4.13 (4.15) Medical rehabilitation and the palliative care patient

Question 1

What are the four types of rehabilitation in the four track model and how does rehabilitation differ early and late in patient care?

Answer 1

preventative
restorative
supportive
palliative

traditional goal is restoration of function whereas in palliative patients goal is maintaining functional independence as long as possible

Question 2

Name two ways rehab strategies can contribute to PC

Answer 2

1. maintaining and if possible promoting functional independence during a period of expected systemic decline
2. providing strategies to prevent or slow deletrious complications like skin breakdown, deconditioning, contractures

Question 3

List four clinician-related barriers that make early involvement of rehab services less likely to take place in patient care

Answer 3

clinicians not necessarily familiar with substance or potential benefits of rehab service

reliable referral patterns not established

non-rehab clinicians are less likely to screen patients for functional decline.

Clinicians may believe that at the stage of illness where disease modifying treatments are of no benefit, rehab also has little to offer.

Clinicians have difficulty determining who and when to refer to rehab services

Question 4

List four situations that might trigger a referral to rehab services in a patient’s care

Answer 4

• any new or significant ADL or iADL difficulty
• any new or significant decrease in household or community mobility
• frail, ill, or disabled caregiver
• recent hospitalization of significant change in medical status (ie period of bed rest, path #)
• symptom (pain, dyspnea) interference with function

Question 5

List five burdens that overwhelm caregivers who are caring for a patient with advanced illness

Answer 5

time and logistics
physical tasks
financial costs
emotional and mental health risks
other health risks

Question 6

List three interventions that can be undertaken to improve things for caregivers who are feeling overwhelmed by the care needs of a loved one

Answer 6

short focussed rehab stays 
intensive teaching prior to dc
understand how to safely transfer
review bowel/bladder programmes
labour saving devices such as mechanical lifts, transfer boards, bathing aids

Question 7

List FOUR patient-related barriers that make early involvement of rehab services less likely to take place in patient care

Answer 7

◆ pts unfamiliar discussing function w/ clinicians
◆ pts consider functional decline an inevitable consequence of their condition and may not bring even catastrophic declines in their mobility/ADLs to their clinician’s attention
◆ rehab interventions require active & ongoing pt participation -> requires pt and support system “buy in”

Question 8

Name the SIX domains of the Functional Independence Measure (FIM)

Answer 8

◆ locomotion
◆ transfers
◆ self care
◆ sphincter control (bladder & bowel)

◆ social cognition
◆ communication