Rehabilitation is care that can help you get back, keep, or improve abilities that you need for daily life. These abilities may be physical, mental, and/or cognitive (thinking and learning). You may have lost them because of a disease or injury, or as a side effect from a medical treatment. Rehabilitation can improve your daily life and functioning.

Rehabilitation is for people who have lost abilities that they need for daily life. Some of the most common causes include:

• Injuries and trauma, including burns, fractures (broken bones), traumatic brain injury, and spinal cord injuries
• Stroke
• Severe infections
• Major surgery
• Side effects from medical treatments, such as from cancer treatments
• Certain birth defects and genetic disorders
• Developmental disabilities
• Chronic pain, including back and neck pain

The overall goal of rehabilitation is to help you get your abilities back and regain independence. But the specific goals are different for each person. They depend on what caused the problem, whether the cause is ongoing or temporary, which abilities you lost, and how severe the problem is. For example,:

• A person who has had a stroke may need rehabilitation to be able to dress or bathe without help
• An active person who has had a heart attack may go through cardiac rehabilitation to try to return to exercising
• Someone with a lung disease may get pulmonary rehabilitation to be able to breathe better and improve their quality of life

When you get rehabilitation, you often have a team of different health care providers helping you. They will work with you to figure out your needs, goals, and treatment plan. The types of treatments that may be in a treatment plan include:

• Assistive devices, which are tools, equipment, and products that help people with disabilities move and function
• Cognitive rehabilitation therapy to help you relearn or improve skills such as thinking, learning, memory, planning, and decision making
• Mental health counseling
• Music or art therapy to help you express your feelings, improve your thinking, and develop social connections
• Nutritional counseling
• Occupational therapy to help you with your daily activities
• Physical therapy to help your strength, mobility, and fitness
• Recreational therapy to improve your emotional well-being through arts and crafts, games, relaxation training, and animal-assisted therapy
• Speech-language therapy to help with speaking, understanding, reading, writing and swallowing
• Treatment for pain
• Vocational rehabilitation to help you build skills for going to school or working at a job

Depending on your needs, you may have rehabilitation in the providers' offices, a hospital, or an inpatient rehabilitation center. In some cases, a provider may come to your home. If you get care in your home, you will need to have family members or friends who can come and help with your rehabilitation.

Rehabilitation medicine describes efforts to improve function and minimize impairment related to activities that have been hampered by disease, injuries, or developmental disorders.

Injuries, illnesses, or conditions that may cause or contribute to disability can include stroke, traumatic brain injury, spinal cord injury, musculoskeletal injuries, pain, a number of intellectual and developmental disorders such as cerebral palsy, Fragile X syndrome, and autism spectrum disorders (ASDs), and other conditions and injuries.

The primary effects of many such conditions are physical—perhaps mobility or sensory problems. But individuals facing them can also experience intellectual, behavioral, and communication difficulties. They might have problems with making decisions, paying attention, or speaking. These can also require rehabilitation medical care.

NICHD—through its National Center for Medical Rehabilitation Research—focuses on addressing chronic physical disabilities in its rehabilitation medicine research. Other NIH Institutes may focus on specific aspects of rehabilitation medicine, as explained throughout the rest of this topic.

Rehabilitation medicine differs from drug and alcohol rehabilitation, which aims to help a person control or eliminate his or her substance use, and from the rehabilitation that is commonly referred to within the context of the criminal justice system.

There are many reasons why a person may need care related to rehabilitation medicine.

For example:

• Injuries and trauma, such as:
  • Burns
  • Limb loss or amputation
  • Fractures, including multiple fractures to the long bones in the limbs and fractures of the hip, spine, or skull
  • Traumatic brain injury (TBI) or concussion (mild TBI)
  • Spinal cord injury
  • Loss of sight or hearing
• Diseases and conditions that can cause loss of mobility function, such as:
  • Muscular dystrophy
  • Spina bifida
  • Cerebral palsy
  • Arthritis
  • Scoliosis or curvature of the spine
  • Damage to muscles, ligaments, tendons, or cartilage
  • Knee arthroplasty/replacement
  • Hip replacement
  • Stroke
  • Multiple sclerosis
  • Parkinson’s disease and related degenerative disorders
• Surgery or prolonged treatment for other diseases or illnesses that can cause loss of function, such as:
  • Chronic pain/neuropathy
  • Severe infection
  • Diabetes
  • Cancers (including chemo- and radiation therapies)
  • Peripheral artery disease
  • Cardiac arrest

Likewise, certain intellectual and developmental disabilities, such as autism spectrum disorders, may benefit from rehabilitation medicine in the form of occupational or physical therapy or other rehabilitation services.

These are but a few examples, and many of them fall outside the research portfolio of the NICHD and NCMRR. In general, though, any person might need care related to rehabilitation medicine at some point in his or her life, for a variety of reasons.

Secondary Conditions

Many people who experience the disorders listed above also face their secondary effects—problems that are not necessarily part of the main diagnosis, but that can also have an impact on patients’ health, independence, and quality of life.

Rehabilitation medicine may include treatments for these and other secondary symptoms:

• Muscle atrophy (wasting), blood clots or circulation issues, obesity, or other problems resulting from disuse
• Problems caused by overuse of prosthetics or medical devices
• Ulcers, bed sores, or other problems with skin integrity
• Local or widespread infections or sepsis
• Injuries resulting from falls
• Problems with balance or vision
• High blood pressure, diabetes, and other conditions
• Bladder and bowel problems
• Breathing problems, including those related to mechanical ventilation
• Emotional or cognitive difficulties, such as anger, depression, or difficulty controlling emotions or behavior

If not addressed in a timely manner, many of these secondary conditions can become serious, some of them fatal.

Rehabilitation medicine uses many kinds of assistance, therapies, and devices to improve function. The type of rehabilitation a person receives depends on the condition causing impairment, the bodily function that is affected, and the severity of the impairment.

The following are some common types of rehabilitation:

• Cognitive rehabilitation therapy involves relearning or improving skills, such as thinking, learning, memory, planning, and decision making that may have been lost or affected by brain injury.
• Occupational therapy helps a person carry out daily life tasks and activities in the home, workplace, and community.
• Pharmacorehabilitation involves the use of drugs to improve or restore physical or mental function.
• Physical therapy involves activities and exercises to improve the body’s movements, sensations, strength, and balance.
• Rehabilitative/assistive technology refers to tools, equipment, and products that help people with disabilities move and function. This technology includes (but is not limited to):
  • Orthotics, which are devices that aim to improve movement and prevent contracture in the upper and lower limbs. For instance, pads inserted into a shoe, specially fitted shoes, or ankle or leg braces can improve a person’s ability to walk. Hand splints and arm braces can help the upper limbs remain supple and unclenched after a spinal cord injury.
  • Prosthetics, which are devices designed to replace a missing body part, such as an artificial limb
  • Wheelchairs, walkers, crutches, and other mobility aids
  • Augmentative/Alternative Communication (AAC) devices, which aim to either make a person’s communication more understandable or take the place of a communication method. They can include electronic devices, speech-generating devices, and picture boards.
  • Hearing aids and cochlear implants
  • Retinal prostheses, which can restore useful vision in cases in which it has been lost due to certain degenerative eye conditions
  • Telemedicine and telerehab technologies, which are devices or software to deliver care or monitor conditions in the home or community
  • Rehabilitation robotics
  • Mobile apps to assist with speech/communication, anxiety/stress, memory, and other functions or symptoms
• Recreational therapy helps improve symptoms and social and emotional well-being through arts and crafts, games, relaxation training, and animal-assisted therapy.
• Speech and language therapy aims to improve impaired swallowing and movement of the mouth and tongue, as well as difficulties with the voice, language, and talking.
• Surgery includes procedures to correct a misaligned limb or to release a constricted muscle, skin grafts for burns, insertion of chips into the brain to assist with limb or prosthetic movement, and placement of skull plates or bone pins.
• Vocational rehabilitation aids in building skills for going to school or working at a job.
• Music or art therapy can specifically aid in helping people express emotion, in cognitive development, or in helping to develop social connectedness.

These services are provided by a number of different healthcare providers and specialists, including (but not limited to):

• Physiatrists (also called rehabilitation physicians)
• Occupational therapists
• Physical therapists
• Cognitive rehabilitation therapists
• Gait and clinical movement specialist
• Rehabilitation technologists
• Speech therapists
• Audiologists
• Orthopedists/surgeons
• Neurologists
• Psychiatrists/psychologists
• Biomedical engineers
• Rehabilitation engineers

In biology, plasticity is a healing process in which the body reorganizes in response to changes in the environment. For example, the cells in our brains constantly form new connections.

Scientists used to believe that people with brain injury were not able to recover or relearn lost functions and that the brain was not capable of plasticity. Scientists have found that training—such as physical therapy—can help harness the brain's natural plasticity and help people with brain injuries regain lost function by stimulating new connections between brain cells. Researchers now believe the brain has a significant amount of plasticity and that certain rehabilitation methods can harness this ability.

Using techniques that harness or enhance the body's natural plasticity is an important aspect of rehabilitation medicine. NICHD supports research on the biology of plasticity and research to develop new rehabilitation approaches that engage and enhance human plasticity and aid in restoring function.

Physical therapy

Physical therapy (PT) can be a help in getting you back to a point where you can perform ordinary, everyday activities without reduced to no pain and reduced difficulty in movement.Here’s what you can get from PT:

• Exercises.Physical therapists will show you exercises and provide you with an exercise plan designed to strengthen the muscles surrounding the arthritic joint. Strong muscles can help to stabilize a weakened joint and lessen the pain of movement. Using these muscles correctly can restore normal joint mechanics and increase your range of motion.
• Movement techniques.If you are having trouble shifting from one position to another (like getting into and out of a car or bathtub), your therapist can show you the best way to do it. You can learn to how to use walking aids, such as crutches, canes, or walkers, if you need them.

Manual Therapy

You may also be treated with manual therapy. In manual therapy, physical therapists employ a variety of specific, hands-on techniques (such as massage, joint mobilization, and strain and counterstrain) with the aim of decreasing pain, increasing range of motion, lessening swelling, and stretching tight tissues. Recent studies have shown that therapeutic programs that include both manual manipulation and exercise-based PT produce remarkably improved function and decreased pain as compared to programs that include only exercise-based PT. Manual therapy. A recent study showed that patients with knee OA who received manual therapy from a physical therapist in addition to exercise-based therapy had dramatically improved results over patients who did exercise-based therapy alone.

Training coaches and physical therapists

Training coaches and physical therapists use the knowledge of relationships between forces and torques in the treatment of muscles and joints. In physical therapy, an exercise routine can apply a particular force and torque which can, over a period of time, revive muscles and joints. Some exercises are designed to be carried out under water, because this requires greater forces to be exerted, further strengthening muscles. However, connecting tissues in the limbs, such as tendons and cartilage as well as joints are sometimes damaged by the large forces they carry. Often, this is due to accidents, but heavily muscled athletes, such as weightlifters, can tear muscles and connecting tissue through effort alone.

Physical therapy includes activities and exercises that build motor skills and improve strength, posture, and balance.

For example, this type of therapy aims to help a child build muscle control and strength so that he or she can play more easily with other children.

Problems with movement are common in autism spectrum disorder (ASD), and many children with autism receive physical therapy. However, there is not yet solid evidence that particular therapies can improve movement skills in those with autism.

To help people achieve their full potential, and to ensure the health, productivity, independence, and well-being of all people, the NICHD supports rehabilitation medicine research to improve people’s physical and mental functioning.

NICHD’s National Center for Medical Rehabilitation Research (NCMRR) was established in 1990 to support research and research training related to the rehabilitation of individuals with physical disabilities. Since then, the NCMRR has supported a large portfolio of cutting-edge research that has improved the health of those with physical disabilities.

Other parts of NICHD’s focus on improving the mental functioning of individuals who are recovering from a traumatic brain injury or stroke, and on identifying effective supports and interventions for intellectual and developmental disability.

Findings and interventions from rehabilitation medicine have relevance to those without illness or injury, too. For example, rehabilitation physicians may learn skills and techniques working with complicated multiple trauma patients that they can apply to injury prevention in athletes.

Although more than two decades of NCMRR research have revealed improvements in rehabilitation, there remain unanswered questions, for example regarding:

• Mechanisms of injury and repair
• Ways to restore critical pathways
• Genetic and genomic contributions to outcomes.

The All of Us Research Program (previously the Precision Medicine Initiative) is poised to have an impact on rehabilitation medicine by focusing attention on ways to incorporate variations in genes, environment, and lifestyle in individualized treatments.

For certain types of rehabilitation, best practices have not yet been developed. Research has generated many discoveries, but applying new and better interventions and adapting them for wider use remain priorities. Basic, translational, and clinical research in rehabilitation medicine will continue to be an important part of NICHD’s overall mission.