Areas covered: Physician and Support Staff
People Mentioned: Dr. Rameezan, Professor Cumberland, Zaireen Nadia and Zuraini Abd Karim

What Is Rehabilitation and Why Is It Important?

Ali meets with a motor vehicle accident in July 2012. This resulted in a C5-6 spinal cord injury. He was rushed to hospital where he received medical treatment for eight days. Thereafter, he was under the care of the Rehabilitation Unit at PCMC. During the next 10 weeks, the rehabilitation team helped him understand that he could become mobile, independent and continue to lead a full life. In addition, his family and primary care-giver received support and training as to how to help Ali once he leaves the hospital. Before he was discharged, the team also helped in the redesigning of Ali’s bathroom and the building of a ramp to allow him access to the second floor of his double-storey house.

“All you’ve described above is what we do,” says Dr. Rameezan Begum Abd Rahim, Consultant Rehabilitation Medicine Physician and Head of the Department of Rehabilitation Medicine at Prince Court Medical Centre (PCMC). She explains that rehabilitation is a process of restoring skills and functions of patients with illness or injury to their optimal physical, psychological and social functioning.

Rehabilitation Medicine, in particular, is a branch of medicine that specialises in the diagnosis, evaluation and active treatment of patients with a disease, disorder or injury that impairs normal function. As a consultant in rehabilitation medicine, Dr. Rameezan is a registered medical practitioner whose practice is exclusively by referral and who, by training and experience in rehabilitation medicine is able to give a learned opinion regarding patients with loss or impaired function (temporary or permanent).

“What this means,” she elaborates, “is that when I see the patient, I start by taking the history of the patient, examine and assess him or her. Then, I may suggest the rehabilitation assessment of function and relevant investigations of the patient. This includes continuing management, procedural treatment peculiar to rehabilitation care, prescription of rehabilitation treatment plan and prescription of rehabilitation equipment used in rehabilitation care.”

Dr. Rameezan does not do all this alone. In fact, there is a consultative process with the other practitioners in her team who will include the consultants who referred the patient to her in the first place and other relevant health professionals. She explains, “Other than the physician, we have rehabilitation nurses, physical therapists (physiotherapist), occupational therapists and speech language pathologist with assistance of a registered dietician and clinical psychologist.”

Professor Dr. David Cumberland, Consultant Cardiologist at PCMC says that studies have shown that when cardiac patients undergo a rehabilitation programme, it not only increases the speed of recovery, it reduces the recurrence of an episode. “I can say that without doubt, PCMC has a very skilled cardiac rehab team.”

Zaireen Nadia, the Senior Physiotherapist says, “We begin treating patients in the ICU and CCU. Some of them suffer from impairment of gross motor function’. When we start early, we can help them restore the functions of their muscles and limbs faster. Some of our physiotherapists specialise in neurology, musculoskeletal, sports, women’s health, paediatric and spinal cord injury. You know, in burns patients, we can prevent contractures if we start therapy early.”

As for occupational therapists, Dr. Rameezan says, “They focus on functional activities, fine motor function and give advice on the equipment and exercise machines to use in both acute and post-acute settings.” Probably good to give some examples of functional activities (e.g. activities of daily living like dressing, going to the toilet, climbing stairs); examples of ‘fine motor function’.

Datin Farah Diba Khan, Head of Lifestyle Modification says that one of the first things she does is to visit the patient in the ward post-surgery. “We will see them within three days of an operation. Often, when we first meet them, they are either depressed or have a loss of appetite. This can be as a result of the medication they’re on. But, the idea on this initial visit is to get to know the patient first. We can’t just tell them what to do.”

By far, the biggest resistance she faces, especially with cardiac patients who need rehabilitation, is patients’ refusal to modify their diet. “They want their nasi lemak for breakfast. They want that roti canai and teh tarik,” she says, smiling. What Datin Farah does in such cases is to show patients how to create the same dishes, but make sure they’re low in fat and sugar content. “This is done using food substitution. What this means is that we use healthier ingredients as an alternative to not-so-healthy ingredients in preparing food. For example, instead of using full-cream milk, you can substitute it with low-fat milk. Another example is when cooking nasi lemak you can either dilute the coconut milk or use a mixture of coconut milk and low-fat milk. That way, the taste of the food is retained and the patient doesn’t feel he’s being deprived of what he normally eats.”

Ultimately, what rehabilitation medicine and the services provided by PCMC offer is this: you are assured continuous care from the moment you step into PCMC seeking treatment, your stay at the hospital and long after you have been discharged.

Areas covered: Rehab Medicine – Specific Equipment and Hydro Pool
People covered: Dr. Rameezan, Zaireen Nadia

A Pool for All Seasons

Your boss has told you to carry a box full of books to his office. You bend over to pick up a box. When you come up, something in your back goes ‘click’. But, you continue to carry the box and walk to your boss’s office. The next day, there is a niggling pain in your back. It does not get better and, by the end of the week, you’re in distress. A visit to the doctor confirms that you’ve suffering from a slipped disc. The doctor will usually prescribe medication to alleviate the pain and suggest you undertake therapy.

Inpatient rehabilitation is a treatment programme, usually based in a hospital, that assists people who have experienced major injury, disorder or illness to regain the function needed to return to everyday living.” Examples of such patients are those with acute medical or surgical illness such as stroke, spinal cord injury, traumatic brain injury, hip fracture, amputation of limbs, severe deconditioning or myocardial infarction.

Whether or not the patient is staying at the hospital, any rehabilitation usually involves an interdisciplinary team approach. “The inpatient rehabilitation programme covers everything from regaining the ability to walk after an amputation, to talking after a stroke, to being able to safely take daily medications after a serious illness,” explains Dr. Rameezan. “Regardless of what caused the disability, the rehabilitation team works to restore maximum function and quality of life for the patients: at home, in the workplace and in the community.”

The aim of the team is to prepare the patient for life after discharge from the hospital. “People often think that after they’ve recovered from a stroke, they can just go back to their lives before with ease. Sometimes they need to relearn simple things like picking up a spoon,” says Zaireen Nadia, Senior Physiotherapist.

Any rehabilitation programme has to be individually planned for each patient. What Dr. Rameezan and her team look at are issues like the complexity of the condition e.g. function caused by the illness/ injury, the patient’s medical and or surgical stability, potential for functional improvement and the ability of patients to tolerate the rehabilitation programme. For patients who will need help from a caregiver, Dr. Rameezan and her team will train this person as part and parcel of managing the rehabilitation of the patient.

She then explains in some detail, the kind of specialised care that will be provided for a patient requiring neurological rehabilitation for e.g. after a stroke.

As the Rehab Medicine physician, Dr Rameezan’s key role is in coordinating the programme of care being provided by the multidisciplinary team of therapists – physiotherapy, occupational therapy, speech pathologist.  Each therapist has a specific role to play in the rehabilitation of the patient.

“As the physician, I will maintain his medical stability. I, effectively, manage the team that will help this patient during his rehabilitation. For instance, together with physical therapists, the patient will be introduced to the exercise equipment in the gym. The occupational therapist will help the patient with activities of daily living (ADLs) such as eating, dressing, bathing, going to the toilet, handwriting, cooking, and basic housekeeping. The speech therapists will help patients with speaking, reading, writing or even swallowing.”

Dr. Rameezan then considers other sorts of patients. “Sometimes, new mothers will seek our help with issues like bladder control. Those with back ache prior to giving birth will see us and we will help them with an exercise programme to help both during pregnancy and delivery. For those who suffer from a ‘frozen shoulder’, I might recommend they undergo ‘Radial Shockwave Therapy’”

At the mention of back pain, though, Zaireen is keen to point out something that is special to PCMC: the hydrotherapy pool. “As you know, physical therapy is an important component in healing back pain. Patients can use ice and heat to decrease any inflammation and ease muscle stiffness. We also have ultrasound therapy and a full range of exercise equipment to help them. But,” she adds with a nod, “the exercises can be painful for the patients to do. So, what we sometimes suggest is the hydrotherapy pool.” In simple words, this is physical rehabilitation in a swimming pool.

Dr. Rameezan then explains that rationale behind the hydrotherapy pool. She starts by saying that throughout history, water is known to have a therapeutic effect as an aid to healing post-surgery, relief from arthritis and help tone the muscles.

“The advantages of water therapy,” she says, “is that water allows buoyancy. So, when the patient in water, it is a counterforce to gravity. This means the patient feels lighter and will not have to bear their weight. This, alone, helps them to do their exercises.” When this happens, patients can retain their muscle mass and improve the condition of their muscles faster.

Zaireen adds to this by saying that, “In the hydrotherapy pool, the water is heated. It’s kept at a constant 35° Celsius.  This is good to help the muscles relax. Also, it reduces fatigue and helps to control a patient’s spasms.” She does warn, however, that while the hydrotherapy pool is suitable for many patients (such as those with neurological issues and sports-related injuries), it may not be suitable for patients with heart disease.

Ultimately, rehabilitation is the process of restoring skills and functions of persons with illness or injury. This process can be made easier and more pleasant with the dedicated team from PCMC who strive to provide a holistic management to patients and family.

Cardiac Rehabilitation 

Cardiac rehabilitation is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab program at Prince Court Medical Centre includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.

This program aims to help people who have heart problems to recover after a heart attack or heart surgery and prevents future hospital stays by adopting healthy lifestyle changes which include a heart healthy diet, increased physical activity, and learning how to manage stress. Overall, it will improve your health and quality of life.

You will have a program that’s tailored to your personal needs, abilities and interests. A multidisciplinary team will help to achieve the goals of this program, namely to:

  • Increase your understanding about your condition and treatment
  • Help you make the right lifestyle changes to decrease your risk of a heart attack or stroke and reduce the need for future surgery
  • Increase your ability to perform your job and your daily or recreational activities
  • Provide you and your family with the support and motivation you need to make important lifestyle changes

Doctors often prescribe cardiac rehab for people who have had a heart attack or bypass surgery. But people with many types of heart or blood vessel disease can benefit from cardiac rehab. Rehab might help you if you have:

  • Heart failure
  • Peripheral artery disease (PAD)
  • Had or plan to have a heart transplant
  • Had angioplasty to open a coronary artery
  • Had another type of heart surgery, such as valve replacement

In cardiac rehab, you will learn how to:

  • Manage your heart disease and problems such as high blood pressure and high cholesterol
  • Exercise safely
  • Eat a heart-healthy diet
  • Break bad habits, like smoking
  • Reduce stress and depression
  • Get back to work sooner and safely

At first your rehab team will keep a close watch on how exercise affects your heart. By the end of rehab, you will be ready to continue an exercise program on your own.

Cardiac rehab may help you to:

  • Have better overall health
  • Lose weight or keep weight off
  • Feel less depressed and more hopeful
  • Have more energy and feel better about yourself

Changing old habits is hard. But in cardiac rehab, you get the support of experts who can help you make new healthy habits. And meeting other people who are in cardiac rehab can help you know that you’re not alone.

Clinical research has confirmed many benefits of cardiac rehab, including:

  • A reduced risk of major heart problems and death after a heart attack for those who participate in a cardiac rehab program that includes exercise
  • Decreased severity of angina and decreased need for medicines to control angina
  • Reduced need for hospital stays because of heart problems. Costs for doctor visits and hospital stays are reduced for those who participate in cardiac rehab. Visits to the emergency room are also reduced
  • Decreased blood pressure
  • Reduced shortness of breath and less fatigue in people with heart failure
  • Ability to exercise longer
  • Lower cholesterol and triglyceride levels
  • Reduced emotional stress, depression, and anxiety

Cardiac rehab can increase the quality of your life by improving your health overall; helping you lose weight, if necessary; reducing depression, stress, and anxiety; and helping to increase your self-esteem.

 

Physical & Rehabilitation Medicine Consultant:
Dr. Rameezan Begam Abd. Rahim