Beyond Scalpels and Stethoscopes: A Phenomenology of Cognitive Artefacts, Classifications, and Schema Integration in Rehabilitation Medicine

Tool use is a defining capability of the human species. In the field of Health, tools are pervasive and integral to practice. Whilst the function of many tools used in Health are overt, (e.g. a scalpel), tools designed to support cognition, (i.e. cognitive artefacts), may be less so. For this reason, the description and analysis of cognitive artefacts is important. The ability to classify represents a primary cognitive skill in Healthcare practice where classifications serve to provide information infrastructures upon which practice unfolds. Formal classification systems in Health continue to evolve for which the development of cognitive artefacts can assist in their practical application. With the availability of multiple classifications in Health, practitioners concerned with holistic, person-centred approaches to care require an ability to integrate classifications when engaging in cognitive tasks such as problem solving. The cognitive task of integrating classifications introduces a framing problem for practitioners where multiple schemas, or representations of the world, require simultaneous mapping to a common global schema or framework. The design of cognitive artefacts targeting the integration of classificatory schemas in Health practice appeals to practitioners whose lived experience involves this work. To that end, this thesis provides a first-person phenomenological account of a cognitive artefact designed for the integrated application of the reference classifications of the World Health Organisation’s Family of International Classifications (WHO FIC) in the field of Rehabilitation Medicine. Using a phenomenological approach, taken-for-granted assumptions about the WHO FIC are set aside to permit reconsideration of classifications with reference to basic phenomena of time and space from which the building blocks of the cognitive artefact are constructed. Elaboration of this model occurs with the additional representation of the Body, Activities, and the Environment as dynamic interacting components within the temporospatial field. These 3 components are further represented in a 20-cell array derived using the main chapter headings from the International Classification of Functioning, Disability and Health (ICF) which is viewed as analogous to a 2-dimensional cellular automaton. Following description of the cognitive artefact design worked, examples of problems in Rehabilitation Medicine are provided that highlight the cognitive artefacts capacity to address and integrate multiple framing perspectives. Key phenomenological findings from the study include: 1) recognition of the role of artefacts in grounding a subjects temporospatial ‘lifeworld’ using visual diagrams and imagery, 2) highlighting the value of utilising a generic problem space when approaching Rehabilitation Medicine problems that demand multiple-frame perspectives, 3) using a 2-dimensional automata-like structure to appreciate the relational complexity of problems encountered in Rehabilitation Medicine, 4) appreciating the role of artefact construction for framing integration in Rehabilitation Medicine problem solving, and 5) locating the lived experience of the practitioner as a moral actor who can be positioned (alongside their patient) within the artefact frame. The study findings provide a sound basis for potential future research into the role of artefacts in Rehabilitation Medicine practice where an overarching goal is the integrated application of health classifications in the pursuit of person-centred care