Rehabilitation Therapy - Types, Treatment Strategies, and Steps Involved

Introduction

Following an injury or illness, the individual might have altered anatomy and function that would disable the individual. Rehabilitation therapy helps restore the lost function and anatomy for a better lifestyle for the individual. Rehabilitation therapy helps achieve short-term and long-term goals in managing an illness or disability. Various physical therapy techniques and procedures are employed to help with rehabilitation.

What Are the Different Types of Rehabilitation?

Inpatient and outpatient rehabilitation are the two types of rehabilitation. Inpatient refers to the treatment or therapy received during the stay at the hospital, and outpatient refers to care outside a hospital or a clinic.

What Are the Treatment Strategies in Rehabilitation Therapy?

• Functional Training: Education and training of daily activities of living that are intended to improve the ability to perform tasks independently, in an efficient way, even when performed repetitively. Task-specific training is implemented.

• Manual Therapy: Manual therapy involves stimulating and activating muscle fibers through various techniques. They help in managing chronic pain.

• Prescription of Assistive and Protective Devices: Patients with activity limitations for a prolonged time benefit from assistive devices. Patients with joint disorders and other diseases that may produce weakness can be prescribed assistive and protective devices.

• Airway Clearance Techniques: Airway clearance techniques like huffing and coughing are taught by the therapist to clear the airway in cases of airway obstruction. However, medical management is advised in cases of airway obstruction.

• Integumentary (Organ) Repair: Integumentary system comprises arterial, venous, and lymphatic systems. Any problems with the integumentary system can complicate almost all organs. So impairments in these systems are noticed and managed as quickly as possible.

• Electrotherapeutic Modalities: TENS (transcutaneous electrical nerve stimulation), interferential therapy, and ultrasound are some of the electrotherapeutic modalities used in physiotherapy for the reduction of symptoms.

• Physical Agents and Mechanical Modalities: Heat, cold, ultrasound, laser traction, and TENS (transcutaneous electrical nerve stimulation) are some of the modalities used for treating symptoms. It can also be prescribed to the individual as a self-care strategy in cases of acute pain and other symptoms.

What Are the Steps in Rehabilitation Therapy?

A) Clinical Decision-Making:

1. A thorough history is taken, and an examination is done to derive a clinical decision on diagnosis and treatment protocol based on the prognosis.

2. Examination of vital signs like temperature, pulse rate, respiratory rate, and blood pressure are taken into account.

3. Sensory function is examined, and impairment is identified through various tests on consciousness and arousal, cognition, orientation, memory, attention, and various other motor functions.

4. A thorough musculoskeletal examination is done to identify the tissues causing impairment.

5. Examination of motor function and learning considering the factors like sensory integrity, joint mobility, postural alignment, and many other motor functions.

6. An overall assessment is done on coordination and balance, including the movement capability of the individual.

7. A proper examination of the gait and the functions of the body, like mental function, sensory function, and functions of all systems.

B) Intervention Strategies for Rehabilitation:

The underlying disease or impairment is identified, and the treatment plan is formulated accordingly.

1. Motor Function: Motor control is the understanding of neural, physical, and behavioral aspects of human movement. Motor skills like mobility, static postural control, and dynamic (movement) postural control are being assessed and trained. In addition, functional training and strengthening exercises are taught to the individual to improve posture and movement. Aerobic training is also included to enhance physical function and cardiovascular health and decrease anxiety and depression.

2. Locomotor Training: Walking is focused on this training, and training is provided in parallel bars, overground indoors, and community. Exercise is also given for body weight support and training on the usage of assistive devices. Gait training is also implemented.

3. Chronic Pulmonary Dysfunction: Rehabilitation is done for patients with a chronic respiratory disease designed to reduce symptoms, optimize physical functioning, and reduce health care costs. Aerobic training and general strength training are prescribed based on the capabilities of the patient.

4. Heart Disease: Cardiovascular diseases can be life-threatening and should be managed appropriately. Rehabilitation is done both before and after surgery. Assessment of aerobic capacity and endurance is done before rehabilitation. Both inpatient and outpatient exercise prescriptions are given to the individual.

5. Vascular, Lymphatic, and Integumentary Disorders: Wound healing and other vascular and lymphatic problems such as arterial insufficiency, venous insufficiency, lymphedema, pressure ulcers, and neuropathy are identified and assessed. Muscle performance is enhanced, and the symptoms of the disease are relieved through various physiotherapeutic interventions like compression therapy, manual lymphatic drainage, stretch bandages, and pneumatic compression devices. Assistive devices like ulna’s boot, neuropathic walker, cast shoes, and extra-depth shoes are encouraged in disabling conditions.

6. Stroke: Stroke is defined as the sudden loss of neurological function due to interruption of blood supply to the brain. A stroke will bring about many complications, and they are treated symptomatically. Rehabilitation is done in acute and subacute phases to restore motor function, postural control, and balance. Along with this, treating disabling conditions like spasticity, gait problems, cognitive function, and other sensory impairments is included.

7. Multiple Sclerosis: It is an autoimmune disease characterized by inflammation, selective demyelination, and gliosis. It can cause acute and chronic symptoms that can drastically affect the patient. Training for balance, gait, posture, and locomotion is included. Management of spasticity, coordination deficit, speech, and swallowing problems are done. Exercise training and aerobic conditioning are included in rehabilitation.

8. Parkinson’s Disease: It is a progressive disorder of the central nervous system with both motor and non-motor symptoms like rigidity, bradykinesia (slowed movements), tremor, and at later stages, postural instability. Motor learning strategies are implemented through various exercises. Strength, resistance and functional training, speech therapy, and addressing psychosocial issues are critical elements in rehabilitation.

9. Traumatic Brain and Spinal Cord Injury: A severe injury occurring due to direct blows and most commonly due to road traffic accidents, violence, and falls. Physiotherapy plays an important role in restoring function. It is done through aerobic and endurance training, resistance training along with managing conditions like pressure ulcers, wounds, neuropathic pain, and bladder and bowel incontinence.

10. Arthritis: It is a degenerative condition of the joints and can disable the patient. The cause of the disease is understood, and the treatment plan is strategized for early healing and restoration of function. Range of motion, joint stability, strength, and mobility are restored through rehabilitation.

C) Prescription of Orthotics and Assistive Devices:

Some patients may not fully recover even after rehabilitation, and some have permanent disabilities which cannot be cured through rehabilitation. Such patients may require assistive devices to help with locomotion and to perform daily tasks. Orthotics, prosthetics, and wheelchairs are different assistive aids. Orthotics are external appliances worn to restrict motion or to transfer load from one area to another. Prosthetics are an alternative for an absent leg or arm that are fitted to help in mobility and to perform various tasks.

Conclusion

Rehabilitation is a vast field, and an interdisciplinary team works to provide the desired effect to the patient. However, various innovations in the medical field have brought about effective management of different permanent disabling conditions. As a result, it is now possible to restore the normal form and function of many organs through rehabilitation. Furthermore, some conditions can be treated through rehabilitation alone, without undergoing surgery.