The document discusses models and methods of rehabilitation. It describes rehabilitation as helping a person reach their fullest potential physically, psychologically, socially, and educationally given their limitations. Rehabilitation nursing aims to restore abilities, prevent further disability, protect abilities, and assist patients. Principles of rehabilitation include beginning rehabilitation early, restoring independence, maximizing function within limits, and focusing on specific conditions. Methods include neurological, cardiac, drug, alcohol, physical, medical, vocational, vestibular, and stroke rehabilitation as well as community-based approaches. Models of rehabilitation include the Nagi, IOM, NCMRR, and new IOM models which define concepts like impairment, functional limitation, and disability and their interactions.

1. MODELS AND
METHODS OF
REHABILITATION

2. REHABILITATION
Rehabilitation is the process of helping a person to
reach the fullest physical, psychological, social,
vocational, and educational potential consistent
with his or her physiologic or anatomical
impairment, environmental limitations, and desires
and life plans.
 According to WHO “ Rehabilitation is the
combined and coordinated use of the medical,
social, educational, and vocational measures for
training and re-training the individual to the
highest possible level of functional ability”.

3.  REHABILITATION NURSING
 Important and essential part of comprehensive nursing.
 Rehabilitation nursing ideally starts at the moment a
patient enter into the health care system. However,
rehabilitation programme may take place in the special
units of hospital or independent centre in the community.
 OBJECTIVES OF REHABILITATION NURSING
 There are 4 broad objectives of rehabilitation nursing:
 a. To restore affected abilities to the highest possible level
of function.
 b. To prevent further disability/ handicap.
 c. To protect the person abilities.
 d. To assist the person / patient to use his or her abilities

4. PRINCIPLES OF REHABILITATION:
 Rehabilitation should begin during the initial contact with the
patient.
 Restoring the patient to independent or to regain his pre-
illness/pre-disability level of function in as short a time as possible.
 Maximising independence within the limits of the disability.
 He must be an active participant.
 The activities of daily living are facilitated.
 The individual with a disability is encouraged to wear his clothing
enhances self-esteem and dignity. Motivates the patient and helps
him to attain social independence.
 Focus is on the needs of groups of people with specific condition
 Every patient has a right to the rehabilitation services.

5. METHODS OF REHABILITATION
 NEUROLOGICAL REHABILITATION
 In this type of rehabilitation, patients suffering from stroke, neuromuscular
disease, certain types of head trauma and spinal cord injury are treated.
 It aims at making the patient self-dependent
 It helps create a positive thinking in patient
 The patient is treated so that he leads a improved life physically, emotionally,
and socially.
 CARDIAC REHABILITATION
 Cardiac rehab program is designed to help those people who have heart
problem. Heart patients are educated to live a healthy life and reduce stress for
the proper functioning of the heart.
 Educating people about the various risk factors that contribute to developing a
heart disease. These risk factors include, high blood pressure, obesity, smoking,
drinking, drug abuse, lack of physical activity, etc.
 Recovery programs from heart disease/surgery.
 Educating people about improving their quality of life.

6.  DRUG REHABILITATION
 Drug rehabilitation programs involve programs that are designed to make
an addict free from the addiction of alcohol, prescription drug and street
drugs (cocaine, heroin etc)
 ALCOHOL REHABILITATION
 Alcohol rehabilitation program is designed to make an alcoholic free from
the addiction. It involves programs that will teach people the various bad
effects of consuming excess alcohol
 Effective detox programs that will cleanse the body from the various toxins
of alcohol
 PHYSICAL REHABILITATION
 Physical rehabilitation is for those people whose lifestyle has changed after
they have gone through a serious illness, surgery, accident or illness. Here
the therapist introduces programs to improve the mobility and functioning
of the injured body part of the patient.
 Proper exercising program is designed to improve the functioning often
physical body.
 Includes therapies that will help a patient re-learn the basic physical and
cognitive functioning.

7.  MEDICAL REHABILITATION
 Medical rehabilitation includes treatment programs that help a
person perform better in all his daily physical and mental activities.
 Medical rehabilitation is a follow up treatment after any kind of
treatment program.
 VOCATIONAL REHABILITATION
 Programs focus on improving major and minor skills that are
in the basic life.
 Assessing patient in every step to improve the activities of basic
 Vocational rehab program is designed to
 help those people who find it difficult to employment or retain it
they have gone through certain situation that caused mental or
physical disability in them.
 Providing physiological and medical assessment Job placement, job
training and on job training

8.  VESTIBULAR REHABILITATION
 It helps in improving the ear deficit by working the central
nervous system. Also deals in improving eye and head
coordination
 STROKE REHABILITATION
 This treatment type helps to restore damage that is
caused after a stroke, which is the 3 rd leading cause for
death worldwide
 Stroke rehabilitation aims at helping people gain
normal functioning after the occurrence of a stroke.
 Help the person to get back to normal lifestyle and be
independent in daily activities.
 COMMUNITY BASED REHABILITATION

9. MODELS OF REHABILITATION
NAGI MODEL
 The Disablement Model is one of the many models
developed over the years initially developed by
sociologist Saad Nagi in the 1960,several revisions of
Nagi’s model was done in the mid 1990
 Nagi described four basic phenomena that he
considered fundamental to rehabilitation as follows.
 active pathology
 impairment
 functional limitations
 disability

10.  Active pathology is an interruption in normal body
processes that leads to a deviation from the normal
state such as infection, trauma, disease processes or
other degenerative conditions.
 Impairment is a loss or abnormality at the tissue, organ,
and body system level.
 Functional limitations relate to the individual's inability
to perform the tasks.
 Disability defined as a physical and/or mental limitation
in performing socially defined roles and tasks expected
of an individual.
 For instance, a 12-year old girl with mental retardation does not attend
school, she stays home with her parents helping with household chores

11. INSTITUTE OF MEDICINE (IOM)
MODEL
 IOM used the original Nagi model but incorporated
two important concepts in known as secondary
conditions or risk factors and quality of life
 Risk factors included biological, environmental
which include both social and physical, and lifestyle
or behaviour factors capable of interacting with the
disabling process
 quality-of-life or the general wellbeing of the
individual was seen to both affect and be affected
by each stage of the process.

12.  In 1997 IOM revised its own model as follows:
 disability was removed from the model, and
was instead viewed as an outcome of the
individual interacting within the environment.
 disability was defined through an
"enablement-disablement process," which is
important because it identifies disability is as
changeable and reversible the risk factors were
renamed to transitional factors, as they were
responsible for the transitions between the
categories of the enabling-disabling process.

13. NATIONAL CENTER FOR MEDICAL REHABILITATION
(NCMRR)
 NCMRR incorporated the basic NCMRR incorporated the basic
phenomena described in the Nagi model but also included a specific
component but also included a specific component related to societal
influences or limitations related as contributors to disability.
 NCMRR defines societal limitations as the restrictions resulting from
social or barriers, which limit fulfilment of roles or deny access to
services and opportunities associated with full participation in society.
 The model defined disability as limitations in performing tasks,
activities, and roles to levels expected in personal and social contexts
where focus was placed on how a person with a disability adapts to
functional limitations in the family, work, local community.
 In 2006 the NCMRR started working on a new version in which
rehabilitation is seen as an active process, requiring the active
participation of the patient, with the ultimate goal of improving the
patient's quality of life.

14.  A NEW MODEL FOR THE ENABLING-DISABLING PROCESS
 A common understanding of such terms as injury,
impairment, handicap, functional limitation, disabling
conditions, and disability is essential to building effective,
coherent programs in rehabilitation science and
As described above, several frameworks have been
to describe disability-related concepts, but none of these
been universally adopted. The lack of a uniformly accepted
conceptual foundation is an obstacle to research and to
other elements critical to rehabilitation science and
engineering. this committee presents a new set of models,
based primarily on the previous IOM model (1991),
to enhance the robustness of the previous models with
respect to reversing the disabling process, i.e.,
This section presents an overview of "the enabling-disabling
process," explains its stages, and describes the nature of
disability

16.  NEW IOM MODEL
 Some modifications are designed to both improve the model
and to adapt it more towards rehabilitation. The 1991 IOM
model (IOM, 1991) established a new conceptual foundation
the field of disability in that it analyzed and described the
components of the disabling process in such a way as to
for the identification of potential points for preventive
intervention. Identifying and describing the importance of the
different types of risk factors that affect the disabling process
as well as the interaction and integral nature of quality of life
were fundamental contributions to the emerging field of
disability prevention. Over time, however, some shortcomings
in the 1991 IOM model have emerged, including the
implication that the disabling process is unidirectional,
progressing inexorably toward disability without the possibility
of reversal.

17.  The person: Arrows pointing left were added to represent the potential
effects of rehabilitation and the "enabling process" (risk factors and
enabling factors are now combined into "transitional factors"). In
addition, the new model includes the designation "no disabling
conditions" to indicate that there is a beginning and an end to the
disabling process when a pathology, impairment, functional limitation,
disability does not exist.
 The environment: The shaded gray area from the 1991 model becomes
"the environment," including the physical, social, and psychological
components of the environment, and is represented as a three-
dimensional mat that supports and interacts with the person and the
disabling process, serving to highlight the importance of the person-
environment interaction.
 Disability: The box that was labeled "disability" in the 1991 model has
been moved from being a part of the disabling process to being a
product of the interaction of the person with the environment.
 The Person In the new model a new designation was added to indicate
people with no disabling conditions. This feature of the model will allow
for ''complete" rehabilitation

18. Transitional Factors in the new model, the committee defines
the converse of risk factor as "enabling factor." Risk factors are
phenomena that are associated with an increase in the
likelihood that an individual will move from left to right in the
new model, that is, from no disabling condition toward
functional limitation. In contrast, enabling factors are
phenomena that are associated with an increase in the
likelihood that an individual will move from right to left in the
new model, that is, toward less limitation. He general types of
enabling factors are the same as the general types of risk
factors, that is, environmental (social, psychological, and
physical) along with lifestyle and behavioral. Thus, since both
disabling and enabling factors affect transitions between the
stages of the model, the committee groups them together as
"transitional factors."

19.  The Environment The environment is represented as
a flexible three-dimensional mat in the new model.
The strength and resilience of this mat are
proportional to the quantity and quality of accessible
support systems and the existence of various
Stronger mats equate with more supportive
environments, for example, access to appropriate
health care, the availability of assistive technology
social support networks, and receptive cultures.
Weaker mats equate with non-supportive
environments. For example, physical barriers,
discrimination, lack of accessible and affordable
assistive technology, and lack of appropriate health
care result in greater displacement of the mat and,
therefore, cause greater disability.

20.  The environment is represented as having two general
categories: the social-psychological and the physical.
 Psychological and Social Environments
 Discrimination, Access to health and medical care,
Appropriate care, Access to technology
 Culture, Employment, Family, Economy, Community
organizations, Access to social services, Traits and
personality factors, Attitudes and emotional states, Access
to fitness and health-promoting activities, Education,
Spirituality, Independence
 Physical Environments
 Architecture, Transportation, Climate, Appropriate
technology, Geography, Time