Rehabilitation Interventions

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Introduction

If we consider the definition of rehabilitation " a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments.” then rehabilitation is in effect composed of multiple components that are themselves interventions, and is thus complex and multifaceted. Its interventions address issues related to body functions and structures, capacity for activities, performance of participation activities, environmental factors, and personal factors. Most individuals participating in rehabilitation require interventions addressing many or all of these International Classification of Functioning, Disability and Health (ICF) components. In addition, one or more of these components may have more than one functioning category contributing to the overall lack of optimal functioning [Table 1]. Appropriate rehabilitation interventions address all or most of the factors contributing to the lack of optimal functioning and thus are comprehensive.

Rehabilitation professionals organize their interventions to target the many factors contributing to the lack of optimal functioning. Addressing all of them requires a wide range of expertise and competencies that exceed those possible for a single discipline. Thus, there are multiple disciplines of rehabilitation professionals, each addressing its own part of the spectrum of measures needed to achieve the comprehensive goals of rehabilitation. Rehabilitation interventions except in rare instances require the involvement of multiple disciplines and from this perspective are multidisciplinary in nature. Rehabilitation may vary in its intensity, generally measured by the frequency and duration of individual interventions or treatment sessions. The intensity of therapies best for individual patients varies by their needs for improvement in functioning and by their tolerance of therapeutic activities. Different rehabilitation settings may vary in their capacities to provide specific intensities of therapies.

Rehabilitation is outcome oriented. Its core outcomes include preventing the loss of function, slowing the rate of loss of function, improving and restoring function, or compensating for lost function.[1] Rehabilitation interventions may target outcomes for any or all of the three areas of human functioning:

1. impairment,
2. capacity for activities, and
3. performance of activities and participation.

Common functional goals for patients with the recent onset of disability include those related to mobility, self-care, communication, and cognition. Later, goals focus more on education, work, employment, socialization, and quality of life.

Rehabilitation is a process, generally composed of a series of cycles having short-term goals that represent steps toward the goals of a long-term rehabilitation plan. Each cycle has the following components:

• assessment of the functioning status of potential rehabilitation recipients;
• identification of the functioning categories with potential for improvement;
• selection and quantification of the goals of the intervention program;
• assignment of treating professionals to the areas of needed improvement that match their expertise; (5) implementation of the assigned interventions; and
• evaluation of the results of the interventions.

At the end of each cycle, the process begins again until there is no significant improvement in functioning from the application of the rehabilitation interventions.

Rehabilitation interventions can however be described in terms of the following;

• Situations in which actions are taken (context)
• Goals the actions intend to achieve
• The level at which the intervention is acting
• Specific therapeutic procedures
• Knowledge and skills required
• Any equipment required
• Other concomitant procedures
• Underlying theories/principles guiding actions

The World Health Organisation's International Classification of Functioning (ICF) and model of rehabilitation were used to develop a classification system of rehabilitation interventions which has been proposed, developed and used in practice.

Target Situation (Input)

This describes the clinical and physical presentations leading to rehabilitation.

Goals

These include both immediate and general expected outcomes of the intervention.

Activity

This refers to all activities involved in the rehabilitation of a specific condition, it includes both direct and ancillary procedures taken to bring patients back to normal health. The intervention procedures should be described using the ICF.

Resources

This includes all physical implements, knowledge, skills and expertise required in the management and rehabilitation of the patient.

Context

Context encompasses the theoretical basis of procedures being undertaken, if there are any as well as the setting under which healthcare is being provided