Rehabilitation aims to facilitate recovery from loss of function. (See also Overview of Rehabilitation Overview of Rehabilitation Rehabilitation aims to facilitate recovery from loss of function and reduce pain. Loss of function may be due to fracture, amputation, stroke or another neurologic disorder, traumatic brain... read more .)
Arthritis
Patients 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, patients 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 (eg, 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
Such instruction may occur in outpatient settings, in the home via a home health care agency, or in private practice.
Blindness
Patients who are blind are taught to rely more on the other senses, to develop specific skills, and to use specific devices (eg, Braille, cane, reading machine). Therapy aims to help patients function to their maximum and become independent, to restore psychologic security, and to help patients deal with and influence the attitudes of other people. Therapy varies depending on the way vision was lost (suddenly or slowly and progressively), extent of vision loss, the patient’s functional needs, and coexisting deficits. For example, patients with peripheral neuropathy and diminished tactile sensation in the fingers may have difficulty reading Braille. Many people who are blind need psychologic counseling (usually cognitive-behavioral therapy) to help them better cope with their condition.
For ambulation, therapy may involve learning to use a cane; canes used by people who are blind are usually white and longer and thinner than ordinary canes. People who use a wheelchair are taught to use one arm to operate the wheelchair and the other to use a cane. People who prefer to use a trained dog instead of a cane are taught to handle and care for the dog. When walking with a person with sight, a person who is blind can hold onto the bent elbow of that person, rather than use an ambulation aid. A person who is blind should not be led by the hand because this action could be perceived as dominant and controlling.
Brain injury
The term head injury is often used interchangeably with traumatic brain injury Traumatic Brain Injury (TBI) Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function. Diagnosis is suspected clinically and confirmed by imaging (primarily... read more (TBI). Abnormalities vary and may include muscle weakness, spasticity, incoordination, and ataxia; cognitive dysfunction (eg, memory loss, loss of problem-solving skills, language and visual disturbances) is common.
Early intervention by rehabilitation specialists Rehabilitation Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function. Diagnosis is suspected clinically and confirmed by imaging (primarily... read more is indispensable for maximal functional recovery. Such intervention includes prevention of secondary disabilities (eg, pressure injuries, joint contractures), prevention of pneumonia, and family education. As early as possible, rehabilitation specialists should evaluate patients to establish baseline findings. Later, before starting rehabilitation therapy, patients should be reevaluated; these findings are compared with baseline findings to help prioritize treatment. Patients with severe cognitive dysfunction require extensive cognitive therapy, which is often begun immediately after injury and continued for months or years.
Chronic pain
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 manages the care of patients with chronic pain, which is a complex condition that benefits from the use of a biopsychosocial model to guide treatment. Thus, a rehabilitation program may involve a combination of the following:
Supervised exercises for trunk and postural conditioning
General exercises (in individual or group fitness classes)
Manipulative therapy Chiropractic In chiropractic (a manipulative and body-based practice), the relationship between the structure of the spine and other articulating surfaces and their interaction with the nervous system is... read more or chiropractic manipulation Chiropractic In chiropractic (a manipulative and body-based practice), the relationship between the structure of the spine and other articulating surfaces and their interaction with the nervous system is... read more
Physical modalities
Pain neuroscience education
Cognitive therapies (eg, cognitive behavioral therapy, pain reprocessing therapy)
Pharmacologic measures
Injection procedures
Surgical referral when appropriate
COPD (chronic obstructive pulmonary disease)
Patients with COPD Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. Alpha-1 antitrypsin deficiency and various occupational... read more can benefit from exercises to increase endurance and from strategies to simplify activities and thus conserve energy. Activities and exercises that encourage use of the upper and lower extremities are used to increase muscle aerobic capacity, which decreases overall oxygen requirement and eases breathing. Supervising patients while they engage in activity helps motivate them and makes them feel more secure. Such instruction may occur in medical facilities or in the patient’s home.
Critical illness polyneuropathy
Critical illness polyneuropathy can present as failure to wean from mechanical ventilation Overview of Mechanical Ventilation Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding... read more . In multisystem organ failure secondary to sepsis Sepsis and Septic Shock Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure... read more , the systemic inflammatory response syndrome, presumably resulting from cytokine and free radical release, impairs peripheral nerve microcirculation, resulting in polyneuropathy of mixed or motor nerves. Noninflammatory axonal degeneration and resulting neurogenic muscle atrophy may cause weakness of the diaphragm, limbs, and facial and paraspinal muscles. Sensory fibers are minimally affected. Serial serum creatinine kinase levels and serial electrodiagnostic studies are helpful in monitoring the disease course in some patients. Recovery time ranges from 3 weeks to 6 months.
Rehabilitation focuses on prevention of pressure ulcers, contractures, and compression neuropathies and return to normal function. Strengthening exercises, mobility and ADL (activities of daily living) retraining, as well as appropriate orthotics and adaptive equipment, should be provided at appropriate stages of recovery.
Foot drop
Differential diagnosis of foot drop includes common peroneal nerve (fibular) neuropathy, diffuse peripheral polyneuropathy (eg, caused by diabetes), L4 and/or L5 radiculopathy, tumor, stroke, multiple sclerosis, spinal cord injury, and other causes. Patients may present with weakness of ankle dorsiflexors, ankle evertors, and/or toe extensors, as well as possible foot slap and steppage gait (compensatory excessive hip and knee flexion).
Treatment of foot drop includes treatment of the underlying cause when possible; training in the use of ankle-foot orthosis (AFO); strengthening of weak ankle dorsiflexors, ankle evertors, and/or toe extensors; stretching of ankle plantar flexors; and gait training. Functional electrical stimulation (FES) is currently used in patients with multiple sclerosis to produce fibular nerve stimulation during the gait swing phase to help with foot clearance.
Spinal cord injury
Specific rehabilitation therapy varies depending on the patient’s abnormalities, which depend on the level and extent (partial or complete) of the spinal cord injury (see Spinal Trauma Spinal Trauma Trauma to the spine may cause injuries involving the spinal cord, vertebrae, or both. Occasionally, the spinal nerves are affected. The anatomy of the spinal column is reviewed elsewhere. Spinal... read more , particularly see table ). A patient’s functional capacity depends on the level of injury (see Overview of Spinal Cord Disorders: Symptoms and Signs Symptoms and Signs Spinal cord disorders can cause permanent severe neurologic disability. For some patients, such disability can be avoided or minimized if evaluation and treatment are rapid. The spinal cord... read more ) and the development of complications (eg, joint contractures, pressure ulcers, pneumonia, and bowel/bladder incontinence).
The affected area must be immobilized surgically or nonsurgically as soon as possible and throughout the acute phase. During the acute phase, daily routine care should include measures to prevent contractures, pressure ulcers Pressure Injuries Pressure injuries are areas of necrosis and often ulceration (also called pressure ulcers) where soft tissues are compressed between bony prominences and external hard surfaces. They are caused... read more , and pneumonia Overview of Pneumonia Pneumonia is acute inflammation of the lungs caused by infection. Initial diagnosis is usually based on chest x-ray and clinical findings. Causes, symptoms, treatment, preventive measures, and... read more ; all measures needed to prevent other complications (eg, orthostatic hypotension Orthostatic Hypotension Orthostatic (postural) hypotension is an excessive fall in blood pressure (BP) when an upright position is assumed. The consensus definition is a drop of > 20 mm Hg systolic, > 10 mm Hg... read more , atelectasis Atelectasis Atelectasis is collapse of lung tissue with loss of volume. Patients may have dyspnea or respiratory failure if atelectasis is extensive. They may also develop pneumonia. Atelectasis is usually... read more , deep venous thrombosis Deep Venous Thrombosis (DVT) Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. DVT is the primary cause of pulmonary embolism. DVT results from conditions... read more , pulmonary embolism Pulmonary Embolism (PE) Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. Risk factors for pulmonary embolism are... read more ) should also be taken. Placing patients on a tilt table and increasing the angle gradually toward the upright position may help reestablish hemodynamic balance. Compression stockings, an elastic bandage, or an abdominal binder may prevent orthostatic hypotension.