--- module: 072-01 language: en chapter: 72 title: "Rehabilitation Medicine, Disability, Function, and Participation" module_title: "Models of function, adaptation, recovery, impairment, and rehabilitation trajectories" source_sha256: e96bc05bdac2da9fa3b2704329584256f824a8e88d221751f791781c34b9e17d --- # Rehabilitation foundations and presentation ## Scope of rehabilitation medicine ### Disease, injury, environment, personal factors interact ### Target: activity, participation, adaptation, quality of life ### Recovery routes #### Repair, plasticity, compensation #### Technology, environment, redefined goals ## Biopsychosocial model of function ### International Classification of Functioning #### Weakness: impairment #### Difficulty dressing: activity limitation #### No return to work: participation restriction ### Relationships are bidirectional #### Inaccessible transport magnifies modest impairment #### Support and technology enable participation ### Medical model: pathology and treatment ### Social model: barriers, discrimination, exclusion ### Function is task- and context-specific #### Clinic walk does not prove road, stairs, work ## Immobilisation and activity ### Bed rest #### Loses plasma volume, aerobic capacity, strength #### Atrophy, bone resorption, tissue shortening #### Pressure injury, thrombosis, delirium #### Older and critically ill lose reserve fastest ### Strength #### Early resistance gains neural, then hypertrophy #### Disuse lowers synthesis, raises breakdown ### Aerobic training #### Mitochondria, capillaries, stroke volume #### Specific to intensity, duration, mode #### Excess load without recovery harms ### Dynamic exercise physiology #### Cardiac output and oxygen extraction rise #### Systolic pressure up, resistance down #### Ventilation rises beyond thresholds ### Recovery kinetics #### Slow heart-rate recovery: less vagal reactivation #### Symptoms may appear after the session ### Bone remodels to strain ### Tendons adapt slower than fitness ## Recovery, compensation, substitution ### Restitution restores original function ### Compensation does the task differently ### Substitution uses equipment or assistance ### Early compensation may limit recovery ### Neuroplasticity #### Repetition, salience, intensity, sleep, mood #### Maladaptive: spasticity, pain, phantom ### Motor learning #### Cognitive, associative, automatic stages #### Variable practice improves transfer #### Fade feedback for independent control ## Impairment across functional systems ### Weakness: central to deconditioned ### Upper motor neuron: hyperreflexia, spasticity ### Lower motor neuron: atrophy, fasciculation ### Spasticity #### Velocity-dependent resistance #### May support standing or transfers #### Treat function, not tone alone ### Ataxia, apraxia, neglect ### Aphasia, dysarthria, dysphonia differ ### Dysphagia #### Aspiration may be silent #### Balance safety, nutrition, enjoyment ## Pain, fatigue, cognition as modifiers ### Pain alters control, sleep, willingness to move #### Fear and sensitisation perpetuate avoidance #### Graded exposure, never imaginary ### Fatigue has many causes #### Post-exertional exacerbation needs pacing ### Cognition affects safety, learning, work ## Common rehabilitation trajectories ### Stroke #### Early: reperfusion, oedema, network change #### Test plateau is not a functional ceiling ### Spinal cord injury #### Level and completeness #### Spinal shock, then spasticity #### Autonomic dysreflexia causes hypertension ### Traumatic brain injury #### Physical recovery can conceal cognitive loss ### Amputation #### Prosthesis is a tool, not an endpoint ### Cardiac, pulmonary, cancer rehabilitation ## Goals, participation, identity ### Specific, measurable, time-linked goals ### Identity, culture, roles define relevance ### Living well with persistent impairment ### What prevents doing what matters