Welcome back to the Healing Pain Podcast with Winston Kennedy, PT, DPT, PhD
Despite the continued advancements in healthcare, pressing issues still make access to care difficult, especially for those with disabilities. There are still barriers that we need to remove to make our systems more inclusive. Tackling the important topic of disability, inclusion, and justice, Dr. Joe Tatta interviews Winston Kennedy, PT, DPT, PhD. Dr. Kennedy is a physical therapist who holds a Master’s degree in Public Health as well as a PhD in Kinesiology with a concentration on Adapted Physical Activity. He has been a strong advocate for the health and well-being of people with disabilities and their intersecting identities. In this episode, he dives deep into the value of bringing these conversations to light so we can have a better understanding of disability and translate that into how healthcare providers can better support these clients. Dr. Kennedy also dives deep into the intersectionality of disability, justice, and inclusion, letting us see disability from a cultural lens and the way our care impacts someone’s social identity. Take part in this great conversation and help raise awareness on these important issues.
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Disability, Inclusion & Justice: Why Do We Need To Talk About This? With Winston Kennedy, PT, DPT, PhD
In this episode, we’re discussing the intersection of disability justice and inclusion. This episode is number 310. I want to thank all of you who have followed along for the continuing weeks, months, and years with the show. If you like what you read or enjoy our guests, make sure to hop on over to iTunes to give us a five-star review. Share this episode with your friends and family. That helps us reach more people and deliver a message of hope and healing for the millions of people with chronic pain and disability.
My guest is Dr. Winston Kennedy. Dr. Kennedy is a physical therapist and also holds a Master’s degree in Public Health as well as a PhD in Kinesiology with a concentration on Adapted Physical Activity. Dr. Kennedy is a Postdoctoral Fellow at the University of Massachusetts Chan Medical School where he’s committed to conducting research that supports the health and well-being of people with disabilities and their intersecting identities.
Some of his research includes how physical activity interventions accommodate youth with psychiatric and intellectual developmental disabilities. Dr. Kennedy is also interested in understanding and ultimately influencing healthcare professional curricula in order to train health professionals to work with and better support people with disabilities.
In this episode, we discuss disability justice and inclusion and what it has to do with physical therapy, how we should conceptualize or re-conceptualize disability, what healthcare providers can do to support clients with disabilities, both in and outside of the clinical practice setting, and the topic of intersectionality and how it relates to disability justice. Without further ado, let’s begin and meet Dr. Winston Kennedy.
Winston, welcome. It’s great to have you on.
I am happy to be a part of the show.
I’m excited to talk to you. People read your bio so they have a flavor of the things you’re about. When you start to dig into your DBT education, your Master’s in Public Health, and how you’re pursuing some post-doctoral work and teaching, you have a large body of work that’s pointing toward disability advocacy and social justice, which is not common in physical therapy. It’s great to speak with someone about these topics that are growing. They’re more in our awareness, but we want to raise more awareness around it. Tell me how you got started in this.
It started when I was working in the clinic. I graduated in 2015. From 2015 to about 2017, I was working full-time. I worked hospital outpatient for a lot of that time. I had patients who had chronic neurological disorders. They were asking me, “I wanted to be more physically active outside of rehab,” and I had no answer for them. They had a couple of places, but they cost a lot and there were some barriers, so I wanted to investigate how we can be better at this.
That led me to get a PhD in Kinesiology at Oregon State University. The concentration of the program was Adapted Physical Activity. The emphasis was on providing access to physical activity across the lifespan for people with disabilities. That’s what got me grounded in disability studies, public health, and health promotion. It started snowballing from there. I was like, “This is great information. This would be great to have in physical therapy.” That’s when I started trying to build that bridge of thinking about disability less in a medical context and more in a cultural context. There is room for both. That’s how I got rolling.
Explain that to us. It is looking at disability as a medical condition, so to speak, or looking at disability as a social construct, if I heard you correctly. Is that right?
It is more like a dimension of culture from a cultural lens.
Tell us about that.
In PT, we learn about how to treat the individual. They usually come with a medical diagnosis. PTs don’t treat medical diagnoses, but when we hear those diagnoses, it gives us a picture in our minds. That’s the unofficial way we go about treating some of our patients. It overemphasizes that medical aspect, and then that leads you to start talking about limitations and deficits. There’s an emphasis on what someone can’t do.
When you shift to that cultural perspective, it’s looking at disability as more of an identity of the individual. You’re not so focused on their limitations. You are more focused on who this individual is and what they want to get from coming to you as a physical therapist. That’s so different. It can impact how you go about implementing your plan of care.
It is less on the normalizing impairments. Even that word normalizing is probably a little tricky, right?
Yeah. Even the term impairment is also tricky as well because it’s based on a normative standard, like able-bodied individuals like you and me.
The reason why I use normalizing impairments is that the idea that there’s one body type that’s ideal has a lot of challenges and problems that go along with it, especially for the disability community. It is not normalizing impairments, but looking at identities. Identities is an interesting word because that starts to place care a little more in the psychosocial realm. What you’re saying is there may be a change of identity status as someone is going through their rehabilitation process or because of an injury potentially.
For a lot of us, when we have an injury or we come in contact with a disorder or disease, it changes the way we do a lot of things, like how we interact with our physical environment and how we interact with our social environment. For example, even from living with your family, roles change. Maybe your status or role in the family has changed. Dealing with that on top of going to rehabilitation or you probably have medical doctor’s visits, it’s a lot to take in and to do. Always, you should take that into account in PT, but do we always?
The answer is no, right?
Yeah. I would say that. I’m trying to be nice to our profession. We’re coming along.
I’m trying to imagine what this conversation looks like to maybe someone who’s not so aware of the idea of, “I have more skills than just addressing an impairment.” What does that look like? How do I, as a physical therapist, impact someone’s social identity?
A lot of it has to do with being open and letting who you’re working with guide you through that. I’ll be honest. It’s harder than it sounds. Let’s be honest. I’ll be honest. Oftentimes, we don’t always get it right. A lot of our aforementioned beliefs or things we grew up understanding or seeing sometimes, even implicitly, come up.
I believe the biggest thing is keeping an open mind. As physical therapists, we have the tools and the knowledge to implement the plan of care. I also believe we have the tools to adapt our plan of care based on the needs of our patients. Oftentimes, that means instead of me coming up with a goal of you walking 500 feet, it might be the participant telling me, “I need to be able to get out of bed and go to the bathroom. I can use my wheelchair in any other space or for mobility.”
Instead of saying, “We can get you to walk,” or, “We can keep trying to walk,” when my patient says, “I want to be able to walk to the bathroom and I can use my wheelchair,” then we can do that. If that changes, then we can accommodate and change with that. It is to push perspectives from having an able body or even considering what someone used to be able to do and trying to overemphasize you doing it the exact same way that you did before. That’s even from an acute orthopedic injury. Things might have to change. My care might have to change, and that’s okay.
It makes me think there’s a difference between rehabilitation and recovery. Rehabilitation is almost like that older process of, “Here’s what we do to people.” They’re coming into a rehabilitation center and, “Here’s the process that we take you through when you come into our facility.” The person who is interested in recovery, it sounds like you’re saying, is the one who sets the plan.
The person who’s in recovery is leading the plan rather than creating it. It is my primary goal and whether it is possible to, for example, get back to walking. If that’s a stated goal, and as a PT, it’s a possibility, I can support that with no issue. The reverse is, “I want to be able to use my wheelchair in different environments on different surfaces. I would like that to be my primary mode of mobility.” As a PT, I can support that versus, “You used to walk. We want to get you back to walking.”
A lot of it is alignment between my patient and the PT. Even if the patient is not aware of the possibility to walk and you foresee in your prognosis that this is a possibility, I don’t think it’s wrong to say, “We can work towards that.” There may come a time when you say, “We need to also focus on wheelchair mobility or an assisted device in some manner. There is no one better way. The only better way is what’s more comfortable and feasible for you.” There’s a way to do a lot of different things, but it is also being aware of the individual, what they need, and what they’re telling you they want.
A lot of your research focuses on looking at what’s happening within our profession, the profession of physical therapy. What do disability justice and inclusion have to do with physical therapy per se?
It has a lot to do with the advocacy side of what we do. That stems from advocating for assistive devices for our patients and for different services for our patients. Those services can range from trying to help get increased support in the home, returning to work, helping support the need for accommodations at work, and all those things. Outside of a disability justice lens, we might not think that we are as important on the advocacy side because we see our role in the clinic, treating what we need to treat. After a patient gets discharged, it is of out my hands. I might do a follow-up call, but that’s pretty much it.
As PTs, our knowledge and expertise extend beyond that. One, we need to be better at acknowledging that generally, but specifically on the disability justice side because a lot of times, we’re one of the first points of contact. We spend a lot of time in inpatient rehab and skilled nurse facilities. 75 minutes to 90 minutes is about volume. You’re getting to know your patient. They’re telling you all these things. That information gives you the ability to say, “My patient needs this. This is their living situation. This is the support they had. I agree. They’re telling me they need these additional supports, so let’s go out and do it.” That’s even partnering with other professionals like MDs, nurses, case workers, or case managers.
I feel like if you look back on our profession to the ‘60s, ‘70s, and maybe ‘80s, it seemed like there was more of a focus on disabilities within our profession. As we grew and have a lot more outpatient facilities, physical therapy has become a dominant force in the outpatient world. I wonder if that’s changed or if we, as a profession, have changed. I’m wondering where you think we are, as a profession, as far as supporting people with disabilities.
I’m happy you brought that up because I didn’t think about it. We all know outpatient ortho is the dominant setting and specialty in PT. That dominant domain is going to get a lot of visibility and support. That shift might have taken us away from maybe some of the things that we were doing that we’re probably not doing anymore.
As a profession as a whole, we’re starting to realize and get back to the level of awareness that we probably had in the past, but it is a slow grind. The APTA passed a motion supporting physical therapists with disabilities by providing resources and accommodation, which is wonderful, but there wasn’t an action plan behind that. It was lip service to an extent. It stops becoming lip service when there are actionable items afterward.It stops becoming lip service when there are actionable items afterward. Click To Tweet
Supporting physical therapists who themselves have a disability.
That’s a whole other area that we’re starting to begin talking about. Other health professionals are farther ahead than us. We see a lot of work with medical doctors and trying to support medical doctors with disabilities in their professions. It is the same with nursing. There isn’t anything both from a scholarship perspective or professional organizations on the bulk of trying to support our colleagues with disabilities. In 2022, at CSM, you started to see a little bit more of that, but it needs to be more. We don’t know how many PTs with disabilities there are. Another side of that and a big part of the disability justice lens is creating a safe space for you to disclose that. A lot of PTs don’t feel safe disclosing that for a lot of reasons.
When I was at CSM in San Diego, I sat in on a wonderful lecture on disability justice where a physical therapist with disabilities presented. and I’m not sure if you were at that lecture. There were people like the first physical therapist who was blind. It was interesting to hear her story of the accommodations that she did receive and the ones that she did not receive, both in school and in her workplace.
There were other physical therapists there who had some physical disabilities and lost their job because of it. You think to yourself, “How can a physical therapist lose their job because they’re looking for accommodation for a disability?” We’re supposed to be leading the conversation in disability justice. When that happens, it makes me concerned.
Firing someone for a disability is pretty much illegal but I’m sure it’s easy to get around that. Technically, you’re not firing someone because of the disability, but you make up a reason why you’re finding that individual. That’s what’s holding a lot of PTs back from disclosing.
You’ve done some research on looking at a physical therapist’s attitudes and behaviors toward people with disabilities. Can you tell us a little bit about that research?
Yes. One of the first studies I started when I was doing my PhD was looking at the perspectives of physical therapists and occupational therapists regarding their attitudes toward disability. That’s been an area of research that’s been going on for a while since the ‘60s and ‘70s, which was perplexing because we know that unfavorable attitudes impact health outcomes.
Unfavorable attitudes towards disability lead to how you implement your plan of care and how you refer or recommend other treatments if you’re promoting physical activity or not or promoting engaging in recreational activity outside the clinic. That’s a strong research area, and we are not at the forefront of doing anything about it.
I’ve started trying to host continuing education courses, going into PT schools, and talking about disability from more of a psychosocial cultural perspective. The goal is for things like that to be embedded in our curriculum. I don’t think that’s a heavy lift. Occupational therapists do a great job of including that psychosocial and even cultural aspects in how they work. I believe we can do the same.
A lot of it is not even about adjusting the curriculum. A lot of it is honestly adding to what you’re already teaching. In your orthopedics class, you can work with someone who has a disability or an orthopedic injury. Are you being taught how to do that? Probably not. That goes back to how we form those attitudes and perspectives toward disability.
One study I did was I asked a bunch of kinesiology students how they define disability. We know kinesiology students are likely to go on to help in professional positions or physical therapy positions in physical therapy school and such. I was investigating how they see disability gives us an idea of how those perspectives will translate when they go into those health professions.
What we found was that they defined disability as an inherently difficult experience. That was one of the major findings. The issue with that is that’s an assumption you’re making without having the experience or having someone tell you that’s their experience. You’re viewing things like, “If I were in that position, that looks hard and difficult. Things must be, in general, hard and difficult for this group of people.” It is not to say that someone can’t have that experience, but the assumption that’s the experience for everyone is the issue.
They may have a difficult time taking a different perspective at that point in their career.
That can get reinforced in PT school. We have those disabilities simulations where you go in a wheelchair, blindfold yourself, and put on some earmuffs, and then students are like, “This is hard. I couldn’t do this. I sympathize with this population of people. I understand.” What is happening is you’re creating a stigma. You’re saying that an individual who may have been born a certain way or may have acquired a new way of living and you within the 5, 10, or 15 minutes pretending that you have this great idea of what this is like.
It is a stigma in ableism again. A lot of health professionals have been through those disability simulations. I went through one in school. We had to spend a whole day role-playing or picking a disability. I know there’s research that probably shows that that’s not the best way for us to take the perspective of another individual. Someone could be born a certain way and learn how to effectively cope versus you, all of a sudden, let’s say, put a patch over your right eye so it impairs your vision. It doesn’t give you a real sense of what it’s like to live like that over the life course of someone.
In other professions, things are changing and shifting to more of bringing the population of people that you’re going to be working with. Physical therapists can do this, too. If you’re having a lab, bring in people with this lived experience and learn from them. That’s doable. There are a lot of disability advocates who would love to get into that space because that helps make their experience better when they interact with other health professionals. Programs have to want to do something like that because there’s some work on the back end.
It is bringing the lived experience. We bring it into school and into research, and then it will be somewhat easier when you first start to work with it in the clinic. You mentioned early in the episode that a lot of your work looks around maybe social barriers for people with physical activity. Do you have any research or do you get a sense, or is there an evidence-based out there that these social barriers could have an impact on the development or the maintenance of chronic pain?
For chronic pain, I am not so sure. Can you repeat that question?
When we look at, let’s say, someone accessing physical activity outside of a physical therapy clinic, if they can’t access it or there is a barrier, does that impact their pain?
Definitely. What we know about pain is that the huge shift is biopsychosocial. We know about the physiological aspects of pain. As PTs, we’re less open to the psychosocial aspect of pain. You see that when, let’s say, your patient comes in and they’re like, “I’m at a 10 out of 10 pain.” As a PT, you’re like, “You’re always at a 10 out of 10 pain. Why are you not in the hospital if you were 10 out of 10 XYZ?”
It’s more so if this person is telling you they’re at a 10 out 10 pain, you should be like, “It’s an issue. How can I help with that? Do we need to call the emergency and get an ambulance to take you in?” If they say no, I don’t have to do that. You’re like, “Do we need to not do treatment?” If they say no, they can participate. It is not relying so much on that number, but probing more to see what’s happening.
Who knows what they could say? They could say, “I had a bad day. My kid wanted me to pick them up. I had back pain. I couldn’t do it. My wife was telling me to wash dishes, but I couldn’t do it because I can’t stand for too long. I remember that I can’t do all these things and I have increased pain.” When that pain is invalidated, you step back. You stop talking about it. You might disengage from other things you do outside of the clinic. If you are not getting validation from a health professional, you might be like, “Am I going to get the validation from anyone else or even at a gym if I’m working with a personal trainer?” or things of that nature.
On the other side of that, you’re like, “Is my PT helping me work through the pain depending on what type of pain it is?” That also has some carryover outside of the clinic because if I can do these things in the clinic and manage my pain and I’m learning how to do that on my own, it gets transferred. When you are unable to validate and probe, that leads to a huge social barrier.
I’ve had experiences with that in a skilled nursing facility. They’re complaining about the pain and the nurses are telling me, “They’re lying.” I go in and we have a conversation. I’m like, “I’m sorry that happened to you. I understand you’re in pain. Would you like to sit up? That might help you feel better.” All of a sudden, we’re doing all these things and the nurses are like, “How did you get them to do that?” I’m like, “I listened, validated, and acknowledged. We worked through it.”
That’s the biopsychosocial approach right there. Sometimes, it doesn’t take that long. It takes a couple of moments to sit, listen, and be with someone as they’re talking about their entire pain experience, not just the description of the sensation they’re experiencing. Tell us about intersectionality and how it relates to disability justice.
Intersectionality is considering an individual’s identity or several identities in how they connect to account for discrimination. For example, if it’s one thing to be Black, it’s one thing to have a disability. It’s another thing to be a Black person with a disability. It’s similar to one thing to be Hispanic, one thing to be a woman, and one thing to have a disability, and then one thing to be a Hispanic woman with a disability. Intersectionality takes those identities into account and gives us an idea of the discrimination and oppression that might be layered on top of those identities.
From a disability justice lens, that tells us, even within disability, that we can’t look at just disability. Race, ethnicity, socioeconomic status, culture, language, place of origin, and all these things can give us an idea of an individual experience. The second part of that is taking that idea and not projecting it, but using it as a guide to listen to who you’re talking to.
As a Black man, a lot of people might assume what my experience is. It’s okay to think you have an idea. There’s a lot of social media. There are a lot of things we learn. We’re learning about a lot of people’s experiences, but on the other side, do you know me? Don’t assume that that experience that happens to Black people has automatically happened to me.
You can ask me a question versus, “I’m so sorry for the police brutality.” I’m like, “I am fortunate enough to not have experienced that type of police brutality. Why are you bringing this up to me?” It’s those types of things that’ll make anyone feel uncomfortable, much less if you know you’re not a majority in a particular group.
I’ve experienced this myself. You feel singled out even if it’s in a positive way or what someone intends to be positive. If I’m in a room and I’m the only individual like myself, I don’t want you to call on me because we’re talking about something that relates to myself or people who are like me. If I raise my hand and want to give my input, sure, but pointing your finger and being like, “You tell us,” is not the best way to go about it.
It’s a nice little microaggression, right?
Yeah. What do they say? Microaggression is like 1,000 paper cuts. It’s getting at you.Microaggression is like 1,000 paper cuts. Click To Tweet
You mentioned in that description the word oppression, which probably no one has brought up on this show. I’ve done over almost 400 episodes at this point. Oppression is a word that people relate to a lot of different things. Those overlapping intersections that you’re talking about, you’re saying that they layer on oppression, and then that impacts someone’s lived experience.
By oppression, I mean exclusionary practices, lack of accessibility, and a decreased sense of belonging. Being an outsider, being told you’re an outsider, and being treated as an outsider leads to oppression because if you’re seen as an outsider, will I have a policy that supports you? No. Will I have procedures and practices that support you? No. If I’m thinking about creating a building for a certain group of people, am I thinking about an outsider? No. With that decreased accessibility, I can’t be a part of society like I need to be. I can’t function in society like I need to. A lot of people and groups in this country feel that. It gets layered through that intersectionality perspective.Being an outsider, being told you're an outsider, and being treated as an outsider leads to oppression. Click To Tweet
A lot of these sound like they’re assumptions to a certain extent. People make assumptions about what someone’s experience is based on maybe what they see or what they momentarily hear. If you don’t mind me using a different example, I was reading them up in your bio. For example, you were a football player at one point. You’re a strong male football player. If you came into my clinic and I made the assumption that since you played football and you’re relatively tall and somewhat husky, you have a higher pain tolerance than other people. That also gets wrapped up in race, sex, gender, etc.
I’ve seen a study where physicians reported a disconnect between what they reported as a Black woman being in pain and that it was way different. They said that Black women inherently have a higher pain tolerance. When they report pain, they’re less likely to describe medications because they believe they don’t need them. Don’t quote me on that. Google it yourself because I haven’t seen that study in a while, but from what I remember, that was the gist of it. That’s a trend in healthcare where Black women are three times as likely to not survive during pregnancy. That’s a wild concept to me.
We’ve talked about that study on the show before. We’ve got into that study somewhat deep. Although, that conversation needs to be revisited many times because it has a lot of implications for people of color. People think women, especially if they’re pregnant, have a higher pain tolerance, which is silly. There’s not a whole lot of evidence there to support any of that. The work you’re doing is great. That oppression piece is powerful for all of us to think about. I appreciate you leaving that with us. If people want to follow you and your work, how can they learn more about you and keep up to date?
I’m not as active on social media as I was, but you can check me on Instagram. I am TheRollin_Stone_. Hopefully, I’ll get back to that. Also, you can google the Disability Justice and Anti-Ableism Catalyst Group. We have a page through the Academy of Leadership and Innovation through the APTA. You can google that and look up my email. Contact me for more information on the group. We’re hoping to do some great things this coming 2023. My email is [email protected]. Any questions, any opportunities to chat and talk about the profession, or anything at all, I’d be happy for it.
I want to thank Winston for joining us on the show to talk about disability advocacy and social justice both within and outside the physical therapy profession. For people with disabilities and chronic health conditions like chronic pain, make sure to share this with your friends and family on Facebook, LinkedIn, Twitter, or Instagram. I’m always on Instagram like Winston. You can find both of us there. Tag us and let us know how much you enjoy this episode. Make sure you download the latest episode by going into your iPhone and choosing the show so you can stay in touch with us each week. I’ll see you next time.
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About Winston Kennedy
Dr. Kennedy is a physical therapist (DPT) and also has a master’s degree in public health (MPH) and a PhD in Kinesiology with a concentration in adapted physical activity. He was funded by the Office of Special Education Programs, U.S. Department of Education to pursue his research training. Dr. Kennedy has expertise in multiple areas of focus in physical therapy, including orthopedics, pediatrics, neurological disorders and geriatrics. Dr. Kennedy is currently a Post-Doctoral Fellow at Merrimack College/UMass Chan Medical School. He is committed to conducting research that supports the health and well-being of people with disabilities at their intersecting identities.
He is currently investing how physical activity interventions accommodate youth with psychiatric and intellectual developmental disabilities. Dr Kennedy is also interested in understanding, and ultimately influencing, healthcare professional curricula in order to train health professionals to work with and better support people with disabilities. Included in Dr. Kennedy’s accomplishments are his nine peer-reviewed published papers, 11 peer-reviewed published abstracts, and his production of over 50 presentations internationally and nationally. He has also been the recipient of numerous awards, including being recognized by the Association of University Centers on Disability in 2021 as an emerging leader.
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