Rehabilitation
Definitions
It is important that there is a clear understanding of what is meant by the different terms used in describing the sequelae of injury or illness. In 1980, the World Health Organisation proposed the following International Classification of Impairment, Disabilities and Handicaps (ICIDH):
- Impairment is a change in normal structure or function resulting from a disease, disorder or injury. It encompasses any loss or abnormality of a psychological, physiological or anatomical structure or function. The disturbance is at the level of the 'organ', e.g. loss of a limb, hearing or sight. The result is a structural disablement
- Disability is any restriction or lack (resulting from an impairment) of the ability to perform an activity, e.g. climbing stairs or operating machinery, in the manner or within the range considered normal for a human being. It reflects disturbance at 'person' level, e.g. behaviour, performance, mobility, communication, memory. As a functional disablement, it should be seen as a continuum in terms of severity, ranging from very slight to severe. This has importance in relationship to employment as progression of the disability may require further modifications and adaptation of the workplace to allow continuing employment
- Handicap is a disadvantage for a given individual resulting from an impairment or disability that limits or prevents the fulfilment of a normal role for that individual. That role may be in relation to a particular environment, e.g. work and the consequences may be cultural, social, economic and environmental. They may be manifested as physical, in relation to independence; social, in respect of integration and economic,in relation to self sufficiency. Handicap is a restrictive disablement
Issues of fitness for work, disability and rehabilitation may need to be considered in the following contexts:
- Pre-employment
- Change of job within the company
- Deterioration in performance
- After sickness absence
- Considering retirement on grounds of ill-health
The assessment should be functional, i.e. in relation to what tasks an individual is able to do. It is helpful to understand the terms, 'impairment', 'disability' and 'handicap' and to appreciate that work is important not only as a means of providing for basic needs but has implications for self esteem and has an important social aspect.
Having said that the assessment should be functional, one has to appreciate that there may be other constraints to be taken into consideration, e.g. in assessing fitness account must be taken of the following.
Disability in this context may be the result of functional impairment in various ways, e.g.:
- Mobility, manual dexterity, or physical co-ordination
- Ability to lift, carry or otherwise move every day objects
- Speech hearing or eyesight
- Memory or ability to concentrate, learn or understand
- Perception of the risk of physical danger
Occupational disability may impinge on various aspects of workplace policy, e.g.:
- Recruitment and selection
- Sickness absence
- Work performance
- Safety at work
- Alcohol and substance abuse
- Transfer/promotion/relocation
- Premature retirement through ill-health or redundancy
Rehabilitation and employment of the disabled
Sadly, few workplaces employ their legal quota of registered disabled or do enough to rehabilitate ill or disabled employees safely and effectively.
What ways and means can you think of to bring about occupational rehabilitation?
The following are some suggestions:
- Graded return to work duties
- Part time working
- Alteration in tasks
- Limitation in the range of tasks to be undertaken
- Providing appropriate aids (see below)
- Arranging re-training and supervision
- Relocation to another job, after appropriate re-training
- Close liaison with the Occupational Health Service provided by the particular business, is essential if the firm has one
- Liaison with governmental agencies, e.g. EMAS - Employment Medical Advisory Service, or the local Employment Service PACT (Placing Assessment & Counselling Team) which can be contacted through a local Job Centre), which offer services to support disabled people in the work place. e.g. on assessment of disability; training & education; job matching; sheltered employment; building access and technical aids
- Other special support, e.g. from voluntary bodies(e.g. for substance abuse) etc
- Liaison with the General Practitioner and other National Health Service facilities, but like the Hospital Consultant, they might not have intimate knowledge of the work performed by the patient
- In addition to the responsibilities to the individual who is 'disabled' or returning to work after sickness absence, steps must be taken to ensure that the workplace is safe enough and compliant with relevant obligations in relation to the environment for all employees
- The legal aspects must be carefully considered. In the UK, the Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities. The Society of Occupational Medicine, has prepared guidelines regarding the Disability Discrimination Act
Problem examples to consider, as learning tasks:
- A man aged 45 who works in an electronics firm as an operator has been off work following a cerebrovascular accident. What factors will affect his rehabilitation?
- A manager aged 42 who has been off work for three months with depression. What extra factors must be considered to take account of his managerial role?
- A woman aged 50 works as a typist for a local Hospital Trust. She had polio in infancy which resulted in a shortened weak right leg. Recently she has had increasing pain in her neck and back...
Acknowledgement
Part of this page has been adapted, with permission, from Practical Occupational Medicine © Arnold publishers
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