The waiting room was ordinary enough. People checked in, handed over insurance cards, completed forms, and waited for their names to be called. Patients were brought back in pairs, each moving through the same routine with little explanation.
When my name was called, two occupational therapy providers were waiting in the examination room. Neither introduced herself. Their roles became clear only after I asked: one was an experienced occupational therapist, and the other was a student. No one had explained that a student would participate in the evaluation or asked whether I was comfortable with the arrangement.
The appointment was intended to evaluate continuing weakness and loss of function in my left hand after ulnar nerve transposition surgery. Cerebral palsy and spasticity also needed to be considered because both affect how my body moves. The purpose was to understand what had changed, what the evaluation showed, and what treatment options might be appropriate.
The assessment moved quickly into range of motion, strength, movement, and function. Measurements were taken, symptoms were discussed, and diagnoses entered the conversation. Then came the words: atypical, anomaly, impaired, unusual, abnormal.
During the evaluation, my attention remained on the weakness in my hand and the loss of function after surgery. I wanted to understand what had changed, how cerebral palsy and spasticity affected the results, and whether the therapists could offer an appropriate treatment plan. There was already a great deal to take in without stopping the assessment to question every word.
Questions about the terminology came later. What, specifically, was atypical? Did anomaly refer to my anatomy, movement, or nerve response? Was impaired being used to describe my grip strength, range of motion, or overall hand function? What did the therapists consider unusual or abnormal? Without clear explanations, the words seemed to describe more than the measurements taken during the evaluation.
Comparisons are part of an evaluation. A therapist may look at expected measurements, compare one hand with the other, or consider how the person functioned before an injury or surgery. These comparisons can help identify what changed, but they do not all mean the same thing. Comparing my hand with a standard measurement is different from comparing it with how my hand functioned before surgery.
Measurements of grip strength, range of motion, and nerve response can show where function has changed. They can also help guide treatment. They do not explain how a person completes tasks, what support the person uses, or what the person wants to regain.
What Is Being Compared?
For a person with a disability, comparisons with what is considered typical can begin early. The way a person moves may be compared with the movement of other people of the same age. Communication may be evaluated according to speech, pace, or delivery, while tasks are often judged by how independently, quickly, or efficiently they are completed.
Some comparisons provide useful information. Developmental milestones can identify areas where a child may need support. Clinical measurements can document a change, guide treatment, or show whether an intervention is working. Problems arise when the comparison extends beyond the specific issue being evaluated.
Disability affects people in different ways and to different degrees. Even people with the same diagnosis may not have the same abilities or support needs. One person may need support in a particular area, while another may not. A single baseline cannot reflect those differences.
Words like typical and atypical can suggest a clearer dividing line than actually exists. They may be useful as shorthand, but they do not account for the different ways people move, communicate, complete tasks, or use support. They can also leave a person wondering which part of what they do has been judged to fall outside the expected range.
An evaluation involving ulnar nerve damage offers a clear example. Grip strength, sensation, range of motion, and nerve response may be compared with expected measurements or with the person’s earlier function. Those comparisons can help document a loss and guide treatment. They measure specific aspects of function; they do not provide a complete description of what a person can do.
A person’s level of function before an injury or surgery is an important point of comparison. For someone with cerebral palsy, an established way of moving may differ from a standard clinical reference without indicating a new change in function. In my evaluation, the more relevant comparison was how my hand functioned before surgery and what had changed afterward. If the evaluator does not clearly identify the baseline being used, a lifelong disability can be mistaken for a recent loss of function.
Identifying the baseline becomes especially important when the word normal is used. In medicine, normal may refer to a statistical range, an expected test result, or the absence of a clinical concern. The person hearing the word may understand it more broadly. A measurement outside the expected range can begin to sound like a judgment about the person rather than a description of the result.
Clinical terminology may be familiar to the professionals using it, but familiarity does not make every use clear or appropriate. A term may be recognizable within medicine, occupational therapy, or physical therapy and still leave the person feeling categorized rather than informed. How the term is explained, applied, and understood by the person matters just as much as its technical definition.
The goal is not softer medical language. It is more exact language. Saying that a nerve response is reduced provides concrete information. Describing increased muscle tone, loss of strength, restricted range of motion, or a specific functional change does the same. Difficult information does not need to be avoided; it needs to describe the right thing.
When the Standard Becomes Personal
During my evaluation, words such as atypical, impaired, abnormal, and anomaly were used alongside measurements of strength, movement, and range of motion. None was clearly connected to what the therapists were observing or measuring. As a result, it was difficult to tell whether they were describing the nerve damage, movement related to cerebral palsy, or my function more broadly.
In rehabilitation, progress is often measured by whether a person can complete a task in the expected way and without help. Walking without a mobility device, fastening clothing independently, or holding an object with a standard grip may be treated as better outcomes. A person may complete the same task with assistance or adaptive equipment. A different technique may also be safer and equally effective. An evaluation centered on independence does not fully account for pain, fatigue, the time required to complete the task, or whether the outcome reflects the person’s own goal.
Research by Feldner et al. (2022) examined the experiences of people with disabilities in rehabilitation education, healthcare, and related settings. Their research found that efforts to normalize, correct, or overcome disability can sometimes take priority over the person’s own experience, goals, and priorities. During my evaluation, the focus remained largely on how my hand compared with a standard range of movement and function. The discussion did not clearly distinguish my longstanding movement patterns from the functional loss that developed after surgery, nor did it establish what I wanted to regain.
Those comparisons can also influence how a person views their own abilities. Internalized ableism may develop when certain ways of moving or completing tasks are repeatedly treated as preferable. Independence can become associated with competence, while the use of assistance or accommodations may be viewed as evidence of lesser ability.
Over time, a person may begin applying those same standards to their own choices, progress, and capabilities. Their assessment of what they can do may then become tied to how closely they conform to those expectations rather than to what works for them.
The result may be a feeling that asking for help represents failure. A successful way of completing a task may be dismissed because it looks different, or an accommodation may be avoided because independence has been presented as the better outcome. Not every person with a disability experiences internalized ableism. The term describes the influence of outside expectations, not a belief that begins with the person or with disability itself.
Research by Jóhannsdóttir et al. (2022) examined internalized ableism through the experiences of young people with disabilities. Participants described pressure to downplay disability, distance themselves from it, and measure themselves against expectations shaped by people without disabilities.
During my evaluation, terms related to expected function were used without making clear what standard I was being compared with. Repeated use of these comparisons can influence how a person defines ability, progress, and success, particularly when the standard does not reflect the person’s own needs, choices, or circumstances.
The same pressures can appear outside formal evaluations and rehabilitation settings. A child may be encouraged to complete a task without help even when doing so requires more time, effort, or causes pain. An adult may feel pressure to manage without an accommodation even when that accommodation makes the task safer or more effective.
In both situations, success can become tied to doing things in a way that appears less disabled. A more useful measure of progress considers whether the person has greater choice, comfort, control, and access to the support needed to accomplish what they want to do.
Language used during an evaluation can repeat the same message. Hearing abnormal or impaired once does not automatically change how a person understands themselves. Repeated use can still reinforce the idea that one way of moving or functioning is preferable, particularly when the words are not connected to a specific test result or functional change.
Research by Friedman, VanPuymbrouck, and Gordon (2024) asked 347 professionals in disability-related fields to define ableism. Their analysis found recurring misunderstandings about ability, othering, language, and assumptions about what people with disabilities can do. Fewer than half of the participants demonstrated a full understanding of ableism.
The study included professionals from several fields, so the findings are not specific to occupational therapy or healthcare and should not be applied to every professional encounter. Even with those limits, the research shows that working with people with disabilities does not automatically mean that a professional fully understands ableism or the assumptions that can shape communication.
My evaluation raised a related concern about how disability-related language was used. Terms related to function were not clearly tied to nerve damage, movement associated with cerebral palsy, or my overall level of function. Without that distinction, it was difficult to understand what the therapists were describing or how their conclusions related to the changes I experienced after surgery.
Measuring my grip strength, movement, and range of motion was appropriate and provided useful information about my function. The problem was not the use of clinical measurements, but the use of words like abnormal and anomaly without explaining what they referred to. When terminology is left undefined, it can obscure rather than clarify the findings. A clinical term is only useful to the person being evaluated when its meaning and relevance are explained.
The Person in the Evaluation Room
The purpose of the evaluation was to determine why the strength and function in my hand had declined after surgery. As the therapists measured my movement and strength, I explained how my hand had functioned before surgery and how cerebral palsy and spasticity affected the way I moved. There was a considerable amount of medical information to explain, hear, and process during the appointment. Stopping to question each unfamiliar or unclear term would have taken attention away from the changes in function I needed the therapists to evaluate.
The terminology was only one concern. Neither provider introduced herself, and I had not been told before the appointment that a student would participate in the evaluation. No one asked whether I was comfortable with the student’s involvement. Those interactions affected how I understood my role in the evaluation and whether I was being included in decisions about what was happening during the appointment.
Research on healthcare interactions involving people with disabilities provides a broader context for these concerns. It looks not only at the words professionals use, but also at whether the person with a disability is spoken to directly, included in the conversation, and involved in decisions about their care.
A 2024 training study involving medical and dental students examined verbal and nonverbal behavior during interactions with people with disabilities. The training addressed disability-related microaggressions, meaning subtle comments, assumptions, or behaviors that can communicate bias or disrespect toward a person with a disability, even when harm is not intended.
Examples included assumptions about a person’s abilities and speaking to a companion rather than directly to the person with a disability. After the training, students reported greater knowledge of disability-related microaggressions, greater comfort discussing them, and a better understanding of how to create more disability-sensitive healthcare environments. Ninety-three percent of students completing the post-training survey said they felt better prepared to contribute to an anti-ableist learning environment (Isaacson et al., 2024).
A separate 2024 qualitative study of people with disabilities receiving mental healthcare found recurring concerns involving misplaced assumptions, limited provider knowledge about disability, medical gaslighting, interpersonal ableism, accessibility barriers, and broader systemic ableism. Participants described situations in which providers misunderstood their experiences or relied on assumptions about disability rather than the person’s stated needs (Wang et al., 2024).
The study focused on mental healthcare, not occupational therapy, so it does not tell us what happens in every occupational therapy setting. It does, however, identify a broader concern across healthcare: assumptions about disability can affect how a provider understands a person’s symptoms, abilities, and experience.
My evaluation raised a similar question. The purpose was to assess a specific decline in hand strength and function following surgery while also accounting for the effects cerebral palsy and spasticity had on movement before surgery. An important part of that process was distinguishing longstanding characteristics from changes that occurred afterward. When the communication and terminology did not clearly make that distinction, it became difficult to tell whether the evaluation was centered on the functional loss I described or whether some observations were being interpreted through assumptions about how a person with cerebral palsy moves and functions.
The research provides useful context for understanding the interaction while recognizing that clinical terminology is not inherently inappropriate or evidence of a microaggression. Terms such as abnormal and atypical can serve a legitimate clinical purpose when they describe a test result that falls outside an expected range, a movement pattern that differs from a standard measurement, or another specific clinical observation.
These terms are easier to understand when they are connected directly to what is being measured or observed. A clinician might be referring to reduced grip strength, restricted movement, altered sensation, or another measurable result, and providing that context makes the meaning clearer. Without it, a person may be left unsure whether the clinician is describing a specific test result, a change in function, or a broader conclusion about the person or their disability.
A More Useful Baseline
Clinical accuracy is one part of effective communication. The language also needs to be specific enough for the person to understand what is being described. A comment about strength can identify the degree or location of weakness. A comment about nerve function can identify what is affected and explain why it matters.
A reduced ulnar nerve response gives the person something concrete to understand. A measurable decrease in grip strength or reduced sensation in the areas supplied by the ulnar nerve does the same.
Terms like abnormal, atypical, or dysfunctional can be difficult to interpret without additional explanation. Even when they are clinically appropriate, the person may not know exactly what the term refers to, how it was determined, or what it means for strength, sensation, movement, or function.
A useful question is whether the person understands what the term refers to and why it is being used. Technical accuracy alone does not mean the language will be understood as intended. When discussing nerve function, strength, sensation, movement, or other functional changes, the language should stay connected to the specific issue being described. This keeps the focus on the clinical issue rather than allowing the language to sound as though it defines the person.
Medical professionals, occupational therapists, physical therapists, and other rehabilitation professionals influence how these encounters are experienced through choices that may seem routine. Introductions help establish who is present and why. Explaining each person’s role gives the patient a clearer understanding of who is participating in the evaluation or treatment. Asking before involving a student also gives the patient an opportunity to understand and agree to that participation.
Language is part of the same interaction. A clinician can identify a functional loss while keeping the description focused on the specific function being assessed. A therapist can describe restricted movement or a difference from an expected clinical range without extending that description beyond what was observed. Documentation can remain accurate and specific. It can also distinguish between a clinical description and the person experiencing it.
An abnormal test result describes the result, not the person. An atypical movement pattern describes a pattern of movement. Impaired function identifies an area in which function has been affected. An anatomical anomaly is a clinical description of a physical characteristic. These terms can be useful, but their meaning is clearer when they remain connected to the specific aspect of function or anatomy they are intended to describe.
The issue may not be the use of a baseline or clinical comparison itself. Comparison is an important part of assessment. It can provide useful information about changes in function. Disability can also affect people differently. Function can change over time, and people with the same diagnosis may have different abilities, limitations, and support needs. A baseline is most useful when it helps explain the individual situation rather than becoming the explanation by itself.
The occupational therapy evaluation provided useful measurements, but it did not provide the explanation or direction I had hoped to receive. Questions remained about the cause of the continuing weakness, the effects of surgery, and the possible role of spasticity. I also left without a clear understanding of what treatment or rehabilitation might be appropriate.
During the evaluation, terms such as “abnormal,” “atypical,” and “anomaly” were used without clearly explaining what specific findings they described or how those findings related to my function and care. Without that context, the terminology added uncertainty rather than helping me understand the results of the evaluation or what they meant for the next steps in treatment.
Words used during an examination are necessarily limited. Their purpose is to describe what was observed, explain its clinical significance, and help determine what may come next. A useful baseline keeps the description connected to the specific movement, measurement, anatomical characteristic, diagnosis, or area of function being discussed. Doing so allows clinical language to remain precise. It also preserves a fuller understanding of the person receiving care.
Words used in an examination room cannot capture a whole person, nor are they meant to. They can identify what was observed, explain its clinical significance, and help guide treatment or further evaluation. A better baseline keeps the clinical description where it belongs: with the specific movement, measurement, diagnosis, or function being discussed. The language should describe the clinical issue without allowing it to define the person receiving care. Good clinical language should clarify care, not reduce a person to the terms used to describe it.
Disclaimer
This opinion essay reflects my personal experience during an occupational therapy evaluation following ulnar nerve surgery. It discusses clinical language used in the course of that evaluation and my understanding of how certain terms were communicated. It is not intended to assess the competence, conduct, or quality of care of any individual provider, facility, or profession, nor should one experience be understood as representative of occupational therapy or rehabilitation practice generally. Any discussion of clinical terminology is presented for purposes of personal commentary and general information only. This essay is not medical, psychological, legal, or other professional advice.
References
- Feldner, H. A., Evans, H. D., Chamblin, K., Ellis, L. M., Harniss, M. K., Lee, D., & Woiak, J. (2022). Infusing disability equity within rehabilitation education and practice: A qualitative study of lived experiences of ableism, allyship, and healthcare partnership. Frontiers in Rehabilitation Sciences, 3, 947592. https://doi.org/10.3389/fresc.2022.947592
- Friedman, C., VanPuymbrouck, L., & Gordon, Z. (2024). “Not seeing people as capable”: Disability professionals’ mis/understandings of ableism. Journal of Applied Research in Intellectual Disabilities, 37(3), e13218. https://doi.org/10.1111/jar.13218
- Isaacson, A., Coleman, J., Fok, K., & Tolchin, D. W. (2024). Creating an anti-ableist learning environment: Development of a novel disability-related microaggressions session for medical and dental students and mixed methods analysis of impact on learning and empowerment. Disability and Health Journal, 17(3), 101584. https://doi.org/10.1016/j.dhjo.2024.101584
- Jóhannsdóttir, Á., Egilson, S. Þ., & Haraldsdóttir, F. (2022). Implications of internalised ableism for the health and wellbeing of disabled young people. Sociology of Health & Illness, 44(2), 360-376. https://doi.org/10.1111/1467-9566.13425
- Wang, K., Ostrove, J. M., Manning, R. B., Fodero, S., Ash, S. L., Whang, J., Bogart, K. R., Cipollina, R., Nario-Redmond, M. R., Adler, J. M., & Lowe, S. R. (2024). Ableism in mental healthcare settings: A qualitative study among U.S. adults with disabilities. SSM: Qualitative Research in Health, 6, 100498. https://doi.org/10.1016/j.ssmqr.2024.100498
Ulnar Nerve Recovery Series
This essay is part of Ulnar Nerve Surgery, Recovery, and Disability, a chronological collection about diagnosis, surgery, hand weakness, rehabilitation, adaptation, and disability-informed care.
