Society: AssemblageTheory and Social Complexity. New York, Continuum.

Deleuze G 1992 Postscript on the societies of control.October 59(Winter): 3–7.

Deleuze G, Guattari F 1987 A Thousand Plateaus —Capitalism and Schizophrenia. Minneapolis, University ofMinnesota Press.

Denzin NK 1969 Symbolic interactionism and ethnometho-dology: A proposed synthesis. American SociologicalReview 34: 922–934.

Featherstone M, Hepworth M 1991 The mask of aging andthe postmodern lifecourse. In: Turner BS (ed) The body:Social processes and cultural theory, pp 371–389. London,Sage.

Foot C, Gilburt H, Dunn P, Jabbal J, Seale Goodrich J, Buck D,Taylor J 2014 People in Control of their Own Health andCare: The state of Involvement. London, The King’s Fund.

Fox N 1999 Beyond health: Postmodernism and embodi-ment. London, Free Association Books.

Freidson E 2001 Professionalism – The third logic. Chicago,Chicago University Press.

Forder K, Glendinning C, Caiels J, Welch E, Baxter K,Davidson J, Windle K, Irvine A, Dolan D, King P 2012Evaluation of the Personal Health Budget PilotProgramme. London, Department of Health.

Gibson BE 2006 Disability, connectivity and transgressing theautonomous body. Journal of Medical Humanities 27:187–196.

Gibson BE 2014 Parallels and problems of normalization inrehabilitation and universal design: Enabling connectiv-ities. Disability and Rehabilitation 36: 1328–1333.

Groven KS, Engelsrud G 2013 Allowing one’s own bodilyexperience to “count”: Elaborating on inter-subjectivity

10 D. A. NICHOLLS ET AL.

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

and subjectivity in phenomenological studies. Journal ofEducation and Research 3: 24–40.

Handberg C, Thorne S, Midtgaard J, Nielsen CV, Lomborg K2015 Revisiting symbolic interactionism as a theoreticalframework beyond the grounded theory tradition.Qualitative Health Research 25: 1023–1032.

Haraway D 2006 A cyborg manifesto: Science, technology,and socialist-feminism in the late 20th century. In: Weiss J,Nolan J, Hunsinger J, Trifonas PP (eds)) The internationalhandbook of virtual learning environments, pp 117–158.London, Springer.

Hawthorne S, Klein R 1999 Cyberfeminism: Connectivity,critique and creativity. North Melbourne, Spinifex Press.

Hughes B 2007 Being disabled: Towards a critical socialontology for disability studies. Disability and Society 22:673–684.

Hughes B, Paterson K 2010 The social model of disability andthe disappearing body: Towards a sociology of impair-ment. Disability and Society 12: 325–340.

Hutcheon E, Wolbring G 2013 “Cripping” resilience:Contributions from disability studies to resilience theory.M/C Journal 16: 5.

Keshet Y 2009 The untenable boundaries of biomedicalknowledge: Epistemologies and rhetoric strategies in thedebate over evaluating complementary and alternativemedicine. Health 13: 131–155.

Laszlo E 2003 The Connectivity Hypothesis: Foundations ofan Integral Science of Quantum, Cosmos, Life, andConsciousness. Albany, State University of New YorkPress.

Latour B 2005 Reassembling the Social: An Introduction toActor-Network-Theory. Oxford, Oxford University Press.

Lupton D 2012 Medicine as culture: Illness, disease and thebody in Western society. London, Sage.

Lupton D, McLean J 1998 Representing doctors: Discoursesand images in the Australian press. Social Science andMedicine 46: 947–958.

Marmot M, Friel S, Bell R, Houweling TA, Taylor S 2008Closing the gap in a generation: Health equity throughaction on the social determinants of health. Lancet 372:1661–1669.

McLaughlin H 2009 What’s in a name: ‘Client’, ‘patient’,‘customer’, ‘consumer’, ‘expert by experience’, ‘serviceuser’-what’s next? British Journal of Social Work 39:1101–1117.

McRuer R 2002 Critical investments: AIDS, ChristopherReeve, and queer/disability studies. Journal of MedicalHumanities 23: 221–237.

McRuer R 2003. As good as it gets: Queer theory and criticaldisability. GLQ: A Journal of Lesbian and Gay Studies 9:79–105.

McRuer R 2013 Compulsory able-bodiedness and queer/dis-abled existence. In Davis LJ (ed) The Disability StudiesReader, pp. 369–380. Abingdon, Oxon, Routledge.

Mead GH, Morris CW 1934 Mind, self and society from thestandpoint of a social behaviorist. Chicago, University ofChicago Press.

Merleau-Ponty M 2002 Phenomenology of perception, 5thedn. Translated by Landes DA. Abingdon, Routledge.

Mills CW 2000 The sociological imagination, p. 15. Oxford,Oxford University Press.

Mol A 2002 The body multiple: Ontology in medical practice.Durham, Duke University Press.

Morrall P 2009 Sociology and health: An introduction.Abingdon, Routledge.

Nettleton S 2005 The sociology of the body. In: CockerhamWC (ed) The Blackwell Companion to Medical Sociology,pp 43–63. London, Blackwell.

Nicholls DA, Gibson BE 2010 The body and physiotherapy.Physiotherapy Theory and Practice 26: 497–509.

Owens J 2015 Exploring the critiques of the social model ofdisability: The transformative possibility of Arendt’snotion of power. Sociology of Health and Illness 37: 385–403.

Petersen A, Bunton R 1997 Foucault, health and medicine.Abingdon, Routledge.

Praestegaard J, Gard G, Glasdam S 2014 Physiotherapy as adisciplinary institution in modern society – A Foucauldianperspective on physiotherapy in Danish private practice.Physiotherapy Theory and Practice 31: 17–28.

Renshaw P, Choo J, Emerald E 2014 Diverse disability iden-tities: The accomplishment of ‘child with a disability’ ineveryday interaction between parents and teachers.International Journal of Educational Research 63: 47–58.

Schoeb V, Rau B, Nast I, Schmid S, Barbero M, Tal A, Kool J2014 How do patients, politicians, physiotherapists andother health professionals view physiotherapy research inSwitzerland? A qualitative study. Physiotherapy ResearchInternational 19: 79–92.

Scotch RK 1989 Politics and policy in the history of thedisability rights movement. The Milbank Quarterly 67:380–400.

Scott S, Morgan D 2004 Body matters: Essays on the sociol-ogy of the body. London, Falmer Press.

Shaw JA, Connelly DM 2012 Phenomenology and phy-siotherapy: Meaning in research and practice. PhysicalTherapy Reviews 17: 398–408.

Shaw JA, DeForge RT 2012 Physiotherapy as bricolage:Theorizing expert practice. Physiotherapy Theory andPractice 28: 420–427.

Shildrick M 1997 Leaky bodies and boundaries: Feminism,postmodernism and (bio)ethics. Abingdon, Routledge.

Shilling C 2012 The body and social theory. London, Sage.Shusterman R 2005 The silent, limping body of philosophy.

In: Carman T, Hansen MB, Boris M, Hansen N (eds) TheCambridge Companion to Merleau-Ponty, pp 151–180.Cambridge, Cambridge University Press.

Shuttleworth R, Meekosha H 2013 The sociological imaginaryand disability enquiry in late modernity. Critical Sociology39: 349–367.

Slatman J 2014 Multiple dimensions of embodiment in med-ical practices. Medicine, Health Care, and Philosophy 17:549–557.

Standal F, Engelsrud G 2013 Researching embodiment inmovement contexts: A phenomenological approach.Sport, Education and Society 18: 154–166.

Stromquist NP 2002 Education in a globalized world: Theconnectivity of economic power, Technology, andKnowledge. Lanham, Rowman & Littlefield.

The Health Foundation 2010 Improvement in Practice: ThePersonal Touch – The Dutch Experience of PersonalHealth Budgets. London, The Health Foundation.

PHYSIOTHERAPY THEORY AND PRACTICE 11

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16

Timmermans S, Berg M 2003 The practice of medical tech-nology. Sociology of Health and Illness 25: 97–114.

Turner BS 2008 The body and society: Explorations in socialtheory. London, Sage.

Unhelkar B 2009 Handbook of research in mobile business:Technical, methodological, and social perspectives.Hershey, Information Science Reference.

Van Dijck J 2013 The culture of connectivity: A criticalhistory of social media. Oxford, Oxford University Press.

WebbW 2007Wireless communications the future. Chichester,John Wiley.

Wikström-Grotell C, Broberg C, Ahonen S, Eriksson K 2013From Ling to the academic era – An analysis of the historyof ideas in PT from a Nordic perspective. EuropeanJournal of Physiotherapy 15: 168–180.

Wikström-Grotell C, Eriksson K 2012 Movement as abasic concept in physiotherapy – A human scienceapproach. Physiotherapy Theory and Practice 28: 428–438.

Winance M 2006 Trying out the wheelchair: The mutualshaping of people and devices through adjustment.Science, Technology and Human Values 31: 52–72.

12 D. A. NICHOLLS ET AL.

Dow

nloa

ded

by [

Auc

klan

d U

nive

rsity

of

Tec

hnol

ogy]

at 1

4:13

07

Apr

il 20

16