For many surgeons, the role of the rehab team is somewhat of a mystery and the criteria for what qualifies for transfer to the inpatient rehabilitation unit arbitrary and somewhat random. This leads to confusion and frustration in dealing with the rehabilitation team, but it does not have to be that way. Ideally, rehabilitation of the trauma patient begins during the initial hospitalization. During the acute hospitalization, the rehabilitation team can initiate functional assessments and help prevent secondary disability. An example would be initiating proper splinting to avoid heel cord contractures that may delay ambulation and mobilization once the patient is out of the ICU. Frequently during these assessments and therapies, injuries or conditions that may impair recovery and return to function may be identified. Small hand fractures or traumatic rotator cuff tears that may not been detected during initial triage can impair the use of ambulatory aids and also delay return to ambulatory status. There may also be any number of musculoskeletal issues or conditions present prior to injury as well as psychological issues that may impair return to function. The rehab team is uniquely able to assess and address these issues and thus expedite your patient toward the goal of disposition. Perhaps one of the rehab team’s most valuable contributions is the ability to maximize function during the acute hospitalization and determine and arrange appropriate disposition, whether that be home, skilled nursing facility, inpatient unit, or other venues. In short, we can make them go away once your work is done! In the absence of a rehab team, this responsibility usually falls to you and an overworked social worker, and in my experience, most surgeons find this aspect of patient care their least favorite and this the rehab specialists most appreciated talent.

In rehab, we use a team approach to patient care. The patient is always the most important member of the team; however, the rehabilitation team is led by the physiatrist, who coordinates and directs the other members of the team and consults on medical issues. Physiatrists are trained in neurologic/musculoskeletal evaluation and functional assessment as well as the various treatment options and modalities. The rehab consultant is frequently called on to assist the primary team in coordination of care and addressing acute care issues such as spasticity and bowel/bladder management, as well as prevention of secondary injury including skin breakdown and contractures. Most important are the assessment of function and the anticipation of future needs once definitive care of the trauma team is completed.

All of the members of the rehab team have their roles. Members of the rehabilitation team include nurse, physical therapist, occupational therapist, speech therapist, recreational therapist, vocational therapist, psychologist, and social worker. They each function in their own area of expertise, as well as in conjunction with the other team members. Not all patients will require treatment from all of the various disciplines; that is for the physiatrist to determine (i.e., who needs PT, who needs speech therapy, etc.).