High Level Management – Levels 5 and 6
It is often at these late stages of rehabilitation people are discharged from in patient care and come to see me in clinic. It is very important to, especially initially, to mimic the in-patient structure of rehabilitation to encourage compliance and reduce anxiety, confusion and decline. This should not be to the detriment of the rehabilitative process as you envisage it however. As these reduce environmental control can reduce as appropriate and expression as well as forward and differential thinking should be encouraged.
As people start to have insight in to their situation and it is very important to involve them in their decision-making process. You must try to listen acknowledge their emotion and stress during these often life changing situations. Listen to their goals and beliefs in regards to their injuries and prognosis and educate and instill positivity and confidence as appropriate. Knowledge, even daily if not retained, is essential as it gives them a sense of control and understanding, reducing fears and threat. Demonstrate progress through notes, videos and assessments as appropriate again to reduce frustration and show momentum and achievement of milestones.
Key factors
- Listening skills
- Collaboration
- Goal setting
- Education
- Positivity
These stages often involve a combination of independent and co-operative work. The primary goal is to integrate cognitive, emotional as well as their own physical goals to get as close to independent function as possible. Key factors are assessment, forward planning and problem solving as well as keeping community, social and daily living skills in mind. Feedback and feed-forward as well as vulnerability from both sides have direct positive effects on the rehabilitative process.
Sensorimotor integration is both the process and goal that requires amongst many others the integration of:
- Speed
- Power and strength
- Flexibility and range of motion
- Co-ordination
- Rhythm and timing
- Balance and proprioception