“Dis-” words have gotten my attention. They become a mainstay in the US and UK political discourse over the past few years as disinformation became an ongoing topic and concern. “Dis-” is a simple little prefix that turns a word on its head! A word of opposite meaning is formed just by placing “dis” in front if it. In the field of rehabilitation, we seem to love this metamorphosis.
We could start with disease. If there wasn’t disease in the world, we wouldn’t have a profession. We begin the rehabilitation journey with patients who are lacking ease. Seems our job must be to give them ease.
Particularly with diseases of or affecting the movement system, we often say that the movement is disordered. When the movement system loses its order and organization, we lose the beautiful, fluid and effortless quality of movement. In rehabilitation, returning order to the movement system is a high priority.
If we fail, then surely disability ensues. Patients with disease and disordered movement systems lose their many abilities to move. This renders them unable to perform in basic life tasks as well as in chosen tasks of interest. Our job is to make them able.
If we fail, huge disadvantage overtakes even the smallest attempts for patients to live independently. The control of their movement system has lost the many options and advantages they were accustomed to. Even a few small advantages in the movement system can make an enormous difference . . . maybe the difference in standing or being confined to a wheelchair. We have to create advantages for patients.
If we fail, the patient will give up and disuse will perhaps become an even bigger obstacle than the primary disease and disadvantages. Disuse is also a natural outcome of substitution based therapy. We have a “work around” for everything in the therapy world. We need more “working on” in therapy, requiring use of the limbs and movement synergies and actions that make us capable of meeting the physical demands of life. Restoring use is the focus of therapy.
If we fail, our patients become discouraged. Who could blame them? They don’t know how to get their lives back! They lose hope and fade further into the wheelchair and into the background of their own lives. We must be the ones to hold the knowledge, to hold the hope, and to encourage them in their bid to regain control over their body.
If we fail, the patient will disengage with the process of rehabilitation and possibly (dangerously) the process of living. They aren’t dead but they aren’t really living either. This is a very dark space for patients. They can’t see a way or don’t see a reason to be engaged. We can lead them to a better place by engaging them in therapy involving things they really care about!
If we fail, we won’t be able to tolerate our own shortcomings and we will discontinue the patient’s therapy. We never blame ourselves. It is either a “plateau”, or “low patient motivation”, or some other fault that we place at the feet of the patient. We must continue to make ourselves more capable of solutions, so the patients can continue to progress.
You and I may disagree about some of my thoughts about these “dis” words. But it would be dishonest if I didn’t express how dissatisfied I am some days about the kind of disservice done to patients by well-meaning but under prepared, unenthusiastic, or disinterested therapists in neurorehabilitation.
The “dis” words of rehabilitation bother me a lot. If we could lose the “dis”, and set those words right side up again, we would be left with ease, order, ability, advantage, use, courage, engagement and continuation to work on. But only if we are interested enough to honestly provide satisfactory service to all the people who are counting on us.