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Geriatrics > Rehab Intro + SCI > Flashcards

Rehab Intro + SCI Flashcards

1
Q

What is rehabilitation?

A

Process of returning a person to maximal physical, psychological, social and vocational functions with their physiologic or anatomic impairment, environmental limitations and desires or life plans.

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2
Q

What is the role of rehabilitation medicine?

A

Delivers medical management and multidisciplinary therapy to address impairments, limitation in ADLs (disability) and participation restrictions in the person’s social role (handicap)

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3
Q

How does medical model view disability?

A

Problem of the person, caused by disease / trauma / health condition which requires medical care in treatment by professionals.

  • Mx aimed at cure or individual’s adjustment of behaviour if cure not possible
  • medical care viewed as main issue
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4
Q

What is the social model of disability?

A
  • Main issue is socially created problem and matter of fully integrating individual within society
  • Disability attribute of social environment not individual
  • Solution = environmental modifications required for full participation of people with disabilities
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5
Q

What is the FIM score?

A

Functional Independence Measure: preferred tool in rehab settings. More sensitive development of Barthel scale (adds communication, social behaviour, memory and problem solving to basic domains assessed by Barthel).

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6
Q

What is ICF?

A

International Classification of Functioning, Disability and Health.
Framework for conceptualisation, classification and measurement of disablity.

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7
Q

What are impairments?

A

Problems in body function or structure such as significant deviation or loss

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8
Q

What are activity limitations?

A
  • Activity = execution of task or action by an individual

- Activity limitation = difficulties an individual may experience executing activities

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9
Q

What are participation restrictions?

A
  • Participation = involvement in a life situation

- Participation restrictions = problems an individual may experience in involvement in life situations

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10
Q

What are environment factors in the context of rehab?

A

Physical, social, attitudinal environment in which people live and conduct their lives. Either barriers to or facilitators of the person’s functioning

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11
Q

Example of impairment without limitation?

A

Disfigurement in leprosy has no effect on person’s capacity

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12
Q

Performance and activity limitation without evident physical impairment?

A

Reduced performance in ADLs associated with many diseases

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13
Q

Example of Participation restrictions without impairments or activity limitations

A

e.g. HIV +ve person, ex-patient recovered from mental illness; may face stigma or discrimination

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14
Q

Activity limitations without assistance but no performance problems in current environment - example?

A

an individual with mobility limitations may be provided assistive technology by society to move around

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15
Q

What are the criteria for suitability for a rehab program?

A
  • Medical stability i.e. pt with untreated CHF cannot participate in exercise program
  • Reasonable cognition, or expectation that cognition will improve
  • Motivation to attend therapy and participate
  • Expectation that program will result in performance gains within a reasonable amount of time
  • Availability of supportive family / carers
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16
Q

What are the considerations in starting rehab?

A
  • Who - appropriate v inappropriate
  • What: intensity, content
  • When: early intervention v post acute
  • Where: inpatient, OP, home based, proximity to home, centre of excellence
  • Why: realistic expectations (pt and family)
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17
Q

Group most affected by traumatic spinal cord injury?

A

Males (80%); 15-30y.

Small peak age 65+

18
Q

Major cause of spinal cord injury?

A

Road traffic accidents

19
Q

Aim of early management of traumatic spinal cord injury?

A

-Preventing secondary cord damage OR preventing cord damage at all in those with vert # w/o cord damage

20
Q

Where and why are pts with spinal cord damage best managed?

A
  • Specialised acute comprehensive spinal cord service

- Minimise complications e.g. respiratory, bladder, bowel and skin problems

21
Q

What must be addressed in rehab following spinal cord injury?

A
  • Psychosocial management
  • Bladder management
  • Skin care
  • Bowel care
  • Sexual function
  • Spasticity
  • Autonomic dysfunction
  • Pain
  • Gait
  • Respiratory function
22
Q

Psychosocial aspects of rehab following traumatic spinal cord injury?

A
  • Mx psychosocial distress
  • Review by psych and SW after admission
  • Restoration personal and social structures
23
Q

Bladder management SCI rehab?

A
  • Initially IDC / SPC (removed 3-6/52 post injury)
  • condom drainage reflex emptying (for some males)
  • intermittent self catheterisation
24
Q

What baseline tests should be undertaken in bladder management post SCI?

A
  • IVP
  • CUG
  • Most pts: video urodynamics
25
Q

Bladder Mx options for pts with LMN lesion?

A

Usually mobile and can void by increasing intra abdominal pressures:. If incontinent:

  • M: condom drainage
  • F: artificial external urethral sphincter and intermittent catheterisation
26
Q

What is required in pts with long term IDC or SPC?

A

Yearly cystoscopies after 10y of catheterisation.

27
Q

When does reflex bladder usually occur?

A

Injuries T12 or above

28
Q

When does flaccid bladder usually occur?

A

The flaccid bladder usually occurs below spinal cord injuries of T12 to L1, where the spinal cord injury is in the cauda equina area of the spinal cord.

29
Q

Why is skin care important in Mx SCI?

A
  • Pt has no awareness of need to relieve pressure on anaesthetic skin / cannot do so
  • W/o pressure relief, skin, S/C tissue and muscle become anoxic and die
  • Other skin problems from scolds, burns, grazes, shear stresses
30
Q

What must pt do post SCI regarding skin?

A

Twice daily skin checks using mirror to visualise areas not in direct sight

31
Q

How can UMN bowel be managed?

A

Reflexic; can be regulated with

  • good diet with high fibre content
  • adequate fluid intake
  • aperients and stool softeners
32
Q

When are aperients given?

A

~12h before bowel action intended

33
Q

What is the role of aperients in SCI UMN?

A

Stimulate bowel function to remove colonic contents into the rectum

34
Q

How can the patient stimulate rectal emptying (SCI, UMN)?

A

-Increasing intra abdominal pressure
-gentle digital dilation of sphincter
-+/- suppository
~12h after using aperient

35
Q

LMN SCI bowel management?

A
  • Empty bowel with abdominal pressure

- To prevent incontinence when rising from chair / car etc, may have colostomy

36
Q

What are reflex spasms in SCI?

A
  • Reflex spasticity often presents as spasms precipitated by movement after being in one position too long
  • Hypertonia may precipitate formation of contractures
37
Q

How is spasticity managed in SCI?

A
  • Movement of joints and stretching of muscles to full length
  • Treat irritatants (e. UTI) that might precipitate spasticity
  • When no precipitant and full stretches as often as practical, consider Rx baclofen +/- diazepam
38
Q

Which patients are disposed to autonomic dysfunction?

A

High spinal cord injury patients predisposed to unstable BP, esp above T6 lesion

39
Q

What is autonomic dysreflexia?

A

Massive rise in BP in SCI pts with autonomic dysfunction. Occurs when noxious stimuli applied below level of injury. Medical emergency

40
Q

Aids for low spinal cord / incomplete SCI patients?

A

Aids e.g. Ankle Foot Orthosis (AFO) or Knee Ankle Foot Orthosis (KAFO)

41
Q

Return to work post SCI?

A
  • Aided by OT and SW
  • Aim to return to same position or different position with same company
  • Some may require retraining
42
Q

What are major late complications of SCI?

A
  • Severe osteoporosis. Not uncommon to break a long bone with relatively minor trauma.
  • Post traumatic syrinx: SC may heal with small cyst. 2% cases expand, cause further neuro damage. Emergency.

Geriatrics (15 decks)

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