Introduction

Rehabilitation helps people recover lost function. Many people think of rehabilitation in terms of recovering a physical ability (physical rehabilitation). But it can include any therapy or service that helps people function better and more independently. Rehabilitation may include doing physical exercises, using devices that make doing activities easier, modifying the person's living environment, and teaching family members how to help the person.

Most people who have been disabled can benefit from rehabilitation. A disability is any reduction in the ability to function requiring a change in normal daily activities. Conditions that can disable people include a stroke, hip surgery, replacement of a knee, amputation of a limb, a severe injury, an infection, cancer, or a chronic progressive disorder (such as arthritis). Even a few days of bed rest (for example, after surgery) can cause muscles to become weak and stiff and result in disability.

After an illness, an injury, or surgery, rehabilitation is particularly important for older people. Rehabilitation helps them remain independent—able to live on their own and take care of themselves.

Services and Settings

Which therapies and services are used in rehabilitation depends on the person's needs. Physical therapy, occupational therapy, recreational therapy, and speech therapy are commonly used. Some people need social services, such as help finding appropriate services or home care after discharge from the hospital. Rehabilitation can also involve techniques to relieve pain and inflammation, which can interfere with the movements required by therapy.

Because rehabilitation can include so many services, it is usually provided by a team of health care practitioners. The rehabilitation team may include doctors, nurses, therapists, psychologists, and social workers, as well as the person and family members. Sometimes specialists who fit braces and supportive devices (orthotists) or who fit replacements for body parts (prosthetists) are also included.

The severity of the person's disability determines the type of rehabilitation program. Programs may be informal. In such cases, the person's primary care doctor may provide an exercise program directly to the person or family members. Or programs may be formal, requiring a referral (similar to a prescription) from the person's doctor. The referral may be to a doctor who specializes in rehabilitation (physiatrist), an occupational or a physical therapist, or a rehabilitation center.

If the disability is severe, rehabilitation in a hospital or rehabilitation center is needed. If the disability is milder, rehabilitation can be started in other places, such as a nursing home, a clinic, a doctor's office, or the person's home.

For people who have been hospitalized, rehabilitation is usually started in the hospital. It may be continued at a rehabilitation center, where the person stays for a relatively short time, usually several days to several weeks. When possible, it is then continued elsewhere. Sometimes people can continue the exercise programs set up during rehabilitation at fitness centers.

Rehabilitation can occur at home if a person understands instructions and can transfer from a bed to a chair without help or with help from one person. Rehabilitation at home is desirable for several reasons. The person can learn how to function at home under normal living conditions. The person may be more comfortable at home. Also, the home can be assessed in terms of the person's limitations and, if needed, modified. Family members or a caregiver can be trained to help with rehabilitation. Sometimes a visiting physical therapist, occupational therapist, or home health aide can help. However, rehabilitation at home can be physically and emotionally taxing for all involved. Family members may become exhausted, funds for outside help may be limited, or therapists may be unable to come as often as needed.

Goals of Rehabilitation

The immediate goals of rehabilitation are to help people become independent and to prevent them from losing the ability to function.

The long-term overall goal of rehabilitation is usually to enable people to function as well as they did before the problem that prompted rehabilitation. This goal may mean something different for older people than it does for younger people. For example, older people may have a chronic disorder, such as heart failure, that already limits their ability to function. If they have a stroke or a hip fracture, functioning as well as before may simply mean being able to take care of basic needs: eating, dressing, bathing, moving (transferring) between a bed and a chair, and using the toilet without help from others. (Such activities are called basic activities of daily living.)

Before rehabilitation is started, the therapist or another rehabilitation team member reviews what the long-term overall goals are and how long rehabilitation is expected to take. Then the person can better understand what to expect from rehabilitation. Specific short-term goals and a time frame for accomplishing each goal are also discussed. For example, goals may be to enable the person to move a shoulder more freely, to walk better, to eat without assistance, and to open a jar. Team members encourage the person to achieve each short-term goal, and they track the person's progress. The goals of rehabilitation may be changed if the person progresses more rapidly or slowly than expected or if rehabilitation has to be cut short because the person is unwilling or unable (financially or otherwise) to continue.

Outcome and Support

Regardless of the severity of the disability or the skill of the rehabilitation team, the person's motivation greatly influences the final outcome. Many older people have doubts about their ability to recover. Family members and friends may need to help with motivation.

Rehabilitation for people who have depression may take longer. Sadness or lack of interest blunts the motivation to improve. For people with dementia, rehabilitation may be particularly difficult because they cannot understand what they need to do or why. However, people with dementia can often benefit from rehabilitation if it is tailored to their needs.

Rehabilitation programs designed specifically for older people can be helpful. Then older people will not be tempted to compare their progress with that of younger people. Doing so can be discouraging. Programs that are designed for a particular situation (such as recovery after hip surgery) can also be helpful. Then people with similar problems can empathize with, encourage, and help each other.

Family members and friends are taught to enable the person to be as independent as possible. If they help or protect the person too much, the person may lose improvements in function gained through rehabilitation. The person may become more dependent on others than is necessary—a quality called learned helplessness. On the other hand, if family members and friends do not help when help is needed, the person may be injured, give up trying to function independently, or become depressed.

See the sidebar Devices That Help People Function.