Rehabilitation has its own vocabulary, and much of it appears in therapy notes, discharge papers and insurance letters without explanation. This glossary explains the terms families ask about most, grouped by topic: the scores used to measure progress, the members of the team, common conditions and complications, therapies, equipment, levels of care and the insurance words that decide where a patient goes next.
Scores and Scales
ADLs and IADLs
Activities of daily living (ADLs) are the basic self-care tasks: eating, dressing, bathing, toileting, transferring (for example from bed to chair) and walking. Instrumental activities of daily living (IADLs) are the more complex tasks needed to live alone: cooking, shopping, managing money and taking medication correctly. Therapy goals and discharge decisions are usually framed in these terms.
FIM (Functional Independence Measure)
The FIM rates 18 activities, from eating to memory, on a scale of 1 (total help needed) to 7 (fully independent), for a total between 18 and 126. It is still widely used in research and by many programs. Since October 2019, Medicare’s assessment for inpatient rehabilitation (the IRF-PAI) uses its own self-care and mobility items, known as Section GG, instead of the FIM.
Glasgow Coma Scale (GCS)
Emergency teams score eye opening, verbal response and motor response after a brain injury, for a total of 3 to 15. A score of 13 to 15 indicates a mild injury, 9 to 12 moderate and 3 to 8 severe. The first score is only a starting point; it does not predict an individual’s recovery on its own.
Rancho Los Amigos Levels
The Rancho Los Amigos Levels of Cognitive Functioning describe the stages people typically pass through after a brain injury, from no response to stimulation, through confusion and agitation, to purposeful and appropriate behavior. The revised scale has ten levels. Therapists use it to explain behavior, such as restlessness or confusion, that families find alarming.
ASIA Impairment Scale
Part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the scale grades an injury from A to E. A is complete, with no sensation or movement in the lowest sacral segments; B is sensory incomplete; C and D are motor incomplete, with D showing more preserved strength; E means normal sensation and strength.
Post-Traumatic Amnesia (PTA)
The period after a brain injury during which a person cannot store new memories and is often confused about time and place. The longer PTA lasts, the more severe the injury is considered. Staff often track it with short daily orientation questions.
The Rehabilitation Team
- Physiatrist: a physician specializing in physical medicine and rehabilitation, who leads the medical side of the program, manages problems such as spasticity and pain, and coordinates the team.
- Physical, occupational and speech-language therapists: see “Therapies” below.
- Rehabilitation nurse: a nurse trained in bladder and bowel programs, skin care, medications and teaching families.
- Neuropsychologist: a psychologist who tests memory, attention, reasoning and problem solving, and advises on return to work, school or driving.
- Case manager or social worker: arranges discharge, equipment and home services and deals with insurance.
- Prosthetist and orthotist: specialists who design, fit and adjust artificial limbs (prostheses) and braces (orthoses).
Conditions and Complications
- Aphasia: loss of language after a stroke or brain injury, affecting speaking, understanding, reading or writing. Intelligence is usually not affected.
- Dysarthria: slurred or unclear speech caused by weakness of the muscles used for speaking.
- Apraxia: difficulty planning and carrying out movements, including speech movements, despite adequate strength.
- Dysphagia: difficulty swallowing, which can let food or liquid enter the airway. Texture-modified diets and thickened drinks are common.
- Hemiparesis and hemiplegia: weakness (hemiparesis) or paralysis (hemiplegia) of one side of the body.
- Paraplegia and tetraplegia: paralysis affecting the legs and lower body (paraplegia) or the arms as well (tetraplegia, also called quadriplegia).
- Spasticity: involuntary muscle tightness and spasms after damage to the brain or spinal cord.
- Contracture: permanent shortening of a muscle or joint that limits movement, prevented by stretching and positioning.
- Neglect: reduced awareness of one side of space or the body, common after strokes in the right hemisphere.
- Ataxia: loss of coordination, causing unsteady walking and clumsy movements.
- Neurogenic bladder and bowel: loss of normal bladder and bowel control due to nerve damage, managed with scheduled programs and, where needed, catheters.
- Pressure injury: damage to skin and underlying tissue from prolonged pressure, also called a pressure ulcer or bedsore. Regular position changes and cushions help prevent it.
- Autonomic dysreflexia: a sudden, dangerous rise in blood pressure in people with a spinal cord injury at T6 or above, often triggered by a full bladder or bowel. It is a medical emergency: sit the person up, look for and remove the trigger, and call 911 if it does not resolve.
- Orthostatic hypotension: a drop in blood pressure when sitting or standing up, causing dizziness or fainting.
- Heterotopic ossification: bone forming in soft tissue around joints such as the hip, limiting movement.
- Deep vein thrombosis (DVT): a blood clot in a deep vein, usually in the leg, a risk for anyone who cannot move much.
Therapies
- PT (physical therapy): strength, balance, transfers and walking.
- OT (occupational therapy): dressing, bathing, cooking, use of the hands and adapting the home.
- SLP (speech-language pathology): speech, language, swallowing and thinking skills.
- Gait training: relearning to walk, sometimes with a harness that supports part of the body weight or with a robotic exoskeleton.
- Constraint-induced movement therapy: the stronger arm is restrained for much of the day so the weaker arm is used intensively.
- Functional electrical stimulation (FES): small electrical currents make weak or paralyzed muscles contract, for example to pedal a stationary bike or to grasp.
- Vestibular rehabilitation: exercises for dizziness and balance problems caused by the inner ear or brain.
- Spasticity treatments: botulinum toxin injections into specific muscles, oral medications, or an intrathecal baclofen pump that delivers medication directly to the spinal fluid.
- Cognitive rehabilitation: training and practical strategies, such as planners and phone reminders, for memory, attention and planning.
Equipment and Devices
- Orthosis and prosthesis: an orthosis is a brace that supports an existing body part; a prosthesis replaces a missing one.
- AFO (ankle-foot orthosis): a brace that holds up a weak foot so the toes do not drag while walking.
- DME (durable medical equipment): wheelchairs, hospital beds, walkers and commodes. Medicare Part B covers medically necessary DME prescribed by a doctor.
- AAC (augmentative and alternative communication): anything from a letter board to a tablet or speech-generating device for people who cannot rely on speech.
- Transfer board: a smooth board for sliding between bed, wheelchair and car seat.
- Hoyer lift: a mechanical patient lift with a sling, used when a person cannot help with transfers.
Levels of Care
- Acute care hospital: where emergency treatment, surgery and stabilization happen.
- LTACH (long-term acute care hospital): for patients who still need hospital-level care for weeks, for example to be weaned from a ventilator.
- IRF (inpatient rehabilitation facility): intensive rehabilitation, typically three hours of therapy a day at least five days a week, for patients who can take part. Under Medicare’s “60 percent rule”, at least 60 percent of an IRF’s patients must have one of 13 listed conditions, including stroke, spinal cord injury, brain injury, amputation and hip fracture.
- SNF (skilled nursing facility), also called subacute rehab: lower-intensity therapy with nursing care. Medicare Part A covers up to 100 days per benefit period after an inpatient hospital stay of at least three days: the first 20 days in full, then with a daily coinsurance.
- Day rehab: several hours of coordinated therapy a day while living at home.
- Outpatient therapy: scheduled visits, usually one to three times a week.
- Home health: nurses and therapists who visit the home.
Insurance and Discharge Terms
- Prior authorization: the insurer’s approval required before admission to many rehab settings.
- Peer-to-peer review: a call in which the treating doctor discusses a denial with the insurer’s medical reviewer.
- Appeal: a formal request to overturn a denial; the denial letter states the deadline.
- Discharge planning: arranging the next setting, equipment, home services and family training before a patient leaves.
- Observation status: a hospital stay billed as outpatient care. Days under observation do not count toward the three inpatient days Medicare requires for SNF coverage, so families should ask about the patient’s status.
Frequently Asked Questions
What is the difference between an IRF and a skilled nursing facility?
An inpatient rehabilitation facility provides intensive therapy, typically three hours a day, with daily physician oversight. A skilled nursing facility provides fewer therapy hours over a longer stay, for patients who cannot yet tolerate intensive therapy or need mainly nursing care.
What does a physiatrist do?
A physiatrist is a physician specializing in physical medicine and rehabilitation. The physiatrist leads the rehab team, manages medical problems during rehabilitation and sets the overall plan with the patient and family.
What is the FIM score?
A rating of 18 everyday activities from 1 to 7, totaling 18 to 126, that shows how much help a patient needs. Medicare now uses different items (Section GG) for inpatient rehab, but many programs and studies still report the FIM.
What does “incomplete” spinal cord injury mean?
Some sensation or movement is preserved below the level of the injury, graded B, C or D on the ASIA scale. A complete injury (ASIA A) has no sensation or movement in the lowest segments of the spinal cord.
This site is an independent reference on rehabilitation medicine and does not replace advice from the treating team.
