Culture in Rehabilitation: From Competency to Proficiency

Journal of Physical Therapy Education, Fall 2006 by Leavitt, Ronnie

Culture in Rehabilitation: From Competency to Proficiency. Royeen M, Crabtree J, eds. Cranbury, NJ, Pearson/ Prentice Hall, 2006, softcover, 386 pp, $48.60.

Culture in Rehabilitation: From Competency to Proficiency explores the crucial role of culture in the rehabilitation process. The book aims to provide theoretical, ethical, and practical reasons for health practitioners to strive toward cultural proficiency. It is not written specifically for physical therapists (PTs). Royeen is a consultant to international and diversity programs, and Crabtree is an occupational therapist (OT). Although most of the chapters were authored by OTs, other allied health professionals contributed chapters, including 3PTs.

Royeen and Crabtree use the term cultural competence to describe the notion of self-examination in relation to one's own culture, values, beliefs, and experiences, and the application of the relevant cultural concepts to patients of different cultural backgrounds. Cultural proficiency is promoted as an ongoing, evolving process, rather than an outcome. At best, individuals who strive for cultural proficiency change their way of thinking about other people and their respective cultures. In institutionalized cultural proficiency, the institution incorporates standards that call for culturally proficient behaviors based on self-examination and an effort to understand and appreciate the beliefs and behaviors of people from different cultures.

The book is organized so that the reader can "learn about the cultural context of a presenting problem and integrate that knowledge into a professional assessment, diagnosis, and intervention." Each chapter has stated objectives and a case study, as well as thoughtprovoking questions for the reader. Reference lists are adequate.

The first section (Chapters 1-4) focuses on the introduction of cultural competence and rehabilitation, as well as discrimination, communication, and ethics. section Two introduces themes of ethnic diversity. Chapters 5-12 offer overviews of European Americans, African Americans, Native Americans, Asian Americans, Arab Americans, Jewish Americans, Hispanic Americans, and Pacific Islanders, respectively. Within each chapter, there is recognition of a range of smaller cultural groups that are contained within the larger, general group. For example, the chapter on European Americans specifically mentions people from Poland, Croatia, Hungary, Romania, Greece, Italy, Germany, Ireland, the United Kingdom, and France. Each chapter has its own organization and style. Generally, the chapters include specific information about migration history, demographics, communication style, and health beliefs and behaviors, to name a few. In an effort to have a wide breadth of content, the depth of each chapter (or about each group) is relatively limited.

section Three focuses on the cultural constructs of gender, age, disability, poverty, class, and sexuality. The inclusion of gender, class, and sexuality is unusual but very important, in my opinion. It is helpful for physical therapists to become more knowledgeable about cultural groups that are less likely to traditionally be discussed in a physical therapy forum. Understanding that culture is a very broad concept and that we all belong to many cultural subgroups based on the aforementioned categories is a worthy goal.

Culture in Rehabilitation will facilitate the never-ending journey from cultural competence to cultural proficiency. I would recommend this resource for any present or future physical therapy practitioner, educator, researcher, or administrator.

Ronnie Leavitt, PT, PhD

Associate Clinical Professor

School of Allied Health

University of Connecticut

Storrs, CT