One very simple insight explains all rehabilitation. Rehabilitation is the education of a person who has a persistent problem with their health where the underlying disease cannot be reversed, cured, or stopped. If everyone, including healthcare professionals and healthcare managers understood this, rehabilitation services would be given the attention they deserve. Moreover, most of the debates and questions about rehabilitation would be resolved.
Rehabilitation is …
Education, education, education
The table below illustrates how education and rehabilitation are analogous.
|Teaching staff||The rehabilitation service’s multi-disciplinary team|
|Teacher||Individual healthcare professions working in the service|
|Teaching assistant. learning support||A shared role by most healthcare professionals who will reinforce advice given by other people in the team, and in many hospital setting there are students, employed assistants, and people starting their training who will provide support.|
|Classroom||Ward (if an inpatient); gyms and departmental rooms if in a hospital setting (in- or out-patient); home and community including workplace|
|Playground||Any space in hospital that is not a ward or department – shops, corridors, cafe etc. If in care home or community, all areas including, for example, leisure centres and shopping arcades.|
|School (organisation, buildings)||The rehabilitation service (organisation), and the building(s) associated with it.|
|Homework, self-learning||Practicing undertaken by the patient in the many hours when he or she is not actually in face-to-face contact with a therapist.|
|Out-reach work||Community-based rehabilitation delivered in the home or other community centre.|
|Careers advice||Counselling and advice to help someone adjust their goals and expectations if they are limited by illness|
|University, colleges etc||Usually the hospital, but could be equated to services that manage particularly complex or rare conditions or treatments. A rehabilitation service with an unusual particular expertise that is not commonly needed.|
|Appraisal||Increasingly in employed work, employees are appraised to ensure that they know all they need to know. Rehabilitation is no different. Some people need ongoing monitoring to check they are performing safely at the expected level.|
|Life-long learning||Almost all people continue some form of educational activity after leaving formal full-time education. Rehabilitation is exactly the same. When something changes, such as when demands increase or the illness progresses, further rehabilitation input is needed.|
|Retirement||Not really an option! (but many people who have retired continue learning and take up formal education|
The important messages to take from this analogy are as follows.
Learning is central.
Education is not really about teaching. It is about the child learning. Initially the formal learning requires considerable expert guidance from the teacher. After a relatively severe acute illness, a patient also needs considerable input. But, from the outset, both pupils and patients are (or should be) taught how to learn. All the principles attached to learning in any situation apply both to pupils and to patients: it requires practice with feedback; the learner has to put in the effort, and so needs to understand and accept the long-term goals; the learned skill has to be practiced in different settings (e.g. arithmetic is useful in a shop).
Learning continues through life.
Even if not through formal, educational teaching, all humans continue to learn through life even if it is only how to use the most recent TV remote or washing machine. A well-taught person know how to learn, and how to solve problems without much support. Other people needs help when faced with something new. Someone who has a disabling condition may have difficulty in self-learning and solving problems precisely because of their condition. Therefore, in rehabilitation as in education, intermittent access to rehabilitation/education is part of normal life (or should be).
Learning is the responsibility of the person.
As many teachers can attest, teaching a person who does not want to learn is futile. However, in rehabilitation as in education, the answer is not simply to give up. Before finally giving up, the teacher or rehabilitation professional should analyse why the person is not engaging, and how the person can be helped to understand the value. In rehabilitation, the goal-setting process is specifically centred on understanding what is important to the patient. Schools probably could learn from rehabilitation (though government-mandated payment systems severely constrain teachers in engaging their pupils in learning).
Rehabilitation is not a medicine.
Most patients, and most people, think of healthcare as giving ‘treatments’, something that a patient takes. Moreover, within limits, it is assumed that more treatment is necessarily better. This is not the case. Often a small thing, unnoticed by the teacher, can have a profound impact upon a pupil. This phenomenon – the lack of a ‘dose-response’ relationship – occurs both in teaching and in rehabilitation. The dose of interest is practice time, not teaching time.
If you always return to the idea that rehabilitation is education, you will find it a useful analogy – especially when discussing matters with non-clinical managers and funding agencies. Managers like appraisal and continuing professional development. The analogy with regular if infrequent review and intermittent access to rehabilitation when a need is identified maps easily onto their professional practice.