Monitoring is repeatedly measuring and following the care being provided at regular intervals.

It is important in the provision of rehabilitation care because it provides information on the:

1. Progress of a person’s functioning
2. Effects of various rehabilitation interventions
3. Detection of a change or lack of it in a person’s functioning

The process of monitoring needs to be performed from the beginning of care until the discontinuation of care.

Monitoring how a person goes through the rehabilitation process includes the following steps:

i.          Re-assess difficulties

ii.         Review the rehabilitation care provided

iii.         Progress the rehabilitation care

iv.        Refer if needed

i.          Re-assess difficulties

This helps in determining whether there is an improvement or a decline in functioning or the functioning is stagnant.

At every appointment,

•   Re-assess the impairment using the same assessment tool used in the first step
• Record the results and compare it with previous results

ii.         Review the rehabilitation care provided

This helps in making sure that the person and or the caregivers have been performing the exercises correctly and enables the correction of any issues with the technique.

At every appointment,

• Ask the person and/or caregiver to repeat the exercises
• Go over the tips or cues to enable them remember
• Ask the person and/or caregiver if they have been having any problems with the exercises or if they have any other questions.
• Ask the person if the exercises have been too hard, too easy or just right for them, use the modified BORG RPE scale if necessary.

iii.        Progress the rehabilitation care

Where possible try to teach the person or caregiver how to progress exercises by themselves between appointments.

If on re-assessment person’s function has improved and intensity per the BORG scale has become easy, progress exercises to reflect most recent assessment

Teach new exercises, educate on when it is safe to progress to new exercise.

iv.        Refer if needed

There are different specialists in the field of rehabilitation. These include occupational therapists, speech and language therapists, rehabilitation nurses, physical medicine and rehabilitation physicians, physical therapists as well as orthotists and prosthetists.                          

Refer to these specialists if:

• No improvement seen after 2 weeks of daily treatment
• Red flags are seen during treatment
• You feel that the person’s rehabilitation needs are too complex for you to manage

Before you refer, identify the centers within a travel distance which have rehabilitation specialists or services and the kind of specialists and services available.

When to discharge a person from rehabilitation

Monitoring ends when a person is discharged from rehabilitation.

The duration or length of rehabilitation care however depends on the goals set and progress made.

It is important to let the person understand that more progress will be made if the person receiving rehabilitation care:

• Attends all scheduled appointments
• Has difficulties addressed by the trained health worker as best as possible
• Completes all assigned home exercises

A person can be discharged from rehabilitation if:

• Goals set are reached – once the health worker providing the rehabilitation care and the person receiving it are satisfied with the person’s success based on the goals set at the beginning of rehabilitation, discharge can be made.
• A referral is being made to a rehabilitation specialist