Principles of Rehabilitation

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Original Editors - Joseph Ayotunde Aderonmu and Naomi O'Reilly

Top Contributors - Kim Jackson      

Introduction[edit | edit source]

The vast benefits of rehabilitation stem from a robust foundation that is hinged on rehabilitation principles. These principles are essential aspects of rehabilitation that distinguishes the medical approach to treatment from the rehabilitation approach. Thus, it is responsible for the orientation and uniqueness of rehabilitation and its professionals.

Foundations of Rehabilitation[edit | edit source]

Rehabilitation is founded on the philosophy that every person has the right to be in charge of their health, and they also have inherent worth.[1] This philosophy results in the viewpoint of every individual as being a comprehensive, holistic and unique entity.[2] This makes the rehabilitation team responsible for providing the necessary training, knowledge and skills to the person with a disability, enhancing and maximising their independent function.[2]

The Rehabilitation Model[edit | edit source]

In the medical model of care, the physician is tasked with ensuring the survival of a patient.[2][3] The physician is in an active role of diagnosis and treating a patient with the patient performing a passive role in the process of care.[3] Therefore, the medical model's direction is towards acute diseases, specific organs, and the body's systems. This model is useful in addressing various critical conditions. Still, it becomes very limited in helping patients with conditions where functionality and participation in activities is the real challenge.[3] To put this in perspective, in a condition such as stroke, the concerns of the patient may go beyond addressing pains or spasticity, but be centred on functionality in returning to work, sexuality, grooming and transfers, and so on.

On the other hand, the rehabilitation model shifts its focus from the disease to the individual with the disability following a disease condition.[2] The rehabilitation model focuses on empowering the individual with disabilities actively on ways to learn to maximise his/her residual functions, intending to limit impairments and disabilities.[3] This rehabilitation role is carried out by a team of rehabilitation professionals, including physicians, nurses, physical therapists, occupational therapists, speech/language therapists, psychologists, social workers and so on.[3] Through this model, the patient can recover holistically, and rather than the disease being treated alone, both the patient and the diseases are healed, including the family members of the patients, who are carried along the rehabilitation process to enable them to understand the condition and develop strategies to manage the individual with the disability effectively.[3]

Principles of Rehabilitation[edit | edit source]

Principles direct the discharge of rehabilitation care. These principles guide the rehabilitation professional in developing the plan of care for the individual undergoing rehabilitation.[2][4] Also, rehabilitation principles need to be understood by all rehabilitation team members to obtain desirable outcomes in the process of rehabilitation.

The principles which guide rehabilitation follow below.

Promote Adaptation[edit | edit source]

The challenges that accompany disabilities are often overwhelming for the patient, and they are not only physical but also emotional.[2] Due to this, to obtain desired results in rehabilitation, there must be an understanding of the client's condition. This understanding must be channelled to support, encourage and build strength and resourcefulness in the patient.[2]

It is also essential for rehabilitation practitioners to understand that total recovery may not always apply to rehabilitation patients. Therefore, they must know that rehabilitation helps individuals adjust to challenging health conditions and not only “recover” from them.[2] The term “recovery,” often gets misunderstood by patients as different from what a health professional may intend.[5] Therefore, the use of “adaptation” may create more realistic suggestions to the patient 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 limitation and increase in community reintegration levels 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.[6]

Emphasise Abilities[edit | edit source]

Rehabilitation emphasises an optimistic perspective for individuals who have undergone different health challenges based on life-altering conditions.[2] 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 patient.[7]

Treat the Whole Person[edit | edit source]

A foundation principle in rehabilitation is a holistic approach to treatment.[8] It has to be remembered at all times that an individual is being treated and not the disease. This means that patient's preferences, background, culture, religious beliefs, social support, physical abilities, developmental stages, psychology, and others must be considered as plans of care are being developed by the rehabilitation team members. [2][9]

Time[edit | edit source]

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. [10][11] Broadly time is important in rehabilitation. Early commencement of rehabilitation can reduce the risk of readmission for certain conditions like chronic obstructive pulmonary diseases [12], improve motor function in spinal cord injury [13] and stroke and so on.

Educate[edit | edit source]

Rehabilitation is not magical, and patients and caregivers have to be educated on what the rehabilitation of the specific condition that is being managed entails.[14] Education of patients in rehabilitation enables patients to assume better responsibilities for their health, promotes patient-centred care, and promotes individual independence in activities and involvement in rehabilitation plans.[14]

Conclusion[edit | edit source]

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 in activities for the patient.

Resources[edit | edit source]

References [edit | edit source]

  1. Gender A. Scope of Rehabilitation and Rehabilitation Nursing. Rehabilitation Nursing Practice. McGraw-Hill. 1998. pp.3-20
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Mauk KL. Overview of rehabilitation. Rehabilitation Nursing: A Contemporary Approach to Practice. 2011.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Cobble N, Burks JS. Introduction to principles of rehabilitation. Journal of Neuro. 1990.
  4. Habel M. Rehabilitation: Philosophy, goals, and process. McCOURT, AE (Ed.). 1993.
  5. Easton KL. Gerontological rehabilitation nursing. WB Saunders Company; 1999.
  6. Rawl SM, Easton KL, Kwiatkowski S, Zemen D, Burczyk B. Effectiveness of a nurse‐managed follow‐up program for rehabilitation patients after discharge. Rehabilitation Nursing. 1998 Jul 8;23(4):204-9.
  7. Cardol M, Jong BD, Ward CD. On autonomy and participation in rehabilitation. Disability and rehabilitation. 2002 Jan 1;24(18):970-4.
  8. Barnitt R, Pomeroy V. An holistic approach to rehabilitation. British Journal of Therapy and Rehabilitation. 1995 Feb 2;2(2):87-92.
  9. Lindberg J, Kreuter M, Taft C, Person LO. Patient participation in care and rehabilitation from the perspective of patients with spinal cord injury. Spinal Cord. 2013 Nov;51(11):834-7
  10. Burns AS, Marino RJ, Kalsi-Ryan S, Middleton JW, Tetreault LA, Dettori JR, Mihalovich KE, Fehlings MG. Type and timing of rehabilitation following acute and subacute spinal cord injury: a systematic review. Global spine journal. 2017 Sep;7(3_suppl):175S-94S..
  11. Fehlings MG, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke DS, Chiba K, Dettori JR, Furlan JC, Harrop JS, Hawryluk G. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of rehabilitation. Global spine journal. 2017 Sep;7(3_suppl):231S-8S.
  12. Fehlings MG, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke DS, Chiba K, Dettori JR, Furlan JC, Harrop JS, Hawryluk G. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of rehabilitation. Global spine journal. 2017 Sep;7(3_suppl):231S-8S.
  13. Sumida M, Fujimoto M, Tokuhiro A, Tominaga T, Magara A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Archives of physical medicine and rehabilitation. 2001 Mar 1;82(3):391-5.
  14. 14.0 14.1 Dreeben-Irimia O. Patient education in rehabilitation. Jones & Bartlett Publishers; 2010 Oct 22.