Rehabilitation

10 Key excerpts on "Rehabilitation"

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  eBook - ePub

  Handbook of Psychosocial Rehabilitation

  • Robert King, Chris Lloyd, Tom Meehan(Authors)
  • 2013(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  Psychosocial Rehabilitation, also referred to as ‘psychiatric Rehabilitation’ (Anthony, 1998) or ‘Rehabilitation in mental health’ (NSW Health Department, 2002) has been a politically and scientifically suspect endeavour for some years. This has been particularly due to multiple definitions and poorly operationalised concepts (Anthony et al., 1982; Cnaan et al., 1988). It is difficult to claim that psychosocial Rehabilitation is effective, if researchers and practitioners apply the term differently. Anthony (1998) referred to the ‘black box’ of psychiatric Rehabilitation, stating that from a process point of view we know what the inputs are and what the outputs are, but what happens in between has been ill defined. This chapter provides a definition of psychosocial Rehabilitation consistent to that provided in Chapter 1, but goes one step further by prescribing five domains of psychosocial Rehabilitation. The definition is as follows:

  Psychosocial Rehabilitation is a purposeful interpersonal process that involves a person with a mental illness making subjective and objective progress towards at least one of the following aims: • Self-management of the mental illness and overall health • Meaningful occupation • Increased and improved social interaction and community inclusion • Management of a changed sense-of-self and emotions from living with a long-term mental illness, and • Improved living conditions

  Psychosocial Rehabilitation involves professional or peer support services that provide interventions consistent with these five aims. There are many strategies for providing psychosocial Rehabilitation services to meet these aims and it is equally important for services to be able to describe comprehensively the range of specific service characteristics that meet these needs (e.g. philosophy, staffing, organisational structures, types of interventions provided, etc.).

  The definition of psychosocial Rehabilitation above complements recovery, as described in Chapter 1, which can be viewed as a personal rather than interpersonal process. Recovery may or may not involve these five areas, but is likely to involve the management of a changed sense-of-self and emotions related to living with a long-term mental illness. The metaphor of a lens is useful to clarify and understand the topography of psychosocial Rehabilitation. A lens can zoom in to characteristics of an individual’s chemistry or zoom out to communities and society. A lens can be well focused or out of focus. A lens can take stills, snapshots such as measurement of outcomes, or ongoing films, such as understanding the recovery process. Different lenses will emphasise different aspects of the topography, for example emphasising the empirical, the ethical, the economic or the conceptual. A lens can have different filters, for example highlighting deficits or strengths. A lens can capture a myriad of brilliant colours (e.g. quality of relationships) or just black and white (e.g. hospitalised or not). Moreover, a lens can be held by different people (e.g. family, consumer, clinician) from many different vantage points (e.g. control, care) and is portable.

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  The Brain Injury Rehabilitation Workbook

  • Rachel Winson, Barbara A. Wilson, Andrew Bateman, Rachel Winson, Barbara A. Wilson, Andrew Bateman(Authors)
  • 2016(Publication Date)
  • The Guilford Press

    (Publisher)

  1 “Neuropsychological Rehabilitation” is a process whereby people who have sustained insults to the brain are helped to achieve their optimum physical, emotional, psychological, and vocational well-being (McLellan, 1991). The main purposes of such Rehabilitation are to support people with disabilities resulting from brain insults in achieving their optimum level of well-being, to reduce the impact of their problems in everyday life, and to help them return to their own most appropriate environments. Rehabilitation is not about teaching cli- ents to score better on tests, to learn lists of words, or to be faster at detecting stimuli. The focus of treatment is on improving aspects of everyday life; Rehabilitation therefore needs to involve personally meaningful themes, activities, settings, and interactions (Ylvisaker & Feeney, 2000). PRINCIPLES OF Rehabilitation This workbook has grown out of the psychoeducation groups run for clients with acquired brain injury (ABI) who attend The Oliver Zangwill Centre (OZC) for Neuropsychologi- cal Rehabilitation in Ely, Cambridgeshire, United Kingdom. The Rehabilitation program at OZC is based on six core components that the staff members believe illustrate the principles of good clinical practice, and that underpin the material offered in this book: 1. Therapeutic milieu. A concept derived from the work of Ben-Yishay (1996), the “therapeutic milieu” in holistic Rehabilitation refers to the organization of all aspects of the environment to provide maximum support in the process of adjustment and increased social participation. The milieu embodies a strong sense of mutual cooperation and trust—a sense that underpins the working alliances between clients and clinicians. C H A P T E R 1 General Introduction Barbara A. Wilson 2 THE BRAIN INJURY Rehabilitation WORKBOOK 2. Meaningful goals. Care is taken to make the goals set with clients meaningful and functionally relevant.

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  Psychiatric Issues in Parkinson's Disease

  A Practical Guide

  • Matthew Menza, Laura Marsh, Matthew Menza, Laura Marsh(Authors)
  • 2005(Publication Date)
  • CRC Press

    (Publisher)

  Rehabilitation includes multidisci-plinary assessment and problem definition, treatment planning and delivery, evaluation of effectiveness and reassessment. 5 Even if a coordinated rehabili-tation program is not available, clinicians can consider these standards in their management of individual patients with PD. 258 Psychiatric Issues in Parkinson’s Disease Table 16.1 Definitions of Rehabilitation A process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimum physical, psychological and social functioning The application of all measures aimed at reducing the impact of disabling and handicapping conditions, and enabling disabled and handicapped people to achieve social integration The process of restoration, to the maximum degree possible, of function (physical or mental) or role (within the family, social network, or workforce) A problem-solving and educational process aimed at reducing the disability and handicap experienced by someone as a result of disease, always within the limitations imposed both by available resources and by the underlying disease Assessment A comprehensive Rehabilitation assessment is very different from that offered by a physician working independently. At the complex disability stage, the person with PD will have multiple factors affecting functional performance that may present as a single problem. When a team works together, they need a structure for assessment and description of the difficulties. The World Health Organization (WHO) International Classification of Function (ICF) provides such a structure. It classifies functioning at both the level of body/body part, whole person, and whole person in social context. 6 Disablements are: 1. losses or abnormalities of bodily function and structure (impairments) 2. limitations of activities (disabilities) 3. restrictions in participation (formally called handicaps).

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  Rehabilitation, Crime and Justice

  • P. Raynor, G. Robinson(Authors)
  • 2005(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  We will come on to ‘criminals’ or offenders (our preferred term) in a moment, but first let us consider a further, non-criminological definition of Rehabilitation, namely one derived from medicine. According to a medical definition, Rehabilitation denotes: ‘the restor- ation to health and working capacity of a person incapacitated by disease, mental or physical, or by injury’ (Macpherson, 1992). In this context, Rehabilitation is clearly understood as a process which follows a mental or physical setback or deterioration: the subject has become ill or sustained an injury, and Rehabilitation clearly refers to efforts to re-establish the subject’s former, ‘healthy’ status of physical or mental fitness or well-being. This shares much in common with the generic definition considered above: that is, Rehabilitation is understood as a process of getting ‘back to normal’. In this definition there is no reference to ‘appropriate training’, but for most of us the notion of 4 Rehabilitation, Crime and Justice rehabilitating the sick or injured will conjure up images of physical and occupational therapists and other medical experts, all intervening in appropriate ways to enable the person’s recovery. The Rehabilitation of offenders: Criminological definitions Having considered some non-criminological definitions of Rehabilitation, let us now move on to the subject of this book, namely the meaning(s) of Rehabilitation in the context of offending. We have already noted that, despite the longevity and continuing relevance of the concept of Rehabilitation in the context of offending, it has rarely been ‘unpacked’ or examined critically. Indeed, it is quite common to come across ‘offender Rehabilitation’ in both academic and policy contexts with no accompanying definition of the term. Even where Rehabilitation has been defined, we have not always been left with a crystal clear picture.

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  The Emotional Brain and the Guilty Mind

  Novel Paradigms of Culpability and Punishment

  • Federica Coppola(Author)
  • 2021(Publication Date)
  • Hart Publishing

    (Publisher)

  Social Rehabilitation rejects punitiveness, deprivation, coercion, and exclusion as ways to challenge wrongdoing. 22 Instead, the concept espouses a constructiv-ist approach to social reintegration that hinges on individual and social needs, fosters social connections, and prompts inclusion and support. Thus, social reha-bilitation replaces the punitive and exclusionary aspects of the traditional model of punishment with an empowering and constructive approach to self-change and social reintegration. For some, this approach will mean the restoration of a former state; for others, this will mean the acquisition of knowledge and skills, as well as the establishment of rank, rights, and responsibilities previously denied. For still others, this will entail a process of reversion and overcoming of traumas and victimisations. For others, this will imply a process of accountability through an appreciation of the interpersonal and normative values they violated that may serve as a guidance for future behaviours. Altogether, while the aim of social reha-bilitation (ie, social reintegration) is unitary, the possible means to achieve it are various and multifaceted because of individual and structural factors inherent to the relevant person. B. Social Rehabilitation, Dynamic Personhood, and Crime Desistance A critical aspect of social Rehabilitation, which finds support in the body of (neuro) scientific knowledge I reviewed, lies with its view of human agency in relation to individual change. Foremost, social Rehabilitation understands human agency as a multidimensional, or holistic, concept that is determined by individual and social factors. Therefore, it acknowledges that the choice to engage in offending behav-iour results from an interaction between cognitive, emotional, and social aspects, all of which must receive the same weight in informing justice responses to crime.

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  Rehabilitation Counselling in Physical and Mental Health

  • Kim Etherington(Author)
  • 2002(Publication Date)
  • Jessica Kingsley Publishers

    (Publisher)

  Glanville defined Rehabilitation as ‘making able again’ (from its Latin roots) and identified aims of promoting research in rehabilita-tion and training of Rehabilitation therapists at undergraduate and postgrad-uate levels, as well as encouraging more doctors to specialize in rehabilita-tion. He called for more emphasis on home treatment and noted that remedial therapists were beginning to ‘see themselves in new roles such as 30/ Rehabilitation COUNSELLING IN PHYSICAL AND MENTAL HEALTH counsellors and teachers’ where the role would comprise teaching and advice ‘for people disabled whose families are prepared to care for them’ (pp.21, 23). He envisaged staff working in ‘parallel’ at a time when interprofessional teamwork was still undeveloped. His characterization of Rehabilitation as a ‘new discipline’ underlines the increased recognition this area was now receiving. The development of new technologies, the influence of social science studies and the beginning of a move away from institutional settings towards community-based care were all influential in this initiative. Sociological perspective As recently as 1996 sociologists have been criticized for not taking disabil-ity seriously by relegating this area to the margins of sociological theory (Oliver 1996). Key theories have been influential in studies in the area of chronic illness and disability and have been incorporated into curricula for medical and health-care professional training programmes. These include Parsons’ (1951) analysis of the sick role which associated it with social deviance and introduced the idea of health as adaptation. Later Goffman’s (1963) concept of stigma, a term traditionally used to mark those seen as morally inferior and therefore shunned by the rest of society, was influential in beginning to highlight the position of people with disabilities in society.

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  Rehabilitation Goal Setting

  Theory, Practice and Evidence

  • Richard J. Siegert, William M. M. Levack, Richard J. Siegert, William M. M. Levack(Authors)
  • 2014(Publication Date)
  • CRC Press

    (Publisher)

  It is important to acknowledge then that while Rehabilitation has profitably drawn from psychological theories of goals and goal setting, there are some important differences in the general approach each discipline takes to goal setting. Most importantly, Rehabilitation tends to view goals as observable outcomes that are negotiated or agreed upon by a client and the Rehabilitation team, whereas psychology typically regards the goal as a part of an individual’s cognitive or mental world. This difference between the concept of a goal in psychology and in Rehabilitation is especially evident when we consider research within psychology on implicit or uncon-scious goals (Custers & Aarts, 2010). For not only are goals in psychology typically viewed as mental representations but goals and goal-related behaviour are both considered to be influenced by environmental stimuli in the absence of conscious awareness (Bargh & Chartrand, 1999; Custers & Aarts, 2010). This reflects an extensive body of research in contemporary cognitive psychology that attests to the impact of implicit or non-conscious influences upon human behaviour. Consider just a few recent examples of this line of research. In a series of studies, Holland, Hendriks and Aarts were able to show that simply exposing research participants to the citrus-like odour of a household cleaner resulted in better performance on a word task in which some of the correct answers were synonymous with hygiene or tidiness and also resulted in participants leaving less mess after eating 61 Psychology, Goals and Rehabilitation (Holland, Hendriks, & Aarts, 2005). Importantly, participants seemed totally unaware of any influence of the odour upon their own behaviour. A series of studies by Kay, Wheeler, Bargh and Ross (2004) showed that simply exposing participants to objects connected with the business world, such as a briefcase or boardroom table, increased the cognitive accessibility of the idea of competition.

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  Neurology

  A Queen Square Textbook

  • Robin Howard, Dimitri Kullmann, David Werring, Michael Zandi(Authors)
  • 2024(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  Neuropsychological assessment identifies both strengths and weaknesses in the patient’s profile and indicates the relative contri- bution of organic, psychological and external factors (e.g. effort, education, culture). Cognitive Rehabilitation should be tailored to the individual’s cognitive profile, personal values and goals for life activities and participation. Intervention can be delivered in a group format for individuals with mild to moderate cognitive difficulties, and/or in an individual format for those with more severe deficits or where there is a complex interplay between emotional, psychoso- cial and cognitive changes. Cognitive Rehabilitation may take many forms, including: • Education about the cognitive consequences of brain injury, which includes individualised feedback from the neuropsychological assessment, facilitating increased self-awareness and motivation for therapy. • Environmental manipulations that improve function and well- being by changing living, training or working conditions. These may include provision of a quiet, distraction-free space or break- ing down of tasks into their components with smaller subgoals. • Compensatory strategy training focused on using residual cogni- tive strengths to minimise the functional impact of impairment on daily task performance. This may include use of internal com- pensatory strategies (e.g. visual imagery techniques to support verbal memory) and external compensatory strategies (e.g. diary or calendar for daily routines and appointments). Metacognitive strategy training is an internal compensatory approach that teaches an individual to regulate and monitor their own thinking and behaviour; for example, by predicting their performance in advance of an activity and identifying possible solutions or paus- ing to review whether performance is in line with a target goal. • Restorative training, aimed at recovery of lost function through retraining and practice of specific cognitive skills.

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  Clinical Neuropsychology

  A Practical Guide to Assessment and Management for Clinicians

  • Laura H. Goldstein, Jane E. McNeil, Laura H. Goldstein, Jane E. McNeil(Authors)
  • 2012(Publication Date)
  • Wiley

    (Publisher)

  Part 6 Rehabilitation Passage contains an image 19 Theoretical Approaches to Cognitive Rehabilitation Fergus Gracey and Barbara A. Wilson Introduction

  The Royal College of Physicians and British Society for Rehabilitation Medicine (BSRM) in the United Kingdom define Rehabilitation as ‘a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function,’ and in terms of service provision this entails ‘the use of all means to minimise the impact of disabling conditions and to assist disabled people to achieve their desired level of autonomy and participation in society’ (Royal College of Physicians and British Society of Rehabilitation Medicine, 2003, p. 7). In the terms of the United Kingdom's Medical Research Council's (2008) guidelines on healthcare research, Rehabilitation in general, including cognitive Rehabilitation, can be considered a ‘complex healthcare intervention’ in that it involves varied clinical presentations and problems, described at different levels of explanation, with deficits likely to interact, requiring multiple targets of change, multiple behaviours and skills on the part of the clinicians, delivered across multiple treatment and community contexts.

  Rehabilitation is, therefore, one of many fields that needs a broad theoretical base incorporating frameworks, models and methodologies from a number of different fields. This chapter considers some of the influential models relevant to cognitive Rehabilitation together with their strengths and weaknesses, and their impact on current clinical practice. A key aim of this chapter is to illustrate how models of cognitive functioning alone will not help to inform us about the multiple factors that may influence engagement, change and maintenance of Rehabilitation gains.

  What Is a TheoreticalModel?

  A theoretical model is a representation that helps to explain and increase our understanding of related phenomena. Models vary in complexity and detail, ranging from simple analogies, to help us explain relatively complex situations such as the ‘faulty switch’ analogy to help explain why someone is sometimes able and sometimes unable to carry out a task, through to highly complex computer-based representations to predict the weather. In Rehabilitation, models are useful for facilitating thinking about treatment, explaining treatment to therapists and relatives, and enabling us to conceptualize interventions and outcomes. This is especially important when working with complex healthcare interventions. The Medical Research Council (2008) guidelines note the importance of theoretical accounts of the disorder being treated, the intervention itself and the change process in evaluating complex interventions. They argue that by measuring the hypothesized effects of treatment components in addition to pre–post outcome measures, one can advance scientific understanding of the intervention as well as the disorder being targeted. Attempts to conceptualise the Rehabilitation process have been made (e.g., Gracey, Evans and Malley, 2009; Hart, 2009). Hart contrasts complex Rehabilitation interventions (where the specific influence of the content and process of the intervention are often not known) with pharmacological interventions where such factors may well be known. These authors’ proposals signify a convergence between Rehabilitation research and psychotherapy research – understanding the biological or neuropsychological processes is helpful and may point towards potential treatments. However, other factors such as therapist skills and features of the therapeutic interaction (process and content) are also critically important.

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  Reablement Services in Health and Social Care

  A guide to practice for students and support workers

  • Valerie Ebrahimi, Hazel Chapman(Authors)
  • 2018(Publication Date)
  • Red Globe Press

    (Publisher)

  TAKING CONTROL: THE PSYCHOSOCIAL BENEFITS OF REABLEMENT 191 the knowledge and views of the person and the professional (Horne et al. 2005). Outmoded emphasis on the importance of compliance with health and social care professionals, which creates a barrier to open communica-tion, undermines the value of the individual and reinforces their view of themselves as helpless, leading to dependence and disability. These psycho- emotional dimensions of disability that oppress people are described by Thomas (2004, p. 38) as ‘being made to feel of lesser value, worthless, unattractive, or disgusting’ and can affect both their self-concept and their understanding of their relationships with others. Consequently, it is essen-tial for all health and social care professionals and support workers who work in reablement to understand these ideas and to value and respect the humanity of the service users with whom they interact. This chapter will provide an explanation and synthesis of key theo-retical concepts that underpin a psychosocial understanding of the issues associated with disability, ageing and long-term conditions. Initially, it will explore the idea of the self, and how the psychology of the self influ-ences human thoughts, feelings and behaviours within, and as a result of, the reablement interaction. This will be followed by a broad discus-sion of ageing theories such as disengagement, active ageing and gero-transcendence as well as elements of positive psychology. Understanding stigma will enable understanding of personal values in order to develop non-stigmatising attitudes and behaviour. Centrally, the need to facilitate the personal motivation and self-efficacy of service users, while enabling them to feel secure and confident, will illustrate the complexity of work-ing with individuals within the context of reablement.

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