Rehabilitation in Neurology

Question 1

Rehabilitation?

Answer 1

The active participation of a disabled person and others to reduce the impact of disease and disability on everyday life.

Question 2

In terms with rehabilitation, what role does the patient play?

Answer 2

Must voluntarily engage

Question 3

Long term neurological conditions affect the patient and their family in one way or another for the rest of their life.
List some sudden-onset long-term neurological conditions.

Answer 3

Stroke
Acquired brain injury e.g. haemorrhage, meningitis, etc.
Spinal cord injury

Question 4

List some unpredictable/intermittent long-term neurological conditions.

Answer 4

Epilepsy
Early MS

Question 5

List some congenital long-term neurological conditions.

Answer 5

Cerebral palsy
Spina bifida

Question 6

List some progressive long-term neurological conditions.

Answer 6

Huntington’s
Progressive MS

Question 7

What is Guillain Barre syndrome?

Answer 7

Rapid onset of ascending polyneuropathy as body attacks itself as produces antibodies to myelin glycoproteins and gangliosides.

Question 8

What most commonly causes Guillain Barre syndrome?

Answer 8

Infection but can be triggered by trauma or surgery

Question 9

What are some of the clinical features of Guillain Barre Syndrome?

Answer 9

Paraesthesia and weakness which begins distally in hands and feet.

Question 10

Which classification is used to assess severity of traumatic head injury?

Answer 10

GCS

Question 11

What GCS would be suggestive of a severe head injury?

Answer 11

3-8

Question 12

What GCS would be suggestive of a moderate head injury?

Answer 12

9-12

Question 13

What GCS would be suggestive of a mild head injury?

Answer 13

13-15

Question 14

How long does post-traumatic amnesia last in those with severe head injuries?

Answer 14

1-7 days

Question 15

How long does post-traumatic amnesia last in those with moderate head injuries?

Answer 15

1-24hrs

Question 16

How long does post-traumatic amnesia last in those with mild head injuries?

Answer 16

Less than an hour

Question 17

Give an example of a metabolic cause of acquired brain injury.

Answer 17

Hypoglycaemia

Question 18

Give some examples of infective causes of acquired brain injury.

Answer 18

Meningitis
Encephalitis

Question 19

List some of the physical impairments that arise from neurological conditions.

Answer 19

Weakness
Loss or abnormal sensation
Change in tone
Autonomic dysfunction e.g. bladder, bowel
Swallowing and communicative difficulties
Pain syndrome
Seizures
Neuroendocrine disturbance
Fatigue

Question 20

List some of the cognitive impairments which may arise after brain injuries.

Answer 20

Post-traumatic amnesia
Confusion
Severe memory problems
Poor concentration/attention
Slower thinking
Mental fatigue
Poor executive function, planning and reactions to changing events
Impaired reasoning and problem solving

Question 21

List some of the psychiatric/behavioural impairments following brain injury.

Answer 21

Depression
Anxiety
Personality change
Irritability
Childishness, selfishness, laziness
Behavioural problems
Anhedonia- inability to feel pleasure

Question 22

What are some of the secondary complications of long term neurological conditions?

Answer 22

Pressure sores
Chest or urine infections
Falls
DVT
Malnutrition
Constipation
Pain and spasticity
Contractures
Low morale and depression

Question 23

List some activities which may potentially be limited by long term neurological conditions.

Answer 23

Mobility
Manual abilities
Thinking and planning
Reading and comprehension
Speaking
Nonverbal communication
Feeding self
Continence and hygiene
Daily activities- driving, housework, preparing food
Self-medicating

Question 24

What are some of the personal factors which may influence to impact of a disabling condition on an individual?

Answer 24

Premorbid health
Emotional health
Family support- spouse, children and dependants
Motivations and psychology

Question 25

What are some of the environmental factors which may influence to impact of a disabling condition on an individual?

Answer 25

Therapy provisions
Domestic arrangements

Question 26

What are the benefits of rehabilitation?

Answer 26

Greater independence
Greater chance of getting home
Increased comfort and dignity
Increased chance or remaining or returning to work
Improved QoL
Reduced need for care or assistance

Question 27

What are the five stages in the process of rehabilitation before a patient is discharged and helped by therapists/OT/physios?

Answer 27

Goal setting -> discharge aims -> rehab objectives -> rehab tasks -> review

Question 28

What are some of the components of management of rehabilitation?

Answer 28

History and examination
Treatment of any underlying medical conditions
Preventative meds
Identifying impairments
Identify activity limitations
Set goals with patient and formalate management plan with the involvement of family and carers.

Question 29

In terms of goal setting, what can be done in the build up to the overall goal?

Answer 29

Breaking down goals into smaller steps to provide patient with evidence of progression

Question 30

Which goals will physiotherapists be involved in?

Answer 30

Mobility and standing

Question 31

Which goals will occupational therapists be involved in?

Answer 31

Upper limb function
Self care
Personal hygiene
Cognitive skills

Question 32

Which goals will speech and language therapists be involved in?

Answer 32

Goals involving the improvement of communication

Question 33

Goals should be SMART. What is meant by this acronymn>?

Answer 33

Specific
Measurable
Achievable
Realistic
Timely