Chapter 15: Overview of Rehabilitation Intervention for Peripheral Nerve Injury

Objectives

On completion of this chapter, the student/practitioner will be able to:

• Explain the concept of International Classification of Functioning, Disability and Health within the context of treating a patient with peripheral neuropathy and the commonality of terms when discussing this diagnosis with other health care practitioners.

• Discuss the use of the Hypothesis-Oriented Algorithm for Clinicians as a model for evaluating patients with peripheral neuropathy.

• Identify three paradigm shifts within health care that affect the provision of rehabilitation services to patients with peripheral neuropathy.

• Describe the focus of therapeutic intervention by rehabilitation services professionals for patients with peripheral neuropathy.

Key Terms

• Disability and Health

• Hypothesis-Oriented Algorithm for Clinicians

• International Classification of Functioning

• Intervention

Introduction

Medicine is undergoing an accelerated change in theory, practice, documentation, and reimbursement. Rehabilitation services are not immune to these paradigm shifts. The key to being a successful provider of health care services is effective management of this change. In the past few years, rehabilitation services moved from older disability models such as Nagy to the World Health Organization's International Classification of Function, Disability and Health. Documentation for many of us has moved from pen and paper to keyboard. The medical record, once a collection of thousands of paper medical charts, is becoming a secured (hopefully!) connection to the Internet. Diagnosis, previously the isolated domain of physicians, is now being performed by therapists. Therapists working in the inpatient and outpatient arenas are struggling with decreased lengths of stay and lower facility reimbursement.

Physical and occupational therapy intervention for diagnoses related to peripheral neuropathy is provided within the aforementioned constraints and process shifts. Great clinical strides have occurred in recent years with the publication of many excellent peer-reviewed, evidenced-based studies related to the many possible impairments associated with peripheral neuropathy. One example is the “sickness behavior” observed in many clients with neuropathy. Sickness behavior is a downstream effect of the elevation of serum proinflammatory mediators resulting in anorexia, sleep disturbances, anemia, and depression. Lifelong learning is mandatory for all practicing therapists.¹

This chapter begins with a discussion of the International Classification of Functioning, Disability and Health (ICF); continues with a short discussion of the use of the Hypothesis-Oriented Algorithm for Clinicians (HOAC), which is a succinct and rational method of evaluating patients with neuropathy; and ends with a brief overview of the various therapeutic interventions used to treat patients with peripheral neuropathy. Later chapters expound on each of these interventions.

International Classification of Functioning, Disability and Health

Functional limitations and disability are universal experiences that affect people of all ages, races, ...