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Chapter 1
Introduction
1.1 What is rehabilitation?
As academics we are in the habit of defining any important terms that we use in our teaching or research publications and this is a practice that we expect from our students in their assignments. So it is hard to avoid starting a textbook on rehabilitation without defining precisely what we mean by this word. But at the same time a part of us already knows that we are doomed to fail in this rather ambitious task. Why this sense of pessimism?
It may be that it stems from our having sat through too many lengthy and heated discussions at learned conferences about how best to define rehabilitation. It is actually hard to find the right words to capture all the meanings that rehabilitation has for different people. It is especially hard to do this in a few pithy sentences since we all have different perspectives on rehabilitation depending on whether we are a health professional, a client or patient, a caregiver or relative of a patient, or a health manager with budgetary responsibility.
Or it might come from the knowledge that the field subsumes such a wide range of diseases and health conditions across the lifespan and such a growing range of methods for assessing and intervening in these conditions. So the physiotherapist who works with a 7-year-old boy with cerebral palsy to improve his gait is engaging in rehabilitation. Similarly the nurse who specializes in continence management in adults with multiple sclerosis is engaged in rehabilitation. But what about the physiotherapist who works with an elderly man in the end stage of heart failure to maximize his strength, mobility and quality of life? Is this rehabilitation or palliative care?
Notwithstanding these concerns we shall begin this text on rehabilitation with a fairly searching consideration – what exactly is rehabilitation. To do this we will first clarify what rehabilitation is not – or at least what we the authors do not include as rehabilitation for the purposes of this book. Then we will consider a number of definitions that other authors have offered and attempt to tease out some of the key ideas that they share and also the problematic issues in arriving at a consensus definition of rehabilitation. Next, we will introduce the five core concepts that lie at the heart of this book. These core concepts will, to a large extent, define what we understand by the term rehabilitation. However, we will not conclude this chapter by selecting or proposing a single, ‘best’ definition of rehabilitation. Rather, we prefer to let all these definitions and concepts, ideas and opinions, percolate for a time while we examine our core themes in depth. Having completed that journey we will then ask you, in Chapter 7, to revisit the issue of how we might best define rehabilitation.
1.2 Setting boundaries – or what we don’t mean by rehabilitation
The word ‘rehabilitation’ has become a buzzword in the early 21st century. Wherever you look there is somebody using the word rehabilitation. But depending on who is talking or writing, who is being rehabilitated and the context in which they are using it, the meaning can vary considerably. Hardly a day goes by without us reading in the tabloid press about the latest film star or pop singer to go into ‘rehab’. Our daily papers also feature heated arguments in the Letters to the Editor section about the merits of spending taxes on trying to ‘rehabilitate’ hardened criminals – or whether we should simply be locking them away for longer sentences. Not so long ago dissident politicians in some communist countries occasionally disappeared from public life only to reappear some years later having been politically ‘rehabilitated’. A famous example of this was Deng Xiaoping who fell from grace during the Cultural Revolution but was later ‘rehabilitated’ and eventually became the leader of the People’s Republic of China. In searching electronic databases for our own research, using rehabilitation as keyword, we discovered that the term is also commonly used for the process of restoring land that has been ravaged by mining.
Interestingly, although none of these uses of the word have any great relevance for our text, they do all convey the sense of someone or something that has in some way become damaged or corrupted and then, through some prolonged process, has been restored to an acceptable or desirable state of existence.
However, we wish to be quite clear in this book, that in using the term rehabilitation, we are not referring to interventions for substance misuse problems, criminal offending, (perceived) political misdemeanours or natural environments devastated by human technology. In general we will use the term only for referring to ways of working with people who have some type of disability resulting from a congenital, traumatic or chronic health condition. Some examples of these conditions are amputations, cerebral palsy, chronic obstructive pulmonary disease, lower back pain, multiple sclerosis, myocardial infarction, Parkinson’s disease, spinal cord injury, stroke, schizophrenia and traumatic brain injury. However, this is starting to sound like a definition of rehabilitation, so it might be a good point to consider some of the ways in which other people have already defined the concept.
1.3 Some definitions of rehabilitation
Chambers Twentieth Century Dictionary gives the following definition of rehabilitate ‘to reinstate, restore to former privileges, rights, rank etc,: to clear the charter of: to bring back into good condition, working order, prosperity: to make fit, after disablement or illness, for earning a living or playing a part in the world’ (Macdonald, 1974, p. 1138).
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