EXHIBIT 4.23 

                         FIRST AMENDMENT dated as of April 15, 1996 (this
                    "FIRST AMENDMENT"), to the Amended and Restated Credit
                    Agreement dated as of September 26, 1995 (as amended to
                    the date hereof, the "AMENDED CREDIT AGREEMENT"), among
                    Horizon/CMS Healthcare Corporation, a Delaware
                    corporation ("HORIZON"), Continental Medical Systems,
                    Inc., a Delaware corporation ("CONTINENTAL", and
                    together with Horizon, the "BORROWERS"), the lenders
                    listed on the signature pages thereto (the "LENDERS")
                    and NationsBank of Texas, N.A., as agent for the
                    Lenders (in such capacity, the "AGENT") and as issuing
                    bank (in such capacity, the "ISSUING BANK").

     The parties hereto have agreed, subject to the terms and conditions 
hereof, to amend the Amended Credit Agreement as provided herein.

     Capitalized terms used and not otherwise defined herein shall have the 
meanings assigned to such terms in the Amended Credit Agreement (the Amended 
Credit Agreement, as amended and waived by, and together with, this First 
Amendment, and as hereinafter amended, modified, extended or restated from 
time to time, being called the "AMENDED AGREEMENT").

     Accordingly, the parties hereto hereby agree as follows:

     SECTION 1.01.  AMENDMENT TO SECTION 1.01.  The following parenthetical 
phrase is hereby added to the definition of "subsidiary" in Section 1.01 of 
the Amended Agreement after the word "Controlled" in the second to the last 
line of such definition:

          "(other than Control arising solely from a management contract
     entered into in good faith and on an arms-length basis with an
     independent, unrelated third party),"

     SECTION 1.02.  AMENDMENTS TO SECTION 2.20.  (a) The following sentence 
is hereby added at the end of Section 2.20(a) of the Amended Agreement:

          "For purposes hereof, the "issuance of a Letter of Credit"
     includes the amendment, renewal or extension of a Letter of Credit."

     (b)  The following phrase is hereby added in clause (i) of Section 2.20(b)
of the Amended Agreement immediately following the "(i)":

          "subject to extension (including pursuant to any automatic
     renewal provision in customary form),"



     SECTION 1.03.  AMENDMENT TO SECTION 6.01.  Section 6.01 of the Amended 
Agreement is hereby amended by deleting the period at the end of paragraph 
(i) thereof and adding "; and" and by adding the following paragraph 
immediately after paragraph (i) thereof:

          "(j) Guarantees permitted by Section 6.04(e)(ii)."

     SECTION 1.04.  AMENDMENT TO SECTION 6.04.  Paragraph (e) of Section 6.04 
of the Amended Agreement is hereby amended as follows:

          (a)  a "(i)" is hereby added immediately following the "(e)"
     which begins paragraph (e) thereof;

          (b)  the following language is hereby added after the word
     "parties" and before the ";" on the fifth line of paragraph (e)
     thereof:

               "and (ii) loans and advances to, and guarantees in favor of,
          any person which Horizon or any of its Subsidiaries has an option
          or other right to acquire, whether such option is exercisable
          immediately, upon the passage of time or upon the occurrence of
          specified events";

          (c)  the word "investment" after "PROVIDED in the case of each
     such" in the fifth line of paragraph (e) thereof is hereby deleted and
     the following language is hereby added after "PROVIDED that in the
     case of each such" and before the ", that:":

               "equity investment, loan, advance or guarantee (each of the
          foregoing being referred to herein as an "INVESTMENT")";

          (d)  clauses (i), (ii) and (iii) of the proviso to paragraph (e)
     are hereby redesignated as clauses (A), (B) and (C), respectively;

          (e)  the following language is hereby added after the word
     "Subsidiary" and before the ")" on the fifth line of clause (B) of the
     proviso to paragraph (e):

               ", and in the case of investments in connection with an
          option or other right to acquire any person, including the
          maximum aggregate potential liability of Horizon and the
          Subsidiaries related to such option or other right and any loan,
          advance or guarantee associated therewith";

          (f)  a "," is hereby added after the ")" following the language
     added pursuant to the preceding paragraph (e) hereof;

          (g)  the following language is hereby added to the beginning of
     clause (C) of the proviso to paragraph (e):



               "in the case of investments referred to in clause (i) above,
          such person (I)";

          (h)  a "(II)" is hereby added to clause (C) of the proviso to
     paragraph (e) after "as applicable, or" and before "shall have
     executed", and an "and" is hereby added to the end of clause (C) of
     the proviso to paragraph (e); and

          (i)  the following language is hereby added immediately following
     clause (C) of the proviso to paragraph (e):

               "(D) in the case of investments referred to in clause (ii)
          above, (I) any such loan or advance shall be repaid, retired or
          refinanced as otherwise permitted hereunder, and any such
          guarantee shall be released, upon consummation of the acquisition
          of such person or upon termination of such option or other right
          and (II) in the case of any loan or other advance, Horizon or the
          applicable Subsidiary shall have (1) pledged and delivered to the
          Agent for the benefit of the Secured Parties a promissory note of
          such person evidencing its obligation to repay such loan or
          advance and (2) assigned to the Agent for the benefit of the
          Secured Parties any collateral for such promissory note received
          by Horizon or such Subsidiary in connection therewith;"

     SECTION 1.05.  WAIVER.  On and as of (but not before) the First 
Amendment Effective Date (as defined in Section 1.07), the failure of the 
Borrower to comply with Section 6.04 of the Amended Credit Agreement prior to 
(but not after) the First Amendment Effective Date as a result of its 
investments in Texas Health Enterprises, Inc. shall be permanently waived.  
The preceding sentence shall be limited precisely as written.

     SECTION 1.06.  REPRESENTATIONS AND WARRANTIES.  The Borrowers hereby 
represent and warrant to the Agent and the Lenders, as follows:

          (a)  The representations and warranties set forth in Article III
     of the Amended Agreement, and in each other Loan Document, are true
     and correct in all material respects on and as of the date hereof and
     on and as of the First Amendment Effective Date with the same effect
     as if made on and as of the date hereof or the First Amendment
     Effective Date, as the case may be, except to the extent such
     representations and warranties expressly relate solely to an earlier
     date.

          (b)  Each of the Borrowers, the Subsidiary Pledgors and the
     Subsidiary Guarantors is in compliance with all the terms and
     conditions of the Amended Agreement and the other Loan Documents on
     its part to be observed or performed and no Default or Event of
     Default has occurred or is continuing under the Amended Agreement.



          (c)  The execution, delivery and performance by each of the
     Borrowers of this First Amendment have been duly authorized by such
     party.

          (d)  This First Amendment constitutes the legal, valid and
     binding obligation of each of the Borrowers, enforceable against it in
     accordance with its terms.

          (e)  The execution, delivery and performance by each of the
     Borrowers of this First Amendment (i) do not conflict with or violate
     (A) any provision of law, statute, rule or regulation, or of the
     certificate of incorporation or by-laws of either of the Borrowers,
     (B) any order of any Governmental Authority or (C) any provision of
     any indenture, agreement or other instrument to which either of the
     Borrowers is a party or by which it or any of its property may be
     bound and (ii) do not require any consents under, result in a breach
     of or constitute (with notice or lapse of time or both) a default
     under any such indenture, agreement or instrument.

     SECTION 1.07.  EFFECTIVENESS.  This First Amendment shall become 
effective only upon satisfaction of the following conditions precedent (the 
first date upon which each such condition has been satisfied being herein 
called the "FIRST AMENDMENT EFFECTIVE DATE"):

          (a)  The Agent shall have received duly executed counterparts of
     this First Amendment which, when taken together, bear the authorized
     signatures of the Borrowers and the Required Lenders.

          (b)  The Required Lenders shall be satisfied that the
     representations and warranties set forth in Section 1.06 are true and
     correct on and as of the First Amendment Effective Date and that no
     Default or Event of Default has occurred or is continuing.

          (c)  There shall not be any action pending or any judgment, order
     or decree in effect which, in the judgment of the Required Lenders or
     their counsel, is likely to restrain, prevent or impose materially
     adverse conditions upon performance by any of the Borrowers, the
     Subsidiary Pledgors or the Subsidiary Guarantors of its obligations
     under the Loan Documents.

          (d)  Horizon Facilities Management, Inc. ("HORIZON FM") shall
     have pledged and delivered to the Agent for the benefit of the Secured
     Parties a promissory note of Texas Health Enterprises, Inc. in the
     principal amount of $30,000,000 payable to Horizon FM.

          (e)  The Required Lenders shall have received such other
     documents, legal opinions, instruments and certificates as they shall
     reasonably request and such other documents, legal opinions,
     instruments and certificates shall be satisfactory in form and
     substance to the Required Lenders and their counsel.  All 



     corporate and other proceedings taken or to be taken in connection with 
     this First Amendment and all documents incidental thereto, whether or not
     referred to herein, shall be satisfactory in form and substance to the
     Required Lenders and their counsel.

     SECTION 1.08.  APPLICABLE LAW.  THIS FIRST AMENDMENT SHALL BE GOVERNED 
BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK, 
EXCEPT TO THE EXTENT THAT THE FEDERAL LAWS OF THE UNITED STATES OF AMERICA 
MAY APPLY.

     SECTION 1.09.  EXPENSES.  The Borrowers shall pay all reasonable 
out-of-pocket expenses incurred by the Agent and the Required Lenders in 
connection with the preparation, negotiation, execution, delivery and 
enforcement of this First Amendment, including, but not limited to, the 
reasonable fees and disbursements of counsel.  The agreement set forth in 
this Section 1.09 shall survive the termination of this First Amendment and 
the Amended Agreement.

     SECTION 1.10.  COUNTERPARTS.  This First Amendment may be executed in 
any number of counterparts, each of which shall constitute an original but 
all of which when taken together shall constitute but one agreement.

     SECTION 1.11.  CREDIT AGREEMENT. Except as expressly set forth herein, 
the amendments and waiver provided herein shall not by implication or 
otherwise limit, constitute a waiver of, or otherwise affect the rights and 
remedies of the Lenders, the Agent or the other Secured Parties under the 
Amended Agreement or any other Loan Document, nor shall they constitute a 
waiver of any Default or Event of Default, nor shall they alter, modify, 
amend or in any way affect any of the terms, conditions, obligations, 
covenants or agreements contained in the Amended Agreement or any other Loan 
Document.  Each of the amendments and waiver provided herein shall apply and 
be effective only with respect to the provisions of the Amended Agreement 
specifically referred to by such amendment or waiver, as the case may be.  
Except as expressly amended herein, the Amended Agreement shall continue in 
full force and effect in accordance with the provisions thereof.  As used in 
the Amended Agreement, the terms "Agreement", "herein", "hereinafter", 
"hereunder", "hereto" and words of similar import shall mean, from and after 
the date hereof, the Amended Agreement. 



     IN WITNESS WHEREOF, the parties hereto have caused this First Amendment 
to be duly executed by their duly authorized officers, all as of the date 
first above written.

                         HORIZON/CMS HEALTHCARE CORPORATION,
                         as a Borrower

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         CONTINENTAL MEDICAL SYSTEMS, INC.,
                         as a Borrower

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         NATIONSBANK OF TEXAS, N.A., as Agent, as Issuing
                         Bank and as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         BANK OF AMERICA NT & SA, as Managing
                         Agent and as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         MORGAN GUARANTY TRUST COMPANY OF NEW
                         YORK, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         CREDIT LYONNAIS CAYMAN ISLAND BRANCH,
                         as Co-Agent and as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:



                         LONG TERM CREDIT BANK OF JAPAN, LTD., LA
                         AGENCY, as Co-Agent and as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         PNC BANK, NATIONAL ASSOCIATION, as Co-Agent
                         and as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         CHEMICAL BANK, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         FIRST INTERSTATE BANK OF TEXAS, N.A.,
                         as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         TORONTO DOMINION (TEXAS) INC., as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         BANKERS TRUST COMPANY, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:




                         BANQUE PARIBAS, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         BANQUE NATIONALE de PARIS, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         DEUTSCHE BANK AG, LOS ANGELES AND/OR
                         CAYMAN ISLANDS BRANCHES, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         MELLON BANK, N.A., as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         FLEET BANK OF MASSACHUSETTS, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:



                         SOCIETY NATIONAL BANK, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         SUNWEST BANK OF ALBUQUERQUE, N.A., as a
                         Lender and as Issuing Bank

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         THE BANK OF TOKYO TRUST COMPANY, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         THE BOATMEN'S NATIONAL BANK OF ST. LOUIS,
                         as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         THE NIPPON CREDIT BANK, LTD., LOS ANGELES
                         AGENCY, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         THE SUMITOMO BANK, LIMITED, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:

                         THE SUMITOMO TRUST & BANKING CO., LTD., NEW
                         YORK BRANCH, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:



                         THE SUMITOMO BANK, LIMITED, CHICAGO
                         BRANCH, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:


                         THE MITSUBISHI BANK, LTD., LOS ANGELES
                         BRANCH, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title:


                         THE INDUSTRIAL BANK OF JAPAN, LIMITED,
                         LOS ANGELES AGENCY, as a Lender

                         By 
                            ------------------------------------------------- 
                            Name:
                            Title: