Inpatient Rehabilitation: A Stay for Daily Therapy When Home Isn't Ready Yet

Some people call it inpatient rehab. Others say residential rehabilitation, or just "admitting him for rehab". All the same idea. The person sleeps and eats at a rehab centre for a while, and the day is planned around getting everyday abilities back. In hospital, the question was how to keep him safe. Once he's stable, it becomes how he starts doing things for himself again. A PM&R doctor leads the work. That's short for physical medicine and rehabilitation, the branch of medicine focused on getting function back. Physiotherapists, occupational therapists, speech therapists and rehab nurses work alongside, plus a psychologist when needed. Anyone who needs close medical monitoring should stay in hospital until their doctors say otherwise.

Worth talking to the doctor if this sounds like your house right now:

• Can't get from bed to toilet safely
• Needs two people for every move
• Needs several therapy sessions in a day
• Stiff, tight muscles that need close watching
• The main carer is completely worn out
• Progress with therapy at home has gone flat
• Daily travel to therapy drains all their energy
• Nobody at home has moved someone like this before

Families often tell us "she looks brighter". Lovely to hear. But it doesn't say whether she can get to the toilet alone yet, so we score things on the first day and keep scoring. The Functional Independence Measure, or FIM, rates how much help someone needs across 18 everyday activities. The Barthel Index is a shorter list of 10, like feeding and bathing. The Berg Balance Scale checks balance through a set of small tasks, and the 10-metre walk test times walking speed. Those first scores become the baseline, which simply means the starting point. Do the same tests a few weeks later and you can see what has changed. Or what hasn't, yet.

The right place is wherever your family member can safely get enough of the right practice. A stay suits someone who needs help with most things, or several sessions a day. Outpatient visits suit people who can travel without being wiped out afterwards. Home rehab suits people who can't travel but are safe at home. Oddly, home has a bonus. They practise on the real two steps at the front door and the real Indian-style toilet. And digital rehabilitation can keep practice going between visits. Then there's money, and we know it worries people. A study of stroke survivors in India found cost and clear information were among the biggest unmet needs for families. Daily taxis with a wheelchair, an ayah, a visiting nurse. It adds up. For some families a stay works out easier. For others, home wins.

A rehab centre isn't an ICU. If your family member still needs frequent medical checks or a breathing machine, hospital or transitional care comes first. Some signs mean you stop and get help at once. Call 112 or your local ambulance for sudden new weakness, a drooping face, slurred speech, a seizure (a fit), a sudden severe headache, chest pain or breathlessness. A painful, swollen calf could be a blood clot. New confusion or a high fever needs a doctor too. After a spinal cord injury at chest level or higher, a pounding headache with flushing above the injury can mean autonomic dysreflexia, a sudden and dangerous rise in blood pressure. Treat that as an emergency.