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.
This chapter focuses on two broad types of developmental disabilities, namely, intellectual disability and autism spectrum disorder. In 1959, the American Association of Mental Deficiency now called the American Association on Intellectual and Developmental Disabilities (AAIDD) defined an intellectual disability in terms of a person’s level of intelligence and level of adaptive behavior. Intellectual disability has traditionally been divided into levels of severity, with these levels linked to the individual’s level of intellectual functioning or IQ score. In regard to classification of intellectual disability, mild intellectual disability is the most commonly diagnosed category, with it being suggested that as many as 85" of those people diagnosed as having an intellectual disability fall within this category. The three major known causes of intellectual disability are Down Syndrome, fetal alcohol syndrome, and fragile X syndrome; however, there are hundreds of other factors that have been identified as contributing to intellectual disability.
Musculoskeletal disorders (MSDs) are among the most common causes of disability in the community. Disorders of the musculoskeletal system may result from hereditary, congenital, or acquired pathologic processes. This chapter provides the clinician with an overview of the most commonly occurring musculoskeletal disorders (MSDs) affecting the working population, including low back pain, rotator cuff (RTC) tendinopathy, acromioclavicular (AC) joint arthritis, and carpal tunnel syndrome (CTS). The difficulty of treating MSDs, whether it is back pain, shoulder pain, or carpal tunnel syndrome (CTS), is the multifactorial issues that surround each condition. Although effective treatment options may be in place for the physical disorder, the overall treatment of each condition is complicated by non-occupational, emotional, and psychosocial factors. The ideal treatment includes a multidisciplinary approach coupled with effective communication regarding treatment goals and outcomes. Prevention through education and ergonometric evaluation of workstations is ideal.
Visual impairment was categorized as moderate, severe, profound, near-total, or total vision loss depending on the degree of loss of visual acuity or visual field. The main impairments affecting visual function are reduced visual acuity, visual field loss, poor contrast sensitivity, lighting and glare problems, and visual skills and binocularity problems. Visual acuity is usually written as a fraction, the numerator represents the test distance, and the denominator represents the letter size. Primary care physicians should be especially aware that, vision loss is a leading cause of falls in the elderly. Perimetry, which is the technique of measuring the visual field, uses a variety of techniques. These may include manual and automated evaluation of the entire visual field with kinetic or static stimuli. The automated perimeter has paved the way for more standardized and accurate visual field testing in all types of patients, including those with low vision.
This chapter overviews social work services from public health and boundary spanning perspectives. Social workers work to prevent negative long-term outcomes for persons with disabilities and to optimize the habilitation of the person with residual disabilities. The chapter is based on biopsychosocial framework for understanding the broad range of needs of people with disabilities and will present the epidemiology of disability in American adults. It discusses the policies that underlie disabilities support and services. Using an ecological approach, a multilevel, problem-solving approach to social work services will be defined, with special attention to services that are delivered within a family-centered perspective, which optimize use of policies, benefits, and financial resources to promote optimal rehabilitation and inclusion of the disabled person, and that integrate physical and behavioral health issues in viewing the whole person in a person-centered care approach.
Chronic renal failure poses a singular challenge for health professionals who deal with illness-related disability and rehabilitation. The course of progressive chronic kidney disease (CKD) leading to renal failure often spans many years; during the period before dialysis or renal transplantation is undertaken, the patient may experience disabilities related to cardiovascular disease, anemia, malnutrition, metabolic bone disease, neuropathy, muscle wasting, and acid-base and electrolyte disturbances. Dialysis treatment and transplantation significantly prolong the lives of patients with renal failure. A better understanding of the pathophysiological basis for many of the disabling aspects of chronic renal failure has led to therapies that may reduce the frequency and/or severity of these aspects of the disease. Prevention of disability and rehabilitation has become increasingly important as the number of patients treated with dialysis therapy and renal transplantation has become more common.
Stroke is a common and prevalent disease. Stroke presents a greater burden of disease to minority populations and older patients. Ischemic strokes can be caused by a variety of disease processes including small vessel disease, large vessel disease, and cardioembolism. Small vessel strokes are present in 25" of ischemic stroke patients. They result from damage that occurs to the small, nonmuscular, perforating arteries that branch from the middle cerebral and basilar arteries. This damage occurs from sustained damage to the vessels from chronic diseases such as hypertension, diabetes, and hyperlipidemia. Over time, these vessels can become occluded through a process called lipohyalinosis, causing strokes. While many of these strokes are silent and without any clear clinical correlates, some can result in severe acute neurologic symptoms such as unilateral weakness and unilateral numbness.
This chapter highlights the selected nursing care topics based on themes that span various disabilities and are essential to the patient’s rehabilitation process. The scope of rehabilitation nursing care is broad; hence, the topics selected are core elements related to basic human needs with an overarching perspective of psychosocial health, which is vital to the patients’ recovery. The rehabilitation nurse’s practice is guided by both standards of practice and standards of professional performance to which the nurse is held accountable. The standards of practice refer to a “competent level of nursing care as demonstrated by critical thinking model known as the nursing process”. These practices include assessing, diagnosing, planning, and implementing aspects of patient care, educating patients and their families, identifying patient outcomes, and coordinating care. The rehabilitation nurse works with the emotional, as well as the physical, aspects of the patient’s condition.
Quality in health care refers to a systems approach to evaluating and improving the health of the individuals served and is closely linked to quality improvement (QI) as an ongoing process of problem identification, intervention, evaluation, and further refinements in service delivery. QI strives for measureable improvements in services and health status of targeted patient groups. Significant variations in health care services have been well documented in various areas including stroke rehabilitation, brain injury outcomes, and the management of acute myocardial infarctions, hip fractures, colon cancer, diabetes, and depression, along with surgical procedures such as coronary artery bypass graft, hysterectomies, and spinal procedures. Risk-adjusted rehabilitation functional outcomes vary by insurance type, geographic region, and race/ethnicity. The variations in patient outcomes, high rates of medical errors, and heath care costs imply that changes in service delivery could lessen these disparities and improve the overall quality of care.
Rheumatic diseases encompass all disorders in which some portion of the musculoskeletal system, including synovial joints, periarticular structures, or muscle, is involved. Arthritis is the general term used when the joint disease predominates in the patient’s illness. This chapter reviews rheumatic diseases in detail, rheumatoid arthritis, spondyloarthropathies, and particularly degenerative joint disease, are chronic disabling forms of arthritis that afflict otherwise healthy working adults. Rheumatoid arthritis is an autoimmune disease in which the normal immune response is directed against an individual’s own tissue, including the joints, tendons, and bones, resulting in inflammation and destruction of these tissues. The cause of rheumatoid arthritis is not known, but current evidence suggests that the initiating event is an immune reaction to a foreign antigen such as a virus or bacteria. In an individual with the genetic susceptibility for rheumatoid arthritis, this normal immune response is unchecked, perpetuating the inflammatory response.
The Renaissance era brought advancements in the technical study and understanding of disability and disease especially in terms of anatomy and the study of kinetics. In addition, the Renaissance period also put forward the practice and idea of disability prevention using “medical gymnastics”. Medical gymnastics was the term used at the time to describe therapeutic exercises designed with the aim of helping patients recover from a physical disability or impairment. Rehabilitation is a process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, vocational, social, and functional potential. The most common causes of impairment and disability include chronic diseases such as diabetes, cardiovascular disease, cancer, traumatic injuries, mental impairments, birth defects, malnutrition, HIV/AIDS, and other communicable diseases. These conditions are creating overwhelming demands for health and rehabilitation services (WHO). Managing these conditions is one of the biggest challenges of health care system.
This chapter reviews medical, psychosocial, and vocational implications of epilepsy as a disability. Epilepsy is the fourth most common neurological condition in the United States. The common risk factors for developing epilepsy include febrile seizures during childhood, brain lesions, head trauma with loss of consciousness, meningitis, encephalitis, and a family history of seizures. Several chromosomal derangements, genetic mutations, inborn errors of metabolism, and neu-rophakomatoses are commonly associated with epilepsy. Epilepsy is also common in patients with developmental delays, cerebral palsy, autism, and learning disabilities. About 50" of patients with intellectual disabilities with an IQ less than 50 have epilepsy. Epilepsy with seizures originating in the temporal lobe is more common than frontal lobe epilepsy. Parietal and occipital lobe epilepsy represent a very small percentage of epilepsy syndromes. Patients with epilepsy (PWEs) may or may not have a preceding aura, but the presence of an aura favors possible focal epilepsy.
Cardiovascular disorders constituted a major health epidemic in the 20th century and will continue to do so in the 21st century also unless effective measures are taken to control or eliminate this epidemic. Cardiovascular disorders are those that affect the heart and the vascular system. The coronary arteries are deemed to be the most important blood vessels in the body because they supply blood to the heart itself. Cardiovascular disorders, resulting from primary disease of the coronary arteries, are the single leading cause of death in the United States today. The risk factors for coronary atherosclerosis are abnormal blood lipids, high blood pressure, cigarette smoking, diabetes, obesity, and a sedentary but stressful life style. Depression has been determined to be a separate and independent risk factor. Ischemic chest pain, or angina pectoris, is one cardiac symptom in cardiac patients.
Assistive technology (AT) provides powerful tools used to diminish disability, enable activities of daily living (ADLs), and promotes recreational and vocational pursuits. This chapter serves as an introduction to AT tools, patient assessment, person-centered application of AT and resources for patients, and clinicians alike. AT can increase independence, improve quality of life, and aid persons with disabilities in accomplishing educational and vocational pursuits. Although there are an increasing number of commercial technology and fee-based “add-on” programs available to meet the needs of persons with disabilities, this chapter emphasizes emerging technologies and basic complementary computer-based commercial applications, which are commonly found as part of standard operating systems. Computer technology, including Internet applications, serves as an indispensable tool to enhance vocational reentry and personal satisfaction. The chapter has a major emphasis on profiling specific AT solutions that enhance prognostic efficacy of vocational rehabilitation programs.
Treatment of cancer is specific to the type of cancer, its primary location, and the extent to which it has spread throughout the body, but general principles are applied to all cancer types. From the time of diagnosis to the start of treatment, most patients have encountered a surgeon, radiation oncologist, a medical oncologist, and, ideally, a rehabilitation physician. Although patient survival has increased as a result of earlier detection and newer treatment modalities, the actual treatment process can result in other medical problems such as anemia, impaired cognition, and neuropathies that can seriously compromise patients’ ability to function in their everyday lives. Many of these adverse effects of treatment are often best addressed by rehabilitation specialists, who are becoming increasingly recognized as vital members of the multidisciplinary team that comprehensively cares for the cancer patient.
This chapter discusses the relationship between the clinically observed “plaques and tangles” of Alzheimer’s disease (AD) and the observed behavioral course of AD. In the United States, AD is the sixth leading cause of death for all age groups, after heart disease, cancer, respiratory diseases, accidents, and stroke. Studies have indicated that a large majority of the approximately 1.4 million residents in nursing homes in the United States manifest a dementia syndrome generally associated with AD. The clinically observable symptomatology of AD dramatically changes in form from the earliest manifest deficits to the most severe stage; therefore, recognition and differentiation of the stages of this illness are imperative for proper diagnosis, prognosis, management, and treatment. Anger and other more overt behavioral symptoms of AD, such as anxieties, paranoia, and sleep disturbances, are frequently evident.
- Go to chapter: Organ Transplantation and Rehabilitation: Process and Interdisciplinary Interventions
This chapter focuses on the four most common solid organ transplants seen in rehabilitation medicine: liver, renal, cardiac, and pulmonary. Liver transplantation is indicated for acute liver failure, chronic liver failure leading to cirrhosis, inherited metabolic liver diseases, hepatocellular carcinoma (HCC), and other hepatic cancers. Renal transplantation is the treatment of choice for patients with end-stage renal disease (ESRD). Renal or kidney transplantation is a surgical procedure during which a diseased kidney is replaced by a healthy kidney from another person. Cardiac transplantation is a major surgical procedure utilized for persons with cardiomyopathy, coronary artery disease, congenital heart disease, retrotransplant/graft failure, valvular heart disease, and other serious cardiac conditions unresponsive to other forms of medical management. Application of a structured pulmonary rehabilitation (PR) program following lung transplantation (LT) is regarded to be an essential component of “best practice management”.
Limb deficiency is a complete or partial loss of an upper or lower limb. This chapter focuses on the lower-limb deficiency. It describes individuals with an upper-limb deficiency, focusing on etiology, amputation levels, pre- and postoperative management, prostheses, and prosthetic training. Lower-limb deficiency is most commonly due to vascular disease. An episode of acute arterial insufficiency can lead to gangrene. Small-vessel occlusion may also progress to ulcers over pressure points, infection of the skin, cellulitis, and bone, osteomyelitis, as well as gangrenous changes in the distal lower limbs. Individuals with vascular disease often undergo several procedures in an attempt to salvage the involved limb. Traumatic limb loss is most often secondary to motor vehicle or industrial accidents. Loss of a limb produces a permanent disability that can have a devastating effect on a persons’s self-image, self-care, and mobility.
This chapter discusses cerebral palsy and spina bifida, two of the more common handicapping conditions of childhood, and the strategies that allow for appropriate medical treatment and rehabilitation. Children with spina bifida and cerebral palsy require attention to their psychological issues and neuropsycho-logical challenges to facilitate both rehabilitation courses and general functioning within a community setting. Cerebral palsy is a descriptive clinical term that denotes a group of static encephalopathies of diverse etiologies resulting from nonprogressive lesions of the brain sustained in the prenatal, perinatal, or postnatal periods. The disorder is characterized by abnormalities in muscle tone, muscle control and movement, and postures, of which spasticity is the most common type of presentation, occurring in 65" to 80" of cases. Spina bifida, or myelomeningocele, denotes a condition in which there are congenital abnormalities of the vertebral elements in association with extrusion of abnormally formed neural elements.
This chapter overviews each state workers’ compensation law with an explanation of issues, concerns, or critical areas in service delivery that may arise from it. It aims to contribute to the ability of rehabilitation professionals to assist employers and individuals with disabilities in navigating this maze. Assisting the individual through rehabilitation process to return to productive functioning in the community and in the workplace is the core of the rehabilitation professional’s job. When employment outcomes are part of the rehabilitation goal, knowledge of regulatory requirements that surround the workplace and have an effect on employer and employee behavior is vital for the rehabilitation professional to function effectively. The chapter highlights some of possible areas of conflict or concern that may influence both worker and employer behaviors and has provided a basic introduction for practitioners to pursue further information, given the nature of their services and interventions for persons with disabilities.
This chapter reviews the medical aspects of traumatic brain injury (TBI) with attention paid to its epidemiology, etiology, mechanisms of injury, measurement of injury severity, and potential complications. It discusses the role of an interdisciplinary treatment team in addressing the unique cognitive and behavioral rehabilitation needs of individuals with varying severity of TBI in both the acute inpatient rehabilitation setting and in the community. A TBI often results in devastating and lifelong challenges that can impact a person’s physical, cognitive, and psychological functioning. TBIs occur worldwide resulting in many deaths, mortality, as well as in significant disability and dysfunction, morbidity, within a subset of every nation’s population. Substance abuse often plays an indirect role in the onset of a TBI. The most widely used substance is alcohol, with more than 50" of patients who experience a TBI found to have elevated blood alcohol levels at the time of injury.
This chapter reviews specific conditions that may create disability in persons infected with HIV. HIV is caused by one of two retroviruses, HIV-1 or HIV-2, the former being more common worldwide and leading to a hastier decline in immune function. The hallmark of HIV disease is a profound immunodeficiency that results from a progressive quantitative and qualitative deficiency in the subset of T lymphocytes known as T-helper, or cluster of differentiation 4+ (CD4+), cells. Peripheral nerve damage is the most common neurological complication for individuals with HIV/ AIDS. The most common form of peripheral neuropathy in this patient population is distal symmetric peripheral neuropathy (DSPN). Didanosine and stavudine, drugs previously used to treat HIV, are no longer recommended because of their potent neurotoxic effects. Symptoms may include allodynia, which is a painful response to a stimulus that is not typically painful.
For the rehabilitation industry, it is suggested that a rehabilitation-focused accreditation quality model is the best fit as a quality framework for advancing the performance of organizations that provide medical rehabilitation services. In an era where health care expenditures are so significant, value-based rehabilitation in a pay-for-performance environment may be the only way to competitively lower care costs, improve care quality, and drive better patient outcomes. The accreditation model provides the blueprint to cost containment through outcomes. To understand and appreciate the value of accreditation for medical rehabilitation as a quality framework, it is important that accreditation be considered within its evolutionary context in relation to the dynamics of the broader health care industry. Accreditation as a quality framework was constructed by the rehabilitation industry in response to environmental pressures to demonstrate a commitment to quality.
This chapter discusses telerehabilitation and focuses on the challenge of sustainability. It also reviews programs and concepts from a clinical framework: patient-to-clinician telerehabilitation, clinician-to-clinician telerehabilitation, programmed therapy, and apps. Telerehabilitation (TR) is within telehealth-care along with telehomecare, telenursing, and telecoaching. Telerehabilitation seeks to access and enhance patient function by connecting members of the interdisciplinary team to patients for assessment and therapy using adjunctive equipment in the home or community as needed. Telemedicine brings clinical care to the patient in their own environment. This is a potent tool for the interdisciplinary team to sustain the rehabilitation process in the home and community. For patients with brain injury, cognitive rehabilitation that occurs within the patient’s home and community accomplishes greater patient initiation and insight into deficits through self-comparison to past function. Rehabilitation models help to clarify the focus and impact of interventions in planning.
Diabetes mellitus is a pandemic affecting more than 380 million people worldwide, posing significant public health challenges. Diabetes can be classified into many categories and subtypes. Type 1 diabetes is due to beta cell destruction in the pancreas and an ultimate deficiency of insulin. Type 2 diabetes is a result of a progressive defect in the secretion of insulin and insulin resistance. Gestational diabetes mellitus (GDM) is generally diagnosed in the second and third trimester of pregnancy. The last category is characterized by specific types of diabetes, which are due to other medical causes. These include individuals with genetic defects in beta cell function, genetic defects in insulin action, exocrine pancreatic diseases such as cystic fibrosis, and drug- or chemical-induced diabetes caused by medications used for HIV/AIDS and after organ transplantation.
Blood contains a variety of mature differentiated cells that have specialized functions. Cancers that develop because of abnormal proliferation of the white blood cells in the blood are known as leukemia, and in the lymph nodes are called lymphoma. Multiple myeloma is the type of hematological cancer derived from a single plasma cell that has undergone malignant transformation. The plasma cell is an immunoglobulin-secreting cell that helps fight off foreign “invaders”. Treatment for multiple myeloma is focused on control of the clonal plasma cell population and consequently decreases the signs and symptoms of disease. Hemostasis is the process by which blood clots in response to injury to the vessels. Patients with thalassemia have widely variable clinical presentations, ranging from nearly asymptomatic to severe anemia requiring lifelong blood transfusions with complications in multiple organ systems.
The total surface area of the average person’s skin spans approximately 20 square feet and makes up 16" of the total body weight. It provides sensory function and interface with the environment. Because of these physiological functions, an injury to the skin such as a burn can be devastating to the body. Burn rehabilitation is a dynamic process that requires a skilled therapist. Phases of rehabilitation have been described as emergent, acute, skin grafting, and rehabilitative. The purpose of orthotic fabrication during the rehabilitation phase is to preserve ROM by opposing the force of the contracting scar, usually during periods of patient inactivity. Both static and static progressive orthoses are utilized but in some cases, dynamic orthosis may be beneficial. A serial digit extension orthosis and/or casting fabrication should be considered during the rehabilitation phase when wounds are less of a concern.
This chapter reviews some of the basics of pulmonary anatomy, physiology, and pathophysiology as they relate to some of the more common chronic pulmonary disorders that cause long-term disability. It describes some the epidemiologic aspects associated with these disorders, morbidity and mortality issues, etiologies, clinical characteristics, functional limitations, medical evaluation, and methods to assess disability. The chapter provides significant insight into the issues concerning the medical aspects of pulmonary disability. During normal unforced exhalation, the natural elasticity of the lungs, known as elastic recoil pressure, causes the lungs to deflate or contract, thereby expelling the air. However, in many pulmonary disorders such as chronic obstructive pulmonary disease (COPD) and asthma there is obstruction to airflow. Spasm of the smooth muscle lining the respiratory tract, edema or swelling of the airways, excessive mucus production, and compression or collapse of the bronchi and bronchioles all contribute to airflow obstruction particularly during expiration.