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Neurology 2 > Clin Med - NeuroRehab > Flashcards

Clin Med - NeuroRehab Flashcards

1
Q

When was rehab medicine formally recognized by the AMA?

A

1920s

Physical therapy = physical medicine

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2
Q

Where was the first academic physical medicine department?

A

Temple

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3
Q

When did physical therapy become a medical subspecialty

A

1930s
Focus on rehab of the disabled
Mayo - residency in “physical medicine”

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4
Q

Who is one of the founding fathers of active rehab?

A

Howard Rusk , MD

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5
Q

Philosophy of rehab medicine

A
  • team basis for rehab care, with patient as team member
  • multi-disciplinary approach, including services
  • look at entire patient, environment, and goals (disease process, socioeconomic background)
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6
Q

Define PM&R - physical medicine and rehab

A
  • team consisting of multidisciplinary focus, who provide services which can help individuals regain body functions lost to injury or illness
  • identified as a rapidly growing PA specialty
  • includes: PT, OT, TR, S/LT, dietitians, nursing , COP/OP, social work, pharmacists
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7
Q

PM&R focuses on…

A

maximizing recovery

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8
Q

PM&R clinical areas of care

A
  • Neuromuscular Medicine
  • Pain Medicine
  • Pediatric Rehab Medicine
  • Spinal Cord Injury
  • Sports Medicine
  • Brain Injury
  • Hospice/Palliative care
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9
Q

PA roles in rehab medicine (10)

A
  1. pre-admission evals
  2. H&Ps, consults
  3. IP care
  4. procedures - joint injections, trigger point injections, Botox…
  5. team conferences
  6. coordination of medical care
  7. discharge reconciliation plan
  8. precautions, restrictions, return to work, diet, f/u
  9. formal discharge instructions
  10. discharge summary
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10
Q

Big picture - PA role

A
  • EDUCATION: internal/external
  • program/team members
  • community
  • patient/caregiver
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11
Q

Rehab medicine is NOT…

A
  • addressing acquired “vice” and/or dependency
  • physical or specialty therapy provided on regular or recurrent basis for the remainder of one’s life
  • without engagement of caregivers / family-social support
  • a guarantee of returning to “life as before”
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12
Q

Rehab describes…

A
  • a variety of services across life spectrum in variety of settings/locations.
  • it is a team sport
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13
Q

Rehab is…

A

IP = inpatient
OP = outpatient
Home care
4 Life

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14
Q

Rehab program characteristics

A
  • specific criteria for each type of service
  • program specific = duration, location
  • can include IP, OP
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15
Q

Rehab programs can be in what facilities?

A
  • SNF - skilled nursing facility
  • “swing bed” units
  • nursing home
  • longer term care
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16
Q

What goes into the personalized plan of rehab?

A

Key is education and shared goals:

  • anatomy/physiology
  • prognosis and secondary medical complications
  • bowel/bladder
  • self-care and caregiver education
  • psychology of illness, new state of “health”, coping
  • sexuality, adjustments, conception
17
Q

Development of personalized journey

A
  • home modifications (doors wide enough for wheel chairs, living on the first floor, etc.)
  • equipment needs and safety in use
  • community resources
  • financial planning
  • emergency preparedness
  • recreation, leisure
18
Q

Certification is through…

A

CARF - commission on accreditation of rehab facilities (international)

TJC - the joint commission (USA)

19
Q

Functional Assessment Tools

A

CMS scores 0-100 (0 = no disability)
“Wellness” scale (100 = no disability)
FIM (Functional Independence Measure)***

20
Q

FIM Key – the language of function

A 
1 = TOTAL ASSIST
2 = MAXIMUM ASSIST 
3 = MODERATE ASSIST 
4 = MINIMUM ASSIST
5 = SUPERVISION
6 = MODIFIED INDEPENDENCE
7 = INDEPENDENT
21
Q

Why is the FIM score important?

A
  • initial screenings
  • admission
  • goals (met/not met) *** timeline for patients to get better
  • interim during ongoing care
  • discharge
  • f/u
22
Q

Common program specifics

A
  • vestibular
  • language / speech
  • pelvic floor
  • hand
  • dysphagia
  • cancer
  • pain
  • stroke
  • TBI
  • amputee/ spine / joint / trauma
  • spinal cord disease/ injury
23
Q

When does a diagnosis or decrease in “normal” warrant rehab?

A
  • history and discharge planning to next level of care starts at the first engagement
  • outpatients identified appropriate for IP or OP programs
  • after acute work-up if the pt is medically stable, then consider transfer/admission
24
Q

Things to identify in pt to consider rehab

A
  • functional deficit which can be potentially improved with rehab
  • recommendations based on cognition and tolerance for rehab
  • pt/caregiver demonstrates ability and willingness to participate
25
Q

What are the goals for stroke rehab?

A

Goals may be:

  • return to home
  • mobility increased
  • ADLs maximized
  • caregiver burden reduced
  • placement
26
Q

Rehab considerations for Parkinson’s pts

A
  • gait, balance
  • swallowing
  • memory Aid
  • DME/ AE
  • MSK pain
  • fall risk
27
Q

TBI (traumatic bran injury) causes and etiology

A

-penetrating, closed head injury, repetitive injury

Etiology:

  • sports
  • military
  • unfortunate accidents, risk taking behavior
  • medical
28
Q

Rehab considerations for TBI pts

A
  • mood, behavior
  • scheduled environment
  • caregiver education
  • cognitive “reprogramming”
  • associated health (ex: chronic headache)
29
Q

Movement “robbing” disorders

A
  • MS
  • cerebral palsy
  • guillain barre
30
Q

Spinal cord disease/injury

A
  • myelopathy
  • infection, tumor
  • trauma
  • incomplete/complete
31
Q

Maximizing independence with technology in rehab

-mobility

A
  • crutches, canes, walkers
  • exoskeleton
  • power mobility (custom scooters)
32
Q

Maximizing independence with technology in rehab

-ADLs

A
  • electronic, voice control, pad control
  • bathroom, kitchen, driving
  • home/community
33
Q

Maximizing independence with technology in rehab

-others

A
  • amputee services
  • joint replacement, spine surgery
  • electronic stimulation
34
Q

When considering rehab - THINK

A 
T - toxic situation (CHF, shock, dehydration, deliriogenic meds, new organ failure)
H - hypoxemia
I - infection/sepsis (nosocomial)
N - nonpharmacological interventions
K - K+ or electrolyte problems
35
Q

DELIRIUM(S) mnemonic

A

D - drugs
E - eyes, ears, and other sensory deficits
L - low O2 states (e.g. heart attack, stroke, and pulmonary embolism)
I - infection
R - retention (of urine or stool)
I - ictal state
U - underhydration/undernutrition
M - metabolic causes (DM, post-op state, sodium abnormalities)
(S) - subdural hematoma

36
Q

Who has added risk for DVT?

A
  • recent serious injury, broken bone
  • recent surgery
  • active (think undiagnosed, too) cancer
  • inactivity (sitting/lying for long periods)
  • h/o prior blood clot
  • estrogens (OBC, et al)
  • over age 65
  • overweight
  • sitting during travel longer than 4 hours
37
Q

DVT prophylaxis options

A
  • diagnosis/clinical setting drives the duration of rx:
  • mobility/ambulation
  • SCD: sequential compression devise (cyclic compression leg sleeve around calf, typically used until mobile
  • injectable: heparin, LMWH
  • oral agents: aspirin, warfarin, “newer agents” (DTI- direct thrombin inhibitors, factor Xa inhibitors)
38
Q

Asking about end of life decisions…

A
  • should be part of your consult, history, at each engagement
  • document in your note
  • follow state and facility protocol for documentation

Neurology 2 (21 decks)

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