ABSTRACT
Rehabilitation is a descriptive term for a treatment process involving restoration of function or capacity, a process that is common to many medical disciplines. Indeed, the roots of the wordrehabilitation translate as “to restore to a former rank or capacity.” This restoration process can be applied to any damaged body organ, system, or function, from lung capacity to vocal flexibility, from cardiac muscle strength to athletic prowess. With rehabilitation thus broadly conceived, a cogent discussion of the issues surrounding patient adherence to rehabilitation would be nearly unmanageable. In this chapter, discussion is restricted to rehabilitation as practiced primarily by physiatrists and physical, occupational, and speech therapists. These practitioners seek to restore the physical functioning necessary for common activities of daily living such as walking, grooming, dialing a telephone number, or traveling to a medical appointment. Traditionally, physical medicine and allied rehabilitation disciplines have focused on treatment of musculoskeletal disorders, generally the result of orthopedic and/ or neurological conditions that interfere with functioning in daily life. I follow that tradition here and consideration of adherence issues is focused on these types of disorders and diseases. However, some of these disorders—in particular, neurological disorders—often affect cognition, necessitating cognitive rehabilitation in addition to physical rehabilitation. Discussing adherence in rehabilitation without addressing cognitive impairment is akin to trying to diagnose a stalled automobile without referring to its electrical system. Therefore, cognitive impairment and its rehabilitation are reviewed throughout the chapter.
