[Rehabilitation] Practice and training must not become the goal itself - The importance of understanding the original meaning -

When people hear the word "rehabilitation," I think many imagine functional training by physical therapists, occupational therapists, or speech-language-hearing therapists.

According to the WHO (World Health Organization), "rehabilitation" is defined as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments.” The concept is broad, and its purpose is for people to live in a way that is true to themselves.

Furthermore, the purpose of "rehabilitation" is considered to be “holistic restoration,” which originally comes from the Latin re (again) + habilis (suitable). In medieval and early modern Europe, it was used in the context of Christian "revocation of excommunication" or "restoration of honor," such as the rehabilitation (restoration of honor) of Joan of Arc or Galileo Galilei.
In Japan, we have interpreted rehabilitation as the restoration of dignity, rights, and human rights that were taken away or damaged due to social prejudice or policy errors to their rightful state, describing it as holistic restoration.
(Partially quoted from the website of the Japanese Society for Rehabilitation of Persons with Disabilities)

Rehabilitation includes the following fields:

1. Medical rehabilitation
2. Vocational rehabilitation
3. Social rehabilitation
4. Educational rehabilitation
5. Rehabilitation engineering (participation support engineering)

I believe this is true for anything, but even though it is clearly stated that the first session will focus on interviews, evaluation, and orientation, there are sometimes people who come to the clinic with the mindset of doing practice or training for the entire 40 or 60 minutes from the very beginning.
These are people with a "practice-first" mentality, where the act of practicing or training itself has become the primary goal, or people who tend to feel a sense of accomplishment only by doing practice or training.

Also, there are cases where the professionals themselves are at fault.
This happens when they force the consultant (patient) into a single method or approach or when they recommend doing as much practice as possible.

There are many methods and approaches.
Also, the appropriate amount is important.
Even if there are people with similar conditions or situations, no two people have the exact same state or situation.
The suitable method or approach also differs for each individual.

Therefore, it is necessary to select the appropriate one from the many available methods and approaches according to each person's state and situation.
Also, some people think they should just keep doing the same method or approach from the beginning.
Whether improving or worsening, states and situations are constantly changing.
It is necessary to examine and select methods and approaches as appropriate in accordance with changes in state and situation.

Techniques and methods are ultimately just "one of the means."
If the practice method, practice amount, and form of support match the state and situation, improvement will occur and distress will be reduced.
However, if the practice method, practice amount, or form of support does not match the state and situation, it may be ineffective, or in the worst case, it may worsen despite the practice.

I will explain using stuttering as an example.

Repetitions, blocks, and secondary symptoms were frequently observed, and the person's way of speaking was denied or corrected at work. The situation was such that the person's boss and colleagues could not be said to be understanding.
Support person A was having this person practice pronunciation.
Even though the consultant and the support person were working hard, they felt that there was no improvement and that the distress had not been reduced.
Rather, they felt that it might be getting worse...

Why is this?

The first reason is that inappropriate practice can become a factor in worsening symptoms the more it is repeated. (It is said that inappropriate things are
five times more likely to be reinforced than appropriate ones...)Conversely, it can be said that
by using appropriate practice methods and amounts, improvement and reduction can be achieved.

(Example) Difference between pronunciation and stuttering

● Pronunciation
Clearly, vigorously, (saying it briefly)

● Stuttering
Speak slowly, softly, and extend the whole (do not cut off a certain length, speak fluently)

The goals and methods for stuttering practice/support and pronunciation practice/support are different.
If you look at the content above, you can see that the effective methods and ways of doing things are the exact opposite.
For those who stutter, introducing pronunciation practice methods is not appropriate.
If you are going to the trouble of practicing, but it is making things worse, then it is all for nothing, isn't it?

There are also cases where children or individuals who stutter have co-occurring pronunciation problems (articulation disorders).
In such cases, depending on whether the pronunciation aspect is affecting the stuttering, it is considered best to perform pronunciation practice while simultaneously performing stuttering practice.

And the second reason is that it does not approach environmental factors.
If your way of speaking is denied or corrected, or if there is a situation where you cannot say that those around you have appropriate understanding or support, it becomes difficult for symptoms and feelings of distress to be alleviated.
Also, even if you are practicing with appropriate methods and ways of doing things, if you do not adjust the environmental factors, it will not be effective or it will be difficult to alleviate.
It can also be said that by adjusting the environmental aspects, symptoms and feelings of distress become easier to alleviate.

Many people think that practice is necessary even when they are doing well, but what is important is
① Practice requires methods and quality that match the state and situation
② Grasping whether the state is one that requires practice in the first place
.

If you end up breaking down a good state by practicing, this is also all for nothing.
● Do necessary practice, but refrain from (do not do) unnecessary practice.
● Practice/training is not everything.
I think knowing these things is also important in rehabilitation.