Introduction to Rehabilitation
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 the conditions that impact their functions 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.
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 non-communicable diseases. These changing health and demographic trends are contributing to rapid global increases in the number 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.
According to the World Health Organisation (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”. Thus, rehabilitation focuses on achieving functional independence in activities of daily living (ADL), participation in work, recreation and education, with individuals being able to achieve meaningful roles in daily life. 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 an expert in their own health care. This, therefore, marks the distinction between acute care and rehabilitation, where acute care is concerned with an individual’s survival, while 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. Despite this there is currently no universal definition or understanding of rehabilitation, and it is portrayed in many ways depending on the context, including as a development issue, disability issue, health issue, human rights issue, substance abuse issue, and security issue, to name a few. As such there are a broad range of definitions for rehabilitation used by different authorities:
“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).” 
“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.” 
“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” 
Rehabilitation is one of the core health strategies of the World Health Organisation, along with the promotion, prevention, treatment, and palliative care. WHO defines 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.” 
Rehabilitation is then a "set of interventions designed to optimise functioning in individuals with health conditions in interaction with their environment". Health conditions can refer to disease (acute or chronic), injury or trauma, which may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition. Anyone with a health condition who experiences some form of limitation in functioning, such as mobility, vision, or cognition, may need rehabilitation. As such rehabilitation is best characterised through use of the biopsychosocial model through the use of interventions that address impairments, activity limitations and participation restrictions, considering contextual factors both personal and environmental, including assistive technology that impact functioning.
Rehabilitation should be seen as an essential service offered across all levels of the health care system. Many people without long-term impairments will need rehabilitation services at some point in their lives. Similarly, many people with long-term impairments do not constantly need rehabilitation services e.g., a person with a spinal cord injury may need intensive rehabilitation in the months following their initial spinal cord injury, but once they have received enough therapy to function to their maximum capabilities and have been provided with the assistive devices they need to enable them to continue to function well in their community and home environment, then they may not need to access more rehabilitation services. Some people with long-term impairments may also need episodic rehabilitation services, such as persons with depression or degenerative conditions.
Rehabilitation is a highly person-centered health strategy where treatment caters to the underlying health conditions as well as the goals and preferences of the user. Information on functioning is essential to decision-making in rehabilitation at all levels of the health system since the goal of rehabilitation is to optimize functioning in light of impairments, injuries, & acute or chronic diseases:
- At the user level, information on functioning guides goal setting and outcome evaluation across the continuum of rehabilitation care (primary, secondary and tertiary), and in the treatment phases (acute care, post-acute care and long-term care).
- At the facility or programme level, information on functioning from users can be aggregated to help monitor clinical outcomes and improve service planning and quality assurance.
- At the policy level, aggregated clinical information on functioning gives policy-makers a source of evidence for planning health and rehabilitation services and monitoring their impact.
Rehabilitation occurs across the life-course, from newborns to end-of-life, can occur from before a health condition (preventative ‘prehabilitation’, promotive), in acute care, and post-acute to long-term care and that rehabilitation interventions’ are provided by many health and non-health professionals, as well as individuals, their families and carers. By restoring, preventing, or slowing deterioration in functioning (sensorial, physical, intellectual, mental, cognitive, or social), rehabilitation places the person at the center of the process and it helps people in reaching their full potential and encourages participation in society. Its impact is therefore, not only on the individuals, but also on their families, communities, and economies.
Rehabilitation Elements[edit | edit source]
Dietz  described four elements of rehabilitation in relation to people with cancer, which has now been utilised and applied across rehabilitation for a wide range of conditions: preventive, restorative, supportive, palliative:
Preventative Rehabilitation[edit | edit source]
Occurs shortly after a new diagnosis or onset of new impairments. The aim is to provide education, advice and interventions to prevent or slow onset of further impairments and maintain a person’s level of ability. This is a common form of rehabilitation in long-term conditions, such as Cancer, Chronic Obstructive Pulmonary Disease (COPD), Diabetes and many neurological conditions. It also underpins supported self-management and can include interventions aimed at maintaining function for as long as possible.
Restorative Rehabilitation[edit | edit source]
Restorative rehabilitation focuses on interventions that improve impairments such as muscle strength or respiratory function and cognitive impairment to get maximal recovery of function. This is a common form of rehabilitation after surgery, illness or acute events such as a major trauma or a stroke in order to maximise function.
Supportive Rehabilitation[edit | edit source]
Supportive rehabilitation increases a person’s self-care ability and mobility using methods such as providing self-help devices and teaching people compensatory strategies or alternative ways of doing things. This may include the provision of assistive equipment or environmental modifications. This is sometimes referred to as adaptive rehabilitation. 
Palliative Rehabilitation[edit | edit source]
Palliative rehabilitation enables people with life limiting conditions to lead a high quality of life physically, psychologically and socially, while respecting their wishes. It often focusses on relieving symptoms, such as pain, dyspnoea and oedema, preventing contractures, breathing assistance, psychological wellbeing, relaxation or the use of assistive device, in order to maximise functional independence and support comfort, dignity and quality of life.
Rehabilitation Objectives[edit | edit source]
Rehabilitation objectives include:
- 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
Rehabilitation Outcomes[edit | edit source]
Rehabilitation outcomes are the benefits and changes in the functioning of an individual over time that are attributable to a single measure or set of measures. There is also compelling evidence that rehabilitation services can also deliver long-term cost reductions and add value and equality across the health and care system. They may include:
- Prevention and Reduction in Demand for Health Services
- Integration of out-of-hospital care, so length of stay and unplanned admissions can be reduced
- Fewer Hospital Admissions or Readmissions
- Decreased Length of Stay
- Increased independence
- Increased self-management of condition
- Decreased burden of care
- Return to role/occupation that is age, gender, and context-relevant (e.g. home care, school, work)
- Improved quality of life
Range and Scope of Rehabilitation[edit | edit source]
Rehabilitation covers an enormous spectrum within our patients’ pathways. It includes support to learn basic communication skills; exercise classes to improve or maintain optimum health, wellbeing and occupation; and complex neurological rehabilitation following major trauma or stroke. Rehabilitation may be appropriate at any age as a person’s needs change through the course of their life. For example, they may require support to:
- Develop New Skills - Children may require help to develop skills (habilitation) in order to overcome barriers presented by developmental difficulties and health conditions to achieve maximum health and independence. 
- Maintain Skills and Independence - for progressive conditions (such as dementia, motor neurone disease and terminal cancer), early diagnosis, assessment and rehabilitation intervention can help people to maintain their skills and independence for as long as possible. 
- Enhance Performance - Rehabilitation will provide the opportunity to enhance performance in athletes and sports people following injury or time away from sport.
- Recover from Unexpected Illness - such as depression, anxiety, psychosis, acute admission to hospital following a stroke, surgery, a fall, chest infections and cardiac events. 
- Recover from Major Trauma - Rehabilitation and reablement help people to regain and maximise their skills and independence, including returning to work.
- Manage Long-term Conditions - When people with a chronic or long-term condition become unexpectedly ill or have an exacerbation, they benefit from rehabilitation intervention to help them regain or maximise their independence. 
- Self-manage Conditions - People with a chronic or long-term condition are enabled to manage their own health and reduce the risk of developing secondary complications affecting either their mental or physical health, such as loss of strength and cardiovascular fitness, contractures, pressure ulcers, pain, anxiety and depression. 
- Access Advocacy - People who are vulnerable and need support (such as those with cognitive impairment or communication difficulties) are offered advocacy as part of their rehabilitation interventions.
Misconceptions about Rehabilitation[edit | edit source]
Summary[edit | edit source]
Rehabilitation is, without doubt, a crucial aspect of health that is aimed at enhancing function 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 function of individuals experiencing various health challenges. Regardless of who the beneficiary is, who delivers it, or the context in which rehabilitation is delivered, optimising function is the ultimate goal of rehabilitation and is instrumental to a patient's wellbeing, regardless of the underlying health condition.  By restoring, preventing or slowing deterioration in functioning (sensorial, physical, intellectual, mental, cognitive, or social), rehabilitation places the person at the centre and contributes to people reaching their full potential and participating in society.  Its impact is therefore not only on the individuals, but also on their families, communities, and economies. 
Resources[edit | edit source]
References [edit | edit source]
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