Rehabilitation Therapy

Rehabilitation, or rehab, therapy refers to the therapeutic, healing treatment a patient receives after an illness or injury. The illness or injury could be cancer, a stroke or an automobile or skiing accident. Drug rehabilitation therapy is treatment that drug addicts receive to help them learn to live without a dependence on drugs to be at their physical, emotional and mental best. All forms of rehabilitation therapy strive to help people recover from challenges or problems and function at their best ability.

Physical therapy focuses on strengthening muscles and relieving pain. Physical rehabilitation treatments often include massage and exercise. If a patient is too weak to exercise on his or her own, a qualified physical therapist may gently move the patient's arms or legs to help build strength. Patients with more physical strength may lift weights to build muscle, while others hurt in an accident may need a cane or other device to help them walk. Patients in wheelchairs are often taught to do exercises made to do in a wheelchair in physical therapy.

Speech rehabilitation therapy helps stroke patients and others with speaking difficulties relearn to communicate. Speech rehab also helps those who have experienced damage to their language skills such as some brain injury patients. Patients who experienced memory loss may have difficulty with the reasoning skills needed for forming coherent language. A qualified speech therapist may be able to help patients with memory loss and other conditions improve their ability to speak clearly with the aid of reading comprehension materials and other learning devices.

Drug rehabilitation therapy may include several components, such as counseling and medication. Inpatient drug rehab programs may be short term or long term. Drug treatment centers typically offer residential drug rehabilitation therapy for at least a month and up to a year. Outpatient drug rehab usually follows a residential stay in a treatment center and continues to try and help people cope with life and avoid substance abuse. A weekly counseling session that may be individual or in a group setting is often a large part of outpatient drug rehabilitation.

One person may require different kinds of rehabilitation therapy. For example, a person with a substance abuse problem who is involved in a motorcycle accident could need both drug rehabilitation and physical therapy. A stroke patient who is paralyzed in his or her face and other areas of the body may need physical as well as speech therapy. Rehab therapists may work together on a patient's case in order to coordinate an effective therapy program.

Welcome to the School of Rehabilitation Therapy at Queen’s University! The School is well known for high quality professional programs in Occupational Therapy and Physical Therapy and excellent masters and doctoral research programs in Rehabilitation Science. Offering a unique fraternal Queen’s environment, study at the School gives students a high quality academic experience while building life-long friendships.

The mission of the School of Rehabilitation Therapy is “To educate leaders in Occupational Therapy, Physical Therapy and Rehabilitation Science by developing skills and competencies in rehabilitation; by facilitating problem-solving; self-directed learning and acquisition of attitudes and skills for lifelong learning; by fostering the development of human qualities and attitudes that promote commitment to clients and their communities throughout the world; and by conducting research in the promotion, restoration and maintenance of health through rehabilitation.”

There are four programs at the School, all at the graduate level. There are two-year, twenty-four month masters professional programs in Occupational Therapy leading to the degree of MSc (OT) and in Physical Therapy leading to the degree of MSc (PT), each being the entry-level degree to practice. Sixty-six students are admitted to each program each year. There are masters and doctoral research programs in Rehabilitation Science, leading to the degree of MSc (Rehabilitation Science) and PhD (Rehabilitation Science) respectively. Two fields are offered: Human Motor Performance and Disability and Wellness in the Community. While students vary in their times to completion, the master’s program usually requires two years and the doctoral program about four years to complete.

Whatever your reason for seeking information about the School of Rehabilitation Therapy, we welcome you and would be happy to have contact with you. 

Speed, instant gratification, accessibility — these are a few of the appealing hallmarks of digital technology. It’s no coincidence that we love our smart wireless devices: Humans are a notoriously impatient species, born with a preference for immediate rewards.

The Digital Doctor

In this special issue of Science Times, we look at some of the many ways that technology is changing the world of medicine.

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But the virtues of the digital age are not always aligned with those of psychotherapy. It takes time to change behavior and alleviate emotional pain, and for many patients constant access is more harmful than helpful. These days, as never before, therapists are struggling to recalibrate their approach to patients living in a wired world. 

For some, the new technology is clearly a boon. Let’s say you have the common anxiety disorder social phobia. You avoid speaking up in class or at work, fearful you’ll embarrass yourself, and the prospect of going to a party inspires dread. You will do anything to avoid social interactions. 

You see a therapist who sensibly recommends cognitive-behavioral therapy, which will challenge your dysfunctional thoughts about how people see you and as a result lower your social anxiety. You find that this treatment involves a fair amount of homework: You typically have to keep a written log of your thoughts and feelings to examine them. And since you see your therapist weekly, most of the work is done solo.

As it turns out, there is a smartphone app that will prompt you at various times during the day to record these social interactions and your emotional response to them. You can take the record to your therapist, and you are off and running. 

Struggling with major depression? Digital technology may soon have something for you, too. Depressed patients are characteristically lacking in motivation and pleasure; an app easily could lead patients through the day with chores and activities, like having a therapist in one’s pocket. Not just that, but the app might ask you to rate depressive symptoms like sleep, energy, appetite, sex drive and concentration in real time, so that when you next visit your psychiatrist, you can present a more accurate picture of your clinical status without having to worry about your recall. 

When it comes to collecting and organizing data, software is hard to beat. But information has a tendency to spread, especially digital information. To wit, electronic medical data containing sensitive personal information can be released, either accidentally or deliberately, and disseminated. Anyone who has followed the hacking of supposedly secure and encrypted financial databases knows this is not a remote possibility.

More worrisome to therapists, perhaps, is that technology also enables access: These days patients reach out via text, e-mail, Facebook, Twitter. For some of them, the easy connectivity that technology makes possible is a decidedly bad idea. 

Take a patient who has a fundamental problem in maintaining intimate relationships and who can’t tolerate being alone without feeling bored or anxious — in other words, a patient with typical features of borderline personality disorder. Not surprisingly, such a patient would love instant access to a therapist whenever an uncomfortable feeling arises. 

 

In this case, connectivity would interfere with the central goal of any reasonable treatment, namely acquiring the skills to manage painful feelings by oneself and the ability to tolerate some degree of disappointment. Access-on-demand would mitigate efforts to develop patience and frustration tolerance, and might encourage a sense of entitlement and an illusory notion of power and control. 

But perhaps the more difficult challenge is this: By removing barriers to access, digital technology can make therapists more real and knowable to their patients. This cuts both ways.

Recently, a patient I had treated for depression was struggling with the approaching death of his beloved dog. Just divorced, he was dreading another loss. One night while surfing the Internet, he came across a piece I wrote years ago about the death of my own dog. 

“So you understand what it’s like,” he said during one of our sessions. This discovery made him feel understood and comforted. 

Sometimes, though, digital technology can undermine the clinical rationale for a therapist to maintain distance.

For example, in insight-oriented psychotherapy, which focuses on unconscious processes at the root of personal conflicts, the patient essentially uses his relationship with the therapist to understand how he structures relationships with people in general. The therapist must be free to “become” many different important people in the patient’s life; the more the patient knows of the therapist’s real life, the likelier it is that the treatment will be confounded. 

Imagine how you might feel if you had a philandering parent and were having trouble in your own relationships, and you discovered that your own therapist was married and having an affair. It would be hard to believe this would not affect your relationship with your therapist. 

Many patients don’t want to know how their therapists feel or the details of their personal lives, and for a good reason: It can undermine the perceived authority of the therapist, making patients feel less secure. And it can inhibit patients from being open for fear of hurting or upsetting their therapists.

I wonder if it’s even possible for therapists to remain anonymous in the age of the Internet, where we can all be found in the electronic cloud. A Google search might not reveal a therapist’s deep, dark secrets, but even basic information begins to alter the relationship. 

Last summer, a patient learned that I was swimming in a benefit race in Cape Cod because I’d written something about it that was available online.

“Be careful, Dr. Friedman,” he said with a smile on the way out of my office. “I heard there were sharks out there.” Beneath the humor was anxiety — or perhaps something darker.

Digital technology has the potential to either enhance or confound therapy, but much depends on the patient and the condition being treated. Some patients will find that the glowing screen only feeds their psychopathology. Others will find digital technology a boon to self-esteem and assertiveness. We are only beginning to figure out which patients are which.

In the world of health care, Nintendo Wii golf is more than a high-tech toy. The video game has become a tool in physical, occupational and neurological rehabilitation. 

“It really is helpful as an adjunct to what we do in physical therapy,” said Dean Beasley, the director of inpatient rehabilitation at Doctors Hospital in Augusta, Ga. “It allows the patient to put into practical application what they’ve done in therapy and, in some cases, it helps them know if they could still play golf.”

Balance and movement are common concerns for those recovering from brain injuries or strokes. Others may be working to improve range of motion or gross motor coordination, like walking and lifting. 

Although the treatment for each patient is different, Wii golf brings an element of pleasure into physical therapy, which is often abbreviated as P.T. and sometimes referred to by patients as “pain and torture.”

“If it’s something like golf that they previously enjoyed, the patients are more motivated to do it,” said Michaela St. Onge, an occupational therapist at Aroostook Medical Center in Presque Isle, Me. “They like it because it’s a change of pace from the normal exercises we give them in therapy.” 

To play the game, a patient swings the Wii’s wireless hand-held motion-sensitive wand in front of animated screens that simulate holes on a course. Physical therapists have marveled at the ease in coaxing patients into movements that could have taken more time to achieve in the traditional manner. Patients may gain the ability to coordinate by pressing buttons on the wand and maintain balance while looking at the screen. 

Two years ago, Aroostook’s inpatient and outpatient units added Wii Sports, which includes golf, baseball, bowling, boxing and tennis games.

“I have to give some credit to this Wii game,” said Mike Pelletier, who had a stroke in June and spent four weeks at Aroostook. “It helped me work on my balance.”

Pelletier, who struggles with balance and double vision, played Wii golf from his wheelchair during occupational therapy sessions. Now he returns to Aroostook twice a week for outpatient physical therapy.

Pelletier said he also played Wii golf at home and competed with his granddaughter. He said that the game helped him become less dependent on the physical therapists in improving his balance and also motivated him to stay active. 

“I made it my own challenge to try to beat my previous score,” Pelletier said. “The game is fun, but it’s also constructive.”

Scoring provides immediate feedback to patients as their motor skills, range of motion, balance and coordination improve with activity, said Renee Guerette, program manager for Aroostook’s neurological rehabilitation unit. 

“We used to use board games with patients, but it didn’t have the same feedback as the Wii,” Guerette said. “It’s nice to offer something that has a positive, fun approach that can be shared with family members at home.”

Guerette observed that when recuperating patients played Wii golf at home, they did not regard it as exercise. Still, the repetition of movement and the practice of balance have had a positive effect.

“We have seen it actually speed up their recovery time when patients elected to come to the rehab center in their free time to play Wii golf,” St. Onge said. “Every little bit helps with recovery.” 

Dr. Arlene McCarthy, the director of the neurological physical therapy residency program at Kaiser Permanente in Redwood City, Calif., was convinced of the therapeutic value of Wii golf after observing a class for stroke patients there. She said she saw them “cheering each other on as they watched each other use the Wii.” 

McCarthy also witnessed a sense of competition among the patients.

“In using Wii golf as therapy, you are asking a patient to practice a skill in something they might already be interested in doing,” she said. “As they watch their score, they get feedback right away if they’ve done it correctly.” 

In her experience, McCarthy said, the Wii game has attracted golfers and nongolfers.

But, she said, “The weight shifting that is used in Wii golf may come more naturally to someone who has actually played golf.”

She added, “If you think about sports, it’s about skills that you are learning coupled with practice and repetition. Patients are more willing to do the practice and repetition we’re asking them to do in therapy if they are having fun.”

McCarthy acknowledged that she could design patients’ workouts using more traditional therapy and achieve the same results. 

“The difference is that by using the Wii, it’s more fun for the patient,” she said. “I believe therapy should be fun and meaningful for the individual, and if they are having a good time while getting better, it’s another tool in our toolbox that we can use.”

Kaiser Permanente’s neurological physical therapy program added Wii golf more than two years ago. Since then, McCarthy has seen patients use the game to move beyond medically supervised rehabilitation — often buying the units for personal entertainment at home. She has also seen Wii golf used as a regular activity to keep seniors engaged and exercising.

“It’s so important to keep people moving, and this game achieves that,” McCarthy add