What is Rehabilitation? Principles and Benefits of Rehabilitation

What is rehabilitation?

Rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.  

Put simply, rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. It does so by addressing underlying conditions (such as pain) and improving the way an individual functions in everyday life, supporting them to overcome difficulties with thinking, seeing, hearing, communicating, eating or moving around.

Rehabilitation

Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease or illness, or because their functioning has declined with age.

Some examples of rehabilitation include:

  • Exercises to improve a person’s speech, language and communication after a brain injury.
  • Modifying an older person’s home environment to improve their safety and independence at home and to reduce their risk of falls.
  • Exercise training and education on healthy living for a person with a heart disease.
  • Making, fitting and educating an individual to use a prosthesis after a leg amputation.
  • Positioning and splinting techniques to assist with skin healing, reduce swelling, and to regain movement after burn surgery.
  • Prescribing medicine to reduce muscle stiffness for a child with cerebral palsy.
  • Psychological support for a person with depression.
  • Training in the use of a white cane, for a person with vision loss.
  • Rehabilitation is highly person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences. Rehabilitation can be provided in many different settings, from inpatient or outpatient hospital settings, to private clinics, or community settings such as an individual’s home.

The rehabilitation workforce is made up of different health workers, including but not limited to physiotherapists, occupational therapists, speech and language therapists and audiologists, orthotists and prosthetists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses.

Principles of Rehabilitation

Principles direct the discharge of rehabilitation care. These principles guide the rehabilitation professional in developing the plan of care for the individual undergoing rehabilitation. Also, rehabilitation principles need to be understood by all rehabilitation team members to obtain desirable outcomes in the process of rehabilitation. The following principles guide rehabilitation;

Promote Adaptation

The challenges that accompany impairments and loss of function are often overwhelming for the patient, and often include physical, social and emotional challenges. Due to this, to obtain desired results in rehabilitation, there must be an understanding of the overall individuals condition. This understanding must be channeled to support, encourage and build strength and resourcefulness.

It is also essential for rehabilitation practitioners to understand that total recovery may not always to the end goal for rehabilitation for many individuals, but rather to maximise function. Therefore, they must know that rehabilitation helps individuals adjust to challenging health conditions and not only “recover” from them. The term “recovery,” often gets misunderstood by the individual as different from what a health professional may intend. 

Principles of Rehabilitation

Therefore, the use of “adaptation” may create more realistic suggestions to the individual to enable them to cope and make adjustments with alterations, which have occurred following a health condition especially conditions which involve making lifelong changes.

Indeed, reduction in activity limitations and increase in community participation and reintegration occurs with rehabilitation, yet, creating a sense of adaptation in the patient increases their level of self-confidence and improves their acceptance of their self-image and adjustment to roles following health challenges.

Emphasise Abilities

Rehabilitation emphasises an optimistic perspective for individuals who have undergone different health challenges based on life-altering conditions. Therefore, rehabilitation focuses not on what is lost but what can be regained and achieved through mutual goal-setting by the rehabilitation professional and the individual.

Treat the Whole Person

A foundation principle in rehabilitation is a holistic approach to treatment. It has to be remembered at all times that an individual is being treated and not the disease. This means that individual's preferences, background, culture, religious beliefs, social support, physical abilities, developmental stages, psychology must be considered as plans of care are being developed by the rehabilitation team members. 

Time

The impact of time on rehabilitation has been widely studied from the best period to commence rehabilitation to the duration necessary for rehabilitation to achieve the greatest benefits.  Broadly time is important in rehabilitation. Early commencement of rehabilitation can reduce the risk of readmission for certain conditions like chronic obstructive pulmonary diseases, improve motor function in spinal cord injury  and stroke and so on.

Educate

Rehabilitation is not magic pill, and educate is the vital aspect of rehabilitation process throughout all stages that ensures the individual and their support structures have a good understanding of what is going on, in order to set realistic expectations and set SMART goals. Education of the individual in rehabilitation enables that person to assume responsibility for their health, promotes patient-centred care, and promotes the greatest level of independence in activities and involvement in rehabilitation plans.

People Centred Care

An approach to care that consciously adopts individuals’, caregivers’, families’ and communities’ perspectives as participants in, and beneficiaries of, trusted health systems that are organised around the comprehensive needs of people rather than individual diseases, and respects social preferences. People-centred care also requires that patients have the education and support they need to make decisions and participate in their own care and that caregivers are able to attain maximal function within a supportive working environment. People-centred care is broader than patient and person-centred care, encompassing not only clinical encounters, but also including attention to the health of people in their communities and their crucial role in shaping health policy and health services.

Rehabilitation and restorative nursing care are designed to assist residents to attain and maintain the highest level of physical, mental, and psychological function possible in light of each resident’s unique situation. Both types of care are based on a belief in the dignity and worth of each resident. The residents’ individual abilities, strengths, and needs are considered. The principles of restorative nursing care apply to all residents. They are:

Begin treatment early. Starting restorative care soon after admission or early in the disease will improve the outcome.

Activity strengthens and inactivity weakens. Keep residents as active as possible. Encourage independence, even if the resident is cognitively impaired.

Prevent further disability. For example, nursing personnel develop a preventive care plan for high-risk conditions, such as falls, pressure ulcers, contractures, and deformities. Practice safety.

Stress the resident’s ability and not the disability. Emphasize what the resident can do. Avoid expressions such as, “You can’t use your right arm.” Instead, say, “You can use your left arm.” Do not assume the resident cannot complete a task until you’ve tried, particularly with residents who are cognitively impaired.

Treat the whole person. You cannot isolate a medical problem from the rest of the person. Consider all of the resident’s strengths and needs. Use and build on the strengths to overcome the needs.

Understanding the foundations and principles of rehabilitation equips the professional with the essential knowledge to confidently and accurately approach rehabilitation to promote the most significant gains in functional independence and participation.

Benefits of Rehabilitation

The benefits of rehabilitation

Rehabilitation can reduce the impact of a broad range of health conditions, including diseases (acute or chronic), illnesses or injuries. It can also complement other health interventions, such as medical and surgical interventions, helping to achieve the best outcome possible. For example, rehabilitation can help to reduce, manage or prevent complications associated with many health conditions, such as spinal cord injury, stroke, or a fracture.

Rehabilitation helps to minimize or slow down the disabling effects of chronic health conditions, such as cardiovascular disease, cancer and diabetes by equipping people with self-management strategies and the assistive products they require, or by addressing pain or other complications.

Rehabilitation is an investment, with cost benefits for both the individuals and society. It can help to avoid costly hospitalization, reduce hospital length of stay, and prevent re-admissions. Rehabilitation also enables individuals to participate in education and gainful employment, remain independent at home, and minimize the need for financial or caregiver support.

Rehabilitation is an important part of universal health coverage and is a key strategy for achieving Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages”.

Misconceptions about rehabilitation

Rehabilitation is not only for people with long-term or physical impairments. Rather, rehabilitation is a core health service for anyone with an acute or chronic health condition, impairment or injury that limits functioning, and as such should be available for anyone who needs it.

Rehabilitation is not a luxury health service that is available only for those who can afford it. Nor is it an optional service to try only when other interventions to prevent or cure a health condition fail.

For the full extent of the social, economic and health benefits of rehabilitation to be realized, timely, high quality and affordable rehabilitation interventions should be available to all. In many cases, this means starting rehabilitation as soon as a health condition is noted and continuing to deliver rehabilitation alongside other health interventions.                    
Principles and Benefits of Rehabilitation

Unmet global need for rehabilitation

Globally, about 2.4 billion people are currently living with a health condition that benefits from rehabilitation. With changes taking place in the health and characteristics of the population worldwide, this estimated need for rehabilitation is only going to increase in the coming years.

People are living longer, with the number of people over 60 years of age predicted to double by 2050, and more people are living with chronic diseases such as diabetes, stroke and cancer. At the same time, the ongoing incidence of injury (such as a burn) and child developmental conditions (such as cerebral palsy) persist. These health conditions can impact an individual’s functioning and are linked to increased levels of disability, for which rehabilitation can be beneficial.

In many parts of the world, this increasing need for rehabilitation is going largely unmet. More than half of people living in some low- and middle-income countries who require rehabilitation services do not receive them. The COVID-19 pandemic has led to a new increase in rehabilitation needs as well as causing severe disruption to existing rehabilitation services in 60-70% of countries worldwide.
  • Global rehabilitation needs continue to be unmet due to multiple factors, including:
  • Lack of prioritization, funding, policies and plans for rehabilitation at a national level.
  • Lack of available rehabilitation services outside urban areas, and long waiting times.
  • High out-of-pocket expenses and non-existent or inadequate means of funding.
  • Lack of trained rehabilitation professionals, with less than 10 skilled practitioners per 1 million population in many low- and middle-income settings.
  • Lack of resources, including assistive technology, equipment and consumables.
  • The need for more research and data on rehabilitation.
  • Ineffective and under-utilized referral pathways to rehabilitation.
  • Rehabilitation in emergencies
Natural hazards such as earthquakes or disease outbreaks and human induced hazards including conflict, terrorism or industrial accidents can generate overwhelming rehabilitation needs as a result of injury or illness. They also simultaneously disrupt existing services and have the greatest impact on the most vulnerable populations and the weakest health systems.

While the important role of rehabilitation in emergencies is recognized in clinical and humanitarian guidelines, it is rarely considered as part of health system preparedness and early response. The result is that pre-existing limitations in rehabilitation services are magnified, health service delivery is less efficient, and people directly affected are at risk of increased impairment and disability.

WHO response

For rehabilitation to reach its full potential, efforts should be directed towards strengthening the health system as a whole and making rehabilitation part of health care at all levels of the health system, and as part of universal health coverage.

In 2017, WHO launched the Rehabilitation 2030 initiative, which emphasizes the need for health system strengthening, and calls for all stakeholders worldwide to come together to work on different priority areas, including: improving leadership and governance; developing a strong multidisciplinary rehabilitation workforce; expanding financing for rehabilitation; and improving data collection and research on rehabilitation.

WHO is responding to the identified challenges and promoting health system strengthening for rehabilitation through:

Providing technical support and building capacity at country level
Increasing leadership, prioritization and resource mobilization
Developing norms, standards and technical guidance
Shaping the research agenda and monitoring progress

The rehabilitation program

Rehabilitation medicine is designed to meet each person's specific needs; therefore, each program is different. Some general treatment components for rehabilitation programs include the following:
  • Treating the basic disease and preventing complications
  • Treating the disability and improving function
  • Providing adaptive tools and altering the environment
  • Teaching the patient and family and helping them adapt to lifestyle changes
The success of rehabilitation depends on many variables, including the following:
  • The nature and severity of the disease, disorder, or injury
  • The type and degree of any resulting impairments and disabilities
  • The overall health of the patient
  • Family support
Areas covered in rehabilitation programs may include the following:
  1. Patient need
  2. Self-care skills, including activities of daily living (ADLs)
  3. Example
  4. Feeding, grooming, bathing, dressing, toileting, and sexual function
  5. Physical care
  6. Nutritional needs, medication, and skin care
  7. Family support
  8. Assistance with adapting to lifestyle changes, financial concerns, and discharge planning 
  9. Psychological counseling
  10. Identifying problems and solutions with thinking, behavioral, and emotional issues 
  11. Pain management
  12. Medications and alternative methods of managing pain 
  13. Vocational training
  14. Work-related skills
  15. Socialization skills
  16. Interacting with others at home and within the community 
  17. Cognitive skills
  18. Memory, concentration, judgment, problem solving, and organizational skills 
  19. Communication skills
  20. Speech, writing, and alternative methods of communication 
  21. Respiratory care
  22. Ventilator care, if needed; breathing treatments and exercises to promote lung function 
  23. Mobility skills
  24. Walking, transfers, and self-propelling a wheelchair 
  25. Education
  26. Patient and family education and training about the condition, medical care, and adaptive techniques 

Dr Rohit Bhaskar, Physio
Dr Rohit Bhaskar, Physio Dr. Rohit Bhaskar, Physio is Founder of Bhaskar Health and Physiotherapy and is also a consulting physiotherapist. He completed his Graduation in Physiotherapy from Uttar Pradesh University of Medical Sciences. His clinical interests are in Chest Physiotherapy, stroke rehab, parkinson’s and head injury rehab. Bhaskar Health is dedicated to readers, doctors, physiotherapists, nurses, paramedics, pharmacists and other healthcare professionals. Bhaskar Health audience is the reason I feel so passionate about this project, so thanks for reading and sharing Bhaskar Health.

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