Lecture 41 Rehabilitation in Neurology Flashcards
Conceptual Definition of Rehabilitation
• A process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function.
Service Definition of Rehabilitation
• The use of all means to minimise the impact of disabling conditions and to assist people with activity limitation to achieve their desired level of autonomy and participation in society.
Who might need rehabilitation
- Acquired brain injury
- Spinal cord injury
- Stroke
- Epilepsy
- Early multiple sclerosis (relapses and remissions)
- Post-polio syndrome
- Cerebral palsy in adults
- Spina bifida in adolescence/adults
- Motor Neurone Disease
- Parkinson’s disease
- Progressive Multiple Sclerosis (primary or secondary)
- Guillain Barre Syndrome
- Muscle diseases (myopathies and muscular dystrophies)
- e.g. myotonic dystrophy
- Hereditary spastic paraparesis
- Fascio-Scapular-Humeral Dystrophy
- Huntington’s disease
Names types of acquired Brain injury
- Head injury (traumatic brain injury)- Coup, Contrecoup, Shearing, twisting
- Haemorrhagic (e.g. SAH)
- Hypoxic / Anoxic (e.g. out of hospital cardiac arrest)
- Metabolic (e.g. hypoglycaemic)
- Infective (meningitis, encephalitis)
Using GCS and PTA define severe head injury
- GCS 3-8
* PTA 1-7 days (Post Traumatic Amnesia)
Using GCS and PTA define moderate head injury
- GCS 9-12
* PTA 1-24 hours
Using GCS and PTA define mild head injury
- GCS 13-15
* PTA less than 1 hour
Define Impairment
- Any loss or abnormality of physiological, psychological or anatomical structure or function (1980)
- Problems in body function or structure such as a significant deviation or loss (2002)
Physical impairments from neurological conditions
• Weakness (hemiparesis/paraparesis) • Loss of / abnormal sensation • Increased or decreased tone / spasticity • Autonomic dysfunction o Bladder instability o Bowel disturbance o Difficulty in bowel and bladder sensation and recognition • Swallowing and communication difficulties • Pain Syndrome o Somatic o Neuropathic • Seizures • Neuroendocrine disturbance • Physical fatigue
Name cognitive impairments after brain injury
• Post-traumatic amnesia • Confusion / disorientation o Time, Place, Person • Severe memory problems o Recall of recent events o Working Memory • Poor concentration/ attention • Slowed thinking and mental fatigue • Poor executive function, planning, reaction to changing events • Impaired reasoning and problem solving
Name other cerebral function impairments
• Dyspraxia and Perceptual Difficulties • Dysphasia o Expressive o Receptive o Impaired language skills • Visual cortical difficulties o Hemianopia / Quadrantanopia • Loss of hearing • Loss of smell and taste
Psychiatric/Behavioural Impairments after Brain Injury
• Depression • Anxiety • Personality change • Irritability • “Childishness, selfishness, laziness” • Behavioural problems o Aggression o Disinhibition o Apathy • Anhedonia- inability to feel pleasure in normally pleasurable activities
Secondary complications of Lon-term neurological conditions
- Pressure sores
- Infections
- Urine, Chest
- Falls and other secondary injury
- Deep venous thrombosis
- Malnutrition
- Constipation
- Pain and Spasticity
- Contractures
- Low morale and depression
- Social complications- relationship and family breakdown, childcare issues, unemployment, social isolation
Define Limitation
- Any restriction or lack of activity to perform an activity in the manner or in the range considered normal for people of the same age, sex and culture (1980).
- Difficulties an individual may have in executing activities (2002)
What activities may be listed through a long term neurological conditions
• Mobility o Outdoor mobility • Manual abilities o Fine motor skills • Thinking and Planning • Reading and Comprehension • Speaking • Nonverbal communication • Feeding self • Continence and hygiene • Personal care • Activities of Daily living o Food preparation o Driving o Housework • Self-medicating
