Areas of Specialty Practice
Although rehabilitation is a component of every patient’s care, there are specialty rehabilitation programs established in general hospitals, free-standing rehabilitation hospitals, and outpatient facilities. The Commission for the Accreditation of Rehabilitation Facilities (CARF) sets standards for these programs and monitors compliance with them.
Specialty rehabilitation programs often meet the needs of pa-tients with neurologic disabilities. Stroke recovery programs and traumatic brain injury rehabilitation emphasize cognitive reme-diation: assisting patients to compensate for memory, perceptual, judgment, and safety deficits as well as teaching self-care and mo-bility skills. Other goals include assisting patients to swallow food safely and to communicate effectively. In addition to stroke and brain injury, other neurologic disorders treated include multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis, and nervous system tumors.
The number of spinal cord injury rehabilitation programs has in-creased since World War II. Integral components of the programs include understanding the effects and complications of spinal cord injury; neurogenic bowel and bladder management; sexuality and male fertility enhancement; self-care, including prevention of skin breakdown; bed mobility and transfers; and driving with adaptive equipment. The programs also focus on vocational assessment, training, and reentry into employment and the community.
Orthopedic rehabilitation programs provide comprehensive services to traumatic or nontraumatic amputee patients, patients undergoing joint replacements, and patients with arthritis. Learn-ing to be independent with a prosthesis or a new joint is a major goal of the program. Pain management, energy conservation, and joint protection are other goals.
For patients who have had myocardial infarction, cardiac re-habilitation begins during the acute hospitalization and contin-ues on an outpatient basis. Emphasis is placed on monitored, progressive exercise; nutritional counseling; stress management; and sexuality.
Patients with restrictive or chronic obstructive pulmonary dis-ease or ventilator dependency may be admitted to pulmonary re-habilitation programs. Respiratory therapists help the patient achieve more effective breathing patterns. The programs also teach energy conservation techniques, self-medication, and home ventilatory management.
Comprehensive pain management programs are available for sufferers of chronic pain, especially low back pain. These pro-grams focus on alternative pain treatment modalities, exercise, supportive counseling, and vocational evaluation.
A comprehensive burn rehabilitation program may serve as a step-down unit from an intensive care burn unit. Although reha-bilitation strategies are implemented immediately in acute care, a program focused on progressive joint mobility, self-care, and ongoing counseling is imperative for the burn patient.
Children are not exempt from the need for specialized rehabili-tation. Pediatric rehabilitation programs meet the needs of children with developmental and acquired disabilities, including cerebral palsy, spina bifida, traumatic brain injuries, and spinal cord injuries.
As in all areas of nursing practice, nurses practicing in the area of rehabilitation must be skilled and knowledgeable about care of patients with substance abuse. For all individuals with disability, including adolescents, the nurse must assess actual or potential sub-stance abuse. Almost 15 million Americans use illicit drugs; ap-proximately 58 million engage in binge or heavy drinking of alcohol; and about 30% of the population uses nicotine products. Parental alcoholism is one of the strongest predictors of substance abuse. Alcohol abuse rates for people with disability may be twice as high as the general population. Forty to eighty percent of spinal cord injuries are related to substance abuse, and 40% to 80% of all traumatic brain injured patients are intoxicated at the time of in-jury (U.S. Department of Health and Human Services, 2000).
Substance abuse is a critical issue in rehabilitation, especially for disabled individuals who are attempting to gain employment via vocational rehabilitation. Treatment for alcoholism and drug dependencies includes a thorough physical and psychosocial eval-uation; detoxification; counseling; medical treatment; psycho-logical assistance for the patient and family; treatment of any coexisting psychiatric illness; and referral to community resources for social, legal, spiritual, or vocational assistance. Length of treat-ment and the rehabilitation process depends on the individual’s needs. Self-help groups are also encouraged, although attendance in such groups (eg, Alcoholics Anonymous, Narcotics Anony-mous) poses various challenges for the person who has neurologic deficits, is confined to a wheelchair, or must adapt to encounters with able-bodied attendees who may not understand disability.
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