9.2 The Rehabilitation Process

After an individual experiences an acute illness, injury, or significant change in health status, there is always a period of recovery. During recovery, some individuals participate in rehabilitation. Rehabilitation helps people regain body functions they lost due to medical conditions or injury. Rehabilitation can help improve many body functions, including bowel and bladder problems, chewing and swallowing, problems thinking or reasoning, movement or mobility, speech, and language.^[1]

The goal of the rehabilitation is to return the person to their prior level of function before the health event. The length of time for recovery varies for each individual, and there are several factors that can influence its progression. A list of factors that can affect an individual’s recovery process include the following:

• Comorbidities: Comorbidities are coexisting health conditions. Having another chronic diagnosis or other acute condition may slow the progression of healing. Here are some examples of how comorbidities affect healing and recovery:
• • If a person has diabetes, their healing process is slower, and their risk of infection is higher.
  • If a person has chronic respiratory or cardiac conditions such as asthma, chronic obstructive pulmonary disease (COPD), or heart failure, their endurance to complete rehabilitation exercises may be decreased.
  • If a person has dementia, they may not remember they are injured and may try to move without assistance, resulting in a fall or further injury to the affected area.
• Age: As people age, healing slows down, and the functioning of various body systems declines. Older adults are more likely to have comorbidities and complications related to these coexisting conditions that can slow or even halt the rehabilitation process.
• Motivation: If a person lives with severe chronic illness or experienced health events that previously required rehabilitation, they may feel like giving up or not putting in the effort to return to their prior level of functioning. Some people prefer someone assisting them with their ADLs for a variety of reasons, such as experiencing increased pain with movement, severe fatigue, or feeling lonely and desiring increased interaction with others.
• Resources: Resources include support from family members or friends who offer encouragement, nearby health care providers in the community, and transportation available to get to appointments. Insurance also plays a role in recovery because the amount of reimbursement for rehabilitation services is determined by insurance coverage.

The types of therapy provided are determined by the individual’s illness or injury. The roles and responsibilities of different disciplines will be further discussed in the “Members of the Therapy Team” section of this chapter. Rehabilitation may begin in an acute care setting when intensive interventions are required several times throughout the day and then transfer to a short-term stay or rehabilitation unit in a long-term care facility for further rehabilitation. In the long-term care facility, they typically see therapists once or twice a day until they are independent enough to return to their previous home environment. Both of these situations are referred to as in-patient therapy because the rehabilitation treatment occurs in a facility where the client is staying. However, in some cases, the individual can return home and visit a therapist once or twice a week, which is referred to as out-patient therapy. Out-patient therapy is commonly prescribed for post-operative rehabilitation, such as that required for a hip, knee, or shoulder replacement.

Therapists determine the types of interventions needed and the frequency of treatments based on each individual’s situation. Therapists provide rehabilitation treatment for as long as the client continues to improve, but it will conclude when their progress plateaus (i.e., their level of function remains the same and no longer improves). Sometimes an individual is unable to achieve their prior level of functioning and must remain in a long-term care facility for assistance and supportive care for the remainder of their life. When this occurs, the individual will have a restorative care plan that is further discussed in the “Rehabilitation Versus Restorative Care” section of this chapter.