- Research Article
10
- 10.1136/bmj.290.6464.301
Severe disability: 1--Tasks of rehabilitation.
- Jan 26, 1985
- British medical journal (Clinical research ed.)
- D Gloag
Restoration from to person is how a relative of a severely disabled patient defined rehabilitation; and an important element is choice.1 Many people we see in the role do not believe enough in themselves to act, says Cochrane, and he mentions two essential qualities for those working in rehabilitation ?the ability to restore confidence when it has been weakened by reproach and disadvantage and the diligence to uncover talents that are obscure and to burnish them.2 As someone said to me, Maximise every conceivable ability?rehabilitation is thinking wide and thinking sensitively. Beyond this, autonomy?the kind of choice and control over one's life that adults normally have?and oppor? tunity describe what many severely disabled people are striving for. Of course, many people severely disabled with neurological conditions are in no position to exercise autonomy; some others do not really want to, and many feel threatened by all the talk about independent living. Staff used to traditional concepts of care may also have a sense of confusion and conflict about their roles, A further conflict may arise as workers in rehabilitation become more aware of how much improvement is possible even in apparently irrecoverable conditions, while social workers and sociologists on the other hand eschew the model and any paternalistic approach. At the same time many people live in residential homes, and for that matter in their own homes, quite untouched by ideas of either rehabilitation or autonomy. My impression from the visits I have made, the people I have met, and the conferences I have attended is that with this kind of vision the different philosophies and approaches all have their place in catering for the multitude of different needs and personalities; the problem is that so often the right resources do not get to the right people or that efforts go off at half cock for want of adequate resources or adequate thought. In this article and the next I discuss rehabilitation in the context of care of younger disabled people (defined as those aged 16-64 years), looking at the extent of the medical role and at ways of helping people to achieve the best possible quality of life.
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