Rehabilitation in Neurology Flashcards
What is impairment?
Problems in body function or structure such as a significant deviation or loss
What is disability?
Difficulties an individual may have in executing activities (2002)
Also referred to as activity limitation
What is a handicap?
Problems individuals may have in involvement in life situations
Also referred to as a participation restriction
What is 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.
BSRM service definition: 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 are long-term neurological conditions?
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 the causes of sudden onset of long-term neurological conditions?
Acquired brain injury
Spinal cord injury
Stroke
What are the intermittent unpredictable presentations of long-term neurological conditions?
Epilepsy
Early multiple sclerosis (relapses and remissions) lead to marked variation in the care they need
What are the long-term progressive conditions?
Motor neurone disease
Parkinson’s disease
Later stages of multiple sclerosis
What are the stable conditions of LTNC?
Changes due to development or ageing
Post-polio syndrome
Cerebral palsy in adults
Spina bifida in adolescence / adults
Other neurological conditions
–Guillain Barre Syndrome
–Muscle diseases (e.g. myotonic dystrophy)
–Hereditary spastic paraparesis
–Huntington’s disease
What are the physical problems from a long-term neurological condition?
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 are the psychiatric / behavioural problems after brain injury?
Depression
Anxiety
Personality change
Irritability
Childishness, seflishness, laziness
Behavioural problems, including aggression disinhibition, apathy
What things do you assess in rehabilitation?
History and Examination
Mobility
Activities of Daily living
Mood and Cognition
Bladder and bowels
Communication and swallow
Skin (for things like pressure sores), Vision and hearing
What is the process of rehabilitation?
Problem lists
Set Goals
Identify barrier issues
Formulate management plan
Draw upon all relevant disciplines
Involve patient (family/carers)
(basically, find out what the problem is, set a target, set a plan to meet the target, and involve MDT and others)
What are SMART goals?
–Specific
–Measurable
–Achievable
–Relevant / realistic
–Time limited
Who is involved in the MDT in rehabilitation?
–Physiotherapist
–Occupational therapist
–Speech and Language therapist
–Nurses
–Dietician
–Orthotists
–Doctors
–Neuropsychologist
–Social worker
Buzz phrases for MDT - ‘work together’ ‘co-ordinated team of professionals’ ‘ patient/family centred’ ‘active partnership’
What is spacticity?
Motor disorder, features are:
Velocity dependant increase in tonic stretch reflexes
Exaggerated tendon jerks
UMNL resulting in intermittent or sustained involuntary activation of muscles
What are 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
What is the management of spasticity?
Prevention,Prevention and Prevention!
Multidisciplinary team approach
Physical therapy
Exclude exacerbating factors
Oral antispasticity agents
Focal treatment with Botulinum toxin
Drug Treatment not always necessary
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 are 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
Give examples of secondary complications
Pressure sores
Chest infections
Deep venous thrombosis
Malnutrition
Constipation
Musculoskeletal pain
Contractures
Low morale and depression
What are the different classifications of acquired brain injury?
Acquired brain injury classified as:
–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 the different classifications of severity of head injury?
Severe head injury
–GCS 3-8
–PTA 1-7 days
Moderate head injury
–GCS 9-12
–PTA 1-24 hours
Mild head injury
–GCS 13-15
–PTA less than 1 hour
PTA - post traumatic amnesia
Other specialist services
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
Links with:
–Pain management
–Neuro psychiatry / clinical psychology
–National behavioural management service
–National ABI service in Edinburgh
–Carers centre
–Brain injury group / Headway
