Rehabilitation Matters

Posts in this category are not easily categorised! They will cover any aspect of rehabilitation and a range of topics peripheral to rehabilitation, matters that should be discussed and considered but may not be – yet.

Consciousness – cause and effect

Thinking about prolonged disorders of consciousness Consciousness implies awareness: subjective, phenomenal experience of internal and external worlds. Consciousness also implies a sense of self, feelings, choice, control of voluntary behaviour, memory, thought, language, and (e.g. when we close our eyes or meditate) internally-generated images and geometric patterns. But what consciousness actually is remains unknown. Our …

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A model of person-centred rehabilitation

This blog post is based on an extensive systematic review that generated a sound, theoretically-based model of person-centred rehabilitation. I can only develop some central themes and messages here. For more details, read the article. (here) The authors conclude that person-centred rehabilitation “is a way of thinking about and providing rehabilitation services “with” the person.” …

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Prolonged disorders of consciousness (PDOC); history and update.

The diagnosis and management of patients with prolonged disorders of consciousness is an area of expertise acquired by rehabilitation specialists starting in 1992 with the Bland case. There were few developments until 2010. Change accelerated, culminating in 2018 with a Supreme Court ruling that removed the requirement to involve the Court of Protection in every …

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Chronic non-malignant pain

A recent article stated, “It has long been established that phantom limb pain is a real physiological condition.” (here) This statement begs the question, “What limb pain is not real?” Yet many patients and many healthcare professionals still refer to a patient’s pain as being real, with a strong implication that to be real, there …

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Ready for discharge?

Is this patient ready for discharge? This question must be asked endlessly by care staff, managers, and sometimes the patient themselves. In this blog post, I will argue that it is the wrong question and that, by asking the wrong question without thought, we are failing to provide the best care to our patients. Moreover, …

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Rehabilitation is holistic, or is it?

new wave

Rehabilitation usually promotes itself as holistic, considering the patient as a whole and being patient-centred. Using the biopsychosocial model should indeed enforce a holistic, patient-centred approach. (here) Nevertheless, there are counter-forces at play, forces that we sometimes encourage. The primary countervailing power is a desire to categorise, classify, and develop small specialise treatment programmes. For …

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Multidisciplinary, Interdisciplinary, or Transdisciplinary?

Teams use many different words to describe themselves. A team recently asked me to help them decide whether they are a multidisciplinary or an interdisciplinary team. The background information provided perfectly illustrated the difficulty in defining the team, as illustrated in this figure. (here) The question prompted me to write this blog post to show …

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Using the MCA in health services

The Mental Capacity Act (MCA) is a well designed, useful piece of legislation that governs decision-making for people who lack the mental ability to make decisions (in England and Wales). Unfortunately it has been blown right off course by well-meaning but clinically inappropriate guidance which has rendered it unused and unusable. The principles of the …

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Pain in PDOC

PDOC stands for Prolonged Disorder of Consciousness; the term covers two previously defined states: the vegetative state, and the minimally conscious state. This post considers the question, “Does a person in a prolonged disorder of consciousness experience pain?” This question covers both pain caused by care or treatment, and also pain arising secondary to consequences …

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An impossible decision

Doctors make decisions, and are particularly used to making difficult decisions which involve not simply clinical facts, but family, ethical, legal and societal factors. Nevertheless, we are lucky to have an ultimate fall-back, the legal system, when decisions are ‘impossible’. In England and Wales, this is the Court of Protection which, fortunately, has some exceptionally …

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