General Considerations

Rehabilitation culture

Rehabilitation should be understood as the implementation of a series of interventions to prevent the onset of irreversible outcomes, both biological and social , that may result from any disease. This means it should prevent disability , but unfortunately certain approaches to rehabilitation present some weaknesses in terms of knowledge, methodologies, planning, management and evaluation of the activities of international cooperation, instability in policy-making, lack of financial resources and therefore lack of critical mass. In recent years a neurocognitive theory was developed in Italy, that has caused an actual revolution in rehabilitation also at international level, with a clear change of the perspective on rehabilitation: a regenerative medicine that reconsiders the importance of experience.
Thus, the progress of basic knowledge is making the rehabilitation process more and more complex, so that it now requires more and more competence. This is why the approaches to rehabilitation in developing countries (and not only…) can not afford the luxury not to update and to neglect research, especially in the light of the latest scientific discoveries, which are directing the intervention more and more towards those methodologies that have strong neurocognitive and phenomenological connotations, since the world is currently working on behavioural parameters, that were absolutely not taken into account just until a few years ago, such as consciousness, intentionality, the self, the descriptions in first person, the mind-body relationship.
Therefore it is necessary that we discourage practical interventions by incompetents who act as therapists , with all that this entails. Rehabilitation is a science, so it requires accuracy and rigour, in both research and practical intervention: thus the wide theoretical session dedicated to the training by the association is justified.
For these reasons, we believe it useful to create an association committed to spreading, not only through skilled operators but at the broadest level, a rehabilitation culture that will offer a more complex way to see man and the products of his brain, among which stands movement.

For a new consciousness of rehabilitation, creative and "exciting".

Rehabilitation

Learning process

The rehabilitator was too long tied to a conception that sees the movement as a series of pre-determined and automatic steps, considering a proper work exclusively towards the periphery ( bones, muscles, ligaments), totally ignoring the relationship between this and the nervous central system as processor of behavior.
Accordingly, since time is in progress an operation, (non painless) of criticism of the old ways of working, which although considered outdated in terms of relevance and scientific references , are abandoned with difficulty and very slowly due to their deep roots of discipline.

Propose the Rehabilitation process as a learning process progressively more advanced, conducted in the presence of a specific deficit induced by different injuries, can allow to build the foundations for a science of rehabilitation.

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The physiotherapist

Role and competences

In many countries it doesn’t exist a specific operator in rehabilitation and this greatly contributes to the fact that many act as rehabilitators, with all that this entails.
Every rehabilitative intervention is a process of teaching, therefore the therapist must be able, no matter the alteration to be treated, to identify what should be taught and to whom, that is what are the motor behaviours the patient must learn, what are the difficulties of the patient encounters while learning and at what level of integration they are located.
In many contexts, the rehabilitative treatment is not planned, which is limited to the simple proposal of a series of codified exercises, which are not based on observation and evaluation of the patient.

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Our Association wants to be main sponsor and protagonist of these changes. Our aim is to strengthen capacity of existing facilities through a process of upgrading existing health workforce.

The Perfetti's method

History and recent developments

Very often the essential element for the rehabilitative intervention has not been learning, but the evocation of voluntary activated muscle contractions and the activation of combinations of muscle contractions through the stimulation of absolute reflexes by the therapist. Thus, the rehabilitator has neglected all those parameters of behavior that are generally considered subjective (intentionality, attention, spaciality, etc.), limiting its interest to a movement which we can define as abstract, as it is not connected with the ones moving, with its purposes and with the situation in which it is performed to correct or evoke movements altered by the lesion.
Traditionally, the problem has been faced with a passive patient since the methods used mainly focused on the evocation, through external stimuli, of reflex activity to correct or evoke movements altered by the lesion.
The object of study and analysis became thus manifest behaviour, that is that set of responses and events of the organism directly observable and recordable from the outside.
Instead, the neurocognitive phenomenological therapeutic exercise, now called CTA (Comparison of Shares), elaborated by Prof. Charles Perfetti from the early ’70s, is characterized not by reference to muscle contraction voluntarily activated by the therapist’s verbal stimulus, nor by that more complex reflex activity evoked by mechanical stimulation (such as in case of intervention on children ), but by reference to the planning of the organizational processes that can lead to the development of behavioral sequences: these are the ones which ensure the formation of patterns that allow the fulfilment of certain tasks, and it is therefore extremely important for the rehabilitator to examine movement as a process triggered not by a person, but by a system which finds itself in a certain situation and has to maintain its organization, reaching precise purposes.

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CTA

Comparison of Actions

It is impossible in a presentation of this kind to provide sufficient information on what the rehabilitative intervention (meant as the performance of the necessary exercises) should be, but it is important to emphasize a few key points, if only to discourage “empirical” interventions and keep a situation, already complicated in itself, from worsening: proceeding by trial and error is often the first step towards failure and this is always to be kept in mind, especially in rehabilitation.
The principles that characterize this type of intervention go the opposite direction of the old way of working, which has always favoured the immediate and functional recovery of patients, neglecting by far the qualitative aspect of the movement. Those who intend to provide an innovative service with regards to rehabilitation must inevitably direct their object of study and the consequent rehabilitation choices this way: this is the goal to which the association aims.

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