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Posts Tagged ‘Rehabilitation’

Rehabilitation aims to improve the ability of people of all ages to perform day-to-day activities, and to restore their physical, mental and social capabilities as far as possible. Acute illness in older people is often associated with loss of their usual ability to function, and common disabling conditions such as stroke, fractured neck of femur, arthritis and cardio-respiratory disease become increasingly prevalent with advancing age.

Disability is an interaction between factors intrinsic to the individual and the context in which they live, and interventions at both a medical and a social level are needed in response .Doctors tend to focus on health conditions and impairments, but patients are more concerned with their effects: the limitation of their activities and restricted participation in everyday life.

Rehabilitation is a problem-solving process focused on improving a patient’s function. This includes not only physical function, but also psychological and social functioning. It covers:

Assessment. The nature and extent of the person’s problems are identified from a comprehensive assessment using the framework in. Specific assessment scales such as the Elderly Mobility Scale or Barthel Index of Activities of Daily Living can be used to quantify components of disability.

Goal-setting. Goals set are specific to the patient’s problems, realistic and agreed by the patient with the rehabilitation team.

Intervention. This includes active treatments to achieve the set goals and to maintain the patient’s health and quality of life.

Reassessment. There is ongoing re-evaluation of the person’s function and progress towards the set goals. This requires regular review by all members of the rehabilitation team, the old person and the carer.

The core rehabilitation team includes several professional disciplines like Physiotherapist, Occupational therapist, Speech and language therapist, Dietitian, Social worker, Nurse, Doctor, although others may be involved as needed, e.g. audiometry for hearing impairment, podiatry for foot problems and orthotics where prostheses or splinting are required. Good communication and mutual respect are essential. Rehabilitation is not where the doctor orders ‘Refer to physiotherapists’ or ‘Get a home visit’, and takes no further role.

The interventions used in rehabilitation can be divided into ‘hard’, i.e. hands-on treatment by therapists using a functional, task-orientated approach to improve day-to-day activities, and ‘soft’ interventions such as psychological support and education, often just as important to progress. The emphasis on the type of intervention will be different depending on the patient’s disabilities, psychological status and progress. The patient has to be an active participant in the process, working to overcome disability with the encouragement and help of the rehabilitation team.

Effective rehabilitation has a major impact on reducing disability in older patients after acute illness or emergency and elective surgery. There is good evidence that rehabilitation improves functional outcome following stroke and myocardial infarction, and in those with chronic obstructive pulmonary disease. It also reduces mortality after stroke. Rehabilitation obviously involves complex multi-component interventions and it is not clear which has the greatest effect. Is it specific therapy techniques, better delivery and organization of care, or simply staff enthusiasm? The concept of the ‘black box’ of rehabilitation has been used to describe this poor understanding of the process, and is the subject of ongoing research.