Self Care and Participation in Function Based Rehabilitation
Top Contributors - Ewa Jaraczewska and Jess Bell
Introduction
The ultimate goal of rehabilitation is to ensure that people with health conditions can function optimally within their environment and maintain the highest possible quality of life. The ability to perform self-care forms the foundation of a patient's independence, while community participation promotes overall well-being and reduces isolation.
Self-care includes a range of tasks, from basic activities, like bathing and dressing, to more complex tasks like household management. Various health conditions can impact a person's ability to maintain self-care and community engagement. Well-coordinated rehabilitation strategies with a multidisciplinary approach can help patients achieve meaningful roles in their daily lives. This article discusses the importance of self-care and community participation in function-based rehabilitation. It offers practical insights into how rehabilitation teams can better support patients in achieving functional independence and maintaining active participation in their communities.
Self-Care and Rehabilitation
"The aim of rehabilitation is to ensure that people with health conditions can function optimally within their environment and to reduce disability."[1]
Function-based rehabilitation can help an individual achieve functional independence in activities of daily living (ADL), participate in work, recreation, and education and achieve meaningful roles in daily life.[1]
Self-care may include bathing, personal hygiene, dressing, toileting, feeding, household chores, and going shopping.[1]
Physical dysfunction from an acute, chronic or degenerative health condition can affect a person's level of independence in self-care.[2] Rehabilitation interventions and assistive technology can positively impact the performance and satisfaction of an individual with physical dysfunction.[2]
The following examples guide you through the role of different rehabilitation team members in specific rehabilitation scenarios.
Example: An individual with a recent stroke wants to be able to eat independently[1]
Overall goal: to be able to eat independently and prevent complications
Activity analysis: the components of eating include:
- mobility and positioning: (1) transfer to appropriate seating, (2) maintain an upright position, and (3) maintain balance during meal duration
- physical components: (1) orient to plate location, (2) grasp and hold utensils, (3) scoop food, (4) bring food to the mouth, (5) open/close mouth, (6) chew and swallow effectively, and (7) clean the mouth area
To help the patient achieve their goal of independent eating, each member of the rehabilitation team focuses on specific areas and activities:
- doctor: monitors medical stability and oversees overall patient care
- physiotherapist: provides safe mobility training, teaches transfer techniques, and works on sitting balance, endurance, and postural control
- speech and language therapist (pathologist): performs a swallowing assessment, recommends an appropriate diet, and offers communication strategies
- occupational therapist: prescribes assistive devices (built-up spoons, plate guards), completes a wheelchair/seating assessment, trains eating techniques, and works on upper limb coordination activities
- nursing staff: implement strategies introduced by other team members, provide supervision during meals, ensure proper positioning, promote independence, and carry over therapy recommendations
- psychologist: offers adjustment support and coping strategies and ensures emotional well-being
The absence of rehabilitation services can significantly impact patient outcomes and increase the risk of preventable complications, which may include chest infections, aspiration pneumonia, poor positioning-related issues, and decreased quality of life.
Example: An individual with a spinal cord injury needs an effective bowel management programme on discharge home[1]
Overall goal: to achieve predictable bowel movements that fit in with the patient's home routine
Activity analysis:
- mobility and positioning: improving physical abilities for safe transfers
- physical components: educating on independent bowel management and providing training on equipment and routines
- environmental components: adapting the home environment for accessibility
- psychological component: addressing emotional and practical support needs
To achieve the overall goal, the rehabilitation team will focus on the following key activities:
- doctor and nurses: establish the patient's individualised bowel programme, including pharmacological and non-pharmacological interventions and educate the patient on how to follow the bowel programme with or without a caregiver
- physiotherapist: improve the patient's strength, mobility, and balance to enable safe bed mobility and transfers
- occupational therapist: assess the home environment and make necessary adaptations to ensure bathroom accessibility and safety, prescribe appropriate assistive technologies, such as a commode, to support bowel management at home and train the patient and the caregiver on how to use the adapted equipment and environment
- doctor, nurses, and occupational therapist: provide comprehensive education and training to the patient and the caregiver on managing the bowel routine at home
- psychologist: support the patient with the emotional challenges of incontinence and bowel management
- social worker: arrange for a caregiver to assist the patient and connect them with community resources
- dietitian: advise the patient on an appropriate diet using readily available foods at home to support the bowel programme
The multidisciplinary rehabilitation team is essential in supporting this patient in managing their bowel programme effectively at home after discharge. By addressing the physical, environmental, educational, emotional, and practical aspects of care, the team can ensure the patient has the knowledge, skills, resources, and support to maintain predictable bowel movements, access the toilet independently, identify and address any complications, and integrate the bowel programme into her home routine.
Community Participation and Rehabilitation
"Community participation is engaging in activities within the community. Examples include pursuing leisure or recreational interests and hobbies, engaging in regular sporting activities, accessing the community and its resources."[1]
Community participation has various benefits. It can decrease isolation and reduce the negative effects of isolation on health. It can also promote a sense of belonging in the community, help with stress management and have a positive impact on a person's overall health.[3]
Example: A teenager with a long-standing diagnosis of polio is not participating in any community leisure or sports activities[1]
Overall goal: to be able to actively participate in community activities
Activity analysis:
- community participation restrictions: limited mobility and cumbersome gait, lack of awareness or access to adapted activities, concerns about bladder incontinence, fatigue and body image issues impacting self-esteem, difficulty accessing the community due to transportation
To achieve the patient's goal of increased participation, the rehabilitation team will focus on the following key activities:
- doctor, nurses, pelvic physiotherapist: manage bladder incontinence
- physiotherapist: improve mobility, strength, and balance, and collaborate with an orthotist on assistive devices
- occupational therapist and social worker: address community access barriers, provide education and training, connect with resources
- psychologist: provide mental health support and counselling
By taking a holistic, multidisciplinary approach, the rehabilitation team can address the various factors hindering the patient's community participation and empower the patient to reintegrate successfully into the local community.
The Impact of Health Conditions on Self-Care and Participation
Acute Conditions
Hospitalisation leads to a decline in an individual's ability to perform self-care.[4] During hospitalisation for an acute health condition, a healthcare team provides interventions to prevent complications and to encourage healing. These interventions may include mobilising the patients for meals, giving encouragement and assistance to eat, walk or use the toilet, and engaging the family in promoting self-care-related tasks.[4] The goal is for an individual to be up and moving with the appropriate restrictions and to be able to participate in activities at home as soon as possible. Rehabilitation in these areas can be integrated into medical specialities in tertiary and secondary healthcare.[1]
Chronic Conditions
Understanding self-care and participation becomes particularly complex when considering individuals living with chronic conditions. While these individuals may have previously undergone rehabilitation, it's crucial to recognise that their circumstances and abilities can evolve.[1] The dynamic nature of chronic conditions necessitates regular assessment of self-care and participation levels during routine healthcare interactions.
There is a two-directional relationship between health status and self-care and participation. Health impacts an individual's ability to participate in self-care and other tasks. For example, an individual who is experiencing complications or symptoms may be limited in their ability to engage in various activities. At the same time, participation and self-care levels impact health. For example, the manner and extent of an individual's participation in daily activities can influence if they develop or can manage complications.[1]
Research by Hauser and colleagues,[5] focusing on community-dwelling older adults with chronic conditions, revealed significant insights into participation patterns. Their study identified physical limitations and environmental constraints as two primary barriers.[5] However, this research highlighted that individuals can continue to participate when targeted adaptations are successfully implemented and the individual is motivated despite these challenges. This understanding reinforces the importance of considering barriers and potential adaptations when developing rehabilitation strategies.
Degenerative Conditions
Degenerative conditions present unique challenges to maintaining participation and self-care. As these conditions progress over time, individuals often experience a gradual regression in their abilities.
The healthcare team must adapt to the changing needs of individuals with degenerative conditions. They must understand barriers to self-care and participation[6] and monitor for any signs of decline in individuals with degenerative conditions, which requires continuous assessment.[6] They must make proactive adjustments to a person's environment and assistive technology needs and choose activities that allow maximal participation in daily life, even as dependence on support increases.
Rehabilitation efforts focused on self-care and community participation must be integrated into the primary healthcare or community-based rehabilitation services accessed by those with degenerative conditions. This holistic approach ensures that all aspects of the individual's functioning and quality of life are addressed in a coordinated manner.
Outcomes of Rehabilitation in Self-Care and Participation
Effective rehabilitation in self-care is important as it can enhance independence, improve quality of life, and reduce caregiver burden. Positive outcomes can be achieved through adaptive strategies, assistive devices, education and training.[1]
Effective rehabilitation in community participation is important because it fosters social inclusion, promotes mental and physical well-being, and enhances a sense of purpose. Community-based programmes, support groups, advocacy and awareness are strategies leading to achieving good outcomes.[1]
To achieve these outcomes, rehabilitation specialists can ensure the following:
- Regular assessments of participation levels during routine follow-ups. These assessments should include:
- functional capacity
- environment
- activity analysis
- participation barriers
- cultural context
- Monitoring outcomes over time:
- progress tracking
- adjust goals
- quality of life
- participation levels
- outcomes measures
- Exploring both barriers and facilitators to participation:[1]
- home adaptation
- work modification
- community access
- assistive technology
- education on the benefits of community participation
- education and instruction on adapting activities to the individual's disability
- connection with community resources
Van Dam et al.[7] have found that assistive living technology (ALT) increases independence for people with a physical disability by allowing them to control their environment and perform and adapt ADLs.
- Supporting the development and implementation of adaptive strategies through direct interventions:
- ADL training
- instrumental activities of daily living (IADL) support
- adaptive strategies
- energy conservation
- work simplification
A study by Thichanpiang et al.[8] on occupational therapists' experience with home adaptation and assistive technology as "interventions for older individuals and persons with disabilities" indicated that these interventions can reduce the risk of falls and help to improve function and safety when performing activities for these individuals.
- Fostering motivation and resilience in maintaining participation through advocacy and empowerment:
- rights awareness
- community integration
- vocational support
- social participation
- inclusion strategies
- Providing education and training:
- patient education
- family training
- community education
- health literacy
- support systems
Resources
- Assistive technologies are central to the realization of the Convention on the Rights of Persons with Disabilities
- Occupational Therapy Practice Framework Table: Occupations
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Oelofse W. Self-Care and Participation in Function-Based Rehabilitation. Plus Course 2024
- ↑ 2.0 2.1 Luthfi M.The effectiveness of assistive devices for activity daily living (ADL) among people with physical dysfunction. Proceedings of the 6th International Conference on Vocational Education Applied Science and Technology (ICVEAST 2023). Atlantis Press 2023: 985-991.
- ↑ Haricharan HJ, Stuttaford M, London L. The role of community participation in primary health care: practices of South African health committees. Prim Health Care Res Dev. 2021 Jun 15;22:e31.
- ↑ 4.0 4.1 Rodrigues C, Mendonça D, Martins MM. Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial. Porto Biomed J. 2020 Nov 18;5(6):e086.
- ↑ 5.0 5.1 Hauser DR, Tripathi NS, Smith MN, Williams CL, Lefebvre BM, Ly A, Higgins MK. The Impact of Chronic Conditions on Leisure Participation among Community-Dwelling Older Adults. Physical & Occupational Therapy In Geriatrics 2022, 40(4), 419–443.
- ↑ 6.0 6.1 Kooranian F, ParsaYekta Z, Rassouli M. Barriers and challenges to self-care among older adults with knee osteoarthritis: a qualitative study. Ethiopian Journal of Health Sciences. 2022 Sep 20;32(5):963-74.
- ↑ Van Dam K, Gielissen M, Bles R, van der Poel A, Boon B. The impact of assistive living technology on perceived independence of people with a physical disability in executing daily activities: a systematic literature review. Disabil Rehabil Assist Technol. 2024 May;19(4):1262-1271.
- ↑ Thichanpiang P, Sansri V, Thongchoomsin S, Juntorn S, Wangkawan T, Sorasak S, Baramee P, Permpoonputtana K, Thawisuk C, Nopparat C, Kaunnil A. Occupational Therapists' Experience of Using Home Adaptation and Assistive Products as Interventions for Older Individuals and Persons with Disabilities in Thailand. The Qualitative Report 2023, 28(3), 761-783.