IM25.16 | Geriatric Rehabilitation — Summary & Reflection

KEY TAKEAWAYS

Geriatric rehabilitation principles: Task-specific, high-intensity, early (within 24–48 hours of medical stability), interdisciplinary, patient-centred, goal-directed.

Rehabilitation team: Geriatrician (medical coordination), physiotherapist (mobility, balance, respiratory), occupational therapist (ADL, home assessment, assistive devices), SLT (aphasia, dysphagia), neuropsychologist (cognitive assessment), social worker (discharge planning, community services).

Functional assessment tools:
- Barthel Index (0–100; BI >60 = likely home discharge; BI 20–60 = inpatient rehabilitation benefit)
- FIM (18–126; comprehensive, captures communication and cognition)
- Modified Rankin Scale (0–6; mRS ≤2 at 3 months = good stroke outcome)
- TUG test (<12 sec = normal; >14 sec = fall risk)
- Berg Balance Scale (0–56; <45 = fall risk)

Physiotherapy: Gait/mobility (task-specific walking, CIMT for hemiparesis), balance (Otago programme — 35% fall reduction), respiratory (ACBT, pulmonary rehabilitation)

Occupational therapy: ADL retraining, assistive devices, home assessment, vocational/leisure rehabilitation

Barriers to rehabilitation: Post-stroke depression (screen with GDS/PHQ-9; treat with fluoxetine 20 mg — FLAME trial), pain (hemiplegic shoulder, neuropathic — tailor analgesia), spasticity (botulinum toxin type A), cognitive impairment, malnutrition

Social rehabilitation: Community physiotherapy, day hospitals, stroke support groups, carer training

REFLECT

Return to Murugadoss and his physiotherapist's question: 'What does he want — bathroom independence, going home, or attending his granddaughter's wedding in three months?' These three goals are not the same rehabilitation goal. Bathroom independence requires bed-to-chair transfer, safe standing, and a few metres of walking. Going home to a first-floor flat with stairs requires stair-climbing and negotiating external steps. Attending a wedding in three months requires outdoor walking, endurance, and perhaps some communication ability to engage with guests. Each goal implies a different rehabilitation trajectory, intensity, team focus, and timeline. Reflect on what you now know about the evidence for rehabilitation — the dose-response relationship, the plasticity window, the importance of depression and nutrition — and consider how you would explain to Murugadoss's family why 'intensive rehabilitation for three months' gives him a fundamentally different chance than 'a few sessions of physio in hospital.' The framing that rehabilitation is passive ('he needs rest to recover') is the most dangerous misconception to dismantle — both in your patients and in yourself.