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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 to prevent secondary injury, achieve optimal pain control, employ therapeutic exercise to meet established goals, utilize appropriate assistive technology (AT), and educate and counsel the patient and family. While the first priority in treating trauma patients is to preserve life and limb, early initiation of rehabilitation can have a significant positive impact on recovery, length of stay, community reintegration and quality of life.
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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, early consultation by rehabilitation professionals should be considered while still addressing the acute medical and surgical issues. When considering transfer to an inpatient rehabilitation facility, 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. It is not uncommon for patients on rehabilitation units to continue to need ongoing medical or surgical care.
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As in other areas of medicine, subspecialty designation within the field of “rehabilitation” is common. Many physicians, therapists, nurses, and counselors receive subspecialized training and board certification in areas such as spinal cord medicine, neurological rehabilitation, amputee care and TBI. 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
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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. Healthcare professionals should also recognize that the medical and surgical care they provide during the acute phase of treatment may have long-lasting implications for the patient’s overall health, recovery and quality of life.
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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. A thorough understanding of these potential consequences will help optimize any treatment plan.
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MUSCULOSKELETAL EFFECTS
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Muscle Atrophy and Weakness
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Muscle responds to alterations in loading conditions. While increased activity leads to muscle fiber hypertrophy, less activity may result in disuse atrophy. The muscles most affected by such disuse atrophy during immobilization are the antigravity muscles of the lower limbs and trunk. Thus, muscles with different functional roles atrophy ...