Rehabilitation for Other Disorders

Chronic pain from conditions such as low back pain is one of the most common causes of chronic disability. A physiatrist or pain management specialist typically oversees the management of chronic pain. Because chronic pain is a complex condition, treatment frequently requires a combination of the following:

• Supervised exercises (to strengthen core muscles and improve posture)

• General exercises (in individual or group fitness classes)

• Manual therapy or chiropractic manipulation

• Massage therapy

• Acupuncture

• Pain neuroscience education (discussing biopsychosocial causes of pain)

• Cognitive therapies (for example, cognitive-behavioral therapy, pain reprocessing therapy)

• Meditation

• Medications

• Injection procedures

• Referral to surgery (if appropriate)

People with arthritis can benefit from activities and exercises to increase joint range of motion and strength and from strategies to protect the joints. For example, people may be advised to

• Slide a pot of boiling water containing pasta rather than carry it from the stove to the sink (to avoid undue pain and strain to joints)

• Get in and out of the bathtub safely by following specific steps

• Get a raised toilet seat, a bathtub bench, or both (to reduce pain and stress on the lower-extremity joints)

• Wrap foam, cloth, or tape around the handles of objects (for example, knives, cooking pots and pans) to cushion the grip

• Use splints to protect inflamed, unstable, or painful joints

• Use tools with larger, ergonomically designed handles

Foot drop is an inability to flex the ankle to lift the front part of the foot because of weakness or paralysis of the muscles involved. A person's toe drags when taking a step. To avoid catching the toe, people with a dropped foot may lift their leg higher than normal during a step. Foot drop can be caused by an injured nerve or damage to the nerves (polyneuropathy), which is common in people with diabetes. It can also be caused by a disorder or injury that affects the brain or spinal cord, such as multiple sclerosis, tumor, or stroke.

Treating foot drop includes treating the underlying cause. Wearing braces called ankle-foot orthosis (AFO) helps people with foot drop walk. Physical therapy and occupational therapy to strengthen and stretch the involved muscles and to learn how to properly wear and use the AFOs may help. People whose foot drop is caused by multiple sclerosis may benefit from nerve stimulation therapy to stimulate the nerve that lifts the foot. Vocational counseling may help people maintain vocational skills even though the disorder is progressing.

Critical illness polyneuropathy is a nerve disorder that causes generalized weakness. It is most common in people who had been in an ICU (intensive care unit) on mechanical ventilation. It causes weakness of the diaphragm, limbs, and facial and back muscles. People take from 3 weeks to 6 months to recover. Physical therapy and occupational therapy can help people regain strength. Initially, therapy helps people prevent pressure sores, contractures (when the muscles of the arms and legs tighten in permanent, flexed positions), and nerve damage caused by pressure on a nerve.

As rehabilitation progresses, physical and occupation therapy helps people return to their normal activities and includes strength training, mobility or gait training to help people walk properly, and lessons in using appropriate orthotics and assistive devices, such as a cane.