WHAT IS REHABILITATION?
Rehabilitation focuses on the existing capacities of the handicapped person, and brings him to the optimum level of his or her functional ability by the combined and coordinated use of medical, social, educational and vocational measures. It makes life for the handicapped individual more meaningful, more productive and therefore adds more life to years. It is the third phase of medical care; after preventive and curative.
|Rehabilitation, Medical Rehabilitation|
Preventive & Curative Medicine:
Preventive medicine is the first phase where a disease is prevented from occurring, by avoiding the interaction between agent, host and environment. Curative medicine, the second phase focuses on attempting to cure the disease. Most doctors practice curative medicine. However there are several conditions like rheumatoid arthritis which has no cure, and others, like poliomyelitis in which the agent causing the disease has been eliminated from the host, but residual effects like paralysis still persist. Therefore, there is a need for a third phase, namely rehabilitation, which is not just medical but also a social responsibility.
Onset of Rehabilitation Period:
Rehabilitation must, be started at the earliest possible time in order to ensure the best results. It is administered in conjunction with specific medical or surgical treatment of the precipitating disease. Rehabilitation may be medical or socio vocational. Medical rehabilitation is the utilization of medical and paramedical skills to help treat the patient. The role of medical rehabilitation is to limit disability. Socio vocational rehabilitation follows, or sometimes is delivered simultaneously along with medical rehabilitation. The role of socio vocational rehabilitation is to limit handicap.
Importance of Physiatry:
Medical and socio vocational rehabilitation is the responsibility of a team of professionals headed by a Physiatrist, the key person in the guidance of the rehabilitation program. The difference in the clinical evaluation by a physiatrist is that the physiatrist views the patient with social and vocational background in addition to the medical background. He tries to get a clear picture of how an illness has affected a person’s life—what he or she can no longer do and how to get over the problem. The other team members in medical rehabilitation are the physiotherapist, the occupational therapist, and many others while the social worker and vocational counselor are in the socio vocational team.
Epidemiology of Rehabilitation:
The word epidemiology is derived from the Greek word epidemios; meaning “among the people” In the early 20th century, CO Stally bross defined epidemiology as “the science which considers infectious disease—their course, propagation and prevention.”
Epidemiology is concerned with the study of the causative factors of disease and the means to prevent or eradicate it. If complete prevention or total eradication is not possible, containment is the second choice.
WH Welch defined epidemiology as “the study of the natural history of disease.”
Lillienfeld described it as the study of “the distribution of a disease or condition in a population, and of the factors that influence this distribution.”
The definition of health put out by the World Health Organization runs as follows:
“A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” The fundamental goal of medical science is not to produce an immortal being but to maintain him in optimum health as long as possible, ideally until death.
It is often said “The fundamental goal of rehabilitation is to add life to years; not years to life”. It is now known that disease is caused by simultaneous interaction of host, agent and environment.
Prevention of disability does not start only at birth, at the onset of disease or after a primary disability occurs. Sometimes it may be done even before the child is born, by anticipating disability due to genetic defects or blood group incompatibility and can be prevented by means of genetic counseling. For example in Duchennes muscular dystrophy, it is possible to counsel the parents on having another child who might later display the symptoms of the disease.
Disability & Rehabilitation:
Current population growth, particularly of the aged, naturally would result in a sharp rise in people with disability in the near future. It is a paradox that because of the tremendous strides that medical science has taken, the number of patients surviving a potentially fatal condition like brain injury is much more. It therefore follows that with a fall in mortality levels there is a rise in morbidity levels. Rehabilitation deals with morbidity; it deals with quality of life. Unfortunately there is a great shortage of medical and paramedical professionals to care for the persons with disability, and this gap keeps widening.
In recent years, specialists in neurology, orthopedic surgery, and pediatrics are increasingly getting involved with and have a vital role to play in the field of rehabilitation medicine. This phenomenon shows the recognition and importance that is being given by other specialties to rehabilitation medicine.
Unless more effective methods of prevention are developed to protect the population from primary disability in the future, the newly detected persons with disability will face a critical situation. The cumulative shortage of health manpower will cause them to be without benefit of rehabilitation services, and superimposed secondary disabilities will render them totally dependent on society for everything. This will result not only in personal tragedy, but will create infinite economical problems for families, communities, and nation.
Consider a nuclear family where husband and wife are working for a living or for a professional career. The presence of a disabled child or senior member would rob this family of all its happiness, its leisure, and time available. A lot of personal sacrifice will be required by each one of its members to take care of the patient. The medical community must act to prevent epidemics of disability in much the same manner that we are now able to prevent communicable diseases.
Levels of Prevention:
Any health care that tries to halt a person’s slide down the slope of the health status scale is termed preventive health care and any attempt to push it up towards the peak, i.e. optimum health, is called therapeutic health care. This total spectrum is classified into three levels of prevention by the World Health Organization.
It is explained as a measure taken before the onset of any disease, e.g. immunization against childhood infections or chlorination of drinking water. It is designed to promote general health and improve the quality of life. It incorporates health education for bringing about awareness of health problems before it occurs. This is similar to the first phase of medicine, i.e. preventive medicine.
It is a measure taken to arrest the progression of a disease while it is still in the early asymptomatic stage of the disease. It involves early diagnosis and immediate treatment, e.g. ergonomic intervention to prevent clinical symptoms in a patient with spondylosis.
It is explained as a measure taken to minimize the consequences of a disease or injury once it has become clinically manifested, e.g. prevention of pressure sores in a paraplegic by turning the patient over regularly. Tertiary prevention is an integral part of Rehabilitation Medicine.
Goals of Rehabilitation:
Handicapped individuals have problems with
Orientation: For a person with head injury or cerebral palsy, the orientation to surroundings would hamper his activities of daily living like feeding or toileting.
Physical independence: It is the prayer of every handicapped person that he reduces dependence on the people taking care of him.
Mobility: Poliomyelitis and paraplegia are conditions that severely hamper mobility and thus even day to day tasks like moving around in the house can become very challenging.
Occupational integration: Training and placement in a suitable job.
Social integration: No man is an island, and attempts must be made to integrate handicapped people into society, and not isolate them.
Economic self-sufficiency: The job must ensure a means of livelihood.
SOCIO VOCATIONAL REHABILITATION:
No person is said to be fully rehabilitated unless all the above criteria have been looked into. Socio vocational rehabilitation is a team effort, which aims at providing the disabled a vocation, a barrier free place to live and the right social environment to reduce his handicap. It must not be misunderstood as just another employment agency. At the heart of vocational rehabilitation, is the concept of the ‘right to work’; that is to treat work as much more than a means to money, but as a way of living and a mode of dignity to the individual. It is thus an outlet for his aspirations, and adds to his self esteem as an independent contributor to society.
It empowers persons—not just economically but in a more basic and meaningful sense. It makes a person stand on his own legs. It does not bind him to a job, it sets him free. Obviously not every handicapped individual can stand on his own feet – literally or otherwise. A more realistic and pragmatic approach is needed.
In a country like ours where even the able bodied do not get work, questions are naturally raised on the need for the disabled to work. However, we must not forget that it is the constitutional right of every citizen to realize himself by mainstreaming himself into society.
The social worker tries to provide emotional support to the patient as well as to his family members and also creates awareness in the community about disability and its limitation. Training the patient in a job, ensuring that he gets placed with a good wage, is also the responsibility of socio vocational rehabilitation. This is a team effort which includes professionals like the vocational evaluator and trainer.
Employers must be encouraged to use the services of the persons with disability with incentives in the form of tax benefits awards and social distinctions. Towards this end, legislation will have to be enacted to give the differently abled their rightful place in society. The passing of the Americans with Disabilities Act (ADA) in 1991 was a landmark in the life of the disabled in that country. In India the act passed is the PWD (People with Disabilities) Act 1995.
The role of the community cannot be overemphasized. Awareness programs must be conducted; trust in one’s abilities must be generated.
Now the emphasis is on community-based rehabilitation, where trained personnel, preferably from within the community are made available even to remote areas, linked to the primary health care set-up. Adults can be trained in a vocation suitable to the community and area. For example, a grass cutter who has lost his right hand can be given a device with a sickle and trained to go back to his original job in his village. There is also the in-built advantage that he is being trained in the profession of his choice and where he has the contacts and goodwill needed to generate employment.
The catchword today is empathy not sympathy. In other words the message that the persons with disability are giving throughout the world is please accept us as we are.
The person with disability is considered an equal and effective partner in the modern social order, and his contribution to the field of politics, administration, science and the arts is second to none. There are several shining examples for this. One has only to recall the name of Stephen Hawking the famous professor of physics who suffers from gross motor disability. Helen Keller was visual and hearing impaired, Milton was visually impaired, and Roosevelt had poliomyelitis. Such great people make us feel proud of the contribution of the handicapped to the progress of humanity
As we march into the 21st century, we look forward to a disability-free population where each can fend for himself and lead a life of independence and dignity.