Unequal neurorehabilitation trajectories – a longitudinal case study combining field structures with social Class–Based Capital Conversion

Inequalities in illness, service provision, and outcomes are all well documented in the universal Nordic welfare state. Long-term Bbrain injury rehabilitation in such context provides a window into hidden aspects of inequalities and the underlying mechanisms on an individual and institutional level, as multifaceted and long-term rehabilitation crosses sectors and legislative regulations. Grounding our research in Bourdieu’s theories, we explore inequality by combining framing structures with a socio-economic perspective of young adults with severe acquired brain injuries (sABI) in order to construct trajectories. A longitudinal case study design encompassing professional records, observations, and interviews enabled us to construct the families’ trajectories during the process of rehabilitation was designed. We found that the rehabilitation process after sABI offers patients unequal access to services and includes various agendas and rules of the game. The ability to navigate this process and overcome barriers was closely related to social class belonging including possession and conversion of cultural health capital (CHC), social and bureaucratic capital and the ability to match the doxas encountered in rehabilitation. These disparities were reflected in the patients’ rehabilitation trajectories characterised by continuity on one extreme and broken trajectories on the other. We conclude that despite the welfare state’s intentions to strive for equality, immanent class relations impact rehabilitation trajectories.