Conceptual changes needed to improve outcomes in rehabilitation medicine: A clinical commentary

Abstract

Rehabilitation medicine has expanded the horizon of all medicine and brought about new human achievements. To facilitate continued advances in achievement, several changes are suggested in customary rehabilitation strategic goals, concepts, and practices. The main rehabilitation goals should focus on prolonged survival, contrary to the opinions of most authors on rehabilitation, and on achievement of maximum ability realization, rather than of independence or any given (including previous) level of functioning. Setting rehabilitation goals should benefit the patient, rather than the caregiver or the insurer. Training should focus on tasks that contribute to the patients’ interests and desires, rather than on any task that reduces the burden of care. The main criterion for admission to a rehabilitation ward should be based on expected advantage in prolonging patient survival and maximizing ability realization.

The role of comprehensive rehabilitation in the care of degenerative cervical myelopathy

“…Comprehensive rehabilitation is carried out in SCL units by a multidisciplinary team managed by physiatrists [ 6 , 8 ]. These rehabilitation teams usually include nurses, physiotherapists, occupational therapists, social workers, and psychologists; they regularly consult spinal surgeons, urologists, psychiatrists, plastic surgeons, otolaryngology specialists, and speech therapists [ 6 ].…”

“…Comprehensive SCL rehabilitation has two main objectives that are highly relevant for persons with neurological and functional deficits caused by DCM: (a) preventing medical complications of SCL (pneumonia, pressure sores, urinary infections, vascular autonomic impairments, and others) to prolong life and avoid loss of function; and (b) minimizing the gap between the potential and actual functioning of each person, aimed at minimizing complications and improving function and quality of life [ 8 ].…”

“…Potential functioning (or potential performance) is determined by the damage to neural tissue and by neurological status [ 3 , 8 , 9 ]. Functioning and disability after SCL may be affected by various factors, including the neurological status reflected in SCL severity and level, the time from injury to examination, the realization of the patient’s potential performance before rehabilitation, and to some extent, the length of stay in rehabilitation, age, presence of pressure sores or spasticity, pain, psychological factors, and environmental factors [ 8 , 10 – 12 ]. Of all these, spine surgery can affect only the neurological status and to some extent pain.…”

“…Spine surgery, therefore, can reduce disability mainly by improving potential performance following the improvement of the neurological status. By contrast, comprehensive rehabilitation can reduce disability mainly by increasing the realization of potential performance, although it may affect the assessment of neurological status, to some extent, by training, which strengthens the muscles [ 8 , 9 ]. In other words, comprehensive rehabilitation can increase ability realization, which is quantitatively described as the ratio of the values of actual performance and potential performance (Table 1 ) [ 8 , 9 ].…”

“…By contrast, comprehensive rehabilitation can reduce disability mainly by increasing the realization of potential performance, although it may affect the assessment of neurological status, to some extent, by training, which strengthens the muscles [ 8 , 9 ]. In other words, comprehensive rehabilitation can increase ability realization, which is quantitatively described as the ratio of the values of actual performance and potential performance (Table 1 ) [ 8 , 9 ]. It increases ability realization by preventing and treating SCL complications, reducing spasticity and pain, improving mood and motivation, and delivering education and training, which may harness the plasticity of the central nervous system [ 8 , 13 ].…”