Principles of Rehabilitation

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]

Figure.1 Disability Prevention and Rehabilitation Week Celebration. Philippines

Rehabilitation is founded on the philosophy that every person has the right to be in charge of their health and that 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 an impairment to optimise, enhance and maximise their independent function.[2]

In the medical model of care, the physician is tasked with ensuring the survival of a patient.[2][3] The physician has an active role in the diagnosis and management of the patient, with the patient frequently performing a passive role in the process of care.[3] This model can play a role when addressing limited critical care situations in emergency care. Although it is often 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 a stroke, the concerns of the patient may go beyond addressing pain or spasticity, but be centred on functionality in returning to work, sexuality, grooming and transfers, and so on.

On the other hand, rehabilitation predominantly utilizes the Bio-psycho-social Model, which shifts its focus from the disease to the individual.[2] Rehabilitation focuses on empowering the individual to learn to maximise their residual function, with a goal of minimising the impact of the impairment on the day to day activity.[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.[3] Through this model, a more holistic approach to care is taken with the individual and their support structures such as family and friends included in the rehabilitation process to enable all to understand the condition and develop strategies to manage the condition 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 following principles guide rehabilitation;

Promote Adaptation[edit | edit source]

The challenges that accompany impairments and loss of function are often overwhelming for the patient and often include physical, social and emotional challenges.[2] Due to this, to obtain desired results in rehabilitation, there must be an understanding of the overall individual's condition. This understanding must be channelled to support, encourage and build strength and resourcefulness.[2] It is also essential for rehabilitation practitioners to understand that total recovery may not always be the end goal for rehabilitation for many individuals, but rather to maximise function. 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 the individual as different from what a health professional may intend.[5] Therefore, the use of “adaptation” may create more realistic suggestions to the individual to enable them to cope and make adjustments with alterations, which have occurred following a health condition especially conditions that involve making lifelong changes.

Indeed, reduction in activity, limitations and increase in community participation and reintegration 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 individual.[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 an individual's preferences, background, culture, religious beliefs, social support, physical abilities, developmental stages, psychology 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 a magic pill, and education is the vital aspect of the rehabilitation process throughout all stages that ensure the individual and their support structures have a good understanding of what is going on, in order to set realistic expectations and set SMART goals.[14] Education of the individual in rehabilitation enables that person to assume responsibility for their health, promotes patient-centred care, and promotes the greatest level of independence in activities and involvement in rehabilitation plans.[14]

People Centred Care[edit | edit source]

An approach to care that consciously adopts individuals, caregivers, families and communities perspectives as participants in and beneficiaries of trusted health systems that are organised around the comprehensive needs of people rather than individual diseases and respects social preferences. People-centred care also requires that patients have the education and support they need to make decisions and participate in their own care and that caregivers are able to attain maximal function within a supportive working environment. People-centred care is broader than patient and person-centred care, encompassing not only clinical encounters but also including attention to the health of people in their communities and their crucial role in shaping health policy and health services.[15]

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.

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.
  15. World Health Organization, "A69/39 Framework on integrated, people-centred health services: Report by the Secretariat to the sixty-ninth World Health Assembly," 2016.