Disability is a moral and global issue that affects over 1 billion people, one in seven individuals, or roughly 15% of the global population.1 The World Health Organization (WHO) has recognized that global disability adversely affects human rights and basic public health (Fig. 1–1). Based upon data from the WHO, disability disproportionately affects individuals who suffer from poverty, and may decrease access to health care, education, and employment.2 Those who suffer from disability are more likely to have had a violation of basic human rights; be abused; and suffer discrimination, violence, and loss of autonomy.
“On the Edges of Disability.” (Image used with permission from Asis Kumar Sanyal, World Health Organization (WHO))
Unlike classic medical models, which are either provider- or disease-centric, the modern rehabilitation model is patient-centric. In this model a group of health care providers, family members, and other caregivers collaborate to care for and restore function of an individual suffering from disability.
The specialty also addresses the complex interplay of social circumstances of patients with impairments and disability. These include the home environment (e.g., numbers of steps to enter; location of kitchen, bedroom, and bathroom; accessibility of spaces) and assessments of activities of daily living, occupation, vocation, health insurance status, presence of family caregivers, and hobbies.
The rehabilitation model is further unique, as functional goals are defined by the team and require patient participation. The goals often include the diminution of impairment, disability, and the patient's handicap—ultimately the restoration of function. These goals are achieved through the utilization of medications, interventions, therapies, modalities, patient education, and lifestyle and workplace modifications. Oftentimes caregivers are included as part of the rehabilitative team.
The primary objective of the field of rehabilitation medicine is to achieve the maximal functional restoration of an individual suffering from impairment, disability, and ensuing handicap. Impairment is defined as the loss or diminution of psychologic, cognitive, physiologic, or anatomic function. Examples of impairment may include the loss of a limb, diminished motor strength, or a cognitive deficit. Disability is described as the diminished ability to perform a task or activity that would generally be considered normal for a person within their societal context. The loss of the ability to perform activities of daily living (e.g., dressing, grooming, and cooking) is an example of disability. The overall societal disadvantage that an individual may have in which an impairment causes disability is further defined as their handicap.
The American Board of Physical Medicine and Rehabilitation has defined the goal of the specialty as “[t]o restore function, reduce pain and improve quality of life.”3 The definition is further expanded to “caring for the whole person.” Not surprisingly, the definition of rehabilitation is different in different ...