Rehabilitation in neuro Flashcards
what concepts are rehabilitation practices based around
Impairment
Disability (activity limitation)
Handicap (Participation restriction)
what is impairment
Problems in body function or structure such as a significant deviation or loss
what is disability
an activity limitation (AL)
Difficulties an individual may have in executing activities
what is handicap
a participation restriction (PR)
Problems individual may have in involvement in life situations
most often referred to in terms of the individuals social role
what is rehabilitation
The restoration of patients to their fullest physical, mental and social capability
acquiring the knowledge and skills needed for optimal physical, psychological and social function
eg getting back to work, sex, golf, etc
what is rehabilitation medicine
specialty of Medicine involved with the prevention and reduction of activity limitation and participation arising from impairments
the management of disability from a physical, psychosocial and vocational point of view.
what are long term neurological conditions (LTNC)
Disease of, injury or damage to the nervous system which will affect the individual and their family in one way or another for the rest of their life
what are some sudden onset
acquired brain injury
spinal cord injury
stroke
what are some intermittent/unpredictable LTNC
epilepsy
early MS
what are some progressive LTNC
motor neurone disease
parkinsons
later stages of MS
what are some stable LTNC
needs only change due to development or ageing
post-polio syndrome
cerebral palsy in adults
spina bifida in adolescence/adults
name some other neurological conditions
Guillain Barre Syndrome
Muscle diseases (e.g. myotonic dystrophy)
Hereditary spastic paraparesis
Huntington’s disease
what physical problems can LTNC cause
Weakness (hemiparesis/paraparesis) Loss of / abnormal sensation Increased or decreased tone / spasticity Visual disturbance, e.g. homonymous hemianopisa Loss of hearing Loss of smell and taste Swallowing and communication difficulties Bladder and bowel difficulties Pain Syndrome Seizures / Epilepsy
what are some cognitive “thinking” problems that occur after brain injury
Post-traumatic amnesia Confusion / disorientation Severe memory problems (especially with recent events / working memory) Poor concentration/ attention Slowed thinking Poor “executive functioning”
what are some psychiatric/behavioural problems after brain injury
Depression Anxiety Personality change Irritability “Childishness, selfishness, laziness” Behavioural problems, including aggression disinhibition, apathy
what assessments are examined in rehab
History and Examination Mobility Activities of Daily living Mood and Cognition Bladder and bowels Communication and swallow Skin, Vision and hearing
what components are involved in the process of rehabilitation
Problem lists Set Goals Identify barrier issues Formulate management plan Draw upon all relevant disciplines Involve patient (family/carers)
what are SMART goals
Specific Measurable Achievable Relevant Time limited
what professionals are involved in rehab
a multidisciplinary team: Physiotherapist Occupational therapist Speech and Language therapist Nurses Dietician Orthotists Doctors Neuropsychologist Social worker
what is spasticity
from an UMN lesion - presenting as intermittent sustained involuntary activation of muscles
what are some complications of spasticity
Poor seating and lying positions Sleep difficulties and fatigue Dressing and hygiene issues Pain, spasms and associated reactions Communication and feeding problems Pressure sores and contracture Poor self-image and relationship issues
what is the management of spasticity
PREVENTION MD team approach physical therapy exclue exacerbating symptoms oral antispastcity agents focal treatment - botulinum toxin
where can rehabilitation take place
Acute hospital Rehabilitation ward Outpatient centre Community facilities, e.g. local sports hall Vocational rehabilitation service In the patient’s home
what are some benefits of rehabilitation
Greater independence
Greater chance of getting home or remaining at home
Increased comfort and dignity
Increased chance of remaining in / returning to work
Improved quality of life
Reduced need for care / assistance
what are some secondary complications that can be prevented by rehab
Pressure sores Chest infections Deep venous thrombosis Malnutrition Constipation Musculoskeletal pain Contractures Low morale and depression
what are the different classes of acquired brain injury
Head injury (traumatic brain injury)
Haemorrhagic (e.g. SAH)
Hypoxic / Anoxic (e.g. out of hospital cardiac arrest
Metabolic (e.g. hypoglycaemic)
Infective (meningitis, encephalitis)
what can be used to classify and find severity of head injury
GCS
length of consciousness
post-traumatic amnesia (PTA)
what classifies severe head injury
GCS - 3-8
PTA - 1-7 days
what classifies moderate head injury
GCS - 9-12
PTA - 1-24 hrs
what classifies mild head injury
GCS - 13-15
PTA - <1hr
what are some other specialist services that can help in rehab
Spasticity management Wheelchair and seating Continence service Sexual / relationship counselling Orthotics Driving assessment service Pain management Psychology Carers centre
give some examples of evidence that rehab world
stroke units provide better outcome than medical wards
inpatient MS rehab leads to reduced disability
brain injury receiving early rehab more likely to be discharged home
