Principles of Neurorehabilitation

Question 1

Neurology has an undeserved reputation for being a specialty where _______ requires great intellectual effort, although from which little ____________________________________.
Explain this.

Answer 1

Diagnosis.
therapeutic intervention flows.

We figure out whats wrong with them but not so much how to fix them.

Question 2

Name the widely used classification system by WHO.

Answer 2

International classification of Functioning Disability and Health.

Question 3

What is the WHO ICFDH used for?

Answer 3

it is used to describe the facets of human functioning that may be affected by a health condition.

Question 4

Name the 3 domains of the ICFDH.

Answer 4

Body Function and structures
activities
participation

Question 5

What allows us to put a label on what the patient is experiencing?

Answer 5

the International Classification of Functioning Disability and Health.

Question 6

Define Impairment.

Answer 6

Any loss of psychological, physiological or anatomical structure or function.

Question 7

Any RESTRICTION or LACK OF ABILITY to perform an ACTIVITY (resulting from an impairment) within the range considered normal for a human being. - Name this.

Answer 7

Disability.

Question 8

Define Handicap.

Answer 8

A disadvantage for a given individual (resulting from a disability) that limits or prevents the fulfillment of a role that’s normal.

Question 9

Name two competing view/models.

Answer 9

Medical model vs. Social model.

Question 10

Summarise the medical model.

Answer 10

• Disability is a disease state located within an individual
• Requires treatment or cure
• regarded as inferior to able bodies person
• Health care professionals assume the dominant decision making role.

Question 11

Summarise the social model.

Answer 11

• A persons’s impairment isn’t the cause of restriction of activity- its actually the organisation of society
• society discriminates against disabled people
• Attitudinal, economic and architectural barriers are equally if not more important than health barriers.

Question 12

Neurological Rehabilitation is a ______ of approaches.

Answer 12

synthesis.

Question 13

Name the 3 approaches of neurological rehabilitation.

Answer 13

Selection
Optimisation
Compensation

Question 14

Define Selection.

Answer 14

Can the disability be reduced and therefore increased?

Question 15

Define Optimisation.

Answer 15

regardless of whether disability can be reduced or not, can the individual acquire new skills and strategies to increase participation?

Question 16

Define Compensation.

Answer 16

Can the environment be changed both physically or socially so that the effects of disability are minimised?

Question 17

Name the principles of the rehabilitation process.

Answer 17

Assessment
Goal Setting
Intervention
Review

Question 18

Monophasic impairment, ______ _______ expected.

Answer 18

Full recovery

Question 19

Non-progressive impairment, ______ ________ or ______ ________ expected.

Answer 19

Substantial improvement

Full recovery

Question 20

Non-progressive impairment with full recovery unlikely, ______ __________ is anticipated.

Answer 20

Some improvement

Question 21

For _______ ________ _________ recovery isn’t really expected/ very slight improvements possibly.

Answer 21

Progressive neuro-degenerative conditions

Question 22

Why are psychological factors important in rehabilitation?

Answer 22

Psychologically they may be really affected by their injury/condition/diagnosis
We must appreciate this
We can spend some time counselling them
Make sure not to overwhelm them etc.
They may not be feeling up to much therapy that day etc.

Question 23

What are the kinds of psychological responses to injury are there?

Answer 23

Cognitive Response
Emotional Response
Behavioural Response

Question 24

What factors can affect responses to an injury?

Answer 24

Personality type (are they resilient, optimistic etc.)
Coping resources (do they focus on problem? or how to fix it?)
History (has it happened before)
Intervention (do they believe intervention will work).

Question 25

What happens if a patient doesn’t believe intervention will work?

Answer 25

Then it probably won’t work!

Question 26

The cognitive response is what the patient is ______ about. Name some examples.

Answer 26

Thinking.

Perceived injury severity
Their expectations for rehabilitation process
Treatment effiacy
Risk of return
Missed opportunities.

Question 27

What is often a problem with people’s expectations for rehab?

Answer 27

They set their expectations too high, they think that they can return back to normal.

Question 28

_____ disturbances are common after physical injuries.

Answer 28

Emotional.

Question 29

Name the 5 step emotional response that Kulbler-Ross (1969) suggested.

Answer 29

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance and re-organisation

Question 30

Give an example of each step in the grief reaction.

Answer 30

1. denial - its fine
2. anger - its not fair
3. bargaining - if i do X will i get better
4. depression - reality hits- v. sad, changes view of world
5. acceptance and re-organisation- accept new reality and find new ways of coping.

Question 31

The emotional response often follows the ______ reaction.

Answer 31

grief.

Question 32

Through goal setting what do we aim to do?

Answer 32

Increase confidence and motivation.

Question 33

Who is it important to include when setting goals and why?

Answer 33

It’s important for the patient to be actively involved in setting both long and short term goal.
This gives them a sense of control, facilitates motivation, persistence and commitment.

Question 34

Goals should be _________.

Answer 34

SMARTER

Question 35

What doe SMARTER goals stand for?

Answer 35

Specific
Measurable
Achievable
Realistic
Time based
Evaluated 
Recorded

Question 36

Why does goal setting work?

Answer 36

• Directs attention on specific tasks
• Increases effort and intensity
• Encourages persistence in the face of failure and adversity
• Promotes the development of new task or problem-solving strategies
• Stops unrealistic goals being set! (people always overestimate what they want to achieve)

Question 37

What is the last stage in the rehabilitation process principles?

Answer 37

Review.

Question 38

Why is it important to review?

Answer 38

• patients don’t have the same understanding as we do
• situations can change
• emphasis may shift eg. patient priorities might change

Question 39

It is important to ask how the patient is ________.

Answer 39

Feeling.