rehab questions Flashcards by mel k

The four main fields of health sciences

1) Prevention
2) Treatment
3) Rehabilitation
4) Chronic care

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Definition of rehabilitation

Rehabilitation is an organised service provided by the society to the disabled persons so that they could take their place in the society again.

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Components of the comprehensive rehabilitation

Medical, Education, Vocational and Social
measurements. In a purposeful, comprehensive personalized way.
The active participation of the
disabled person in this process is essential.

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Definition and most frequent types of disability

Disability is a condition when sensory,
locomotor, mental, communicative abilities of a person do not meet the average of the society, and it
results in activity limitations and participation restrictions. Types: Vision, movement,
hearing, thinking, remembering, learning, communicating, mental health, social relationships.

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What are the main differences between acute care and rehabilitation?

Acute care has a shorter
time, passive patient, mostly done to save a patient’s life, Done in stroke unit, ED etc. Rehabilitation is
longer, for active patients and to improve quality of life- done in rehab centers

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What does functional approach mean?

A certain condition can be caused by several reasons
For us the condition is Important not the reason
Eg. Hemiparesis : Stroke, brain trauma , tumor, Ms

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Teamwork in rehabilitation

MD, psych, social worker,
physiotherapist, occupational therapist, orthopaedic technician, music therapist, speech therapist,
relatives, nurse.

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Types of rehabilitation depending on their timely implementation

Acute at the active care e.g. Stroke centre, traumatology dept.
Post-acute- rehabilitation centres
Rehabilitation in chronic conditions- rheumatology

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Criteria of admission to a rehabilitation programme

Is there any indication to start rehabilitation
is the rehabilitation program performable
what is the current status
what is the (achievable) goal
what are the achievements

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What is functioning and disability and how it can be influenced?

Functioning is an umbrella
term for the integrity of body functions and structures including the realisation of activities and social
participation. Disability is those who have long term physical, mental, intellectual or sensory
impairments which in interaction with various barriers may hinder their full and effective participation
in society on an equal basis with others.

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When is a rehabilitation assessment is needed, what are its goals, and who is doing it?

a patient has a disability that affects the quality of life and its self care. The gaol is to incorporate the
patient into society again, improve activity and diminish the physical limitations and reduce
environmental obstacles for the patient. Rehabilitation centers, multidisciplinary team.

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Levels of mobility and mobilization

FAC functional ambulation category: independent(1) - non functional (5)
Barthel index: rating pt’s 10 ability of daily activity
International Classification of functioning, disability and health

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What do we examine during rehabilitation assessment besides body structures?

Case history (anamnesis)- general, rehabilitation specific, social environment
Clinical (physical, instrumental) examination: medical (internal) status, nutritional status, physical fitness, heart fitness, musculoskeletal , neurological status, mental status (disease insight, cooperation, motivation)
Functional status: mobility level, independence measure (eating, clothing, toileting), impaired functions
Quality of life

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Methods for measuring muscle strength

British medical research council 0-5
0 – no muscular contraction
1 – muscular contraction present, no active movement
2 – active movement only by eliminating gravity
3 – active movement against gravity
4 – active movement against resistance, but weaker than expected (than the intact muscle)
5 – normal strength

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What is ICF and what do we use it for

International classification of functioning, disability and

health is a framework for describing and organising information on functioning and disability.

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What do we mean by self care in rehabilitation medicine? What factors are we looking at?

Activities of daily living- Bathing, ambulation, toileting, transfers, eating, dressing Eating
Working (financial care )
Family life Social activity
leisure

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What do we mean by social participation?

Family
Workplace - earning money 
Sexual activities
learning activities 
Interaction with other people

What kind of factors affect disability?

Dynamic interaction btw health condition of the Patient and both Personal and environmental
factors ( Age motivation - Personal factors )

What do we mean by quality of life?

Consist of broad concepts that affect global life satisfaction, good health , adequate housing,
employment , personal and family safety , interpersonal relationships, education and leisure pursuits
In relation to health care: the term is applied specifically to those life concerns affected by Illness/
health

What are the most common places for pressure ulcers (bedsores, decubitus ulcers)

Localized areas of damage to the skin and / or soft tissue usually over a bony prominence as a result of pressure / Pressure In Combination With Shear.
Eg : Sacrum Calcaneus Ischium
Lesions are related to Immobility ( bed bound /Chair bound in d.)

Most common consequences of a spinal cord injury

Flaccid areflexic paralysis - paraplegia, tetraplegia, areflexia, bilateral diaphragm paralysis.
Autonomic dysfunction: neurogenic shock, loss of bladder control, loss of bowel control, absent bulbocavernosus reflex priaprism may occur.

Alternatives for urethral catheterization

Intermittant catheterisation, bedside bladder US,

external condom catheters, suprapubic catheters

Methods of thrombosis prophylaxis

Mechanical methods- intermittent pneumatic compression, graduated compression stockings, venous foot pump
Pharmacological therapy- LMWH/fondaparinux, oral agents (warfarin, DOAC)

What is monoparesis, hemiparesis, paraparesis, tetraparesis/plegia

 Mono- one limb motor insufficiency
 Hemi- one side (arm and leg) motor insufficiency
 Para- both arms/legs motor insufficiency
 Tetra- all 4 limbs paralysis

What are the differences between a standard and an active wheelchair?

Active wheelchair is desigened to be an extension of the body ( for good upper body + trunk strength). It is also lighter than the st.manual wheelchair. Set up to allow an energy efficient drive- can go further and faster.

Most common causes of spinal cord injury

motor vehicle accidents, falls, violence, sport accidents, other causes

What is occupational therapy (ergotherapy)

Focuses on fine motor skill activities to develop, | recover/maintain meaningful activities.

What are orthoses? What are their characteristics?

Correction, fixing, supporting, off loading, limiting range of motion, repairing/improving function of remaining body part. Application is temporary/permanent. Traditional substances: steel,aluminium, leather, wood. Up to date substances: special metal alloys, carbon , fiberglass

What are prostheses? What are their characteristics?

Prostheses are amputated limbs or other body parts replacement devices. LL: standing, walking, UL: manipulation, tactile. Low vs high dynamic prostheses Consists of a socket and prefabricated component.

What are the different types of rehabilitation services?

Basic rehabilitation, Traumatic brain injury + spinal cord, pulmonological rehabilitation , cardiac rehabilitation, children rehabilitation.

What characterizes proper rehabilitation care and what conditions are necessary for it?

Rehabilitation center with proper facilities  Trianed and professional rehabilitation team  Copperating patient  Family support  Targeted rehabilitation plan  Proper follow up

Consequences of stroke

``` lack of motivation, mental slowness cognitive disorders hemineglect praxis disorder speech disorder emotional and behavioral disorder ```

Why do we have to rehabilitate someone after stroke?

To help the spontaneous recovery, adaptation to the disability, reach the max possible independence, prevent secondary complications and improve quality of life.

What are secondary complications, and how do we prevent them?

Contractures, pressure ulcers, infections. Integrating a multidisciplinary mobility program in the acute care setting and hospital length of stay can help prevent them

Team members involved in stroke rehabilitation and their task

Patient, nurse, physiotherapist + assistant, ergotherapist, conductor, doctor, psychologist, speech rhythm therapist, social worker, orthopaedic technician, caring family member

What are the characteristics of an arthrosis, and what kind of functional limitations do they cause?

degeneration , degradation and then destruction of articular cartilage, accompanied by inflammatory processes Causing : Painful joint stiffness , local inflammation difficulty moving, dysfunction Standing ability decreases, walking speed and distance decreases, dexterity deteriorates, sleep disorder (night pain).

What is the importance and the task of rehabilitation in arthrosis?

 Pain relief-  Physiotherapy program  Toolbar of physiotherapy- wraps, cryotherapy, thermotherapy  Education- teaching energy saving movements, pain management, diet  Rehabilitation surgeries in arthrosis

What is mono-, poly- and multitrauma? What are their rehabilitation needs?

 Monotrauma: injury to one body region Rehabilitation when : multi morbidity, disabled Pt . complications  Multitrauma: injury to more than one body region without SIRS Often recommended rehabilitation  Polytrauma: Life threatening. Injury to at least two body region with the presence of SIRS. Obligatory rehabilitation SIRS= systemic inflammatory response syndrome

Musculoskeletal complications in a polytraumatized patient

```  Muscle atrophy  Contracture  Refracture  Delayed union and non-union fracture (pseudoarthrosis)  Mechanincal complications  Algoneuro dystrophia  Sceptical complications. ```

How is the rehabilitation of a total hip arthroplasty and a fractured hip different?

Rehabilitation principles are similar but in total hip replacement we have the opporturenity to carry out prehab. Outpatient guided exercise before the hip replacement for pain and functional outcomes.