Rehabilitation Centre and their Types

Rehabilitation is termed as an array of interventions designed to enhance functioning and lessen disability in individuals with health issues in relation with their environment.  

Rehabilitation helps a child, adult or older person to be as independent as possible in daily activities and allow involvement in education, work, recreation and meaningful life roles such as taking care of family. Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease or illness, or because their functioning has deteriorated with age.

Some examples of rehabilitation include:

•           Helping a person with depression with the help of psychological and emotional support.

•           Improving a person’s speech and communication after he/she has undergone a brain injury.

•           Restructuring an older person’s home to ameliorate their safety and autonomy and to lessen their risk of falls.

•           Educating about a healthy lifestyle to a person with heart disease.

•           Prescribing medicine to decrease muscle rigidity to a child diagnosed with Cerebral Palsy.

Rehabilitation is highly individual centred which means that the interventions chosen for each individual depends on their objectives and preferences. Rehabilitation can be provided in many distinct settings, from inpatient or outpatient hospital settings, to private clinics, rehab centre, or community settings such as an individual’s home.

The rehabilitation centre workforce is made up of divergent health workers, including rehabilitation psychologists, clinical psychologists, physiotherapists, occupational therapists, speech and language therapists and audiologists, orthotists and prosthetists, physical medicine and rehabilitation doctors, and nurses.

Types of Rehabilitation

Psychosocial Rehabilitation

Psychoeducation

Psychoeducation is one of the interventions designed to help patients understand their illness, treatments, outcomes and coping strategies. Understanding the illness, generating insight, compliance of medications, and regular follow-ups are emphasized in this training. Strategies are developed to recognize triggering signs of a possible relapse and to prevent a new episode from emerging. A psychologist communicates this information to the patient and their family in an interactive way. The training is generally provided individually or in groups to patients in their chronic phase. Books or articles that may be beneficial to the patients and their families for generating profound insight may be distributed as a supplementary reference during training. Besides providing information during sessions, care should be taken to correct myths and misconceptions that the patient and their family might have. They are allowed to share their experiences in sessions.

Cognitive Behavioral Therapies (CBT)

A cognitive behavioral approach takes the interface of thoughts, feelings, and behaviors as its basis. Emphasis is placed on the role of irrational thoughts and behaviors and detecting the negative thoughts in the emergence and maintenance of symptoms. Main goals include construing of the cognitive distortions and out of reality thinking pertaining to delusions and hallucinations, insight generation, reality testing and augmenting functionality. To this end, various techniques are used including reshaping patterns of distorted thinking, challenging cognitive distortions, developing alternate thoughts, guided discovery, and reality testing. The main goal is to help patients cope with their psychotic symptoms and related distress, attenuate symptoms such as depression and anxiety and enhance functioning. CBT has been shown to increase the protective factors pertaining to treatment adherence, reduction of relapses, improving functioning, and enhancing recovery. CBT practices are recommended by treatment guidelines for patients in both the acute and chronic phases as well as while in the recovery phase. There are also studies showing that CBT is beneficial for the in the early phase. It will be useful when added with pharmacological management to mitigate the effect of distress caused by the illness particularly in resistant Schizophrenia and Bipolar Disorder. It has been found more beneficial when administered for a long period of time involving at least 16 sessions.

Social Skills Training

Social skills training is a set of structured skills development training designed to alleviate patients’ stress in social settings and to improve their social interactions. By developing verbal and non-verbal communication skills, it tries to help patients examine social clues in an appropriate manner and give reactions suitable to the occasion. The skill is elucidated and demonstrated by the trainer, the patient is encouraged to engage in role playing, positive reinforcement and corrective feedbacks are provided, in vivo exercises are carried out, and homework assignments are given. They are found beneficial especially in patients who are under the influence of negative symptoms of Schizophrenia. Often the patient is encouraged to interact with other patients in IPD settings such as rehabilitation centre with techniques of behavioural therapy of shaping and contingency management used.

Cognitive Remediation Therapy

Impairments in the areas of attention, working memory, speed of processing, verbal memory, visual memory, reasoning and problem-solving, abstract thinking, verbal comprehension, and social cognition are apparent in Schizophrenia and also in patients with Neuropsychological disorder like Traumatic Brain Injury, Epilepsy and Dementia. Cognitive remediation therapy is a rehabilitation method where a sequence of exercises are implemented in combination to solve the problems in attention, memory, language, reasoning, and executive functions. Cognitive remediation therapy (CRT) interventions include exercises directly targeting deficits in cognitive capacities, developing complementary strategies for cognitive deficits, and provision of environmental support to help patients perform cognitive tasks. CRT has been shown to augment targeted cognitive function areas and ameliorate overall functioning.

Family Education

The main objective of family education is to include the family members, caregivers, or concerned affiliates of the patient in the treatment and rehabilitation process in both acute and chronic periods. During this education, predominantly supportive sessions with cogntive and behavioural therapies are aligned with the components of the family psychoeducation. Such interventions are deigned sequentially wherein the patient initiatlly emotionally vents out his/her issues to the family members. In the subsequent sessions, emphasis is placed more on family making the patient understand about their unmanageabilites before hospitalization in rehab centreand the reason for admissions. Further, the interventions include the provision of training to families in a way to support them in helping their patients develop coping skills, educate them about their expressed emotions, making them understand the nature of illness and the course of management and improve their problem-solving and communication skills. This has been observed to improve relationships between patients and their families, decrease patients’ perception of stress, and improve patient adherence to treatment. Consequently, relapses and hospitalizations decrease, and the level of recovery increases. With direct or indirect influence, the burden and distress of family members decrease, and their own relationships improve.

Peer Support

When patients with similar problems interact and support each other emotionally which helps the other patient also understand their own problem is considered peer support. Treatment adherence can be ameliorated through learning and gaining influence from peers. Patients can acquire positivitywith peer support resulting in less discrimination. Practices through peer support can be accomplished in various ways with inclusion of self-help groups where participants can share their events, episodes and incidents, patients can seek guidance from other patients as well who are experienced and adroit, and in some cases where skillful patients take part in mental health services which are also called as peer mental health services.

Occupational Therapy and Art Therapy

Occupational therapy and art therapy consist of a set of occupational and art activities using psychotherapy techniques such as developing creative expression, increasing communication skills, developing insight, and supporting socialization. These practices include engaging into recreational activities like sketching, painting, craft, drama, dance, music etc. and are arranged in group level under the supervision of persons who are expertise in their respective fields. It is one of the important interventions in rehabilitation method and has been used in best rehab centreclinics for a number of years. Resources for Occupational and Art Therapy needs to be provided by clinics in a routine manner.

Neuropsychological Rehabilitation

Neuropsychological rehabilitation focuses on four main components:

1.     Assessment of problems

2.     Formulation and planning of course of management

3.     Intervention

4.     Reassessment and evaluation of intervention

Neurpsychological rehabilitation is a process of enabling individuals to recover from the neuropsychological dysfunctions (cognitive, emotional, behavioural) which are impaired due to brain damage. It includes those psychological procedures which targets the damaged function. It aims to restore the patient to premorbid levels of functioning.

This can further be divided into two broad categories- cognitive and emotional. Cognitive rehabilitation includes rehabilitation of neurocognitive functions of arousal, orientation, attention, memory, visuo-spatial skills, executive functions, language and verbal skills.

The behavioural category includes work towards managing both behavioural excesses (perseveration, anger outbursts) and deficits (decreased social interaction, poor self care).

Methods of Neuropsychological Rehabilitation

a)     Basic Functions Approach

This aims at curbing the deficient function. First line of management is restoration of the function to premorbid levels of functioning. If this is not possible then second is reorganisation of the target functions with the help of available functional components. The third strategy is compensation strategies for the deficient function.

b) Functional Skills Training Approach

The focus in this approach is retraining of the damaged brain functions through cognitive retraining, behaviours and skills with the help of task analysis. The composite function is broken down into functional components and smaller tasks and then through the process of shaping and chaining each component skill is taught to the patient.

Benefits of Rehabilitation

Acute or chronic diseases, illnesses, injuries can be reduced through different interventions of rehabilitation at rehab centre. Medical and surgical interventions including other health interventions can also be supplemented with rehabilitation to attain the best result. For example, rehabilitation can help to alleviate, manage or prevent complications associated with many health conditions, such as spinal cord injury, stroke, or a fracture.

Rehabilitation helps to lessen or slow down the deteriorating effects of chronic health conditions, such as cardiovascular disease, cancer and diabetes by equipping people with self-management strategies and the requirement of the products that they require with assistance or by addressing pain or other complications.

Rehabilitation also enables individuals to participate in education and gainful employment, remain independent at home, minimize the need for financial or caregiver support and maintain a healthy lifestyle with adaptive functioning in society.