Description of specialty
Rehabilitation medicine (RM) focuses on a goal-directed process of rehabilitation for people with conditions of sudden onset (eg head injury, limb loss, spinal cord injury) and for people with progressive conditions (eg multiple sclerosis, neuromuscular disorders). RM is also involved in long-term disability management for people with long-term disabling conditions (eg cerebral palsy, limb loss, spinal cord injury and acquired brain injury). Consultants in RM, and their teams, manage patients along a continuum: from rehabilitation following acute illness or injury, through inpatient rehabilitation, and into community settings. Specialist rehabilitation teams provide holistic care, including management of emotional and psychological consequences of disabling illness/injury and long-term conditions. RM consultants are involved in vocational rehabilitation and electronic assistive technology services.
RM serves people with complex disabilities affecting what would be considered by most as normal everyday activities (eg personal care, domestic activities, community access, mobility), and participation in societal roles such as relationships (including family life) and employment. The most common conditions managed by RM are:
- spinal cord injuries, traumatic and non-traumatic (spinal cord injury medicine)
- neurological conditions of sudden onset, eg head injury, intracerebral haemorrhage and infection, stroke
- neurological conditions present from birth or childhood, eg cerebral palsy, spina bifida, muscular dystrophy
- progressive neurological conditions, eg multiple sclerosis, motor neurone disease, neuromuscular conditions, progressive brain tumours
- musculoskeletal disorders, including complex trauma
- congenital or acquired limb loss due to disease or trauma (amputee medicine).
The specialty was originally intended for disabled people of working age. However, with improvements in healthcare over the decades and expectations of people who are not of working age, RM is involved with an ever-increasing number of older adults, often in partnership with physicians specialising in ageing and complex medicine, to ensure that appropriate rehabilitation is provided to everyone who has potential to benefit from it.
Patients with specialist rehabilitation needs present with a diverse mixture of medical, physical, sensory, cognitive, communicative, psychological, social and environmental problems, which require specialist input from a wide range of disciplines working together as a coordinated team.
Roles of the consultant
Roles of the consultant in RM include:
- diagnosis and prognosis of disabling conditions
- leadership and coordination of the multidisciplinary team within inpatient and community settings
- prevention and treatment of symptoms, and prevention of remediable complications
- contribution to complex ethical medical decision making
- provision of education, support and counselling for patients, families and carers
- liaison with and support of other specialty colleagues in areas of overlapping practice, such as neurology, neurosurgery, rheumatology, palliative care, psychiatry and gerontology. The World Health Organization’s (WHO’s) International Classification of Functioning, Disability and Health provides the conceptual framework for RM practices, recognising that social and physical environments are targets for intervention. For example, an individual complaining of spinal pain may benefit not only from medications, but also from adequate provision of seating arrangements or other medical interventions.
Drivers for change in RM have included the Darzi report High quality care for all (2008) and The National Service Framework for long-term conditions (2005). (It should be noted that both these reports are specific to the English NHS.) Commissioners of services need to understand and accept the requirement for disability management and for repeated interventions for people who have complex and changing needs as a result of long-term conditions. The non-linear nature of disabling illness does not fit into the ‘diagnose–treat–discharge’ pattern of modern hospital medicine. It is therefore critical to support joint working and the development of truly interdisciplinary working practice and clinical pathways, which take into account the complexity of need at different stages of an illness and at different stages of life (see Medical rehabilitation in 2011 and beyond, 2010).
The British Society of Rehabilitation Medicine (BSRM) provides further information on the specialty.