L3_Rehabilitation team.pdf

Ahmad Alahmary By the end of this lecture you will be able to: Recognize why different specialities are essential in the rehabilitation team. Have an overview about professions involved in the rehabilitation. Understand the role of each profession in the rehabilitation team. Why differ...

Ahmad Alahmary By the end of this lecture you will be able to: Recognize why different specialities are essential in the rehabilitation team. Have an overview about professions involved in the rehabilitation. Understand the role of each profession in the rehabilitation team. Why different specialities are required in the rehabilitation team? Why different specialities are required in the rehabilitation team?  All rehabilitation professionals require profession-specific clinical knowledge to assess patients who need or would benefit from rehabilitation services and share the same requirement of having the knowledge, skills and ability to implement evidence- based intervention and management programs that are patient- centred while also monitoring, adapting, and redesigning intervention plans based on the patient’s needs and response to care. Why different specialities are required in the rehabilitation team?  Rehabilitation team members will play different roles within the rehabilitation process based on the type of team structure they are working in, what phase of rehabilitation they are involved in, the environment or context and specific resources available. Key facts: Rehabilitation is an essential part of the universal health coverage along with promotion of good health, prevention of disease, treatment and palliative care. Rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. Globally, an estimated 2.4 billion people are currently living with a health condition that benefits from rehabilitation. The need for rehabilitation worldwide is predicted to increase due to changes in the health and characteristics of the population. For example, people are living longer, but with more chronic disease and disability. What is rehabilitation? According to WHO rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment.” Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease or illness, or because their functioning has declined with age. Some examples of rehabilitation include: Exercises to improve a person’s speech, language and communication after a brain injury. Modifying an older person’s home environment to improve their safety and independence at home and to reduce their risk of falls. Exercise, training and education on healthy life style for a person with a heart disease. Making, fitting and educating an individual to use a prosthesis after a leg amputation. Positioning and splinting techniques to assist with skin healing, reduce swelling, and to regain movement after burn surgery. Prescribing medicine to reduce muscle stiffness for a child with cerebral palsy. Psychological support for a person with depression. Training in the use of a white cane, for a person with vision loss. Global rehabilitation needs continue to be unmet due to multiple factors, including: Lack of prioritization, funding, policies and plans for rehabilitation at a national level. Lack of available rehabilitation services outside urban areas, and long waiting times. High out-of-pocket expenses and non-existent or inadequate means of funding. Lack of trained rehabilitation professionals, with less than 10 skilled practitioners per 1 million population in many low- and middle-income settings. Lack of resources, including assistive technology, equipment and consumables. The need for more research and data on rehabilitation. Ineffective and under-utilized referral pathways to rehabilitation. Examples of short-term goals of rehabilitation: 1-To maintain mobility of joints 2-To increase range of motion (ROM) 3-To strength weak muscles …. etc. Long-term goals of rehabilitation: Adjust patients to live or re-engage in their society with their disabilities and reducing the associated physical, psychological or social problems. Help patients to be independent in their functions and activities and to be more productive in their societies. Assist patients to manage their own problems by themselves and reduce depending on others as much as possible (i.e. to be independent as much as possible). Long-term goals of rehabilitation can be achieved by: 1. A patient and family centred care. 2. Multidisciplinary team approach 3. Cooperation between disabled person, rehabilitation team and family. 4. Availability of community services. 5. Using of evidence-based modalities, tools, technique, and treatment methods in rehabilitation services. 6. Developing new skills or hobbies which may help a disabled person to have a suitable job for his/her residual ability. Patient- and family-centred care Patient- and family-centred care is an approach to health care that: Empowers patients and their families and fosters independence Supports family care-giving and decision-making. Respects patient and families’ choices and their values, beliefs and cultural backgrounds. Builds on individual and family strengths Involves patients and their families in the planning, delivery and evaluation of health care services. The core concepts of patient- and family- centred care are: Dignity and respect. Staff listen to and respect patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care. Information sharing. Staff communicate and share complete, objective and accurate information with patients and families in ways that are supportive and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making. The core concepts of patient- and family- centred care are: Participation. Patients and families participate in care and decision making at the level they choose, with the support and encouragement of staff. Collaboration. Patients, families and staff collaborate in policy and program development, implementation and evaluation, in health care facility design, in professional education, as well as in the delivery of care. Benefits of the rehabilitation team to patients: 1. Is a patient-centered approach. 2. Involvement of the patient and family in goal setting and treatment. 3. Increasing a coordination of care. 4. Patient can be treated holistically 5. Supports patient and family education 6. Increases the patient’s knowledge about his/her illness, rehabilitation process, progress and discharge options. 7. Enhances the patient’s independence. Benefits of the rehabilitation team to Health Care Providers: 1. Increased communication between health care providers. 2. Building of knowledge and respect for other disciplines. 3. Building of trust and work relationships and improve patient services. 4. Increase opportunities for training and practice on new techniques and learn new skills. skills required for team members: Cooperation and sensitivity to others. Communication and empathy. Flexibility. Self-confidence. Commitment. Ability to solve problems. Knowledge about boundaries. Knowledge about the team roles. Rehabilitation Team: Medical: To limit the disability. Paramedical or Allied Health Professionals: To reduce the handicap. Socio-vocational: To reduce social, economic and psychological burdens that emerge after disability. The Rehabilitation Team: Medical team: Physical Medicine and Rehabilitation (Physiatrist). Neurologist and neurology surgeon. Orthopaedic Surgeon. General Surgeon. Paediatrician. Ophthalmologist. Obstetrician and Gynaecologist. Psychiatrist. Para-medical Team: Physiotherapist. Occupational Therapist. Orthotist and Prosthetist Speech-Language Pathologist (speech Therapist) Audiologist Psychologist Rehabilitation engineer Horticulture therapist Rehabilitation Nurse Socio-vocational Team: Social Worker Health educator Mental health educator Rehabilitation counselor Vocational counselor None-Governmental Organizations (NGOs) Special education teacher Community Physiatrist: is a physician who has completed training in a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Physiatrist supervises the rehabilitation program for patients and make sure the services that they are receiving are consistent with their diagnosis, functional limitations, and prognosis. Physiatrist also directs the interdisciplinary team toward facilitating treatment goals. Physical therapist (PT): PTs are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery and often reducing the need for long-term use of prescribed medications and limit their side effects. PTs can teach patients how to prevent or manage their conditions so that they can achieve long-term health benefits. PTs examine patients and develop their treatment plans, using treatment techniques to promote their ability to move, reduce pain, restore function, and prevent disability. (APTA, 2022) Physical therapist (PT): PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyle. PTs provide care for patients in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. (APTA, 2022) Occupational Therapist (OT): Occupational therapists evaluate and treat physical and functional disability of daily activities. The occupational therapist can help improve the ability to perform everyday tasks, such as dressing, eating, personal hygiene, meal preparation, housekeeping, and community and pre-vocational skills. For injured workers, occupational therapists can develop ergonomic assessments, assist in pre-employment screening, and creation of modified return to work, work conditioning and transitioning programs. Orthotist and Prosthetist: The prosthetist is the professional who designs and fabricates prostheses for individuals with partial or total absence of a limb. The orthotist provides care to individuals with disabling conditions of their limbs or spine by recommending, fitting, fabricating and maintaining orthopaedic braces that support or limit the movement of weakened joint or limb. The orthotist and prosthetist are members of the rehabilitation team who enables people suffering from disabilities to live as much normal as possible. Speech-Language Pathologist / Speech Therapist: Speech-language pathologist (speech therapist) evaluates and treats cognitive, communicative, and swallowing deficits that may interfere with the ability to speak, understand, read, write, focus, remember, or problem solve. Rehabilitation Nurse: Nursing is playing an important role in the rehabilitation team. A nurse who specializes in rehabilitative care is assisting patients in achieving maximum independence, especially in regards to medical care, prevention of complications, and patient and family education. They often help to facilitate the carry over of the rehabilitation program throughout the hospital stay. Rehabilitation Nurse: In addition to daily bedside care, rehabilitation nurses work on ensuring bowel and bladder continence, maintaining good skin care, ensuring healthy, nutritional intake, medication management and reinforcing carryover of learned skills. Education of the individual and family are vital to achieving a successful return back home. Psychiatrist, Psychologist, or Neuropsychologist: A physician or counselor who conducts cognitive (thinking and learning) assessments of the patient and helps the patient and family adjust to the disability. Their role is to work with the individual, family and entire rehabilitation team to assist with adjustment difficulties and other psychological issues that can develop during the rehabilitation process. Counseling and support are essential for the individual and family during this time. Horticulture therapy: including the following forms: Imagining nature, viewing nature, visiting a hospital healing garden and, most important, actual gardening. It is expected to influence healing, alleviate stress, increase well-being and promote participation in social life and re-employment for people with mental or physical illness. Rehabilitation engineering: Rehabilitation engineering: is the systematic application of engineering sciences to design, develop, adapt, test, evaluate, apply, and distribute technological solutions to problems confronted by individuals with disabilities. Functional areas addressed through rehabilitation engineering may include mobility, communications, hearing, vision, and cognition, and activities associated with employment, independent living, education, and integration into the community. Recreational therapists (RT)-1: Also referred to as therapeutic recreation specialists; provide treatment services and recreation activities for individuals with disabilities or illnesses. Using a variety of techniques, including arts and crafts, animals, sports, games, dance and movement, drama, and community outings, therapists improve and maintain the physical, mental, and emotional well-being of their clients. Recreational therapists (RT)-2: RT helps clients to enjoy greater independence and reduce or eliminate the effects of their illness or disability by: 1.Helping them to reduce depression, stress, and anxiety. 2.Recover basic motor function and reasoning abilities. 3.Build confidence. 4.socialize effectively. RT helps people with disabilities to integrate into the community by teaching them how to use community resources and recreational activities. Recreational Therapists are different from recreation workers, who organize recreational activities primarily for enjoyment. Social Worker: Assist people by helping them cope with and solve issues in their everyday lives, such as family and personal problems and dealing with relationships. Help clients who face a disability, life-threatening disease, social problem, such as inadequate housing, unemployment, or substance abuse. assist families that have serious domestic conflicts, sometimes involving child or spousal abuse. Conduct research, advocate for improved services, or become involved in planning or policy development. The medical social worker is a liaison between the healthcare staff, the patient and family. Health educators: They work to encourage healthy lifestyles and wellness through educating individuals and communities about behaviors that can prevent diseases, injuries, and other health problems. They attempt to prevent illnesses by informing and educating individuals and communities about health-related topics, such as proper nutrition, the importance of exercise, how to avoid sexually transmitted diseases, and the habits and behaviors necessary to avoid illness. They begin by assessing the needs of their audience, which includes determining the appropriate topics to cover. Mental health counselors: work with individuals, families, and groups to address and treat mental and emotional disorders and to promote mental health. They are trained in a variety of therapeutic techniques used to address issues such as depression, anxiety, addiction and substance abuse, suicidal impulses, stress, trauma, low self-esteem, and grief. They also help with job and career concerns, educational decisions, mental and emotional health issues, and relationship problems. Rehabilitation counselors: They help people deal with the personal, social, and vocational effects of disabilities. They counsel people with both physical and emotional disabilities resulting from birth defects, illness or disease, accidents, or other causes. They evaluate the strengths and limitations of individuals, provide personal and vocational counseling, offer case management support, and arrange for medical care, vocational training, and job placement. Special education teachers: work with children and youths who have a variety of disabilities. A small number of special education teachers work with students with severe cognitive, emotional, or physical disabilities, primarily teaching them life skills and basic literacy. The majority of special education teachers work with children with mild to moderate disabilities, using or modifying the general education curriculum to meet the child's individual needs and providing required remedial instruction. Vocational Counselor: They evaluate vocational abilities and employment history. Vocational counselors can connect with career training or re-training and job placement services. They can recommend any adaptations and equipment that may be necessary for in a particular workplace, as well as related to your transportation to/from the workplace. None-Governmental Organizations (NGOs): NGOs supplement the efforts made by governments. Local NGOs reach the grass-root level and provide relief to the people. References: World Health Organization. (2022). Rehabilitation. Geneva, Switzerland; 2020. Accessed from [https://www.who.int/news-room/fact-sheets/detail/rehabilitation].[Cited 2022 February 8]. Physiopedia. Rehabilitation Team Members. (2022). [https://www.physio- pedia.com/Rehabilitation_Team_Members].[Cited 2022 February 8]. King JC et al (1989). Rehabilitation Team Function and Prescriptions, Referrals, and Order Writing. Rehabilitation Medicine: Principles and Practice (ed by Delisa JA). 4th Ed