Rehabilitation Frame of Reference Notes

Introduction to the Rehabilitation Frame of Reference

• Focuses on compensation when remediation of deficits is not possible.

• Historical development of rehabilitation practices:

• 1822: Manual on self-help devices by a hemiplegic man.

• 1918: Compensatory techniques became formal in military hospitals.

• 1946: First U.S. rehabilitation center established at NYU Hospital.

• 1949: University professors published pamphlets on handicapped homemaking.

• 1956: Dr. Rusk published self-care equipment pamphlets.

• Legislative impacts on rehabilitation practices:

• 1954: Vocational Rehabilitation Amendment Act mandated funding but had limitations.

• 1963: Social Rehabilitation Act revised the rehabilitation goal to maximize usefulness.

• 1968: Architectural Barriers Act mandated accessibility in public buildings.

• 1990: Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities.

Assumptions of the Rehabilitation Frame of Reference

1. Compensation allows independence: Patients regain some independence but differently than pre-illness.

2. Motivation is key: Patients' motivations are influenced by values, life roles, task preferences, and purpose.

3. Environmental context matters: Discharge plans should consider living conditions, lifestyle, and social resources.

4. Emotional and cognitive prerequisites: Skills like motivation, emotional health, and cognitive abilities influence success in rehabilitation.

5. Clinical reasoning should be top-down: Assess environment and patient capabilities before developing plans.

Function/Dysfunction Addressed

• Three continua for rehabilitation:

• ADLs: Self-care activities including eating, grooming, and hygiene.

• Work: Tasks related to employment and home management.

• Leisure: Non-specific activities enhancing quality of life.

Evaluation Critique

• ADL Evaluation Forms: Need comprehensive support and better reliability.

• Many assessments lack sensitivity to changes in functionality.

• Reliability issues due to variability in patient performance and subjective grading.

Postulates Regarding Change

• Change is targeted based on dysfunctions such as dependence in ADLs, focusing on achievable long-term functional outcomes.

• Functional outcomes should include behavior, criterion, and condition statements.

Summary of Rehabilitation Methods

• Rehabilitation methods are summarized as:

1. Adaptive devices: Compensate for physical limitations.

2. Orthotics: Support weak areas and prevent deformities.

3. Environmental modifications: Adapt the patient's environment for improved accessibility and safety.

4. Wheelchair modifications: Ensure proper fit and accessibility.

5. Ambulatory devices: Assist mobility and reduce weightbearing.

6. Adapted procedures: Modify tasks to enhance function.

7. Safety education: Train patients in safe movement and technique to prevent injury.

Important Considerations

• Adaptive devices: Can stigmatize but may foster independence.

• Environmental modifications: Can be costly and not portable but crucial for accessibility.

• Wheelchair modifications: Essential for mobility but often encounter societal barriers.

• Adapted procedures: Cost-effective and less visible but may require habit changes that are hard for some patients.

• Safety education: Supports independence but may be challenging for some to understand and implement.

Study Questions Overview

1. How does motivation for independence relate to environmental context?

2. What is the significance of reciprocity in rehabilitation?

3. Why do cognitive deficits impede compensation?

4. What are the steps involved in the top-down approach to therapy?

5. What are the three main domains of concern in rehabilitation?

6. Compare different levels of supervision in ADL assessments.

7. Discuss factors impacting ADL evaluation sensitivity.

8. Explain essential preparation steps before conducting home management assessments.

9. Describe types of work evaluations and the factors affecting them.