To work or not to work? The occupational trajectories of wheelchair users

Abstract

Purpose. To throw light upon the dynamic processes which may or may not lead persons with severe motor disability to employment.

Method. A qualitative approach to the chronology of both the professional and non-professional occupations of wheelchair users between acquisition of the disability and the interview; this approach focuses upon actions and meanings, thus allowing the authors to identify the diverse factors which help build the occupation situation at the time of the study. The narratives of 36 wheelchair users of working age were used. The objective of the analysis was to reconstitute the occupation trajectories of the participants and hence to suggest a typology. This involved pinpointing the various actors, the external and cognitive contexts of their decisions and actions, and their consequences and related feelings.

Results. The wide diversity found in the trajectories forced the authors to go beyond any simple notion of ‘work versus non-work’ and to focus on the quality of the individual's process of occupation appropriation. Indeed, it is possible to successfully appropriate both work and non-work situations, just as, inversely, it is possible for a person to fail to appropriate either type of situation. Analysis of this process allows one to pinpoint different types of trajectory. On the one hand, trajectories within which people appropriate their occupations – gradual, intermittent, through rupture and successive adjustment – and, on the other hand, unstable or endured occupation trajectories.

Conclusions. The findings suggest that with regard to rehabilitation practices, we should be focussing as much on the appropriation process as on return to work.

Keywords:

• Disability
• return-to-work
• rehabilitation
• occupation trajectories

Notes

1. ‘Disability, Incapacity, Dependence’ survey (1999) by the Institut National de Statistique et des Etudes Economiques, on a population of approximately 17,000 persons living at home, and representative of the French population. Tétrafigap study (1995) on the long-term outcome of tetraplegic cord injured persons, carried out on 1668 persons under the aegis of the AFIGAP (Association Francophone Internationale des Groupes d'Animation de la Paraplégie).

2. Another field of research, which we will not go into here, studied the return to work on the basis of job characteristics (type of job, the work market, employer attitudes, etc.).

3. For information, the Minimum Wage for a full-time job in France is 1154 euros per month. Although this may seem high, the level of benefits remains insufficient for people who are highly dependent and who have to pay for a helper. We are therefore aware of the relative nature of the work/not work alternative and of the disparities that exist between individuals due to the different benefit systems in operation.

4. Sheltered work in an institution.

5. A bank holiday to celebrate the ‘Fête du Travail’ (literally the ‘work holiday’).

6. We must remember that the study of occupation trajectories begins after the disability has been acquired. When we speak of the initial situation or project, we are referring to the first since the person became disabled.

7. Two exceptions should be noted: Gilles, who immediately chose to become involved in sport at competition level, and Paul, who decided to make a career change.

8. Commission Technique d'Orientation et de Reclassement Professionnel = technical commissions for professional orientation and retraining.

9. Vocational retraining and follow-up unit.