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Who Provides Rehabilitation and Assistive Technology

Original Editor - Ewa Jaraczewska based on the Creating Awareness of Rehabilitation and Assistive Technology course

Top Contributors - Ewa Jaraczewska, Jess Bell, Rachael Lowe, Tarina van der Stockt and Kim Jackson  

Introduction

Effective rehabilitation care involves a diverse team of healthcare professionals who work collaboratively to provide comprehensive, person-centred care.[1] In many countries, rehabilitation services are increasingly being integrated into primary healthcare systems.[2] This article overviews the key healthcare providers involved in rehabilitation care, from physical and rehabilitation medicine doctors to physiotherapists and occupational therapists, as well as primary care providers and community health workers. It also explores the essential role family members and caregivers can play in supporting rehabilitation outcomes.

Person-Centred Care

Person-centred care recognises each patient as unique.[3] It acknowledges and considers each person's needs, goals, experiences, circumstances and cultural background. Several key principles underscore person-centred care, including respect and dignity, shared decision-making, flexibility, and responsiveness.[4]

Healthcare professionals prioritise respect and dignity by recognising each patient as a whole person, with unique values, beliefs and cultural backgrounds.[5] This approach leads to personalised care planning and meaningful dialogue between clinicians and patients. Clinicians and patients work collaboratively to establish goals and action plans. Healthcare professionals demonstrate respect by acknowledging that while clinical goals are important, patient goals may differ and deserve equal consideration in the treatment planning process.

Shared decision-making is a process where clinicians and patients make decisions together. Healthcare providers present and discuss treatment options using the best available evidence.[6] At the same time, patients share their preferences, goals, experiences and what works for them. Together, they make decisions that reflect clinical evidence and the patient's preferences and goals, as well as their cultural and contextual circumstances.[7]

Healthcare providers can demonstrate flexibility and responsiveness by responding to a patient's changing needs and goals over time. They must be able to communicate and actively engage with patients and caregivers, address their non-clinical needs and respect their preferences and values.[8] They may need to adapt their communication strategies to suit their patient's preferences, offer flexible appointment scheduling and ensure access to appropriate clinicians or equipment. They can demonstrate responsiveness through a willingness to listen to and address any concerns the patient or their family may have.[9]

The Role of Family Members and Caregivers

"A family caregiver is a family member, such as a spouse, child, friend, or unpaid neighbour, who provides care to a person with a chronic illness who needs assistance with daily living tasks, such as bathing, dressing, and taking medicine."[10]

According to the World Health Organization's Global Disability Action Plan 2014-2021, caregivers play an essential role in supporting individuals with disabilities.[11] They can provide emotional, practical, and educational support that is vital for effective rehabilitation. However, healthcare professionals must provide families and caregivers with the proper resources and assistance to deliver care effectively.[12]

Family members need guidance to recognise when professional help is necessary for their loved ones.[13] Receiving education about the patient's condition can help them identify warning signs and signs of an emergency. Resources such as community health programmes and helplines can also provide valuable information for caregivers.[11]

It is important that caregivers understand rehabilitation goals and the management approach to effectively support their loved ones. Education that outlines the rehabilitation process, including expected outcomes and methods, can empower caregivers to meaningfully engage in rehabilitation programmes. Families can help to clarify goals and ensure they align with their loved one's needs by participating in discussions with healthcare providers. Receiving information about treatment options and potential challenges can enhance family involvement and decision-making.

Family members should be given training on the practical skills they need to support rehabilitation efforts.[14] This can include learning to assist with transfers or exercises, manage medications, and provide emotional support. Workshops or training sessions offered by rehabilitation centres can equip family members with the necessary skills to support daily activities.[15] Involving family members in therapy sessions also gives them an opportunity to practise skills they need at home with professional guidance. This approach helps foster a collaborative environment.

Caregivers should also be provided with training on assistive technology (e.g. walking aids, communication devices, etc.).[16] Ideally, they will learn how to use assistive technology products correctly, navigate barriers, and maintain these products. Resource guides from healthcare providers or community organisations can help families understand how to effectively integrate assistive technology into daily routines. This knowledge helps to enhance the patient's independence and empowers families to advocate for appropriate resources.

Primary and Community Healthcare Providers

"Primary care refers to the first point of contact for individuals seeking healthcare services."[17]

The World Health Organization highlights the importance of integrating rehabilitation services into primary healthcare systems to ensure wider accessibility and person-centred care delivery.[18]

Primary healthcare is typically provided by general practitioners, family physicians and paediatricians.[17] Primary healthcare providers can effectively coordinate care between different healthcare and rehabilitation professionals, ensuring an integrated and holistic approach to treatment. In areas where rehabilitation services are not available, many primary care doctors and nurses can be trained to provide basic rehabilitation interventions. Moreover, because of their ongoing relationships with patients and their understanding of their patients' health histories, preferences, and social contexts, they are able to ensure this care is personalised and culturally appropriate.[17]

Community health workers also play an important role in accessible rehabilitation care. They work directly in people's homes, identifying people with rehabilitation needs, providing basic rehabilitation education, helping with exercise programmes, monitoring progress and identifying when referrals to more specialised services may be necessary. They provide a link between healthcare systems and local communities, particularly in areas with limited access to formal healthcare facilities.[5]

Rehabilitation assistants and technicians often work alongside qualified professionals. They help to implement rehabilitation treatment plans and maintain assistive technology products.

In some areas, advanced interprofessional rehabilitation services are integrated into primary healthcare. These teams include a range of professionals, including nurses, physiotherapists, occupational therapists, psychologists and dietitians. Each team member works together to provide comprehensive rehabilitation services in the primary healthcare setting.[19] Collaboration among team members is crucial for effective rehabilitation delivery in primary healthcare settings.[20]

The Rehabilitation Workforce

Effective rehabilitation services rely on a diverse team of healthcare professionals working together to enhance patient outcomes. Each profession brings distinct knowledge and skills, allowing the team to provide care that is tailored to each patient's unique circumstances and needs.[5]

The role of professionals within the rehabilitation team will be highlighted in the following sections using a fictional case example. Joseph is a 55-year-old patient who had a left middle cerebral artery stroke three weeks ago. This stroke has caused right-sided hemiplegia and a right foot drop. Joseph also has developed communication and swallowing difficulties and is struggling to perform most activities of daily living as a result of his stroke. He was previously independent and worked as a teacher. He and his wife live in a second-floor apartment. After his stroke, Joseph was also diagnosed with type 2 diabetes.

Physical and Rehabilitation Medicine Doctor

Physical and rehabilitation medicine (PRM) doctors (also known as rehabilitation physicians or physiatrists) specialise in rehabilitation medicine. Their scope varies in different countries and healthcare systems, but they can work across a range of fields, including orthopaedics, neurology, sports medicine, etc.[21] They are involved in the diagnosis, medical management and delivery of specific rehabilitation interventions. In some settings, they may coordinate with rehabilitation team members, while in others, they focus on the medical aspects of rehabilitation.

Joseph is currently staying in a rehabilitation ward where the PRM doctor is the team leader. The PRM doctor conducts a comprehensive medical assessment and coordinates Joseph's rehabilitation care. They evaluate his stroke-related impairments, prescribe appropriate medications, and establish rehabilitation goals in collaboration with Joseph and the team. The PRM doctor continues to monitor Joseph's medical status, manages risk factors to prevent stroke-related secondary complications, and adjusts the medical aspects of the rehabilitation programme based on Joseph's progress.

Physiotherapist

Physiotherapists work with "individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan."[22] They are involved in health promotion, disease prevention, treatment / intervention and rehabilitation.[22]

Joseph works closely with a physiotherapist in the rehabilitation ward. Together, they focus on improving Joseph's mobility, balance, and motor function. They conduct a full assessment, including muscle strength, range of motion, muscle tone, and movement patterns and then design specific interventions to address identified impairments and regain function. Together, they work on functional tasks such as bed mobility, sitting balance, standing, and walking. The physiotherapist assesses Joseph's needs for mobility aids (e.g. wheelchair or walking aid). They also teach Joseph's wife appropriate positioning techniques.

If you would like to learn more about the role of physiotherapists in the rehabilitation team, please see: Role of Physiotherapist in a Rehabilitation Team.

Occupational Therapist

"Occupational therapy is a client-centred health profession concerned with promoting health and wellbeing through occupation."[23] Occupation is defined as the practical and purposeful activities that allow people to live independently and have a sense of identity.[23]

In the rehabilitation unit, the occupational therapist works with Joseph to help him regain independence in daily activities. After completing a thorough assessment, they provide interventions and adaptive equipment to help him participate in tasks like dressing, bathing, and eating. They assess Joseph's hand position and provide a wrist splint for proper positioning of his right hand, especially at night. The occupational therapist is also involved in evaluating Joseph's home environment, recommending environmental modifications such as grab bars in the bathroom and a shower chair. They would also consider Joseph's return to work, focusing on workplace modifications, upper limb rehabilitation and cognitive strategies to help him eventually return to work-related tasks.

If you would like to read more about occupational therapy, please see: Role of Occupational Therapist in a Rehabilitation Team.

Prosthetist and Orthotist

Prosthetists and orthotists "are health care professionals who use evidence-based practice to provide clinical assessment, prescription, technical design, and fabrication of prosthetic and/or orthotic devices."[24]

Joseph is referred to the orthotist for his right foot drop. The orthotist fabricates and fits Joseph with an ankle foot orthosis (AFO). They ensure that it fits properly and make adjustments to prevent pressure injuries or discomfort. They observe Joseph during a physiotherapy session to ensure that the AFO safely and effectively supports Joseph's ankle.

If you would like to learn more about the role of the orthotist and prosthetist, please see: Role of Prosthetists and Orthotists in a Rehabilitation Team.

Speech and Language Therapist

Speech and language therapists (pathologists) are specialists in communication, voice, speech, language, hearing, feeding and swallowing, as well as the social and cognitive aspects of communication. They provide assessment, diagnosis, treatment and support across the lifespan for people who have difficulties with communication, feeding, and swallowing.[25]

The speech and language therapist addresses Joseph's communication and swallowing difficulties. They assess his speech and language abilities, diagnose specific areas of impairment, and develop a treatment plan to improve his verbal expression and comprehension. They also evaluate his swallowing function, recommend appropriate food textures, and teach safe swallowing techniques to prevent aspiration. The therapist works with Joseph and his wife on communication strategies and exercises to improve his speech clarity.

If you would like to learn more about speech and language therapy, including their assessment and intervention techniques, please see: Role of Speech and Language Therapist in a Rehabilitation Team.

Other Healthcare Professionals in Rehabilitation

Depending on the country and healthcare setting, many other healthcare professionals may be part of the rehabilitation team. Their involvement varies based on local healthcare structures, available resources, and individual needs.[5]

The following healthcare providers may also contribute to Joseph's rehabilitation journey.

Rehabilitation Nurse

Rehabilitation nurses play a key role in rehabilitation by supporting basic body functions, coordinating interventions, and enabling mobility and self-care.[26]

They monitor Joseph's vital signs, manage his medications, provide essential care and assist with bladder and bowel management. They also reinforce therapy techniques throughout the day, ensuring Joseph practises appropriate transfers, positioning and activities of daily living. Rehabilitation nurses work closely with Joseph's wife, teaching her necessary caregiving skills for when Joseph returns home.

Clinical Psychologist

Psychologists have an important role in promoting healthy behaviours and enhancing a patient's quality of life. They assess, diagnose, and treat psychological issues and behavioural dysfunctions that are associated with physical and mental health conditions.[27]

The clinical psychologist helps Joseph cope with the emotional impact of his stroke. They identify that he has post-stroke depression and anxiety and establish an appropriate care plan. The psychologist provides counselling to help Joseph adjust to his new circumstances and develop coping strategies. They also use cognitive behavioural therapy to help Joseph manage his frustration during the rehabilitation process. In addition to these interventions, they work with Joseph's wife to address caregiver stress and help the couple adapt to their changed roles.

Social Worker

Social workers address the psychosocial needs of patients through a biopsychosocial lens. They provide psychosocial assessment, information and counselling, health education, discharge planning, and case management.[28]

The social worker assists Joseph and his family with the practical aspects of recovery. They help navigate insurance coverage, coordinate community resources, and plan for discharge. The social worker assesses the family's financial situation, considering Joseph's inability to work, at least in the short term, and connects them with appropriate support services. They also help arrange home modifications and community support services and assist in planning Joseph's eventual return to work, possibly in a modified capacity.

Dietitian

Dietitians promote health and prevent and treat illness by optimising the nutrition of individuals, communities and populations.[29] They assess a patient's needs, create personalised meal plans and provide guidance on healthy eating.

Given Joseph's swallowing difficulties, the dietitian works closely with the speech and language therapist to ensure proper nutrition while maintaining safe swallowing. The dietitian assesses his nutritional needs, considering factors like preventing weight loss during recovery and managing his new diagnosis of diabetes. The dietitian develops a meal plan that meets his nutritional requirements while adhering to the recommended food textures. They also provide education to Joseph's wife on meal preparation and proper nutrition for stroke recovery and diabetes.

If you would like to learn more about dietitians and their role, please see: Role of Dietitian in a Rehabilitation Team.

Ophthalmologist or Optometrist

Ophthalmologists are medical doctors who specialise in eye and vision care. They diagnose and treat all eye diseases, perform eye surgery and prescribe and fit eyeglasses and contact lenses to correct vision problems. Optometrists are healthcare professionals who can complete comprehensive eye examinations, prescribe and fit glasses and contact lenses, diagnose certain eye conditions, and prescribe medications for some eye conditions.[30]

If Joseph's stroke had affected his visual field, an ophthalmologist would have assessed the extent of his visual impairment and provided appropriate interventions. They would also work with the occupational therapist to develop strategies to compensate for visual field deficits during daily activities. The ophthalmologist would monitor for other vision changes and prescribe appropriate visual aids to support Joseph's rehabilitation and eventual return to reading and computer work.

Audiologist

Audiologists are experts in the prevention, identification, assessment, treatment and (re)habilitation of auditory and vestibular difficulties across the lifespan.[31]

Although Joseph does not have a direct hearing impairment from his stroke, an audiologist could assess his hearing to ensure optimal communication during rehabilitation. This is particularly important given his speech therapy needs. If they did identify subtle auditory processing difficulties that could affect his communication recovery, they would provide strategies to enhance his ability to follow complex conversations.

For further information on the role of the audiologist, please see: Role of Audiologist in a Rehabilitation Team.

Conclusion

Rehabilitation care starts with the person at the centre. Patients are supported by a range of people, from their family and caregivers to community health workers, primary healthcare workers and rehabilitation professionals.

Rehabilitation professionals bring unique skills and knowledge to each person's rehabilitation journey. They work collaboratively with the entire rehabilitation team to help a person maximise their recovery and independence.

Resources

References

  1. ↑ Doornebosch AJ, Achterberg WP, Smaling HJA. Interprofessional collaboration during multidisciplinary team meetings in geriatric rehabilitation: an observational study. BMC Geriatr. 2025 Mar 29;25(1):213.
  2. ↑ Waterworth CJ, Smith F, Kiefel-Johnson F, Pryor W, Marella M. Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low- and middle-income countries: a scoping review. Disabil Rehabil. 2024 Dec;46(25):5965-5976.
  3. ↑ Lefurgey S, Detillieux S, Shaheen A, Daigle P, Nolan D, Rudnick A. Person-Centered Care: Learning from the Evolution of Mental Health Care. Encyclopedia. 2025; 5(1):29.
  4. ↑ Nelson MLA, MacEachern E, Prvu Bettger J, Camicia M, García JJ, Kapral MK, Mathiesen C, Cameron JI; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Exploring the Inclusion of Person-Centered Care Domains in Stroke Transitions of Care Interventions: A Scientific Statement From the American Heart Association. Stroke. 2024 Jun;55(6):e169-e181.
  5. ↑ 5.0 5.1 5.2 5.3 Xuan D. Who Provides Rehabilitation and Assistive Technology Course. Plus, 2025.
  6. ↑ Barton S. Using clinical evidence. BMJ. 2001 Mar 3;322(7285):503-4.
  7. ↑ Tzelepis F, Sanson-Fisher RW, Zucca AC, Fradgley EA. Measuring the quality of patient-centred care: why patient-reported measures are critical to reliable assessment. Patient Prefer Adherence. 2015 Jun 24;9:831-5.
  8. ↑ Delaney LJ. Patient-centred care as an approach to improving health care in Australia. Collegian. 2018 Feb 1;25(1):119-23.
  9. ↑ Tarrant C, Angell E, Baker R, Boulton M, Freeman G, Wilkie P, Jackson P, Wobi F, Ketley D. Responsiveness of primary care services: development of a patient-report measure – qualitative study and initial quantitative pilot testing. Southampton (UK): NIHR Journals Library; 2014 Nov. (Health Services and Delivery Research, No. 2.46.) Chapter 1, Introduction and background. Available fromhttps://www.ncbi.nlm.nih.gov/books/NBK263686/ [last access 16.03.2025]
  10. ↑ Reinhard SC, Given B, Petlick NH, Bemis A. Supporting Family Caregivers in Providing Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 14.Available from: https://www.ncbi.nlm.nih.gov/books/NBK2665/ [last access 29.01.2025]
  11. ↑ 11.0 11.1 World Health Organization. WHO Global disability action plan 2014-2021. Better health for all people with disability [Internet]. Geneva, 2015. Available from: https://iris.who.int/bitstream/handle/10665/199544/9789241509619_eng.pdf?sequence=1 (accessed 28 January 2025).
  12. ↑ Sidek NN, Kamalakannan S, Tengku Ismail TA, Musa KI, Ibrahim KA, Abdul Aziz Z, Papachristou Nadal I. Experiences and needs of the caregivers of stroke survivors in Malaysia-A phenomenological exploration. Front Neurol. 2022 Sep 23;13:996620.
  13. ↑ Wu X, Liang Y, Zheng B, Wang H, Ning M, Zheng H, Shi B. Care stress in caregivers of disabled stroke patients: a cross-sectional survey. Ann Palliat Med. 2020 Jul;9(4):2211-2220.
  14. ↑ Schumacher KL, Stewart BJ, Archbold PG, Dodd MJ, Dibble SL. Family caregiving skill: development of the concept. Res Nurs Health. 2000 Jun;23(3):191-203.
  15. ↑ Weir RL, Danilovich MK, Hoover DL. A systematic review of the effectiveness of caregiver training with functional mobility tasks for informal caregivers assisting patients with neurological diagnoses. Disabil Rehabil. 2022 Sep;44(18):5082-5089.
  16. ↑ Islam M, Khandaker N, Rahman MS, Sultana A, Yasmin K, Dewan PD, Islam MH, Hasan K, Ranjan R. Efficacy of Caregivers Training in Rehabilitation of Stroke Survivors in Bangladesh: A Quasi-experimental Study. Cureus. 2023 Jan 16;15(1):e33812.
  17. ↑ 17.0 17.1 17.2 Gemperli A, Essig S. Editorial: The role of primary and community care in rehabilitation. Front Rehabil Sci. 2023 Jul 12;4:1235049.
  18. ↑ World Health Organization. Rehabilitation 2030: a call for action. Available from https://cdn.who.int/media/docs/default-source/documents/health-topics/rehabilitation/callforaction2.pdf?sfvrsn=50299fc6_2&download=true (accessed 13 March 2025).
  19. ↑ Ravn MB, Uhd M, Svendsen ML, Ørtenblad L, Maribo T. Why Do Patients With Ischaemic Heart Disease Drop Out From Cardiac Rehabilitation in Primary Health Settings. A Qualitative Audit of Patient Charts. Front Rehabil Sci. 2022 Apr 4;3:837174.
  20. ↑ Wener P, Leclair L, Fricke M, Brown C. Interprofessional Collaborative Relationship-Building Model in Action in Primary Care: A Secondary Analysis. Front Rehabil Sci. 2022 May 31;3:890001.
  21. ↑ Arabi H. Physical Medicine and Rehabilitation: From the Birth of a Specialty to Its Recognition. Cureus. 2021 Sep 2;13(9):e17664.
  22. ↑ 22.0 22.1 World Physiotherapy, Description of Physical Therapy Policy Statement, 2019. Available from: https://world.physio/sites/default/files/2020-07/PS-2019-Description-of-physical-therapy.pdf (accessed 16 March 2025).
  23. ↑ 23.0 23.1 World Federation of Occupational Therapists (WFOT). About Occupational Therapy. Available from: https://wfot.org/about/about-occupational-therapy (accessed 18 March 2025).
  24. ↑ International Society for Prosthetics and Orthotics. ISPO Education Standards for Prosthetic and Orthotic Occupations. ISPO, 2018.
  25. ↑ Professional Profile. Available from https://eslaeurope.eu/wp-content/uploads/2021/06/ESLA-Statement-on-SLT-Professional-Profile.pdf (accessed 17 March 2025).
  26. ↑ Gutenbrunner C, Stievano A, Stewart D, Catton H, Nugraha B. Role of Nursing In Rehabilitation. J Rehabil Med Clin Commun. 2021 Jun 14;4:1000061.
  27. ↑ Wahass SH. The role of psychologists in health care delivery. J Family Community Med. 2005 May;12(2):63-70.
  28. ↑ Freymüller N, Knoop T, Meyer-Feil T. Social work practice and outcomes in rehabilitation: a scoping review. Front Rehabil Sci. 2024 Nov 18;5:1348294.
  29. ↑ Dietitians Australia. Dietitians and nutritionists. Available from: https://dietitiansaustralia.org.au/seeing-dietitian/what-expect/dietitians-and-nutritionists (accessed 18 March 2025).
  30. ↑ American Association for Pediatric Ophthalmology & Strabismus. Difference between an Ophthalmologist, Optometrist and Optician. Available from: https://aapos.org/glossary/difference-between-an-ophthalmologist-optometrist-and-optician (accessed 17 March 2025).
  31. ↑ American Academy of Audiology. Scope of Practice.https://www.audiology.org/practice-resources/practice-guidelines-and-standards/scope-of-practice/ (accessed 17 March 2025).
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