Clinical Rehabilitation
This section of the website concerns clinical matters. It is not a textbook of rehabilitation. It discusses areas of rehabilitation that interest me from a practical perspective and offers my perspective on the best approach. I will provide evidence when I have found some. I started it on January 20th, 2024, with my first area of interest, patients with a prolonged disorder of consciousness. As I add more content, this introductory page will be adapted. Healthcare is a complex adaptive system, as are healthcare teams, and each part must be considered in context. This is especially true of rehabilitation; the best clinical expertise in the world is valueless if there are no other team members or resources. Thus, the content will link to material on the rehabilitation process, academic aspects of rehabilitation, and service design and delivery.
Table of Contents
Introduction
Clinicians help people to solve and adapt to their health problems. In all healthcare, the issues are unique to the patient. Evidence will guide the approach, whether diagnostic or management-oriented, but it cannot dictate decisions. Often, evidence is reviewed and collated in guidelines.
Nevertheless, all clinicians must use their experience and accumulated knowledge to develop solutions appropriate for the patient and discuss their suggestions with them. Inevitably, people with more experience accumulate more excellent knowledge and skills. This is the essence of professional practice, and one duty of all professionals is to transmit their expertise to the next generation. I have been fortunate enough to acquire expertise in rehabilitation over about 45 years; this website offers me an opportunity to share that freely.
My blog posts have shared specific ideas. The sections on the nature of rehabilitation and academic rehabilitation offer my perspective on general issues and training. Inevitably, they also touch on clinical rehabilitation practice generally. This section considers matters starting from a clinical challenge.
I do not know what I will discuss. To the despair of my managers over the last 40 years, I have never had any explicit long-term goals. I know my general goal is to improve the rehabilitation of individual patients, but I am opportunistic, saying yes to anything consistent with my general aspiration. I started this website when several alternative opportunities failed to materialise – I thought of the idea and name at about 02:00 hours one night. I registered the domain name early the following day.
Clinical rehabilitation; context.
Science and society face an intractable challenge. The scientific revolution started around 1500, and its success arose from individuals accumulating specialist knowledge and skills in specific domains such as astronomy or biology. This change was associated with the fissuring of knowledge and, later, of practice. We have silos affecting research and practice. Although we recognise the problem, we have not succeeded in overcoming it.
Rehabilitation has started to address the issue; we have embraced the concept of teamwork, where different people and professions work together. However, we have failed to ensure shared training in rehabilitation principles and practice besides our other expertise.
More importantly, the healthcare focus on individual patients and professionals has led to less attention to and investment in the complicated social, physical, and cultural structures underpinning healthcare. The UK is afflicted by crumbling and unsafe hospitals, which inevitably affects clinical services and the delivery of good clinical care. Staff expertise cannot overcome these challenges!
This section focuses on how to approach the clinical rehabilitation of a person with a particular problem. It does not consider the surrounding context – team function, service resources, other broader resources such as housing, other specialist healthcare services, etc.
Prolonged Diorders of Consciousness (PDOC)
I have been seeing people left unconscious after brain injury or at the end of their life with progressive conditions since 1984, and as an expert since 1994 when the Official Solicitor asked me to see two cases being taken to court. My role was limited to confirming the person was in a vegetative state (as it was then called).
In 1995, I saw a person who two experts had confirmed as being in a vegetative state who was aware. This case was written up, with a follow-up five years later. The failure of two recognised experts to detect awareness fostered my interest and still makes me thorough.
Since then, I have written extensively about many aspects of the condition, been involved in developing national guidelines, and seen hundreds of patients as part of my routine work and over two hundred when deciding on treatment in a person’s best interests. I have also published blog posts on some aspects, such as recent developments and pain.
The content (not yet completed) of this topic is shown in the MindMap below:
Conclusion
Successful, effective rehabilitation requires holistic practitioners who care about the patient, their healthcare, and their social context. Clinical rehabilitation expertise is crucial but not sufficient. This section of the site covers clinical expertise. Other parts cover the goals, structures, processes, the underlying theory and training required, and services.
