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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.

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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.

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Management of Common Problems in Rehabilitation

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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.

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Inadequate Nutrition

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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.

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Decubitus Ulcers (Pressure Sores)

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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 ...

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