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KEY POINTS

KEY POINTS

  • The fundamental principles of rehabilitation are founded on mitigating and preventing (when possible) the effects of immobility.

  • Daily range-of-motion, flexibility, and muscle strengthening exercises help maintain the appropriate balance of muscle activity across joints and can be used to both prevent and treat muscle atrophy, disuse osteoporosis, and contracture formation.

  • Immobilized patients have a reduction in blood volume, venous return, and stroke volume.

  • Decreased gastric transit time in immobilized patients may cause symptoms of gastroesophageal reflux, regurgitation, and heartburn.

  • To determine pain level, most health care organizations use a visual analog scale typically ranging from 0 (no pain) to 10 (worst imaginable pain).

  • Approximately 12,000 spinal cord injuries occur nationally each year, and approximately 259,000 trauma survivors are living with spinal cord injuries in the United States.

  • Spinal cord injuries are classified by their severity and level of injury, using the American Spinal Injury Association Standard Neurological Classification Worksheet.

  • Between 25% and 80% of patients with a spinal cord injury eventually develop a decubitus ulcer.

  • It is estimated that 19% to 23% of military service members who deploy overseas sustain a concussion or mild traumatic brain injury.

  • Vascular occlusive diseases cause over 80% of amputations and account for nearly 30,000 new cases annually.

INTRODUCTION

The goal of rehabilitation is to optimize an individual’s physical, cognitive, and psychological recovery from a disease, injury, or traumatic event to maximize the patient’s functional independence. This is achieved through an interdisciplinary team of professionals who use therapeutic exercise, assistive technology, patient and family education, and fundamental rehabilitation principles to prevent secondary injury, optimize pain control, and achieve established patient goals. Although the first priority in treating trauma casualties is to preserve life, early initiation of rehabilitation can have a significant positive impact on recovery, length of stay, community reintegration, and quality of life.1

Trauma patients, especially those who sustain spinal cord injury (SCI), traumatic brain injury (TBI), burns, and/or amputation, often experience polytrauma and are particularly vulnerable to secondary complications, which are best addressed by early preventative strategies. Rehabilitation professionals are especially skilled at mitigating the risks in developing secondary complications frequently associated with trauma; therefore, consultation to rehabilitation specialists should be initiated upon early hospitalization. In fact, evidence demonstrates that early mobilization in the intensive care setting results in fewer ventilator days, fewer intensive care unit and hospital days, less hospital complications, less sedation and delirium days, improved overall functional outcomes, reduced overall hospital cost and mortality, and increased likelihood of being discharged home.2 The rehabilitation team can also be very helpful regarding other critical decisions during the acute management of trauma patients, including pain control strategies, bowel and bladder management, selection of definitive amputation levels, facilitating patient and family education, and disposition considerations, including the timing of transfer to a rehabilitation center.

As in other areas of medicine, subspecialty designation within the field of rehabilitation is ...

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