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Geriatrics 1 > Physical Medicine & Rehabilitation > Flashcards

Physical Medicine & Rehabilitation Flashcards

1
Q

WHO ICF (international classification of functioning, disability, & health) defines rehabilitation as

A

The ability of an individual to participate in “living”

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2
Q

Medical diagnosis vs. rehabilitation diagnosis

A

Medical -> focus on disease process (e.g. 65 yo w/ stroke)

Rehabilitation -> focus on functional consequences of disease (e.g. unable to walk)

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3
Q

Functional assessment requires an understanding of

A
  • Disease
  • Impairment
  • Disability
  • Handicap
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4
Q

Impairment definition

A

Any loss or abnormality of psychological, physical, or anatomical structure or function (e.g. lower extremity paralysis)

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5
Q

Disability definition

A

Any restrictions or lack of an ability to perform an activity in the manner or range considered normal for a human being (e.g. inability to operate foot pedals in vehicle)

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6
Q

Handicap definition

A

A disadvantage for a given individual that limits or prevents the fulfillment of a role that is normal for that person - depending on age, sex, social and cultural factors (e.g. pt. can’t drive for his job)

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7
Q

Sites of rehabilitative care - inpatient

A

Rehab hospital, SNF

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8
Q

Sites of rehabilitative care - outpatient

A

Hospital-based clinic, independent clinic, day hospital, home

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9
Q

Who is admitted for inpatient rehab?

A

Must have at least one of 13 conditions (e.g. neurologic, MSK, etc.)
Must receive 3 hours of therapy 5d/wk

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10
Q

All pt. in inpatient rehab must….

A

Have 24h availability of a physician with expertise in rehabilitation & nursing care
Be managed by an interdisciplinary team of skilled nurses & therapists
Have a reasonable expectation if improvement

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11
Q

SNF

A

24h nursing care
Dietary, pharm, dental, social services
Supervised by a physician
Goal: maintain function

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12
Q

How often should services be prescribed & recertified by a physician for home-based care?

A

60 days

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13
Q

Who is eligible for home-based services

A

Pt. requires intermittent or part0time skilled nursing care/therapy (<7 days per week or <8 hours per day)
Pt. is homebound (considerable effort to leave their home)

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14
Q

Medicare coverage for SNF

A

Per diem rates regardless of problem

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15
Q

Medicare coverage for home-based care

A

Rates based in OASIS (outcome & assessment information set)
- Lengthy assessment for reimbursement

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16
Q

What providers should consider choosing site of care

A
  • Severity of impairments
  • Functional status, ability to withstand active therapy
  • Social support, need for full-time caregiver
  • Insurance plan
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17
Q

Goal of interdisciplinary team management

A

Ensure pt receives comprehensive assessments & interventions for

  • The disabling illness and comorbid conditions
  • The specific impairments and environmental factors that may affect activities and participation
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18
Q

Impact of cormorbid conditions on rehabilitative care

A
  • Interrupt ot delay tx

- Require adaptations in the care plan

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19
Q

Reducing the impact of comorbidities: Delirium

A
  • Screen for toxic or metabolic contributors (e.g. meds, electrolyte disturbance)
  • Sensory aids
  • Planned reassessment for improvement if confusion limits rehabilitation potential
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20
Q

Reducing the impact of comorbidities: DVT, PE

A
  • Mobilization
  • Compression stockings
  • Warfarin or LMWH
  • Intermittent pneumatic compression
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21
Q

Reducing the impact of comorbidities: Depression, apathy

A
  • Screening for depression

- Medication, counseling, support group

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22
Q

Reducing the impact of comorbidities: Kidney or bladder infection

A
  • Avoidance, removal of indwelling catheter
  • Check of postvoid residual
  • Frequent toileting
  • Prophylactic abx RARELY helpful
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23
Q

Reducing the impact of comorbidities: PNA

A
  • Mobilization
  • Tx of COPD prn
  • Flu & penumococcal vaccine
  • IS
  • Screening, precautions for aspiration risk
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24
Q

Reducing the impact of comorbidities: Skin breakdown

A
  • Mobilization & positioning
  • Monitor pressure & wt.-bearing areas
  • Pressure-relieving mattresses, cushions
  • Early care with dressings
25
Q

Goals of rehabilitation

A
  • Restore function
  • Compensate for & adapt to functional losses
  • Prevent secondary complications
  • Maximize potential for participation in social, leisure, or work roles
26
Q

Examples of rehab interventions

A
  • Therapeutic exercises (flexibility, strength, motor control, CV endurance)
  • Speech & language therapy
  • Cognitive rehab
  • Pain mgmt
  • Fitting of mobility aids, orthotics, prosthetics
  • Practice of task-specific activities (e.g. transfers)
  • Retraining activities (e.g. grip)
  • Balance training
  • Retraining in ADLs (e.g. cooking)
  • Massage, heat, cold, US to decrease pain & muscle spasm
27
Q

What is the Harris Hip Score?

A

Measures outcomes after hip surgery

28
Q

People >__years are at highest risk for morbidity & mortality from stroke

A

55

29
Q

> __% are likely to survive from a stroke, but with many neurological deficits

A

80

30
Q

Stroke-related deficits are severe in about ___% of survivors

A

33

31
Q

Recovery is most dramatic in the first ___ days post-stroke

A

30

32
Q

Stroke severity should be assessed using the

A

NIHSS

33
Q

After hip fx, __% of pt. require transient long-term care, and about __% of those remain in long-term care 1 year later

A

50; 25

34
Q

__% mortality in the year following hip fx

A

25

35
Q

After hip fx, __% recover to prior level of function, but up to __% require assistive devices

A

75; 50

36
Q

Two key factors to hip fx rehab

A
  • Early mobilization

- Frequent initial therapy

37
Q

Acute rehabilitation after hospital D/C results in….

A

Results in superior outcomes

38
Q

Preventing recurrent hip fx

A
  • Diagnose & tx osteoporosis, balance problems
  • Encourage safety awareness
  • Assistive devices prn
  • Consider calcium, vitamin D supplementation
39
Q

What is the most common elective procedure in the US?

A

Joint arthroplasty

- Provides pain relief & improved functioning!

40
Q

Most common reason for failure of joint arthroplasty

A

Implant loosening

41
Q

Rehab after total hip arthroplasty (modifications, goal)

A
  • Avoid bending over to tie shoes, crossing legs
  • Raised toilet seat during rehab period
  • Rehab focus: muscle strengthening (esp. abductors)
42
Q

Rehab after total knee arthroplasty (modifications, goal)

A
  • Key to return of fcn -> recovery of ROM
  • Continuous passive motion machine (CPM) + PT -> increases ROM, decreases length of stay
  • Compression stockings, CPM, cryotherapy to reduce swelling
43
Q

How do you use a cane

A

In hand contralateral to affected limb (reduces wt. bearing on opposite leg)

44
Q

What is the most important factor for stability with the use of a cane

A

Proper length (distance from distal wrist crease to the ground in erect pt.)

45
Q

Two types of canes:

A

Straight, quad

46
Q

Purpose of a walker

A

Completely support one lower extremity (NOT full body wt.)

47
Q

Two types of walkers:

A

Stationary “pick-up”, wheeled/rolling/rollator

48
Q

Use of pick-up walker requires

A

Strength + cognitive ability

49
Q

Benefit of pick-up walker

A

Very stable, allows for non-weight bearing movements

50
Q

Benefit of wheeled walkers

A

Allow smoother, more coordinated, faster gait

51
Q

Which type of walker provides more stability?

A

Pick-up

52
Q

Which type of walker is easier to advance?

A

Wheeled

53
Q

Who uses wheelchairs & scooters?

A

Patients who cannot safely use or are unable to ambulate with other mobility aids

54
Q

Motorized wheelchairs are good for these two populations

A
  • Bilateral arm weakness (lack ability to operate wheelchair)
  • Severe cardiopulm disease (lack endurance)
55
Q

Purpose of orthotics

A

Designed to assist, resist, align and stimulate function

56
Q

How are orthotics named

A

By the use of letters for each joint involved

e.g. AFO = ankle & foot orthotic device

57
Q

Adaptations to facilitate dressing

A
  • Shirts that fit overhead
  • Hooks, loops, velcro
  • Long, loose socks
  • Long-handled shoehorn (the fuuuuu is this)
  • Elastic shoelaces
58
Q

Environmental modifications

A
  • Assistive devices (e.g. reachers)
  • Bars installed near tub/shower, toilet
  • Raised toilet seat, bathtub bench
  • Long-handled bath brushes, hand-held shower faucet, & “soap on a rope”

Geriatrics 1 (8 decks)

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