Rehabilitation: connect ability, environment and meaningful goals
Rehabilitation is designed to help individuals recover or improve their functional capacity and participate in activities affected by a health condition. It can encompass physical movements (e.g., walking), communication skills (e.g., using words) cognitive processes (e.g., memory), and daily living tasks (e.g., washing dishes). The foundation for rehabilitation starts with identifying what is important to the individual and which barriers limit them from performing an identified task/activity.
A diagnosis does not describe every practical difficulty
Individuals who experience the same health condition may possess vastly different capacities, utilize varying environments, and prioritize different aspects. The focus of rehabilitation is on the interplay among these three factors. For example, the difficulty in completing a task may stem from a health issue related to the performance of that task, the nature/demands of that task itself, a barrier created by the environment in which the task is performed, or some combination of all. An effective assessment identifies both what the individual can accomplish as well as where there is a need for additional support.
Consider a hypothetical example of an individual returning to their home after being ill. The process of walking a short distance in a clinical setting is quite different from navigating a staircase, traveling via transportation, or participating in a busy workplace. Identify the specific task/activity and setting in which this task/activity will occur versus assuming that one test provides adequate prediction of future performance of each of these tasks. Link the assessment results to the actual conditions under which the demonstrated ability will be utilized.
A useful goal describes an activity that matters
A goal related to rehabilitation can pertain to self care, education, employment/work, family roles, or leisure/recreation. Ideally, the individual will collaborate with other(s) to define what has meaning. A goal (broadly defined as improvement of mobility) becomes more specific and measurable once tied to an activity and a means of measuring progress. Goals can evolve over time based upon changing recovery status, changing circumstances, or evolving priorities. A goal reflects an ongoing dialogue.
As a means of revising, compare assessing strength with having a goal to prepare a meal. Strength may represent an aspect of preparing a meal; however, preparation of a meal requires planning, reaching, etc. Additionally, the task/environment (kitchen) impacts the ability to prepare a meal. Clearly articulate the relationship without presuming that they are interchangeable. This distinguishes a measure of one body function from participation in daily activities.
Rehabilitation can change the task or environment as well as ability
Rehabilitation can include practice, exercises, communication strategies, education, assistive products and environmental changes. Physiotherapists and occupational therapists provide different yet complementary services. Other professionals may contribute according to need. Rehabilitation can help people of different ages and with a wide range of health conditions; it is not limited to recovery after an operation.
An assistive product needs to fit the individual, task and setting, with appropriate assessment and instruction. Providing a device and establishing that someone can use it safely are different steps. In a teaching plan, identify the barrier that the product addresses and the support needed for effective use. The device alone is not the whole intervention.
Progress needs context rather than one universal timetable
Progress reviews consider whether positive improvements have occurred relative to the initial baseline measures such as ability, symptoms, confidence and participation, whether the plan remains suitable, and whether modifications are necessary due to changing recovery, circumstances or priorities. Although some goals are designed to restore a previously acquired skill, others are focused on acquiring new methods or sustaining existing levels of function. Improvement does not necessarily indicate that a task will be accomplished in exactly the manner it was accomplished prior to experiencing the health condition.
A well-developed study account articulates the relationship between each component of a "chain" including: the goal, intervention and outcome measure. Should little to no progress be realized through rehabilitation efforts, ask which components require re-assessment rather than concluding that little effort was applied. General guidelines cannot direct exercise selection, equipment choices or activity limits for an individual. These choices require development of a plan collaboratively developed with rehabilitation professionals possessing expertise relevant to addressing the needs of the individual.
Check your understanding
A short quiz, with an explanation after each answer.
What does rehabilitation focus on?
Repeat your most challenging portion without referencing the page. Then create your own description of the rationale behind that description. Repeat your quiz responses at a later date. Your ability to articulate your thought process is much more valuable than your ability to recall where you located the correct response on a given question.