Rehabilitation recommendations for institutionalized motor-disabled patients

Consultation reports on 142 profoundly retarded and severely motor-disabled patients in a state residential care facility who were seen by physiatrists from an academic department of physical medicine and rehabilitation (PM&R) were reviewed. In all, 168 reasons for consultation were listed: 117 for specific identification or management of disabilities related to gross-motor or fine-motor function, 37 for surgical problems, and 10 for medical problems. The consultants made 314 recommendations altogether: 100 suggested the evaluation or treatment of gross-motor disabilities by a physical therapist, 43 suggested occupational therapy evaluation or treatment, and an additional 73 suggested adaptive equipment involving an orthotist. The recommendations also involved the following problems: medical-33; surgical-37; behavioral-27; further rehabilitation-1. The skills of a consultant knowledgeable in the management of multiply handicapped people include the coordination of medical, surgical, physical and behavioral care. Such knowledge is also a useful adjunct to overall patient care in complex cases with motor involvement. The preliminary association during which these consultations were done served as the basis of a growing affiliation between the state institution and the department of PM&R.