Biomedical Engineering Reference
In-Depth Information
ATA process is to “address, in a specific context of use, the personal
well-being
of the user
through the best
matching
of user/client and assistive solution” by means of “clinical mea-
sures, functional analysis, and psycho-socio-environmental evaluations” (see Conclusions,
Section I, this volume.).
2.1.1.2
From the Measures to the Purposes (Well-Being), From the
Purposes to the Measurers (Multidisciplinary Team)
This statement indicates two orders of questions that need to be addressed: (1) the nature of
the “well-being” concept and measurement, and (2) how to “team up” professionals at the
center for technical aid. With regard to 1, it is plain that the nature of the well-being variable
is merely subjective; in fact, it “measures 'what people say' rather than 'what people do'. It is
true that self-reported well-being has potential shortcomings such as response bias, memory
bias and defensiveness” (Uppal 2006, p. 525). Nevertheless, “subjective data have proved to be
stable and useful” (Uppal 2006, p. 525) and “there is increasing acceptance of patient-reported
outcomes for those constructs where one's subjective reality cannot be objectified (e.g., feel-
ings, pain, energy levels, perceived health and so on)” (Kayes and McPherson 2010, p. 1011).
As part of this discussion it is important to point out that, even today, both in the literature
and in the different classifications of disability that have succeeded over time, there is no
space for the inner world of the individual. In particular, a few authors have focused on the
difference between the objective and the subjective dimensions of functioning and disability.
For example, if people cannot play golf because of impairment (capacity limitation
within activity limitation) or because of environmental obstacles (participation restric-
tion), the MEANING of that fact will be quite different from person to person. For a
life-long regular golfer it would be disast[e]rous, but for a person, otherwise similar,
who has never played it, the fact itself that he is not playing golf would not be essen-
tial. It follows that evaluation of meaning or satisfaction (which are both subjective) of
the objective activity or participation is indispensable especially for items other than
common basic survival needs. (Ueda and Okawa 2003, p. 598)
But what is the subjective experience of functioning and disability? Ueda and Okawa
define it as
a set of cognitive, emotional and motivational states of mind of any person, but
particularly of a person with health condition and/or disability. It is a unique combina-
tion of, on one hand, a disability experience, i.e. a reflection (influence) of existing health
conditions, impairments, activity limitations, participation restrictions and negative
environmental factors (obstacles) into the person's mind (negative subjective experi-
ence), and on the other hand an experience of a positive nature, which includes, among
other things, the psychological coping skills developed, often unconsciously, in order to
overcome these negative influences (positive subjective experience). (2003, p. 599)
The assessment of a subjective experience is a focal point in identifying the best assistive
solution for a given user/client, and its misunderstanding or underestimation has a major
role in abandonment (Elliott et al. 2002). It must also be highlighted that the subjective
dimension of functioning and disability does not coincide with the objective dimension,
i.e., that one currently coded by ICF. The relationship between the subjective and objec-
tive dimensions of functioning and disability is interactive and bidirectional. However,
the two dimensions are relatively independent of each other. At present, although it is
not possible to introduce a comprehensive codification of subjective experience, this
