REHABILITATION AFTER INJURY AND THE NEED FOR COORDINATION

The outcome of treatment after injury can be measured using the general terms of mortality and morbidity. Mortality is an all-or-none phenomenon, but morbidity is a graded response to injury and its medical treatment, varying from complete return to normality at one end of the scale to total dependence on other people requiring residence in an institution at the other end. The words disability (the individual's response) and handicap (society's reaction) specify the morbidity. Rehabilitation affects these two outcomes of disability and handicap and is a complex process involving the patient, carers and a team of specialists. The rehabilitation team is comprised of professionals each with specialist skills who aim to rehabilitate the individual as far as possible back to his former health and independence, All aspects of an individual's life are treated, including the physical, functional, psychological and social. The team operates in a number of ways according to the setting and treatment approaches used. The rehabilitation process should remain consistent throughout and focus on the patient's strengths and deficits. The key to effective rehabilitation is good organization with a comprehensive team approach working towards common goals and aims. Whether the patient is located in an acute hospital, rehabilitation unit, nursing home or in his own house, rehabilitation must be continuous. It is a mistake to believe that the rehabilitation process can only exist in a special centre, it must start in the acute hospital and be maintained even when at home, although its intensity may vary at different stages. It is suggested that coordination of this continuous process should be done by a rehabilitation coordinator, who must commence work early in the acute phase after the initial injury. Monitoring the amount of disability and the effectiveness of the rehabilitation process is essential and is best performed using the Functional Independence Measure. This simple scale can help to assess progress by nurses, doctors, therapists, and carers. It must be made part of the therapeutic process and utilized to fix goals. It can also act as the outcome measure to assess the cost effectiveness of rehabilitation after injury.