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Insensitivity and lack of awareness of the role of culture can make rehabilitation difficult, particularly in multicultural, multiracial and multilingual.
Stigma. Negative attitudes and erroneous beliefs about disability has resulted in stigma, which has be defined as an attribute possessed by a person or group that is regarded as undesirable or discrediting. For persons with disabilities and their families, stigma often results in a lowering of status within
2. As a nurse i
specialize in helping people with disabilities and chronic illness attain optimal function, health, and adapt to an altered lifestyle.as a Rehabilitation nurse i assist patients in their move toward independence by setting realistic goals and treatment plans.
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Rehabilitation Interventions
Online Course: Introduction to Rehabilitation Interventions
Introduction
If we consider the definition of rehabilitation as “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”, then rehabilitation is in effect composed of multiple components or “interventions” to address issues related to all domains within the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) including: body functions and structures, capacity for activities, the performance of activities, participation, environmental/contextual factors, and personal factors.[1]
Most individuals participating in rehabilitation require interventions addressing one, many or all of the components of the ICF that are contributing to reduced functioning, with the overriding goal of rehabilitation being to utilise appropriate interventions that allow the individual to optimise their function.[1] Given this, individuals with health conditions or injuries may require rehabilitation at various points in time across the course of their lifespan. The timing and type of intervention that a rehabilitation provider selects depend greatly on several factors which include: the aetiology and severity of the person’s health condition; the prognosis; the way in which the person’s condition affects their ability to function in their environment; as well as the individual’s identified personal goals and what it is they want to achieve from the rehabilitation process.
Outcome Orientated
Goal setting in rehabilitation forms the basis for the selection of rehabilitation interventions which can include goals related to mobility, self-care, communication, and cognition and on more specific activities related to play, education, work, employment, socialisation, and quality of life. Different rehabilitation settings may vary in their capacities to provide specific intensities of therapies, and rehabilitation itself may vary in its intensity, generally measured by the frequency and duration of individual interventions or treatment sessions. The selection of rehabilitation interventions and intensity of rehabilitation should always be based on the individual patient’s needs, which should include their tolerance of therapeutic activities. More importantly, rehabilitation interventions should be generally outcome-oriented, in that rehabilitation goals are developed to achieve a specific outcome that is based on the following five broad areas:
Prevention of the loss of function
Slowing the rate of loss of function
Improvement or restoration of function
Compensation for loss of function (compensatory strategies)
Maintenance of current function
Role of Rehabilitation Interventions
Rehabilitation intervention is provided across the whole range of healthcare settings including the primary care setting, in the acute hospital setting (during an inpatient episode or as an outpatient referral) or in the community settings. The breadth of rehabilitation means that a range of organisations may contribute to meeting a person’s individual needs. Rehabilitation intervention is essential in helping to address the impact of: [2]
Physical or Movement Problems such as impaired motor control; reduced range of movement; reduced balance, strength or cardiovascular fitness; loss of limbs; fatigue; pain or stiffness.
Sensory Problems such as impairment of vision or hearing; loss of or altered sensation of touch or movement; pain; sensory processing difficulties.
Cognitive or Behavioural Problems such as lapses in memory and attention; difficulties in organisation, planning and problem-solving.
Communication Problems such as difficulties in speaking; using language to communicate; understanding what is said or written.
Psychosocial and Emotional Problems such as the effects on the individual, carer and family of coping with a new health condition or living with a long-term condition. These can include stress, depression, loss of self-image and cognitive and behavioural issues.
Mental Health Conditions such as anxiety; depression; obsessive/compulsive disorders; schizophrenia; eating disorders; post-traumatic stress disorder and dementia.
Medically Unexplained Symptoms where a holistic approach is needed to ensure the best possible support for both mental and physical wellbeing.
Classification of Interventions
Rehabilitation interventions are hugely diverse and, except in rare instances, require the involvement of many different health and rehabilitation professionals and cross multiple disciplines often at the same time, which as a result make the classification of rehabilitation interventions quite complex. It is this complexity that makes the classification of rehabilitation interventions a challenge, and as a result, there is still no classification that has been universally accepted across all fields of rehabilitation currently, despite several attempts made to develop a classification system to fully describe rehabilitation interventions.[3]
Levack and Dean have outlined three key reasons for this:
Firstly, rehabilitation interventions are not only about the intervention itself and what the healthcare professional does but are significantly influenced by experience and relationships and how the healthcare professional engages and interacts with the individual and other significant people in their lives. It is within these interactions that rehabilitation interventions now work towards changing how patients think about their disability, their motivation for rehabilitation, their self-efficacy and the way they participate within therapeutic activities.[3]
Secondly, most rehabilitation interventions do not work on one component or domain alone but rather involve a number of interacting components.
Example: An occupational therapist may use a simple cooking activity to help an individual regain skills in activities of daily living following a stroke. While the primary focus may be on cooking, the activity itself also incorporates strengthening of weak muscles in a hemiplegic arm and leg (standing in the kitchen, lifting and using kitchen utensils, and bending and reaching); retraining of balance (standing and moving around the kitchen); cardiovascular exercise; conditioning and fatigue management; training in the use of assistive technology (mobility aids and adapted kitchen implements) and cognitive retraining (following a recipe, safe use of an oven). Concurrently, the occupational therapist may also use the same therapy session as an opportunity to provide some education on the nature of stroke and how to adjust for the loss of function on return home, as well as providing general emotional counselling and support. Furthermore, a collaborative approach can be taken to address the patient’s various functional limitations by using the same task but combining the session with another member of their rehabilitation team (e.g. the speech-language therapist or physiotherapist).[3]
rehabilitation interventions can be provided for within a group environment or individually across a broad range of rehabilitation settings from a hospital environment, to primary care and community-based settings such as the home, work, local gym etc. Each approach has its own advantages and disadvantages but no matter what pPhysiopedia
Contents
Editors
Share
Rehabilitation Interventions
Online Course: Introduction to Rehabilitation Interventions
Introduction
If we consider the definition of rehabilitation as “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”, then rehabilitation is in effect composed of multiple components or “interventions” to address issues related to all domains within the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) including: body functions and structures, capacity for activities, the performance of activities, participation, environmental/contextual factors, and personal factors.[1]
Most individuals participating in rehabilitation require interventions addressing one, many or all of the components of the ICF that are contributing to reduced functioning, with the overriding goal of rehabilitation being to utilise appropriate interventions that allow the individual to optimise their function.[1] Given this, individuals with health conditions or injuries may require rehabilitation at various points in time across the course of their lifespan. The timing and type of intervention that a rehabilitation provider selects depend greatly on several factors which include: the aetiology and severity of the person’s health condition; the prognosis; the way in which the person’s condition affects their ability to function in their environment; as well as the individual’s identified personal goals and what it is they want to achieve from the rehabilitation process.
Outcome Orientated
Goal setting in rehabilitation forms the basis for the selection of rehabilitation interventions which can include goals related to mobility, self-care, communication, and cognition and on more specific activities related to play, education, work, employment, socialisation, and quality of life. Different rehabilitation settings may vary in their capacities to provide specific intensities of therapies, and rehabilitation itself may vary in its intensity, generally measured by the frequency and duration of individual interventions or treatment sessions. The selection of rehabilitation interventions and intensity of rehabilitation should always be based on the individual patient’s needs, which should include their tolerance of therapeutic activities. More importantly, rehabilitation interventions should be generally outcome-oriented, in that rehabilitation goals are developed to achieve a specific outcome that is based on the following five broad areas:
Prevention of the loss of function
Slowing the rate of loss of function
Improvement or restoration of function
Compensation for loss of function (compensatory strategies)
Maintenance of current function
Role of Rehabilitation Interventions
Rehabilitation intervention is provided across the whole range of healthcare settings including the primary care setting, in the acute hospital setting (during an inpatient episode or as an outpatient referral) or in the community settings. The breadth of rehabilitation means that a range of organisations may contribute to meeting a person’s individual needs. Rehabilitation intervention is essential in helping to address the impact of: [2]
Physical or Movement Problems such as impaired motor control; reduced range of movement; reduced balance, strength or cardiovascular fitness; loss of limbs; fatigue; pain or stiffness.
Sensory Problems such as impairment of vision or hearing; loss of or altered sensation of touch or movement; pain; sensory processing difficulties.
Cognitive or Behavioural Problems such as lapses in memory and attention; difficulties in organisation, planning and problem-solving.
Communication Problems such as difficulties in speaking; using language to communicate; understanding what is said or written.
Psychosocial and Emotional Problems such as the effects on the individual, carer and family of coping with a new health condition or living with a long-term condition. These can include stress, depression, loss of self-image and cognitive and behavioural issues.
Mental Health Conditions such as anxiety; depression; obsessive/compulsive disorders; schizophrenia; eating disorders; post-traumatic stress disorder and dementia.
Medically Unexplained Symptoms where a holistic approach is needed to ensure the best possible support for both mental and physical wellbeing.
Classification of Interventions
Rehabilitation interventions are hugely diverse and, except in rare instances, require the involvement of many different health and rehabilitation professionals and cross multiple disciplines often at the same time, which as a result make the classification of rehabilitation interventions quite complex. It is this complexity that makes the classification of rehabilitation interventions a challenge, and as a result, there is still no classification that has been universally accepted across all fields of rehabilitation currently, despite several attempts made to develop a classification system to fully describe rehabilitation interventions.[3]
Levack and Dean have outlined three key reasons for this:
Firstly, rehabilitation interventions are not only about the intervention itself and what the healthcare professional does but are significantly influenced by experience and relationships and how the healthcare professional engages and interacts with the individual and other significant people in their lives. It is within these interactions that rehabilitation interventions now work towards changing how patients think about their disability, their motivation for rehabilitation, their self-efficacy and the way they participate within therapeutic activities.[3]
Secondly, most rehabilitation interventions do not work on one component or domain alone but rather involve a number of interacting components.
Example: An occupational therapist may use a simple cooking activity to help an individual regain skills in activities of daily living following a stroke. While the primary focus may be on cooking, the activity itself also incorporates strengthening of weak muscles in a hemiplegic arm and leg (standing in the kitchen, lifting and using kitchen utensils, and bending and reaching); retraining of balance (standing and moving around the kitchen); cardiovascular exercise; conditioning and fatigue management; training in the use of assistive technology (mobility aids and adapted kitchen implements) and cognitive retraining (following a recipe, safe use of an oven). Concurrently, the occupational therapist may also use the same therapy session as an opportunity to provide some education on the nature of stroke and how to adjust for the loss of function on return home, as well as providing general emotional counselling and support. Furthermore, a collaborative approach can be taken to address the patient’s various functional limitations by using the same task but combining the session with another member of their rehabilitation team (e.g. the speech-language therapist or physiotherapist).setting or structure is involved, rehabilitation should always be designed to meet the individual needs of each patient. Given this, being able to adapt, modify, create and be flexible are vital skills required by rehabilitation professionals in order to be able to adapt interventions and therapeutic activities depending not only on the particular spectrum of impairments that someone might present with, but also on the specific goals of rehabilitation for that individual, the environmental context under which a patient is performing targeted activities, and on their personality and personal interests.[3]
Example: An athlete following an ACL injury may start their early rehabilitation individually within the physiotherapy clinical for individual assessment and treatment. This may also be incorporated with some group-based activity with teammates within the gym, where they get to train with teammates while working on their own specific rehabilitation programme and goals. As they progress through their rehabilitation programme and work towards a return to play, rehabilitation may continue to include both individuals, small groups and team-based activities, but may be field or court-based to prepare for a return to competition.
4.
Educate. Rehabilitation is not a magic pill, and education is the vital aspect of the rehabilitation process throughout all stages that ensure 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.
5. Some culture believe poses as a barrier yet rehabilitation would not be full achieved