Health and Me

Dr Shahin KE

Fatigue, Monotony, Lack Of Visible Progress: Why Patients Skip Physical Rehab?

One of the major challenges in <span>rehabilitation</span> is that patients may discontinue midway through the recovery process. In rehabilitation, it is not just the physical journey; it involves both emotional and psychological factors. 

When patients begin the rehabilitation journey, they are usually informed of the prognosis, which helps them start the journey with hope. During the process, they might face unexpected encounters such as slow progress and fatigue during exercises. Financial burden, family responsibilities, and social pressures can further add to their stress. 

Some patients will not expect the recovery to be too long. Unlike a surgery, where results may appear immediately, rehabilitation demands repeated efforts and commitment for weeks or sometimes months. This might make the patient feel like they have put in a lot of effort, but results might be delayed. 

As a rehabilitation physician, it is important to understand that this is not non-compliance or laziness. In a few cases, it is the patient’s exhaustion, fear, and loss of confidence. Additionally, patients might also experience a lack of engagement and fatigue in the exercises. They might feel uninterested in the exercise routine. Once these problems are addressed, there will be more measurable progress. The core idea of rehabilitation is not only to treat the body but to support the patient's mental and emotional well-being. 

The main barriers in rehabilitation are fatigue and pain. For instance, in a spinal cord injury, stroke, post amputation, orthopedic condition such as chronic musculoskeletal pain, and polytrauma, the patient will already be experiencing pain due to the injury. In rehabilitation, physical therapy, and occupational therapy, experts will make the patient do repetitive movements, resulting in emotional fatigue. 

From a rehabilitation perspective, repetition is necessary for the development of neuroplasticity; the nervous system learns from repetition. On the contrary, from the patient's perspective, it might feel like a punishment. Even though they understand the benefit, they are frustrated, and it might alleviate the pain. This pain might develop into a fear response associating exercising with suffering, affecting the rehabilitation process. 

Rehabilitation must be patient-centered, engaging, and goal-oriented. Today, several newer technologies are helping improve patient involvement and engagement in therapy. Approaches such as gamification and functional training can make rehabilitation more interactive and motivating for patients. For instance, new age AI-enabled devices such as ‘ArmAble’ that have games like chapati rolling, mosquito swatting, dosa making, etc. keep the patient very engaged as they do those activities. Though it might be repetitive, it is still very engaging for the patients. 

<h2>Importance Of Progress During The Recovery Journey </h2>

Small achievements and visible progress can make a significant difference to the patient. For example, standing for 10 seconds longer, climbing one extra step, or moving a finger that could not be moved earlier. As human beings, when we begin to notice progress, hope naturally starts to grow. That hope becomes an important part of rehabilitation. 

The challenge in rehabilitation is that progress is often slow in <span>neurological recovery</span>. Improvements may be microscopic, which are not immediately visible to the patient. This is why it is important to actively help patients recognize and understand their progress. 

To help the patient understand, we document the patient’s condition from the beginning and show them the difference with the help of functional scores. We record videos to show the patient’s movement and compare it over the weeks of treatment. We also use functional assessment scores and balance testing equipment that convert progress into measurable numerical values. This can help patients see how much they have improved over time. 

Setting weekly or fortnightly milestones. Smaller milestones are more realistic and achievable. Patients see progress after certain milestones. This helps rebuild their confidence and belief in the process. 

Long-term risks of skipping rehabilitation 

In case of neurological conditions like stroke or spinal cord injury, there is a golden period for rehabilitation. This is the time for spontaneous recovery, where the brain starts to relearn. The brain keeps making new connections with repetition. If the patient is not actively participating or completing rehabilitation during that time, they may lose the opportunity to achieve the results. 

Even if the patient resumes rehabilitation after a period of time, benefits might not be as significant as envisioned. Discontinuing rehabilitation can lead to stiffness, reduced mobility, and functional limitations. In such cases, if the surgery may be technically successful, the outcome may not be satisfactory. 

Beyond physical complications, incomplete or skipping rehabilitation can result in loss of independence. The ultimate goal of rehabilitation is to help patients restore their maximum potential and help them perform everyday activities with ease. Thus, completing rehabilitation is necessary, especially at the right time. 

<h2>Motivated And Consistent During The Rehabilitation </h2>

Motivation is the fuel for rehabilitation. Motivation should not depend only on the patient’s willpower; it should be supported and guided throughout the journey. 

For example, in a high spinal cord injury, independent walking with an orthosis may be unrealistic, resulting in loss of motivation. Instead, rehabilitation should focus on short-term goals that can be achieved gradually. If goals are realistic, patients stay encouraged and committed to the process. 

<h3>Importance of Family Involvement</h3>

Recovery is never limited to the patient alone; it should involve the entire support system to see desirable results. Families should be educated about the goals and be updated on the patient’s progress. Documenting the improvements can also help both patients and families stay positive and motivated during rehabilitation. 

<h3>Communication</h3>The rehabilitation team should work together with seamless communication. The goals should be discussed amongst the team of rehabilitation physicians, physiotherapists, and other healthcare professionals. This can help goals to remain realistic, coordinated, and transparent across the entire team. 

Celebrating small victories, such as a slight improvement in balance or movement, should be acknowledged. This can significantly boost the patient’s confidence and motivation in the journey.

At times, we as rehabilitation professionals do much more than provide clinical treatment. We also become motivators, coaches, educators, and emotional support systems for our patients throughout their recovery journey. 

We work with the patients during the most vulnerable phase of their lives, when they are not only struggling with the disease but also with their identity, confidence, and independence. So our responsibility is not just to improve muscle strength or to correct gait. We have to help restore their independence, daily functional movements, and help restore dignity, which makes it more meaningful.

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One of the major challenges in rehabilitation is that patients may discontinue midway through the recovery process. In rehabilitation, it is not just the physical journey; it involves both emotional and psychological factors.  When patients begin the rehabilitation journey, they are usually informed of the prognosis, which helps them start the journey with hope. During the process, they might face unexpected encounters such as slow progress and fatigue during exercises. Financial burden, family responsibilities, and social pressures can further add to their stress. Some patients will not expect the recovery to be too long. Unlike a surgery, where results may appear immediately, rehabilitation demands repeated efforts and commitment for weeks or sometimes months. This might make the patient feel like they have put in a lot of effort, but results might be delayed.  As a rehabilitation physician, it is important to understand that this is not non-compliance or laziness. In a few cases, it is the patient’s exhaustion, fear, and loss of confidence. Additionally, patients might also experience a lack of engagement and fatigue in the exercises. They might feel uninterested in the exercise routine. Once these problems are addressed, there will be more measurable progress. The core idea of rehabilitation is not only to treat the body but to support the patient's mental and emotional well-being.  Barriers To Rehabilitation  The main barriers in rehabilitation are fatigue and pain. For instance, in a spinal cord injury, stroke, post amputation, orthopedic condition such as chronic musculoskeletal pain, and polytrauma, the patient will already be experiencing pain due to the injury. In rehabilitation, physical therapy, and occupational therapy, experts will make the patient do repetitive movements, resulting in emotional fatigue.  From a rehabilitation perspective, repetition is necessary for the development of neuroplasticity; the nervous system learns from repetition. On the contrary, from the patient's perspective, it might feel like a punishment. Even though they understand the benefit, they are frustrated, and it might alleviate the pain. This pain might develop into a fear response associating exercising with suffering, affecting the rehabilitation process.  Rehabilitation must be patient-centered, engaging, and goal-oriented. Today, several newer technologies are helping improve patient involvement and engagement in therapy. Approaches such as gamification and functional training can make rehabilitation more interactive and motivating for patients. For instance, new age AI-enabled devices such as ‘ArmAble’ that have games like chapati rolling, mosquito swatting, dosa making, etc. keep the patient very engaged as they do those activities. Though it might be repetitive, it is still very engaging for the patients.  Importance Of Progress During The Recovery Journey  Small achievements and visible progress can make a significant difference to the patient. For example, standing for 10 seconds longer, climbing one extra step, or moving a finger that could not be moved earlier. As human beings, when we begin to notice progress, hope naturally starts to grow. That hope becomes an important part of rehabilitation.  The challenge in rehabilitation is that progress is often slow in neurological recovery. Improvements may be microscopic, which are not immediately visible to the patient. This is why it is important to actively help patients recognize and understand their progress.  To help the patient understand, we document the patient’s condition from the beginning and show them the difference with the help of functional scores. We record videos to show the patient’s movement and compare it over the weeks of treatment. We also use functional assessment scores and balance testing equipment that convert progress into measurable numerical values. This can help patients see how much they have improved over time.  Setting weekly or fortnightly milestones. Smaller milestones are more realistic and achievable. Patients see progress after certain milestones. This helps rebuild their confidence and belief in the process. Long-term risks of skipping rehabilitation  In case of neurological conditions like stroke or spinal cord injury, there is a golden period for rehabilitation. This is the time for spontaneous recovery, where the brain starts to relearn. The brain keeps making new connections with repetition. If the patient is not actively participating or completing rehabilitation during that time, they may lose the opportunity to achieve the results.  Even if the patient resumes rehabilitation after a period of time, benefits might not be as significant as envisioned. Discontinuing rehabilitation can lead to stiffness, reduced mobility, and functional limitations. In such cases, if the surgery may be technically successful, the outcome may not be satisfactory.  Beyond physical complications, incomplete or skipping rehabilitation can result in loss of independence. The ultimate goal of rehabilitation is to help patients restore their maximum potential and help them perform everyday activities with ease. Thus, completing rehabilitation is necessary, especially at the right time.  Motivated And Consistent During The Rehabilitation  Motivation is the fuel for rehabilitation. Motivation should not depend only on the patient’s willpower; it should be supported and guided throughout the journey.  Set Realistic goalsFor example, in a high spinal cord injury, independent walking with an orthosis may be unrealistic, resulting in loss of motivation. Instead, rehabilitation should focus on short-term goals that can be achieved gradually. If goals are realistic, patients stay encouraged and committed to the process.  Importance of Family InvolvementRecovery is never limited to the patient alone; it should involve the entire support system to see desirable results. Families should be educated about the goals and be updated on the patient’s progress. Documenting the improvements can also help both patients and families stay positive and motivated during rehabilitation.  CommunicationThe rehabilitation team should work together with seamless communication. The goals should be discussed amongst the team of rehabilitation physicians, physiotherapists, and other healthcare professionals. This can help goals to remain realistic, coordinated, and transparent across the entire team.  Tracking progressCelebrating small victories, such as a slight improvement in balance or movement, should be acknowledged. This can significantly boost the patient’s confidence and motivation in the journey. At times, we as rehabilitation professionals do much more than provide clinical treatment. We also become motivators, coaches, educators, and emotional support systems for our patients throughout their recovery journey. We work with the patients during the most vulnerable phase of their lives, when they are not only struggling with the disease but also with their identity, confidence, and independence. So our responsibility is not just to improve muscle strength or to correct gait. We have to help restore their independence, daily functional movements, and help restore dignity, which makes it more meaningful.

fatigue, monotony, lack of visible progress: why patients skip physical rehab?

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Fatigue, Monotony, Lack Of Visible Progress: Why Patients Skip Physical Rehab?

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