Clin Med - NeuroRehab Flashcards
1
Q
When was rehab medicine formally recognized by the AMA?
A
1920s
Physical therapy = physical medicine
2
Q
Where was the first academic physical medicine department?
A
Temple
3
Q
When did physical therapy become a medical subspecialty
A
1930s
Focus on rehab of the disabled
Mayo - residency in “physical medicine”
4
Q
Who is one of the founding fathers of active rehab?
A
Howard Rusk , MD
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)
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
7
Q
PM&R focuses on…
A
maximizing recovery
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
9
Q
PA roles in rehab medicine (10)
A
- pre-admission evals
- H&Ps, consults
- IP care
- procedures - joint injections, trigger point injections, Botox…
- team conferences
- coordination of medical care
- discharge reconciliation plan
- precautions, restrictions, return to work, diet, f/u
- formal discharge instructions
- discharge summary
10
Q
Big picture - PA role
A
- EDUCATION: internal/external
- program/team members
- community
- patient/caregiver
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”
12
Q
Rehab describes…
A
- a variety of services across life spectrum in variety of settings/locations.
- it is a team sport
13
Q
Rehab is…
A
IP = inpatient
OP = outpatient
Home care
4 Life
14
Q
Rehab program characteristics
A
- specific criteria for each type of service
- program specific = duration, location
- can include IP, OP
15
Q
Rehab programs can be in what facilities?
A
- SNF - skilled nursing facility
- “swing bed” units
- nursing home
- longer term care
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
What are the goals for stroke rehab?
Goals may be:
- return to home
- mobility increased
- ADLs maximized
- caregiver burden reduced
- placement
26
Rehab considerations for Parkinson's pts
- gait, balance
- swallowing
- memory Aid
- DME/ AE
- MSK pain
- fall risk
27
TBI (traumatic bran injury) causes and etiology
-penetrating, closed head injury, repetitive injury
Etiology:
- sports
- military
- unfortunate accidents, risk taking behavior
- medical
28
Rehab considerations for TBI pts
- mood, behavior
- scheduled environment
- caregiver education
- cognitive “reprogramming”
- associated health (ex: chronic headache)
29
Movement "robbing" disorders
- MS
- cerebral palsy
- guillain barre
30
Spinal cord disease/injury
- myelopathy
- infection, tumor
- trauma
- incomplete/complete
31
Maximizing independence with technology in rehab
| -mobility
- crutches, canes, walkers
- exoskeleton
- power mobility (custom scooters)
32
Maximizing independence with technology in rehab
| -ADLs
- electronic, voice control, pad control
- bathroom, kitchen, driving
- home/community
33
Maximizing independence with technology in rehab
| -others
- amputee services
- joint replacement, spine surgery
- electronic stimulation
34
When considering rehab - THINK
```
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
DELIRIUM(S) mnemonic
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
Who has added risk for DVT?
- 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
DVT prophylaxis options
* 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
Asking about end of life decisions...
- should be part of your consult, history, at each engagement
- document in your note
- follow state and facility protocol for documentation
