T Hospital Setting: Physical
Rehabilitation
LE)
Physical Rehabilitation within hospitals provides therapy that
is directed to helping a wide variety of patients meet their
individual goals regarding their physical impairment. Many
individuals who are treated in these facilities are individuals
who have experienced some sort of traumatic injury or
neurological disorder that has disrupted their previous
lifestyle and their ability to take part in everyday living
activities. With the help of an interdisciplinary team these
individuals are able to overcome physical and emotional
challenges and continue living their lives to its full potential.
Physical Rehabilitation within a
Hospital Setting
Treatment Approach
There is a great variety and diversity of the clients that
treated in these types of facilities. There is a large
population of clients who have to take part in physical
therapy due to traumatic injuries. There is a large amount
of injuries that professionals within hospitals deal with such
as individuals who have endured a Spinal Cord Injury or
Traumatic Brain injury from a fall, accident, or sport related
injuries. A lot of boys between their teen years into their
twenties experience such accidents because they tend to
be more involved in physical contact sports. This is not to
say that girls are not clients as well, any individual
regardless of their sex or age also receive treatment for
such injuries. Neurological disorders that effect an
individual’s physical condition such as Multiple Sclerosis,
Parkinson’s disease and Muscular Dystrophy. For example
an individual with Multiple Sclerosis may have an
exacerbation where their symptoms flare up and they lose
motor abilities that they were once capable of doing. Within
a hospital physical rehabilitation is used to help individuals,
who are usually older in age, to recover from the physical
damage that the stroke has caused their body. Stroke
patients often experience weakness of their limbs and even
paralysis of parts of their body. It is difficult for stroke
patients to walk, hold or grasp objects in their hands, or
complete fine motor skills. The stay of patient who has
suffered a stroke depends on the severity of the stroke and
how quickly the patient recovers from the damage caused.
For all of these cases whether they are caused by physical
injury, neurological disorders, or strokes, the length of their
stay in these facilities is unique to the individual and the
severity of the injury. Most of the cases that are dealt with
in a hospital setting are those of acute care, which are
relatively short stays within the hospital setting until they
are physically stable to leave and then receive outpatient
care. Usually after a client is released from an acute care
facility they begin treatment in Rehabilitation Hospitals
which are characterized by long-term treatment which can
also include either inpatient or outpatient treatment for the
patient.
Within a hospital setting all patients who receive
physical therapy are usually ordered to do so by a
doctor and other member of the team for the treatment
of an individual. So prior to the beginning the physical
portion of rehabilitation the patient is in the hands of
doctors and nurses who initially diagnose the individual
and stabilize their condition and then consider whether
physical rehabilitation is needed for a full recovery or if
the patient is ready for physical rehabilitation yet. A
typical treatment approach involves slowly building up
strength of physical functions that have been lost
through the use of mild physical activity that is
appropriate to the individual’s conditions. Depending on
the facility there is different ways to achieve the goals of
the patients of the team of professionals who are
treating this individual. Activities such as stretching,
lifting different objects, and practicing fine motor
movements such as writing with a pencil are all
involved in the treatment approach. The team who is
involved in physical rehabilitation includes doctors,
nurses, physical therapist, recreational therapist, and
occupational therapist. With such a wide variety of team
member the individual is receiving a treatment
approach that is approved and over looked by each of
these professionals.
Recreational Therapy and Physical Rehabilitation in Hospitals
Recreational Therapist is very involved in the recovery of individuals who have had any experience which has resulted in a
change in their physical function. The setting where the majority of Certified Recreational Therapist Specialist work in is
within hospitals. They are able to help individuals regain a positive outlook on taking part in physical activities by making
the activities personally enjoyable to the individual. Leisure education is also very important when dealing with clients who
have experienced damage to their body that changes their previous lifestyle. With that being said the Recreation Therapist
first has to assess the individuals’ diagnoses and their level of function. They will review existing documents such as
medical records of a specific individual which gives them an understanding of the diagnoses and other medical
components that may affect the treatment of the individual. Such documents will also give them information on specific
precautions to be aware of. Also during the assessment process the RT will consult with other professionals such as their
primary doctor who have knowledge of the individual and their condition and how the progress they have made so far. In a
hospital setting where the CTRS is dealing with individuals with physical impairments they use the Comprehensive
Evaluation for Therapeutic Recreation (CERT) and Inpatient Rehabilitation Facility-Patient Assessment Inventory (IRFPAI). Another method that is commonly used by a CTRS is to just simply interview the individual who is in need of therapy
and ask them personally about the goals they wish to reach, their thoughts, beliefs and interest in relation to leisure.
Observing individuals behaviors is also very important because interviews may not be completely accurate due to multiple
reasons. The client may give inconsistent or answers that are not fully truthful or they may not wish to be interviewed at
all. If the individual has difficulty in expressing themselves observing behaviors is the best way to learn information about
who the individual is and what types of attitudes and beliefs they have. This helps the professional to go into the next step
of the APIE process which is planning. Because the CTRS in a rehabilitation environment are dealing with individuals who
have different injuries and diagnoses they need to use an individualized program plan(IPP) in order to provide the best
therapy. They must identify the goals of the individual, which in this case is to achieve physical improvements. They
identify what activities are appropriate for the individual and then properly engage them in these activities, which are
always goal orientated. The CTRS decides which programs are best for the individual based off of the assessments they
have made and which of those would benefit the individual in the best way possible. After they have a goal orientated plan
that fits the needs of the individual they begin to put their plans into action, which is the implementation portion of the
process. When dealing with physical rehabilitation the CTRS will have patients take part in activities that they have
carefully planned and specialized for the individual. The CTRS will inform the client about what they will be participating in
and how it is related to reaching their ultimate goal. The CTRS introduces activities that are leisure related which
introduces clients to new options of leisure activities while living a new lifestyle. They will allow the client to choice in
activities they enjoy and encourage them to reach for the next step of their rehabilitation. Sequencing is an important part
of therapy because the individual is dealing with physical changes in their body they need to complete smaller and simple
activities in the beginning and when they reach that goal. They will then move on to activities that are call for more
movement, strength, and tone. Some modalities used are aquatics, exercises of all sorts, community outings, and games.
This process continues until the ultimate goal has been reached. During this time the CTRS monitors the clients’ level of
flow and observes if the activity is helpful and enjoyable to the individual. The CTRS then evaluates how effective the
program or activity was and if it helped and furthered their recovery. They learn and change any aspects that may have
worsened the well-being of the individual. They CTRS is usually working alongside physical therapist and occupation
therapist and they all try to improve and reach goals that each professional as set so they are synchronized.
Intervention
The interventions used in physical rehabilitation setting
vary depending on the individual and their diagnoses.
There are a few diverse examples that will show the range
of interventions used for different diagnoses. For instance an
individual who is in physical therapy and has a Spinal
Cord Injury may have to learn how to write, brush their
teeth, transfer into their wheelchair, change their clothes,
and a variety of other daily activities. A CTRS may use
adaptive equipment such as a writing aid attachment,
which is attached to their hand or wrist by a cuff that is
around their wrist. This allows the client to engage in
activities such as practicing writing their name or drawing
pictures. Activities like this help the client to slowly gain
fine and gross motor skills. Once the client has progressed
some professionals may decide to take individuals on outing
where they will go out to lunch or to the park and
reintroduce them to the public and feel more comfortable
with their change in lifestyle.
If the client is recovering from a stroke the intervention may
involve activities such as painting which would help
strengthen the individuals’ fine motor skills while also
allowing the client to express themselves and stimulate their
brain in an enjoyable and relaxing manner.
A person who has Multiple Sclerosis may be engaged in
physical activities such as swimming in a pool with the
support of a CTRS. Aquatic exercise is very commonly used
for individuals who have MS because this activity causes
very little stress and pressure on their joints. Also the CTRS
would of course make sure the pool temperature is at an
appropriate temperature since these types of patients very
commonly have problems with thermoregulation. So by
engaging in water activities the individual does not become
overheated and can exercise for longer durations of time.
Aquatics will help these individuals gain muscle strength
and tone while also introducing them to a potential new
hobby.
References
Gassaway, J., & Dijkers, M., & Rider, C., & Edens, K., & Cahow, C., & Joyce, J. (2011). Therapeutic
Recreation Treatment Time During Inpatient Rehabilitation. The Journal of Spinal Cord
Medicine, 34, 176-185. doi:10.1179/107902611X12971826988138
Long, T. (2008). The Therapeutic Recreation Process. In T. Robertson & T. Long (Eds.),
Foundations of Therapeutic Recreation (pp. 80-97). United States: Human Kinetics
Stumbo, N. J. (2010). In Rehabilitation and Health Assessment: Applying ICF Guidelines (Assessing
Recreation and Leisure Participation). Retrieved from
http://www.springerpub.com/samples/9780826157348_chapter.pdf
Swann-Guerrero, S., Rauworth, A. (2010). Inclusive Recreation, Fitness, and Physical Activity. In G.
Kassing & R.E Sanner & A. Rumery (Eds.), Inclusive Revreation:Programs and Services for
Diverse Populations (pp.209-229), United States: Human Kinetics.
Williams, R. (2008). Places, Models, and Modalities of Practice. In T. Robertson & T. Long (Eds.),
Foundations of Therapeutic Recreation (pp.64-66). United States: Human Kinetics.