ABSTRACT
The process of rehabilitation is based on the principles of education and enablement. These principles are at variance with medical practice in general which often, of necessity, is based on the need to care for a sick individual. The fundamental difference between conventional medical practice and rehabilitation can be summarised as the former being “hands on” and the latter being “hands off”. Many organisations of disabled people argue strongly against a medical model of management. It is argued that a disabled person is not sick and thus does not require to be “looked after” by health professionals (Oliver, 1990; Wolfensberger, 1972). This approach is undoubtedly valid for disabled people with relatively static, long-term disabilities but is it valid within the context of the acute situation or for people with deteriorating conditions? This chapter explores the role of the health-care system in the management of disabled people and attempts to define an appropriate structure for a neurological service. It is proposed that there is a continuum of service delivery from a health-oriented rehabilitation model in the acute phase working towards a client-centred psychosocial model for the later stages of rehabilitation.
