Principles of Rehabilitation - Physiopedia
Introduction
The vast benefits of rehabilitation stem from a robust foundation that is hinged on
rehabilitation principles. These principles are essential aspects of rehabilitation that
distinguishes the medical approach to treatment from the rehabilitation approach.
Thus, it is responsible for the orientation and uniqueness of rehabilitation and its
professionals.
Foundations of Rehabilitation
Figure.1 Disability Prevention and Rehabilitation Week Celebration. Philippines
Rehabilitation (https://www.physio-pedia.com/Introduction_to_Rehabilitation) is
founded on the philosophy that every person has the right to be in charge of their
health and that they also have inherent worth.[1] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-1)
This philosophy results in the viewpoint of
every individual as being a comprehensive, holistic and unique entity.[2]
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)
This makes the
rehabilitation team responsible for providing the necessary training, knowledge and
skills to the person with an impairment to optimise, enhance and maximise their
independent function.[2] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)
In the medical model of care, the physician is tasked with ensuring the survival of a
patient.[2] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)[3]
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:1-3)
The physician has an
active role in the diagnosis and management of the patient, with the patient
frequently performing a passive role in the process of care.[3] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:1-3)
This model can play a role when
addressing limited critical care situations in emergency care. Although it is often
limited in helping patients with conditions where functionality and participation in
activities is the real challenge.[3] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:1-3)
To put this in perspective, in a condition
such as a stroke, the concerns of the patient may go beyond addressing pain or
spasticity, but be centred on functionality in returning to work, sexuality, grooming
and transfers, and so on.
On the other hand, rehabilitation predominantly utilizes the Bio-psycho-social Model
(https://www.physio-pedia.com/Biopsychosocial_Model), which shifts its focus
from the disease to the individual.[2] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)
Rehabilitation focuses on empowering
the individual to learn to maximise their residual function, with a goal of minimising
the impact of the impairment on the day to day activity.[3] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:1-3)
This rehabilitation role is carried out by a
team of rehabilitation professionals, including physicians, nurses, physical
therapists, occupational therapists, speech/language therapists, psychologists,
social workers.[3] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:1-3) Through
this model, a more holistic approach to care is taken with the individual and their
support structures such as family and friends included in the rehabilitation process
to enable all to understand the condition and develop strategies to manage the
condition effectively.[3] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:1-3)
Principles direct the discharge of rehabilitation care. These principles guide the
rehabilitation professional in developing the plan of care for the individual
undergoing rehabilitation.[2] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:0-
2)[4] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-4)
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.[2] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:0-2) 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.[2] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)
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 maximise function. Therefore, they
must know that rehabilitation helps individuals adjust to challenging health
conditions and not only “recover” from them.[2] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)
The term “recovery,” often gets
misunderstood by the individual as different from what a health professional may
intend.[5] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-5) 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 health challenges.[6]
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-6)
Emphasise Abilities
Rehabilitation emphasises an optimistic perspective for individuals who have
undergone different health challenges based on life-altering conditions.[2]
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)
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.[7] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-7)
Treat the Whole Person
A foundation principle in rehabilitation is a holistic approach to treatment.[8]
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-8)
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
[2] (https://www.physio-
of care are being developed by the rehabilitation team members.
pedia.com/Principles_of_Rehabilitation#cite_note-:0-2)[9] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-9)
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
[10] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-10)[11]
greatest benefits.
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-11)
Broadly time is important
in rehabilitation. Early commencement of rehabilitation can reduce the risk of
[12]
readmission for certain conditions like chronic obstructive pulmonary diseases
(https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-12)
, improve motor function in
[13] (https://www.physio-pedia.com/Principles_of_Rehabilitation#cite_note-13)
spinal cord injury and
stroke and so on.
Educate
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 set SMART goals (https://www.physio-
pedia.com/Goal_Setting_in_Rehabilitation).[14] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:2-14)
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.[14] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-:2-14)
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 organised 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 (https://www.physio-
pedia.com/Patient_Engagement), 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.[15] (https://www.physio-
pedia.com/Principles_of_Rehabilitation#cite_note-15)
Conclusion
Understanding the foundations and principles of rehabilitation equips the
professional with the essential knowledge to confidently and accurately approach
rehabilitation to promote the most significant gains in functional independence and
participation in activities for the patient.
