Journal of Medicine Vol 4 - Amrita Institute of Medical Sciences and ...

Amrita Journal of Medicine
Comprehensive Rehabilitation: A New Dawn for the Disabled
its or prevents the fulfillment of a role or participation in
society that is considered normal (International Classification
of Impairments Disabilities and Handicap, WHO
1980). In the patient described in the case vignette, paraplegia
and inability to pass urine are examples of impairment,
difficulty to walk is his disability and inability to look
after the family and earn a livelihood are likely to be his
handicaps.
THE REHABILITATION TEAM
Rehabilitation relies upon several disciplines that work
together and cohesively to achieve aims and goals. Team
effort is essential and the only criterion for becoming a
member of the team is interest in contributing to the
medicosocial rehabilitation of the patient. All team
members are equal in position and the patient is the central
figure (Fig.1). In institutional based rehabilitation,
the members of the multidisciplinary team include:
1. Doctor plays many roles in rehabilitation (Table 1).
Doctors on the team may include the original treating
physician such as neurologist, neurosurgeon,
internist, pediatrician, geriatrician, orthopedic surgeon
or plastic surgeon, who may be interested in
continuing to care for the patient during the rehabilitation
phase of treatment, and/or physiatrists, who
have specialization in rehabilitation. In a
multidisciplinary team, the doctor is generally the
team leader and his most important function is perhaps
to coordinate the entire rehabilitation efforts
to ensure smooth and goal-directed progress.
2. Physical therapist is responsible for strengthening
muscle power, improving range of joint movements
and reducing spasticity through a variety of exercises.
He also plays an important role in training patients
to improve sitting and standing balance, gait and
transfers from bed. He may use various physical
modalities such as heat, cold, electrical stimulation,
LASER and massage for pain relief. Pool based therapies
(hydrotherapy) facilitates many of the functions
of the therapist.
3. Occupational therapist trains patients in maximizing
self-care activities such as dressing, bathing, toilet
and eating. He also trains patients to transfer from
the bed, improve hand functions and explore various
vocational skills. He evaluates the home of the
patient and suggests modifications to make it barrier-free
to facilitate movement of the disabled. He
can advice regarding proper wheelchair prescription
and also in driving skills.
4. Prosthetist/Orthotist is responsible for designing, fabricating
and fitting orthoses (caliper, splint) and
prostheses (artificial limb).
Table 1: Role of the Doctor in Rehabilitation
1. Clinical Assessment and Confirmation of the diagnosis
2. Identification of the medical, surgical and rehabilitation-specific problems faced by the patient
3. Evaluation of the extent and severity of disabilities
4. Goal setting
5. Liaison between various team members to facilitate a coordinated effort
6. Planning physical, occupational therapy and types of calipers/splints
7. Planning and carrying out relevant investigations: electrophysiology, radiology, urodynamic
studies
8. Medical management of spasticity, urinary bladder/bowel/sexual dysfunction, seizures, pain
9. Planning specific measures for spasticity management such as botulinum toxin injections and
baclofen pump implantation
10. Surgical correction of deformities
11. Liaison with other medical and surgical specialists
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