Rehabilitation in Surgery

Rehabilitation in SurgeryAfter certain injuries and some diseases, restoration to a perfectly normal state of health is not possible. In former years medical science has had little to offer those individuals who were handicapped through such crippling injuries or diseases. In the more recent war years, however, it has been realized that many persons so afflicted were impaired in their quest of a nor­mal and happy life to a greater extent than was necessary; so, the science of rehabilitation has evolved. The National Council on Rehabilita­tion has defined this new art as the restoration of the handicapped to the fullest physical, men­tal, social, vocational, and economic usefulness to which they are capable. From this definition it is apparent that the field of rehabilitation is broad. In essence, every person whose impaired physical condition can no longer be improved by surgery or medication is a candidate for this form of therapy.

Basically, the objective of rehabilitation is to elicit the innate resourcefulness of the individual in coping with his physical disabilities while seeking a normal useful life. To this end the methods of rehabilitation are many. But all methods and schemes are not adaptable to all persons. The basic principle of rehabilitation is individualization. As with any other type of therapy, the patient must first be evaluated, and as the therapy program progresses further evalu­ation must continually be made.

Rehabilitation is directed at restoration of the individual as a whole to the most efficient state of function and not merely his afflicted part. Of primary importance is the adjustment of the mental attitude. This may be the most difficult phase of the person’s program of restora­tion, but no progress can be made without first establishing a proper frame of mind. The person has to want to be helped and has to want to help himself. The individual must be taught to face the facts and to live to his fullest extent with his handicap. A vision of the goal and prob­able end result must activate his mind. Educa­tional, orientational, and even psychological measures may be used to create a mental attitude conducive to progressive rehabilitation.

Similar to most other forms of treatment, rehabilitation is most effective when started early. Often certain measures are begun at the patient’s bedside very soon after injury. At least the mental and educational phases may begin here. Each step in the schedule is made progres­sive, and all parts of the plan are co-ordinated with one another to assure a purposeful and integrated program.

Needless to say, the subject of rehabilitation can only be mentioned here. A treatise of this subject could become voluminous, because there are very few standardized specific procedures for use in rehabilitation, since each particular pa­tient requires particular methods. A few of the commoner general methods and techniques em­ployed in rehabilitation programs are physical therapy, corrective therapy, occupational ther­apy, manual arts therapy, educational and men­tal therapy, and vocational guidance. The titles are self-explanatory.

Many of the individual methods prescribed in these subdivisions of the rehabilitation science require active effort on the part of the patient. Such terms as recuperation and convalescence must no longer be considered synonymous with rest. Concerted but controlled physical activity and exercises play an important role in both the restoration of the handicapped to the greatest functional capacity and the rapid and complete recovery of most other patients. In this field of corrective therapy may be the prescription of various prostheses (artificial parts and devices) and crutches and braces, with education in their usage.

The importance of the application of rehabili­tation programs whenever there is a possibility of improving the usefulness of a handicapped person cannot be afforded too much emphasis. Persons who are liabilities to their families be­come great assets. The disabled person acquires an entirely new outlook on life when his physical, mental, social, vocational, or economic usefulness is enhanced. When the employability of the handicapped has been improved so he is placed in a remunerative vocation, he leads a more normal independent life with less obliga­tion to others. To be sure, many people with good health and all their normal capabilities could well heed a lesson in resourcefulness from the numerous handicapped persons of great ac­complishment.

The majority of cases treated by surgical methods proceed through all phases of therapy without incident, in a more or less routine man­ner. But a certain small percentage are accom­panied by surgical complications. No treatise of a surgical subject is considered complete with­out mention of the possible diseases and con­ditions which may ensue as complications. It is those occasional cases with complicating factors which are most dramatic and spectacular in the layman’s eye. The surgical patient who has or develops a condition which complicates his course, is desirous of greater knowledge about the condition. For these reasons, this chapter discussing surgical complications is included.

The listing of surgical complications for the layman’s reference becomes a perilous task. To be sure, the conditions which may be present, or may ensue to impede the usual progress of recovery, are many. But the incidence of any one of such complicating conditions is extremely low. It must be realized that only the surgeon’s mindful awareness of all surgical complications, regardless of how remote, is the deterring fac­tor in the development of many of them. In­deed, it is not the author’s intent to alarm the patient who is a candidate for surgical treatment; nor is it intended to undermine the faith of laity in the surgical profession, which has made won­derful strides in recent years and greatly added to the longevity of man. But neither can the importance of any complicating factor be be­littled. The surgeon has them foremost in his mind, and it is only because of this that most operative complications are prevented.

Most patients who seek the surgeon’s care have already been seen by another phsyician, or at least have entertained the thought that their diseased state may be treated by surgical means. It is the surgeon’s lot not only to decide whether any form of surgical therapy will be of benefit to the patient, but also to weigh such benefit from surgery against the possible risks involved in its application. In this decision the confident patient is entirely passive. The surgeon is aware of the possibility of occurrence of each complication, and he does not advise surgical intervention if the risk is too great or the bene­fit too small.

Almost all diseases and abnormal physical states could be listed as surgical complications. But only the most common and the most serious conditions are included here. Many of them are present before surgical treatment begins; some always threaten development during the course of surgical therapy, and a few are entirely fortuitous and occur without warning signs. Surgical complications may be considered as conditions which occur in conjunction with a surgical disease, or result from surgical manage­ment. This is the scheme selected as an outline for their listings here.

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