Rehabilitation Therapies

Rehabilitation constitutes the act or process of therapeutic intervention that restores or redevelops the sensory, physical, and/or cognitive capacities of the individual. Alternatively, in cases where full recovery is not possible, rehabilitation involves maximizing functional outcomes within the limits of the individual's physical disability. Those individuals who perform therapeutic intervention are a part of the rehabilitation team that typically is composed of physicians; nurses; physical, occupational, and speech therapists; nutritionists; care managers; and supportive staff. As a result of increasing need, specialties in each of these disciplines have evolved to improve the management and care of older adults and to facilitate their return to independence. Physical and occupational therapy are the disciplines that are primarily responsible for the act of providing the therapeutic rehabilitation. They are involved in the preventive, acute, rehabilitative, and chronic stages of rehabilitation, and their focus is on restoring health, alleviating pain, preventing the onset of permanent dysfunction, and addressing and reversing functional limitations, impairments, and disabilities as well as general declines in health status.

The overall goal of the rehabilitation team is to successfully identify and address the four major components of the disabling process defined by the Institute of Medicine in 1990 as pathology, impairment, functional limitation, and disability. Pathology reflects the changes at the tissue level caused by disease, infection, trauma, and/or other factors affecting molecules and cells of the body. Impairment results from the functional loss of biochemical, physiological, or mental control at the organ or organ system level. The inability to accomplish tasks that require the coordinated use of the organ system lead tofunctional limitations such as rising from a chair and getting out of bed. Disability is the culmination of the preceding three components and reduces the individual's ability to function fully within society or at the level of expected performance. In the geriatric setting, disability has a narrower range of expectations because society has a diminished expectation of older people's ability or capacity to function as individuals within society.

Rehabilitation starts with a thorough evaluation. This involves gathering pertinent patient history such as past medical (e.g., hypertension, chronic obstructive pulmonary disease) and surgical (e.g., total knee arthroplasty, coronary bypass surgery) histories and current living status (e.g., living alone in a home, living in an assisted-living facility). During the interaction with the older adult, the therapist will develop [Page 494]a sense of overall arousal level and mentation as well as the older adult's ability to process information. A physical examination will reveal the general status of the musculoskeletal, cardiopulmonary, neurological, and integumentary systems, and specific tests will determine motor function, coordination, balance, muscle strength and power, joint integrity, mobility and range of motion, aerobic capacity and endurance, and ambulation status. The assimilated information, along with a clinical diagnosis provided by the geriatrician, will allow the development of a plan of care that will then outline a course of action in terms of therapeutic intervention. Short-term goals, which will specify time points for meeting certain levels of progress critical for the overall attainment of long-term goals, will be established. Long-term goals are those levels of performance that are to be accomplished by the end of rehabilitation. Once the goals have been established, a treatment plan specifying the frequency of treatment, duration of treatment, and intensity and type of exercises prescribed will be organized. With older adults, the primary focus is on maintaining, regaining, or maximizing physical function at the independent level in activities of daily living (ADLs).

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