SEMINAR ON

RESTORATIVE AND VOCATIONAL

REHABILITATION

V.Beenamadhuri
M.Sc 2 nd year
INTRODUCTION

 Rehabilitation and restorative care provided to improve

and maintain the patients physical abilities. This may
include mobility skills and the ability to carry out activities
of daily living. Activities of daily living are the task that
we learn as children and do through out life. The tasks
include bathing, oral care, hair and nail care, dressing and
undressing, eating, toileting, and mobility being
independent with daily care promotes positive self esteem.
HOW REHABILITATION AND
RESTORATIVE NURSING ALIKE
 Assist patient to attain optimum level of physical, mental and
psychosocial function in light of condition.
 Considers how one weak area of function can affect to the
whole person.
 Helps patient adapt to limitations imposed by illness or injury.
 Helps patient lost skills or learn a new way of doing skills lost
because of illness or injury.
 Requires physician order.
COMPARISON OF REHABILITATION AND RESTORATIVE REHABILITATION

Rehabilitation Restorative
Aggressive and intensive Slower place
Scheduled 1-4 hours a day,7 days a Not scheduled , given 24 hours a
week day, whenever needed.
A separate and distinct services. Approaches integrated into regular
nursing care.
Goal is to improve Goal is to maintain, improvement is
desirable, but not required
Patient makes rapid significant process Patient may or may not progress ,
does not decline.
Planned and implemented by therapist. Planned and implemented by nursing
Must have potential for improvement May participate even if no potential
for improvement
Provided in any setting but not Required in long term car, usually
required provided in home care health care,
long term care facilities sub acute
and long term acute care hospitals
Rehabilitation Restorative

Licensed personnel Licensed and unlicensed

Provided most services Personnel provided services

unlicensed personnel are primary
care givers

Paid by Medicare, medic aid, Inconsistently paid by Medicare

private insurance. and medic aid in some situations
usually not paid by private
insurances
 Requires initial evaluation and periodic re evaluation.
 Must be verified by .documentation.
 Assists with activities of daily living.
 Work toward goals
 Patients benefits from services
 Provides a necessary services, not given as a activity or to
keep the patient occupied.
 Prevents complications.
 Maintains current abilities.
 Improves quality of life.
 A restorative program establish by the therapist to
complement the rehabilitation program reinforce what the
therapist are teaching and the patient masters the skill more
quickly, when you follow the program develop by the licensed
nurse, you are helping patient master skills for which nursing is
responsible, such as bowel and bladder management.
Regardless of whether the services is planned and provided by
therapy or nursing, it is a functional services for the patient
THE GOALS WILL BE TEACH THE
PATIENT TO:-

 Adapt t the present circumstances.

 use adaptive devices to increase independence.
 Learn new ways of doing routine tasks, such as dressing or
bathing.
 Become as independence as possible in light of the disability
patients with severely limiting conditions such as tetraplegia
are taught to assume responsibility for personal wellbeing,
including verbally directing care givers to accomplish the
results the patients wants.
THE INTERDISCIPLINARY HEALTH
CARE TEAM
1. Physiatrists.

2. Speech therapist.

3. Occupational therapist.

4. Nursing assistants.
REASONS FOR REHABILITATION/
RESTORATIVE CARE
 A person may need rehabilitation because of a disability. A
Disability exists when the person has an impairment that affects the
ability to perform an activity that a person of that age would
normally be able to do. Adults for example, are able to dress and
undress independently if a person is unable to do this because of a
diseases or injury, a disability exists. A disability may be temporary
and permanent. Impairment or disabilities results from trauma or
diseases. Disorders of the musculoskeletal system, such as
amputation of an extremity or arthritis, may require rehabilitation.
 Dietician services to help the patient learn to manage new dietary
restrictions for a low –sodium diet ( to reduce blood pressure and to plan
and prepare meals.
 Psychological support to adapt to the sudden changes brought about by
the stroke.
 Social services to plan the for impending discharge.
 All disciplines work together with the patient and family to solve
problem and plan care. There are many sub specialties in rehabilitation.
 Health care professionals ma choose to work n geriatric or pediatric
rehabilitation.
ROLE OF NURSING ASSISTANT
 The nursing assistant ho works in the rehabilitation and
restorative nursing unit will assist the nurses with
 Procedure to prevent complications.
 Mobility skills (transfer and ambulation).
 Bathing and personal care procedures.
 Bowel and bladder management program.
 Maintaining the patient nutritional status.
 Programs to increases the patients independence
PRINCIPLES OF REHABILITATION
 Four principles form the foundation of successful rehabilitation or
restorative care.

1. Treatment begins as soon as possible.

2. Stress the person’s ability, not the disability.

3. Activity strengthens and inactivity weakens.

4. Treat the whole person.

5. Team work.

6. Use of care plan all staff are familiar with the patients ‘s problems, goals
and approaches.
7. Consistency of care all staff use the same approaches (as listed
on the care plan) when caring for the patient.
8. Continuity of care there is smooth progression and flow
between care givers and between shifts.
9. Good communications among all care givers, the patient and
interested family members.
COMPLICATIONS FROM
IMMOBILITY
 People with disabilities may be unable to move bout at
will. The inactivity or immobility can results in
numerous complications affecting body system as shown
in table
COMPLICATIONS FROM IMMOBILITY
System Complications
Integumentary Pressure ulcers may develop in a short
time from lack of oxygen to the tissues,
pressure ulcers may worsen quickly and
be difficult or impossible to reverse.

Muscular Weakens and atrophy from lack of use

contracture develop because of the
patients position; freezing the muscle in
a permanent state of flexion contractures
are painful an difficulty or impossible to
reverse.

Skeletal Calcium drains from the bones when

they are inactive. This contributes to
fractures lack of healing, osteoporosis,
and other complications
 System Complications

Integumentary Pressure ulcers may develop in a short

time from lack of oxygen to the tissues,
pressure ulcers may worsen quickly and
be difficult or impossible to reverse.

Muscular Weakens and atrophy from lack of use

contracture develop because of the
patients position; freezing the muscle in a
permanent state of flexion contractures are
painful an difficulty or impossible to
reverse.

Skeletal Calcium drains from the bones when they

are inactive. This contributes to fractures
lack of healing, osteoporosis, and other
complications
RESTORATIVE PROGRAM
If the patients has the potential to relearn an ADL an dis
motivated to try, a restorative program is planned. These
programs are sometimes called retraining program or ADL .
Approaches used in restorative programs
The approaches to use will be on the care plan it is important
that the same approach be used consistently.
Set up patient with self care deficits are not able to set up or
prepare for activities of daily living.
 Verbal cues : The care provider uses short, simple
phrases to prompt the patient.
 Hand – over hand technique : Examples for eating
program place a glass in the patient hand. Place your
over the patient’s hand. Place your hand over the patient
hand. Guide the glass to the patients mouth.
 Demonstrations : Act out what you want the patient to
do
VOCATIONAL REHABILITATION

 A process that enables people with functional,

psychological, developmental ,cognitive and emotional
impairments or health conditions to overcome barriers
to assessing ; maintaining or returning to employment or
other useful occupation.
 The focus of vocational rehabilitation is to help people
re tain or regain the ability to participate in work, rather
than to treat any illness or injury it self.
 Vocational rehabilitation programs
 Primary purpose = help PwD –

 Prepare for employment

 Obtain gainful employment

 Wide range of disability are catered to by rehab counselors

 SCI

 Stroke

 Arthritis

 MS

• Amputations
• Chronic pain
• Developmental and learning disabilities
• Psychiatric disorders
GOVERNMENT HAS SET UP 20
VOCATIONAL REHABILITATION
CENTERS
 The main objectives of VRC –
 Vocational evaluation and adjustment of PwDs

 Assessment of the medical, psychological, rehabilitation

needs
 Assist in developing rehabilitation plans

 Sponsor physically handicapped registrants against

notified/identified vacancies
 Distribution centers for various
schemes(Scholarship/aids/appliances)
 Make referrals to financial institution for funding self-
employment ventures.
VR PROCESS
 This process generally involves
 Evaluation

 Job-seeking skills training – Readiness and placement

strategies
 Job analysis

 Job placement and accommodation

 Job follow-up Consumer movement in rehabilitation

VOCATIONAL EVALUATION AND
VOCATIONAL ASSESSMENT
 Often used interchangeably
 Vocational assessment is a general term that
includes many different forms of evaluation
 Vocational evaluation is defined as a comprehensive
assessment that utilizes a variety of tools, including
paper-and-pencil tests, structured interviews, and
real or simulated work
 With its focus on work-related abilities, a vocational
evaluation may use work samples, situational
assessments, and on-the-job evaluations
EMPLOYMENT READINESS
 Medical stability - important concern
 Stamina and endurance (i.e., to determine part-time vs. full-
time)
 Psychosocial factors such as the individual's support systems
 Availability of adequate attendant care
 Transportation is another critical element in job success, as
public transportation can be inaccessible and is often
unreliable
 Psychological readiness to go to work - This includes
motivation, self-confidence, interpersonal flexibility,
coping resources, and realistic expectations about work
 People have needs beyond the financial, such as
satisfying interpersonal contact, achieving a sense of
belonging, being productive, and enjoying creative
expression, all of which can greatly contribute to
motivation for work
JOB PLACEMENT STRATEGIES
 Once the individual is ready to seek employment - must develop or refine
the employment skills
 Individual with virtually no work history will require far more extensive
job-seeking-skills training, (following up on job leads, resume writing,
application completion, and interviewing skills)
 Primary role of the VR counselor - assist in developing these skills using
tools as coaching, role playing, or video taping
 In addition he or she must also know how to respond to questions about
disability on an application or in an interview

 Knowledge of legal protections is critical

JOB ANALYSIS
 Job analysis critical to the ultimate success of job placement
efforts
 By analyzing a particular job in a certain environment,
suitable accommodation recommendations can be made
 Must be analyzed for factors in the

 Work environment - parking at the worksite, restrooms,

canteens, and building accessibility
 Job tasks - lifting, grasping, standing, walking, sitting,
talking, hearing, writing, and reading
 Productivity - For people with cognitive or affective
limitations, other critical factors might include the work
atmosphere (e.g., busy or relaxed) and cognitive demands
(e.g., memory, reasoning, problem solving)
JOB ACCOMMODATIONS
 Requesting a job accommodation is another skill

 Although the individual is expected to know what accommodations are

required, the VR counselor can often act as a consultant to the employer and

can help to negotiate these

 Some accommodations like rearrangement of equipment. For example, for

individuals using wheelchairs, a height-adjustable desk, a voice-activated

speakerphone, or moving office supplies to accessible drawers

 Other examples - job restructuring, flexible schedules, large print, allowing

use of personal care attendants or service animals, and large-button phones

JOB FOLLOW-UP SERVICES

 Follow-up services for both consumer and employer

 Ensure a successful outcome
 Accommodations may require further adjustments after
the individual actually begins the job.
 It is important that an employee who cannot function
successfully be removed from the job, as the primary
goal of VR is a successful outcome for both the
individual and the employer
THE CONSUMER MOVEMENT IN
REHABILITATION
 Gradually emergence of the consumer is occurring in contrast to patients
or clients
 Emphasis on self-help and self-direction
 Pioneered by Ed Roberts and other individuals with severe disabilities
during the early 1970s, the philosophy of IL asserted that individuals with
severe disabilities were capable of managing and directing their own lives
 Services and supports that PwD need are best delivered by individuals
who themselves have disabilities and whose knowledge about both
disability and services is derived from firsthand experience
CONSUMER-RELATED SERVICES
AND CENTERS FOR
INDEPENDENT LIVING
 The specific features of individual IL programs are
determined by
 Individual needs of the consumers served
 Availability of existing community resources
 Physical and social make-up of the communit
 Goals of the program itself
SERVICES FOR EMPLOYERS
 Pre-screening of qualified applicant.
 Assistances in helping current employees retain their
jobs after becoming disabled.
 Accessibility surveys for ADA compliance.
 Assistances in utilizing in the work opportunity tax
credit
FINANCIAL INCENTIVES
 Work opportunity tax credit
 On the job training (half the trainee's wages training
period).
 Supported employment ; job coaching.
CONSULTANT SERVICES
 Disability Awareness.
 ADA
 Accessibility survey
 job development
 job placement and follow up
COUNSELING AND GUIDANCE
 Our rehabilitation counselors assist people in choosing a career
path and help them develop a plan for obtaining their goals.
 Job placement
 Counselors can arrange for intensive job placements
assistances for their clients
 Additional skills
 We can also provide on the training and work adjustment
training through the services offered by our community
partners.
PROGRAM ASSISTANTS
 Purpose is to meet the clinicals and accounting needs of
our customers.
 Rehabilitation job readiness technique

 Purpose is to provide job readiness assessment job

training and individuals drivers.
 Rehabilitation employment specialist

 Purpose is to meet the needs of business and vr clients

by providing personal individuals
TEAM

 Employment manager
 Account representatives
 counselors
 program assistances.
 Work preparation technician
 General counselors

Purpose is to provide services to individuals with dis

abilities in Georgia to achieve competitive employment.

Transistion counselors

Work with geogia youth with dis abilities in the high

school setting.

They assist high school students with disabilities to

transition into employment.