Rehabilitation services are needed by people who have lost the ability to function normally, often because of an injury, a stroke, an infection, a tumor, surgery, or a progressive disorder (such as arthritis—see Physical measures). A pulmonary rehabilitation program (see Overview of Pulmonary Rehabilitation) is often appropriate for people who have chronic obstructive lung disease. People who become weak after prolonged bed rest (for example, because of a severe injury or after surgery) also need rehabilitation. Physical therapy, occupational therapy, treatment of any pain and inflammation, and retraining to compensate for specific lost functions are the typical focus of rehabilitation. Treatment usually involves continued sessions of one-on-one training for many weeks.
The need for rehabilitation crosses all age groups, although the type, level, and goals of rehabilitation often differ by age. People with chronic impairments, often older people, have different goals and require less intensive rehabilitation or a longer period of rehabilitation than do younger people with a temporary impairment (such as that due to a fracture or burn). For example, the goal of an older person who has severe heart failure and has had a stroke may simply be to regain the ability to do as many self-care activities—such as eating, dressing, bathing, transferring between a bed and a chair, using the toilet, and controlling bladder and bowel function—as possible. The goal of a younger person who has had a fracture is often to regain all functions as quickly as possible. Nonetheless, age alone is not a reason to alter goals or the intensity of rehabilitation, but the presence of other disorders or limitations may be.
To initiate a formal rehabilitation program, a doctor writes a referral (similar to a prescription) to a physiatrist (a doctor who is board-certified in rehabilitation medicine), an occupational or physical therapist, or a rehabilitation center. The referral establishes the goals of therapy, a description of the type of illness or injury, and its date of onset. The referral also specifies the type of therapy needed, such as ambulation training (help with walking) or training in activities of daily living.
Where rehabilitation takes place depends on the person's needs. Many people recovering from injuries can be treated as outpatients in a therapist's office. People with severe disabilities may need care in a hospital or inpatient rehabilitation center. In such settings, a rehabilitation team provides care. With the doctor or therapist, this team may include nurses, psychologists, social workers, speech pathologists (who evaluate speech, language, and voice), audiologists (who evaluate hearing), other health care practitioners, and family members. A team approach is best because significant loss of function can lead to other problems, such as depression, apathy, and financial problems.
Care at home can be appropriate for people who cannot travel easily but who require less care, such as those who can transfer from bed to a chair or from a chair to a toilet. However, family members or friends must be willing to participate in the rehabilitation process. Providing rehabilitation at home with the help of family members is highly desirable, but it can be physically and emotionally taxing for all involved. Sometimes a visiting physical therapist or occupational therapist can help with home care.
Many nursing homes have less intensive rehabilitation programs than rehabilitation centers. Less intensive programs are better suited to people less able to tolerate therapy, such as frail or older people.
The rehabilitation team or therapist sets both short-term and long-term goals for each problem. For example, a person with a hand injury may have restricted range of motion and weakness. The short-term goals may be to increase the range of motion by a certain amount and to increase grip strength by so many pounds. The long-term goal may be to play the piano again. Short-term goals are set to provide an immediate, achievable target. Long-term goals are set to help people understand what they can expect from rehabilitation and where they can expect to be in several months. People are encouraged to achieve each short-term goal, and the team closely monitors the progress. The goals may be changed if people become unwilling or unable (financially or otherwise) to continue or if they progress more slowly or quickly than expected.
In many situations, the goals are to help people walk again and to enable them to do the daily activities they need to do (such as dressing, grooming, bathing, feeding themselves, cooking, and shopping).
Regardless of the severity of the disability or the skill of the rehabilitation team, the final outcome of rehabilitation depends on the person's motivation. Some people delay recovery to gain attention from family members or friends.
Last full review/revision March 2014 by Alex Moroz, MD, FACP