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MD3 > AC - Rehabilitation > Flashcards

AC - Rehabilitation Flashcards

1
Q

What is rehab?

A

Process of helping person achieve fullest potential across many domains (physical, social, psychological, vocational, educational)

Maintain health and prevent secondary complications

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2
Q

What are the main principles of rehab?

A

Consistent with the person’s life goals, environmental limitations and impairment

Holistic approach - significant inter-disciplinary and multi-disciplinary contribution

Addresses patient issues in all domains – communication, mobility, self-care, cognition, behaviour, social supports, community access

Patient needs to be suitable for a rehabilitation program

SMART goals - tailored, monitored, reviewed and revised

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3
Q

What factors contribute to determining a patient’s suitability for rehab?

A

Medically stable

Appropriate supports available (social, family, carers)

Cognition adequate memory & problem-solving skills to allow them to learn new skills

Motivation & mood

Expect performance gains within a timely manner

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4
Q

What are important components of goal setting in rehab?

A

SMART - specific, measurable, achievable, relevant and timely

Monitored and reviewed regularly

Include current issues as well as predicted issues and prevention of further possible impairments or their complications

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5
Q

How can goals/progress be monitored?

A

Barthel, FIM, ICF scales

Assess patient performance across various domains

Measure and quantify performance gains and rehab progress + determine level of funding and care needs

Barthel mainly used in aged care - Dressing, continence and ambulation

FIM specific to rehab setting - Barthel + communication, problem-solving, memory, social behaviour

ICF body functions & structure, environmental factors (barriers & facilitators), activities & participation

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6
Q

What do you need to consider when planning a rehab program?

A
  1. Patient suitability
  2. Where it will take place
  3. Timing of commencement
  4. What it will involve and the intensity
  5. Manage pt and family expectations
  6. Goal setting
  7. Early discharge planning and post-discharge therapy planning
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7
Q

What are common cognitive issues in TBI?

A

Global impairment
Slowed processing of information
Cognitive fatigue
Cognitive overload - irritable/behavioural when overstimulated
Impaired attention & concentration - esp. divided attention

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8
Q

What tools are best for assessing congnition in TBI?

A

NuCOG, CLQT, Cognistat - validated for TBI and cover good range of cognitive domains

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9
Q

How can you manage cognitive deficits in TBI rehab?

A
  • Education to patient and family about fatigue, behaviour, cognitive deficits, effects of alcohol and drug intake, good sleep hygiene
  • Education about driving +/- occupational driving test
  • Vocational rehabilitation provider promote return to work or new work opportunities
  • Social reengagement
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10
Q

What are common neurological issues in TBI?

A
  1. Visual changes hemianopia, diplopia, impaired accommodation
  2. Anosmia
  3. Balance/coordination dizziness/vertigo
  4. Language deficits
    Focal neurological deficits uncommon
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11
Q

What are common Medical issues in TBI?

A
  1. Mood disorders - common, screen for them
  2. Spasticity +/- contractures focal or generalised
  3. Post-traumatic epilepsy increased risk if seizure occurs between 24 hrs – 72 hrs, high risk injury
  4. Endocrine diabetes insidious, SIADH
  5. Heterotrophic ossification abnormal bone deposition around joints, causes pain, limits ROM, increases spasticity, conservative Rx (NSAID) or surgery if impairs function
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12
Q

What are common signs of depression in rehab patient?

A

slowed or stalled rehab progress, refusal to engage in activities, anhedonia, deteriorating cognition

Insomnia, appetite disturbance less common in this group

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13
Q

What are the criteria for mild, moderate, mod-severe & severe head injury and their prediction of impairment and recovery time?

A
  1. Mild injury PTA 4 weeks, expect significant disability, permanent deficits certain
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14
Q

What are common long-term lifestyle issues in TBI?

A
  1. Difficulty returning to work financial hardship
  2. Difficulty maintaining or forming personal relationships social support, isolation
  3. Minimal participation in age-appropriate recreational activities
  4. Increased strain on family supports
    Difficulty living independently in the community
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15
Q

What are the important acute Rx and goals for spinal cord injury?

A

Prevention of secondary cord damage (if vertebral #) - Careful movement stabilising aids, team, surgical, Halo vest or collar to prevent hyperextension injuries

Neurological assessment and classification of patient to ASIA (American spinal injury association)

Optimise health status and prevent complications associated with immobility
(DVT, Wound Rx, Pressure area monitoring, Nutrition and fluids, bowel and bladder - IDC or acute suprapubic catheter (SPC), diet & fluids and aperients, monitoring & Rx of labile BP, adequate analgesia

Optimise psychosocial status and minimise secondary mood disorder
(Early psychiatry and social work consultation, Monitor mood, early management strategies)

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16
Q

What are the ASIA spinal injury categories?

A

A complete injury

B incomplete (sensory but no motor preservation below injury level)

C incomplete (motor function preserved, 50% key muscle groups 3 power)

E normal

17
Q

What are important issues for Rx & goals in medium-long term for spinal injury patients?

A

Bowel & Bladder

Neuropathic pain or musculoskeletal pain

Mobilisation and independence

Skin management

Sexual function & fertility

Psychosocial - coping, mood, return to work

18
Q

How can bowel & bladder be managed in spinal injury patient?

A

Secondary complications (i.e. constipation, incontinence, acute retention, UTI, psychological distress)

Education and counselling on long term changes and management

Baseline imaging IVP, CUG

SPC, reflex condom drainage (men) or intermittent clean self-catheterisation

Consider urinary antiseptics

Optimise dietary intake of fibre and fluids & apperients (UMN bowel is reflexic)

Consider ileostomy or colostomy for LMN bowels (LMN bowel requires increased abdominal pressure to empty)

19
Q

How can pain be managed in spinal injury patient?

A

Psychosocial strategies to enhance ability to cope with ongoing musculoskeletal or neuropathic pain

Optimise analgesia medications gabapentin, Pregabalin most effective (Amitriptyline also useful)

Increase physical activity

20
Q

How can you optimise mobility in spinal injury patient?

A 
Orthosis 
Gait retraining programs 
Wheelchair and cushions 
Commode chair for showering and bowel care 
Home modification  (access and safety)
21
Q

How can you manage spasticity and tone issues in spinal cord patient?

A

Regular movement and repositioning of patient

Regular movement of joints and complete stretching of muscles to full length (physio)

Baclofen +/- diazepam, intrathecal baclofen (generalised spasticity/increased tone), botulinum injection (specific muscle group effected)

22
Q

Common medical/acute and rehab goals in rehabilitation setting?

A
  1. Optimise health status i.e. nutrition, BP, glycaemic control, hydration, infection, wound management
  2. Prevent complications and reoccurrence - falls risk identification/reduction strategies/injury prevention, VTE prophylaxis, pressure monitoring, mood monitoring, mobilisation, secondary prevention of stroke/CVD, prevent contractures
  3. Promote return to pre-morbid function - assess baseline & current function, optimise current abilities, compensatory and modifications, mobility, confidence, nutrition, pain and mood not limiting function
  4. Maximise participation and facilitate reintegration across all domains (social, vocational, educational..) - physical, psychological, carer supports, skills retraining, education, driving
  5. Early discharge planning and follow-up
23
Q

What are some prognostic indicators for stroke rehabilitation & recovery?

A

Severity of stroke - shrug shoulders at 2 weeks, fine movement within 6 weeks, early attention deficits, behavioural or executive dysfunction, LOC at time, size and site of stroke, sitting balance, visuospatial deficits

Age

Social situation, presence of carer

Premorbid function and mobility

Comorbidities

24
Q

What is the expected recovery rate in stroke rehabilitation?

A

Most rapid gains in first 3 mths, esp. first month

Usually maximally recovered by 6 mths - minimal gains thereafter

25
Q

Secondary prevention of stroke

A
  1. BP, glycaemic, lipid control - drugs
  2. Aspirin + dipyridamole OR clopidogrel
  3. Carotid endarterectomy within 2 weeks if >70-75% stenosis
  4. Anticoagulation in AF, stop clot promoting meds i.e. HRT
  5. ACEI - BP control + reduces risk of stroke recurrence
  6. Alcohol abstinance for 1st year and no more than 2/day thereafter
26
Q

How common is depression post-stroke?

A

Very common - ~40% become depressed

Risk of depression remains higher for significant period after stroke ~2 years

27
Q

What advice to give about driving to patient’s after stroke?

A
  1. Can’t drive for one month after
  2. Require doctor assessment thereafter - will either ok driving or refer to OT Ax to confirm
  3. May be able to return to driving if deemed safe, may need some modifications to assist them if impairment or may have restricted license
  4. Must inform VicRoads and insurance company of stroke event to ensure continued coverage

MD3 (21 decks)

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