Rehabilitation: A process aimed at restoring function and quality of life.

Introduction

Rehabilitation is commonly used to describe an effort that has been made to assist a person regain their functionality and overall well-being after being affected by an illness, an injury or a disability. It is a more passive and integrated model of delivering care by undergoing active participation from the patient and the family/ caregivers and different health care professionals in achieving the best results.

The purpose of our rehabilitation approach is to assist the patient to get back to pre-illness level of functioning and engage in meaningful activities within society. This process is not only centered on physical healing but is also done bearing in mind other aspects that concern the mental, social, environment and others that affect the health of a person.

Types of Rehabilitation

There are several specialty areas of rehabilitation:There are several specialty areas of rehabilitation:

Physical Rehabilitation

Physical rehabilitation enables patients to regain movement, muscle power, balance, coordination, stamina, and the capacity to execute activities of daily living. Common conditions requiring physical rehab include:Common conditions requiring physical rehab include:

• Stroke
• Spinal cord injury
• Traumatic brain injury
• Amputation
• Neurological disorders
• Orthopedic injuries/surgeries

Therapies used by the physical therapist may involve exercise prescription, joint mobilization/manipulation, application of heat/cold and electricity, braces/splints, training for basic self-care, walking, and balance among others.

Cognitive Rehabilitation

Cognitive rehabilitation is for the patients that are struggling with cognitive deficits affecting memory, attention, concentration, information processing, executive functions, etc. Conditions that often require cognitive rehab include:Conditions that often require cognitive rehab include:

• Traumatic brain injury/concussion
• Stroke
• Brain tumors
• Diseases such as multiple sclerosis affecting the neurons
• Therefore, diseases such as dementia which is a neurodegenerative disease.

Cognitive rehabilitation involves methods such as computerized brain training programs, memory and attentional skills training through the use of functional activities, compensation strategies for disabilities, and more. Another is family education, which involves educating the family about the disorder, their roles, and various strategies.

Speech-Language Rehabilitation

SLPs perform an essential role in the treatment and rehabilitation of patients with various communication disorders, problems with swallowing, and others. Some examples include:

• The disorders of speech as a consequence of stroke or other lesion in the brain
• Neuropsychological disorders, such as aphasia or dementia, result in language difficulties.
• Radiation effects on the voice and larynx, including concerns of laryngeal cancer
• Swallowing problems (dysphagia)
• Any condition that affects one’s ability to hear or the sounds being produced by the speaker.

It comprises articulation practice and language stimulation, dysphagia therapy, and use of augmentative and alternative communication.

Vocational Rehabilitation

Vocational rehabilitation assists patients to gain meaningful employment or facilitate their school participation. Services include:

• WCE: workload assessment, job content.IContainer: capacity, demand.
• Transitional work programs
• Job readiness training
• Career counseling
• This is an area that requires education so that people with such conditions are able to manage them effectively.
• Assistive technologies/workplace accommodations

Individuals with physical and mental disabilities, as well as long-term illnesses and injuries, must overcome barriers to employment.

Psychological Rehabilitation

Psychological rehabilitation addresses the emotional, behavioral, and mental health aspects of disability and illness including:Psychological rehabilitation addresses the emotional, behavioral, and mental health aspects of disability and illness including:

• Depression
• Anxiety
• Trauma
• Poor adjustment

Services include the use of counseling/therapy, support, stress/anger management, psychotherapy and, in some cases, psychiatric services. The psychological setting is a crucial aspect that enhances the chances of actual engagement in the rehab.

Rehabilitation Team

Rehabilitation utilizes an interprofessional team approach with various types of healthcare providers collaborating to meet the unique needs of each patient:Rehabilitation utilizes an interprofessional team approach with various types of healthcare providers collaborating to meet the unique needs of each patient:

• Physiatrists: Assume the role of the medical expert in diagnosing and developing treatment strategies for the case while supervising the overall patient management.
• Rehab Nurses: Provide 24/7 skilled nursing services such as training, administering medications, reviewing and monitoring the patient’s health conditions or other risks and more.
• Physical Therapists: Offer services that facilitate the development of mobility skills, strength and balance among the affected individual.
• Occupational Therapists: There is an emphasis on patient enablement in managing tasks of daily living such as feeding, dressing, work, and recreation.
• Speech-language Pathologists: Assess and manage speech and language difficulties, dysphagia, and other cognitive-communication disorders.
• Recreational Therapists: As a means of enhancing the health and quality of life of the elderly, enhance recreation participation to increase the levels of well-being and functionality, independence in basic living skills, and overall quality of life.
• Rehab Psychologists: Offer advice, support, and assist in finding ways to cope with changes resulting from disability.
• Vocational Rehabilitation Counselors: Ensure patients are productive in their workplaces or other learning institutions after they have been ill or injured.

Rehabilitation also involves social workers, rehabilitation technicians/therapy assistants, orthotists, pharmacists, spiritual care, and other support staff as playing a significant role. As much as it is important to assess patients, their families and caregivers are critical in providing information as well.

 The application of an interdisciplinary technique provides the rehabilitation team with a synergistic strategy for the administration of care that is primarily aimed at restoration of function to the patient with consideration given to his/her specific background and requirements.

The Rehabilitation Process

Rehabilitation programs follow a systematic patient-focused process:Rehabilitation programs follow a systematic patient-focused process:

Evaluation

This entails conducting a thorough assessment to provide a correct diagnosis, assess present strengths and weaknesses, establish achievable and realistic goals from the patient’s perspective, and outline appropriate treatment plans.

 Assessments include the patient’s medical history, components of the physical examination, diagnostic investigations and results, and the PALS-SS, which addresses physical, psychological, functional, occupational, communication, and social dimensions. 

Another important derived concept is the assessment of facilitators and barriers in a patient’s environment.

Interventions

The resulting treatment plan is then implemented through coordinated rehabilitation services across the community setting. Employing the latest medical research, treatments aim at the rectification of the deficits but most importantly, train practical workarounds, which would help the individual achieve the best quality of life possible. 

Treatments may incorporate physical therapy, gait training, self-care training, cognitive training, counseling, group sessions, recreational therapy, vocational training and many others – all planned and implemented based on the patient’s individual needs.

Re-Evaluation

In this process, the progress is always being assessed through the administration of the assessments done during the course of the treatment. Patient satisfaction with the progress they are making in their treatment is also obtainable through feedback. It involves the use of data in identifying how effective the current intervention strategies are as well as coming up with a new plan of action where necessary. 

It is the practice of informing the patient and the family members where the objective assessment is made, and the patient is also involved in all the goals that are set during the rehabilitation period.

Follow-Up

Especially in chronic and progressive cases, patients are gradually moved on to correct wellness and community reintegration programs to ensure that the clients or patients remain optimally functional in the long term. Subsequent rehabilitation could be from outpatient facilities, community services such as exercise classes that target medical necessity, home health therapy, tele-rehabilitation, among others. 

The overall aim is to encourage long-term adherence to healthy behaviors and tasks and patients’ education for the prevention of other illnesses or injuries.

Settings

Many patients receive rehabilitation care in inpatient or outpatient facilities, because of the medical, functional, resource, and insurance status of the patient. Examples include:

Inpatient Rehabilitation Facilities

Inpatient rehabilitation facilities offer 3 hours of rehabilitation therapy daily with the patient receiving specialized nursing care all day, every day. This program involves an interprofessional team, and the treatment is delivered in a hospital-like environment; thus, the program is tailored to the patient’s endurance to achieve the highest efficiency of functional improvement.

 The involvement of the patient, as well as the family to ensure that he/she is able to manage the situation at home is also stressed.

Outpatient Rehabilitation Clinics:

Outpatient clinics provide outpatient rehabilitation in terms of 1–2 sessions per day, including individual and group sessions. Patients remain at home, however, they have access to quality interdisciplinary rehab that is centered around realistic goals for returning to their community. This is crucial especially after acute admission or can offer periodic rehab check-ups for chronic conditions.

Home Health Rehabilitation

Rehabilitation therapists visit a patient’s home in cases of mobility problems or transportation issues that make it almost impossible for the patient to access outpatient services on his or her own. Squashed but more repeated ones are focused on functional use within the natural environment of an actual home hence more confidence.

 Other avenues that are also slowly gaining popularity are the tele-rehabilitation virtual platforms.

Skilled Nursing Rehabilitation

In a situation where the individual needs functional assistance or medical observation around the clock, rehabilitation can occur in a skilled nursing facility. 

However, rehab intensities are generally lower and the nursing environment facilitates reaching out to the patients who are perhaps more medical and also does not put much pressure on the family caregivers.

Outcomes

Rehabilitation programs examine its own outcome data on the services they offer to confirm its effectiveness and relevance. Standard measures used across most rehab settings include:Standard measures used across most rehab settings include:

• Functional Independence Measure (FIM): Evaluates the level of independence in basic functions in a home such as eating, bathing, dressing, and mobility. Measured on an ordinal scale with 1 as the highest level of dependence and 7 as the lower level of dependence.
• 10 Meter Walk Test: It identifies gait speed which is useful in determining the course of rehabilitation and possibilities of falls.
• Six Minute Walk Test: Assesses the walking distance endurance which is essential in the independence of daily movements in the community.
• Montreal Cognitive Assessment (MOCA): Tools for screening of MCI, addressed to different cognitive areas such as memory, praxis, spatial ability, working memory, attention, language, or time and place awareness.
• Quality of Life Questionnaires: Collect patient feedback on their satisfaction with general health, psychological well being, interpersonal relationships, living space, personal growth, disability adaptation, and others.

Rehabilitation success rates are highly subjective and depend on the patient’s condition before their illness, etiology of the illness/injury, level of support from family/friends, and stage of recovery. 

But the research has shown that the spending in the rehabilitation programs has led to the reduction in the level of disability, hospitalization and mortality, and hence, the need for quality services which is a key point.

Barriers to Accessing Rehabilitation

While rehabilitation services are crucial, many barriers prevent patients from accessing needed care including:While rehabilitation services are crucial, many barriers prevent patients from accessing needed care including:

• This insurance may be very basic or even minimal in comparison to what is offered for other rehab therapies.
• Shortage of specialists who are willing to work in such regions or who live in such regions
• Transportation difficulties
• Interpersonal deficits that undermine advocacy for the individual
• Poor health literacy that affects health consumer involvement
• Issues related to cost or how expensive it is and high levels of out of pocket expenses.
• Healthcare delivery inequities at a systemic level

Increasing the level of awareness of all stakeholders regarding rehabilitation techniques that produce the best results irrespective of the diagnostic clusters that are prevalent at present is a way of overcoming the present barriers to rehabilitation access. 

There is a need for a collaborative voice in advocacy for rehab policies that address financing of rehab research and insurance exclusion to fill large gaps in rehabilitation.

Such a multi-layered rehabilitation system provides exponential returns in the long term of development – low disability, decreased probability of risky hospitalization, capacity to return to the workforce, and facilitating effective and productive community and family role participation to improve individual and collective quality of life.

Conclusion

Rehabilitation is a vital concept of maintaining the progress of healing and reintegration into society for individuals affected by an illness or disability. Developing of the rehabilitation programs is an interprofessional patient- and family-centered process using the best evidence; the programs contain individualized, coordinated and comprehensive interventions to restore the quality of life in the physical, emotional, cognitive, communicative, social, recreational, occupational, cultural and spiritual aspects and others.

Essentially, there are limitations regarding the accessibility of adequate rehabilitation, but the promotion of awareness about the rehabilitation models and the demand for policies that increase the coverage and funding for this area remains significant for achieving the best results for many diagnostic categories. 

In totality, investment in complex rehabilitation systems advances reduction in mortality or disability, as well as enhancing the participation of the population, promoting quality of life, and displaying lasting positive health effects.