Professor Diane Playford
President of the British Society of Rehabilitation Medicine
Though long-term rehabilitation services in the UK are still limited, their value is acknowledged, with neuroplasticity treatment an exciting new area.
Rehabilitation medicine (RM) is the specialty that encompasses the diagnosis, assessment, acute and long-term management of people with complex disabilities –physical and/or cognitive.
It is a dynamic and developing specialty with three main areas: neurological (e.g. brain injury, stroke, spinal cord injury, progressive neurological disease and lifelong conditions), musculoskeletal (e.g. major trauma, complex pain syndromes and arthritis) and amputee (e.g. trauma, vascular and congenital limb deficiency).
Professor Diane Playford, President of the British Society of Rehabilitation Medicine (BSRM), says there is “a wealth of evidence to show that medical rehabilitation works.”
Rehabilitation medicine is a relatively new speciality
The difficulty in Britain is that we have very small numbers of beds and specialist rehabilitation physicians.
This is partly because rehabilitation medicine was only established as a speciality in the UK in 1991, and partly because it is still seen as less important for funding when measured against immediate priorities for saving lives such as emergency helicopters and trauma units, says Prof Playford. “There’s rationing by service: it’s common to be limited to a six-week block of rehabilitation, but many people need longer and you can deteriorate late after stroke or injury.”
The BSRM has laid out what effective services should look like, and RM is a “broad church” benefiting from doctors whose early training has been in a number of different fields of medicine, and who are increasingly interested in technological as well as human aspects of rehabilitation.
Investing in technology is paying off
Rehabilitation is still seen as less important for funding, when compared to things like emergency helicopters and trauma units.
“Technology is at a tipping-point,” says the professor. “It’s about to become cost-effective. Neuroplasticity is greater immediately after injury and repetitive task therapy can help patients recover functions. Technology enables patients to continue practising the tasks at home and can help boost motivation and manage anxiety, providing a more cost-effective option and building on face-to-face sessions with therapists. Intensity improves ability.”
However, as she points out, it’s not just about practising exercises. “Patients want a meaningful life caring for their families, working, going out with friends. So repetitive task therapy has to fit into the human context. ‘Yes, my arm is better, what am I going to do with that?’ It’s all about combining tech and the human element to ensure the best quality of life and independence. The skill is in achieving the right mix.”