Rehabilitation is often needed after hip fracture, amputation, stroke, serious cardiac events, or prolonged bed rest that results in deconditioning or as part of the treatment of arthritis or various other illnesses or injuries causing varying degrees of functional loss. Usually, for younger patients, the goal is to achieve full, unrestricted function and, for older patients, to restore the ability to perform as many activities of daily living as possible. Recovery is often rapid for younger patients, but progress may be slow for elderly patients.
Rehabilitation may begin in an acute care hospital, but organized rehabilitation programs rarely exist there. Rehabilitation hospitals usually provide the most extensive and intensive care and should be considered for patients who have the most potential and who can participate in aggressive intervention (eg, patients must be able to tolerate therapy for >= 3 h/day). Many nursing homes have programs that are less intensive (generally 1 h/day, < 5 days/wk) and, thus, are better suited to those who need more gentle rehabilitation (eg, frail or elderly patients). Rehabilitation programs with less variety and frequency of services may be offered in outpatient settings or at home and are appropriate for many patients.
To initiate formal rehabilitation therapy, a physician must write a referral to a physiatrist, therapist, or rehabilitation center. The referral should establish the goal of therapy and, therefore, should be detailed, including relevant information and initial instructions. Although vague instructions (eg, "physical therapy to evaluate and treat") are often accepted, they are not adequate. Physicians unfamiliar with writing referrals should consult with a senior therapist, physiatrist, or orthopedic surgeon.
Disabled patients tend to be depressed and may lose motivation for restoring lost function and returning to the community. Mental health specialists may help the patient overcome these adverse emotional states and focus on functional recovery. The family may have to adjust to the patient's disability and appropriately assist the patient. Disability may cause financial hardship to the patient and family. A social worker helps the patient and family adjust.
Initial evaluation includes discussions on objectives, which generally focus on restoring function for activities of daily living (ADLs). ADLs include personal care such as grooming, bathing, dressing, feeding, and toileting as well as cooking, cleaning, shopping, managing medications, managing finances, using the telephone, and traveling. The referring physician and rehabilitation team can determine which of these activities are achievable and which are essential for the patient to remain independent.
Rehabilitation: A combination of physical, occupational, and speech therapy; psychologic counseling; and social work directed toward helping patients maintain or recover physical capacities.
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