REHABILITATION AFTER INJURY AND THE NEED FOR COORDINATION

The outcome of treatment after injury can be measured using the genera l terms of mortality and morbidity. Mortality is an all-or-none phenom enon, but morbidity is a graded response to injury and its medical tre atment, varying from complete return to normality at one end of the sc ale to total dependence on other people requiring residence in an inst itution at the other end. The words disability (the individual's respo nse) and handicap (society's reaction) specify the morbidity. Rehabili tation affects these two outcomes of disability and handicap and is a complex process involving the patient, carers and a team of specialist s. The rehabilitation team is comprised of professionals each with spe cialist skills who aim to rehabilitate the individual as far as possib le back to his former health and independence, All aspects of an indiv idual's life are treated, including the physical, functional, psycholo gical and social. The team operates in a number of ways according to t he setting and treatment approaches used. The rehabilitation process s hould remain consistent throughout and focus on the patient's strength s and deficits. The key to effective rehabilitation is good organizati on with a comprehensive team approach working towards common goals and aims. Whether the patient is located in an acute hospital, rehabilita tion unit, nursing home or in his own house, rehabilitation must be co ntinuous. It is a mistake to believe that the rehabilitation process c an 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 continu ous process should be done by a rehabilitation coordinator, who must c ommence work early in the acute phase after the initial injury. Monito ring the amount of disability and the effectiveness of the rehabilitat ion process is essential and is best performed using the Functional In dependence Measure. This simple scale can help to assess progress by n urses, doctors, therapists, and carers. It must be made part of the th erapeutic process and utilized to fix goals. It can also act as the ou tcome measure to assess the cost effectiveness of rehabilitation after injury.