By Richard C. Senelick, MD
You never expected to get sick or injured—it was the furthest thing from your mind. Just the day before you were jogging around the block and playing catch with your son, but now you find yourself in the hospital. How will you ever get home and get your life back on track?
We never think we will need rehabilitation. We worry about a heart attack or cancer, but most of us don’t see ourselves in a wheelchair or living with a severe disability. Yet, there are almost 50 million people with disabilities in the United States. Rehabilitation is the key to getting back to functioning at a level where you can live at home, enjoy your family, and hopefully work.
This weekly, four-part series of articles will help you understand:
- Why rehabilitation is important.
- What actually takes place in a rehabilitation hospital.
- Why it makes a difference where you go for rehabilitation.
- What you should do if you find yourself or a loved in need of rehabilitation.
The Glass Ceiling
Hilary Clinton spoke about how her presidential candidacy cracked women’s glass ceiling, but the glass ceiling effect still exists in many aspects of our society. Many women still do not have the same opportunities as men. Likewise, children who are deprived of a proper education have fewer opportunities. The same concept is true for the disabled. If we assume that a stroke survivor or other rehabilitation candidate is too impaired to participate in rehabilitation, we are creating a glass ceiling for that individual. Without the proper rehabilitation, patients are unlikely to reach their full potential.
The decision to refer a patient for rehabilitation may be the first — and the last — chance for them to get the type of rehabilitation that will lead to their maximum recovery. A decision to withhold access to aggressive therapy creates a self-fulfilling prophecy:
• The physician or insurance company didn’t think they would get better so they did not give them the intensive therapy needed
• The patient confirmed their theory by showing little improvement.
Just Like School
Going for therapy and rehabilitation is just like going back to school, because you may have to learn new information. If you were going back to school later in life, you may have to “relearn” information that you had previously acquired. In therapy, there are tasks that may require physical activities like learning to walk again or learning to transfer yourself from your bed to a chair. You may need to learn to read again, speak clearly, or improve your memory. Rarely is it easy, and I always told patients and families that it will be the hardest thing they will ever do. Like school or learning a new skill there are certain principles that make a difference.
When we take a medication for a medical problem, we carefully adjust the dose. Too little or too much antibiotic and the infection gets worse or never goes away. The same is true of rehabilitation. The intensity and amount of therapy matters. Much like it takes hours of practice to learn and improve playing a musical instrument, it takes hours of therapy to retrain the brain, nervous system, and muscles. Typically, an inpatient rehabilitation hospital will provide 3 hours of therapy a day. Nursing homes do not.
If you want to learn to play a piano, you need to practice on a piano and not just read about it. The same is true for rehabilitation. If you have had a stroke and have lost the use of your right arm, you will need to do tasks and therapy that require the use of your right arm. Performing these tasks will help rewire your brain. The more “functional” tasks you perform the more you will improve and more positive changes will take place in your nervous system.
The person who is motivated and tries harder has a better chance of getting better. It is not always the brightest student who is the most successful: hard work can make a huge difference. People undergoing rehabilitation are motivated by their caregivers and therapists, but also by their surroundings. Think of working in a brightly lit office with a great view versus one in the basement with a drab cubicle. Rehabilitation can be the same. Are you at a place that specializes in rehabilitation or is it just part of a facility that does other things?
So, don’t forget: Dose, Function, and Motivation matter.
In the next article, we will review the process of rehabilitation and how it helps repair the brain and nervous system.
Richard C. Senelick, MD is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He is the Medical Director of HealthSouth RIOSA, The Rehabilitation Institute of San Antonio, and an associate clinical professor in the Department of Neurology at the University of Texas Health Science Center in San Antonio. He has authored several books on stroke, spinal cord injuries, and brain injuries. Dr. Senelick is an expert in the WebMD Stroke Community.