Section 1. Fundamentals

Chapter 7. Rehabilitation

Topics: Introduction | Treatment of Pain and Inflammation | Physical Therapy | Occupational Therapy | Rehabilitation for Specific Problems

Introduction

Rehabilitation services are needed by people who have sustained severe injury, often due to trauma, a stroke, an infection, a tumor, surgery, or progressive disease. A pulmonary rehabilitation program (see Section 4, Chapter 40) is often appropriate for people who have chronic obstructive lung disease. People whose bodies become severely weak after prolonged bed rest (for example, because of a heart attack or surgery) are also in need of rehabilitation. Physical therapy, occupational therapy, and the treatment of any pain and inflammation are the focus of rehabilitation.

The need for rehabilitation crosses all age groups, although the type, level, and goals of rehabilitation often differ. People with chronic impairments, often older people, have different goals, require less intensive rehabilitation or a longer period of rehabilitation, and need different types of therapy than do younger people. For example, the goal of an older person with severe heart failure who has had a stroke may be to restore the ability to perform as many self-care activities (eating, dressing, bathing, transferring between a bed and a chair, using the toilet, controlling bladder and bowel) as possible. The goal of a younger person who has had a heart attack or been in a car accident is often to restore full, unrestricted function. Nonetheless, age alone is not a reason to alter goals or the intensity of rehabilitation; the presence of disease and limitations, however, may be.

Intensive rehabilitation that involves several components, such as physical therapy, occupational therapy, and speech therapy, usually requires continued sessions of one-on-one training for weeks to be of benefit. Sometimes, more immediate health concerns must be attended to before rehabilitation can be addressed.

To initiate a formal rehabilitation program, a doctor writes a referral (similar to a prescription) to a physiatrist (a doctor who is board-certified in rehabilitation medicine), an occupational or physical therapist, or a rehabilitation center. The referral establishes the goals of therapy, a description of the type of illness or injury, and its date of onset. The referral also specifies the type of therapy needed, such as ambulation training (help with walking) or training in activities of daily living (for example, help with eating, dressing, grooming, or toileting).

Where the rehabilitation takes place varies according to the person's needs. Care in a hospital or rehabilitation center may be necessary for people with severe disabilities. In such settings, a rehabilitation team provides care. Along with the doctor or therapist, this team may include nurses, psychologists, social workers, other health care practitioners, and family members.

The rehabilitation team or therapist establishes specific short-term goals for each of the person's problems, which may include restricted range of motion, an uncoordinated gait, and the inability to open a jar or feed himself. The person is encouraged to achieve each short-term goal, and the team closely monitors the person's progress. The goals of therapy may be changed if the person is unwilling or unable (financially or otherwise) to undergo lengthy rehabilitation. Setting a long-term overall goal at the beginning helps people understand what can be expected of rehabilitation and where they can expect to be in several months.

People who require less care, such as those who can transfer from bed to a chair or from a chair to a toilet, can often obtain rehabilitation services in an office or at home. In such cases, however, family members or friends must be willing to participate in the rehabilitative care process. Providing rehabilitation at home with the help of family members is highly desirable, but it can be physically and emotionally taxing for all involved. Sometimes, a visiting physical therapist or occupational therapist can help with home care.

Regardless of the severity of the disability or the skill of the rehabilitation team, the final outcome of the rehabilitation process depends on the person's motivation. In some cases, a person may prolong recovery in order to gain attention from family or friends.