Rehabilitation services are needed by people who have lost the ability to function normally or have pain. Loss of function may be due to fracture, amputation, stroke or another neurologic disorder, traumatic brain injury, sports injury, and/or musculoskeletal impairments from conditions such as arthritis, spinal cord injury, heart or lung disorders, chronic pain, or being very weak (for example, after having some disorders and surgical procedures).
People who become weak after prolonged bed rest (for example, because of a severe injury or after surgery) often need rehabilitation. Physical therapy, occupational therapy, treatment of any pain and inflammation, and retraining to compensate for specific lost functions are the typical focus of rehabilitation. Treatment usually involves continued sessions of one-on-one training for many weeks. A specific pulmonary rehabilitation program is often appropriate for people who have chronic obstructive lung disease.
The need for rehabilitation crosses all age groups, although the type, level, and goals of rehabilitation often differ by age. People with chronic impairments, often older people, have different goals than do younger people with a temporary impairment (such as that due to a fracture or burn). For example, the goal of an older person who has severe heart failure and has had a stroke may be to regain the ability to do as many self-care activities—such as eating, dressing, bathing, transferring between a bed and a chair, using the toilet, and controlling bladder and bowel function—as possible. The goal of a younger person who has had a fracture is often to regain all functions as quickly as possible and participate in vigorous physical activities. Although age alone is not a reason to alter goals or the intensity of rehabilitation, the presence of other disorders or baseline limitations may be.
Did You Know...
|
To initiate a formal rehabilitation program, a doctor writes a referral (similar to a prescription) to a physiatrist (a doctor who specializes 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. The therapist may modify these goals in consultation with the referring doctor based on the person's response to the therapy. Relevant precautions, such as heart rate limits for people with heart disease, weight-bearing restrictions after fractures or because of poor bone density, or supervision requirements for people who are at risk for falling, may help guide the therapists' development of treatment plans.
Setting
Where rehabilitation takes place depends on the person's needs and capabilities. Many people recovering from injuries can receive outpatient rehabilitation treatment in a therapist's office. People with severe disabilities may need care in a hospital or inpatient rehabilitation center. In such settings, a rehabilitation team provides care. With the doctor or therapist, this team may include nurses, psychologists, social workers, speech pathologists (who evaluate speech, language, and voice), audiologists (who evaluate hearing), other health care professionals, and family members. A team approach is best because significant loss of function can lead to other issues, such as
Apathy
Financial problems
Care at home can be appropriate for people who cannot travel easily but who require less care, such as those who can transfer from bed to a chair or from a chair to a toilet. Rehabilitation at home is often used after knee replacement surgery, after a fall, or for people who are homebound due to chronic illness. However, family members or friends must be willing to participate in the rehabilitation 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.
Many nursing homes have less intensive rehabilitation programs than rehabilitation centers. Less intensive programs are better suited to people less able to tolerate therapy, such as frail or older people.
Goals
The rehabilitation team or therapist sets both short-term and long-term goals for each problem. For example, a person with a hand injury may have restricted range of motion and weakness. The short-term goals may be to increase the range of motion by a certain amount and to increase grip strength by so many pounds. The long-term goal may be to play the piano again. Short-term goals are set to provide an immediate, achievable target. Long-term goals are set to help people understand what they can expect from rehabilitation and where they can expect to be in several months. People are encouraged to achieve each short-term goal, and the team closely monitors the progress. The goals may be changed if people become unwilling or unable (financially or otherwise) to continue or if they progress more slowly or quickly than expected.
In many situations, the goals are to help people walk again and to enable them to do the daily activities they need to do (such as dressing, grooming, bathing, feeding themselves, cooking, and shopping).
Regardless of the severity of the disability or the skill of the rehabilitation team, the final outcome of rehabilitation depends on the person's motivation. Some people delay recovery to gain attention from family members or friends.
Spotlight On Aging: Rehabilitation
Disorders that require rehabilitation (such as stroke, heart attacks, hip fracture, and limb amputation) are common among older people. However, older people may have characteristics that make rehabilitation challenging, such as
Nonetheless, age alone is not a reason to postpone or deny rehabilitation. Older people may recover more slowly. Consequently, programs designed specifically for older people are preferable. Older people often have different goals and need different types of care than do younger people. When older people are in programs designed for them, they are less likely to compare their progress with that of younger people and to become discouraged. |
