Rehabilitation Intervention Strategies: Their Integration and Classification
Foremost among the distinguishing features of a profession is its existing systematic body of knowledge (Brubaker, 1981). This body of knowledge, as applied to the human and social science professions, is typically composed of various theoretical approaches to the study of the profession and their practical applications (e.g., appropriate intervention strategies, skills required by practitioners, client-serving community-based clinical settings). In spite of promising developments in the past decade (e.g., Diller, Fordyce, Jacobs, Brown, Gordon, Simmens, Orazem & Barrett, 1983; Dudek & Associates, 1977; Wright, 1980), the field of rehabilitation still appears to be lacking a systematic and coherent view of its most widely adopted intervention strategies (alternatively termed rehabilitation techniques, technologies, practices, or approaches). Several recent endeavors to remedy this situation are however, noteworthy.
Sigelman, Vengroff, and Spanhel (1979), based partially on the work of Dudek and his associates (1977), proposed that rehabilitation technologies and practices can be grouped into four main categories: (1) physical interventions, including such procedures as prosthetics and surgery, (2) training and counseling which refers to educational and psychotherapeutic interventions, (3) environmental manipulation, encompassing removal of architectural barriers, adaptation of transportation systems, etc., and finally, (4) service delivery which appears to tap procedural practices such as rehabilitation planning, follow-up services, and so on. Scofield, Pape, McCracken, and Maki (1980), in their ecological model of psychosocial adaptation to disability, dichotomize intervention strategies into those which are aimed at the person himself or herself and those aimed at the external environment. Moreover, each of these components is further subdivided into smaller units. The person-oriented interventions include techniques aimed at both altering the individual's perception or frame of reference (e.g., perceptual modalities restoration, pain management) as well as techniques geared toward modifying his or her response tendencies (e.g., behavioral modification, systematic desensitization). The environment-oriented interventions, on the other hand, incorporate procedures for altering environmental normative standards (e.g., development of employment opportunities, community education), as well as modifying environmental response tendencies (e.g., employers' biased behaviors, parental verbal statements).
Somewhat akin to Scofield, et al.'s (1980) perspective, Coulton (1981), focusing on health care interventions in her person-environment fit model, suggests a typology of intervention strategies according to both goal of intervention (i.e., change in person or change in environment) and primary target of intervention (i.e., modification of the individual or the environment). She also provides several examples in her four cell typology, which include counseling and providing prosthetic devices (Goal -- change in person; target -- person), behavior modification and milieu therapy (person: environment), teaching individuals to modify their own environment (environment; person), and architectural barrier removal and socio-economic environment modification (environment; environment).
Anthony (1979), in his psychiatric rehabilitation skill development model, places rehabilitation techniques in one or more of the following classes: environmental techniques (i.e., changing physical, social, and work-related environmental conditions), engineering techniques (i.e., using adjunct devices and methods including maps, tools, and medications, to assist in performance of various activities), counseling and psychotherapeutic techniques, didactic techniques, and finally modeling techniques. He and his associates (Anthony & Farkas, 1982, Dion & Anthony, 1987) further divide rehabilitation interventions as to the type of skilled behaviors performed -- Physical (e. …