In the past, rehabilitation was regarded as aftercare, but today,
rehabilitation is recognized as an important part of the acute-care
program. Physicians, therapists, and other health care workers in the
field of orthopedics are involved in rehabilitation programs for
a variety of patients, including those with congenital or acquired
musculoskeletal problems (eg, bone deformities, arthritis, or fractures)
as well as those with neurologic trauma or diseases that affect
limb function (eg, spinal cord injury [SCI], stroke,
or poliomyelitis). Rehabilitation in these patients frequently involves correcting
limb deformities, increasing muscle strength, maximizing motor control,
training individuals to make the most effective use of residual
function, and providing adaptive equipment.
The most successful model for rehabilitation addresses the physical,
emotional, and other needs of the patient 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 accurately all current problems
in the patient, (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.
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 the basis for avoiding many of the
previously listed complications. In trauma patients, the 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.
Yet another form of poor nutrition that should be noted is obesity.
Inactivity leads to diminished calorie need, but boredom may result
in increased consumption.
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 13–1)
and greatly add to the length and cost of the patient’s
hospital stay. The ulcer is a potential source of sepsis in an already
compromised individual ...