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Rehabilitation

Barbara Chandler, Consultant in Rehab Medicine, Regional Rehabilitation Centre, Newcastle Upon Tyne

Open Door - May 2005 pages 8-9

What is it?

Rehabilitation is essentially about helping or facilitating an individual to achieve their personal goals. It is therefore an active process of partnership between an individual and other agencies to overcome or circumvent difficulties; to develop new strategies; and perhaps to develop new interests if existing activities are no longer possible.

Neurological rehabilitation refers to the specific area of supporting people with neurological problems. Specialists will see people with a variety of different diagnoses, but who often experience very similar problems such as fatigue, spasticity, pain, bladder difficulties and memory difficulties.


Who does it?

The person 'does' the rehabilitation helped by members of a multi-disciplinary team. A team is important because there may be a variety of issues that must be addressed in order to achieve a particular goal. Sometimes carers or family members may suggest goals and an agreement will be reached by all concerned as to how to achieve that agreed goal.


A rehabilitation team

  • physiotherapist
  • occupational therapist
  • speech and language therapist
  • psychologist
  • counsellor
  • nurse
  • rehabilitation physician

Professionals linked with the rehabilitation team

  • orthotist
  • dietician
  • social worker
  • benefits advisor
  • sex and relationships counsellor

My own experience is of a weekly team meeting at which we discuss those people with whom we are working. In this way we can ensure that we are all working towards the same goals. Confidentiality is maintained within the team.

Rehabilitation teams are very good at liaising with other agencies and will seek other specialist help as necessary. The rehabilitation team often acts as a central point to which people can turn for advice rather than having to approach a myriad of different agencies.

The importance of the rehabilitation team was recognised by the National Institute for Clinical Excellence (NICE) and recommendations have been made as to what should be available. The National Service Framework for Long-term Conditions also recognises the importance of appropriate rehabilitation. You should have access to a rehabilitation team in your area.


Examples

The easiest way of appreciating what rehabilitation can offer is to look at some examples.

I can't get to the shops

The first question is why? It could be because of fatigue, pain, bladder problems, access to transport or lack of a walking aid.

Having set a goal and worked towards it, progress is reassessed and either the goal has been achieved or if not, a new approach can be taken and the process begins again. Once a period of intervention is over, there would be a plan to reassess after a period of time, eg six months, to ensure that all remained well.

  • Physiotherapy assessment - provision of aid and exercise programme
  • Medical assessment - treatment with anti-spasticity drugs or agents to combat neurogenic pain
  • Nursing assessment - to discuss continence issues and to ensure confidence when going out of the house
  • Occupational therapy assessment - to assess access into the house and access to transport to travel to local shops
  • Assessment of fatigue - this could result in setting goals to manage this symptom through appropriate strategies of rest and activity planning

I can't sleep because of the pain

This might simply involve taking some painkillers but an assessment would allow many possible factors to be explored. The goal of treatment might initially be to achieve one good night's sleep or to achieve four hours unbroken sleep. The goal should be challenging but also realistic. If that initial goal is reached then a new one can be set.

  • Rehabilitation doctor to assess type of pain and decide on medication
  • Physiotherapy assessment to look at contribution of posture and movement to pain and advise on physical measures to improve pain eg acupuncture
  • Counsellor to help explore some of the anxieties that are also affecting sleep
  • Occupational therapist to look at type of bed and seating arrangements

I keep choking - coughing and spluttering when I'm drinking

This is a problem that people often forget to mention in a clinic and yet it can be helped considerably by the right assessment and advice. The goal here is to allow safe and comfortable swallowing so that meals can be enjoyed.

  • A speech and language therapist can carry out a swallowing assessment
  • A physiotherapist may also advise on seating
  • A dietician can advise on foods and thickening agents for drinks

I swallow my pills and ten minutes later I'm asleep

Side effects of medications are so common. It is so easy not to review drugs to reassess whether they are still needed or whether the benefits no longer out-weigh the side effects. A discussion with members of the rehabilitation team may allow alternative ways of managing the problem to be explored eg using physical treatments for pain, paying close attention to posture to allow a reduction in anti-spasticity drugs. Sometimes talking with other people with MS may be helpful to see if others have experienced side effects and how they have managed.

  • Are the pills causing the sleepiness?
  • Is there other medication?
  • Is there another way of approaching the problem that does not involve medication?

My life centres around the toilet

Continence problems are so embarrassing and yet they are so common, not just due to MS but due to many other problems as well. People may be reluctant to admit to having a problem and yet there is always something that can be done to help. If this problem is mentioned to a member of the rehabilitation team they will suggest referral to a continence nurse for assessment and treatment.

I'm so tired when I go to clinic that I forget to ask all my questions and it takes me days to get over it

Rehabilitation is about helping you to meet your goals. Often it is better for assessments to be carried out in your home. Occupational therapists will certainly want to visit you at home to help identify the issues of concern. Often other team members will see you at home if that is best and work with you to overcome the difficulties. Most members of the multidisciplinary team will undertake home visits, especially if travelling is very difficult due to your own needs or problems related to where you live.

I look after my sister and I have so many questions to ask but there is no one I can really turn to

Rehabilitation teams recognise that a huge amount of support comes from family members and close friends. Sometimes caring can be exhausting. Carers can talk to any member of the team about how they feel and if they have particular concerns. There may be practical issues relating to moving and handling, concerns about respite, queries about how to help with exercises, etc. Some rehabilitation teams have a counsellor who will see family members independently of the person with MS.

My MS is very mild, I don't think the rehabilitation team would be interested in seeing me

Rehabilitation is often thought of as dealing with major disability alone, but this is far from the reality. Members of the team can offer assessment and advice for common early symptoms of MS such as fatigue and for a variety of situations such as workplace difficulties or managing at home. Often liaison with other agencies such as social services or occupational health can help sort out an issue.

I just want to find the confidence to start swimming again

It can be easy to lose confidence in undertaking activities after a period of illness such as a relapse in MS. The rehabilitation team may work with you on one goal such as getting back to a leisure activity. This might only involve one or two sessions for you to find your confidence again or to find support in your own local environment.

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