Psychiatric Rehabilitation Programs for Peoples with Disabilities: Literature Review

Disability is a phenomenon which is characterized by difficulties in adapting to social life and meeting the needs of daily life because of the loss, by birth or later for any reason, of physical, mental, spiritual, sensory and social skills at various grades and it needs support services such as prevention, care, rehabilitation and counseling [1]. Prenatal, at birth and postnatal causes play a role in the occurrence of disability. It is classified in seven groups as mental, physical, sight, hearing, language and speech, disability due to persistent diseases, and spiritual emotional disability [2]. According to World Health Organization (WHO) 2011 disability data, the rate of disability is accepted as 10% for developed countries and 15.6% for developing countries and it is estimated that 750 million to 1 billion people are disabled worldwide [3]. Disability rates have reached significant numbers all over the world and have recently been a serious issue to raise awareness on. In disabled people; the risk of biological disposition, unsuccessful experiences in social life, stigma perception and the occurrence of the psychiatric problems that are based upon stress effects originating from the individuals in family or in the environment are five times higher than the other individuals in the society [4]. Therefore, besides treatment programs rehabilitation programs that enable psychiatric strengthening are needed to reintegrate disabled people into society and to enable them live their lives on their own or with minimum support. Psychiatric rehabilitation is a comprehensive, coordinated and long-term treatment that is practiced to meet the mental and social needs of individuals with persistent symptoms and functional impairment [5]. In disabled individuals who are treated as private/different groups; this process progresses according to different and group specific needs because they have different problems than usual patients [4,5]. With this mini-literature compilation, it is aimed to review the “psychiatric rehabilitation programs” for disabled people which are a special group.


Introduction
Disability is a phenomenon which is characterized by difficulties in adapting to social life and meeting the needs of daily life because of the loss, by birth or later for any reason, of physical, mental, spiritual, sensory and social skills at various grades and it needs support services such as prevention, care, rehabilitation and counseling [1]. Prenatal, at birth and postnatal causes play a role in the occurrence of disability. It is classified in seven groups as mental, physical, sight, hearing, language and speech, disability due to persistent diseases, and spiritual emotional disability [2]. According to World Health Organization (WHO) 2011 disability data, the rate of disability is accepted as 10% for developed countries and 15.6% for developing countries and it is estimated that 750 million to 1 billion people are disabled worldwide [3]. Disability rates have reached significant numbers all over the world and have recently been a serious issue to raise awareness on. In disabled people; the risk of biological disposition, unsuccessful experiences in social life, stigma perception and the occurrence of the psychiatric problems that are based upon stress effects originating from the individuals in family or in the environment are five times higher than the other individuals in the society [4]. Therefore, besides treatment programs rehabilitation programs that enable psychiatric strengthening are needed to reintegrate disabled people into society and to enable them live their lives on their own or with minimum support. Psychiatric rehabilitation is a comprehensive, coordinated and long-term treatment that is practiced to meet the mental and social needs of individuals with persistent symptoms and functional impairment [5]. In disabled individuals who are treated as private/different groups; this process progresses according to different and group specific needs because they have different problems than usual patients [4,5]. With this mini-literature compilation, it is aimed to review the "psychiatric rehabilitation programs" for disabled people which are a special group.

Search methodology
The study was carried out by retrospective scanning in the databases of the relevant publications. Studies, between January-March 2017, were scanned via Istanbul University internet access network, with the keywords "psychiatric rehabilitation", "physical handicap", "physical disability", "mental/intellectual handicap-disability-retarded", "deaf", "deafness", "hearing impaired", "visually handicap-disability", "speech and language disability"; in the databases of Ulakbim, Turkish Psychiatry Index, Google Academic, Pubmed, CINAHL, and Cochrane. The

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thesis studies done on the subject and the leaflets presented in the congresses were not included in the scope of the study.

Selection of studies
The following criteria were taken into consideration in the selection of the articles to be included in the study; a.
The practiced psycho-rehabilitation program is towards disabled people, b.
Being a research article that can be reachable as a full text, c.
Language of the publication is either Turkish or English, d.
Being original and quantitative, e.
Published in a national/international refereed journal between 2000 and 2017.
In the summarization of the data; a valid and reliable guideline for systematic reviews "A checklist of items that should be taken into account in the reporting of systematic compilation or meta-analysis studies" (Preferred reporting items for systematic reviews and meta-analyses statement -PRISMA-) was taken into account.

Title & Authors & Date
Aim of the study Methods Results Conclusion [6] To investigate the effect of virtual reality therapy on psychological adaptation in children with cerebral palsy Randomized controlled study Throughout 4 weeks; 1 hour per day for 3 days a week, it was used with Hacettepe Psychological Adaptation Scale after virtual reality therapy with Sony Play Station 2 and Eye Toy system.
(N: 41) The practiced care program was effective and it was found that the post-treatment values of the individuals in the experimental group are better.
Virtual reality therapy is a useful treatment method that can be used for SP rehabilitation and improve spiritual adaptation. [7] To examine the effect of PECS program on social communication in children with autism A randomized controlled study Throughout 6 months; for 30 minutes a day/ once a week, PECS and speech therapy was applied. It consists of 4 stages. (N:18) The practiced therapy program was effective and scores of children in the experimental group were significantly higher when evaluated after the 4th stage.
The practiced PECS program has supported the development of social communication skills of children with autism. [8] To examine the effect of When the values obtained from measurements that made at different times in the experiment group were compared with the values obtained from those in the control group, they were found to be different in the positive direction.
The ability of interpersonal communication psycho-education program has been effective in increasing the empathic tendencies and communication skills of visually impaired adolescents. [9] To learn experiences with a structured program run with visually impaired adolescents A psychoeducation program consisting of 10 visually impaired students who are in the 11-16 age group and 8 sessions was used.
(N = 10) Group conductors were able to improve their empathy and communication skills in the group process in spite of group constructors meeted member's blind corresponding.
The group administrators, in spite of the fact that they have faced the difficulties of visually impaired members in the process, experienced many opportunities to develop many field skills, especially communication and empathy skills. [10] To examine the changes made by communication-focused intervention in autistic children without verbal communication and to identify their benefits.
Randomized controlled study 73 children, between the ages of 4 and 10, from 15 different schools were included and were practiced for 9 months by being divided into groups. (N:83) At the end of the 9th month, the verbal communication level of the experimental group increased significantly.
There is a small but significant difference in the initiation of children's spontaneous communication. [11] To provide behavioral changes in children with persistent and challenging behavioral disturbances 2 therapists and 6 children were included in the program. The program was practiced in 2 steps. (N:6)

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The results of the behavior change session were found significant.
Reductions and changes in their standard harsh behaviors were observed. [12] To prevent depression and anxiety in elderly people who are visually impaired with the Progressive care program Randomized controlled study It contains a program consisting of 4-stages. (N:230) The practiced care program was effective and the depression and anxiety scores of the individuals were lower than the control group.
With the administered care program, depression and anxiety rates were reduced in elderly individuals with decreased visual acuity. [13] To evaluate the effectiveness of the cognitive rehabilitation program in coping with cognitive disabilities of MS patients An experimental study The program was practiced once a week throughout 8 weeks.
(N: 32) The experimental group was found to have a better level of attention, memory, processing speed and verbal fluency than the control group.
The practiced cognitive rehabilitation program was found effective in memory, attention and speech areas of MS patients. [14] To measure the effectiveness of the Healing Pathways program in physically disabled women who are diagnosed with depression To measure the effectiveness of the Healing Pathways program in physically disabled women who are diagnosed with depression At the end of the 14 th week, the depression level of the experimental group decreased significantly.
Healing Pathways program has been found to be effective in depressed women with physical disabilities. [15] To evaluate the efficacy of group therapies on MS patients Randomized controlled study The program was practiced once a week throughout 7 weeks. (N:29) When compared with the experimental group, decrease in depressive symptoms was found to develop in the short term.
The study should be repeated in different areas and long term results should be observed. [16] To measure the efficacy of the self-esteem improvement program for women with disabilities Randomized controlled study The program consisting of 5-step was practiced for 6 weeks. (N:102) At the end of the 6th week, the self-esteem level scores of the test group increased significantly.
Self-esteem improvement program was found effective in women with disabilities. [17] To measure the efficacy of psychotherapy services by communicating via PC and to reduce the feeling of loneliness with relay chat and targeted BD group teletherapy A pretest-posttest experimental study A total of 19 people consisting of 7 groups of 2-3 people were included. Participants were monitored 1 day per week for 4 months.
(N: 19) Participants indicated that they were less lonely in the final test.
At the end of the study indicate that participants felt less lonely after intervention than a similar group that had been placed in a waiting-list control.
Also results indicate that gains were maintained at a 4-month follow-up. [18] To evaluate the efficacy of a novel telehealth intervention, "CareCall", on reducing pressure ulcers and depression.
"Care Call" is an automated, interactive voice response system that have patient education, CB interventions, screening and referrals (N:142) "Care Call" achieved a reduction in presence of pressure ulcers at 6 months in women and "CareCall" reduced 6-month severity of depression, adjusting for age and gender.
The aim is achieved as a result of studying [19] Aim of this study to examine effects of parent-child dyads' participation in a six-week home-based music therapy program.
Parent-child dyads participated in a home-based music therapy program that included six weekly 40-minute sessions, and incorporated five responsive teaching strategies (N:26) Parents' positive physical and verbal responses, as well as children's positive verbal initiations, increased significantly pre-to postintervntion Findings support the use of home-based music therapy programs to facilitate parent-child interactions in the areas of parental responsiveness and child-initiated communication, as well as parent child synchrony When the psychiatric rehabilitation programs for disabled people were examined in the mentioned databases, a total of 7413 studies were reached. When studies were analyzed via the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) scheme by considering the inclusion criteria, 14 studies (Table 1) were considered appropriate and included. When studies are examined, it is seen that there are various cognitive, behavioral and socially supporting programs towards disabled people. Out of 14 studies examined, 7 of them are programs towards children and teenagers with autism, cerebral palsy and sight-disability, 1 of them towards elderly people with sight-disability, 6 of them towards adults with multiple sclerosis, physical or sight disability. In studies examined, it is seen that "Virtual Reality Therapy" (Table 2) practiced on children with cerebral palsy increases spiritual adaptation, "Picture Exchange Communication System (PECS)" practiced on children with

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autism provides a progress in social communication skills, "Communication-based Intervention Program" practiced on children with both autism and lack of verbal communication makes a significant difference in starting the conversation and "Interpersonal Communication Skills Psycho-Education Program" and "Structured Experience of Group Process" practiced on teenagers with sight disability are effective on increasing the empathetic tendencies and communication skills of teenagers.
In consequence of psychoeducation program practiced on elderly individuals with visual impairment, it is seen that depression and symptoms of anxiety reduce, "Healing Pathways" program practiced on physically disabled women with depression diagnosis decreases the points of depression and reduces its symptoms, "Development Programs of Self Esteem" increases the points of self esteem level significantly. Besides, with the development of technology, as a result of practicing telepsychiatry and telehealthprograms which have been often used recently on physically disabled people, it is seen that breakoff phenomenon and depressive symptoms are reduced in people.

Conclusion
With this mini-literature review, the psychiatric rehabilitation programs were revised and it was seen that the programs improved problem solving skills in disabled people, increased perceptions of family communication, social support, self esteem and decreased mood problems such as anxiety and depression. Besides programs examined, teaching daily life skills, assisted living and employment programs, sensory integration therapies, social skills education, behavioral change (regulation) education and spiritual education of the family towards disabled individuals exist and they are practiced.