Rehabilitation - definition, classification

Rehabilitation

1. Organizational and Methodological
Foundations of Medical
Rehabilitation. Peculiarities of the work of
a multidisciplinary team providing medical
rehabilitation of the patient.
Department of medical rehabilitation and sports medicine
with a course of medical rehabilitation, exercise therapy,
sports medicine and physiotherapy of the faculty for
continuing medical education
PhD, assistant professor E. G. Vershinin

2. Individual program of patients’ medical
rehabilitation
A list of actions aimed to restore or
compensate physical and mental abilities,
improving the functional state of the body,
improving physical capacities, psychological
and emotional stability as well as adaptive
resources of the individual by means of
medical rehabilitation.

3. The individual program of patients’
rehabilitation includes:
 
     
Physiotherapy
(electrotherapy, electrical
stimulation, laser therapy,
barotherapy, balneotherapy and
others)
(kinesotherapy)

4. The individual program of
patients’rehabilitation also includes:
•Psychotherapy is a system of therapeutic interventions on
mental processes. It is often defined as measures aimed to
release the person from various problems (emotional,
personal, social, etc.). As a rule, it is provided by a qualified
psychotherapist who establishes good rapport with the patient
(often through sessions and discussions) and uses various
cognitive, behavioral, pharmacological and other techniques.

5. The individual program of patients’
rehabilitation includes:
 
    
traditional methods of treatment:
Acupuncture is a branch of medicine in which the body is
affected with the help of special needles inserted into special
points on the body and manipulated therein. It is believed
that these points are located on the meridians, along which
the "vital energy" circulates.
This method is used to relieve pain or for therapetic
purposes.  

6. the individual program of patients’
rehabilitation includes:
 
 
traditional methods of treatment:
manual therapy (lat. manus hand, Greek. therapeia
treatment) embraces a complex of manual
therapeutic techniques aimed at removing pain as
well as biomechanical disorders in some
degenerative processes in the spine and joints.

7. the individual program of patients’
rehabilitation includes:
  
   
 
 
Speech Therapy is a type of medical assistance and
education provided to people with functional or organic
speech disorders (dyslalia, logoneuroses, aphasia, dysarthria,
etc.). Their timely treatment and correction can accelerate
the development of speech in children, eliminate acquired
speech disorders in adults as well as prevent secondary
changes in the intellectual development due to disorders of
speech.

8. the individual program of patients’
rehabilitation includes:
  
   
  Reconstructive surgery is one of the most sophisticated
and many-sided branches of medicine. The aim of
reconstructive medicine is to restore the damaged part (as a
result of an injury or congenital defect) of the human body
not only anatomically, but also functionally. A restored organ
is expected to look as natural as possible which accounts for
the close relationship between reconstructive and aesthetic
plastic surgery.  

9. the individual program of patients’
rehabilitation includes:

·
Prosthetic and orthopedic care: prosthetics involves
replacement of lost or irreversibly damaged body
parts with artificial replacements, i.e. prostheses.

10. the individual program of patients’
rehabilitation includes:
  
     
 prosthetic and orthopedic care:
orthotics applies orthoses (Greek. orthos- line) which
are technical devices used for fixing, load-reducing,
correcting and activating functions as well as for
cosmetic reasons in pathological conditions of limbs
and trunk segments. The term “orthosis" includes
such things as braces, removable joint-immobilizers,
splints, body jackets, etc.

11. the individual program of patients’
rehabilitation includes:

12. the individual program of patients’
rehabilitation includes:
spa treatment is a type of preventive and
therapeutic care in specialized inpatient
facilities which mostly involves natural
therapeutic factors (climate, mineral waters,
therapeutic mud, etc.). 
   

13. the individual program of patients’
rehabilitation includes:
  technical devices of medical rehabilitation involve the use of modern
technologies to compensate or eliminate persistent physical dysfunctions of a
disabled person. They include:
special tools for self-care;
special devices for individual care (colostomy bags, urine-collecting bags, food
intake restriction devices introduced through a stoma);
special orientation means (including guide dogs with a set of equipment for
communication and information exchange);
special means for training, education (including books for the blind) and
labour activity;
orthopedic devices (including orthoses, orthopedic shoes and special clothing,
eye prostheses and hearing aids);
special exercise and sports equipment.  
 

14. the individual program of patients’
rehabilitation includes:
 
  
  information and advice on medical rehabilitation
.
other activities, services, facilities.

15. Basic Principles of Rehabilitation
· Early rehabilitation,
· Integrated use of all available and necessary
rehabilitation measures,
· Individualization of rehabilitation programs
· Stage-by-stage rehabilitation,
· Continuity throughout all the stages of rehabilitation,
· Social orientation of rehabilitation,
· Supervision of the adequacy and effectiveness of
rehabilitation.

16. It is important as it makes it possible to prevent
possible degenerative changes in the tissues. Early
rehabilitation appropriate to the patient’s condition
promotes a more favorable course and outcome of
the disease to a large extent. It also helps to prevent
disability (secondary prevention).
Early initiation of rehabilitation measures

17. Problems of medical rehabilitation are very complicated and
require teamwork of many professionals: physicians, surgeons,
trauma surgeons, physical therapists, massage therapists and
psychiatrists. Their activities are to be adequate to the
physical and mental condition of the patient at different stages
of rehabilitation. Types of specialists involved as well as
techniques and facilities used will vary depending on the
reasons why the patient seeks rehabilitation.
Combined Use of All Types of Available and
Required Rehabilitation.

18. Medical Rehabilitation Staff
Medical specialists:
1.Rehabilitation physician (position).
2.Doctor specializing in a problem requiring
rehabilitation.
3.Physical therapist.
4.Physiotherapist.
5.Chiropractic, osteopathic physician.
6.Reflexologist.
7.Clinical psychologist.
8.Nutritional therapist.
9.Specialist in functional and laboratory diagnostics.

19. Medical Rehabilitation Staff
Medical specialists:
1.Nurse on duty at the nurses’ station.
2.Charge nurse.
3.Rehabilitation nurse.
4.Physical therapist.
5.Nurse in physiotherapy.
6.Manual therapy nurse.
7.Reflexotherapy nurse.
8.Laboratory and functional diagnostics nurse.

20. Medical Rehabilitation Staff
Non-medical specialists:
1.Counselor inphysical therapy.
2.Speech therapist specializing in aphasiology.
3.Psychologist.
4.Occupational therapist.
5.Social worker.
6.Equipment Engineer.
7.Specialist in computer technologies.
8.Record keeper.
9.Specialist in patient routing.

21. Teaching the principles of multidisciplinary work
e
r
g
o
t
h
e
r
a
p
is
t
p
h
y
s
io
t
h
e
r
a
p
is
t
e
x
e
r
c
is
e

t
h
e
r
a
p
y
d
o
c
t
o
r
t
h
e
r
a
p
e
u
ti
s
t
p
s
y
c
h
o
t
h
e
r
a
p
is
t
n
u
r
s
e
patient's
family
The
patient
p
h
y
s
ic
ia
n

d
ia
g
n
o
s
ti
c
ia
n
s
o
c
ia
l w
o
r
k
e
r
e
x
e
r
c
is
e

p
h
y
s
io
lo
g
is
t

22. Individualization of rehabilitation programs.
Depending on the reasons for rehabilitation as well as the
peculiarities of the patient's condition or disability, their
functional potential, movement activity, age and gender, an
individual approach to patients considering their response
to rehabilitation measures is required when choosing the
specialists, techniques and tools involved.

23. Continuity of the rehabilitation measures
It is important for the rehabilitation to be
continuous both within a particular stage and
during the transition from one stage to another. It
improves the functional status of various systems
of the body, increases their fitness while a short- or
long-term break in the rehabilitation process may
result in an impairment which will require to start
all the measures afresh.

24. Continuity of rehabilitation measures
Continuity is considered a critical rehabilitation principle
when a patient passes from stage to stage as well as when
they are transferred from one medical setting to another.
To ensure this it is important to keep records of the
techniques and tools of treatment and rehabilitation used,
the patient’s functional condition in their case history.

25. The social orientation of rehabilitation.
The main goal of rehabilitation is to enable ill and
disabled people to effectively and early return to their
household and work activities, to integrate into the
society and family and to the restore their identity as
a full-fledged member of the society. The best
outcomes of medical rehabilitation may be complete
recovery and return to regular professional work.

26. Methods of Monitoring the Adequacy of Loads
and Effectiveness of Rehabilitation
Rehabilitation process can be successful only if the mode
and features of restoration of disturbed functions are
considered. To administer adequate comprehensive
differentiated restorative treatment a number of patient’s
parameters relevant to the rehabilitation efficiency are to
be correctly assessed.
For this purpose, special diagnostics and methods of
supervising the current state of the patient during the
rehabilitation process are applied. They can be divided into
the following types:
a) medical diagnostics,
b) functional diagnostics,
c) psychodiagnostics.

27. Rehabilitation Prognosis
is a medically substantiated probability of
achieving the rehabilitation objectives within
the allocated period of time taking into account
the nature of the disease, its course, individual
resources and compensatory abilities of the
patient.

28. Rehabilitation Potential
It is the ill person’s potential to activate their biological and
socio-psychological mechanisms to restore their impaired health,
work capacity, personal and social status with the help of
rehabilitation centres and society as a whole

29. The overall assessment of rehabilitation potential is
made on the basis of a consistent study of its
constituent elements (levels) including quantitative and
qualitative parameters of health (from good health to
marked functional disorders), life activity (from average
to complete inactivity and disability leading to
incapacitation for work ), social status (from normal to
the one completely dependent on other people and
social services).

30. Rehabilitation Potential Constituents
1.Biomedical (sanogenetic) potential
2.psychophysiological potential
3.personal potential,
4.educational potential,
5.social and domestic potential
6.professional (labor) potential
7.social potential
8.socio-environmental potential.

31. Biomedical (Sanogenetic) Potential
The person’s recovery potential (regeneration,
repair, restitution) or potential for compensation
for disorders in the anatomical and functional
integrity of organs, tissues and systems of the
body as a whole.

32. Psychophysiological Potential
Potential use, development and adaptation of
the remaining functional abilities for restoration
(compensation of restraints) of social skills and
activities the person is typically involved in.

33. Personal Potential
Covers opportunities, abilities and
orientation of the individual to actively
participate in rehabilitation process, and
achieve their rehabilitation goals.

34. Educational Potential
Includes the person’s ability to gain general
and professional knowledge as well as
develop professional (labor) skills.

35. Social and Domestic Potential
Implies the ability for self-care as well as
for independent living and managing a
household .

36. Professional (Labor) Potential
Implies the ability to restore one’s
professional, social and employment status
or reach other objectives in the
professional field.

37. Social Potential
Includes the possibility of restoration or
compensation of social status.
Socio-environmental potential covers the
opportunities of integrating into or
returning to the conditions of family and
social life the person is accustomed to.

38. There are four levels of rehabilitation
potential assessment: high, medium (or
satisfactory), low and nearly deficient.

39. Rehabilitation Prognosis
It is anticipated probability of rehabilitation potential
activation as well as anticipated level of integration of
the disabled person into the society as a possible
outcome of rehabilitation. Rehabilitation prognosis is
conditioned not only by the level and content of
rehabilitation potential, but also by available facilities
including up-to-date rehabilitation technologies, tools
and methods.

40. Rehabilitation prognosis is based on a comprehensive
assessment of internal and external factors, which may
to some extent have a positive or negative impact on
the process of health restoration (clinical prognosis),
disability (employment prognosis), personal and social
status of the patient or disabled person (social
prognosis) .

41. The following factors are considered
when making a prognosis
-Features of the disease and its consequences
(pathological potential)
-Rehabilitation potential
-Socio-psychological characteristics of a personality
(their adequate rehabilitation activity)
-Possibility of using modern rehabilitation technologies
for a particular patient
-Socio-environmental conditions
-Rehabilitation environment.

42. Determining indications for rehabilitation requires consistent
assessment of the need and appropriateness of the measures and
means of rehabilitation considering identified disorders and
disability categories. In this case, for each disability category
expected rehabilitation effect is predicted: either restoration/
compensation (total or partial), or recovery/compensation is not
achievable. A rehabilitation expertise conclusion is made on the
basis of rehabilitation expertise diagnostics, as well as on the
determination of the indications for the development of individual
rehabilitation program.

43. Properly provided rehabilitation yields the following
outcomes:
The patient’s active stand in life in relation
to their health and self-fulfillment involving
optimal use of inner resources and
environment.

44. During rehabilitation specialists perform
a variety of duties, they find themselves in
different situations, their relations with
the patient and their family may often
change. The whole complex of such a
relationship can be adequately described
by means of the theory of roles.

45. The most important roles are:
A) Specialist as a caregiver.
The specialist provides direct nursing care as long as necessary
until the patient or their family do not acquire the required
nursing skills. This activity aims at :
· Restoration of functions
· Maintenance functions
· Prevention of complications

46. The most important roles are:
B) Specialist as an educator
A medical professional provides information to the patients and
their family and helps to develop skills required to return to a
normal state of health and to become self-reliant. A health worker
can provide information and materials about the patient’s illness
or disability as well as educate them about the new ways of
performing everyday activities.

47. The most important roles are:
C) specialist as a counselor
A health care provider acts as a constant and impartial
assistant of the patient encouraging them to use their
functional potential, helping to identify the strengths of
the individual patient, organizing their lifestyle to
address their needs best.

48. Programs of vocational and social rehabilitation include educating
patients about various programs, creating most favorable conditions
for achieving its goals, instructing patients how to take care of
themselves as well as use special rehabilitation devices.
Rehabilitation process is a systematic assessment of the situation in
which both the patient and the medical professional interact, as well
as of the problems which arise as an individual program of medical
rehabilitation acceptable to both parties is being implemented.

49. General Objectives of Rehabilitation
Process:
 
      
Creating a database of information about the patient;
· Assessing the needs of the patient for nursing care;
• Providing first aid according to the standards of nursing practice and
standards of medical care for the treatment of diseases considering the
patient’s individual characteristics
· Keeping or making the patient self-dependent as far as his basic needs are
concerned
· Involving the patient and his family in the process of providing
rehabilitation services.
· Evaluating the effectiveness of the rehabilitation process.

50. As for the time required all the tasks are
divided into:
Urgent (they are fulfilled within a few hours, but no
longer than 48 hours such as stabilization of
emergency cases)
Short-term (they are fulfilled within one week, for
example, decrease of body temperature);
long-term (it takes longer than a week to reach
outcomes).
The outcomes may meet the patient’s expectations of
received treatment, for example, the absence of
dyspnea on exertion, stabilization of blood pressure.

51. According to the share of assistance provided
by a medical professional within a
multiprofessional team (MPT) , the following
interventions are distinguished
dependent – actions of a medical specialist are performed on
the basis of the doctor’s recommendations (a written
instructions of the rehabilitation specialist) or with their
supervision;
independent – actions of a specialist which are within their
competence are performed without the rehabilitation
specialist’s instructions, for example, body temperature
measuring, monitoring a response to treatment, providing care,
advice and education to the patient;
interdependent – actions of a specialist which are performed in
collaboration with other members of MPT: physical therapist,
physiotherapist, psychologist, patient's relatives, etc.

52. One of the requirements of the President and the
Federal Assembly of the Russian Federation
concerning the health care reform includes a
standardization of care: It is indispensable to make
medical services sell and create competitiveness
in healthcare.

53. Thank you for
your attention!