Rehabilitation aims to restore people's abilities and independence after illness, injury, or impairment. It addresses biological, psychological, and social factors to improve functioning. The goals are restoration of activities and social roles. Effective rehabilitation is responsive to individual needs, goal-directed, involves multiple disciplines and agencies, and is available when required to maximize participation in life.

1. Rehabilitation
Ahmed Suparno Bahar Moni
MS (Ortho)

2. Definition
• The Concise Oxford Dictionary (www.askoxford.com) defines
rehabilitation as:
• ‘(to) restore to health or normal life by training or therapy after
imprisonment, addiction or illness ‐ ‐ ‐ (to) restore to a former condition’;
• Example ‐ "she underwent rehabilitation and was walking within three weeks"
• The action of restoring someone to former privileges or reputation
after a period of disfavour.
• Example ‐ "a posthumous rehabilitation of the activist"
• The action of restoring something that has been damaged to its
former condition.
• Example ‐ "the rehabilitation of the mangrove forests"

3. Medical Rehabilitation
• The Collins Essential English Dictionary (2003) as:
• ‘to help (a person) to readapt to society after illness ‐ ‐ ‐.’
• The Merriam Webster Dictionary (www.m‐w.com) defines it as:
• ‘to restore or bring to a condition of health or useful and constructive activity’
• The American Heritage Dictionary (www.bartleby.com) define it as:
• ‘to restore to good health or useful life, as through therapy and education’.

4. Clinical Definition
• There is no generally agreed, clinical definition of rehabilitation (Nocon &
Baldwin 1998; Wade & de Jong 2000).
• Nocon & Baldwin reviewed a range of ideas and definitions of
rehabilitation –
• what it involves,
• who does it, and
• when it is carried out ‐ and argued that the core objective is restoration (Nocon &
Baldwin 1998).
• This might include restoration of function, capability, independence, or
physical and mental health.
• Building on the ICF framework, disability is restricted functioning, therefore
rehabilitation is restoration of functioning.

5. Traditional concept of rehabilitation:
• A secondary intervention:
• to restore patients as far as possible to their previous condition
• after a disease or injury (within the limits imposed by pathology and
impairments)
• to develop the maximum extent of their (residual) physical, mental and social
functioning
• where appropriate, to return them to (modified) work.
• (Mair 1972; Tunbridge 1972).

6. • This is a biomedical approach, which generally assumes that:
• Disability is a permanent physical or mental impairment due to disease or
injury
• Disability implies incapacity to work.
• Rehabilitation accepts permanent impairment is irremediable, and
attempts to overcome, adapt or compensate for it

7. • Rehabilitation is a separate, second‐stage process, which is distinct
from medical treatment, and carried out after treatment is
concluded, yet recovery remains incomplete.

9. Case 1:
• A 40 years old Male presented with the infection of dorsum and
palmar surface of his right hand following a foreign body prick while
gardening to our centre.
• He had uncontrolled diabetes.

10. Fig 1 and 2:

11. • Diabetes was controlled
• wound debridement was done.
• Culture and sensitivity report showed mixed infection with gram
positive and gram negative organisms, whish were sensitive to
piperacillin and tazobactam.

12. After 1st surgery:

13. • After control of the infection, he was advised for the amputation of
the index finger. But he did not give consent to the amputation. So
wound reconstruction was done with groin flap for dorsam of the
hand and split thickness skin grafting for the palmar area.

14. 2nd surgery:

15. 3rd surgery:
• After division of the flap, he developed severe depression and was
referred to the psychiatric hospital.
• As there was delay in wound healing, he was agreed for the ray
amputation of the index finger.
• But due to his psychiatric illness he was not attended the
physiotherapy sessions adequately.

16. • After 6 months of the treatment he was evaluated according to the
quick DASH score and it was calculated 68.2%.
• And he was quite unhappy with the outcome though his hand is
cosmetically okay but functionally not at all working.

17. Wound is healed but with contracture

18. Need for a different approach
• This traditional model of rehabilitation is inappropriate for the
management of the common health problems that cause most long‐
term incapacity.

19. Reasons behind that:
1. Severe medical conditions with objective evidence of disease,
pathology, and permanent physical or mental impairments (e.g.
blindness, severe progressive neurological and systemic diseases,
psychoses) now account for a minority of disability and incapacity
benefits.

20. • Some three‐quarters of people of working age with long‐term
incapacity have less severe health problems, the most common of
which are mental health, musculoskeletal and cardio‐respiratory
conditions, which are referred as common health problems (that
cause incapacity).

21. 2. The link between disease or impairment and functioning or (in)‐
capacity is much weaker than commonly assumed.

22. Biological incapacity
• Many people with severe medical conditions and/or permanent
impairment ‐ do work.
• Conversely, many recipients of disability and incapacity benefits have
little evidence of disease and/or impairment.

23. Psychological factor
• Functioning and disability also depend on personal / psychological
factors and interactions between the person and the environment.

24. • Indeed, in common health problems, psychological and psychosocial
issues are often more important for incapacity than any underlying
biological problem.

25. 3. Around 60% of disability and incapacity benefit claimants have no
recent contact with the labour market.

26. • It is then not so much a matter of returning to work, but of support in
seeking work and moving into some form of employment.

27. 4. Sickness and incapacity involve biological, psychological and social
dimensions, and rehabilitation must address them all.

28. • This implies that:
• Rehabilitation is no longer a separate, second stage measurement, after
medical treatment has been concluded
• For the common health problems,
• rehabilitation principles should be integral to clinical and occupational
management.
• Rehabilitation is a (multidisciplinary) professional intervention.

29. Primary objective of rehab
• Nocon & Baldwin considered there was an emerging consensus that:
• The primary objective of rehabilitation involves
• restoration (to the maximum degree possible) either of function (physical or
mental activities) or of role (participation within the family, social network or
work force).

30. Rehabilitation usually requires a combination of therapeutic and also social
interventions that address the clinical problem and issues in the individual’s
physical and social environment.
Effective rehabilitation needs to be:
• responsive to users’ needs and wishes;
• purposeful and goal directed;
• involve a number of agencies and disciplines; and
• available when required.

31. • The use of all means aimed at reducing the impact of disabling and
handicapping conditions and at enabling disabled people to achieve
optimal social integration.
• This process may involve rehabilitation, (re)‐training and
resettlement.

32. • These definitions still tend to assume that rehabilitation is a matter of
overcoming, adapting or compensating for irremediable impairment.
• There is clearly now a strong emphasis on both biomedical and social
dimensions.
• However, like the ICF framework (WHO 2001), there is still some
neglect of the personal/psychological dimension, which rehabilitation
must also address if it is to be about building individual capacity to
enable the person to participate fully and meaningfully in society.

33. Bio‐psycho‐social elements of rehabilitation
• Rehabilitation is often described as multi‐disciplinary, but that places too
much emphasis on professional input and perspectives.
• To understand and develop rehabilitation for common health problems, it
is more helpful to focus on the elements of the intervention (Staal et
al.2002).
• From the biopsychosocial model and the ICF framework of disability,
biopsychosocial issues may all constitute obstacles to return to work, either
singly or in combination.
• Biopsychosocial problems need biopsychosocial solutions.
• Thus, to address disability and overcome these obstacles, a rehabilitation
intervention should address all three of these dimensions.

34. • Biological elements
• Timely and effective health care
• Restoring function and increasing activity levels
• Matching capacity and activity level –v‐ job deman

35. • Personal / psychological elements
• Changing dysfunctional perceptions, attitudes and behaviour is central to
rehabilitation of many common health problems.

36. • Social / occupational elements
• For many people with common health problems, participation is as much an
occupational as a health issue. Occupational interventions may then be as
important and effective as health care for helping people to remain in, return
to, or move into work.

37. • The setting of rehabilitation may carry important, implicit messages:
health care commonly removes workers from the work‐place and
increases the distance from work; locating rehabilitation in the work‐
place may link them conceptually and in practice closer to their goal
(Waddell & Burton 2000).
• The minimum social element of rehabilitation appears to be
agreement by all the players (individuals, health professionals and
employers) that the primary goal is job retention or reintegration
(Frank et al. 1998).

38. Who needs rehabilitation?
• Rehabilitation is for the people who have lost abilities that they need for daily life.
• Some of the most common causes include:
• Injuries and trauma ‐ including burns, fractures (broken bones), traumatic brain
injury, and spinal cord injuries
• CVA ‐ Stroke
• Severe infections
• Major surgery
• Side effects from medical treatments, such as from cancer treatments
• Certain birth defects and genetic disorders
• Developmental disabilities
• Chronic pain ‐ back pain, neck pain, knee pain, shoulder pain, wrist pain

39. What are the goals of rehabilitation?
• The overall goal ‐ is to help one to get back his /her abilities and
regain independence.
• But the specific goals are different for each person.
• They depend on:
• What caused the problem,
• whether the cause is ongoing or temporary,
• which abilities you lost, and
• how severe the problem is. For example,

40. • A person who has had a stroke may need rehabilitation to be able to
dress or bathe without help
• An active person who has had a heart attack may go through cardiac
rehabilitation to try to return to exercising
• Someone with a lung disease may get pulmonary rehabilitation to be
able to breathe better and improve their quality of life

41. What happens in a rehabilitation program?
• When one get rehabilitation, he/she often has a team of different
health care providers helping him/her.
• They will work with him/her to figure out his/her needs, goals, and
treatment plan.
• The types of treatments that may be in a treatment plan include:
• Assistive devices ‐ which are tools, equipment, and products that help people
with disabilities move and function.
• Cognitive rehabilitation therapy ‐ to help relearn or improve skills such as
thinking, learning, memory, planning, and decision making.

42. • Mental health counseling
• Music or art therapy ‐ to help him/her expresses their feelings, improve their
thinking, and develop social connections
• Nutritional counseling
• Occupational therapy ‐ to help you with your daily activities
• Physical therapy to help your strength, mobility, and fitness

43. • Recreational therapy ‐ to improve emotional well‐being through arts and
crafts, games, relaxation training, and animal‐assisted therapy
• Speech‐language therapy ‐ to help with speaking, understanding, reading,
writing and swallowing
• Treatment for pain
• Vocational rehabilitation ‐ to help him/her build skills for going to school or
working at a job

44. Place of rehab
• Depending on the needs, he/she may have rehabilitation in the
providers' offices, a hospital, or an inpatient rehabilitation center.
• In some cases, a provider may come to his/her home.

45. Rehab plan
• A rehabilitation plan is holistic
• It focuses on the medical aspects of the issue and the non‐medical
too.
• In fact, the non‐medical part of it can be pretty extensive.
• It may also include any social care needs he/she has such as benefits,
obtaining necessary equipment and/or adaptations to your home.

46. • It focuses on what matters to him/her
• What is important to him, the daily activities which are the highest
priority for him to return to, and what he wants to be doing because
it makes him happy.

47. • A good rehabilitation plan involves those close to him
• The people close to him are the support network.
• AND this SUPPORT NETWORK IS INCREDIBLY IMPORTANT.
• These people may be family members, relatives, friends, colleagues, others who
have a similar illness or injury, and/or even pets.
• These people are like cheerleaders, they give him comfort when he feels down or
are having a bad time of it.
• They help him to do physiotherapy, shopping, cooking dinner, cleaning house,
looking after his/her children, helping him if he has a health emergency or
something else.
• A key thing is letting them support the patient.
• A rehabilitation plan does not have to be a solo effort.

48. • It specifies what kind of specialist expertise he needs and who can
provide that
• He may not know how to do some things in his plan so he may enlist
the help of someone who does.
• He may need support with an issue that feels too big to handle on his
own.
• A problem shared is a problem halved as they say.

49. • It is goal oriented
• He may have a big goal broken down into smaller goals.
• Or it may be a series of smaller goals.
• Some of these goals may be key milestones, like being able to walk
with good balance and not falling down for 500 meters.

50. • Rehabilitation plan can be adapted
• As he implements his rehabilitation plan, he may find that he needs
to adapt it as his recovery progresses (however slow or fast that is),
stalls or experience a setback.
• As you are not a static person never changing, neither is your
rehabilitation plan.
• Flexibility to adapt as you learn what works and as things change is
key.

51. • It contains a section on what you need to do when you experience a
bad patch
• This may be a setback in your recovery or you experience a
fluctuation in symptoms or a relapse. This is kind of like a sub‐plan of
your main rehabilitation plan which you implement as and when you
need to.

52. • Rehabilitation plan contains a section on what to do in an
emergency
• For example, if he has a spinal cord injury at T6 (T = thoracic level), he
may be at risk for autonomic dysreflexia, which can be life threatening
if not treated.
• Another example is hypoglycaemia if he has diabetes.
• So if he is at risk of having a health emergency and he may need the
support of others to stabilise things, he needs to have a plan what has
to be done, medications to take, who to call, etc.

53. • It contains a section on how he looks after himself when he is doing
really well too
• Just like he needs a plan for when he is not doing well, he needs a
plan for when he is doing well.
• These might include favourite activities that he really enjoys doing
and can do when symptoms are quiet or well controlled, or he is
feeling physically and/or mentally well.
• For example, going to a concert or play, spending a day, afternoon or
evening with friends, going on a walking weekend, entertaining,
bubble bath, etc.

54. • Rehabilitation plan is for life
• Rehabilitation is an ongoing process.
• When someone has experienced a life‐changing illness or injury,
his/her body has changed forever.
• He/she needs tender loving care.

55. • Sometimes he/she may not make noticeable gains in your recovery
and he/she may have even experienced a plateau and wonder if there
is any point in continuing.
• But keeping to the rehabilitation plan often means he/she doesn’t
regress, i.e. he/she doesn’t lose functionality.

56. • Sometimes, they notice a change for the worse when they stop their
physiotherapy, exercise or stretching for example.
• Or they stop an activity that has contributed to keeping their mental
health in a good place.
• In short, a rehabilitation plan is about developing new life habits that
are about looking after all aspects of yourself.