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.

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?

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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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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Goal attainment scaling.

One Friday 2nd July 2021 (at 05.00 hrs) I took part in a debate organised by Professor Barbara Wilson and hosted, virtually, in Melbourne, Australia. The debate concerned the use of goal attainment scaling (GAS). Two speakers supported its use clinically, in audit, and in research and two speakers opposed its use. At the outset …

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Do no harm

I have learned much about making decisions on people in a prolonged disorder of consciousness from The Honourable Justice Hayden, Vice President of the Court of Protection. This post discusses a comment made at the most recent case I attended. He referred, indirectly’ to the saying in the Hippocratic corpus: “‘The physician must… have two …

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