Disabilities can affect eating, bathing, dressing, walking, and the ability to work. These daily activities and others are hard or seem impossible. The degree of disability affects how much function is possible. The person may depend totally or in part on others for basic needs.

Rehabilitation is the process of restoring the person to his or her highest possible level of physical, psychological, social, and economic function. The goals of rehabilitation are to:

• Prevent or reduce the degree of disability.

• Improve abilities. This promotes function at the highest level of independence. Returning to work may be a goal. For others, self-care is the goal. If improved function is not possible, the goal is to prevent further loss of function. This helps the person maintain the best possible quality of life.

• Help the person adjust to the disability.

Some persons return home after rehabilitation. The process may continue in home or community settings.

See Focus on Long-Term Care and Home Care: Rehabilitation and Restorative Nursing Care.

Focus on Long-Term Care and Home Care

Rehabilitation and Restorative Nursing Care

Long-Term Care

Some nursing center residents have disabilities. Causes include strokes, fractures, amputations, injuries, and joint replacement surgery. Goals are to regain function or adjust to a long-term disability. Often these residents return home.

Other residents have progressive illnesses. They become more and more disabled. The goals are to:

• Maintain their highest level of function.

• Prevent unnecessary decline in function.

Restorative Nursing

Some persons are weak. Many cannot perform daily functions. Restorative nursing care is care that helps persons regain health, strength, and independence. With progressive illnesses, disabilities increase. Restorative nursing:

• Helps maintain the highest level of function.

• Prevents unnecessary decline in function.

Restorative nursing measures promote:

Many persons need restorative nursing and rehabilitation. In many agencies, they mean the same thing. Both focus on the whole person.

Restorative Aides

Some agencies have restorative aides. A restorative aide is a nursing assistant with special training in restorative nursing and rehabilitation skills. These aides assist the nursing and health teams as needed. Required training varies among states. If there are no state requirements, the agency provides needed training.

Rehabilitation and the Whole Person

A health problem has physical, psychological, and social effects. So does a disability. Suppose an illness left you paralyzed from the waist down.

• Would you be angry, afraid, or depressed?

• How would you move about?

• How would you care for yourself and your family?

• How would you worship, shop, or visit friends?

• Could you work and support yourself?

The person needs to adjust physically, psychologically, socially, and economically. Abilities—what the person can do—are stressed. Complications may cause further disability.

See Focus on Children and Older Persons: Rehabilitation and the Whole Person.

Focus on Children and Older Persons

Rehabilitation and the Whole Person

Children

Disabilities in children occur from birth defects or from illness, injury, or surgery. For normal growth and development (Chapter 11), the child needs hand skills, mobility, communication, play, and relationships with parents, family, and peers. A disability can affect 1 or more of these factors.

Older Persons

Rehabilitation takes longer in older persons than in other age-groups. Changes from aging affect healing, mobility, vision, hearing, and other functions. Chronic health problems can slow recovery. Older persons are at risk for injuries. Fast-paced rehabilitation programs are hard for them. Their programs usually are slower-paced.

Physical Aspects

Rehabilitation starts when the person first seeks health care. Complications are prevented. They can occur from bedrest, a long illness, or recovery from surgery or injury. Bowel and bladder problems are prevented. So are contractures and pressure ulcers. Good alignment, turning and re-positioning, range-of-motion (ROM) exercises, and supportive devices are needed (Chapters 17, 18, and 30). Good skin care also prevents pressure ulcers (Chapters 22 and 37).

Elimination.

Some persons need bladder training (Chapter 24). The method depends on the person’s problems, abilities, and needs. Some need bowel training (Chapter 26). Control of bowel movements and regular elimination are goals. Fecal impaction, constipation, and fecal incontinence are prevented.

Self-Care.

Self-care is a major goal. Activities of daily living (ADL) are the activities usually done during a normal day in a person’s life. ADL include bathing, oral hygiene, dressing, eating, elimination, and moving about. The health team evaluates the person’s ability to perform ADL.

Sometimes the hands, wrists, and arms are affected. Adaptive (assistive) devices are often needed. Equipment is changed, made, or bought to meet the person’s needs.

• Eating devices include glass holders, plate guards, and silverware with curved handles or cuffs (Chapter 27). Some devices attach to splints (Fig. 41-1, p. 668).

FIGURE 41-1 Eating device attached to a splint.

• Electric toothbrushes have back-and-forth brushing motions for oral hygiene.

• Adaptive (assistive) devices for hygiene promote independence.

Adaptive (assistive) devices are useful for cooking, dressing, writing, phone calls, and other tasks. Some are shown in Figure 41-2, p. 668. Also see Chapters 22 and 23.

FIGURE 41-2 A, Light switch extender. B, Jar opener. C, Cutting board. D, Pot stabilizer. (A, C, and D, Courtesy Parsons ADL, Inc. Tottenham, Ontario. B, Courtesy OXO International, Inc., New York, NY.)

See Focus on Surveys: Self-Care, p. 668.

Focus on Surveys

Self-Care

Surveyors pay attention to rehabilitation goals. The ability to perform self-care—bathing, dressing, and grooming—is an example. Surveyors will try to determine if:

• Care measures address the person’s needs and rehabilitation goals. For example, a person needs a bath mitt. Is the mitt available? Does the person use the mitt to bathe? Does staff bathe the person instead of the person doing so?

• The care plan is followed by all staff.

Mobility.

The person may need crutches or a walker, cane, or brace (Chapter 30). Physical and occupational therapies are common for musculo-skeletal and nervous system problems (Fig. 41-3). Some people need wheelchairs. If possible, they learn wheelchair transfers. Such transfers include to and from the bed, toilet, bathtub, sofa, and chair and in and out of vehicles (Figs. 41-4, 41-5, and 41-6, p. 670).

FIGURE 41-3 The person is assisted with walking in physical therapy.

FIGURE 41-4 The person uses a transfer board (sliding board) to transfer from wheelchair to bed.

FIGURE 41-5 The person transfers from the wheelchair to the tub. A transfer board (sliding board) is used.

FIGURE 41-6 The person transfers from the wheelchair to the car.

A prosthesis is an artificial replacement for a missing body part. The person learns how to use the artificial arm or leg (Chapter 44). The goal is for the device to be like the missing body part in function and appearance.

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