Assessment, Prescription and Rehabilitation

During the seminar a wide range of disabilities requiring different methods of assessment, prescription and rehabilitation were covered. The outstanding common element in the different categories was the effort oriented to quantifying the handicaps and the performance of the patient. Two alternate avenues in handicap assessment are possible. The first, classification of the disability prior to rehabilitation, can produce a significantly large number of categories. The second possibility is to formally categorise the residual handicap postrehabilitation, assessing the patient equipped with his assistive device. The resultant list of categories in the second instance will possibly be more restricted. Generally, however, the variables involved are large in number and there is still no clear understanding as to which parameters are more relevant to a certain disability. The trend, firstly, to quantify what can be observed in a clinical situation such as the asymmetry in the gait of the patient and, secondly, to measure certain parameters when the patient is in his own environment. The latter measurements obviously have the distinct advantage of monitoring the long-term activities of a patient and achieving this when he is away from the psychological pressures of the hospital and laboratory. In most cases the parameters measured are mainly used in expanding existing data banks and contributing to the better understanding of the disability rather than directly influencing the choice of treatment. In a limited number of situations, however, the biomechanical data can be used in actually deciding on the prescription. Certain types of below-knee orthoses are a good example of this: by observing the changes in the lower limb kinetics of a patient wearing orthoses of different stiffnesses, a near optimum solution can be reached. Unfortunately, however, even these methods are not yet sufficiently developed for routine clinical use.