Everyday Tragedies: People with Severe Traumatic Brain Injury in the Liminal Spaces of a Level I Trauma Centre

Sustaining a severe traumatic brain injury (sTBI) can have a devastating and permanent impact on a person’s ability to function, on their selfhood, on their families, and on the spaces where they can exist in the world. Individuals with sTBI in Ontario are often transported to Level I Trauma Centres, as textually mediated by the provincial Life or Limb Policy, to ensure access to expert lifesaving medical care. After entering these trauma centres, transitions across the spaces of the trauma centre, from critical care to intensive care to a trauma ward, can signify recovery through decreased reliance on medical technology and medical care. Rehabilitation is required as individuals with sTBI become medically stable to ensure further improvement. This rehabilitation is needed to prepare these individuals to move to other healthcare spaces, such as inpatient rehabilitation, repatriation hospitals, or to return home. Textually mediated institutional relations through the Ministry of Health and Long-Term Care (MOHLTC), specifically the Acquired Brain Injury (ABI) Resource Rehab Tool, ignite sites of struggle in the provision of rehabilitation for individuals with sTBI. These sites of struggles reveal ruling relations that remain hidden until the institution is brought into view using an empirical method of inquiry, institutional ethnography. Specific methods in this dissertation included: participant observation, interviews, a focus group, and analysis of texts. Findings of this study suggest language in the ABI Resource Rehab Tool, specifically the discursive organizer “rehab ready” cleaves individuals with sTBI into two groups: (1) those with faster recoveries able to gain access to inpatient rehabilitation, and (2) those with slower recoveries who do not meet these restrictive guidelines and become unaccounted for in healthcare spaces, with limited options for rehabilitation. Trauma centres are medicalized spaces, whereby provincial funding is distributed on the basis of medical procedures, not rehabilitation. One notable contradiction in funding is revealed for individuals with stroke, who access beds for rehabilitation in acute care and other initiatives outlined by the provincial stroke strategy. No such provincial strategy exists for individuals with sTBI, leaving these individuals marginalized through more limited access to rehabilitation within the healthcare continuum.

Department dc:contributor.department

Rehabilitation Science

Year dc:date.issued

2019

Author dc:creator

• Rutledge, Lynn Margaret

Advisors dc:contributor.advisor

• Rappolt, Susan G
• Bisaillon, Laura

• institutional ethnography
• liminality
• qualitative research
• rehabilitation
• social relations
• traumatic brain injury

Handle dc:identifier.uri

http://hdl.handle.net/1807/97048

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/97048