Rehabilitation Concepts and Strategies
Function-focused rehabilitation
Rehabilitation aims to maximize function, independence, safety, and participation. Know functional assessment: ADLs such as bathing, dressing, toileting, transfers, and eating; and IADLs such as medication management, finances, shopping, and transportation. Tools include the FIM and Barthel; scores guide setting and progress, not diagnosis alone. Levels include acute inpatient rehab (IRF), SNF rehab, home health, outpatient, day treatment, and vocational rehab. The interdisciplinary team includes physiatry, PT, OT, SLP, nursing, psychology, social work, and case management.
Traps
Do not confuse restorative therapy with maintenance therapy or skilled with custodial care. IRF generally requires multidisciplinary needs and tolerance of intensive therapy, often about 3 hours per day, though individualize. SNF consolidated billing and Medicare homebound rules are frequent traps. Insurance caps and visit limits vary. Avoid promising outcomes; document baseline, goals, and measurable progress. DME, home modification, caregiver training, and return-to-work planning are part of the plan.
Worked example
After a stroke, a patient has transfer and dressing needs plus mild aphasia. Assess FIM/ADLs, set SMART goals, and recommend IRF if the patient can tolerate intensive multidisciplinary therapy; otherwise consider SNF or home health with PT/OT/SLP. Rule: function drives setting, goals, and documentation.