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What is work place rehabilitation?

CBR_crop2.jpg This is a poster from the rehabilitation center in Tanzania, illustrating their work. This rehabilitation center works both with adults and children, to improve their function level. © G.Van Den Bergh

Work is essential for most people. The salary is the fundament for food, clothes and housing. If you become sick or disabled in any way and cannot work, you have a problem. Some countries have social benefits that can help you in such situations, but other countries do not provide such help. It is important to realize that many countries do not have any social benefits for disabled persons, and this makes rehabilitation difficult. This lack of support in many countries makes this lecture especially important. It is necessary for stake holders and policy makers to become more aware of the possibility of including also disabled persons in the working life.

Here is the WHO definition of rehabilitation:

“Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination.”

Work rehabilitation is a broad term that encompasses many aspects of intervention, all focused upon facilitating independence at work as well as fulfillment of the worker role.

The expression “rehabilitation” developed after the World War I, as the society wanted to support the mutilated war veterans. Training schools, hospitals and various institutions were founded and programs started to develop. However, the development was rather slow in most countries, even though they had been heavily involved in the war. After the World War II, new rehabilitation programs were established, and this time with more support and strength. Both authorities and different kinds of organizations started to work for restoration of disabled persons who had been participating in the war.

The idea of bringing disabled persons back to the working life grew even further, and also other disabled groups in the society were included in the rehabilitation programs. Departments of rehabilitation were established at hospitals and medical schools. For a long time the main focus of these activities was related to persons who had experienced an amputation, stroke, spinal injury or limb destruction. Later, rehabilitation techniques have been used also for other patient groups, including for instance patients with mental health problems as well as drug abusers. Organizations and associations established by the patients themselves have been of major importance in rehabilitation issues; associations for blind persons, deaf persons, persons with poliomyelitis and so on.

These types of organizations have often succeeded in altering negative attitudes in the society towards the different patient groups. In many low income countries of today, rehabilitation has a relatively minor role in the health system. However, the idea is becoming more and more known among health personnel, and rehabilitation units are established several places. For instance, the International Committee of the Red Cross (ICRC) can tell that over 235,000 people received treatment at ICRC physical rehabilitation centers worldwide between January and September 2015. This is promising! You can read more about these rehabilitation projects here.

Why rehabilitation

Estimates are given for the occurrence of disabled persons in the world, and the figures are around 15 percent of the population. This is a large number. Actually, it represents a large number of potential workers. Many disabled persons could do a decent job if they were given the opportunity. In many cases, relatively minor help could give the society a productive worker. It seems to be a better idea to look at disabled persons as a resource, rather than as a problem. One of the reasons why rehabilitation has started up after wars is of course that the wars have produced persons with injuries and health problems. Another reason has been the need of work force after wars. Wars destroy important infrastructure in the society, and in the aftermath of such negative events, it is important that as many persons as possible participate in the reconstruction of the society. This creates a need for workers. However, the idea of including persons with disabilities in the working life does not have to be related to post-war situations. Persons with some disability can be a major resource in many types of work.

However, in several countries disabled persons are not in paid work, and it is also very difficult to obtain any statistics on the issue. Still, several countries have programs at a national level providing education and jobs skills training to people with disabilities. On the web pages of ILO you can find the document: “Managing disability in the work place. ILO code of practice”.

TiggerBarn_COLOURBOX5371111.jpg Beggar in the street. © Colourbox

Beggars

Beggars are a problem in many large cities in low income countries, in Ethiopia for instance. In a report from ILO (Disabled beggars in Addis Ababa, Ethiopia, 2013), disabled beggars have been studied. For persons with a disability, begging can be the only way to achieve money and food. Most of disabled beggars in Addis have serious physical disabilities or are blind. Many of them have come from other parts of the country. Some have left their family and come to Addis because they thought they could find a cure for their health problems. When this was unsuccessful, they started begging for a living. They have a social stigma and when excluded from family and community networks, it is often difficult or impossible for people with disabilities to find any paid work. Disabled beggars are a very visible group of persons which need rehabilitation. Read more about the topic “Disabled Beggars in Addis Ababa, Ethiopia” here.

Work place rehabilitation

Work place rehabilitation can be described as two main types:

a) The worker who becomes injured or diseased

When a worker becomes injured or develops a disease which makes it difficult to perform the work tasks. The injury or disease can be caused by the work situation, but rehabilitation is also needed when injuries or diseases develop from other causes. The aim of the rehabilitation process is to help workers to continue their work despite the development of disability and reduced function level.

b) The disabled person who can become a worker

Some persons do not start any career at any work place, due to an injury or disease developing early in their lives. About 15% of the population of the world has some kind of disability, and to work can be very difficult. However, in many cases, rehabilitation help can be an important process, making work possible even if a disability is present.

It is important to remember that people with disabilities are not a homogeneous group. They may have a physical disability, a sensory, intellectual or mental disability. They may have had a disability from birth, or acquired this in their childhood, teenage years or later in life, during further education or while in employment. Their disability may have little impact on their ability to work and take part in society, or it may have a major impact, requiring considerable support and assistance. This makes rehabilitation work quite challenging.

Bilde 341.jpg A rehabilitation center in Tanzania. © G.Van Den Bergh

Who works with rehabilitation?

Rehabilitation often takes place in hospitals. Skills in rehabilitation can for instance be present among physiotherapists, physicians or nurses with specific education and training. Some hospitals can specialize in rehabilitation of patients with specific diseases. Some hospitals have special rehabilitation departments. Special technicians can develop and produce technical support and aid for the patients. Some countries have specific rehabilitation institutions. Rehabilitation is an important part of the work in occupational health services.

In work place rehabilitation, the practitioners are trained to evaluate individuals’ interactions with their work demands and the work environment through examination of the worker and work task analysis. The evaluation can identify supports and barriers to success in the work environment that, if indicated, can be addressed in an intervention plan in order to facilitate work performance. Some countries have an own specialty called “Occupational Therapy” which is focused upon work place rehabilitation. However, the rehabilitation work is multidisciplinary and teams of professionals are needed for the most successful results. Some large companies have established their own rehabilitation departments. By doing this, they secure the competence in the company; even if a worker is injured, he or she will be helped back to work. It is expensive for the companies to train new workers, and to take care of the workers can be of great economic value. In addition, this type of care increases the loyalty of the workers, and the value of loyalty can be high.

Bilde 144.jpg A multidisiplinary rehabilitation team. © G.Van Den Bergh

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This article is from the free online course:

Occupational Health in Developing Countries

University of Bergen

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