Rehabilitation in neurology Flashcards
Who needs rehabilitation
Those with
-Impairment
-Disability (activity limitation)
or
-Handicap (Participation restriction)
What is the definition of handicap
Problems individual may have in involvement in life situations
what is the definition of impairment
Problems in body function or structure such as a significant deviation or loss
What is the definition of disability
Difficulties an individual may have in executing activities
Define rehabilitation
The restoration of patients to their fullest physical, mental and social capability
What is the conceptual definition of rehabilitation
A process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function
What is the service definition of rehabilitation
The use of all means to minimise the impact of disabling conditions and to assist people with activity limitation to achieve their desired level of autonomy and participation in society
What is the definition of rehabilitation medicine
The specialty of Medicine involved with the prevention and reduction of activity limitation and participation arising from impairments, and the management of disability from a physical, psychosocial and vocational point of view.
What is the definition of long term neurological condition
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 sudden onset if long tern neurological conditions
Acquired brain injury
spinal cord injury
stroke
What are intermittent/ unpredictable long term neurological conditions
Epilepsy
Early multiple sclerosis
What are progressive long term neurological conditions
Motor Neurone Disease
Parkinson’s disease
Later stages of Multiple Sclerosis
What are stable long term neurological conditions
Post-polio syndrome
Cerebral palsy in adults
Spina bifida in adolescence/adults
{Changing needs due to development or ageing}
What are other long term neurological conditions
Guillain Barre Syndrome
Muscle diseases (e.g. myotonic dystrophy)
Hereditary spastic paraparesis
Huntington’s disease
What are physical problems experience from long term neurological conditions
Weakness (hemiparesis/paraparesis)
Loss of / abnormal sensation
Increased or decreased tone / spasticity
Visual disturbance, e.g. homonymous hemianopia
Loss of hearing
Loss of smell and taste
Swallowing and communication difficulties
Bladder and bowel difficulties
Pain Syndrome
Seizures / Epilepsy
What are cognitive problems 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 is psychiatric / behavioural problems after brain injury
Depression
Anxiety
Personality change
Irritability
“Childishness, selfishness, laziness”
Behavioural problems, including aggression disinhibition, apathy
What is assessed in rehabilitation
History and Examination
Mobility
Activities of Daily living
Mood and Cognition
Bladder and bowels
Communication and swallow
Skin, Vision and hearing
What is the process of rehabilitation
Problem lists
Set Goals (SMART)
Identify barrier issues
Formulate management
plan
Draw upon all relevant disciplines
Involve patient (family/carers)
When is rehabilitation most effect
When delivered by a coordinated multidisciplinary team
What is spasticity
Motor disorder characterised by a velocity dependent increase in tonic stretch reflexes with exaggerated tendon jerks
What is the pathology of spasticity
Disordered sensorimotor control due to an upper motor neurone syndrome (UMN) lesion, presenting as intermittent or sustained involuntary activation of muscles
eg stroke, spinal cord injury, traumatic brain injury
What is the 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
Define Contracture
a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints
What is the management of spasticity
Multidisciplinary team approach
Physical therapy
Exclude exacerbating factors
Oral antispasticity agents
Focal treatment with Botulinum toxin
Where does 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 is the 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 secondary complication can rehabilitation prevent
Pressure sores
Chest infections
Deep venous thrombosis
Malnutrition
Constipation
Musculoskeletal pain
Contractures
Low morale and depression
What social complications can rehabilitation prevent
relationship and family breakdown,
childcare issues,
unemployment,
social isolation
What is different classification 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 are important predictors to the severity of head injury
GCS,
length of loss of consciousness
post-traumatic amnesia
What is signs of a sever head injury
GCS 3-8
PTA 1-7 days
What is signs of a moderate head injury
GCS 9-12
PTA 1-24 hours
What is signs of mild head injury
GCS 13-15
PTA less than 1 hour
What are other specialties that must be accessible in rehabilitation
Spasticity management services
Wheelchair and seating services
Continence service
Sexual / relationship counselling
Vocational rehabilitation
Orthotics
Driving assessment
service
Assessment service for people in low awareness states
Pain management
Neuro psychiatry / clinical psychology
National behavioural management service
National ABI service in Edinburgh
Carers centre
Brain injury group / Headway
