Rehabilitation is “a set of measures that assist individuals who experience, or are likely to experience, disability [resulting from impairment, regardless of when it occurred (congenital, early or late)] to achieve and maintain optimal functioning in interaction with their environments”.
The WHO defines the individual in his environment as the centre of the rehabilitation process. “Individuals” should be understood to be not just those “who experience, or are likely to experience, disability,” but also their families, who can be helped to become actors in the rehabilitation process and benefit from the results achieved.
Rehabilitation measures target body functions and structures, activities and participation, environmental factors, and personal factors. They contribute to a person achieving and maintaining optimal functioning in interaction with their environment, using the following broad outcomes:
■ Prevention of the loss of function
■ slowing the rate of loss of function
■ Improvement or restoration of function
■ Compensation for lost function
■ Maintenance of current function.
Rehabilitation outcomes are the benefits and changes in the functioning of an individual over time that are attributable to a single measure or set of measures. Traditionally, rehabilitation outcome measures have focused on the individual’s impairment level. More recently, outcomes measurement has been extended to include individual activity and participation outcomes.
Measurements of activity and participation outcomes assess the individual’s performance across a range of areas including communication, mobility, self-care, education, work and employment, and quality of life. Activity and participation outcomes may also be measured for programmes. Examples include the number of people who remain in or return to their home or community, independent living rates, return-to-work rates, and hours spent in leisure and recreational pursuits. Rehabilitation outcomes may also be measured through changes in resource use – for example, reducing the hours needed each week for support and assistance services
Rehabilitation medicine is concerned with improving functioning through the diagnosis and treatment of health conditions, reducing impairments, and preventing or treating complications. Doctors with specific expertise in medical rehabilitation are referred to as physiatrists, rehabilitation doctors, or physical and rehabilitation specialists.
Medical specialists such as psychiatrists, paediatricians, geriatricians, ophthalmologists, neurosurgeons, and orthopaedic surgeons can be involved in rehabilitation medicine, as can a broad range of therapists. In many parts of the world where specialists in rehabilitation medicine are not available, services may be provided by doctors and therapists.
Rehabilitation medicine has shown positive outcomes, for example, in improving joint and limb function, pain management, wound healing, and psychosocial well-being
Providing someone with physical and functional rehabilitation assumes that that person is in, or is at risk of, a disabling situation due to impairments and disabilities. The latter are analysed in order to establish a therapeutic plan aimed at optimal functioning (autonomy), so that the person can better participate in daily living and social activities. The goal of optimal functioning means working on impairments and disabilities in order to set off a process of full or partial recovery, the latter aimed at adaptation and compensation.
The analysis models
The Rehabilitation Services Unit recommends two models for understanding disability, analysing the situation, putting together a project and evaluating the results.
Disability Creation Process (DCP): This analysis model focuses on the interactions between personal factors (including health), environmental factors and life habits, with all three given equal weight. The analysis of the interactions fosters an understanding of the person’s overall situation (social model).
International Classification of Functioning, Disability and Health (ICF): This model focuses on the individual’s performance (activities performed as part of everyday life), determining a causal link between that performance and the person’s social participation. The WHO recommends this model as an international standard for describing and evaluating health.
The rehabilitation process
Using an analysis model allows construction of a well-argued and justified intervention strategy. The strategy is formalised by a series of actions, starting with identifying and analysing the problems, then planning an intervention and evaluating it so that the initial strategy can, if necessary, be adjusted.
The different phases of the rehabilitation process
Using an analysis model, listening to the person and his family and identifying their explicit wants and implicit needs: The personal factors, environmental factors, facilitating factors, resources and barriers are analysed and evaluated.
A multidisciplinary team puts together an intervention plan with the person and his family. The plan is implemented in the form of care and advice by one or more rehabilitation professionals and, depending on the situation, training for self-care or family care.
It is important to note that “rehabilitation that begins early produces better functional outcomes“. Results are monitored and evaluated in terms of life habits and social participation (optimal functioning). If necessary, adjustments are made (continuum of care).