Rehabilitation

Rehabilitation is a treatment or treatments designed to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible.

A patient (holding paddles) is undergoing a hydrotherapy treatment. (Photograph by Will & Deni McIntyre, Photo Researchers, Inc. Reproduced by permission.)

Purpose

The purpose of rehabilitation is to restore some or all of the patient's physical, sensory, and mental capabilities that were lost due to injury, illness, or disease. Rehabilitation includes assisting the patient to compensate for deficits that cannot be reversed medically. It is prescribed after many types of injury, illness, or disease, including amputations, arthritis, cancer, cardiac disease, neurological problems, orthopedic injuries, spinal cord injuries, stroke, and traumatic brain injuries.The Institute of Medicine has estimated that as many as 14% of all Americans may be disabled at any given time.

Precautions

Rehabilitation should be carried out only by qualified therapists. Exercises and other physical interventions must take into account the patient's deficit. An example of a deficit is the loss of a limb.

Description

A proper and adequate rehabilitation program can reverse many disabling conditions or can help patients cope with deficits that cannot be reversed by medical care. Rehabilitation addresses the patient's physical, psychological, and environmental needs. It is achieved by restoring the patient's physical functions and/or modifying the patient's physical and social environment. The main types of rehabilitation are physical, occupational, and speech therapy.

Each rehabilitation program is tailored to the individual patient's needs and can include one or more types of therapy. The patient's physician usually coordinates the efforts of the rehabilitation team, which can include physical, occupational, speech, or other therapists; nurses; engineers; physiatrists (physical medicine); psychologists; orthotists (makes devices such as braces to straighten out curved or poorly shaped bones); prosthetists (a therapist who makes artificial limbs or protheses); and vocational counselors. Family members are often actively involved in the patient's rehabilitation program.

Physical therapy

Physical therapy helps the patient restore the use of muscles, bones, and the nervous system through the use of heat, cold, massage, whirlpool baths, ultrasound, exercise, and other techniques. It seeks to relieve pain, improve strength and mobility, and train the patient to perform important everyday tasks. Physical therapy may be prescribed to rehabilitate a patient after amputations, arthritis, burns, cancer, cardiac disease, cervical and lumbar dysfunction, neurological problems, orthopedic injuries, pulmonary disease, spinal cord injuries, stroke, traumatic brain injuries, and other injuries/illnesses. The duration of the physical therapy program varies depending on the injury/illness being treated and the patient's response to therapy.

Exercise is the most widely used and best known type of physical therapy. Depending on the patient's condition, exercises may be performed by the patient alone or with the therapist's help, or with the therapist moving the patient's limbs. Exercise equipment for physical therapy could include an exercise table or mat, a stationary bicycle, walking aids, a wheelchair, practice stairs, parallel bars, and pulleys and weights.

Heat treatment, applied with hot-water compresses, infrared lamps, short-wave radiation, high frequency electrical current, ultrasound, paraffin wax, or warm baths, is used to stimulate the patient's circulation, relax muscles, and relieve pain. Cold treatment is applied with ice packs or cold-water soaking. Soaking in a whirlpool can ease muscle spasm pain and help strengthen movements. Massage aids circulation, helps the patient relax, relieves pain and muscle spasms, and reduces swelling. Very low strength electrical currents applied through the skin stimulate muscles and make them contract, helping paralyzed or weakened muscles respond again.

Occupational therapy

Occupational therapy helps the patient regain the ability to do normal everyday tasks. This may be achieved by restoring old skills or teaching the patient new skills to adjust to disabilities through adaptive equipment, orthotics, and modification of the patient's home environment. Occupational therapy may be prescribed to rehabilitate a patient after amputation, arthritis, cancer, cardiac disease, head injuries, neurological injuries, orthopedic injuries, pulmonary disease, spinal cord disease, stroke, and other injuries/illnesses. The duration of the occupational therapy program varies depending on the injury/illness being treated and the patient's response to therapy.

Occupational therapy includes learning how to use devices to assist in walking (artificial limbs, canes, crutches, walkers), getting around without walking (wheelchairs or motorized scooters), or moving from one spot to another (boards, lifts, and bars). The therapist will visit the patient's home and analyze what the patient can and cannot do. Suggestions on modifications to the home, such as rearranging furniture or adding a wheelchair ramp, will be made. Health aids to bathing and grooming could also be recommended.

Speech therapy

Speech therapy helps the patient correct speech disorders or restore speech. Speech therapy may be prescribed to rehabilitate a patient after a brain injury, cancer, neuromuscular diseases, stroke, and other injuries/illnesses. The duration of the speech therapy program varies depending on the injury/illness being treated and the patient's response to therapy.

Performed by a speech pathologist, speech therapy involves regular meetings with the therapist in an individual or group setting and home exercises. To strengthen muscles, the patient might be asked to say words, smile, close his mouth, or stick out his tongue. Picture cards may be used to help the patient remember everyday objects and increase his vocabulary. The patient might use picture boards of everyday activities or objects to communicate with others. Workbooks might be used to help the patient recall the names of objects and practice reading, writing, and listening. Computer programs are available to help sharpen speech, reading, recall, and listening skills.

Other types of therapists

Inhalation therapists, audiologists, and registered dietitians are other types of therapists. Inhalation therapists help the patient learn to use respirators and other breathing aids to restore or support breathing. Audiologists help diagnose the patient's hearing loss and recommend solutions. Dietitians provide dietary advice to help the patient recover from or avoid specific problems or diseases.

Rehabiltation centers

Rehabilitation services are provided in a variety of settings including clinical and office practices, hospitals, skilled-care nursing homes, sports medicine clinics, and some health maintenance organizations. Some therapists make home visits. Advice on choosing the appropriate type of therapy and therapist is provided by the patient's medical team.