Rehabilitation involves care of the injured person with either neurologic or musculoskeletal problems. It focuses on improving function through surgical and nonsurgical management and is recognized as an important part of the care of both acute and chronic problems. Rehabilitation programs address a variety of problems, including congenital or acquired musculoskeletal problems (eg, bone deformities, arthritis, or fractures) as well as neurologic trauma or diseases that affect limb function (eg, spinal cord injury [SCI], stroke, or poliomyelitis). Rehabilitation in these patients frequently involves increasing muscle strength, maximizing motor control, training individuals to make the most effective use of residual function, and providing adaptive equipment to minimize limb deformities.
The most successful model for rehabilitation addresses all the needs of the patient, including physical and emotional needs, and is based on a team approach. Among those frequently included in the team are physicians and nurses from various medical specialties, physical and occupational therapists, speech therapists, psychologists, orthotists, and social workers as well as the patient and members of the patient's family. The shared goal of team members is to prevent barriers to rehabilitation by (1) diagnosing all current problems, (2) treating the problems adequately, (3) establishing adequate nutrition, (4) monitoring the patient for any complications that might impede progress in recovery, (5) mobilizing the patient as soon as possible, and (6) restoring function or helping the patient adjust to an altered lifestyle.
Management of Common Problems in Rehabilitation
Inadequate nutrition, decubitus ulcers, urinary tract infections, impaired bladder control, spasticity, contractures, acquired musculoskeletal deformities, muscle weakness, and physiologic deconditioning are common complications that can obstruct rehabilitation efforts and cause further loss of function in an already compromised patient. Because these problems are costly in both human and financial terms, every effort should be made to prevent them.
Good nutritional status is a basis for avoiding many complications. After trauma, a patient's nutritional requirements are markedly increased from the normal maintenance requirement of 30 kcal/kg/day. Most trauma patients have been receiving intravenous fluids with minimal nutritional benefit and so arrive at the rehabilitation center in various degrees of malnutrition. Patients with chronic illnesses commonly have poor appetites. Physically handicapped people expend much of their energy performing simple activities of daily living (ADLs) and may also have difficulty in obtaining and preparing adequate amounts of food. An often overlooked form of poor nutrition is obesity. Individuals with high body mass index (BMI) can become malnourished after trauma. Also, inactivity leads to diminished calorie need, but boredom may result in increased consumption of an unbalanced diet in which certain nutrients are lacking.
Decubitus Ulcers (Pressure Sores)
The combination of poor nutritional status, lack of sensation at pressure points of the body, and decreased ability to move can cause decubitus ulcers (Figure 12–1) and greatly add to a patient's discomfort and the length and cost ...