INTRODUCTION

Rehabilitation, commonly known as rehab, is a scientifically developed procedure for ensuring the
recovery from any kind of disability, injury or the habit. Rehabilitation is a slow but a steady process.
Many of the rehabilitations have ongoing processes involved in them, i.e. some processes in it are
continuous. Those are set of special instructions to be followed by the patient in order to ensure that
the malfunction does not hit back again.

Definitions

Rehabilitation is defined as the process of restoring the individual to the fullest physical, mental, social,
vocational, and economic capacity of which he or she is capable. It is also defined as relearning of
former skills, learning new skills necessary to adapt and live fully in an altered lifestyle.

Rehabilitation nursing is directed toward the prevention of complications of disease or trauma and the
maintenance or restoration of function.

According to WHO "Rehabilitation is the combined and coordinated use of the medical, social,
educational and vocational measures for training and re-training the individual to the highest possible
level of functional ability". It includes all measures of reducing the impact of disability and handicapping
conditions and enable the disabled and handicapped to achieve social integration. Here the word social
integration means active participation of the dis abled/handicapped in the mainstream of the
community.

In an another view "Rehabilitation is a process of restoring people to useful functions in physical,

mental, social, economic and vocational areas of their lives". It means rehabilitation is a process of
restoring patients or persons to their previous level of health, that is to their previous capabilities or to
the level, that is possible for them.

Objective

• The basic objective of rehabilitation is to restore the physical, social and psychological potential to a
level, so that he can independently function and carry on an independent life.

• Prevent disability and return to normalcy. Maximum level of restoration through different
interventions.

• Training in vocational methods to suit working with residual disability and earn lively and
independently.

Goals

• Maximize the quality of life of the individual

• Address the individual’s specific needs

• Assist the individual with adjusting to an altered lifestyle

• Be directed toward promoting wellness minimizing complications

• Assist the individual in attaining the highest degree of function and self-sufficiency possible
• Assist the individual to return to home and community.

Issues in Rehabilitation

Quality of Life versus Quantity of Life

Rehabilitation focuses on continually improving the quality of the person's life, not merely maintaining
life itself. It focus on making the life productive and returning optimum functioning of the body.

Care versus Cure

Rehabilitation gives importance to care and it is provided at the last stage of treatment. When
treatment is completed rehabilitation starts. Many conditions remain irreversible; therefore, the focus
of care is related to adaptation and acceptance of an altered life rather than to resolving an illness.
Rehabilitation generally depends more on care, exercises, like skill training, acceptance of situation
rather than on medication.

High Cost of Interdisciplinary Care versus Long-term Care

Rehabilitation is expensive. Success is sometimes seen as a return to productive employment. Patient

with chronic illness needs long-term care whereas by rehabilitation may be the individual becomes so
sufficiently independent that no caregiver is required.

Ethical Issues

Three moral principles serve as a framework for medical ethic which can be followed during
rehabilitation respect for autonomy, beneficence and justice.

Respect for Autonomy

In moral philosophy, autonomy refers to self-governance, or the personal rule of the self. A person must
have adequate understanding and not be controlled by others or by personal limitations that prevent
choice. When we respect people as autonomous, we recognize their right to hold views, make choices
and take actions based on their own set of personal values and beliefs. In rehabilitation also same
principles should be followed. They must be accorded the moral right to have their own opinions and act
upon them.

Beneficence

The ‘beneficence’ means kindness, charity and the doing of good. It refers to a moral obligation to help
other people, to avoid harming them, and to try and balance benefits with harms. In the health care
setting, it means an obligation to promote the health and well being of the patient and to prevent
disease, injury, pain and suffering.

Justice

People are treated according to the principle of justice if they are treated according to what is fair, due
or owed to. The principle of justice concerns the question of what is due to whom, and how to distribute
the costs and benefits of living in a society.

Ethical Dilemmas
Ethical and moral decisions are made on a daily basis in the field of rehabilitation. Keeping in mind the
ethical principles just mentioned, ethical issues in three settings commonly encountered in rehabilitation
will be discussed under resource allocation and patient selection, the ethics of team care and ethical
issues in goal-setting.

Patient Selection and Resource Allocation

The selection of patients who are to be selected for rehabilitation in any setting is generally made by the
physiatrist. Because in many centers demand for admission exceeds the number of available beds,
difficult decisions often have to be made. In some cases there may be a clearly defined set of guidelines
available, but selection is often more subjective. Patient selection requires consideration of both
medical and nonmedical factors. Medical factors include diagnosis, prognosis, secondary complications,
functional performance and prognosis and ability to learn. Nonmedical factors can be social, vocational,
personal and financial.

Ethical Issues in Teamwork

Because of its emphasis on maximizing a patient’s physical, emotional and psychosocial well-being and
independence, rehabilitation medicine places a premium on teamwork to help a patient achieve his or
her goals. The emphasis within rehabilitation is to try and develop interdisciplinary or transdisciplinary
rather than multidisciplinary teams, which means that each person unctions within the context of the
team, rather than as an isolated individual. The team generally consists of a physiatrist, nurses
specialized in care of the rehabilitation patient, a social worker and multiple therapists, although team
make-up may vary depending on the rehabilitation center and the focus of the team. The patient should
also be included as a member of the team, and whenever possible, should be involved in discussions and
decision-making.

Ethical Issues in Goal Setting

When examining teamwork in rehabilitation, the role of the patient within the team must also be
considered important in goal setting. Goals are the functional outcomes that the patient and team strive
to achieve, and, as such, help to define and focus the team's entire rehabilitative treatment plan. Thus,
goals can be used as outcome criteria for evaluating the efficacy of care. In fact, systems of goal setting
have become so widely accepted in the rehabilitation industry that quality assurance examiners
sometimes use them as indicators. The goal setting must be done by the decision of patient, team
members and family members of the patients. The patients themselves want to make their own
decisions in societies that respect self-determination and individual rights. They know which goals and
outcomes would be most meaningful to them and how much energy and time they wish to expand on
therapy and retraining. The members of the rehabilitation team want to provide the patient with the
highest possible level of functioning. They may assume and expect that patients will seek and generally
follow their advice. So, they are also important in goal setting. Family members often wish to be
involved in the design of the treatment program. This expectation is quite reasonable, as family
members often assume the burden of providing ongoing care for patients and should be involved in
decision-making that affects their own future. That's why, during goal p setting, the opinion of patient,
family members and team members will be given the same importance.

Types and Methods of Rehabilitation

There are different types of rehabilitations available for different types of disabilities.

Neurological Rehabilitation : In this type of rehabilitation, patients suffering from stroke,

neuromuscular disease, certain types of head trauma and spinal cord injury are treated. It aims at
making the patient self-dependent and helps to create a positive thinking in the patient. The patient is
treated so that he leads an improved life physically, emotionally, and socially.

Cardiac Rehabilitation

Cardiac rehabilitation program is designed to help those people who have heart problem. Heart patients
are educated to live a healthy life and reduce stress for the proper functioning of the heart, cardiac
rehabilitation, educating people about the various risk factors that contribute to developing a heart
disease. These risk factors include high blood pressure, obesity, smoking, drinking, drug abuse, lack of
physical activity, etc. Recovery programs from heart disease/surgery, educating people about improving
their quality of life.

Drug Rehabilitation

rehabilitation means to make an addict free from the addiction of alcohol, prescription drug and street
drugs (cocaine, heroin, etc.) which include counselling programs designed to know the underlined cause
behind a person becoming an addict. Educating the person about the various side effects of drug abuse
and how it impacts one's social, professional, physical and personal life. Designing programs that will
prevent the relapse of the drug addiction.

Alcohol Rehabilitation

Alcohol rehabilitation is to make an alcoholic free from the addiction. It involves programs that will
teach people the various bad effects of consuming excess alcohol. Effective detoxification programs
cleanse the body from the various toxins of alcohol.

Physical Rehabilitation

Physical rehabilitation is for those people whose lifestyle has changed after they have gone through a
serious illness, surgery or accident. Here the therapist introduces programs to improve the mobility and
functioning of the injured body part of the patient. It includes appropriate exercise therapy for joint
movements.

 Restoring the function of affected part physio training

 Provision of external appliances and splints
 Relief of pain by application of hot and cold fomentation. Bladder and bowel exercise to control
incontinence
 Training in daily activities to restore lost function
 Education of patients to maintain the physical status and returning to normal life.

Medical Rehabilitation

Medical rehabilitation includes treatment programs that help a person perform better in all his daily
physical and mental activities. Medical rehabilitation is a follow-up treatment after any kind of
 treatment program. Medical Rehab Programs focus on improving major and minor skills that are
required in the basic life, assessing patient in every step to improve the activities of basic living.

Psychosocial Rehabilitation

It is the process of rehabilitation which is not complete without psychosocial intervention.

 To raise the morals of the patient, counselling, positive attitude and support
 Sympathetic attitude of doctors, family members and community support
 Psychotherapy for depression, anxiety, personality changes and suicidal tendency
 Financial support, workplace support to raise the morale and take away depression.

Vocational Rehabilitation

Vocational rehabilitation means to help those people who find it difficult to get employment or
retain it after they have gone through a certain situation that caused mental or physical disability in
them. Vocational Rehab Program provides physiological and medical assessment, Job placement,
and on the job training.

Vestibular Rehabilitation

It helps in improving the ear deficit by working on the central nervous system. Also deals in improving
eye and head coordination.

Stroke Rehabilitation

This treatment type helps to restore damage that is caused after a stroke, which is the 3 rd leading cause
for death worldwide. Stroke rehabilitation aims at helping people gain maximum normal functioning
after the occurrence of a stroke. Help the person get back to normal lifestyle and be independent in
daily activities.

Educational Rehabilitation

Efforts to be made to continue the education:

 Integrated education for disabled child in normal school.

 Preschool training, parents’ counseling
 Special training in speech and language
 Orientation and mobility training for blinds
 Day-to-day living and practice training and skill development.

REHABILITATION TEAM AND THEIR ROLES

Rehabilitation usually encompasses a number of special health services that may be made available
to the individual patient on the basis of particular need. Personnel representing these special
services include the physician and the nurse and may also include a physical therapist, social worker,
vocational counselor, or other professional personnel when indicated. Because rehabilitation is a
complex process involving the patient and a number of professional personnel, a team relationship
usually provides the structure through which each member can make special knowledge and skills
 available for the greatest benefit to the patient. The team evaluates the patient's need for
rehabilitation and develops a plan to give maximum assistance in achieving rehabilitation goals. The
patient is key member of the team and that the degree of determination to be rehabilitated may be
the deciding factor in the success of the plan. The rehabilitation team promotes independence, self-
respect and an acceptable quality of life. The patient's family is incorporated into the team. The
family provides ongoing support, participates in problem-solving and learns to provide necessary
ongoing care. The rehabilitation nurse develops a therapeutic supportive relationship with the
patient and the family. She always emphasizes on patient's strengths. Here the nurse assumes role
of care giver, teacher, counselor, and patient's advocate and consultant. Frequently, the nurse is
called a manager.

Types of Rehabilitation Team

The Rehabilitation Council of India (RCI) was set up as a registered society in 1986. In September 1992,
the ORCI Act was enacted by Parliament and it became a Statutory Body on 22 June, 1993. The Act was
amended by Parliament in 2000 to make it more broad based. The mandate given to RCI is to regulate
and monitor services given to persons with disability, to standardize syllabi and to maintain a Central
Rehabilitation Register of all qualified professionals and personnel working in the field of Rehabilitation
and Special Education. The Act also prescribes punitive action against unqualified persons delivering
services to persons with disability. For rehabilitation, there are different types of models of team
functioning. These are:

Multidisciplinary Rehabilitation Team

Characterized by discipline-specific goals, clear boundaries between disciplines, and outcomes that are
the sum of each discipline's efforts.

Interdisciplinary Rehabilitation Team

Collaborates to identify individuals’ goals and is characterized by a combination of expanded problem

solving beyond discipline boundaries and discipline specific work toward goal attainment.

Transdisciplinary Rehabilitation Team

Characterized by the blurring of boundaries between disciplines, as well as by cross-training and

flexibility to minimize duplication of effort toward individual goal attainment.

Members of the health care team include:

Patients and their families: Patients and their family members are important members of the health
care team as the goals and ideas of patients are critically important for determining their ideal model of
care.

Psychiatrists (rehabilitation doctors) direct therapies and services provided by the rehabilitation team
and coordinate care provided by other specialists.

Rehabilitation psychologists provide psychological testing and individualized and family counseling, if
needed.
Rehabilitation care coordinators are registered nurses with special training, who coordinate the care
from admission to discharge.

Rehabilitation nurses encourage and help to practice the skills learned in therapy sessions.

Physical therapists develop treatment programs to help the patient improve mobility through exercise
and training.

Occupational therapists help to develop the skills needed for the activities of day-to-day life.
Recreational therapists assess the leisure needs and interests and develop treatments to help in return
to a satisfying lifestyle.

Speech-language pathologists work to improve speech and language, conversation skills and the
thinking skills necessary for communication.

Registered dietitians advise about healthy diet choices and special dietary needs.

Respiratory therapists help the people with breathing disorders, including training in use of ventilators.

Medical social workers provide emotional support, identify economic resources and community
agencies and help for making arrangements to leave the hospital and find follow-up care.

Vocational case coordinators help develop a plan to return to work in your community.

Child life specialists help children and their families prepare for, adjust to, and benefit from hospital
experiences.

Chaplains support the spiritual, religious and emotional needs of you and your family.

Psychosocial Rehabilitation (PSR)

Psychiatric rehabilitation, also known as psychosocial rehabilitation, and sometimes simplified to psych
rehab by providers, is the process of restoration of community functioning and well-being of an
individual diagnosed in mental health or mental or emotional disorder and who may be considered to
have a psychiatric disability.

Definitions

Psychosocial rehabilitation is a process initiated by the family of a person with severe mental disorder, in
collaboration with the community's natural support system which includes the health professional, that
seeks to maximize their socio occupational functioning of the patient with the final stated objective of
preventing marginalization.

It is a process that facilitates the opportunity for individuals who are impaired, disabled or handicapped
- by a mental disorder-to reach their optimal level of in dependent functioning in the community.

The goal of Psychosocial rehabilitation is returning the individual to community working and living
condition as much independently as possible.

Objectives
• To enable patients to achieve their optimal functioning.

• To enable patients to live independently.

• To empower patients to understand and manage their illness effectively.

• To encourage involvement of families in care.

COMMUNITY-BASED REHABILITATION (CBR)

It is a strategy within general community development for the rehabilitation, equalization of

opportunities and social inclusion of all people with disabilities. The primary objective of CBR is the
improvement of the quality of life of people with disability/marginalized persons. Key principles relating
to CBR are equality, social justice, solidarity, integration and dignity. CBR is not an approach that only
focuses on the physical or medical needs of a person or delivering care to disabled people as passive
recipients. It is not outreach from a center. It is not determined by the needs of an institution or groups
of professionals, neither it is segregated and separate from services for other people.

CBR is a systematized approach within general community development, whereby persons with
disabilities are enabled to live a fulfilling life within their own community, making maximum use of local
resources and helping the community become aware of its responsibility in ensuring the inclusion and
equal participation of PWDs. In the process, PWDs are also made aware of their own role and
responsibility, as they are part of the community.

CBR is now defined as a community development program that has seven different components:

 Creation of a positive attitude towards people with disabilities

 Provision of rehabilitation services
 Provision of education and training opportunities
 Creation of micro and macro income-generation opportunities
 Provision of long-term care facilities
 Prevention of causes of disabilities
 Monitoring and evaluation.

Principles of CBR

Inclusion

Community-based Rehabilitation (CBR) works to remove all kinds of barriers which block people with
disabilities from access to the mainstream of society. Inclusion means placing disability issues and
people with disabilities in the mainstream of activities.

Participation

Participation focuses on abilities, not disabilities. It depends on the participation and support of people
with disability, family members and local communities. It also means the involvement of people with
disabilities as active contributors to the CBR program, from policy making to implementation and
evaluation, for the simple reason that they know what their needs are.
Empowerment of Local People

Empowerment of local people is important for starting any Community Development Program. Local
people specifically people with disabilities and their families, should make the program decisions and
control the resources. This requires people with disability taking leadership roles within programs. The
CBR workers, service providers and facilitators include people with disabilities in planning and organizing
the program.

Equity

Principle equity means equality of opportunities and rights. Community-based rehabilitation emphasizes
equality of opportunities and rights for all without discrimination. The service will be equally shared
among all.

Raising Awareness

Raising awareness about CBR addresses attitudes and behavior within the community, developing
understanding and support for people with disabilities and ensuring sustainable benefits. It also
promotes the need for and benefit of inclusion of disability in all developmental initiatives.

Primary Health Care and Rehabilitation

Health is defined as a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. Primary health care is essential health care based on practical
scientifically sound and socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and at a cost that the
community and country can afford to maintain at every stage of their development in the spirit of self
reliance and self-determination. It forms an integral part both of the country's health system, of which it
is the central function and main focus, and of all the overall social and economic development of the
community. It is the first level of contact of individuals, the family and the community with the national
health system bringing health care as close as possible to where people live and work, and constitutes
the first element of a continuing health care process. Community-based rehabilitation is fully consonant
with the concept of Primary Health Care. This approach promotes awareness, self-reliance and
responsibility for rehabilitation within the community. It builds on manpower resources in the
community, including the disabled themselves, their families and other community members. CBR
encourages the use of simple methods and techniques that are acceptable, affordable, effective and
appropriate to the local setting.

Models of Disability and Rehabilitation

Models assist understanding by allowing one to examine and think about something that is not the real
thing, but that may be Similar to the real thing. People use a variety of models to obtain a clearer
understanding of a problem or the world around them.

Evolution of models of Disability

The prevailing wisdom about the causes of disability has changed in the last several decades. In the
1950s, impairment of a given severity was viewed as sufficient to result in disability in all circumstances;
in contrast, the absence of impairment of that severity was thought to be sufficient grounds to deny
disability benefits. Thus, the American Medical Association's Committee on Medical Rating of Physical
Impairments stated that "competent evaluation of permanent impairment requires adequate and
complete medical examination, accurate objective measure of function, and avoidance of subjective
impressions and nonmedical factors such as the patient's age, sex and occupation" (American Medical
Association, Committee on Medical Rating of Physical Impairment, 1958).

By the mid-1970s, Nagi (1976) outlined a process by which a pathology (e.g., arthritis) gave rise to an
impairment (e.g., a limited range of motion in a joint), which may then result in a limitation in function
(e.g., an inability to type), which, finally, may result in a disability (inability to work as a secretary). While
out lining a process that would seem to move inexorably from pathology to loss of a job, Nagi noted that
correlations among impairments, functional limitations, and work loss were poor, and he speculated
that the extent to which the environment accommodated limitations largely determined whether
disability would result from the onset of a medical condition. In the interim, at least three others have
developed models or modifications: the WHO (International Classification of Impairments, Disabilities,
and Handicaps, 1980), the IOM (Disability in America, 1991), and the NCMRR (1993). All of these models
at tempt to facilitate and improve understanding by describing the concepts and relationships among
medical conditions, impairments, functional limitations, and the effects of the interaction of the person
with the envi ronment (i.e., handicap, disability, societal limitation) although each uses different
nomenclatures for the components.

Nagi's model of disability explicitly brought the environment into the conceptualization. His model
initiated a search for the factors in family, community, and society that affect disability as an outcome.
With respect to disability in the work setting, for example, research has focused on the social and
demographic characteristics of the individual and family, the individual's prior occupation and the
industry in which the individual was previously employed, the flexibility of the workplace with respect to
the physical tasks of work and hours of work, the nature of the local economy, customs and laws
governing employment, and the extent of income transfer programs (Yelin, 1992).

Although the Nagi model included the environment, it was limited in how it conceived of the
environment. In his model, the environment impinges on individuals only when activity limitation
interacts with the demands placed on those individuals; the process that gives rise to disability is still
inherently a function of the characteristics of medical conditions and attendant impairments.

The IOM model (IOM, 1991) was derived directly from Nagi, defining disability as "a function of the
interaction of the person with the environment" and beginning to describe certain sub sets of
environmental factors that could potentially affect the development of and movement within a disabling
process. In this model, physical and social environmental risk factors (as well as biological and lifestyle
risk factors) were described as in dependent variables that exist at all stages of the process. These
factors affect progression within the model, and their control therefore affects (prevents) disability.
The NCMRR model adds emphasis to the importance of environment by adding a category called
societal limitations to account for restrictions that society places on individuals and that limit their
ability to participate independently in tasks, activities, and roles. The unwillingness of employer to
provide accomodations and the lack of ramps that deny access to public buildings to persons with
disabilities are given as examples.

A New Model for the Enabling-Disabling Process

A common understanding of such terms as injury, impairment, handicap, functional limitation, disabling
conditions, and disability is essential to building effective, coherent programs in rehabilitation science
and engineering. As described above, several frameworks have been advanced to describe disability-
related concepts, but none of these has been universally adopted. The lack of a uniformly accepted
conceptual foundation is an obstacle to research and to other elements critical to rehabilitation science
and engineering. Using the definitions laid out in Chapter 1, this committee presents a new set of
models, based primarily on the previous IOM model (1991), designed to enhance the robustness of the
previous models with respect to reversing the disabling process, i.e., rehabilitation. This section presents
an overview of "the enabling-disabling process," explains its stages, and describes the nature of
disability.

An Overview of the Enabling-disabling Process

An overview of how disabling conditions affect a person's access to the environment is shown in Figure
3-1. Access to the environment, depicted as a square, represents both physical space and social
structures (family, community, society). The person's degree of physical access to and social integration
into the generalized environment is shown as degree of overlap of the symbolic person and the
environmental square. A person who does not manifest disability (a) is fully integrated into society and
therefore has full access to both: 1) social opportunities (employment, education, parenthood,
leadership roles, etc.) and 2) physical space (i.e. space access equivalent to persons without disabling
conditions). A person with potentially disabling conditions has increased needs (expressed by the size of
the individual) and is dislocated from their prior integration into the environment (b).

The rehabilitative process attempts to rectify this displacement, either by restoring function in the
individual (c) or by expanding access to the environment (d) (e.g., building ramps). This model does not
mean to imply that the two methods (which may be generally characterized as cure and care) are
mutually exclusive. Indeed, the most effective rehabilitation programs include both. The model
separates the two only to illustrate that disability is the interaction between the potentially disabling
conditions of an individual and the environment, and therefore strategies that affect the environment or
the pertinent potentially disabling conditions both target disability. While this model provides an
overview, more detail is provided below

It is important to note that a potentially disabling condition becomes an actual disabling condition once
the person is dislocated from the environ ment as a result of that condition.
FIGURE 16.3Conceptual overview of the enabling disabling process. The environment, depicted as a
square, represents both physical space and social structures (family, community, society). A person who
does not manifest a disability (a) is fully integrated into society and "fits within the square." A person
with potentially disabling conditions has in creased needs (expressed by the size of the individual) and is
dislocated from his or her prior integration into the environment (b) that is, "doesn't fit in the square."
The enabling (or rehabilitative) process attempts to rectify this displacement, either by restoring
function in the individual (c) or by expanding access to the environment (d) (e.g., building ramps).

The New IOM Model

Looking at the enabling-disabling process with more scrutiny requires greater detail in the model. To this
end, this report adopts the IOM model (1991) and makes some modifications de signed to both improve
the model and to tailor it more towards rehabilitation (see Figure 3-2). The original IOM model was
conceived with prevention in mind, and the need for identifying risk factors whose control would
facilitate the prevention of disability. The 1991 IOM model (IOM, 1991) established a new conceptual
foundation in the field of disability in that it analysed and described the components of the disabling
process in such a way as to allow for the identification of potential points for preventive intervention.
Identifying and describing the importance of the different types of risk factors that affect the disabling
process as well as the interaction and integral nature of quality of life were fundamental contributions
to the emerging field of disability prevention. Over time, however, some shortcomings in the 1991 IOM
model have emerged, including the implication that the disabling process is unidirectional, progressing
inexorably toward disability without the possibility of reversal. The unidirectional was implied by the
arrows in the model that pointed only to the right, that is, toward the condition of disability. Although
this may have been a result of that committee's focus on developing interventions to prevent
progression in the disabling process rather than reversal, that is, rehabilitation, it is a shortcoming in the
original model that needs correction and clarification, especially in the context of rehabilitation.

A second apparent shortcoming in the 1991 IOM model is its lim ited characterization of the
environment and the interaction of the individual with the environment. Although the importance of the
environment is discussed in the text in some detail, it is not clearly represented in the model except as a
category of risk factors involved in the transition between the various categories of the disabling
process.

The third apparent shortcoming in the 1991 IOM model that the committee identified as needing
improvement is the representation of societal limitation. Some enhancements to the original model
address these shortcomings.

The new IOM model (Figures 16.4, 16.5, and 16.6) is designed to show disability more clearly as the
interaction of the person with the environment and also to show the possibility of movement in the
direc tion of rehabilitation. To accomplish this diagrammatically, the new model is three-dimensional
and has the following new features:

FIGURE 16.4 Modified IOM model. The Disability in America model (Institute of Medicine, 1991) is re
vised to include bidirectional arrows and a state of “no disabling condition,” and to show transitional
factors and quality of life interacting as part of the enabling-disabling process. The state of “disability”
does not appear in this model since it is not inher ent in the individual but, rather, a function of the in
teraction of the individual and the environment.
 FIGURE 16.5The person-environment interaction.

The enabling-disabling process is depicted as being an active part of the individual person. The physical
and social environments are depicted as a three-dimensional mat, with social factors on one side and
physical factors on the other. The interaction of the person and the "environmental mat" is depicted as
a deflection in the mat.

1. The person: Arrows pointing left were added to represent the potential effects of rehabilitation and
the "enabling process" (risk factors and enabling factors are now combined into "transitional factors").
In addition, the new model includes the designation "no disabling conditions" to indicate that there is a
beginning and an end to the disabling process when a pathology, impairment, functional limitation, or
disability does not exist.

2. The environment: The shaded gray area from the 1991 model becomes "the environment," including
the physical, social, and psychological components of the environment, and is represented as a three
dimensional mat that supports and interacts with the person and the disabling process, serving to
highlight the importance of the person-environ ment interaction.

3. Disability: The box that was labeled "disability" in the 1991 model has been moved from being a part
of the disabling process to being a product of the interaction of the person with the environment.
FIGURE 16.6 Disability as displacement of the environmental mat. The amount of disability that a person
experiences is a function of the inter action between the person and the environment. The amount of
displacement in the environmental mat is a function of the strength of the physical and social
environments that support an individual and the magnitude of the potentially disabling condition. The
amount of displacement represents the amount of disability that experienced by the individual.

Role of a CHN in Rehabilitation

Rehabilitative nursing is not a specialty limited to the particular agencies or settings. It is a vital part of
Nursing in the patient’s home, the hospital emergency room, nursing home, clinic and all health care
settings. The nurse may stimulate development of motivation through an attitude of respect for the
patient and confidence in his or her ability to return to his highest level of independence possible.
Helping the family to help themselves is an integral part of nursing care.

Cancer arthritis, mental illness or cerebral palsy, whether he has stroke, the spinal cord injury or a burn.
It is up to the nurse to apply the appropriate concepts and techniques to the patients under her care.

Home Care

The home care rehabilitation nurse acts as an advocate for clients and their families during the re-entry
process from the hospital into the home and the community. The home care rehabilitation nurse
coordinates the services provided by the interdisciplinary team and enacts the plan of care that has
been developed by the client, the physician, and the rehabilitation team. In this role, the home care
rehabilitation nurse functions as a clinical resource, a care coordinator, an advocate, a primary care
provider, a teacher, a consultant, and a team member. The home care nurse, using rehabilitation
expertise, develops an individualized program for the client and the client’s family in the home setting
provides client-driven care as part of or caregiver. The rehabilitation nurse in the home setting provides
client-driven care as part of a continuum between other health care settings and the client's home. The
goals are to implement the client's self management skills in the home-setting and to restore the client's
relationships with family members and others in the community.

Rehabilitation nursing in home care is highly specialized. However, rehabilitation nurses in this setting
serve a diverse population. Infants, children, adolescents, young adults, middle-aged adults, and older
adults with disabling conditions may receive specialized home care nursing support from rehabilitation
nurses in settings that include alternative living situations and their own home. The nurse plays different
roles in rehabilitation center.

Practitioner

• Serves as a clinical resource for those involved in rehabilitation nursing practice

• Serves as a clinical resource in the care of clients with a complex chronic illness, disabling condition, or
both

• Acts as a resource during a crisis that is aggravated by a chronic illness or a disabling condition

• Assesses the appropriateness of a client’s admission to, and the delivery of rehabilitation services in,
the home environment

• Provides assistance with discharge planning to ensure a smooth transition into the community or,
when appropriate, to help clients who are hiring private attendants

• Collaborates with the interdisciplinary team in the management of the team function in the home
environment; is responsible for ensuring that the client is involved as a significant member of the team

• Helps the client and the client’s family adapt to changes in lifestyle necessitated by the disabling
condition
• Implements rehabilitation nursing care based on scientific knowledge, home care standards, and
rehabilitation principles that are appropriate to the home care environment.

Care Coordinator

Acts as a member of the interdisciplinary health care team and promotes the coordination of client care

Coordinates the activities of rehabilitation professionals; integrates the knowledge and skills of various
rehabilitation disciplines into a comprehensive continuum of care

Facilitates the design and implementation of the plan of care for clients who are chronically ill or who
have disabling conditions.

Advocate

• Advocates for clients and their families or caregivers

• Teaches clients and their families or caregivers to advocate for themselves

• Facilitates the client's transition from the hospital to the home and the community

• Furthers an understanding of home care-based rehabilitation issues among people in the community
and among those in government who are in a position to deal with issues related to this patient
population.

Educator

• Provides education for clients and their families

• Provides staff orientation and guides staff development, both at the professional and the
paraprofessional levels, in the area of rehabilitation home care

• Provides rehabilitation-focused continuing education programs Develops policies and procedures that
are specific to rehabilitation home care

• Develops educational materials designed to help clients and their family members become
knowledgeable consumers in the health care arena.

Consultant

• Identifies clients and families who could benefit from rehabilitation home care services

• Provides case management expertise within the home care environment

• Serves as a liaison with third-party payers and justifies the use of funds for rehabilitation home care •
Serves as a resource for rehabilitation nurses and as a process consultant to staff in the home care
setting

• Promotes rehabilitation nursing services to community health professionals and to the community at
large.

Researcher
  Participates in research involving home care clients and their families
 Participates in the analysis and dissemination of evaluative data that may have an impact on
clients and their families
 Incorporates evaluative data into nursing practice.

Conclusion

Rehabilitation is an essential part of universal health coverage along with promotion of good
health, prevention of disease, treatment and palliative care.Rehabilitation helps a child, adult or
older person to be as independent as possible in everyday activities and enables participation in
education, work, recreation and meaningful life roles such as taking care of family.Globally, an
estimated 2.4 billion people are currently living with a health condition that benefits from
rehabilitation.The need for rehabilitation worldwide is predicted to increase due to changes in
the health and characteristics of the population. For example, people are living longer, but with
more chronic disease and disability. Currently, the need for rehabilitation is largely unmet. In
some low- and middle-income countries, more than 50% of people do not receive the
rehabilitation services they require. Rehabilitation services are also amongst the health services
most severely disrupted by the COVID-19 pandemic.

Bibliography

Dash bijayalaskhmi, A Comprehensive Textbook Of Community Health Nursing , published by jaypee

brothers , first edition , page no- 698-715

Suryakantha AH , Community Medicine with Recent Advances, jaypee brothers medical publishers Ltd,
third edition 2014, page no -776-785

Swarnakar Keshav,” Community Health Nursing”, published by N.R Brothers, second edition , page no 6