In rehabilitation, disability is the central domain of interest. It is referred to as ‘limitation on activities‘ in the World Health Organisation’s International Classification of Functioning. More accurately, it should be considered as those activities that the person does differently, or cannot undertake but wishes to and/or used to. Often the analysis of a rehabilitation will, and probably should start by considering the disability – what are the main disabilities present, and how do they arise.
The first step is to ask the person concerned what their main concerns or problems are, not specifying what types of concerns or problems you are interested in, but listening to pick up (among other things) the disabilities of concern. It is also important to check, at some point, whether there are other, unmentioned disabilities. They may have been overlooked by the patient, or the patient may feel that health services are not interested. The graphic shows some main domains; within each there are many actual activities and questions need to be general.
Thereafter one should encourage the patient to go on talking, enlarging on their problems – what are the causes, what do they expect, what have they been told, what would they want, and so on. As the person talks, with a few brief questions to clarify matters, they will usually give all the information needed to answer the questions shown in the graphic.
The skill of the listener is to re-organise a revealing narrative into an analysis by locating the facts into their respective domains. The other skill is to keep as quiet as possible, using judicious minor comments and questions on occasion, but usually letting silence continue. This approach will ensure both that the person feels (and is) listened to, and that the listener obtains excellent information.