What is Rehabilitation

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Original Editor - Kim Jackson

Top Contributors - Kim Jackson and Aminat Abolade  

Introduction

The term "rehabilitation" is used in many different contexts but the general underlying definition is based on the idea that each person has the right to be an active participant and expert in identifying their needs and making decisions on their health care.. This definition helps to define the difference between acute care and rehabilitation. Acute care is focused on an individual's survival, whereas rehabilitation relates to the education and training of individuals so that they can live independent lives by focusing on the promotion of self-care and functional independence.This general definition has differing meanings depending upon the context, for example, whether discussing a disability issue, health issue, substance abuse or behavioural issue. This article will focus on rehabilitation in a health context.

Rehabilitation in a Health Setting

In health, when referring to acute or chronic diseases, injury or trauma, rehabilitation can be defined as "set of interventions designed to optimise functioning in individuals with health conditions in interaction with their environment". In fact it describes any individual that is unable to function without limitations due to any circumstance including age, acquired or genetic disorder or dysfunction relating to a life event, stress or congenital anomalies.

The key factor in patient care is to help people improve their function and strive towards independence, following an acute injury or diagnosis of a long term condition. For many this is only possible through access to rehabilitation services. Rehabilitation can be preventative, restorative, supportive or palliative. 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”.

According to estimates, more than a billion people—more than 15% of the world's population—live with some kind of impairment. Additionally, 2.41 billion people live with illnesses that affect their ability to carry out everyday tasks and would benefit from rehabilitation services, which translates to 1 in 3 people needing these services over the length of their sickness or injury.

The Role of the Rehabilitation in Healthcare

Rehabilitation aims to provide people with the tools they need to live their lives to the fullest. It assists individuals in regaining skills, abilities, or knowledge that may have been lost or compromised as a result of illness, injury, or disability. To help identify rehabilitation needs The World Health Organisation (WHO) developed the International Classification of Functioning, Disability and Health (ICF) that describes health domains from the perspectives of the body, the individual and society. In contrast to the ICD-10, which is used to classify health conditions, the ICF focuses on how an injury, disease, or disorder affects an individual's functioning and participation in daily activities. The rehabilitation needs have been categorised into the following domains:

• Mental/cognitive functions - There are many diseases and disorders, such as genetic disorders, stroke or traumatic brain injury, that can affect a person's cognitive and perceptual functions Rehabilitation can help to:
  • improve memory and attention through exercises based on scientific evidence
  • ensure safety and improve engagement in activities of daily living through practice, education and the provision of aids and adaptations
• Emotional functions - There are many emotional disorders that affect a person's ability to function, such as anxiety disorder, depression, and bipolar disorder. In many cases, the goal of treating symptoms can be complex and involve not only medical and pharmacotherapy interventions but also education, counselling, and emotional support, as well as teaching techniques that help prevent and manage stress.
• Vision impairment - The rehabilitation of visual impairments can go beyond the assessment and correction of deficits. A person may need help adapting their environment and with practicing daily activities such as basic skills at home, navigating life in the community, such as identifying landmarks and using public transport.They may also need education and support to adapt and adjust to their vision loss
• Speech, language, and communication - The art of expression and being understood depends on clear speech, the right use of words and how we use language and gestures. Difficulties such as aphasia (understanding or communicating language) or speech apraxia (the mental functioning and sequencing of complex movements) can occur due to developmental delays, learning difficulties such as autism spectrum disorders or attention deficit hyperactivity disorders, or following neurological impairments and degenerative conditions such as stroke, Parkinson's, head injury and dementia.
• Dysphagia management - The symptoms and consequences of dysphagia, the inability to swallow foods and liquids. can impact a persons wellbeing and ability to thrive. Without treatment these symptoms can result in choking and aspiration pneumonia. Although not all cases of dysphagia can be cured with the right intervention the symptoms can be managed. The most common symptoms include:
  • coughing or choking when eating or drinking
  • regurgitation of food through the mouth or nose
  • the feeling of food being stuck in the throat or chest
  • persistent drooling
  • the inability to chew food properly
• Nutrition - A well balanced diet is important in restoring and/or optimising health. The body requires energy, proteins and unsaturated fat to help healing and recovery after injury or illness.. Malnourishment either through lifestyle choices or illness can impact on health and recovery.
• Pain Management - Pain can have an impact on a patient's physical, emotional and social well being. Early intervention and adopting a multidisciplinary approach to pain can greatly improve function for patients experiencing acute and chronic pain. Focusing on a patient's needs and goals, rather than focused on individual symptoms has been shown to improve a patient's feelings of control and empowerment as well as adherence and positive outcomes of interventions.
• Bowel/Bladder management and toileting - There are many factors involved in managing symptoms relating to the bowel and the bladder. Alongside cathertisation and bowel management interventions, providing education on dietary choices or instruction on strengthening the pelvic floor can have a positive effect and can empower the patient to make lifestyle changes!
• Respiration functions - Conditions that compromise the respiratory system such as Asthma, COPD, and pneumonia can diminish function, cause shortness of breath and severely impact function. Interventions to educate, treat and prevent breathing difficulties can improve mental and physical well-being.
• Cardiovascular and haematological functions - Stroke, cardiovascular disease, and oedema are examples of cardiovascular and circulatory problems that can result in disability, necessitating not only lifestyle changes but also adaptations to allow independence. Rehabilitation can help patients adopt healthy habits and engage in safe physical activity by providing advice and support. Individuals may require advice on aids and adaptations, nutrition, and/or physical activity depending on their needs.
• Motor functions and mobility- Motor skills can be improved with timely interventions such as aids, adaptations, and exercise. By addressing balance, gait, and upper limb function, re-education of normal movement through advice, training, and exercise can benefit both acute injuries and chronic conditions.
• Activities of daily living - Education, advice and practice in self care, activities of daily living, and leisure and sporting activities can help to improve, safety, independence and participation in social and community life.

These domains provide a common language for identifying and categorising patients' rehabilitation needs, as well as identifying appropriate interventions that empower and promote participation in society. To provide seamless, cost-effective, rehabilitation services it is important to adopt a team approach to care. The approach adopted can be influenced by available workforce, patient needs and cost.

Rehabilitation Teams in Healthcare

Many terms used to describe rehabilitation teams in healthcare. The terms "intradisciplinary", "interdisciplinary", "transdisciplinary", and "multidisciplinary" are increasingly being used interchangeably. These terms describe the varying degrees of the involvement of various disciplines within the team environment, but there are some significant differences between these differing approaches to care.

• Intradisciplinary (unidisciplinary) teams are composed of professionals from one single discipline.
• Interdisciplinary are teams that have overlapping roles that work together to achieve common goals.
• Transdisciplinary teams have flexible roles and responsibilities. They share roles to maximise communication, interaction, and cooperation. Overlapping responsibilities allows flexibility in problem-solving and team interdependence. From day one, team members collaborate to solve problems. This approach eliminates discipline hierarchies and improves organization-wide communication and cooperation.
• Multidisciplinary teams have been described as the main mechanism for ensuring a seamless service and truly holistic care for patients across the boundaries of primary, secondary, and tertiary care and discharge planning from hospital. The importance of incorporating the MDT into a patient's care is important because of the:
  • The increasing complexity and specialisation of care
  • Increasing co-morbidities
  • Increasing chronic disease
  • Global workforce shortages
  • Safe working hours initiatives

The Role of the Multi-disciplinary Team in Rehabilitation

Each member of the multi-disciplinary team (MDT) has a role in improving a person's everyday function and reducing the risk of individuals developing complications which may lead to further health interventions. The team consists of a group of people who have complementary skills and share common goals! Each member of the team collaborates closely to set goals and develop care plans to help patients with their ever-changing physical, psychological, and social needs. Because patient needs are often complex, the members of the team involved in patient care will differ depending on the healthcare setting, available resources, and, most importantly, the patient's individual needs.

Physiotherapist

Physiotherapists are experts in human movement... Physiotherapists are valuable members of multidisciplinary teams when treating acute and chronic pain. They contribute significantly to health promotion, prevention, screening, triage, assessment, and treatment activities. Aside from musculoskeletal conditions, physiotherapists play an important role in the treatment and maintenance of chronic conditions such as cardiovascular disease, chronic obstructive pulmonary disease, diabetes, osteoporosis, obesity, and hypertension.

Occupational Therapist

Occupational Therapists work with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation and/or the environment to better support their occupational engagement.

Speech and Language Therapist

Speech and Language Therapist, also known as speech and language pathologists, are specialists in the area of communication, voice, speech, language, hearing, feeding, swallowing, as well as the social and cognitive aspects of communication

Prosthetist and Orthotist

Prosthetist and Orthotists are technically separate disciplines, but their common goals in rehabilitation unite them into one cooperative entity. In some cases, individuals may have dual training, while others have training only in prosthetics or orthotics.

Podiatrist

Podiatrist specialise in the diagnosis and treatment of lower limb conditions, common foot ailments and chronic medical conditions that affect the feet and lower limbs.

Dietician

Dieticians assess, diagnose and treat dietary and nutritional problems with their overall aim to promote good health and prevent disease in individuals and communities.

Psychologist

Psychologist work with individuals, families and groups to reduce distress and to enhance and promote psychological well-being, minimise exclusion and inequalities and enable individuals to engage in meaningful relationships and valued work and leisure activities

Social Worker

Social Workers facilitate and enable individuals to identify options and make decisions for themselves so that they may develop strategies to solve problems and to effect improvement in the quality of their own lives.

Rehabilitation Nurse

Rehabilitation Nurses have a broad role covering a range of rehabilitation issues including personal care, activities of daily living, short and long term health, social, independence issues and emotional support.

Audiologist

Audiologists are experts in the prevention, identification, assessment, treatment and rehabilitation of auditory and vestibular difficulties across the lifespan in order to improve an individual's quality of life and maximize their participation in society

Optician, Optometry and Ophthalmology

Optician, Optometry and Ophthalmology are three different professions who are all involved in improving vision

• Opticians are technicians trained to design, verify and fit eyeglass lenses and frames, contact lenses, and other devices to correct eyesight. They use prescriptions supplied by ophthalmologists or optometrists, but do not test vision or write prescriptions for visual correction
• Optometrists are healthcare professionals who provide primary vision care ranging from sight testing and correction to the diagnosis, treatment, and management of vision changes, which primarily involves performing eye exams and vision tests, prescribing and dispensing corrective lenses, detecting certain eye abnormalities, and prescribing medications for certain eye diseases.
• An ophthalmologist is a medical doctor who specializes in eye and vision care. Ophthalmologists differ from optometrists and opticians in their levels of training and in what they can diagnose and treat. An ophthalmologist diagnoses and treats all eye diseases, performs eye surgery and prescribes and fits eyeglasses and contact lenses to correct vision problems