On the character and production of 'active participation' in neuro-rehabilitation: an Actor-Network perspective.

Abstract

The importance of patients' active involvement in neuro-rehabilitation after acquired brain injury has been consistently emphasised in recent years. However, most approaches fail to show how 'active participation' is practically enacted, focusing on individualised explanations of patient choice and behaviours, or notions of inherent patient traits. Using actor-network theory (ANT) as a sensitising concept, we investigated neuro-rehabilitation practices, asking how participation is shaped through biological and socio-material specificities, how rights to knowledge and expertise are constructed, and how a body acclimatises and adjusts within an order of participation and transformation. We analysed video-recorded fieldwork extracts, examining the work of adjusting, testing and transforming; the construction of competence and incompetence; and material and social processes involved in the division of the body and its re-composition. Our findings show how an ANT-sensitised approach provides a critical understanding and context-specific characterisation of 'active participation', produced through the association of heterogeneous actors at any one time. Such specificity and the distribution of work suggest that efforts to account for optimum therapy 'dosages', and clinical attention to establishing individually-located levels of 'self-efficacy' or 'motivation' are misdirected. The performance of 'active participation', rather, should be re-imagined as a product of diverse, mutually attuned entities. A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA.