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Habilitation vs Rehabilitation


Imagine driving your car to a familiar place you love to be; you are excited to be going there again. You already know the destination, so the travel plans for the trip are easy. Unless there are detours, the distance is more or less the same. Accounting for toilet breaks, filling the tank and stretching your legs along the way, you can easily estimate your arrival time. To ensure the trip is safe, you keep your eyes on the road, watching for traffic and any possible hazards. If all goes well, you will be there before you know it: back in that wonderful place you know and love. What a wonderful journey it is in your rehabilitation-car.

Rehabilitation is a journey to somewhere known. It is all the activities and physical effort needed for someone to regain lost skills or functioning. Rehabilitation is necessary for those who have lost certain abilities due to injury, infection or surgery. The rehabilitation journey encompasses all the activity needed to help regain a previous level of known physical ability.

Depending on the condition, rehabilitation treatment can take the form of physical therapy, occupational therapy or speech therapy, for example. The treatment needed will vary depending on the nature of the lost function and the age of the person being treated.

Rehabilitation goals are easy to determine. You can ask yourself one question: "What was I able to do before losing my ability?" With the answer to that question you will automatically understand your goal, which you can then set about reattaining with the help of medical professionals.

Rehabilitation results for physical complications are quantifiable and easily monitored. The results of a patient's rehabilitation process are easy to gauge. The patient has either reached the expected level of previous or desired ability or not. Over the course of the entire rehabilitation process, the person should hope to see improvement in ability.

Now, imagine hopping into your friend's habilitation-car. He wants to surprise you and take you on a trip to a place he has never been before but desperately wants to get to. Without a map and only a vague idea of where you are going, you set out on your journey. While driving, you suddenly realise that your friend is not looking where he is going. His eyes are jumping between the rear-view and wing mirrors and occasionally, just seem fixated on the side of the road.
"What are you doing?" you ask as calmly as possible.
"Oh, don't worry! I'm moving us forward by looking backwards or to the side of the road… that's the only way I can drive."

Habilitation, unlike rehabilitation, refers to all activities undertaken by a disabled person to maintain their highest possible level of functional ability. Habilitation relates to the process to develop physical abilities that have not as yet been achieved by that person but might be. In the car analogy, this is the unknown destination, the lack of a map and the vague idea of where you are headed.

The only way that habilitation can determine achievement is by looking at the current ability and comparing it to past ability. The habilitation driver looks in the rear-view and wing mirrors to see if they are on the road. And they can only look at the sides of the road to determine if they are going more or less in the right direction.

Unlike rehabilitation, habilitation is impossible to quantify in terms of improvement. The only real, quantifiable value that can be achieved during habilitation is when there is a decrease in the individual's current ability.  

It is without doubt that rehabilitation has massive advantages in terms of forward-planning compared to habilitation. In rehabilitation planning, we know what was previously possible for the person, so the path to achieve that level is easy to determine. In contrast, a disabled person's attainable abilities are unknown, so habilitation can only look back in time to evaluate current achievement.

Also, we must not forget that for habilitation, there can be no expectation for future improvement. The level of achieved current physical ability might reflect their level of potential and thus be their long-term ability. The notion of 'improvement' cannot be compared to expected future abilities.

My view
In the hundreds of academic articles, books, websites and journals I've delved through over the years, it has never ceased to amaze me how frequently the word 'rehabilitation' is misused. In fact, I have only come across three academic articles in which the correct term of 'habilitation' has been used in addressing cerebral palsy.

It may sound superficial and trite of me to focus on this consistently used misnomer. But for many reasons, I find it important to consider the value of the difference between the two terms.

My main issue is that the word 'rehabilitation' gives an unconsciously positive view when treating cerebral palsy. It makes it seem like there is an attainable, final goal in the individual's improvement possibilities. In many ways, it also makes all those involved feel as if the patient has somewhere known to go and that this objective can be attained by calling the process to get there something it is not. However, referring to CP treatment as 'habilitation' provides a more realistic description of the process at hand, in which there are no preconceived hopes of future improvement, only the continuous challenge of daily physical maintenance.

When all is said and done, there is a good reason that there are two distinct terms. So, I feel it is time everyone started using them appropriately!

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