Ch. 3 Psychological Aspects of Rehab

Responses to InjuryCognitiveEmotionalBehavioral

Response-Injury Severity Relationship

Short Term (4 weeks or less) Long term (more than 4 weeks) Chronic (recurring) Termination ( career ending)

Short Term Respond with shock Then relief that it is not severe They can be impatient when it

comes to rehab

Long Term Respond with fear and anger DABDA Loss of vigor, irrational

thoughts, alienation during sessions

Psychological intervention is sometimes helpful

Chronic Injuries Frustrated and angry to be in

rehab again Extreme reactions during rehab Either willing to try any

treatment or resistant to all protocols and skeptical

Termination Injuries Experience all stages of the

grief process Isolation is common May experience loss of identity Clinicians may want to help

draw patients to new activities

Emotional Responses Grief Anger Anxiety Stress Depression

Phases of Adjustment Shock Realization Mourning Acknowledgement Coping and reformation

Shock Understand the individual may not be

receptive Proceed slowly with information Allow patient time to assess situation

Realization Avoid well-wisher statements Respond empathetically Recognized challenges faced by patient

Mourning Don’t be judgemental Provide constant support Offer encouragement, recognize progress Help them focus on what they can do

rather than what they can’t

Acknowledgement Listen to individual’s concerns Encourage activities that are self re-

inforcing Introduce social contact, modeling

Coping and Reformulation Foster trust and confidence Never ignore or discourage patient Build self confidence and physical

competence Incorporate mental training interventions

Behavioral Responses Coping mechanisms Adherance

Types of Patients “The Malingerer” “The Pediatric Athlete” “The Elite Athlete” “The Senior Adult”

Role of the Clinician Explain the rehab process Develop rapport

Rehabilitation Adherence Strategies

Set effective goals Specific and measureable Written goals Can be posted Short term Attainable Based on physical rehab steps

Rehabilitation Adherence Strategies

Self monitoring and acceptance of responsibility Effort Follow instructions Honestly reporting pain Choices with where to start Keep logs of therapy sessions

Rehabilitation Adherence Strategies

Promote the use of imagery Enhances feelings of control Increases focus and confidence Reduces anxiety and stress Speeds up recovery Patients use it to see and feel their body

mending

Rehabilitation Adherence Strategies

Positive Self Talk Internal monologue Be an optimist Remain realistic and objective Focus on the present View “problems” as challenges rather than

threats View successes as replicable Concentrate on the controllable Separate performance from self worth Provide social support

Pain Management Ice Ultrasound Electrical stimulation Acupressure Massage Medicine Imagery Relaxation Association and dissociation methods

Pain Management Soothing Imagery: -creating a restful image Relaxation: -greater blood flow, less tension -less sympathetic nerve response Association: -reinterprets pain as a challenge Dissociation: -directing attention away from pain

Return to Play Talk to them about concerns Discuss confidence, fear of re-injury and

focus Help them understand that they are

healed Encourage them to imagine a successful

return

Career Ending Injuries

Have more physical and mental health problems

Financial concerns Isolation Provide alternate activity

options

Steps to Successful Referral

Look for symptoms off maladjustment to injury

Consult a mental health professional Express concern for the patient Allow the patient to ask questions and

discuss concerns Obtain written consent to share

information with the referral source Give patient information to schedule

appt. Check to see if appt was made.