Rehabilitation Medicine

What is rehabilitation medicine?

Rehabilitation medicine describes efforts to improve function and minimize impairment related to activities that have been hampered by disease, injuries, or developmental disorders.

Injuries, illnesses, or conditions that may cause or contribute to disability can include stroke, traumatic brain injury, spinal cord injury, musculoskeletal injuries, pain, a number of intellectual and developmental disorders such as cerebral palsy, Fragile X syndrome, and autism spectrum disorders (ASDs), and other conditions and injuries.^1,2,3

The primary effects of many such conditions are physical—perhaps mobility or sensory problems. But individuals facing them can also experience intellectual, behavioral, and communication difficulties. They might have problems with making decisions, paying attention, or speaking. These can also require rehabilitation medical care.

NICHD—through its National Center for Medical Rehabilitation Research—focuses on addressing chronic physical disabilities in its rehabilitation medicine research. Other NIH Institutes may focus on specific aspects of rehabilitation medicine, as explained throughout the rest of this topic.

Rehabilitation medicine differs from drug and alcohol rehabilitation, which aims to help a person control or eliminate his or her substance use, and from the rehabilitation that is commonly referred to within the context of the criminal justice system.

There are many reasons why a person may need care related to rehabilitation medicine.

For example:

• Injuries and trauma, such as:
  • Burns
  • Limb loss or amputation
  • Fractures, including multiple fractures to the long bones in the limbs and fractures of the hip, spine, or skull
  • Traumatic brain injury (TBI) or concussion (mild TBI)
  • Spinal cord injury
  • Loss of sight or hearing
• Diseases and conditions that can cause loss of mobility function, such as:
  • Muscular dystrophy
  • Spina bifida
  • Cerebral palsy
  • Arthritis
  • Scoliosis or curvature of the spine
  • Damage to muscles, ligaments, tendons, or cartilage
  • Knee arthroplasty/replacement
  • Hip replacement
  • Stroke
  • Multiple sclerosis
  • Parkinson’s disease and related degenerative disorders
• Surgery or prolonged treatment for other diseases or illnesses that can cause loss of function, such as:
  • Chronic pain/neuropathy
  • Severe infection
  • Diabetes
  • Cancers (including chemo- and radiation therapies)
  • Peripheral artery disease
  • Cardiac arrest

Likewise, certain intellectual and developmental disabilities, such as autism spectrum disorders, may benefit from rehabilitation medicine in the form of occupational or physical therapy or other rehabilitation services.

These are but a few examples, and many of them fall outside the research portfolio of the NICHD and NCMRR. In general, though, any person might need care related to rehabilitation medicine at some point in his or her life, for a variety of reasons.

Secondary Conditions

Many people who experience the disorders listed above also face their secondary effects—problems that are not necessarily part of the main diagnosis, but that can also have an impact on patients’ health, independence, and quality of life.

Rehabilitation medicine may include treatments for these and other secondary symptoms:

• Muscle atrophy (wasting), blood clots or circulation issues, obesity, or other problems resulting from disuse
• Problems caused by overuse of prosthetics or medical devices
• Ulcers, bed sores, or other problems with skin integrity
• Local or widespread infections or sepsis
• Injuries resulting from falls
• Problems with balance or vision
• High blood pressure, diabetes, and other conditions
• Bladder and bowel problems
• Breathing problems, including those related to mechanical ventilation
• Emotional or cognitive difficulties, such as anger, depression, or difficulty controlling emotions or behavior

If not addressed in a timely manner, many of these secondary conditions can become serious, some of them fatal.

Rehabilitation medicine uses many kinds of assistance, therapies, and devices to improve function. The type of rehabilitation a person receives depends on the condition causing impairment, the bodily function that is affected, and the severity of the impairment.

The following are some common types of rehabilitation:^{1, 2, 3, 4, 5}

• Cognitive rehabilitation therapy involves relearning or improving skills, such as thinking, learning, memory, planning, and decision making that may have been lost or affected by brain injury.
• Occupational therapy helps a person carry out daily life tasks and activities in the home, workplace, and community.
• Pharmacorehabilitation involves the use of drugs to improve or restore physical or mental function.
• Physical therapy involves activities and exercises to improve the body’s movements, sensations, strength, and balance.
• Rehabilitative/assistive technology refers to tools, equipment, and products that help people with disabilities move and function. This technology includes (but is not limited to):
  • Orthotics, which are devices that aim to improve movement and prevent contracture in the upper and lower limbs. For instance, pads inserted into a shoe, specially fitted shoes, or ankle or leg braces can improve a person’s ability to walk. Hand splints and arm braces can help the upper limbs remain supple and unclenched after a spinal cord injury.
  • Prosthetics, which are devices designed to replace a missing body part, such as an artificial limb
  • Wheelchairs, walkers, crutches, and other mobility aids
  • Augmentative/Alternative Communication (AAC) devices, which aim to either make a person’s communication more understandable or take the place of a communication method. They can include electronic devices, speech-generating devices, and picture boards.
  • Hearing aids and cochlear implants
  • Retinal prostheses, which can restore useful vision in cases in which it has been lost due to certain degenerative eye conditions
  • Telemedicine and telerehab technologies, which are devices or software to deliver care or monitor conditions in the home or community
  • Rehabilitation robotics
  • Mobile apps to assist with speech/communication, anxiety/stress, memory, and other functions or symptoms⁶
• Recreational therapy helps improve symptoms and social and emotional well-being through arts and crafts, games, relaxation training, and animal-assisted therapy.
• Speech and language therapy aims to improve impaired swallowing and movement of the mouth and tongue, as well as difficulties with the voice, language, and talking.
• Surgery includes procedures to correct a misaligned limb or to release a constricted muscle, skin grafts for burns, insertion of chips into the brain to assist with limb or prosthetic movement, and placement of skull plates or bone pins.
• Vocational rehabilitation aids in building skills for going to school or working at a job.
• Music or art therapy can specifically aid in helping people express emotion, in cognitive development, or in helping to develop social connectedness.⁷

These services are provided by a number of different healthcare providers and specialists, including (but not limited to):

• Physiatrists (also called rehabilitation physicians)
• Occupational therapists
• Physical therapists
• Cognitive rehabilitation therapists
• Gait and clinical movement specialist
• Rehabilitation technologists
• Speech therapists
• Audiologists
• Orthopedists/surgeons
• Neurologists
• Psychiatrists/psychologists
• Biomedical engineers
• Rehabilitation engineers

To help people achieve their full potential, and to ensure the health, productivity, independence, and well-being of all people, the NICHD supports rehabilitation medicine research to improve people’s physical and mental functioning.

NICHD’s National Center for Medical Rehabilitation Research (NCMRR) was established in 1990 to support research and research training related to the rehabilitation of individuals with physical disabilities. Since then, the NCMRR has supported a large portfolio of cutting-edge research that has improved the health of those with physical disabilities.

Other parts of NICHD’s focus on improving the mental functioning of individuals who are recovering from a traumatic brain injury or stroke, and on identifying effective supports and interventions for intellectual and developmental disability.

Findings and interventions from rehabilitation medicine have relevance to those without illness or injury, too. For example, rehabilitation physicians may learn skills and techniques working with complicated multiple trauma patients that they can apply to injury prevention in athletes.

Although more than two decades of NCMRR research have revealed improvements in rehabilitation, there remain unanswered questions, for example regarding:

• Mechanisms of injury and repair
• Ways to restore critical pathways
• Genetic and genomic contributions to outcomes.

The All of Us Research Program (previously the Precision Medicine Initiative) is poised to have an impact on rehabilitation medicine by focusing attention on ways to incorporate variations in genes, environment, and lifestyle in individualized treatments.

For certain types of rehabilitation, best practices have not yet been developed. Research has generated many discoveries, but applying new and better interventions and adapting them for wider use remain priorities. Basic, translational, and clinical research in rehabilitation medicine will continue to be an important part of NICHD’s overall mission.

Basic information for topics, such as “What is it?” is available in the About Rehabilitation Medicine section. Answers to other frequently asked questions (FAQs) specific to rehabilitation medicine are in this section.