Definition

Rehabilitation means restoring the function of the mind or body, the maintenance of such health
once restored and the resettlement of the individual in the outside world in a job.

Rehabilitation may be defined as a process of assisting a physically disabled, chronically ill, or

convalescent person to realise his particular goals in living and working to the utmost of his
potential.

This process involves various aspects of the individual’s social, economic, mental and physical
functioning, and it includes almost all those receiving health care.

The word “rehabilitation’ itself means “retraining” or ‘restoring” in contrast to the word
“habilitation”, which refers to the initial capacity for living. For example, when a baby first tries to
learn to walk, the process is habilitation, but when an individual learns to walk again, it is
rehabilitation.

Rehabilitation actually begins as soon as a patient place himself under medical care, and not
when he has recovered and is awaiting discharge from the hospital. Once the patient has begun
to recover, the question of his work in the outside world must be considered. In many cases, the
patient has lost his job on entering the hospital, whilst in others the job is unsuitable and for this
reason, it is often necessary to train the patient for a new job.

Team Approach to Rehabilitation

Rehabilitation usually comprises a number of special health services that may be made available
to the individual patient on the basis of his particular need. Personnel rendering these special
services include:-

- The physician

- The nurse

• OccupationalTherapist

• Psychiatrist

• Speechtherapist

• Socialworker

• Psychologist.

Both the patient and patient’s relatives (family) play an active role in the rehabilitation process of
the patient.

Because rehabilitation is a complex process involving a patient and a number of professional

personnel, a team relationship usually provides the structure through which each member can
make his special knowledge and skills available for the greatest benefit to the patient. The team
evaluates the patient’s need for rehabilitation and develops a plan whereby he may receive
maximum assistance in achieving his rehabilitation goals. The success of the team depends on
the patient who is also a key member of the team.

Importance of Rehabilitation

Rehabilitation is designed to:

1. Reduce the severity of symptoms and possibly the number of deaths associated with illness.

2. To restore the function lost through disease.

3. In psychiatry, rehabilitation is important in patients with a chronic mental disorder (e.g.

dementia and schizophrenia). It has been shown that stressful life events exacerbate the course
of schizophrenia, leading to acute relapses and an accelerated decline in social functioning.
Interviewing with patients and their families (e.g. with counselling or psychotherapy) following a
stressful life is both a form of secondary prevention of an acute relapse and tertiary prevention of
further deterioration.

4. In chronically institutionalised patients, the decline in social functioning associated with

routinised behaviour and neglect in some long-term residential settings (called “chronic social
breakdown” of institutionalism) can be reversed by active psychosocial rehabilitation in the form
of stimulation, changes in routine, and activities therapy or occasionally,by release to less
restrictive residence.

Psychosocial Aspects of Rehabilitation

The motivation of the patient is one of the most different problems the rehabilitation team will
have to solve. The patient often stresses the abilities that he had lost rather than those he has
left. In some instances, a disability means that the patient will have to reorganize his entire life,
whereas in others he may be able to return to his former routine, with some modifications. To be
motivated, the patient must have hope. This hope must be of the realistic type, neither the
patient nor his family should set unrealistic goals. The patient should be encouraged to engage in
some creative thinking of his own.

Unless the present abilities of the patient are stressed, he may develop a feeling of inferiority. His
psychological changes may be greater than the physical changes. The rehabilitation team can
help him gain faith in himself by encouraging him to do whatever he can.

Both the rehabilitation team and family need to understand the emotional aspect of the
patient’s condition. Fear itself is a large factor. The patient often has fears of not being accepted
by his family, his friends, or society and also has fears concerning his new limitations and of the
future in general. A patient who is worried and afraid may express his feelings in a multitude of
ways. However, he may not be able to express these feelings as fears or anxiety. If they are not
expressed as fear and worry they may appear as irritability, frustration, hostility, depression,
embarrassment or shame.

An important point in health care for the patient undergoing rehabilitation is to encourage him
to do all that he could do for himself. Allowing sufficient time for his slow movements will avoid
the impression that he is inadequate merely because he cannot do something quickly.

When the patient cannot perform acts for himself, he then should be allowed to make as many
decisions as possible. He should be allowed to make as many decisions as possible. He should be
encouraged to start planning his care in such a way that the routine will be continued at home.

e. In order for the patient to make plans for the future, he may need to talk with the nurse to
clarify his own ideas and to be reassured that his plans are realistic, that is, if they are realistic.

The family too may need assistance in recognising accepting and solving future problems.

It will be seen, therefore that not only is it the duty of those looking after a patient to affect his
recovery in hospital but also to resettle him in the outside world in reasonable environmental
conditions and to follow the patient up after leaving the hospital. In this way, much can be done
to prevent relapses and to produce a healthier atmosphere in the home in which the future
generation is to be brought up.

PRINCIPLES OF REHABILITATION

Principles direct the discharge of rehabilitation care. These

principles guide the rehabilitation professional in developing

the plan of care for the individual undergoing

rehabilitation.Also, rehabilitation principles need to be

understood by all rehabilitation team members to obtain

desirable outcomes in the process of rehabilitation. The

following principles guide rehabilitation;

Promote Adaptation
The challenges that accompany impairments and loss of function
are often overwhelming for the patient and often include physical,
social and emotional challenges.Due to this, to obtain desired
results in rehabilitation, there must be an understanding of the
overall individual's condition. This understanding must be
channelled to support, encourage and build strength and
resourcefulness.It is also essential for rehabilitation practitioners to
understand that total recovery may not always be the end goal for
rehabilitation for many individuals, but rather to maximize function.
Therefore, they must know that rehabilitation helps individuals
adjust to challenging health conditions and not only “recover” from
them. The term “recovery,” often gets misunderstood by the
individual as different from what a health professional may
intend.Therefore, the use of “adaptation” may create more realistic
suggestions to the individual to enable them to cope and make
adjustments with alterations, which have occurred following a
health condition especially conditions that involve making lifelong
changes.
Indeed, reduction in activity, limitations and increase in community
participation and reintegration occurs with rehabilitation, yet,
creating a sense of adaptation in the patient increases their level of
self-confidence and improves their acceptance of their self-image
and adjustment to roles following mental health challenges.

Focus on Abilities
Rehabilitation emphasizes an optimistic perspective for individuals
who have undergone different health challenges based on life-
altering conditions.Therefore, rehabilitation focuses not on what is
lost but what can be regained and achieved through mutual goal-
setting by the rehabilitation professional and the individual.

Treat the Whole Person

A foundation principle in rehabilitation is a holistic approach to
treatment.It has to be remembered at all times that an individual is
being treated and not the disease. This means that an individual's
preferences, background, culture, religious beliefs, social support,
physical abilities, developmental stages, psychology must be
considered as plans of care are being developed by the
rehabilitation team members.

Time
The impact of time on rehabilitation has been widely studied from
the best period to commence rehabilitation to the duration
necessary for rehabilitation to achieve the greatest benefits. Broadly
time is important in rehabilitation. Early commencement of
rehabilitation can reduce the risk of readmission.

Education
Rehabilitation is not a magic pill, and education is the vital aspect of
the rehabilitation process throughout all stages that ensure the
individual and their support structures have a good understanding
of what is going on, in order to set realistic expectations and SMART
goals(specific,measurable,achievable,realistic and time
bound).Education of the individual in rehabilitation enables that
person to assume responsibility for their health, promotes patient-
centred care, and promotes the greatest level of independence in
activities and involvement in rehabilitation plans.

People Centred Care

An approach to care that consciously adopts individuals, caregivers,
families and communities perspectives as participants in and
beneficiaries of trusted health systems that are organized around
the comprehensive needs of people rather than individual diseases
and respects social preferences. People-centred care also requires
that patients have the education and support they need to make
decisions and participate in their own care and that caregivers are
able to attain maximal function within a supportive working
environment. People-centred care is broader than patient and
person-centred care, encompassing not only clinical encounters but
also including attention to the health of people in their communities
and their crucial role in shaping health policy and health services.

METHODS OF REHABILITATION (community based)

1. Half -way house or homes
it is an institute for people with criminal backgrounds or substance
use disorder problems to learn (or relearn) the necessary skills to re-
integrate into society and better support and care for themselves
As well as serving as a residence, halfway houses provide social,
medical, psychiatric, educational, and other similar services. They
are termed "halfway houses" due to their being halfway between
completely independent living and in-patient facilities, where
residents are highly restricted in their behavior and freedoms.

2. Day and night hospital

A day and night hospital is an outpatient facility where patients

attend for assessment, treatment or rehabilitation during the day
and then return home or spend the night at a different facility. Day
hospitals are becoming a new trend in healthcare.Day and Night
Treatment programs are structured to provide clients with a
conducive environment that nurtures high success rate and
prevents relapse. It involves the use of monitored and structured
recovery residences that clients are transported to after completing
therapy at the rehab center for the day.

Unlike inpatient treatment, a major differentiating factor is that in

day and night treatment, you live at an off-site recovery residence
that is supervised and managed by behavioral health technicians.

While in Day and Night rehabilitation centers everyone receives

individual and group therapy from trained counselors and
therapists. This is a very crucial part of the recovery process. You
also learn communication skills and coping mechanisms which are
invaluable for your reintegration into society. Being around people
who understand your situation and share similar experiences gives
added motivation.

OCCASIONAL/TRAIL LEAVE
Mental health trial leave occurs when a
patient using a secure hospital bed in a ward
spends a period of time in a less secure
hospital bed in a different ward on a trial
basis.

SHELTERED WORKSHOPS

it provides people recovering from mental illness and people with

disabilities with a working environment specially designed for
vocational training through an income generating work process.it
could also be described as a facility and a workshop that provides
shelter and work in a supporting environment for people with a
range of disabilities. These sheltered workshops differ
from supported employment.

PAROLE
It is a method of maintaining supervision of a patient whose
treatment is mandated by the court and who has not been
discharged but who is away from the confines of a restrictive
setting, such as a mental institution or halfway house. A patient on
parole may be returned to confinement at any time without formal
action by a court. It can also be defined as a supervised release
from confinement in a correctional facility.