Rehabilitation

The goal of rehabilitation is to return a patient to normal functioning or as close as normal as possible. There are many members of a rehabilitation team. A doctor who specializes in rehabilitation medicine is called a physiatrist. Other members of the team can be physical therapists, speech and occupational therapists as well as nurses and other caregivers. An important member of the rehab team is the patient.

The American Academy of Physical Medicine and Rehabilitation (AAPMR) says that rehabilitation can involve many issues including:

• pain caused by arthritis, injury to the neck or back or disease conditions such as fibromyalgia (Read about "Arthritis" "Neck Pain" "Back Pain" "Fibromyalgia")
• serious injuries resulting in traumatic brain injuries, spinal cord injuries and amputation (Read about "Head Injury")
• other injuries such as sports injuries and carpal tunnel syndrome and work related injuries ((Read about "Avoid Sports Injury" "Carpal Tunnel Syndrome")
• disease conditions such as a heart attack or other heart conditions, stroke, osteoporosis, cancer and post-polio syndrome (Read about "Heart Attack" "The Heart & Cardiovascular System" "Stroke" "Osteoporosis" "Cancer: What It Is" "Post-Polio Syndrome")
• musculoskeletal issues such as joint replacement surgery and other surgeries to repair bones and muscles (Read about "Joint Replacement" "Joint Resurfacing" "Skeletal System")
• some conditions causing vertigo (dizziness), such as benign paroxysmal positional vertigo and Ménière's disease. (Read about "Balance Disorders")

Whatever the condition, one of the most important keys to recovery is participation. According to the National Institutes of Health (NIH), results from several studies stress the role of physical activity in rehabilitation. Rehab can happen at many locations - a doctor's office, a physical therapy center at a hospital or even at home.

NIH says you should take an active role in planning your rehabilitation.

You should set meaningful goals. Both long-term and short-term goals are important. Short-term goals are things you should reasonably be able to do in 1 to 2 weeks, according to NIH. They are the building blocks to get you to your ultimate long-term goals, and they may be revised many times over the course of rehab.

It is important that you communicate with your rehab team. Often there's more than one way to achieve results. If one exercise is not working for you, let your team know. They may be able to recommend another approach.

Surviving the initial phase of an illness or injury was your first success. Playing a major role in your recovery plan - and adding some physical activity to your daily routine - can help speed you along the way.

Physical therapy

Physical therapy (PT) is a crucial part of many rehabilitation programs. A physical therapist will plan exercises to help you retrain your muscles and adjust the way you need to. You'll probably have some discomfort, but the movement will help you recover more quickly, according to NIH.

PT is an important part of the recovery from joint replacement surgery. (Read about "Joint Replacement") Exercises are done, often almost right after the surgery, to regain motion and strength in the affect joint. Some other conditions that also benefit from PT include:

• accident injuries
• low-back pain (Read about "Back Pain")
• arthritis (Read about "Arthritis & Rheumatic Diseases")
• heart disease (Read about "Coronary Heart Disease")
• head injuries (Read about "Head Injury")
• cerebral palsy (Read about "Cerebral Palsy")
• fractures (Read about "Bone Fractures")
• some conditions that cause dizziness (vertigo) (Read about "Balance Disorders")

PT is also often part of recovery from orthopedic issues including sprains and strains, bursitis and tendinitis, plantar fasciitis, injuries to the knee, shoulder, hips, feet, legs and ankles. (Read about "Sprains" "Strains" "Tendinitis & Bursitis" "Plantar Fasciitis" "The Knee" "The Shoulder" "The Hip" "Feet, Ankles & Legs") PT may also benefit patients with chronic conditions such as ankylosing spondylitis, osteonecrosis and post-polio syndrome. (Read about "Ankylosing Spondylitis" "Osteonecrosis" "Post-Polio Syndrome")

The role of a physical therapist is to help the patient restore function, improve mobility, relieve pain and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. A physical therapist works with the patient's doctor and the patient to design and implement a PT plan. They will take a look at the patient's medical history and then run them through a series of tests to measure their strength, range of motion, balance and coordination, posture, muscle performance, respiration and motor function.

Treatment often includes exercises for flexibility, strength or endurance. Physical therapists will encourage patients to use their own muscles to increase their flexibility and range of motion before finally advancing to other exercises that improve strength, balance, coordination and endurance.

Physical therapists may also use things like electrical stimulation, hot packs or cold compresses and ultrasound devices to help relieve pain and reduce swelling. They may use traction or deep-tissue massage to relieve pain. Therapists are also often involved in teaching patients how to use things such as crutches, prostheses and wheelchairs. They also may show patients exercises to do at home to speed up their rehabilitation.

A physical therapist will help you learn to perform the appropriate exercises and will guide you. Form is often the key to progress. If you perform the exercise incorrectly, or you use excess weight, you can do more damage.

Physical therapy can also used to treat certain balance disorders. Conditions, such as benign paroxysmal positional vertigo and Ménière's disease are candidates for such therapy. Vestibular rehabilitation refers to the vestibule or the balance mechanism in the inner ear. (Read about "The Ear & Hearing") The Vestibular Disorders Association (VDA) says the goal is to retrain the brain to filter out confusing information from the inner ear and to use appropriate information, combined with other senses, such as seeing to diminish or eliminate symptoms.

Occupational therapy

Occupational therapy (OT) involves getting the patient back to functioning successfully in daily living habits and at work. OT helps people who have conditions that are mentally, physically, developmentally, or emotionally disabling. The goal is to help the patient develop, recover, or maintain daily living and work skills. The goal is to not only improve basic motor functions and reasoning abilities, but also to compensate for permanent loss of function.

Occupational therapy can help people with varied conditions from injuries, diseases and mental health conditions. Some of those conditions include:

• spinal cord injuries (Read about "The Spine")
• cerebral palsy (Read about "Cerebral Palsy")
• muscular dystrophy (Read about "Neuromuscular Diseases")
• stroke (Read about "Stroke")
• mental illness (Read about "Mental Health")
• mental retardation

Early intervention therapy services may be provided to infants and toddlers who have, or at the risk of having, developmental delays. (Read about "Child Development") Occupational therapy also is beneficial to many seniors. OT can help the elderly lead more productive, active, and independent lives through a variety of methods, including the use of adaptive equipment.

Occupational therapists work with patients on performing activities of all types, ranging from using a computer to caring for daily needs such as dressing, cooking and eating. Physical exercises may be used to increase strength and dexterity, while other activities may be chosen to improve visual acuity and the ability to discern patterns. For example, a client with short-term memory loss might be encouraged to make lists to aid recall, and a person with coordination problems might be assigned exercises to improve hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision-making, abstract-reasoning, problem-solving and perceptual skills, as well as memory, sequencing and coordination - all of which are important for independent living.

An occupational therapist is often involved in teaching those with permanent disabilities how to use what is called adaptive equipment. That includes things such as wheelchairs, orthotics and aids for eating and dressing. They may also be involved in working with a patient and an employer to modify a work area so the patient can perform the tasks required of them. That could include helping design ergonomic workstations for patients with back or neck problems or carpal tunnel syndrome. (Read about "Computers & Health" "Back Tips" "Neck Pain & Work" "Carpal Tunnel Syndrome")

Occupational therapists also work with the elderly and others to assess the home for hazards, and to identify other factors that may contribute to falls. (Read about "Accidental Falls")

When dealing with mental health issues, a therapist chooses activities that help people learn to engage in and cope with daily life. Activities include time management skills, budgeting, shopping, homemaking and the use of public transportation. Occupational therapists also may work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders or stress-related disorders. (Read about "Alcoholism" "Depressive Illnesses" "Eating Disorders" "Stress")

Speech therapy

Speech therapy (ST) is designed to help people with conditions that affect their speech, language, cognitive-communication, voice, swallowing, fluency and other related disorders. This can include, but is not limited to:

• stuttering (Read about "Stuttering")
• aphasia (Read about "Aphasia")
• stroke (Read about "Stroke")
• brain injury (Read about "Head Injury")
• Alzheimer's or dementia (Read about "Alzheimer's Disease" "Dementia")
• Parkinson's (Read about "Parkinson's Disease")
• developmental delays or disorders (Read about "Child Development")
• cerebral palsy (Read about "Cerebral Palsy")
• cleft palate (Read about "Cleft Lip & Cleft Palate")
• hearing loss (Read about "The Ear & Hearing")

Patients suffering from emotional problems and mental retardation may also benefit from ST. Patients with swallowing problems brought on by disease, such as cancer (Read about "Cancer: What It Is") are often referred for speech therapy as well.

A speech therapist is also referred to as a speech-language pathologist. Speech-language pathologists help patients develop, or recover, reliable communication and swallowing skills.

Speech-language pathologists use things such as standardized tests, as well as special instruments, to analyze and diagnose the nature and extent of a patient's speech, language and swallowing issues. They then develop an individualized plan of care, tailored to each patient's needs. For individuals with little or no speech capability, speech-language pathologists may select alternative communication methods, including automated devices and sign language, and teach the patient how to use them. They teach these patients how to make sounds, improve their voices or increase their oral or written language skills to communicate more effectively. They also teach individuals how to strengthen muscles or use other methods to swallow without choking or inhaling food or liquid.

A speech therapist will also work with a patent's family to help them understand, not only the patient's condition, but also how to cope with any stress (Read about "Stress") and misunderstandings that may surface. They also work with family members to recognize and change behavior patterns that impede communication and treatment and show them communication-enhancing techniques to use at home.

Stroke

After a stroke (Read about "Stroke"), thoughts of making a comeback take a backseat to simple survival. But once a patient is stabilized, recovering function is crucial. The goal is to gain back as much - if not all - of the function that you had prior to the stroke.

Your rehab will be designed to retrain your body to use the parts that were affected by the stroke. That might involve exercises for legs and arms that have been left weak or even paralyzed by the stroke. Forced movement can help keep the muscles from growing even weaker. For a period of time, a patient may avoid using the healthy arm to perform daily tasks. Instead, the arm weakened by stroke does all the work. NIH says results so far have shown that the forced activity strengthens the weak arm and helps the stroke survivor recover motor skills faster. Speech therapy can be involved if the ability to speak has been affected by the stroke.

Traumatic brain injury (TBI)

Rehabilitation for traumatic brain injury (Read about "Head Injury") depends on the extent of the injury. During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacute unit of the medical center or to an independent rehabilitation hospital.

At this point, there is a wide variety of options for rehabilitation, based on the patient's strengths and needs. Options include home-based rehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs, independent living centers, club-house programs, school-based programs for children and others.

The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier. Some patients may need medication for psychiatric and physical problems resulting from the TBI.

Some of the techniques used for stroke patients are also used for TBI patients. That might involve exercises to legs and arms that have been left weak or even paralyzed by the TBI. Forced movement can help keep the muscles from growing even weaker. For a period of time, the patient avoids using the healthy arm to perform daily tasks. Instead, the arm weakened by TBI does all the work. NIH says results so far have shown that the forced activity strengthens the weak arm and helps the TBI survivor recover motor skills faster. Speech therapy can be involved if the ability to speak has been affected by the TBI.

Cardiac

Cardiac rehabilitation (Read about "Cardiac Rehabilitation") involves many aspects. According to the Agency for Healthcare Research and Quality (AHRQ) says there are four key things to cardiac rehabilitation:

• Education - learning about what your heart problem involves, as well as other issues you should discuss with your doctor. Did you have a heart attack? Do you have congestive heart failure? What kind of heart risks do you have?
• Counseling - Counseling will include advice from your doctor and others about exercise programs and lifestyle changes, including stress management. (Read about "Stress") The American Heart Association (AHA) also says that patients entering cardiac rehabilitation should receive mental health (Read about "Mental Health") evaluations and support. Counseling can also include answers to personal questions such as physical limitations for the patient, including issues such as sex.
• Behavior change - Any cardiac rehabilitation program will include changing the behaviors that you can control, and carefully monitoring the conditions that put you at risk. Those can include stopping smoking and changing your diet to help control your blood pressure, cholesterol, weight and diabetes. (Read about "Quit Smoking" "Hypertension: High Blood Pressure" "Cholesterol" "Losing Weight" "Diabetes")
• Exercise - An exercise program can help strengthen the heart and reduce stress. AHA says that moderate exercise can also help lower weight and control blood pressure and cholesterol. Once again, any exercise program should be done only with careful consultation with your doctor.

In addition to physical rehabilitation, your physician may also recommend continued treatment with medication.

Cancer

Cancer can leave a person in a weakened state and suffering from side effects of treatment. (Read about "Cancer: What It Is" "Cancer Treatments") Those side effects can vary:

• lymphedema is swelling caused by the buildup of too much lymph fluid in the tissues. It usually affects the arms or legs, but can occur in other parts of the body as well. (Read about "The Lymph System")
• head and neck cancers will sometimes leave the patient with problems that involves the mouth and the throat, including swallow issues. (Read about "Head & Neck Cancers" "Oral Health")
• amputations

Rehabilitation therapy for these problems includes learning new ways to do things and ways that minimize the pain and discomfort caused by the conditions.

Physical activity and exercise is often a part of cancer rehabilitation. Any exercise program will be designed to take into the consideration the patient's condition and limitations. Exercise can help the patient regain strength and to reduce pain.

Your doctor will refer you to appropriate therapists, such as physical, occupational or speech therapists, to help you with your rehabilitation.

Spinal

The National Spinal Cord Injury Association says that after a spinal cord (Read about "The Spine") injury, the nerves above the level of injury keep working, but nerves from the point of injury and below do not. Therefore, the higher the injury is on the spine, the more it can impact how the body moves and what a person can feel. In addition to the location of the injury, the impact also depends on the extent of the injury.

Rehabilitation involves trying to keep muscles from atrophying and to regain as much function possible. It also involves working to improve the quality of life by learning alternative methods of doing things. Treatment techniques and rehabilitation programs are making advances every year. Each case however is individual with varying degrees of success.

Orthopedics/Musculoskeletal

When you suffer a musculoskeletal injury or undergo orthopedic surgery (Read about "Orthopedics"), you may have to undergo some sort of rehabilitation. It will depend on the extent of the surgery or your injury. Simple sprains or strains (Read about "Sprains" "Strains") may involve simply not using the affected muscles for a while and then slowly working them back into condition. More serious injuries - such as a fracture or torn ligaments in your knee or shoulder (Read about "Bone Fractures" "The Knee" "The Shoulder") - may require surgery and more involved rehab that includes physical therapy.

As we age, we may develop conditions that can benefit from rehabilitation practices. We may undergo joint replacement surgery or suffer from osteoarthritis. (Read about "Joint Replacement" "Osteoarthritis")

Your rehabilitation would be designed to help you return to normal functioning. In the case of chronic conditions, such as rheumatic diseases, back pain or fibromyalgia (Read about "Arthritis & Rheumatic Diseases" "Back Pain" "Fibromyalgia") the goal is to help you function as close to normal as possible, and to learn coping techniques.

Amputation

AAPMR says there are about 50,000 people who suffer an amputation each year. About a third of them are the result of an injury. About two thirds are the result of diseases and conditions that affect the vascular system, such as diabetes. (Read about "Vascular System" "Diabetes") Rehab depends on the location of the amputation. Prosthetics, or artificial limbs, are often involved. Recent advances in prosthetics are making it possible for amputees to have a better quality of life that in the past. Any rehabilitation program will involve learning to function in different ways.