Rehabilitation – types, course, benefits. What is rehabilitation?

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Fitness is extremely important for all of us. It is needed for everyday professional and private activities. However, it sometimes happens that as a result of serious accidents or diseases, the efficiency is lost. In such a situation, the only solution is sometimes appropriate rehabilitation.

What is rehabilitation?

Rehabilitation is defined as “the procedure to restore physically and mentally disabled persons to function in society”.

Put simply, rehabilitation helps a child, adult or older person to be as independent as possible in daily activities and enables participation in education, work, recreation and important life roles such as caring for the family. It does this by addressing underlying problems (such as pain) and improving the way the individual functions in daily life, helping them to overcome difficulties in thinking, seeing, hearing, communicating, eating, or moving.

Everyone may need rehabilitation at some point in their life after an injury, surgery, illness, or when their functioning has deteriorated with age.

Some examples of rehabilitation include the following suggestions.

1. Exercises to improve the speech, language and communication of a person with a brain injury.
2. Modifying an elderly person’s home environment to improve their safety and independence at home and reduce the risk of falls.
3. Exercise training and healthy lifestyle education for a person with heart disease.
4. Performing, adjusting and educating a person in the use of a prosthesis after an amputation of a leg.
5. Positioning and splint techniques to aid skin healing, reducing swelling, and restoring movement following burn surgery.
6. Prescribing medications to reduce muscle stiffness in a child with cerebral palsy.
7. Psychological support for a depressed person.
8. Training in the use of a white cane for a person with vision loss.

Rehabilitation is strongly patient-centered, meaning that the interventions and approach chosen for each person depend on their goals and preferences. Rehabilitation can be provided in many different settings, from inpatient or outpatient hospitals to private clinics, or social settings such as a person’s home.

Rehabilitation staff consists of a variety of healthcare professionals including, but not limited to, physical therapists, occupational therapists, speech therapists and audiologists, orthotics and prosthetists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses.

The duration of the recovery depends primarily on the patient’s condition – with significant disability, the rehabilitation process will be longer and more intensive.

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Benefits of rehabilitation

Rehabilitation can reduce the impact of many medical conditions, including diseases (acute or chronic) or injuries. It can also complement other health interventions such as medical and surgical interventions, helping you achieve the best possible result. For example, rehabilitation can help reduce, manage, or prevent complications from many conditions, such as a spinal cord injury, stroke, or fracture.

Rehabilitation helps minimize or slow down the disabling effects of chronic conditions such as cardiovascular disease, cancer and diabetes by equipping people with the self-healing strategies and support products they need or by managing pain or other complications.

Rehabilitation is an investment that benefits both individuals and society. It can help you avoid costly hospitalization, reduce hospital stays, and prevent re-admission to hospital. Rehabilitation also enables people to participate in education and gainful employment, remain independent at home, and minimize the need for financial or caring support.

See also: Degrees of disability

Misconceptions about rehabilitation

Rehabilitation is not only for people with long-term or physical disability. Rather, rehabilitation is an essential health service for anyone with an acute or chronic health condition, disability, or trauma that restricts functioning, and as such should be available to anyone who needs it.

Rehabilitation is not a luxury health service available only to those who can afford it. Nor is it an optional service that should only be tried when other preventive or cure interventions have failed.

To achieve the full range of social, economic and health benefits of rehabilitation, high-quality and affordable rehabilitation interventions should be available to all in a timely manner. In many cases, this means starting rehabilitation as soon as your health is ascertained and continuing rehabilitation along with other health interventions.

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What is rehabilitation after a stroke?

A stroke can happen to anyone when they least expect it. When it happens, there is no way to completely undo the changes that have occurred. The only solution is rehabilitation after a stroke. It should be implemented as soon as possible. Early treatment and rehabilitation after stroke helps many people recover much of their former fitness. Improvement occurs within the first six months after treatment, but can take years.

The main goal of rehabilitation after a stroke is to return to independent functioning as soon as possible.

Functional changes after a stroke will depend on which part of the brain has been damaged and to what extent. The latest data shows that after a stroke, just over a third of people suffer from a disability that affects their daily activities.

There are many approaches to rehabilitation after a stroke. The rehabilitation plan will depend on the part of the body or type of ability affected by the stroke.

Physical activity may include:

1. Motor exercises. These exercises can help improve muscle strength and coordination.
2. Mobility exercises. The patient can learn to use aids such as a walker, canes, wheelchair or ankle brace. Ankle brace can stabilize and strengthen the ankle, helping to maintain your body weight as you learn to walk again.
3. Forced movement therapy. The intact limb is immobilized during the exercise of moving the affected limb to improve its function.

Technology-assisted physical activities may include:

1. Functional electrical stimulation (FES). An electric current acts on weakened muscles and causes them to contract. Electrical stimulation can help re-educate muscles.
2. Automated technology. Automated devices can assist damaged limbs with repetitive movements, helping them regain strength and function.
3. Wireless technology. An activity tracker can help you get more active after a stroke.
4. Virtual reality. Using video games and other computer therapies involves interacting with a simulated real-time environment.

Cognitive and emotional activities may include:

1. Therapy of cognitive disorders. Occupational therapy and speech therapy can help with cognitive decline such as memory, processing, problem solving, social skills, situational awareness, and safety awareness.
2. Therapy of disorders in communication with the environment. Speech therapy can help you regain lost speaking, listening, writing, and comprehension skills.
3. Psychological assessment and treatment. The emotional adjustment of the patient can be tested. The patient may also consult a psychologist or participate in a support group.
4. Anxieties. Your doctor may recommend an antidepressant or medication that affects alertness, agitation, or movement.

The duration of post-stroke rehabilitation depends on the severity of the stroke and the complications associated with it. Some people recover quickly after a stroke. However, most of them need some form of long-term rehabilitation that can take months or years. The post-stroke rehabilitation plan will change as you recover as you re-learn your skills and your needs change. With continuous practice, he can continue to reap the benefits over time.

Healthcare professionals who may be part of a stroke patient rehabilitation team include:

1. Doctors. Primary care physicians – as well as neurologists and physical medicine and rehabilitation specialists – can guide patient care and prevent complications. These doctors can also help you establish and maintain a healthy lifestyle to avoid another stroke.
2. Nurses. Nurses who specialize in caring for people with limited activity can help integrate the acquired skills into everyday activities.
3. Physiotherapists. These therapists will help re-teach the patient to movements such as walking and balancing.
4. Occupational therapists. These therapists will help the patient re-learn how to use the hands and arms in daily activities such as bathing, tying shoes, or buttoning up a shirt. Occupational therapists can also deal with swallowing and cognitive problems and home safety.
5. Speech therapists. These specialists will help you improve your language skills and swallowing ability. Speech therapists can also work with the patient to develop tools for solving problems with memory, thinking, and communication.
6. Psychologists. These specialists assess thinking skills and help solve mental and emotional health problems.

Recovery from a stroke varies from person to person. It’s hard to predict how many skills you can recover and how quickly. Overall, successful rehabilitation after a stroke depends on:

1. Physical factors including the severity of your stroke in terms of cognitive and physical effects.
2. Emotional factors such as motivation and mood, and the ability to stick to rehabilitation activities outside of therapy sessions.
3. Social factors such as support from friends and family.
4. Therapeutic factors including early initiation of rehabilitation and the skills of the rehabilitation team.

The rate of recovery is usually greatest in the weeks and months after a stroke. However, there is evidence that performance can improve up to 12 to 18 months after a stroke.

What is cardiac rehabilitation?

Cardiac rehabilitation is necessary in the case of cardiovascular diseases. It includes comprehensive measures aimed at preventing heart diseases, treating and improving the quality of life and functioning of the patient. The aim is also to minimize the progression of heart disease and reduce mortality from cardiovascular disease.

The first stages of most cardiac rehabilitation programs generally take about three months, but some people will take longer to complete the program. In certain circumstances, some people may be able to follow an intensive program for several hours a day, which may last one or two weeks.

During cardiac rehabilitation, the patient is likely to work with a team of health professionals, possibly including cardiologists, educational nurses, nutrition specialists, physical exercise specialists, mental health specialists, and physical therapists and occupational therapists.

Cardiac rehabilitation is based primarily on:

1. Medical Assessment. The healthcare team will usually conduct an initial assessment to check the physical abilities, medical limitations, and other medical conditions the patient may have. Ongoing assessments can help the team track progress over time. During the evaluation, your healthcare team can look at risk factors for heart complications, especially during exercise. This will help the team tailor the cardiac rehabilitation program to the patient’s needs, making sure it is safe and effective for them.
2. Physical exercise. Cardiac rehabilitation can improve cardiovascular fitness through exercise. Your healthcare team will likely suggest low-impact activities that have a lower risk of injury, such as walking, cycling, rowing, and running. Your program may include yoga, which has been shown to be beneficial for heart health in some studies. The patient usually exercises at least three times a week. Your healthcare team will likely teach you proper exercise techniques, such as warming up. You can also do muscle strengthening exercises, such as weight lifting or other resistance exercises, two or three times a week to increase muscle performance.
3. Lifestyle education. This includes support and education about making healthy lifestyle changes, such as eating a healthy diet, exercising regularly, maintaining a healthy weight and quitting smoking. It can provide advice on how to deal with conditions such as high blood pressure, diabetes, high cholesterol, and obesity. It is likely that the patient will have the opportunity to ask questions about issues such as sexual activity. They will also need to continue taking the medications prescribed by their doctor.
4. Psychotherapy. It often takes time to adjust to a serious health problem. The patient may feel depressed or anxious. If he becomes depressed, it cannot be ignored. Depression can hinder a cardiac rehabilitation program and can affect a patient’s relationship and other areas of his life and health. Psychotherapy can help him learn healthy ways to deal with depression and other feelings. Your doctor may also suggest taking antidepressants or other medications. Occupational or occupational therapy can teach a patient skills that will help him get back to work.

Although it can be difficult to start a cardiac rehabilitation program when the patient is unwell, you can benefit in the long run. Cardiac rehabilitation can guide him through fear and anxiety as he returns to an active lifestyle with more motivation and energy to do the things he enjoys.

Cardiac rehabilitation can help you rebuild your life, both physically and emotionally. As we grow stronger and learn to cope with our disease, we are likely to return to our normal routine with a new diet and exercise habits.

See also: Don’t let yourself have another heart attack

Spine rehabilitation

Rehabilitation of the spine is not only an important element in the treatment of degenerative changes, but also rheumatic ones. It is recommended primarily after injuries, surgeries and discopathy.

Rehabilitation of the spine consists in influencing these sections with appropriately adjusted physical force, and also in the use of:

1. hydrotherapy – which uses water for pain relief and treatment. It covers a wide range of therapeutic approaches and methods that use the physical properties of water, such as temperature and pressure, for therapeutic purposes to stimulate blood circulation and heal symptoms of certain diseases. Therapies used in modern hydrotherapy include: water jets, underwater massage and Kneipp paths.
2. brine baths – they are baths in sodium chloride water of various concentrations, most often from 1,4% to 6%. Salt baths affect the blood vessels of the skin, causing them to be strongly hyperemic. The effect of brine on nerve endings and blood vessels increases with its concentration.
3. whirlpool massages – carried out in specially designed bathtubs, differing in shape and size. The mechanically driven devices inside them make the water rotate. This movement, in turn, affects the skin superficially with slight irritation and increases its congestion. The body resists the resistance of the whirlpool of water by tensing the muscles – thereby increasing congestion. The water temperature ranges from 37 – 38 degrees and the procedure itself takes 15 minutes.
4. shower massage – the so-called Scottish whips, involving the use of a water stream under a pressure of 1,5 to 3 atm. The procedure is performed standing up and on the back surface of the body approximately 4 meters from the spray cathedral. The treatment uses alternating effects of cold and hot water (alternating between water at 37-42 degrees Celsius for one minute and water at 10-15 degrees Celsius for 15 seconds).
5. underwater massage – it consists in the use of a special bathtub with properly arranged nozzles, with different holes and diameters, thanks to which it is possible to direct the water stream to specific parts of the body. It has the effect of improving blood circulation and supporting the lymph flow. In addition, it relaxes the muscles, supports metabolism and improves metabolism.

Another method of spine rehabilitation is application cryotherapy involving the use of extremely low temperatures to obtain a therapeutic effect. The treatment can be used locally as well as generally.

See also: Frequent infections, low mood? Brine to the rescue!

Neurological rehabilitation

Neurological rehabilitation includes a set of activities aimed at improving the health of patients after:

1. vascular disorders such as stroke, bleeding in the brain, or transient ischemic attacks;
2. infections such as meningitis, encephalitis, polio, and brain abscesses;
3. injuries, such as trauma to the brain and spinal cord;
4. structural or neuromuscular disorders such as Bells (facial nerve) palsy, cervical spondylosis, carpal tunnel syndrome, brain or spinal cord tumors, peripheral neuropathy, muscular dystrophy, myasthenia gravis and Guillain-Barré syndrome;
5. functional disorders such as headache, seizures, dizziness and neuralgia;
6. degenerative disorders such as Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), Alzheimer’s disease, and Huntington’s disease.

The goal of neurological rehabilitation is to restore all the essential functions that the patient has lost due to the disease, and to prevent relapse and progression of the disease.

To help achieve these goals, a rehabilitation program may include:

1. Assistance with daily activities such as eating, dressing, bathing, using the bathroom, inking, cooking and basic cleaning;
2. Speech therapy to aid in speaking, reading, writing, or swallowing;
3. Managing stress, anxiety and depression;
4. Activities to improve movement, muscle control, walking and balance;
5. Exercise programs to improve movement, prevent or reduce weakness from lack of exercise, relieve muscle spasms and pain, and maintain range of motion;
6. Retraining of social and behavioral skills
7. Dietetics;
8. Involvement in community support groups;
9. Actions to correct problems with concentration, attention, memory and poor evaluation;
10. Assistance in obtaining assistive devices that support independence;
11. Security measures and home care needs
12. Coping with pain.

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Knee rehabilitation

Knee rehabilitation must be started as early as possible. The best results are obtained with isometric exercises involving the systematic contraction of the quadriceps muscle.

For this purpose, for example, several times a day, you can first straighten your foot and point your toes towards the knee, and then gently lift the leg up, not too high. The exercise shouldn’t be painful, assuming it’s done correctly, of course. Thanks to the exercises, the patient will not experience muscle wasting from the so-called inactivity. When the immobilization is removed from the knee, the patient can exercise more intensively without fear of injury. Remember only to exercise in moderation and adjust the effort to the capabilities of your joint.

Knee rehabilitation also includes physical therapy treatments such as:

1. electromagnetic field – a special device that generates an electromagnetic field is applied to the skin of the knee to reduce swelling and pain in the joint.
2. Interferential currents – this is a type of current that overlaps one another deep down in the body. The current from 4 electrodes applied to the affected area has anti-inflammatory and analgesic properties.
3. sonophoresis – involves the use of ultrasound. It has an analgesic and anti-inflammatory effect.
4. iontophoresis – two electrodes are placed against the knee. One of them is pre-soaked with a drug (e.g. anti-inflammatory). After activating the device, an electric field is created between the electrodes, which through the skin, directly into the sick place, as if forcing the drug. 
5. kinesitherapy – it is a type of gymnastics performed under the supervision of a physiotherapist, adapted to the form and type of joint damage (e.g. exercises without load, with a load, in a swimming pool).
6. Cryotherapy – involves the use of a nozzle from which nitrogen vapor is released, cooled to -160 degrees C. It cools the diseased tissues, eliminating pain and inflammation.

In the rehabilitation of the knee joint, one should be aware that unfinished treatment or interruption of rehabilitation may end very badly for the patient. The effect will be the further development of the disease, the formation of permanent exudate edema and the destruction of the joint by the formation of permanent degenerative changes causing pain and significantly limiting the mobility.

Rehabilitation is a long process and may take many months, the patient must be patient. It may be a consolation that when it comes to tears and strains of ligaments, these heal fully, leaving no permanent marks. In the case of major injuries, these can be felt even after many years. Permanent damage to the knee joints is not removable, so the patient must exercise carefully to protect himself from permanent degenerative changes.

Rehabilitation and life expectancy

Worldwide, about 2,4 billion people currently live with a health condition that benefits from rehabilitation. With changes in health and population characteristics around the world, this estimated need for rehabilitation will only increase in the coming years.

People are living longer and the number of people over 60 is projected to double by 2050, with more and more people living with chronic diseases such as diabetes, stroke and cancer. At the same time, the prevalence of injuries (such as burns) and child developmental disorders (such as cerebral palsy) persists. These conditions can affect the functioning of the individual and are associated with an increased level of disability for which rehabilitation may be beneficial.

In many parts of the world, this growing need for rehabilitation remains largely unmet. More than half of those in some low- and middle-income countries who require rehabilitation services do not receive them. Rehabilitation services continue to be among the health services most severely disrupted by the COVID-19 pandemic.

Global rehabilitation needs are still not being met due to a number of factors, including:

1. Lack of prioritization, funding, policies and rehabilitation plans at the national level.
2. Lack of available rehabilitation services outside urban areas and long waiting times.
3. High out-of-pocket expenses and nonexistent or insufficient funding.
4. Lack of trained rehabilitation professionals, with less than 10 skilled practitioners per 1 million population in many low and middle income environments.
5. Lack of resources, including assistive technology, equipment and supplies.
6. More research and data on rehabilitation are needed.

Ineffective and unused rehabilitation referral pathways.