Introduction to Rehabilitative Surgery
The paralyzed or severely neurologically impaired patient is one of the greatest challenges in long-term chronic care that we face as clinicians, whether we are therapists or neurologists, physiatrists, or surgeons. Because of the complexity of their trea
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Introduction to Rehabilitative Surgery Andrew I. Elkwood, Matthew Kaufman, and Lisa F. Schneider
The paralyzed or severely neurologically impaired patient is one of the greatest challenges in longterm chronic care that we face as clinicians, whether we are therapists or neurologists, physiatrists, or surgeons. Because of the complexity of their treatment and the severity of their injury, these patients may be viewed as a hopeless cause for many physicians, especially surgeons. Optimization of their care – and potentially improvement in quality and length of life – requires a complex and delicate interaction between multiple surgical and medical specialties across disciplines and time. The current state of rehabilitative medicine works to maximize patient function as well as manage the lifelong maintenance required to continue that level of function. Although surgery has always been part of the treatment of the paralyzed patient, it may be seen as an afterthought or the modality of last resort for the rehabilitation community or even surgeons who have little experience taking care of these patients. Once surgery is considered, the procedures needed to care for these patients and improve their lives often exist at the margins of existing surgical
A.I. Elkwood, MD, MBA (*) M. Kaufman, MD, FACS • L.F. Schneider, MD The Plastic Surgery Center, Institute for Advanced Reconstruction, 535 Sycamore Ave, Shrewsbury, NJ 07702, USA e-mail: [email protected]; [email protected]; [email protected]
specialties or at the junction of multiple disciplines, performed haphazardly without a unified understanding of a comprehensive treatment approach. These procedures and their context may be difficult to understand, requiring familiarity with different interlocking yet distinct specialties, making approaching this topic particularly daunting for the student of any field. We introduce the new field of rehabilitative surgery, a unique designation combining state-of-theart surgeries from multiple surgical specialties in order to reimagine our approach to these patients. In this text, Rehabilitative Surgery: A Comprehensive Text for an Emerging Field, we present a completely different framework for understanding, coordinating, and providing treatment for the paralyzed or severely neurologically impaired patient. Contrary to the traditional approach of rehabilitative medicine, surgery is in fact a critical component of the care of the chronically impaired patient and may create opportunities to change their everyday life in a profound way by creating a new baseline of functional status. We believe that much of the resistance to the surgical treatment of these patients arises from a lack of understanding of how even some straightforward interventions, performed in a coordinated way, can dramatically improve a patient’s life. Patients who can now move a joystick on a wheelchair or feed themselves again often have profound appreciation for this incremental increase in in
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