Psychiatric disability refers to a psychiatric disorder associated with functional limitations that prevent achievement of age-appropriate goals. The nomenclature and diagnostic criteria for psychiatric disabilities vary widely, however, across the mental health, rehabilitation, and social security disability systems. Common mental disorders refer to psychiatric disorders that are less disabling than serious mental illness but still impact role functioning. Depression is probably the widest-ranging psychiatric disorder in terms of severity and duration. Substance abuse disorder is among the most common co-occurring disorders in all psychiatric disabilities, affecting 50" of people with psychiatric disabilities at some point in their lifetime. Anxiety disorders are highly comorbid with other psychiatric diagnosevs, including other anxiety disorders, mood and eating disorders, and schizophrenia spectrum disorders. Victimization of people with psychiatric disabilities is a serious public health problem, as they are 11 times more likely to be victimized by violence and crime than the general population.
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Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
The ultimate purpose of rehabilitation research is to improve clinical and community-based practice and service delivery to maximize the function and quality of life of individuals with disabilities. This chapter begins with the history of rehabilitation and rehabilitation research, describes the key values that should be included in conducting rehabilitation research, and introduces some common frameworks that can assist researchers in designing and describing their studies. It also describes the current status of rehabilitation research, discusses the need for knowledge translation at all stages of the research process, and concludes with future directions. The very nature of rehabilitation is to involve multiple disciplines physiatry; physical, occupational, and recreational therapies; speech language pathology; neuropsychology; social work; nursing; and other medical disciplines. Throughout rehabilitation research, knowledge translation needs to be implemented so that decisions informing practice and future research can be made on a solid evidence base.
This chapter addresses the medical, physical, neurological, psychological, social, and vocational aspects of spinal cord injury (SCI) medicine. SCI is often associated with risk-taking behavior. The prevalence of alcohol abuse is high when compared with that of the general population. Injuries involving the cervical and thoracic spinal cord have a deleterious effect on the respiratory system. As ventilatory demand increases with activity, accessory muscles, innervated by segments of the thoracic and cervical cord, are recruited to aid in inhalation and exhalation. A spinal cord injury below the twelfth thoracic vertebrae may damage the defecation reflex and cause paralysis of the anal sphincter muscle. Through proper medical management, psychosocial support, and rehabilitation therapies as well as the patient’s motivation and family/caregiver’s participation, it is possible for a person with SCI to pursue a productive and satisfying life.
Chronic pain syndromes are composed of a multifactorial relationship between biologically based neurological triggers and pathways; psychologically mediated moods, emotions, and behaviors; and socially developed responses, interactions, and consequences. The complex interplay between these factors can devastate a patient’s quality of life, as well as make the diagnoses, treatment, and ongoing management of chronic pain syndromes by health care professionals exceedingly difficult, resulting in psychological and physical disability. In chronic pain, the imprinted signals and perceived pain may persist for several weeks, months, or even years after the original injury has healed. Treatment of chronic pain creates yet another dimension of complexity, as it requires a multimech-anistic, multimodal, or multidisciplinary approach for effective management. Chronic pain often is mixed nociceptive and neuropathic or primarily neuropathic and is associated with imprinted neuroanatomical and chemical changes in the peripheral and central nervous systems, which results in abnormal processing.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.
Neuromuscular disorders are a complex and heterogeneous group of disorders that ultimately impair the general function of the skeletal muscles. Neuromuscular disorders include disorders of the peripheral nerves, plexuses, spinal roots, motor neurons, neuromuscular junctions (NMJs), and muscles. The cornerstone of management for patients with neuromuscular disorders is rehabilitation. An effective rehabilitation program is critical not only for maintaining a patient’s quality of life but also for optimizing one’s physical and psychosocial function. Botulism is a presynaptic disorder of neuro-muscular transmission. There is a variety of therapeutic and cosmetic uses of botulinum toxin. In neuromuscular disorders it is frequently used to treat spasticity and sialorrhea. Neuromuscular electrical stimulation (NMES) is widely used in rehabilitation to prevent disuse atrophy and recover muscle mass and function in immobilized patients. There is growing evidence of safety and benefit of NMES use in many of the inherited myopathies.
Peripheral vascular disease (PVD) encompasses not only diseases of arteries and veins but also multiple underlying medical conditions such as coronary artery disease, diabetes, and renal insufficiency that are associated with, and are often the cause of, the vascular pathology. The brain, abdominal viscera, lungs, and upper and lower extremities are all end organs affected by vascular disease. After treatment of PVD, patients are often left with disabilities that require extensive rehabilitation. The broad scope of PVD may be separated into several areas. A practical organization may include lower extremity peripheral arterial occlusive disease, cerebrovascular disease, venous disease, and peripheral and abdominal arterial aneurysmal disease. Patients with PVD usually have multiple medical problems, and the nature of their disease may be chronic and involve multiple organ systems. The high incidence of limb surgery, limb loss, and stroke makes patients with PVD in particular need of rehabilitation medicine and services.
This chapter discusses integrative medicine utilizing the classification approaches devised by the National Center for Complementary and Integrative Health (NCCIH), and provides selected research findings regarding some of their most popular examples. It is no surprise to those in the modern medical field, that integrative medicine is indeed an enmeshed part of the fabric of health care approaches, whether we choose to accept them or not. It is also no surprise in the scientific communities that integrative medicine needs to continue being studied and researched to validate its integration into “mainstream medicine”. The term “integrative medicine” has been borne out of the scientific need to translate “non-conventional” health therapies and systems, to better serve modern society’s health care needs. It is no surprise that the main driver of increased use of complementary alternative medicine (CAM) derives from the demand of consumers of health care.
Health care has been transforming since its inception when public health issues were not understood, through epidemics and a plethora of infectious diseases, to today’s sophisticated medicine with its myriad levels of subspecialization. As the impact of illnesses transformed over time, so did the medical professions, the health care facilities, and the concept of insurance to assist in covering the rising cost of care. As a subset of telehealth, telerehabilitation has become a viable option for providers and payers to effectively manage rehabilitation care in the postacute environment. Although physicians are primarily focused on their clinical duty to their patient, payment methods clearly have an effect on care delivery. Examples of this, relative to bundled payments, could include the utilization of diagnostic imaging, frequency of physician office visits, inpatient length of stay, and the number of follow-up visits between hospitals and physicians.