Rehabilitation
medicine is the branch that diagnoses and treats neuromusculoskeletal impairment, disability, and handicap and works to restore
persons with
physical disabilities to their highest possible levels of physical, psychological, social, vocational, recreational, and economic functioning.
Rehabilitation medicine tries to eliminate the
disability or to moderate its impact by retraining the
disabled person to live as unrestricted and productive a life as possible.
Modern rehabilitation medicine developed during World War II, when Dr. Howard A. Rusk (1900Ð89) demonstrated that physical and psychological rehabilitation was more effective than restful convalescence in restoring soldiers to the level of fitness sufficient for return to duty. He also found that persons with physical disabilities best benefit from treatment by an interdisciplinary team addressing the multiple and complex problems created by the disability.
Rehabilitation medicine has since merged with physical medicine, a specialty that manages disease by means of physical agents such as light, heat, cold, water, electricity, and various mechanical agents including exercise, traction, manipulation, massage, and other mechanical devices. In 1947 rehabilitation medicine and physical medicine were formally recognized as one medical specialty, called physical medicine and rehabilitation, often referred to as physiatry. Physiatrists, physicians who specialize in physical medicine and rehabilitation, diagnose and set up treatment programs for the management of musculoskeletal pain syndromes and disabilities that result from injuries and diseases afflicting the neuromusculoskeletal systems. Most physiatrists perform electrodiagnostic studies, manage an interdisciplinary team of health-care professionals, and plan long-term treatment.
Demands for rehabilitation services have increased, for several reasons. As medical care has improved, the population is growing older, and more persons survive spinal-cord and traumatic brain injuries as well as many serious illnesses. Rising costs of hospitalization and health care in general demand a quick restoration of function following a number of disabling conditions. In addition, public attitudes toward disabled persons have changed with the recognition of the needs of these people and the philosophy of reintegrating the disabled person into the community. State and federal programs for vocational rehabilitation have been established, and legislation has been passed recognizing the rights and needs of persons with disabilities, including the enactment of the Americans with Disabilities Act in 1990.
The resources of an interdisciplinary rehabilitation team are necessary to meet the multiple needs of persons with physical disabilities. Professional health-care providers with expertise in different areas provide services that address the patients' physical, social, psychological, economic, vocational, and recreational problems. The health-care professionals represented on the rehabilitation team include the physiatrist, physical therapists, occupational therapists, psychologists, rehabilitation nurses, social workers, speech pathologists, vocational counselors, teachers, recreational therapists, home economists, home planning consultants, orthotists (the makers of braces for the body and limbs), prosthetists (makers of artificial limbs), rehabilitation engineers (designers of technical devices and systems used by persons with physical disabilities), driver educators, and dietitians.
When a patient enters the hospital with a disabling injury or illness, his or her condition is best assessed by the physiatrist within 48 hours, to determine the extent of the disability and the management program needed. Physical therapy and occupational therapy may then be started almost immediately to prevent the development of joint contractures, loss of muscle strength, and general deconditioning from not moving around. As the patient'condition stabilizes, the rehabilitation program intensifies and focuses more on improved function. The team members work closely with the disabled person, his or her family, and community resources in order to maximize independence in self-care and mobility, advance communication and cognitive skills, facilitate emotional adjustment to disability, and ease reintegration into the community.
The practice of rehabilitation medicine ranges from short-term outpatient management of various neuromusculoskeletal ailments and pain syndromes to long-term and comprehensive management of severe disabilities resulting from spinal-cord injury, traumatic brain injury, stroke, injuries and disorders of bone, cancer, burns, various neuromuscular diseases, and congenital disorders, such as cerebral palsy and spina bifida. Following onset of a major disability, the patient is admitted to an inpatient rehabilitation service if he or she is able to participate in the rehabilitation program and shows the potential to significantly improve functional performance.
The success of rehabilitation medicine and its team approach has led to the establishment of "model systems of care" for injuries to the spinal cord and brain, which provide coordinated and comprehensive treatment programs and integrate the efforts of local emergency medical services, specialized trauma centers, and comprehensive rehabilitation service programs, beginning immediately after the injury and continuing throughout the life of the disabled person. Modern technology has aided rehabilitation medicine by providing improved design and function of various adaptive equipment used by persons with disabilities, including wheelchairs, artificial limbs, braces, modified vehicles, and the elaborate electronic systems for communication, education, environmental control, and mobility.
More abstracts about the REHABILITATION MEDICINE