Ready for Rehab?

In this episode of Kessler Foundation's podcast, Gretchen March, OTR, Kessler Institute for Rehabilitation, presents “Ready for Rehab?” This podcast focuses on using transtheoretical model concepts to optimize outcomes.



This is part two of an eight part series. Listen to the series as it's posted. 

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Below is an excerpt from the lecture.

So today we're going to talk first about people being ready for rehab. So how many times have you been in your center and you say, "Why is this person here?" like what Dr. Adler was explaining? Either the very high-level person, you're like, "They should have gone home." Or the very low-level person it's like, "What are we going to do?" And that happens, right? So we think about that. And we don't want to say we think about it because then we feel bad. Because then we're being bias or whatever. So what I found is I'm a person who loves change, so change is very exciting to me.

Doesn't excite a lot of people I know, and it takes a long time to happen. In Dr. Adler's presentation, he kind of went over the length of stay and how it's shortened. And we don't have as much time as we used to with our patients, right? So how can we use a tool that might help us determine who's really ready and where are they on the readiness phase for rehab and change? I have nothing to disclose except that I work here. And the objectives today are kind of to define and understand the transtheoretical model of change. Has anybody heard of this? Younger people may have. I'm older so when I went to school they were working on this probably, so. So apply the concepts to patients in rehab settings: develop a mindfulness regarding where the patient is in the process - and I think this is the biggest objective - and also learning to match stages of change with processes to help optimize their outcome. Because we all want people to get better, right?

Transtheoretical Model
So the transtheoretical model is relating to a model of behavioral change that assesses the individual's readiness to act in a new and healthier behavior. It provides strategies or processes to guide the individual through the stages of change. And it was developed by Clemente and Prochaska probably in the early '80s, late '70s. And it was used mostly in things like substance abuse, smoking cessation, and high-risk health behaviors like HIV, how to help people change high-risk behaviors. So hence the song. The transtheoretical model promotes intentional behavior change, looking at change as a process and not an event. And it's characterized by stages. So we all know that when you make a decision to change, you don't change the next day, right? You change a behavior maybe. So think about yourself.

If you've ever tried to lose weight. You wake up and you say, "Oh, I'm going to lose weight. I'm going to start now, and I'm not going to eat sugar." Right? And that lasts, what probably half a day until something tempts you and then you say, "Oh, I'm so mad at myself. I'm going to do it again and I'm going to figure it out." And so you say, "Okay." So it's a process. It's characterized by stages of change. And I think this is going to be kind of helpful. It was very helpful to me because as therapists, I think therapists tend to do this, but they don't realize what they're doing maybe. And maybe we could do it smarter and more targeted. And cycling through stages is common. So again, go back to the example of losing weight. You do it, you start losing weight, you lose five pounds, but you really want to lose 50, and now you're discouraged because it's two months later and you've only lost five pounds. The heck with it, "I'm eating ice cream." Right? And then you start all over again. You say, "I'm so mad at myself. I shouldn't have done that." Okay.