What is rehabilitation?

Rehabilitation is a set of interventions required when a person is experiencing or is likely to experience limitations in daily functioning due to ageing or a condition of health, including chronic diseases or disorders, injuries or trauma. Examples of functional limitations include difficulties in thinking, seeing, hearing, communicating, moving, having relationships, or maintaining a job. Rehabilitation helps people of all ages to continue or return to their daily activities, fulfil meaningful life roles and improve their well-being. 

Rehabilitation service for people with disabilities associated with long-term mental health problems is a recovery-oriented service. Physical illnesses can result in marked impairment in physical and psychological functioning and consequent disability, for example, inability to work. In addition, severe mental illness leads to short- or longer-term disability. The problem may be compounded by personal reactions to the disease, as well as by the effects of social stigma associated with mental illness. 

Psychiatric rehabilitation services address, very directly, the disabilities of people who have not recovered quickly and may experience continuing difficulties in personal functioning and related to others. For example, they may have cognitive impairments that make it difficult to plan ahead, or symptoms that make it difficult to communicate clearly, or they may be vulnerable to exploitation by others, or their behaviour may challenge others. Psychiatric treatment practitioners require skills to determine the severity and causes of these issues. The task then becomes to work in collaboration with the person who uses the service to address these issues in a way that includes and acknowledges the desires and ambitions of that person.

Rehabilitation is a highly person-centered health strategy that can either be delivered through specialized rehabilitation programs (usually for people with complex needs) or integrated into other health programs and services, such as primary health care, mental health, vision and hearing programs.

Some examples of rehabilitation include:

1-Exercises to regain the ability to swallow or upper-limb retraining to regain coordination, dexterity and movement of an affected limb following a stroke.

2-Interventions that improve safety and independence at home and reduce the risk of falls for an older person, such as balance training or improving their home environment.

3-Early interventions aimed at addressing the developmental outcomes of a child with cerebral palsy, such as orthosis fitting, or training in sensory integration and self-care, which in turn can enhance participation in education, play, and family and community activities.

4-Interventions that optimize surgical outcomes after a hip fracture, including exercise prescription, walking aid delivery, and hip movement education to avoid during recovery.

5-Cognitive behavioural therapy and interventions aimed at increasing a person with depression’s exercise.

6-Interventions that support daily activities and access to the community for people with vision loss, such as providing strategies to complete personal care tasks and training in using a white cane.

There are a wide variety of health professionals providing rehabilitation interventions, including physiotherapists, occupational therapists, speech and language therapists, orthotic and prosthetic technicians, and physical medicine and rehabilitation physicians.

Functions of a rehabilitation service 

A rehabilitation service’s main function is to provide specialist treatment in an appropriate setting that helps service users gain or regain the skills and trust to achieve their own goals, such as living in their own flat, getting a job or starting a family.

• Medication

Many people are referred for rehabilitation because they have not responded adequately to drugs, often including those prescribed for “resistance to treatment.” A key skill for psychiatrists in rehabilitation is the ability to find the best drug regime to minimize symptoms without producing distressing side effects.

• Psychosocial interventions

A variety of psychosocial treatments is needed, including therapeutic therapies such as cognitive–behavioural therapy adapted for psychosis, work with families to promote mutual understanding and reduce stress, art therapies and specific interventions for comorbid substance misuse, such as motivational interviewing. Interventions should include self-management strategies whenever possible.

•  Healthy living

Guidance and support are essential for improving unhealthy lifestyles (such as exercise, cessation of smoking and dietary advice) and physical health monitoring. A visiting general practitioner may reduce the need for consultations in departments for accidents and emergencies or long waiting for outpatient appointments for consultants. 

• Self-care

Nurses and support workers have a key role to play in helping service users gain or regain the trust and routine involved in managing their own self-care, keeping their living space clean and laundry.

• Complex living skills

At all stages of rehabilitation, occupational therapists are required to identify specific problems that the service user may have with more complex living skills such as budgeting, shopping, cooking, accessing education and work, and helping with care planning to address them. In the collaborative framework of the recovery approach, all staff should deliver their specialist interventions.

• Managing in society

Skills of social workers are required to advise on accommodation access, benefits, procedures for adult protection, money issues, advocacy and other legal issues.

• Therapeutic living environments

To assist service users in their rehabilitation, a number of hospital and community-based units are required. For longer periods, a small number of service users will require in-patient treatment and it is likely that both short-term (stay length less than 1 year) and long-term in-patient units will be needed. All rehabilitation units should provide a safe and homely space that promotes stability and security, avoids institutionalization, and provides non-abusive relationships experience for service users. Community care coordinators and care managers should maintain continuity of care throughout the rehabilitation period of the service user, including when it is in an out – of-area placement. No service user should be assumed to be in a placement likely to suit their needs forever.

The benefits of rehabilitation

Rehabilitation can reduce the impact of a wide variety of health problems, including acute or chronic illnesses, disabilities, accidents, or trauma. It is a highly integrated form of health care that complements other health services, such as medical and surgical procedures, to help achieve the best possible outcome. Rehabilitation, for instance, can help prevent complications related to many health conditions, such as spinal cord injury, stroke, or fracture. Rehabilitation can also help to minimize or slow down the disabling effects of chronic health conditions such as cardiovascular disease, cancer and diabetes by equipping people with self-management strategies and the aid products they require, or by addressing pain or other complications. Rehabilitation is an investment with cost benefits for both individuals and society. It can help avoid expensive hospitalization, reduce the length of stay in the hospital and prevent re-admission.