Old Terminology  Disabled ◦ suggests that a person is not able, although many people with physical or mental problems are able to work, and care for themselves  Handicapped ◦ Suggests a disadvantage experienced

 Although people with physical challenges may have difficulty performing some tasks, they are still able to do many other tasks, So, we will refer to them as having a  Suggests that it is not that the person is disabled, but that a limitation in function exists

◦ Musculoskeletal impairments ◦ Neurological impairments ◦ Sensory/perceptual deficits ◦ Cognitive disorders ◦ Chronic illnesses

A process of adaptation, or recovery, through which an individual suffering from a functional limitation, whether temporary or irreversible, regains, or attempts to regain maximum function, independence, and restoration.

 Help an individual achieve the highest level of independence and quality of life possible - physically, emotionally, socially, and spiritually.  It does not reverse or undo the damage, but rather helps restore the individual to optimal health, functioning, and well-being.  Rehabilitate (from the Latin "habilitas") means "to make able again."

 The interdisciplinary team helps set short- and long-term treatment goals for recovery and is made up of many skilled professionals, including the following: ◦ Physicians ◦ Nurses ◦ Physical and occupational therapists ◦ Speech therapists ◦ Recreational therapists ◦ Social workers ◦ Psychologists ◦ Nutritionists

 Rehabilitation Specialists ◦ Rehabilitation is provided by several types of specially trained professionals. A person may work with any or all of these:  Physician. ◦ All patients in rehabilitation have a physician in charge of their care. Several kinds of doctors with rehabilitation experience may have this role. These include family physicians and internists (primary care doctors), geriatricians (specialists in working with older patients), neurologists (specialists in the brain and nervous system), and physiatrists (specialists in physical medicine and rehabilitation).  Rehabilitation nurse. ◦ Rehabilitation nurses specialize in nursing care for people with disabilities. They provide direct care, educate patients and families, and help the doctor to coordinate care.

 Physical therapist. ◦ Physical therapists evaluate and treat problems with moving, balance, and coordination. They provide training and exercises and teach family members how to help with exercises for the patient and how to help the patient move or walk, if needed.  Occupational therapist. ◦ Occupational therapists provide exercises and practice to help patients do things they could do before such as eating, bathing, dressing, writing, or cooking. The old way of doing an activity sometimes is no longer possible, so the therapist teaches a new technique.  Speech-language pathologist. ◦ Speech-language pathologists help patients get back language skills and learn other ways to communicate. Teaching families how to improve communication is very important. They also work with patients who have swallowing problems  Social worker. ◦ Social workers help patients and families make decisions about rehabilitation and plan the return to the home or a new living place. They help the family answer questions about insurance and other financial issues and can arrange for a variety of support services. They may also provide or arrange for patient and family counseling to help cope with any emotional problems.  Psychologist. ◦ Psychologists are concerned with the mental and emotional health of patients. They may also treat thinking or memory problems or may provide advice to other professionals about patients with these problems.

 Therapeutic recreation specialist.  These therapists help patients return to activities that they enjoyed before the stroke such as playing cards, gardening, bowling, or community activities. Recreational therapy helps the rehabilitation process and encourages the patient to practice skills.  Other professionals  An orthotist may make special braces to support weak ankles and feet.  A urologist may help with bladder problems. Other physician specialists may help with medical or emotional problems.  Dietitians make sure that the patient has a healthy diet during rehabilitation. They also educate the family about proper diet after the patient leaves the program.  Vocational counselors help patients go back to work or school.

 Rehabilitation works best when the patient, family, and interdisciplinary team work together as a team.  Family members must learn about impairments and disabilities and how to help the patient achieve optimal function again.

 Rehabilitation nursing is a specialty in which nurses with expert knowledge in the care of patients and families affected by a functional limitation assist them to participate in a treatment program which will allow the patient to regain as much normal function as possible, thereby improving quality of life for the patient

 Community-Based services: ◦ Home delivered meals ◦ Chore services ◦ Homemaker ◦ Home health care ◦ Respite care ◦ Adult day care centers

 Facility-based services: ◦ board and care homes ◦ congregate / group living ◦ residential care units ◦ assisted living units ◦ long-term care facilities or nursing homes ◦ acute rehabilitation

 Does my insurance company have a preferred rehabilitation provider that I must use to qualify for payment of services?  What is the cost and will my insurance company cover all or part of the cost?  How far away is the facility and what is the family visiting policy?  What are the admission criteria?  What are the qualifications of the facility? Is the facility accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)?  Has the facility handled treatment for this type of condition before?  Is therapy scheduled every day? How many hours a day?  What rehabilitation team members are available for treatment?  What type of patient and family education and support is available?  Is there a physician onsite 24 hours a day?  How are emergencies handled?  What type of discharge planning and assistance is available?

 Does the program provide the services the patient needs?  Does it match the patient's abilities or is it too demanding or not demanding enough?  What kind of standing does it have in the community for the quality of the program?  Is it certified and does its staff have good credentials?  Is it located where family members can easily visit?  Does it actively involve the patient and family members in rehabilitation decisions?  Does it encourage family members to participate in some rehabilitation sessions and practice with the patient?  How well are its costs covered by insurance or Medicare?  If it is an outpatient or home program, is there someone living at home who can provide care?  If it is an outpatient program, is transportation available?

 According to federal law, employers must provide “reasonable accommodations” for workers with functional limitations or disabilities  An employee cannot be discriminated against or fired on the basis of physical limitations

 IDEA: Individuals with Disabilities Education Act (1975) ruled children with disabilities should receive public education, mainstream children into regular public schools

 Most private insurance covers rehabilitation services, although individual plans may vary in their coverage and requirements.  Medicare will cover rehabilitation services in an inpatient setting when the following requirements are met: ◦ The physician has certified that the patient needs inpatient hospitalization for rehabilitation. ◦ The hospital is a Medicare certified facility. ◦ The inpatient requires relatively intense, multi-disciplinary rehabilitation provided by experienced staff ◦ The care is reasonable and necessary and not actually available at a lower level of care.

 The Medicare Administration has further stipulated that the patient must participate in 3 hours of therapy and at least 2 therapeutic modalities daily.  Medicaid benefits are state based and vary by state, but rehabilitation services are usually at least partially covered.

 Factors across the life span  Physiological factors  Culture and lifestyle factors  Environmental factors  Psychosocial factors

 Health history ◦ Functional Independence Measure (FIM) ◦ Instrumental Activities of Daily Living Scale ◦ Katz Index of Activities of Daily Living ◦ PULSES Profile ◦ Barthel Index  Physical examination  Diagnostic tests ◦ Computed tomography (CT) scan ◦ Magnetic resonance imaging (MRI)

 Defining characteristics ◦ Alteration in perception of role in self or others ◦ Strain, conflict, confusion, ambivalence, denial ◦ Inadequate external support or adaptation to change ◦ Family system conflict ◦ Change in patterns of responsibility ◦ Discrimination, domestic violence, harassment ◦ Inadequate motivation ◦ Inappropriate expectations ◦ Powerlessness ◦ Change in capacity to resume role ◦ Inadequate opportunities for role enactment  Related factors ◦ Social ◦ Knowledge-based ◦ Physical

 Ineffective role performance  Powerlessness  Self-care deficit  Impaired physical mobility  Activity intolerance  Disturbed sensory/perception  Risk for injury

 Rehabilitation goal ◦ Maximizing function ◦ Preventing complications  For Ineffective role performance ◦ Expresses feeling about role within a time frame ◦ Names factors that contribute to disturbance ◦ Describes realistic expectations ◦ Identifies behaviors needed for fulfilling modified role ◦ Assumes behaviors for fulfilling modified role ◦ Designs an alternative role by specified date ◦ Seeks assistance from selected resources

Patient need:Example: Self-care skills, including activities of daily living (ADLs) Feeding, grooming, bathing, dressing, toileting, and sexual functioning Mobility skillsWalking, transfers, and self-propelling in a wheelchair Communication skills Speech, writing, and alternative methods of communication Cognitive skills Memory, concentration, judgment, problem solving, and organizational skills Socialization skillsInteracting with others at home and within the community Vocational trainingWork-related skills Pain managementMedicines and alternative methods of managing pain Psychological testing Identifying problems and solutions with thinking, behavioral, and emotional issues Family support Assistance with adapting to life styles changes, financial concerns, and discharge planning Education Patient and family education and training about stroke, medical care, and adaptive techniques

 Addressing factors that contribute to functional limitations ◦ Making healthy lifestyle choices ◦ Community resources ◦ Social supports  Teaching clients and families about safety

 Assisting with dressing, grooming, and eating  Assisting with medication management  Reducing unilateral neglect  Referring to community resources

 Clarifying roles  Developing resources  Referrals to job training  Teaching  Practicing redefined roles

Health Threats or Complications  Decreased or limited activity can lead to obesity, further limits in functioning, debility  Risk for injury from mobility deficits, environmental hurdles, sensory impairments  Risk for infection from impaired hygiene, impaired oral hygiene, altered urinary elimination, etc.  Routine health care may be neglected – dental care, immunizations, routine screening (BP, eye exams, Pap smears, prostate exams, colonoscopy, etc.)  Mental health issues: stress-related disorders, lowered self- esteem, substance abuse, depression, suicide