Rehabilitation Science - Quality of Life Through Independent Living

The ultimate goal of rehabilitation science (or rehab, for short) is to help people become or remain as independent as possible for as long as possible while participating in activities that are important to them. Thus, it's not surprising that rehab has an active role in treating a vast array of diseases and conditions.

The therapists and physicians who deliver rehab services may be best known for restoring mobility and preserving joint function for trauma survivors or patients with chronic musculoskeletal (MSK) disorders, but they also help equip people with assistive devices (such as a walker or portable oxygen), provide help to people with Alzheimer's disease and other cognitive disabilities, assist people with speech and language problems, as well as design ergonomic solutions for enhancing or preserving quality of life at home, at work or at play.

A Diverse and Challenging Profession

Basic and clinical rehab research encompasses many different fields. Advances in knowledge of the basic biology of skin, muscle and bone, for example, provide insights into the complexities of healing that are then translated into targetted exercises, improved treatment practices, preventive measures and even product design. Indeed, one of the greatest challenges facing rehab specialists is integrating the necessary breadth of knowledge into university curricula, so that students are properly prepared to meet the diverse demands and challenges of their profession.

Thermal injuries, such as third-degree burns, illustrate the need for aggressive, holistic treatment: physiotherapists will help with range-of-motion exercises to preserve muscle tone and joint mobility; whereas occupational therapists will fit burn patients with custom pressure garments to realign and flatten collagen fibres to mold the massive scar-tissue build-up that results from serious thermal injuries. Constant care is needed during the long and often excruciatingly painful recovery phase, which can involve surgical removal of burnt flesh and multiple skin grafts. Since burns can be very disfiguring, the thermal rehab team must also help their patients cope with the emotional and psychological aspects of their trauma.

Graded, focused exercises to increase flexibility, strength and endurance of different muscle groups are a mainstay of MSK rehab. Although exercise has been shown to be clinically effective in preserving mobility and independence, much remains to be learned about the basic biology of muscle tissue - particularly in the context of muscle-wasting diseases, such as muscular dystrophy, or chronic-pain syndromes such as fibromyalgia and temporomandibular disorders. New knowledge about the interior life of muscle cells can be translated into physiotherapy routines that will have a huge impact on an individual's quality of life.

There's considerable evidence that daily exercise and physical activity can prevent osteoporosis or at least slow down the bone-thinning process, but no one is quite sure how they work. Questions abound. Will regular exercise during childhood and adolescence , when the skeleton is maturing, prevent osteoporosis? If so, what kind of exercise, and how much? When should you exercise for maximum benefit? Given that experts expect osteoporosis to appear much earlier in life as result of poor diet and sedentary lifestyles, MSK rehab research will play an important part in reducing the disease's impact on society.

And for the many senior Canadians who have already developed osteoporosis, there's a serious need to improve strategies that diminish their risk of an accidental fall and fracture - an event that can reduce an individual from robust to frail health. At present, hip fractures among the elderly are often life-threatening; many patients never leave hospital. Falls are largely caused by a natural decline in a person's sense of balance. MSK rehab scientists are currently seeking more accurate means for measuring balance and assessing risk.

Injury prevention is as important a part of arthritis management as is preserving a joint's range of motion and pain control. Occupational therapists are expert at adapting living and working spaces to prevent further joint damage and to maximize independence. Sometimes it's as simple as lifting a favorite chair by several centimetres with wooden blocks to reduce mechanical stress on hands, hips and knees when rising. Other times, it may require redesigning a kitchen or an office, or everyday objects, such as fat handles on eating utensils for people with reduced grip strength. Physiotherapy keeps joints mobile and reduces the pain and stiffness of arthritis. And the twin strategies of ergonomics and physical rehabilitation can go a long way towards helping people regain a sense of control over their condition, diminish pain and depression, and forestall disability. Equally important to rehabilitationists and potential users, however, is the ongoing advancement, development and assessment of assistive technologies such as artificial limbs, specialized braces and mobility systems that can greatly facilitate independent living and greater functionality.

Research - The Key to Establishing Best Practices

Whether a condition was acquired congenitally or through disease or trauma, rehabilitation professionals will continue to work towards implementing a system of best practices across the broad spectrum of possible interventions. Ongoing research, however, is the key to developing the kinds of assessment tools and indicators required to help rehab professionals achieve meaningful therapeutic outcomes - especially in light of the introduction of new and improved assistive devices such as artificial limbs, specialized braces and mobility systems. Drawing professionals together from various disciplines in a collaborative, collegial environment, IMHA is ideally positioned to help rehab scientists spearhead applications and clinical trials that will result in new and innovative treatment modalities that will benefit all Canadians.

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