Introduction to Rehabilitation

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Original Editors - Joseph Ayotunde Aderonmu and Naomi O'Reilly

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Introduction[edit | edit source]

Rehabilitation is a concept that is widely discussed globally. This is by no means unexpected since over a billion people live with a form of disability, accounting for over 15% of the world population.[1] Furthermore, between 110 and 190 million adults are faced with significant difficulties that affect their functioning.[1] According to the World Health Organization (WHO), the global demand for rehabilitation is expected to be on the increase, since the world is experiencing changes in the characteristics of the population, especially that which involves an increasingly ageing population with an accompanying increase in chronic diseases and disability. [2]

According to the WHO, rehabilitation is one of the essential components of Universal Health Coverage (UHC), which features alongside “promotion of good health, prevention of diseases, treatment and palliative care”.[2] Thus, rehabilitation focuses on achieving functional independence in activities of daily living (ADL), participation in work, recreation and also education with individuals being able to achieve meaningful roles in daily life.[2] Clearly, rehabilitation is pivotal in achieving not only individual health benefits, but an overall universal health goal that permits the building of a healthy and functional global population.

Definition[edit | edit source]

Fundamentally, rehabilitation is founded on the philosophy that every individual has the inherent tendency and right to be experts of their own health care.[3] This therefore marks the distinction between acute care and rehabilitation; while acute care is concerned with patient’s survival, rehabilitation is concerned with the education and training of individuals to be able to carry out activities of daily living by themselves, thus promoting self care and functional independence.[4]

In terms of definition, rehabilitation has been differently defined by different authorities:

“A set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments.” [5]

“Aims to restore, compensate, prevent or slow deterioration in functioning (sensory, physical, intellectual, mental, cognitive, or social) to help individuals to reach their optimal levels.” [1]

“Refers to services, and programmes designed to assist individuals who have experienced trauma or illness that results in an impairment that creates a loss of function (physical, psychological, social or vocational).” [6]

“A process to restore mental and/or physical abilities lost to injury or disease in order to function in a normal or near-normal way” [7]

For the sake of clarity, a distinction is usually made between rehabilitation and habilitation. Habilitation “aims to help those who acquire disabilities congenitally or early in life to develop maximal functioning.” [8]

Therefore, rehabilitation is an intervention that is individual-focused aimed at enhancing the overall health and functioning. It is highly individualized and varies based on conditions of individuals. For example, it can take a short duration for certain injuries and can be lifelong for certain conditions. Rehabilitation targets improving individual’s functioning, such as in eating, grooming or dressing, and it can also include making changes or modifications to the environment of an individual so as to encourage or enhance functionality.[5]

A core aspect of rehabilitation involves the recognition of the challenges a person has in performing activities of daily living and relating the challenges to factors that are responsible for the challenges, including the environment, structuring rehabilitation goals, establishing a plan for the intervention and utilizing this plan for treatment, then observing the outcomes of the interventions.[9][10]

Historical Perspectives[edit | edit source]

Traditional Perspective[edit | edit source]

Rehabilitation has been traditionally taken to be a secondary approach to health, which aims to restore patients as much as possible to their previous state of health after a disease or an injury, while taking into cognisance the limits that have been imposed by the pathology or the impairments, to foster to the maximum extent the residual physical, mental and social functioning of the patients, and, when appropriate, return patients to their work.[11]

By this perspective, a biomedical approach is being used to address rehabilitation, which broadly makes the following assumptions: [11]

  • Rehabilitation believes that impairments cannot be remediated, and it attempts to overcome, adapt or compensates for it
  • Rehabilitation is apart from treatment, and is a second stage approach, carried out after medical treatment is completed
  • Rehabilitation is multidisciplinary

However, this traditional perspective has been widely criticized, giving way to a newer and more inclusive perspective to rehabilitation.[11]

Modern Perspective[edit | edit source]

Observing from a clinical perspective, symptoms and illnesses often lead to medical conditions, but for these medical conditions to develop into chronic issues and limitations, a number of psychosocial factors are involved.[12][13][14] Yet, from the perspective of the individual with a disability, the restrictions imposed on functioning is based on the organization of the society for people without disabilities.[11] Thus, there is now a wide consensus that human illnesses and disabilities can be rightly understood and managed according to a model that takes into account biological, psychological and social factors, which is known as the biopsychosocial model.[11][15] This model has improved the understanding of rehabilitation.

Biopsychosocial Model to Rehabilitation[edit | edit source]

The biopsychosocial model is focused on the individual, their health challenges and the social factors in rehabilitation.[11] It considers three major components which affect an individual's health and functioning:

Biological[edit | edit source]

This is the physical or mental health condition of an individual.

Psychological[edit | edit source]

This implies that psychological factors also influence the functioning of an individual.

Social[edit | edit source]

Social factors exert pressures and constraints on individual healths, behaviour and functioning. Though these factors are dual-way communications between the environment and the individual, some of these factors which are from the environment must be remediated by the society in order to improve functional outcomes for the patient.

Thus, rehabilitation must address all of these factors which affect an individual’s health and functioning.

Summary[edit | edit source]

Rehabilitation is without doubt a crucial aspect of health that is aimed at enhancing functionality and independence. As a field of health, it has evolved through different stages before arriving at its present model that incorporates different components of biological, psychological and social factors that have effects on the health and functionality of individuals experiencing various health challenges.

Resources[edit | edit source]

References [edit | edit source]

  1. 1.0 1.1 1.2 Duttine A, Battello J, Beaujolais A, Hailemariam M, Mac-Seing M, Mukangwije P, et al. Introduction to Rehabilitation Factsheet. Handicap International. 2016. Available from: https://humanity-inclusion.org.uk/sn_uploads/document/2017-02-factsheet-rehabilitation-introduction-web_1.pdf [Accessed on 8 January, 2020].
  2. 2.0 2.1 2.2 Shimizu Y. Rehabilitation. World Health Organization. 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation. [Accessed on 8 January, 2020].
  3. Gender AR. Scope of rehabilitation and rehabilitation nursing. Chin P, Finocchiaro D. Rosebrough, A. Rehabilitation nursing practice. New york: McGraw-Hill,.1996.
  4. Mauk KL. Overview of rehabilitation. Rehabilitation Nursing: A Contemporary Approach to Practice. 2011.
  5. 5.0 5.1 World Health Organization. World Report on Disability 2011. Geneva: World Health Organization, 2011. Rehabilitation.
  6. Lubkin IM, Larsen PD, editors. Chronic illness: Impact and interventions. Jones & Bartlett Learning; 2006.
  7. National Cancer Institute. Rehabilitation. 2007. Available at: https://www.cancer.gov/search/results?swKeyword=rehabilitation. [Accessed on 8 January, 2020].
  8. Swedish disability policy: services and care for people with functional impairments: habilitation, rehabilitation, and technical aids Stockholm, Socialstyrelsen. The National Board of Health and Welfare, 2006 Article No. 2006–114–24. Available at: http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/9548/2006-114-24_200611424.pdf [Accessed on 8 January, 2020].
  9. Bristol CH. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet, 2008,371:725-735.
  10. Fuzikawa L. Evidence for the effectiveness of rehabilitation-in-the-community programmes. Lepr Rev. 2008;79:65-82.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 Waddell G, Burton AK. Concepts of rehabilitation for the management of common health problems. The Stationery Office; 2004. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/208968/hwwb-concepts-of-rehabilitation.pdf [Accessed 8 January, 2021].
  12. Main CJ, Spanswick CC. Pain management: an interdisciplinary approach. Elsevier Health Sciences; 2000.
  13. Waddell G. Models of disability: using low back pain as an example. Royal Society of Medicine Press; 2002.
  14. Page LA, Wessely S. 2003. Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. Journal of the Royal Society of Medicine 96: 223-227
  15. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36.