Global Health Asia-Pacific Special Issue - Page 100

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REHABILITATION MEDICINE

Text written by Dr Tan Yi Yan

Being an extension of the medical model that practices person centred enablement , Rehabilitation Medicine ’ s foundations come from the Biopsychosocial Model and World Health Organization Model of disablement . Current advancement of modern medicine has resulted in a paradoxical situation with increasingly more people surviving from illnesses and injuries .

Rehabilitation is a process aimed at optimising a person ’ s functions and wellbeing . It is especially crucial for individuals who may have diseases or those who have met with unfortunate circumstances in their lives – resulting them with impairments ( loss of bodily function ) or disabilities .
Disabilities can be complex which requires specific collaboration , treatment , intervention , training and education among healthcare providers , patient and care givers . Often lead by a Rehabilitation Physician , rehabilitation principles and techniques are applied by a team of healthcare providers in a patient-centred manner , aiming to promote restoration of function and improve quality of life of an individual .
Disabling conditions such as stroke , traumatic brain injury , spinal cord injury , multiple sclerosis , and cerebral palsy , as well as musculoskeletal issues and pain , may require various levels of rehabilitation . The goal of rehabilitation medicine is twofold :
• To maximise function , participation , independence , and quality of life for a person with a disabling condition and
• To maintain and prevent any further decline in a person ’ s function .
The type of rehabilitation a person receives depends on the medical condition causing impairment , the bodily function that is affected , and the severity of the impairment .
For example , stroke is one of the most common conditions which will be benefited from rehabilitation service . The types and degrees of impairment that follow
Dr Tan Yi Yan Consultant Rehabilitation Physician
a stroke depend upon which area of the brain is affected . Generally , stroke can cause five types of impairments :
1 . Paralysis or problems controlling movement ( motor control ) Damage to cells and connections in the brain following a stroke can cause various problems with movement and sensation , including :
• Paralysis , loss of voluntary movement , or weakness that usually affects one side of the body , usually the side opposite to the side damaged by the stroke ( such as the face , an arm , a leg , or the entire side of the body ). ( hemiplegia )
• Problems swallowing ( dysphagia )
• Loss of control of body movements , including problems with body posture , walking , and balance ( ataxia )
2 . Sensory disturbances , in such a way losing the ability to feel touch , pain , temperature , or sense how the body is positioned . Some individuals may experience pain , numbness , or odd sensations such as tingling or prickling on the affected limbs .
3 . Problems using or understanding language ( aphasia ) At least one-fourth of all stroke survivors experience language impairments , involving the ability to speak , write , and understand spoken and written language . In right-handed individuals these strokes usually involve the left side of the brain .
4 . Problems with thinking and memory Stroke can damage the parts of the brain responsible for memory , learning , and awareness . A stroke survivor may have a dramatically shortened attention span or may experience deficits in short-term memory . Some people also may lose the ability to make plans , comprehend meaning , learn new tasks , or engage in other complex mental activities .
5 . Emotional disturbances After a stroke someone might feel fear , anxiety , frustration , anger , sadness , and a sense of grief over physical and mental losses . Some emotional disturbances and personality changes are caused by the physical effects of brain damage . Clinical depression — a sense of hopelessness that disrupts the ability to function — is commonly experienced by stroke survivors . Post-stroke depression can be treated with antidepressant medications and psychological counselling .
Typically , Physical therapy or physiotherapy involves in activities and exercises to improve the body ’ s movements , sensations , strength , and balance . Occupational therapy helps a person to re-learn the skills required to carry out daily life tasks such as personal grooming , feeding , bathing , and activities in the home , workplace , and community . Cognitive therapy involves re-learning or improving skills , such as thinking , learning , memory , planning , and decision making that may have been affected by brain injury . Speech-language pathologists assess a person ’ s swallowing function , help to improve the ability to swallow . They provide therapy to help a person to re-learn about how to use language or develop alternative means of communication .
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