--- module: 072-03 language: en chapter: 72 title: "Rehabilitation Medicine, Disability, Function, and Participation" module_title: "Management, monitoring, prevention, safety, ethics, systems issues, and longitudinal care" source_sha256: a89cba2676e31c811c47d9edc38499e64ff024a84b996d542779ce4588ce04a7 --- # Rehabilitation management and longitudinal care ## Principles of management ### Task practice, conditioning, equipment, environment ### More intensity is not always better #### Dose fits healing, reserve, fatigue ### Goals organise; measurement tests strategy ## Exercise prescription ### Frequency, intensity, time, type, progression ### Contraindications depend on intensity, not age ### Aerobic intensity #### Heart rate, oxygen uptake, perceived exertion #### Heart rate unreliable with beta blockade #### Warm-up and cool-down smooth transitions ### Resistance training #### Progress without pain or loss of form #### Power training helps older adults #### Avoid prolonged breath-holding ### Balance training challenges safely ### Stretching does not fix neural weakness ## Motor rehabilitation by diagnosis ### Stroke #### Repetitive task-specific practice #### Do not wait for spasticity to resolve #### Prevent shoulder pain and learned non-use ### Spasticity #### Treat triggers: pain, infection, constipation #### Splints, toxin, intrathecal, surgery #### Lower tone can worsen transfers ### Parkinson disease #### Large amplitude, cueing, freezing strategies #### Medication timing affects performance ### Spinal cord injury #### Pressure relief, transfers, wheelchair skills #### Dysreflexia: sit up, find trigger, monitor ## Assistive technology ### Orthoses #### Stabilise, assist clearance, prevent deformity #### Risk skin injury and non-use ### Prostheses #### Level, limb, cognition, capacity, goals #### Phantom pain: education, mirror, desensitise ### Wheelchairs: manual, powered, power-assisted ### Needs maintenance, charging, backup, funding ## Preventing secondary complications ### Pressure: weight shifts, surfaces, inspection ### Venous thrombosis follows mobility and risk ### Contracture: positioning, movement, splints ### Osteoporosis after immobility ### Respiratory care #### Bulbar weakness risks aspiration #### Normal saturation does not exclude risk ### Falls prevention integrates many factors #### Restricting activity increases future falls ## Fatigue, pacing, return to roles ### Energy conservation and delegation ### Pacing avoids overactivity and collapse #### Energy envelope in post-exertional syndromes ### Return to work begins with task analysis #### Graded hours, modified duties, remote work #### Disclosure is the person's decision ### Driving #### On-road tests integrated performance #### Know reporting obligations ### Adaptive sport supports identity #### Para-sport classes are not severity scales ## Interdisciplinary care ### Distinct professional expertise ### Interdisciplinary integrates shared goals #### Multidisciplinary may stay fragmented ### Team meetings: barriers, accountable actions ### Patient and supporters are team members ### Early discharge planning #### Stable yet unsafe without home access ## Disability-informed ethics ### Clinicians underestimate quality of life ### Disability is not solely tragedy ### Supported communication, least restriction #### Informed choice of risky activity ### Convenience does not justify restraint ### Unequal access #### Rapid-gain selection excludes severe disability #### Allocate by need and equity ## Outcomes and sustaining gains ### Monitor participation and caregiver burden ### No progress prompts review #### Diagnosis, dose, mood, equipment, goal ### Maintenance #### Community exercise, self-management #### Ageing, pregnancy, caregiver change destabilise ### Success: skills, supports, environment