What is a diagnosis? Part 2
First published: November 24, 2025 Last updated: November 23, 2025 In What is a diagnosis? Part 1, I explained that diagnoses can generally be divided into biomedical diagnoses supported...
Clinical matters
The greatest pleasure of rehabilitation is the variety of people one meets and the clinical challenges each one presents. Almost every patient raises some new issue not considered in any depth before. For example, my friend and colleague Peter Halligan worked with me at the Rivermead Rehabilitation Centre for about 15 years. He encountered a fantastic array of fascinating clinical phenomena, with papers arising, such as a report on one patient with a supernumerary phantom arm. The patients were just routine admissions. It pays to listen to what people say; the phenomenon of the supernumerary arm was not detected by the neurology team responsible for his initial care. The posts in this category cover many issues that link to clinical practice.
Table of Contents
Clinical Matters
Rehabilitation offers every clinician an opportunity to learn something new every day and to continue learning for a professional lifetime. This learning extends to discovering new phenomena, as I mentioned above. It only requires curiosity, listening carefully to what people say, and keeping an open mind.
The posts in this category follow from clinical issues I have been confronted by and clinical issues raised by things I have read. A further fascination with rehabilitation is the breadth of journals and books that have relevant information or ideas. Many articles on rehabilitation, including large trials, are published in general medical journals.
More importantly, because rehabilitation is holistic, it is vital to be aware of many related academic disciplines – sociology, management science, humanities, and the law, to give a few examples. All may be considered in this group of posts.
Clinical matters.
The range of clinical issues confronting a rehabilitation team is vast. This site cannot even start to address them, nor would it be sensible to do so because clinical knowledge changes and the site would become dated. An overview of what someone might need to know can be gathered from the rehabilitation syllabus on this site; it will eventually include information about 40 clinical competency areas.
Moreover, many issues are mainly seen and managed by one or two professions, so I do not know how the clinical problems are best analysed and managed.
Thus, the posts will consider various clinical matters. First, anything that interests me, such as the nature of consciousness, or raises more general issues relevant to the team. Second, I may discuss any new advances that will impact most professions. Third, I will discuss long-standing clinical challenges without consensus or ideas on improving matters. The posts may sometimes concern focused, specific problems such as the advantages and risks of spinal cord stimulation for spasticity (not a post I have written).
Broader aspects of practice.
More commonly, I will be interested in broader issues. For example, guidance on managing patients with a prolonged disorder of consciousness has been available since 2013, and the Mental Capacity Act 2005 has been active since 2007. Nonetheless, most patients do not have any consideration of their best interests when treatments are started or continued. Why not? I have written about one case that came to court.
Another area of interest is how patients are referred to rehabilitation services. I accept there are too few consultants in Rehabilitation Medicine in the UK to be actively involved in all patients needing rehabilitation and that other specialities can often provide good rehabilitation. Nonetheless, many patients are not referred. Why not?
This led me to consider the widely used concept of rehabilitation potential, which I argued was seriously flawed; this led to a publication.
Almost every patient will raise issues concerning the broader aspects of rehabilitation:
- How can you arrange for carers to facilitate rehabilitation when Social Services says rehabilitation is a health responsibility, and health thinks they will not fund care?
- How do you get a wheelchair funded for someone in a care home when health says the care home should provide it and the care home says it will not?
- Is helping someone to establish a social support network and to make friends part of rehabilitation? If not, how do we prevent loneliness, depression and loss of function?
The posts
The most recent eight clinical matters posts are below; more can be loaded using the button at the end.
Biopsychosocial disequilibrium
First published: November 14, 2025 Last updated: November 14, 2025 How can we tell when something is wrong with us? In a popular post (6,800 views over four years),...
Malady
First published: November 6, 2025 Last updated: November 6, 2025 In January 1781, The London Medical Journal published a 19-page review of a book written by Dr Tiffot, a...
Holistic best interests in court.
First published: August 31, 2025 Last updated: 31 August 2025 In 2025, in two cases of disputed clinical decisions made for people lacking capacity, the clinical decisions were overturned...
Social participation and rehabilitation.
First published: March 27, 2025 Last edited: March 27, 2025 The patient had previously been active intellectually, creatively, physically, and socially; after his ischaemic brain damage a year ago,...
PDOC clinical features
First published: February 22, 2025 Last updated: February 22, 2025 I have been assessing patients with disordered consciousness since working in neurosurgery in 1976. Initially, most patients were people...
Prolonged disorders of consciousness (PDOC) services
First published: February 10, 2025 On 6 February 2025, three speakers at a seminar organised by COPPA (the Court of Protection Practitioners Association) considered “Withdrawal of treatment applications in...
Knowing the patient.
First published: January 12, 2025 Last modified: January 12, 2025 Recently, I saw a patient in a care home to give a second opinion on rehabilitation needs, and the...