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Rehabilitation for Other Disorders

by Alex Moroz, MD, FACP

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)

  • How to get in and out of the bathtub safely

  • To get a raised toilet seat, a bathtub bench, or both (to reduce pain and stress on the lower-extremity joints)

  • To wrap foam, cloth, or tape around the handles of objects (eg, knives, cooking pots and pans) to cushion the grip

  • To 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 are taught to rely more on the other senses, to develop specific skills, and to use devices for the blind (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 blind people 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 the 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 sighted person, a blind person can hold onto the bent elbow of the sighted person, rather than use an ambulation aid. The sighted person should not lead the blind person by the hand because some blind people perceive this action as dominant and controlling.

COPD

Patients with COPD 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.

Head injury

The term head injury is often used interchangeably with traumatic brain injury (TBI—see Traumatic Brain Injury (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 is indispensable for maximal functional recovery (see also Rehabilitation). Such intervention includes prevention of secondary disabilities (eg, pressure ulcers, 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.

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 injury (see Spinal Trauma, particularly see Table: Effects of Spinal Cord Injury by Location).Complete transsection causes flaccid paralysis; partial transsection causes spastic paralysis of muscles innervated by the affected segment. A patient’s functional capacity depends on the level of injury (see Overview of Spinal Cord Disorders : Symptoms and Signs) and the development of complications (eg, joint contractures, pressure ulcers, pneumonia).

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, and pneumonia; all measures needed to prevent other complications (eg, orthostatic hypotension, atelectasis, deep venous thrombosis, pulmonary embolism) 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.

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