The goal of rehabilitation is to maximize an individual’s physical, cognitive, and psychological recovery from a disease, injury, or traumatic event. An interdisciplinary team of professionals applies fundamental rehabilitation principles with the objective of preventing secondary injury, achieving optimal pain control, employing therapeutic exercise to meet established goals, utilizing appropriate assistive technology (AT), and providing education and counseling to the patient and family. While the first priority in treating a trauma patient is to preserve life and limb, early initiation of rehabilitation can have a significant impact on recovery, length of stay, reintegration into the community, and, ultimately, quality of life.
Trauma patients, especially those with spinal cord injury (SCI), traumatic brain injury (TBI), burns, and amputations, are particularly vulnerable to secondary complications and multisystem problems that are best treated if recognized early. In order to most appropriately address these unique needs, transfer to a specialized rehabilitation facility should be considered as soon as possible after the acute medical and surgical issues are addressed. The optimal timing for transfer is largely dependent on the condition of the patient and comfort level of the providers at both the discharging and receiving institutions, but generally occurs when the emphasis of care transitions from the acute medical and surgical issues to recovery. It is not uncommon for patients who require additional medical or surgical procedures to transfer back to the acute care hospital from the rehabilitation facility in order to facilitate optimal recovery.
As in other areas of medicine, subspecialty designation within the rehabilitation field is common. Many physicians, therapists, nurses, and counselors receive subspecialized training and board certification in areas such as spinal cord medicine, neurological impairments, limb loss, and cognitive rehabilitation. Rehabilitation facilities themselves receive special accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF), which helps to ensure quality.1 The National Institute on Disabilities and Rehabilitation Research (NIDRR) also recognizes excellence in rehabilitation institutions with their Models Systems Programs for Burns, SCI, and TBI.2
Trauma providers should not wait until the resolution of all medical and surgical issues before engaging in rehabilitation; rather, it should be an integral part of every trauma patient’s care starting from initial hospitalization. Trauma professionals should also recognize that the medical and surgical care they provide during the acute phase of treatment may have long-lasting implications for a trauma patient’s overall health, recovery, and quality of life.
The fundamental principles of rehabilitation are founded on mitigating and preventing (when possible) the effects of immobility. The physiological and psychological effects of immobility lead to adverse organ system changes that may complicate healing and recovery. Therefore, a thorough understanding of these potential consequences will help optimize any treatment plan.
Muscle Atrophy and Weakness
Muscle responds to alterations in loading conditions. While increased activity leads to muscle fiber hypertrophy, less may result in disuse atrophy. The muscles ...