REHABILITATION

«  Controlling symptoms often enables rehabilitation.

“I have learned never to underestimate the capacity of the human mind and body to regenerate, even when the prospects seem most wretched” (Norman Cousins, Anatomy of an Illness)

Rehabilitation demands a team approach to the problems of immobility and lack of confidence. It may require physical therapy, occupational therapy, and adaptations to the patient’s home. Sometimes patients have lost confidence and independence because family members have been too kind.

A graded approach to rehabilitation from hospital to home includes:

• Self care (washing, feeding)

• Sitting out of bed

• Getting dressed

• Walking with support

• Walking with a cane or a frame

• Climbing steps

• Assessment of daily living activities

• Home assessment by an occupational therapist and a home care nurse

• A visit home

• A few days at home

• Home with day care support

This gradual approach allows the patient and family members to build up confidence. Achieving short-term goals without loss of security often boosts morale.

Opportunities for rehabilitation are too often lost because professionals lack imagination and initiative. Planning with patients and families can enable the patient to return home, sometimes for weeks and months.

Comments from a patient – Mr. C.B., paraplegic from an advanced cranio-spinal ependymoma (adapted by permission from a recorded conversation):

“When you start thinking about other things apart from the hospital, it starts to clear your mind and I think it really helps. That’s another thing I’d say – if at all possible, argue to try and get out of the hospital, even if its only for a couple of hours. Go into your favorite McDonald’s and have a Big Mac. Maybe not even eating it, but smelling it, and being in the same place you’ve been when you were well. Very, very important to me, That’s where good family and friends come in handy.

There are a lot of things you can do, that you probably think you can’t. And too, you may well struggle, but to have achieved it in the end is a very big plus, and very helpful. And you go home at night and think ‘Geez, I got up that step, and got around that park, and went fishing today, and never thought I would do.’ And its very important in my mind. Very important for me.”

Comment from a family member – Mrs. M.H., 59, with colon cancer and brain metastases, was admitted to an in-patient hospice, immobile due to weakness in the left arm and leg. Intensive physiotherapy and rehabilitation enabled her to walk independently and to return home for a month (after a brief home visit with the occupational therapist and physiotherapist to give her husband confidence). She enjoyed her time at home, was able to go to her husband’s retirement party, and continued to visit the day hospice twice a week. She was readmitted to the in-patient hospice (after a seizure) and despite being weaker she continued to enjoy walking exercises and graded limb exercises up to 3 weeks before she died. A year later her husband Fred wrote:

“We were married for 36 years, and yet it’s those last few months I remember most vividly. We were so grateful for all that hard work — otherwise those precious moments of triumph would never have taken place.”

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.