Introduction to rehabilitation.pdf

SEBB 2513 Basic Rehabilitation Introduction to Rehabilitation Faiz Shakhih, MBBS, MSc [email protected]  Week 1&2: Introduction to Rehabilitation Definition The rehabilitation teams Concept of client-centred care Disablement model The rehabilitation processes Who need rehabilitation? ...

SEBB 2513 Basic Rehabilitation Introduction to Rehabilitation Faiz Shakhih, MBBS, MSc [email protected]  Week 1&2: Introduction to Rehabilitation Definition The rehabilitation teams Concept of client-centred care Disablement model The rehabilitation processes Who need rehabilitation?  4 The five primary areas of human function Physical – - getting around and the ability to do daily activities. Sensory ‐ability to detect any information from our senses - touch (including pressure, pain and temperature), sight, smell, hearing and taste. Intellectual ‐- ability of the individual both in aspects of information processing and in acquiring knowledge. Psychological ‐ emotions and cognitions – thoughts, perceptions, moods, sense of personal control etc. Social– the ability to relate to others; communicate; interaction of individuals within a given society or environment  What is rehabilitation? 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”. (WHO, 2019)  Over 15% of world population live with a form of disability.  The number will continue to rise as ageing population will double in next 30 years  Overview History of Rehabilitation…. 15th century: Early 19th century The AMA Medical 17th Council on rehab of war century Rehab as a 19th century: Physical injuries: profession – Medicine: Early Dr Rusk – prominence approved - Amputation mobilizatio emphasized (Dr Krusen Physical & prostheses n of post- interdisciplinary suffered from medicine (by French surgery teams in TB, 5 months and Rehab surgeon who patient (by addition to in sanitarium, (based on establish Swiss physical rehab deconditione Dr. Rusk phantom Physician) d- physical petition) limb pain ) rehab AMA= American Medical Association  Habilitation vs rehabilitation?  Habilitation aims to help those who acquire disabilities congenitally or early in life to develop maximal functioning;  Rehabilitation aims to assist those who have experienced a loss in function to regain maximal functioning.  targets improvements in individual functioning –e.g. improving a person’s ability to eat and drink independently.  What they need? Habilitation or rehabilitation Picture A: Picture B: below knee deficiency of amputation on the right hand the left leg  What they need? Habilitation or rehabilitation  A 3 yaer old child who still couldn’t walk due to developmental delay What they need? Habilitation or rehabilitation  65 years old man who suffered a stroke attack and now couldn’t walk  Principles of rehabilitation  Rehabilitation should begin during the initial contact with patient  Emphasis on restoration of patient independence as short time as possible  The patient must be active participant  Motivate the patient and help him to attain social independence  Type of rehabilitation  Physical rehab  Help patient restore use of muscles, bones and nervous system through exercise and other technique  Therapist introduce programs to improve mobility and functioning of the injured body part.  Occupational rehab  Help regain ability to do normal daily tasks by teaching new skills to adjust with disabilities.  This can be done with the help of adaptive equipment, orthotics and modification of patient’s home.  Therapist will do home visit to analyse the home surrounding.  Speech rehab  Help correct speech disorders or restore speech.  Help patient with eating and swallowing problem  Involves regular meeting in individual or group setting and home exercise  Strengthening the muscles  Psychiatric rehab  Helping people with mental illness gain or improve skills while obtaining the necessary resources and support in reaching their goals. Type of rehabilitation according to disorders  Cardiac rehab  Stroke rehab  Kidney rehab  Tobacco rehab  Stress rehab  Alcohol rehab  Drug rehab  Many more Rehabilitation Team Medical Rehabilitation model consists of a core group of medical professionals who comprise:  Rehabilitation Physiatrist /Physician  Physical therapist  Occupational therapist  Psychologist  Rehabilitation engineer  Rehabilitation nurse  Social worker  Speech-language pathologist  Others (e.g therapeutic recreational specialist, Types of Team  Multidisciplinary  Activities that involve the efforts of individuals from a number of discipline  Approach primarily through each discipline relating to each own activities  Interdisciplinary  Professionals contribute to the group effort on behalf of patient  Require skills for effective group interaction  SYNERGISTIC effect – provide more than the sum of the individual parts  Crucial in patient with more complex needs Why coordinated rehabilitation? To improve functional outcomes and reduce costs. Evidence has shown that the provision of coordinated, multidisciplinary and interdisplinary rehabilitation services can be effective and efficient. Wade DT, de Jong BA. Recent advances in rehabilitation. BMJ (Clinical research ed.), 20,320:1385-1388 Concept of client/patient centred care Patient-centred care ‘Patient-centredness’ refers to a philosophy intended to underpin care and service delivery focused on meeting the:  person's needs,  values or preferences;  optimising the person's experiences with care;  fully involving persons' perspectives into care. Patient-centredness is a way of thinking and doing things ‘with’ and ‘for’ the person, rather than something that is delivered ‘to’ patients. Jesus et al. 2016 Client centered therapy / care In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.  Active listening o Active or attentive listening can be described as a way of listening and responding to another person that improves mutual understanding. It isn’t about passively sitting and doing nothing, but rather about being present psychologically, socially, and emotionally.  Open-ended questions and reflective conversations o Open-ended communication is designed to introduce an area of inquiry without unduly shaping or focusing the content of the response. It directs the client to a specific area but allows them more discretion in their answer, suggesting that elaboration is both appropriate and welcome.  Empathy o Empathy is often defined as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.  Involvement of family and friends o The involvement of family and friends in the treatment of any condition is considered one of the cornerstones of person-centered practice. In hearing care, it has the potential to motivate clients’ help-seeking behavior and ultimately the success of the rehabilitation process. Very often clients mention that they have been encouraged by their partner/spouse to make the first appointment.  Shared goal-setting and decision-making o This is a process in which clients, when they reach a decision crossroads in their healthcare, can review all the treatment options available to them and participate actively with their healthcare professional in making that decision.  Understanding of individual preferences o This can be thought of as new information to add to the traditional biomedical case history. It is about finding out what matters to the individual person – exploring their beliefs, ideas, concerns, expectations, feelings, and the effects of their hearing loss on their life. Can you identify factors that lead to failure of rehabilitation therapy? Conclusion:  Rehabilitation is a process to help improve person with impairment due to injury or chronic disease to live their life at maximum potential.  The demand for rehabilitation is increasing due to ability of people to live longer with multiple chronic conditions  Interdisciplinary teamwork provide a synergistic effect towards patient improvement  Patient-centred care focus on the patient views rather than focusing solely on patients disorder. Any questions? Disability concept and model Lee Thiam Wah Type of Disabilities  Hearing Disability  Visual Disability  Speech Disability  Physical Disability  Learning Disability  Mental Disability  Multiple Disabilities   Disease – abnormal condition of an organism that impairs the bodily function  Impairment – any loss or abnormality of Disease, psychological, physiological or anatomical structure or function. Impairment,  Disability - any restriction or lack (resulting from an Disability and impairment) of ability to perform an activity in the Handicap manner or within the range considered normal for a human being.  Handicap - a disadvantage for a given individual that limits or prevents the fulfillment of a role that is normal Remember  Impairment DOES NOT justify disability  Disabled people do not have to be handicapped  Handicap is not a characteristic of a person, rather a description of the relationship between the person and the environment. It occurs when they encounter cultural, physical or social barriers which prevent their access to the various systems of society that are available to other citizens. Example 1:  David is a 4-yr.-old who has a form of cerebral palsy (CP) called spastic diplegia. David's CP causes his legs to be stiff, tight, and difficult to move. He cannot stand or walk.  Impairment:  Disability:  Handicap: Example 2:  Cindy is an 8-year-old who has extreme difficulty with reading (severe dyslexia). She has good vision and hearing and scores well on tests of intelligence. She went to an excellent preschool and several different special reading programs have been tried since early in kindergarten.  Impairment:  Disability:  Handicap:   All disabled people are impaired  All handicapped people are disabled TRUE or  A person can be impaired and necessarily be FALSE? disabled.  A person can be disabled without being handicapped.   The disablement model is a framework used in rehabilitation to understand the impact of a health condition or disability on a person's life What is  It helps to identify the different factors that can affect a person's ability to function and participate in daily disablement activities model?  The main model of disability include:  Medical model  Social model  Biopsychosocial model  Medical model  People with disabilities defined by their illness or medical condition  This model regards the person with disabilities is the problem, not society  Under this model, the person with disabilities inability to join in society is seen as a direct result of having an impairment and not as a result of features of our society which can be changed  People with disabilities have generally rejected this model Social Model  Social Model  Alternative models of impairment and disability were developed and formed the basis of what is known as the Social Model.  In the social model, disability is shown as being caused by ‘barriers’ or elements of social environment.  Disability is no longer seen as an individual problem but as a social issue caused by policies, practices, attitudes and/or the environment.  According to this model, the 'cure' to the problem of disability lies in the restructuring of society. Unlike medically based 'cures', that focus on individuals and their impairment, this is an achievable goal and to the benefit of everyone BIO-PSYCHO-SOCIAL MODEL  ICF model (major revision of ICIDH medical model in 2001)  Adopts a bio‐psychosocial model of disability that incorporates what is useful in both medical and social models What is ICF model?  The International Classification of Functioning, Disability and Health (ICF) is a model that provides a comprehensive framework for understanding impact of health conditions on a person's functioning and participation in society.  ICF model consist of three (3) main components:  Body function and structure  Activities and participation  Contextual (environmental and personal factor) International Classification of Functioning, Disability and Health (ICF) - WHO  Impairments- problems in body functions or structures  Activity limitation- difficulty in executing activities  Participation restriction- problems in involvement in life situations  ICF components  Body function and structure – physiology and anatomical function of the body  Activity – a task that an individual execute  Participation – involvement in life situation.  Environmental factor - External elements that can have positive or negative effects on the person’s functioning  Eg: technology, family support, policies, attitudes of others, climate  Personal factors – Factors that influence how the impairment is experienced by the individual  eg: age ,gender, education level, coping mechanism Rehabilitation process Rehabilitation process (cycle) Define Relate problems to rehabilitation goals, Identify problems modifiable and target problems and needs limiting factors and appropriate measures Plan, implement Assess effects and coordinate interventions  Rehabilitation measures & outcomes Achieving Outcomes:  Body functions & - Prevention of the loss of measures target: function structures Rehabilitation - Slowing the rate of loss of  Activities and function participation - Improvement or restoration of function  Environmental factors - Compensation for loss of function  Personal factors -Maintenance of current function Selected references  Bowker, L.K., Price, J.D., & Smith, S.C. (2006). Chapter 4 Rehabilitation. WHO world report on disability https://www.who.int/disabilities/world_report/2011  Jesus TS, Bright F, Kayes N, et al. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959. doi:10.1136/bmjopen-2016  Medical Aspects of Disability for the Rehabilitation Professionals, Fifth Edition