Rehabilitation Concepts and Strategies
This domain tests functional assessment, the rehabilitation continuum, and strategies that help people regain safety and participation. Expect questions on matching setting intensity to need, ADLs versus IADLs, and team roles.
Core concepts
- ADLs include bathing, dressing, toileting, transferring, continence, and feeding; IADLs include shopping, finances, transportation, medication management, and meal preparation.
- The FIM has 18 items scored 1-7 across motor and cognitive domains; the Barthel Index is another functional measure.
- Inpatient rehabilitation is intensive, typically at least 3 hours of therapy per day, 5 days per week, with physician oversight and an interdisciplinary team.
- The continuum includes acute inpatient rehab, subacute/SNF rehab, long-term acute care, home health, outpatient therapy, and day rehabilitation.
- The ICF model describes impairment, activity limitation, and participation restriction, and incorporates environment and personal factors.
- Strategies include task analysis, energy conservation, adaptive equipment, home modification, caregiver training, work hardening, and vocational rehabilitation.
Worked example
A 55-year-old with left hemiparesis after stroke has a FIM motor score of 45 and lives in a two-story home. The team recommends inpatient rehabilitation because the patient needs intensive daily therapy and medical monitoring. OT completes a home evaluation, the family receives transfer training, and vocational rehabilitation is discussed. Reasoning: the setting matches therapy intensity, medical stability, and realistic discharge goals, not bed availability.
Traps
- Treating a SNF stay as equivalent to intensive inpatient rehabilitation.
- Confusing ADLs with IADLs.
- Setting goals from the team's priorities rather than the patient's.
- Ignoring home layout, caregiver capacity, and funding for equipment.
- Discharging before functional goals or safety are addressed.