Rehabilitation: A New Perspective

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.

The Placebo Effect and The Imagination- Lunch w/ TED

Apropos for April Fool’s Day, today’s Lunch with TED clip from a 2009 TEDMED features magician Eric Mead marveling at the effectiveness of placebos in medicine and demonstrating the power of imagination over reason. Be forewarned: this clip is not for the faint of heart. Continue reading The Placebo Effect and The Imagination- Lunch w/ TED

The Problematic Suppositions of Wired

Amy Wallace’s essay “An Epidemic of Fear,” published in this month’s issue of Wired, is both perceptive and worrying. Wired’s articles often comment on the growing debates between social groups and professional communities. This month’s feature focuses on the conflict between anti-vaccination proponents—mainly parents—and the scientific community that contends they are necessary.

Wallace’s essay, while offering some sympathy to parents, argues heavily in support of the scientific community. Unfortunately, her view also creates worries about parental rights.

Consider Wallace’s comments about parents who choose not to vaccinate their children:

In certain parts of the US, vaccination rates have dropped so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitivly, higher rates of non-vaccination often correspond with higher levels of education and wealth).

The figures sound alarming. Wallace provides reasons for us to believe that vaccination exemptions result in serious health concerns for both specific individuals and larger communities. The issue, however, is garbled amidst Wallace’s concern that parents who choose not to have their children vaccinated are doing so on irrational grounds—even though, as Wallace points out, the majority of parents abstaining from vaccinations live in more highly educated communities. Yet she says that naysayers oppose vaccinations because of fear and “unmet need,” as opposed to scientific evidence or reasonable doubt. She adds:

…Science loses ground to pseudo-science because the latter seems to offer more comfort. “A great many of these belief systems address real human needs that are not being met by our society,” [Carl] Sagan wrote of certain Americans’ embrace of reincarnation, channeling, and extraterrestrials. “There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.”

Wallace’s attention to the motivations underlying parents’ objections to vaccinations does not cohere with her primary thesis that vaccinations are necessary. Furthermore, her comment that these objections are a result of fear and irrationality is not far removed from the kind of remarks Sigmund Freud makes in his Civilization and It’s Discontents. He writes, “Life, as we find it, is too hard for us; it brings us too many pains, disappointments and impossible tasks. In order to bear it, we cannot dispense with palliative measures.” Like Freud, Wallace implies that parents are trying to assuage their fears using superstitious means. This line of thought implies that our unmet fears and needs are irrational, and so the direction in which we point our fears and needs is unjustifiable.

Of course, we cannot deny—nor should we—that we are liable to hold beliefs that are not wholly logical. Wallace’s position, however, not only has the capacity to generate more fear among anti-vaccine proponents, but it also has the capacity to undermine parental rights. If she argues that parents who object to the scientific community about vaccinations are irrational, perhaps they should not be allowed the freedom to choose not to have their children vaccinated.

Yet the fact that fear exists among parents does not imply the absence of reason. With all the controversies surrounding treatments, as well as updated information about side-effects and the rise of medical information available online, parents are justified in questioning scientific authority. By dismissing parents’ concerns as illogical, Wallace feeds this distrust. Respect goes both ways. If the scientific community is truly a bulwark of logic and reason, it should seek to bridge the gap between parents and doctors by effectively communicating about the challenges and controversies regarding science and medicine. Furthermore, if Wallace wants to convince parents that the scientific community should be trusted, she will also seek to bridge this gap, instead of engendering more doubt. ‘