Rehabilitation: A New PerspectiveBioethics — By Elizabeth Marten on December 2, 2013 at 8:00 am
In my last post, I spoke on the idea that we expect our lives to be pretty normal. For the most part, we run the race of life at our own pace and do not expect much deviation from the bell curve. But when an anomaly is thrown at us that affects us and causes us to leave a previous way of life and begin a new one, how are we supposed to respond?
One good example to look to is that of a patient striving for a new normal after a physical injury.
Let’s start by first recognizing what our normal is. Most of the people reading this blog will fall into this category; after all it is the most common. These people have the blessing of a well-functioning body. Sure, some things may not be perfect about it, but it will still get you through the day. Medical terminology defines this normal ability with two terms: activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s). ADL’s include simple things that you do every day: brushing your teeth, using the restroom and eating on your own. IADL’s are a bit more complex, they include preparing a meal or balancing a check book. Both of these terms define what it is we must be able to do on our own in order to fall into this “normal”.
For a good amount of people, the normal described above is not done with as much ease as a healthy person. This is because they themselves or a loved one has suffered from a birth defect, an accident, a disease, or something of that nature that prevents them from preforming any ADL’s or IADL’s. Not being able to perform these activities causes a dramatic change in anyone’s life. Making what is called a “new normal” or an adjustment that accounts for physical impairments, takes time, dependence, and learning.
In a way we all make new normals for ourselves throughout our life. Adjustments are made in life for differences, changes or anything that alters a previous routine.
From a medical team’s perspective, the goal for a patient with an impairment that affects these daily activities would be to get them back home and able to live as best as they can despite their circumstances. This is easier said than done. Someone who is paralyzed from the waist down, for example, faces many challenges that a normal person would not even have to think about. Most obviously they would not be able to walk, would have difficulty getting in and out of a car (and would need a different mechanism for using the gas and brakes), and would need to take into account the extra time it takes to move (or be moved) when planning for the day. Disabilities and risks that are not as obvious include possible medical complications such as the development of bed sores due to immobility, clotting in the legs and the fact that by being unaware of pain a paraplegic would not be alerted to an injury if one did occur.
While all of these obstacles differ from impairment to impairment, the road to rehabilitation, or restoration of ADL’s and IADL’s, is one that will be walked very intentionally. Planning, goals, and support will all be needed to assist a disabled person in reaching a new way of living an ordinary life. This tedious process is how we get back on our feet after a traumatic life event has occurred.
Goals given to those just recovering from a permanent injury need to be crafted to suit the individual. Different people have different potentials, and the same goes for those re-learning how to live life normally. Daily, weekly, and monthly goals are all made in consideration of what a certain patient may actually be able to attain. This is done to first and foremost get a person to their new normal and to realistically set up expectations so that there are encouraging results through the rehabilitation process.
The recovery process reaches far beyond a hospital stay and it remains for a lifetime. Every day of a new normal is something more difficult than what our previous normal life taught us. Although one may have gotten back up, the difficulty does not go away.
Even when we have not been physically affected with a debilitating injury, there are still things in life that will force us to find a new normal. Losing a mother, father, sibling, or friend will all drastically change our normal; starting a new job or going through a hardship will also change what normal looks like. Everyone faces this rehabilitation process–it will just present itself differently in different situations.
The lesson that medical rehabilitation teaches us is valuable to everyone. Rehabilitation takes time. We often want to see results immediately and are impatient to return to what was previously our normal. Respond to disaster in patience; make reasonable goals and eventually a new normal will begin and how long that new normal will last we don’t know.