The clinician's voice of brain and heart: a bio-psycho-ecological framework for merging the biomedical and holistic

Effective stroke rehabilitation and the reduction of disability demand the best of biomedical sciences, but that science must be framed within a more holistic perspective that recognizes the essential nature and uniqueness of lived experiences as they occur within physical and cultural places. The traditional biomedical and the dominant biopsychosocial frameworks of disease are not sufficient to characterize the causes and meaning of disability. The bio-psycho-ecological framework is offered as a necessary expansion of the biomedical and biopsychosocial models of illness to guide disability research, to frame rehabilitation care, and to enrich disability studies. Two research projects are presented to illustrate the importance of and synergies between measurable and subjective aspects of science. The first example, as a comparative effectiveness study, has the potential to justify alternative patterns of rehabilitation services through quantifiable evidence. The second example, as a clinical tool for empowerment, has the potential to make those services more personally meaningful through the analysis of patients' preferences and life worlds. The combination of qualitative with quantitative scientific methods can yield a deeper understanding of disability and rehabilitation practices than either type of approach alone.