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.

Is Long Covid a functional disorder?

In 1978, I submitted my first paper to the British Medical Journal. It concerned what we now refer to as functional disorders, the phenomenon of illness with no identified...

Rehabilitation potential

What is a person’s ‘Rehabilitation Potential’? Often this question is asked by one clinician of another about a patient. Still, there is a second interpretation, “What do we mean...

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...

Chronic non-malignant pain

Tamar Makin, in 2021, prefaced her Essay with, “It has long been established that phantom limb pain is a real physiological condition. Why then do we tolerate mystery and...

Pain in PDOC

PDOC stands for Prolonged Disorder of Consciousness; the term covers two previously defined states: vegetative and minimally conscious. This post considers the question, “Does a person in a prolonged...

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...

Covid, FND, and models

“Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations. Lessons Learned From Functional Neurological Disorder.” (here) Published today (9th April 2021), I think this viewpoint is brave; mentioning...

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