The Rehabilitation Model

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History
• This model has been used since the beginnings of occupational
therapy and is also used by other health professionals. Some authors
argue that it is not a model as such but rather a set of techniques. It is
included because it is a very common framework for occupational
therapists.
• This model or frame of reference is a compensatory or adaptation
approach.
• Some authors consider this to be an extension of the biomechanical
model – compensation and adaptation happen when the remediation
process has been exhausted.

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Focus
Clients
Theory

Focus
• Occupational performance
• Participation
• Environment

Clients

Used for people with conditions to which they must adapt either in the short term or the long term.
There may be little or no expectation of improvement and the client is left with residual impairments
which limit the capacity to perform daily occupations.

•  Theory
• Medicine and the physical sciences, disability studies (recent)

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 The professionals included in the rehabilitation team

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Assessment

• Assessment focuses on performance areas and the environment. The

use of client centered assessment such as the COPM is quite
compatible with this model.
• ADL assessments
• Environmental assessments
• Client centered assessments such as the COPM
• Work assessments
• Leisure assessments
• Assessment of support systems
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Intervention

• Intervention in this model covers a wide range of areas and the use of
many different techniques depending on the individual clients needs.
Considerable attention is paid to psychological aspects.
• Some of the commonly used interventions are as follows:
• Assistive devices – for example wheelchairs and other mobility aids,
dressing and other ADL aids, splints.
• Adapting the task to compensate for loss of ROM, strength and
endurance. New ways of performing activities, for example one
handed techniques for dressing, joint protection techniques,
simplification of the task.
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Physical Rehabilitation Process

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Examples of rehabilitation robots.

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Goal Directions
• Restorative / Rehabiliation • Restore previous occupational performance
• Habilitative / educational • Teach new occupational performance skills
• Maintenance • Keep current occupational performance skills
• Modification / adaptive / compensatory/functional • Change contexts or
activity demands to enable occupational performance
• Preventive • Prevent occupational performance deficits from developing
• Health Promotion • Enrich or enhance occupational performance skills

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Restorative approach (remedial approach)
• The restorative (remedial) approach relies upon theories of
neuroplasticity and the ability of the brain to reorganise itself (Nirkko et
al., 1997; Nudo, 1998; Marshall et al., 2000).
• Neurophysiological approaches such as normal movement and motor
relearning are included within the restorative (remedial) approach.
• the therapist provides controlled visual, auditory, vestibular, tactile,
proprioceptive and kinaesthetic stimulation to promote normal CNS
processing of sensory information.
• Therefore, normal sensory processing should help the patient make
normal perceptual motor responses required for performance of
functional tasks.
• This approach therefore aims to reduce the impairment to subsequently
improve activity and participation.

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 Restorative approach (remedial approach) continued

• Neistadt (1990) also classes ‘transfer of training’ under restorative

(remedial) approaches.
• Activities, such as puzzles and pegboards, provide practice in perceptual
skills.
• It is implicit within this approach that these tasks are appropriately
graded to challenge the patient and encourage the brain to adaptively
reorganise itself for successful behaviours.
• People with cognitive impairments tend not to be able to transfer
learned skills, and although some minor, short-term effects may be
seen, the long-term impact and lack of transferrable skills tend to make
this a time-intensive and less-effective approach for people with
cognitive problems.
• Restoration of impairments tends to be more successful for people with
motor impairments alone.

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Adaptive (compensatory/functional)
approach continued
• The adaptive (compensatory/functional) approach focuses on
repetition of particular skills which are normally associated with
activities of daily living (ADL).
• It is based on the belief that man is functional animal and his ability
to do so is essential for his well-being (Turner et al., 1996).

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Adaptive (compensatory/functional)
approach continued
• Adaptive (compensatory/functional) approaches are traditionally
used when restoration is unlikely and assumes that certain functions
will not recover (Zoltan, 2007).
• Compensation for loss of function is achieved by changing the activity,
environment or patient behaviour by using external assistance,
modifying the task or changing the goal or by practice until the task
becomes easier in a variety of environments.

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Adaptive (compensatory/functional)
approach continued
• The advantages of this approach are that it is patient-centred, easy to explain,
uses problem solving, meets short-term needs and gives quick results.
• The disadvantages of this approach are that the therapist may not consider a
range of options open to the patient and may succumb to organizational
pressures for quick functional results at the expense of maximizing true recovery
potential for the patient, leading the therapist to become prescriptive in a ‘one
size fits all’ method.
• It can lead to negativity by the patient who is asked to recognise a permanent
condition and its limitations without any attempt to remediate the underlying
skills.

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Intervention continued
• Environmental adaptations – for example ramps, handrails,
reorganization of space.

• Education of caregivers and training in techniques such as transfers,

bathing etc

• Training in use of technology to enable client to return to

employment, for example use of voice input computer.

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Limitations
• No obvious limitations. Model is very wide and open to individual
interpretation.

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