Chapter 1 Rehabilitation in practice

how this book can help you to help your patients

Introduction 1

Rehabilitation: The key skills 1

Rehabilitation: The knowledge base 1

How to make the most of this book 2

Neurological conditions 2

Rehabilitation tools and techniques 3

Patient assessment 3

Outcome measurement 4

Validity 4

Reliability 4

Recommended outcome measures 4

Intervention 4

The patient at the centre 5

Conclusion 5

Introduction

As McLellan wrote in 1997, rehabilitation is more akin to the active process of education than it is to the traditionally more passive concept of treatment. He defined rehabilitation as:

A process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function.

Rehabilitation professionals also need to acquire considerable knowledge and skills if they are to be useful supporters of patients making those active changes.

Rehabilitation: The key skills

The Brain Injury Association of Queensland (2009) highlights the ‘unique role and skills that neurological physiotherapists offer’. They argue that, while ‘vitally concerned with movement’, like all physiotherapists, the neurological specialists’ interventions may be ‘predominantly in teaching and training’ their clients. Developing skills, of course, requires extensive (hands on) practice, though many authors discuss the rehabilitation therapists’ requisite skills throughout this textbook, especially:

• assessment skills:

understanding the science of measurement

observational skills (including recognizing the response to intervention)

movement analysis

recording

• problem-solving skills:

risk assessment

goal-setting

• communication skills

• handling techniques

• educational skills.

Rehabilitation: The knowledge base

Coupled with good practical opportunities to learn and hone one’s skills under the guidance of clinical experts, this book will provide beginners in rehabilitation with many options for the management of patients. Students of rehabilitation (at any level) would do well to reflect on their own experiences as learners, as they evolve into knowledgeable and skilled professionals capable of contributing to their patients’ rehabilitation (see Figure 1.1).This book will provide students of rehabilitation with an explanation of the theories, tools and techniques that underpin rehabilitation in practice. Recently, Lennon and Bassile (2009) identified eight guiding principles for neurological physiotherapy. Sheila Lennon discusses all eight principles in Chapter 11 of this textbook and the reader will find that many of the other chapters also address these topics. In particular, four of these principles run throughout this textbook, illustrating their significance in current rehabilitation management:

• Teamwork

• Patient-centred care

• Skill acquisition

• Self-management.

Figure 1.1 Rehabilitation in Practice: the Skills and Knowledge

Therapists moving into rehabilitation today are entering a field in which the knowledge base is expanding as the quality of studies improves. In 2002, Moseley et al. surveyed a physiotherapy evidence database (PEDro) and found ‘a significant body’ of high-level evidence (randomized controlled trials and systematic reviews) for all areas of physiotherapy. They further concluded that there remains scope for improving not just the conduct, but also the reporting of trials. These are the same conclusions that they reached in an earlier (Moseley et al., 2000) analysis that was focused specifically on neurological physiotherapy.

How to make the most of this book

The book has three complementary sections, which, when read together with this chapter, offer a comprehensive insight into the challenges of rehabilitation (Figure 1.2). For example, practitioners seeking information about the return of functional mobility after stroke will find relevant details in the chapters on Stroke (Ch. 2 in Section 1), abnormal movement (Ch. 14 in Section 2) and activity and falls (Chs 18 & 20 in Section 3).

Figure 1.2 Topics in Rehabilitation (and the structure of this book)

Wherever possible, chapters are cross-referenced: readers seeking information about exercise or self-management, for example, will find additional information in the condition-specific chapters (of Section 1) that supplement the in-depth information of Section 3.

Example case studies (in Section 1) illustrate how, in practice, therapists tailor assessment, goal-setting and management to an individual patient’s circumstances, history and presentation.

All chapters are heavily referenced, with pointers toward further resources and reading. This book is complimented by the Pocketbook of Neurological Physiotherapy (Lennon & Stokes, 2009), which covers several other topics in detail, including:

• evidence-based practice

• patient- and carer-centred care

• the wider context of neurorehabilitation

• motor control

• neuroplasticity

• motor impairments and impact on activity

• neurological assessment

• outcome measurement

• continuity of care

• communication considerations

• orthotic management

• neurological investigations

• drug treatments.

Neurological conditions

Section 1 of this textbook contains chapters devoted to conditions that form the basis of neurological rehabilitation in practice. It is important to understand how variable the presentation and progression of neurological disorders can be. As De Souza and Bates emphasize in Chapter 5, for example, multiple sclerosis (MS) can mean anything from a mild and temporary focal deficit to a severe permanent disability of rapid onset. Whether a condition is common in the typical caseload (e.g. acquired brain damage, MS, Parkinson’s disease, spinal cord injury, stroke) or relatively rare (e.g. Huntingdon’s disease, motorneurone disease, muscle disorders, polyneuropathies), the authors have gathered as much up-to-date literature as possible in each case on:

• the condition (cause, epidemiology, pathology, signs, symptoms and prognosis)

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