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November 2015
by: Phillip Sheppard

When physiotherapists take part in Global Health initiatives, they have to think of what’s going to happen when they’re no longer there. Because of this, the best strategies often include education and empowerment. Should this idea shape how physiotherapists approach rehabilitation here at home?

The big idea

In this brief summary, the World Health Organization explains that Community Based Rehabilitation (CBR) is implemented through the combined efforts of people with disabilities, their families and communities, and has a large focus on education and empowerment.

Powerful stuff! But, what does this have to do with physiotherapy in Canada? Well, let’s take a look…

My take on things…

In Global Health and CBR, therapists usually have a set amount of time to work on a particular project. Because of this, they are constantly asking themselves what will happen to the community and individuals when they are no longer there. Project goals are typically focused on community development, as well as social inclusion, increased participation, and function for people with a disability. These goals are accomplished by taking into account the wants and needs of the community and the individual, then focuisng on education and empowerment to make them a reality.

When I was volunteering with 4 students from the University of British Columbia at Samuha, a CBR program in Southern India, the main focus of our time was on educating the local CBR workers, family members, and clients on the treatment of certain conditions using the most effective functional exercises. It would have been easy for us to simply treat clients. But then, when we left, the clients and community would find themselves no better off, and would have to rely on external support for rehabilitation. As you can see, the education component is key!

What if, from the very first assessment, we thought about what was going to happen to the client once they were no longer receiving treatment?

Wouldn’t it be nice if we used a similar approach while treating clients in Canada? What if, from the very first assessment, we thought about what was going to happen to the client once they were no longer receiving treatment? What if we focused all of our efforts on making the client independent and able to manage their condition on their own? This all goes back to family-centred care, where we take into account the client and family goals, and work with them to help accomplish these goals. This is a concept that we all learn in school and try to implement. However, all too often in practice, client education and empowerment seems to play a secondary role to treatment and hands on techniques.

Another important take-away from the program at Samuha is that therapy mainly focuses on functional exercises. For example, if a child is having difficulty with sit to stand, we teach families how to provide just enough support as needed during that exercise, and include that in their rehabilitation program. Using functional exercises has a number of benefits:

•  The client is working directly on the skills that he or she needs to develop

•  It gives the family a goal to strive for

•  In my experience, functional exercises help with adherence to exercise programs

Keeping it functional is an aspect of Global Health that has clear and direct applicability to rehabilitation in Canada.

So, there it is… a few of many examples of how you can use CBR concepts to increase the effectiveness of your practice.

Dig Deeper

In case this topic really gets your juices going, I’ve put together a couple more of my favourite resources on CBR and Global Health:

Disabled Village Children (free e-book) by David Werner was written with community workers and talks about effective strategies in CBR as well as innovative ways to use the resources that are available to you to rehabilitate certain conditions.

The WHO CBR Guidelines provides guidance on how to develop and strengthen CBR programmes.

The Global Health Division of the CPA is a great resource to find out as much as you want about Global Health and link with other people who are passionate about the subject.

To see some examples of CBR projects, check out the International Centre for the Advancement of Community Based Rehabilitation (ICACBR) website. The ICACBR is a very well respected international leader in CBR and has projects all over the world.


I really want to hear from you on this one.

Do you consciously think about how your patient will manage without physiotherapy from the very first assessment? What do you think of the idea of incorporating more global health strategies such as education, empowerment, and keeping exercises functional to help improve the effectiveness of our treatment in Canada? What are some other ways that global health can be related to practice in Canada?

Chime in using the comments box below, or via the CPA Facebook page or on Twitter (hashtag #30Reps).

About Phil Sheppard

Phil is developing Community Based Rehabilitation projects in India and Nepal while volunteering as a clinical instructor for students from the University of British Columbia and Queen’s University. He is also an executive member of the Global Health Division and the Leadership Division. You can follow his work at


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