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INTRODUCTION

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LEARNING OBJECTIVES

  1. Discuss the psychosocial factors that influence rehabilitation.

  2. Explain the impact of psychological functioning and social interaction on health, disease, accident proneness, and adjustment to illness and physical trauma.

  3. Recognize the psychological impact of disability on the patient.

  4. Differentiate the various professionals (and their roles) to which physical therapists can refer patients with psychosocial issues.

  5. Apply the interventions used to handle challenging behavior—how to deescalate an agitated patient, manage violent patients, and identify signs of hypersexuality.

  6. Describe the stages of psychosocial adaptation to loss and disability and apply them to treatment.

  7. Differentiate between psychosocial adaptation and psychosocial adjustment.

  8. Analyze different coping strategies that have been found to be important in psychosocial adaptation and adjustment to chronic disability and illness.

  9. Analyze common defensive reactions to disability.

  10. Understand how body image may be affected by disability and what a physical therapist can do to address body image issues.

  11. Recognize the warning signs of possible post-traumatic stress disorder.

  12. Describe the general adaptation syndrome, its aims, uses, and potential dangerous outcomes.

  13. Determine crisis points in the rehabilitation process and use clinical reasoning to problem solve solutions.

  14. Apply psychosocial techniques to facilitate patient/client-centered intervention.

  15. Compare strategies and resources for prevention, wellness, and psychosocial education.

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Psychosocial factors pertain to the psychological development of an individual in relation to his or her social environment.1 Psychosocial factors are numerous, as a person's psyche is affected by countless events in the internal and external environments. This chapter focuses on the psychosocial factors that may influence the direction of physical therapy intervention. Some examples of psychosocial factors include premorbid status or mental illnesses, personality styles, coping strategies, defense mechanisms, and emotional reactions to disability. Others include spirituality, values, environment, adjustment, cognitive abilities, motivation, family, social supports, life roles, and educational level. All of these factors can affect patients and treatment outcomes.

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This chapter (1) identifies and describes how psychosocial factors can influence rehabilitation; (2) demonstrates how to address such factors during physical therapy intervention; and (3) provides indications for referral to psychosocial rehabilitation specialists. Psychosocial factors profoundly affect a patient's ability to recover. Patients who are emotionally upset will have difficulty concentrating on physical therapy goals until emotional issues are addressed. If a patient is motivated to participate in rehabilitation, but his or her family members do not support the patient's rehabilitation goals, the patient will be unlikely to progress on returning home. Mental health status has been shown to be one of the most important predictors of physical health.2 Wickramasekera et al3 found that more than 50% of all visits to primary care doctors involved somatic complaints resulting from psychosocial problems. Patients with physical disabilities may fail to respond to treatment if a prominent psychosocial issue is affecting them as well.

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Treatment outcomes will be influenced by patients' perceptions of their role in the rehabilitation process. Patients who believe that they possess control regarding their ...

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