The Monday Memo
February 20, 2017 PITT DPT STUDENTS
The Three Stages of Rehabilitation
A successful rehab outcome is fostered using both an artistic and a scientific mindset. The exact percentage of each will depend on the education, preferences, and bias of the practicing clinician, and that’s what makes this profession both exciting and frustrating. There are no “cookbook” formulas in rehab, which demands years of “trial and error” from entry-level clinicians. Luckily, we have guidelines and the experience of our mentors to help guide us early on in our professional careers.
One of the most important concepts that has surfaced for me in my education thus far is the concept of “Staging” a patient. This process guides our clinical decision-making and helps us create an effective and efficient plan of attack. It can be applied to anyone, in both inpatient and outpatient settings, and for every kind of injury or disease. It must be done on Day 1, but must also be continually reevaluated throughout the course of care. Below are brief descriptions of the stages:
- Stage 1: Symptom Modulation: This patient is most likely in the “acute” stage of their injury, and their medical status could be either volatile or stable. The hallmark of this stage is that symptoms predominate and are highly volatile. The focus should be on alleviating pain and working towards “calming” the condition down in order to open the door for more long-lasting treatment methods.
- Stage 2: Movement Control: This patient will oftentimes still be in pain, but the pain will simply not be as limiting. The functional impairments present can be more accurately attributed to the neurological and/or neuromuscular impairments, so our treatment methods can consist of relatively more “aggressive” techniques aimed at increasing tissue length, strength, or neuromuscular control of the joints in question.
- Stage 3: Functional Optimization: If you find your patients consistently reaching this stage in their rehabilitation process, you’re clearly doing something right. The patient will likely be in little or perhaps no pain at all, and the focus of your rehab can be on optimizing the patient’s movement patterns, preparing them for return to normal function, and strengthening/reconditioning the physical attributes of the patient.
Make no mistake, as much as we would love for this to be a linear process, reality tells us otherwise. Oftentimes, your patient will experience setbacks. They will have pushed their shoulder repair too far playing with their kids over the weekend and show up to clinic on Monday morning with highly volatile symptoms. You will need to adapt and revisit the symptom modulation phase to temper their symptoms. This is what makes our profession so unique and so individual. This is why we as professionals need to be ever vigilant with our clients and constantly monitoring their status. This adaptability is where the “art” of rehab comes into play, guided by these “scientific” principles.
Are you using the “Staging” process with your patients? Why or why not? Has it helped improve your patient outcomes? Comment below or reach out to Pitt PT to share your story!
- Charlie Badawy, President: DPT Class of 2019
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