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[[File:US Navy 100607-N-5208T-001 Rear Adm. Gerald R. Beaman plays a power chair soccer match with rehabilitating veterans at the Milwaukee VA Medical Center.jpg|300x300px|alt=|thumb|Image.1 Power Chair Football Match at a Veterans Rehabilitation Centre]]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.” <ref>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].</ref> 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.<ref name=":2" />
[[File:US Navy 100607-N-5208T-001 Rear Adm. Gerald R. Beaman plays a power chair soccer match with rehabilitating veterans at the Milwaukee VA Medical Center.jpg|300x300px|alt=|thumb|Image.1 Power Chair Football Match at a Veterans Rehabilitation Centre]]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.” <ref>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].</ref> 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.<ref name=":2" />


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 [[Outcome Measures|outcomes]] of the interventions.<ref>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.</ref><ref>Fuzikawa L. Evidence for the effectiveness of rehabilitation-in-the-community programmes. Lepr Rev. 2008;79:65-82.</ref>
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 [[Outcome Measures|outcomes]] of the interventions.<ref>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.</ref><ref>Fuzikawa L. Evidence for the effectiveness of rehabilitation-in-the-community programmes. Lepr Rev. 2008;79:65-82.</ref>


== Historical Perspectives ==
== Historical Perspectives ==
=== Traditional Perspective ===
Although a comprehensive history of rehabilitation has yet to be written, it is clear that the origins and evolution of rehabilitation science and practice, at least in the USA and Europe, are closely linked to the needs of veterans with permanent injuries returning from wars. 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 consideration 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 indivdual, within all environments.<ref name=":3">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].</ref> By this perspective, a biomedical approach is being used to address rehabilitation, which broadly makes the following assumptions: <ref name=":3" />
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.<ref name=":3">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].</ref>
 
By this perspective, a biomedical approach is being used to address rehabilitation, which broadly makes the following assumptions: <ref name=":3" />
* Rehabilitation believes that impairments cannot be remediated, and it attempts to overcome, adapt or compensates for it
* 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 apart from treatment, and is a second stage approach, carried out after medical treatment is completed
* Rehabilitation is multidisciplinary
* Rehabilitation is multidisciplinary
However, this traditional perspective has been widely criticized, giving way to a newer and more inclusive perspective to rehabilitation.<ref name=":3" />
=== Modern Perspective ===
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.<ref>Main CJ, Spanswick CC. Pain management: an interdisciplinary approach. Elsevier Health Sciences; 2000.</ref><ref>Waddell G. Models of disability: using low back pain as an example. Royal Society of Medicine Press; 2002.</ref><ref>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</ref> 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.<ref name=":3" /> 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.<ref name=":3" /><ref>Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36.</ref> This model has improved the understanding of rehabilitation.
== Biopsychosocial Model to Rehabilitation ==
The [[Biopsychosocial Model|biopsychosocial model]] is focused on the individual, their health challenges and the social factors in rehabilitation.<ref name=":3" /> It considers three major components which affect an individual's health and functioning:


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


=== Psychological ===
However, this traditional perspective has been widely criticized, giving way to a newer and more inclusive perspective to rehabilitation.<ref name=":3" /> 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.<ref>Main CJ, Spanswick CC. Pain management: an interdisciplinary approach. Elsevier Health Sciences; 2000.</ref><ref>Waddell G. Models of disability: using low back pain as an example. Royal Society of Medicine Press; 2002.</ref><ref>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</ref> Yet, from the perspective of the individual, the restrictions imposed on functioning is based on the organization of the society.<ref name=":3" /> 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.<ref name=":3" /><ref>Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36.</ref> This model has improved the understanding of rehabilitation. The [[Biopsychosocial Model|biopsychosocial model]] is focused on the individual, their health challenges and the social factors in rehabilitation.<ref name=":3" /> It considers three major components which affect an individual's health and functioning:
This implies that psychological factors also influence the functioning of an individual.


=== Social ===
* Biological; This is the physical or mental health condition of an individual.
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.
* Psychological; This implies that psychological factors also influence the functioning of an individual.
* Social; 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.
Thus, rehabilitation must address all of these factors which affect an individual’s health and functioning.

Revision as of 18:22, 27 June 2021

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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. Furthermore, according to a recent report, 2.41 billion individuals worldwide live with conditions that impact on their function in daily life and would benefit from rehabilitation services, which equates to 1 in 3 individuals requiring rehabilitation services throughout the course of their illness or injury.[1]

The proportion of the worldwide population over 60 will double in the next 30 years, the majority of whom will live with chronic diseases, particularly noncommunicable diseases. These changing health and demographic trends are contributing to rapid global increases in the numbers of people experiencing decline in functioning, resulting in enormous unmet rehabilitation needs. Much of these unmet needs are concentrated amongst the poorest and most vulnerable populations in low- and middle-income countries and conflict-affected settings, which are often ill equipped to cope with these increasing needs for rehabilitation services.[2][3] 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.

[4]

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.[5] 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.[6] 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.” [7]

“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).” [8]

“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” [9]


Image.1 Power Chair Football Match at a Veterans Rehabilitation Centre
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.” [10] 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.[7]

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.[11][12]

Historical Perspectives[edit | edit source]

Although a comprehensive history of rehabilitation has yet to be written, it is clear that the origins and evolution of rehabilitation science and practice, at least in the USA and Europe, are closely linked to the needs of veterans with permanent injuries returning from wars. 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 consideration 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 indivdual, within all environments.[13] By this perspective, a biomedical approach is being used to address rehabilitation, which broadly makes the following assumptions: [13]

  • 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.[13] 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.[14][15][16] Yet, from the perspective of the individual, the restrictions imposed on functioning is based on the organization of the society.[13] 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.[13][17] This model has improved the understanding of rehabilitation. The biopsychosocial model is focused on the individual, their health challenges and the social factors in rehabilitation.[13] It considers three major components which affect an individual's health and functioning:

  • Biological; This is the physical or mental health condition of an individual.
  • Psychological; This implies that psychological factors also influence the functioning of an individual.
  • Social; 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, societal and contextual factors that have effects on the health and functionality of individuals experiencing various health challenges. Regardless of who the beneficiary is, who delivers it, or the context in which rehabilitation is delivered, optimising functioning is the ultimate objective of rehabilitation and is instrumental to a patient's wellbeing, regardless of the underlying health condition. [18]

Resources[edit | edit source]

References [edit | edit source]

  1. ↑ 1.0 1.1 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. ↑ Cieza, Alarcos. "Rehabilitation the health strategy of the 21st century, really?." Archives of physical medicine and rehabilitation 100.11 (2019): 2212-2214.
  4. ↑ World Health Organisation (WHO). Rehabilitation is about health and functioning in everyday life. Available from: https://youtu.be/uG_VdZe9VNU[last accessed 26/06/2021]
  5. ↑ Gender AR. Scope of rehabilitation and rehabilitation nursing. Chin P, Finocchiaro D. Rosebrough, A. Rehabilitation nursing practice. New york: McGraw-Hill,.1996.
  6. ↑ Mauk KL. Overview of rehabilitation. Rehabilitation Nursing: A Contemporary Approach to Practice. 2011.
  7. ↑ 7.0 7.1 World Health Organization. World Report on Disability 2011. Geneva: World Health Organization, 2011. Rehabilitation.
  8. ↑ Lubkin IM, Larsen PD, editors. Chronic illness: Impact and interventions. Jones & Bartlett Learning; 2006.
  9. ↑ National Cancer Institute. Rehabilitation. 2007. Available at: https://www.cancer.gov/search/results?swKeyword=rehabilitation. [Accessed on 8 January, 2020].
  10. ↑ 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].
  11. ↑ 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.
  12. ↑ Fuzikawa L. Evidence for the effectiveness of rehabilitation-in-the-community programmes. Lepr Rev. 2008;79:65-82.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 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].
  14. ↑ Main CJ, Spanswick CC. Pain management: an interdisciplinary approach. Elsevier Health Sciences; 2000.
  15. ↑ Waddell G. Models of disability: using low back pain as an example. Royal Society of Medicine Press; 2002.
  16. ↑ 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
  17. ↑ Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36.
  18. ↑ Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Dec 19;396(10267):2006-17.

 

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