Disability and Rehabilitation: Assistive Technology

ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: https://www.tandfonline.com/loi/iidt20

‘Reserve is no place for a wheelchair’: Challenges

to consider during wheelchair provision intended
for use in First Nations community

Heather Wearmouth & Trish Wielandt

To cite this article: Heather Wearmouth & Trish Wielandt (2009) ‘Reserve is no place for
a wheelchair’: Challenges to consider during wheelchair provision intended for use in First
Nations community, Disability and Rehabilitation: Assistive Technology, 4:5, 321-328, DOI:
10.1080/17483100902807120

To link to this article: https://doi.org/10.1080/17483100902807120

Published online: 09 Sep 2009.

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Disability and Rehabilitation: Assistive Technology, September 2009; 4(5): 321–328

RESEARCH PAPER

‘Reserve is no place for a wheelchair’: Challenges to consider during

wheelchair provision intended for use in First Nations community

HEATHER WEARMOUTH1 & TRISH WIELANDT2

1
Department of Occupational Therapy, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada and 2Department of
Occupational Therapy, University of Alberta, Edmonton, Alberta T6G 2G4, Canada

Accepted November 2008

Abstract
Purpose. The purpose of this study was to gain an understanding of the post-rehabilitation experiences of First Nations
persons with spinal cord injury who returned to live on reserve using a wheelchair.
Method. A phenomenological approach with purposive sampling was employed to recruit participants with spinal cord
injuries who used a wheelchair and lived in a First Nations community. Data were collected using a short demographic
questionnaire and a semi-structured interview.
Results. Most participants returned to live on reserve in homes that were not wheelchair accessible and only two had home
assessments completed. Nearly all either moved to modified homes or had homes purpose built for them after waiting
considerable periods of time to relocate. However, only one of these homes was considered completely accessible.
Participants identified other challenges they coped with including the effects of other medical conditions, negotiating reserve
terrain and accessing cultural activities.
Conclusions. The findings show that policy changes are required regarding the allocation of funding to ensure accessible on
reserve housing for First Nations persons with a SCI. Further recommendations were made regarding the cultural content of
health professional curricula as well as the need for health professionals to liaison more closely with Aboriginal health care
workers.

Keywords: Wheelchairs, health professionals, accessibility, cultural environment

Introduction not offer rehabilitation services [6]. These services

With an estimated population of more than 32
million people, Canada has more than one million
persons identifying themselves as Aboriginal [1].
First Nations persons living on reserve have income
levels half that of non-Aboriginal Canadians [2]; high
unemployment and reduced secondary schooling
completion rates [3,4]. Further, 31% of First
Nations reserve homes are in need of major repairs
with another 24.5% classified as over-crowded [3].
Additionally, at 32% the disability rate for Aboriginal
persons is twice the national average [5] and
significantly impacts on available health care services.
Currently, the First Nations and Inuit Health
Branch (FNIHB) provide health care in First
Nations communities for public health and health
promotion initiatives and health care centres, but do
may be accessed by moving to urban centres or by
negotiating with local First Nations community
councils who are responsible for such service
provision on reserves. Presently in Canada inter-
jurisdictional disputes between government agencies
regarding funds provision for heath care services to
First Nation persons are commonplace [1,7]. The
remoteness of reserves is thought to contribute to the
high cost and reduced access of health care services
for First Nations communities [2]. The remoteness
of First Nations reserves also forces its residents to
travel lengthy distances on rural roads to obtain
services, often using poorly maintained vehicles
which contribute to the high incidence of motor
vehicle collisions [8], resulting in hospitalisations
almost double the rate for non-Aboriginal persons
[9] and is the leading cause of death in First Nations

Correspondence: Trish Wielandt, Department of Occupational Therapy, University of Alberta, 3–14 Corbett Hall, Edmonton, Alberta, Canada.
E-mail: trish.wielandt@ualberta.ca
ISSN 1748-3107 print/ISSN 1748-3115 online ª 2009 Informa UK Ltd.
DOI: 10.1080/17483100902807120
322 H. Wearmouth & T. Wielandt
communities [10]. By virtue of these statistics it
appears that this population is most vulnerable to
sustaining severe injuries following motor vehicle
collisions which may include a spinal cord injury
(SCI).
A SCI results in some degree of motor, sensory
or neuromuscular deficit below the site of the injury,
with the extent of functional loss dependent on
the level of the injury and whether the injury is
complete or incomplete [11]. SCI leads to a
decreased ability to mobilise and during rehabilita-
tion either power or manual wheelchairs are provided
to facilitate independence in mobilisation. The
researchers sought to gain an understanding of the
post-rehabilitation experiences of First Nations
persons with SCI who returned to live on reserve
using a wheelchair.
Method
Research design
Phenomenological research was chosen for this study
as it describes an individual or group’s lived
experiences [12], with purposive sampling used to
recruit participants. In this study, participants were
recruited until data saturation occurred. Ethics
approval was obtained from the University of Alberta
Health Research Ethics Board, Panel B and from the
Canadian Paraplegic Association (CPA) regional
ethics board.
Procedure
Initial contact with potential participants was made
by the CPA representative regarding their possible
interest in the study. Next, the researchers made
contact via the telephone to answer queries about the
study and schedule interviews. These were con-
ducted in the participants’ homes with the researcher
and the CPA representative present. The CPA
representative accompanied the researchers due to
the remoteness of reserve locations. Participants
were encouraged to have family members present
during the interview and also to indicate whether
they wanted their community council to be aware of
their involvement in this study. The interviews lasted
on average 90 min and were audio-taped if agreed to
by the participant for later transcription. All but one
participant agreed to be audio-taped. In this case,
extensive field notes and observations were relied on
during data analysis. At the completion of the
interview each participant received a $20 gift
certificate from a local department store as an
honorarium.
Participants
Participants were recruited into the study based on
the following inclusion criteria: being a registered
member of the First Nations population; over the age
of 18 years; having had a SCI at least 1 year previous;
residing or having formerly lived on a reserve in
Alberta post-injury; able to comprehend and con-
verse in English; and considered a reliable historian
by the CPAs representative.
Measures
Prior to the interview demographic information was
collected which included participant’s age, level of
SCI, other medical conditions, living arrangements,
wheelchair type and whether a home assessment had
been completed.
A semi-structured interview was developed using
the available literature and following discussions with
health professionals who had extensive experience
working with First Nations populations. The inter-
view was not able to be piloted because of the time
constraints of the study but was re-examined
following the first interview and no major changes
were deemed necessary. The interview consisted of
eight questions surrounding wheelchair prescription,
the usefulness of wheelchair and accessibility issues
around the participant’s home and on reserve.
Data analysis
Manual thematic analysis was completed with
transcripts being read numerous times to get an
overall sense of the data as well as to identify key
themes [12]. Thematic coding and categorisation
was employed where all data relevant to each
identified theme was examined. To establish analy-
tical themes checking and comparison of each item
with the rest of the data occurred. Triangulation was
attained by using field notes, interview transcripts,
member checking and an independent colleague
check. As one participant had passed away after the
interview not all participants were able to complete a
member check.
Results
Demographic characteristics
Four males and three females interviewed as part of
this study were on average aged 50 years, with the
males being younger (mean age of 43.5 years)
compared with the females (mean age 58.7 years).
 ‘Reserve is no place for a wheelchair’ 323

They had lived with a SCI on average for 18.3 years.
At the time of data collection five participants (71%)
lived on reserve, and the two participants with the
highest levels of SCI resided off reserve. All
participants but the youngest (86%, 7/8) had
concurrent medical conditions (see Table I).
‘Well I used to be able to push myself next door
[mother’s home] . . . but now I can’t because I am weak,
so I always call for help when I want to go visit’.
Access to homes

Only two of the participants reported having had

Participants’ perceptions of the usefulness of their current
wheelchair
Generally participants were able to relate positively
when asked whether having their wheelchair made
them feel independent while undertaking their daily
living activities.
‘Yeah, especially with this chair [power wheelchair], to
be able to go out and go around’.
‘I’ve done a lot with my wheelchair, when I was younger
I coached a baseball team . . . I like it but it is pretty old,
my tires are worn out’.
‘Yeah, it’s good to have this [power wheelchair]. I really
need this, if I didn’t have my wheelchair, my power
wheelchair, geez, I don’t know . . . I would be really
bored. I wouldn’t be able to handle it’.
However, some participants identified accessibility
concerns surrounding their wheelchair:
‘I don’t know why they gave me a great big one [power
wheelchair] . . . I sometimes can’t go through doors and
I feel terrible because this thing catches doors and I hit
the wall’.
‘. . . can’t get into the washroom and close the door, the
washroom is too small . . . I am wearing a colostomy
bag. I need to empty it’.
One participant who had upper extremity weak-
ness due to another medical condition explained how
their manual wheelchair was not as helpful anymore:
their home assessed for wheelchair accessibility by a
health professional. One participant, who had a
home visit immediately after discharge indicated that
while extensive work had been undertaken 13 years
ago there were still access issues in the laundry and
kitchen (reaching into cupboards and to the back of
the stove).
Another participant, who had a home assessment
undertaken a year after discharge while living at his
father’s bi-level home reported that an external ramp
was installed, but relatives still had to carry him in his
wheelchair up and down the internal stairs:
‘I didn’t want to stay . . . but there was no place to
go . . . but I stayed there for 5 years’.
Five years later another agency undertook a home
assessment at the father’s home and now this
participant lives in a purpose built home, next door.
He reported providing input into the design of his
current house which included wider doorways, large
washroom and lower kitchen counters
‘everything’s good in this house, I can do everything’.
Three other participants reported that they had
returned home from hospital to live with family
members following discharge, with none of these
homes being wheelchair accessible at that time. They
identified the following experiences:
‘I lived in that small house for a couple of years, it’s
really small, even the washroom I can just barely get in, I

Table I. Demographic profile of study participants.

Age (years)/ Current living

Participant/gender SCI level Years post injury arrangement Concurrent medical condition Wheelchair

A/female 77/L1-L2 13 On reserve* Arthritis, kidney transplant 1{

B/male 42/C3-C4 21 Urban city{ Chronic bladder infections 1{
C/male 51/C5 10 Rural community{ Pressure sores 1{
D/male 43/T10-T11 27 On reserve{ Receiving kidney dialysis 2x
E/female 55/T10-T11 14 On reserve{ Double leg amputee, colostomy, pneumonia 2x
F/female 44/L1 29 On reserve{ Pressure sores 2x
G/male 38/T5-T7 14 On reserve* None reported 2x

*Home assessment completed.

{
Power.
{
Home assessment not completed.
x
Manual.
324 H. Wearmouth & T. Wielandt
sit in my chair, get in and come out, struggle there for a
long time’.
‘It was really small, I could barely fit in the doors . . . all
they laid down there is a ramp, it’s not wheelchair
accessible at all, it still like that . . . I had to squeeze
through the washroom was really hard, I can’t turn
around in there, all I can do is go forward, and that was
it, can’t turn around or anything’.
‘. . . my parents had to take me back and forth on steps
like that house [pointing to house across the field], there
weren’t any ramps at first until about 6 months. For 6
months I don’t go outside unless someone takes me
down the stairs or something’.
Most participants spoke of the difficulties of being
in a wheelchair and living on reserve where homes
have narrow hallways and doorways typical of tract
housing. Yet having modifications completed or even
moving to a bigger home did not equate for all
participants into achieving optimal independence.
One participant now in a modified home related how
he cannot access the living area downstairs as there
was no exterior door and interior access is only via a
staircase:
‘tried to have a door built downstairs when they first
build it, but council did not approve, so they didn’t
make it. She [sister] asked them to make door . . . said I
play with my nephews a lot . . . I enjoy it . . . I don’t
think of things when I am with them . . . but when I am
on my own I sit and always think about what could have
happened, what I could have done . . . too many
memories’.
A relative of another participant reported similar
experiences
‘we just moved in 3 years ago, before that we lived in a
smaller house in X but the washroom was better
there . . . she can’t get in the washroom [here]. And
the other thing is the stove too she really has to stretch to
reach the knobs here. Sometimes I get scared because
when she is using the stove and trying to turn it off
sometimes she almost burns herself . . . [need] to have
knobs right in the front of the stove and a sink that is
lower’.
Another participant explained that although her
house had been modified the contractors did not
complete all of the required alterations. Although the
laundry had been moved upstairs, a doorway widen
and a ramp installed she could not access one
bedroom, her kitchen sink or the stove top.
Both of the participants who had quadriplegia had
chosen to reside off reserve. One of these participants
advised he was on a self-managed programme but
funding for such services would not be available to
him if he lived on reserve
‘it’s just frustrating why I have not been able to move
home in 21 years since my accident . . . I would
definitely move back home if I had that [funding] . . . it’s
the only reason I am not back there . . . you want to be
on reserve but can’t . . . it’s because of our culture and
our lifestyle’.
The other participant who lived off reserve
indicated that for 1-year post-injury he had lived in
a long-term care centre on reserve before moving to
live with a caregiver.
‘I had a home on reserve . . ..while I was staying at the
care centre they had to fix me up a ramp, everything and
then find somebody to come over and take me out of bed
or put me back so I had to wait for all that . . . so I got my
house [modified] . . . but the nurse but she didn’t work
there [on reserve] no more, she came to visit and told me
if I wanted to try it out here [current home] she would
take care of me . . . so I came here 8 years ago’.
One of the participants with quadriplegia men-
tioned climate issues that need to be considered
‘on a reserve people get snowed in a lot, yeah or like
stuck, you can’t get out for a couple of days . . . like you
have to be prepared . . . even in the spring [melting]
when it gets muddy . . . you have to plan for that . . . at
least a month’s supply [incontinence aids] during the
winter. Yeah and there are times out there when the
power shuts off during electric storms . . . you have to
make sure you have back up lights. Well . . . in the
winter I wouldn’t be sitting in my power wheelchair if I
am indoors all day . . . [referring to potential recharging
issues] . . . its not like the power off for weeks but could
be 2 days max or maybe overnight’.
Accessibility on reserve
Besides highlighting housing issues, participants who
used manual wheelchairs also mentioned the chal-
lenges of negotiating reserve terrain. On observation
the majority of reserves visited as part of this study
were situated on the prairies with bi-level style
houses located in clusters. Family members tradi-
tionally resided in houses separated by approximately
200 m of rough dirt fields. When describing reserve
terrain the following comments were reported:
‘a lot of gopher holes and all kinds of little bumps
through there that you have to really be careful of’.
‘well you ain’t going to see any highways . . . it is no
place for a wheelchair’.
‘If you are strong, it is easy, but if you are weak, it’s hard’.
Declining physical ability was highlighted by some
participants as the reason they found it difficult to
manually push their wheelchair on the reserve

terrain. One participant described his experiences by
saying
‘when I was really healthy I could go all over the place here,
even up the hill there on my chair, when my arms were
strong . . . but I can’t do that now . . . they [his arms] were
stronger, but not as strong since going to dialysis’.
During discussions about the challenges of the
reserve terrain, some participants detailed transpor-
tation problems they experienced when travelling
between facilities both on and off reserve to
participate in ceremonies or leisure activities. Those
who had wheelchair accessible motor vehicles in-
dicated such transportation was essential to enable
full participation in reserve life, while frustration was
voiced by those without it.
Participation in cultural ceremonies
Participants were asked about their cultural ceremo-
nies and the challenges they experienced accessing
these in a wheelchair. Predominantly, participants
highlighted the physical requirements of activities
involved with the ceremonies and access to ceremo-
nial buildings as the main barriers to fully participat-
ing. One ceremony, the ‘sweats’ was highlighted as
being particularly difficult to fully participate while in
a wheelchair. Sweat lodges are small huts typically
made of branches with hide or canvas covering.
During the sweat it is common to sit on the floor of
the lodge encircling a stone pit filled with hot stones.
Water is then poured over the stones to fill the lodge
with steam. One participant reported he was now
unable to participate for the following:
‘Because I, I don’t know, the way I am [C5 quad-
riplegia], they would have a hard time bringing me in,
like into the sweat, they have to start wrestling me in, go
in there and well, I can’t just sit up, they have to tie me
and all that . . . so I can’t get into those [sweat lodges]’.
Another participant spoke of his experiences
‘The sweat lodges are just small . . . I was positioned
right where all the activity was going on so they
would have to go around me . . . we got it done but
it’s hard for me to really feel a part of it since I was
unable to do the stuff myself that I was supposed to
do . . . it kinda felt like to me I wasn’t that much a part of
it at times’.
Another participant spoke of attending a smudging
ceremony while seated in her wheelchair. ‘Smud-
ging’ is the burning of certain herbs to create a
cleansing effect, and is used to purify people,
ceremonial places, tools and objects. She also
‘Reserve is no place for a wheelchair’ 325
advised that the ceremony took place in her home
with the elders present
‘Yeah, well I have to be in it [wheelchair], a few
ceremonies I have went to, I stayed in my chair, usually
you sit in a circle but I stayed in my chair and it was
OK’.
Pow wows were another example of cultural
ceremonies provided by participants which are
gatherings to dance, sing, display handicrafts and
visit with family and friends and take place in large
venues with many spectators. One participant
commented about his change of roles in relation to
attending pow wows now that he used a wheelchair
‘I go to a lot of pow wows . . . I mainly just a spectator
I can’t really get involved in that because there is a lot
of dancing, a lot of singing, I can’t get too involved
in that as well because of being disabled, like you’re
there to pray and lots of people like myself that’s
there . . . I am pretty much limited to spectating . . . I
feel frustrated seems like I some how am not quite part
of what’s going on . . . I just feel like an outsider kinda
you know I still get lots of stares, that’s always kinda
awkward too’.
Another participant advised that when he was
younger and using a wheelchair he travelled around
North America singing at pow wows, but that this
was not possible now as he had complicating medical
conditions
‘It didn’t bother me back then, we weren’t home in the
summer, always travelling someplace . . . I want to do it
again in my heart I miss it . . . as I got older it’s a lot
different . . ..everything seems harder [now] for weeks
we slept in cars, our car was the home, just travel-
ling . . . [now] I just sit here and sing’.
Adaptation to disability
During the interviews two of the female participants
talked about coming to terms with their disability.
One participant indicated that over the 13 years since
her accident she had learned to cope with the
disappointments associated with being in a wheel-
chair. Although she was relatively happy with
accessibility around her home, her biggest frustra-
tions were surrounding the lack of access to adequate
transportation on and off reserve.
‘I was very independent before I got hurt and I did
things for people and helped them . . . I used to go all
over the place anyplace I wanted to go . . . it was really
hard for me to accept, couldn’t do nothing, wish you
326 H. Wearmouth & T. Wielandt
could do these things but you can’t . . . and patience is
another thing that you have to bear with’.
The other participant who had her accident as a
teenager indicated it took a long time for her to
grieve for the loss of her old life
‘I was active person, I liked riding horses, playing
football, I was active, running, so it was kinda hard for
me to accept being in a chair for a long time . . . it took
me 14 years to cry because I had to build myself a
wall . . . went to a grieving workshop and that made me
cry and that felt so good’.
This particular participant had a lightweight
manual wheelchair and an accessible motor vehicle
and was able to travel regularly off reserve and attend
rodeos and cultural ceremonies.
One male participant 14 years post-accident
reportedly did not leave his home and advised that
he found it difficult living on reserve. He had access
to van which picked up people on his reserve, but
because he did not like being lifted into the van by
others he did not use the service. He advised that
when he had to go to appointments he asked his
brother for rides. He further advised
‘it is pretty tough, but there is nothing I can do, I’m the
only person here [on reserve] in a wheelchair so there is
not much for me to do . . . when I first got injured some
native guy told me there’s not much to do on reserve [ in
a wheelchair] . . .. I see what he means now’.
This participant further indicated that immediately
after his injury he found it difficult to accept his
disability
‘I didn’t like my accident so I did not want to talk to
people and I was also unsure of what I wanted . . . didn’t
know’.
Now he says that in the last couple of years he is
able to articulate his requirements. However, he
stated he gets frustrated when health professionals do
not understand his requests for wheelchair adapta-
tions in order to increase his maneuverability:
‘with professionals they don’t understand what I
want . . . with them the [text] book says this is the way
it should be . . . when I want it this way’.
Discussion
The purpose of this study was to gain a better
understanding of the relocation experiences of First
Nations persons with SCI who returned to live on
reserve using a wheelchair.
Participants’ perceptions of the usefulness of their
current wheelchair were generally positive but
serious concerns were raised by those who had other
medical conditions, experienced the effects of ageing
and had accessibility concerns. These findings are
consistent with other studies which reported that
aging with a SCI is correlated with experiencing
greater fatigue, decreased participation in activities,
and increased upper extremity pain [13,14]. Further-
more, McColl et al. [15] reporting on a Canadian
study with ageing wheelchair users who had a SCI
reported that during harsh northern winter months
there were fewer opportunities for persons to
mobilise in their wheelchair, which led to isolation
and limited activity engagement.
On the other hand, while participants with power
wheelchairs identified having greater independence
mobilising between houses and on reserve terrain
than those who used manual wheelchairs, issues were
highlighted about restricted access indoors due to the
size of their chair.
Only one participant had her home assessed
immediately after discharge and whereas some
modifications had occurred there were important
accessibility issues still to be resolved. Four partici-
pants reported returning to live on reserve with
relatives in homes that were not modified to
accommodate their wheelchair. The maximum
period of time these participants waited for suitable
accommodation was 5 years. Unfortunately, while
some participants had moved into larger modified
homes or had homes purpose built they related major
outstanding access issues which may never be
remediated because of funding disputes. Participants
living in these circumstances have had their quality of
life negatively impacted.
In 1999, the Consortium for Spinal Cord Medi-
cine Clinical Practice Guidelines [16] advised that
‘to provide the best opportunity for individuals with
SCI to achieve the identified functional outcomes, a
safe and architecturally accessible environment is
necessary (p. 300)’. On the basis of the results of the
current study, it appears that when First Nations
persons with a spinal injury are discharged to home,
because of the remoteness of their reserves, lack of
access to appropriate health care services there and
funding disputes it is difficult to have their homes
assessed for wheelchair accessibility. They are denied
the chance of experiencing functional independence
as well as the opportunity for maximal engagement
and participation in their community.
Results showed that reserve terrain affected the
participant’s ability to mobilise in a wheelchair
efficiently. Six years ago the Research and Training
Centre [17] reported the lack of pavement, sidewalks
and curb cuts in existing sidewalks on reservations.
Practical solutions offered by participants of the

current study to assist in the overcoming the
environmental barriers created by the reserve terrain
included larger tubeless tires and lighter wheelchairs.
The lack of adequate transportation on and off
reserve was also identified as a challenge for wheel-
chair users living on reserve. Most indicated that an
accessible motor vehicle was necessary to ensure
independent travel on and off reserve as little to no
public transportation is available. Participants who
did not have access to such vehicles commented on
the isolation they experienced. Similar findings were
noted in the available literature with comparable
situations noted on most of the 300 American–Indian
reservations surveyed [17]. Likewise, in Australia such
challenges are common place for persons with
disabilities who live in rural communities without
accessible motor vehicle transportation [18].
Analysis revealed that participants had difficulty
engaging in some cultural activities because of acces-
sibility issues surrounding the use of a wheelchair.
However, several participants identified that they had
undergone considerable role changes with some feeling
somewhat disconnected. No literature was located
specific to wheelchair use during cultural ceremonies.
According to Bates et al. [19] the process of
emotionally adapting to living in a wheelchair takes
place over a period of several years. These authors
noted that in contrast pragmatic adaptation can be
achieved within the first year post-injury [19]. The
two participants who mentioned adaptation during
the interviews had lower level paraplegia sustained
between 13 and 29 years ago, having had their
accidents as a teenager and in middle age. Both
women lived in inaccessible yet modified homes.
The older participant used a power chair due other
chronic illnesses and still attended cultural events
but needed maximal assistance from family. The
younger participant used a manual chair but was able
to transfer independently to a vehicle and had hopes
of getting an adapted vehicle so she could indepen-
dently attend ceremonies and travelling off reserve
regularly. Perhaps due to the length of time, since
they were both injured and a having lower level SCI,
these participants appeared to have more readily
adjusted to their disability.
Considering reported reserve conditions it is
possible that the time frame for achieving adaptation
could be significantly longer for First Nations persons
with SCI returning to live on reserve. An important
contributor is the lack of health services to draw upon
due to the geographic remoteness of most reserves
[2,20]. Analysis of the interviews revealed how
participants have spent years living in remote loca-
tions, mostly in inaccessible homes, relying on
relatives to assist with fundamental daily living tasks,
attempting to negotiate uncompromising terrain in
their wheelchair and without adequate transportation.
‘Reserve is no place for a wheelchair’ 327
Limitations
There are a number of limitations to this study.
Participants were recruited from the client pool of a
CPA representative using purposive sampling. A
limitation inherent to this method is the potential for
participants to be chosen for reasons other than the
inclusion criteria.
On average it was 18 years since most participants
had their SCI and this may have affected their ability
accurately self-report and recall their rehabilitation
experiences. Additionally, rehabilitation interven-
tions have since changed and therefore participants
may have been commenting about practices which
occurred at least 10 years ago.
The interview schedule was unable to be piloted
due to time constraints and this may have created a
potential for questions to have been misunderstood
by participants.
Finally, these results are not generalisable as they
only reflect the environmental and cultural chal-
lenges experienced by First Nations persons in a
specific geographic location in western Canada.
Clinical implications
Overall, these findings indicate the need for health
professionals to ensure that a client-centred process
is used when discharge planning for home resettle-
ment for this population. In addition, health profes-
sionals need to build collaborative relationships and
liaise with Aboriginal health care practitioners to
allow for culturally appropriate rehabilitation and
continuity of care post discharge. Finally, health
professional education would benefit from exposure
to information about First Nations in the curriculum
to heighten their awareness and ensure that service
provision to this population is both culturally
sensitive and appropriate.
Conclusion
This phenomenological study used interviews with
seven participants to gain a better understanding of
the relocation experiences of those persons with SCI
who returned to live on reserve using a wheelchair.
Most participants still lived in houses that were not
wheelchair accessible with nearly all having been
discharged to relative’s homes with major access
issues, waiting several years for some modifications
to be undertaken or the chance to move to a larger
home.
This study has underscored the additional diffi-
culties this population experience as a result of the
ageing process and residual weakness from having
328 H. Wearmouth & T. Wielandt
another chronic illness. The challenges of traversing
reserve terrain in a manual wheelchair and partici-
pating in cultural ceremonies as well as the lack of
adequate transportation are important considera-
tions which must be considered as they have wider
implications and ultimately will affect quality of life.
Findings from this study also point to the need for
an overall change in policy regarding the allocation of
resources for health care. In particular, the provision
of timely and appropriate home assessments and
modifications is to be undertaken for those persons
who return to live on reserve.
Acknowledgements
Heather Wearmouth was supported by a Health
Canada National Aboriginal Achievement Founda-
tion Award 2008. Participants are sincerely thanked
for their willingness to share their time and experi-
ences. Toby Redfern from the Canadian Paraplegic
Association is also thanked for providing support,
guidance and company on the field visits.
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