Neurorehabilitation Flashcards
What does this define?
- 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.
The 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.
What classification does impairment, activity limitations and restrictions to life participation come under?
the international classification of functioning, disability and health (ICF)
whaat does impairment, acitivty limitations and restrictions to life partificpation mean as part of the ICF (international classification of functioning, disability and health)?
- imapirment
- disorder of body structure or function e.g. anatomical or physiolgocial/pychological systems physiology
- e.g. L MCA infarct resultin in aphasia w/1 word utterances
- activity limitations
- problems carrying out tasks or acitivities
- e.g. unable to converse successfully with family
- restrictions to life participation
- problems participating in personally relevant aspects of life
- e.g. unable to fulfil role of supportive mother to 5y.o daughter
what are restorative vs comensatory techniques in neurorehab?
- Restorative - assumes impairment is reversible
- Compensatory - assumes impairment is irreversible
What techniques are used to prevent impairments from worsening?
- Passive range of movement
- Stretching
- Positioning to prevent contracture
What does physical therapy and other techniques aim to achieve within neurorehab?
reorginisation of cortical maps –> recovery
What LT complications can arise from chronic neuro conditions seen in neurorehab (that need to be prevented)?
Physical
- Spasticity
- Contractures
- neurogenic bladder and bowel dysfunction
- Aspiration / chest infections
- pressure sores
- DVT
Mental
- Pain
- Depression
What model of rehab is currently used?
Interdisciplinary model of rehab:
Interdisciplinary working involves a partnership between a team of health professionals and a client in a participatory, collaborative and coordinated approach to share decision making around health issues
How do you write a problems list in neurorehab?
you use the ICF by looking at
- what impairments they have,
- the acitivies they require assistance for/are unable to manage and
- the participation thay are unable to do/require assistance with
What is spascticity?
a velocity dependent increase in muscle tone
- results from the disruption of the descending inhibitory modulation of alpha motor neurones
- TF –> hyper excitability + abnormal processing of sensory input from affected muscles and their stretch receptors
- a.g. the affected muscles sensory input is abnormal (stretch receptors) & the alpha motor neurones normal inhibitory modulation is disrupted –> spasticity
what scale measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity?
the Modified Ashworth scale
What complications can spasticity lead to?
- Muscle shortening
- Contractures
- Functional limitations due to limb deformity mechanics
- Associated spams & pain
- Pressure sores
- Low mood
- Baclofen
- Tizanidine
- Dantrolene
- Benzodiazepines
- Gabapentin
- Cannabinoids
Are all what?
Anti-spastic medications
Which anti-spastic drug is this?
- Centrally acting antagonist that binds to GABA B receptors
- May cause nausea, drowsiness, deranged liver function
- Most commonly used and effective
Baclofen
Which anti-spastic agent is this?
Has some anti-spastic properties and my be used as a single agent to treat neuropathic pain and spasticity
gabapentin
Which anti-spastic agent is this?
- Centrally acting antagonist to GABA A receptors
- Causes sedation so much more useful at night than in the daytime
benzodiazepine
Which anti-spastic agent is this?
- Suppresses calcium release from sarcoplasmic receptors therefore reducing the force of muscle contractions
- May cause fatal hepatitis
- Generally considered to be not as well-tolerated as baclofen
Dantrolene
Which anti-spastic agent is this?
- Centrally acting agonist action at alpha-2 adrenergic receptor sites
- May cause sedation, visual hallucinations and deranged liver function
- Generally considered to be not as well tolerated as baclofen
Tizanidine
Which anti-spastic medication does this describe?
Nasal spray licensed for use in multiple sclerosis in patients suffering painful spasms
cannabinoids
What use does orthotics have in spasticity?
Splints may be required to maintain joint position
When may surgery be useful in spasciticty?
Surgical management may be required for
- contracture release and
- deformity correction
nerve blockade may be useful as a permanent method of reducing muscle activity in a group of muscles e.g. spasticity
- the susbtence is injected directly into nerves and denervation is caused by inflammation and subsequent fibrosis
- There was much concern about dysasthesia (unpleasant sensation felt when touched) in the affected nerve but this does not seem to occur in clinical practice
What substance is used?
Phenol
What method of anti-spasmotic delivery is Most commonly used for non-functioning lower limbs when oral medications are not tolerated or sufficient ?
intra-thecal baclofen (between arach & pia)
- Involves the insertion of an electronic pump into the abdominal wall
- which delivers baclofen to the cerebrospinal fluid
Generally well tolerated most complications being infection and bleeding at the catheter insertion site
- Test doses are required first
What injection blocks the release of Ach at the NMJ and tf prevents muscle contraction, making it useful for focal spasticity….?
Botulinum toxin A!
- however limited dose per procedure and number of injections per year
- repeat injections maybe required
- Peak effects at 3-4 weeks post injection with lasting effects up until 3-4 months
- Very well-tolerated
- rarely serial use may result in antibody formation
