Rehabilitation in Neurology

Question 1

Benefits of rehabilitation

Answer 1

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

Question 2

Definition of rehabilitation medicine

Answer 2

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

Question 3

Rehabilitation practice is based around the concept of what?

Answer 3

Impairment
Disability (activity limitation)
Handicap (participation restriction)

Question 4

Definition of impairment

Answer 4

Any loss or abnormality of psychological, physiologically or anatomical structure or function
Problems in body function or structure such as significant deviation or loss

Question 5

Definition of disability / activity limitation

Answer 5

Any restriction or lack of activity to perform an activity in the manner or in the range considered normal for people of the same age, sex and culture
Difficulties an individual may have in executing activites

Question 6

Definition of handicap / participation restriction

Answer 6

A disadvantage for a given individual that limits or prevents the fulfillment of a role that would otherwise be normal for that individual

Question 7

What does handicap depend on?

Answer 7

The situation

Question 8

Definition of rehabilitation

Answer 8

The restoration of patients to their fullest physical, mental and social capability

Question 9

Definition of long term neurological conditions

Answer 9

Diseases of, injuries 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

Question 10

What does LTNC stand for?

Answer 10

Long term neurological conditions

Question 11

Causes of sudden onset LTNC

Answer 11

Acquired brain injury
Spinal cord injury
Stroke

Question 12

Causes of intermittent / unpredictable LTNC

Answer 12

Epilepsy

Early MS

Question 13

Causes of progressive LTNC

Answer 13

MND
Parkinsons
Later stages of MS

Question 14

Causes of stable LTNC

Answer 14

Changing needs due to development or ageing
Post polio syndrome
CP in adults
Spina bifida in adolescence/adults

Question 15

Physical problems from LTNC

Answer 15

Weakness (hemiparesis/paraparesis)
Loss of/abnormal sensation 
Increased or decreased tone/spasticity
Visual disturbance e.g. homonymous hemaniopia
Loss of hearing
Loss of smell and taste
Swallowing and communication difficulties
Bladder and bowel difficulties
Pain syndrome
Seizures/epilepsy

Question 16

Cognitive problems after brain injury

Answer 16

Post traumatic amnesia
Confusion 
Disorientation 
Severe memory problems 
Poor concentration/attention 
Slowed thinking 
Poor "executive functioning"

Question 17

Psychiatric problems after brain injury

Answer 17

Depression 
Anxiety
Personality change
Irritability 
Behavioural problems
- aggression 
- disinhibition 
- apathy

Question 18

Types of acquired brain injury

Answer 18

Head injury 
Haemorrhage
Hypoxic/anoxic
Metabolic
Infective

Question 19

What are important predictors of outcome of a head injury?

Answer 19

GCS
Loss of consciousness
Post traumatic amnesia

Question 20

Classification of head injury

Answer 20

Severe 
- GCS 3 - 8
- PTA 1 - 7 days
Moderate 
- GCS - 9 - 12
- PTA 1 - 24 hours
Mild 
- GCS - 13 - 15 
- PTA < 1 hr

Question 21

What is assessed in rehab?

Answer 21

History and exam 
Mobility 
ADL
Mood and congition 
Bladder and bowels
Communication and swallow
Skin, vision and hearing

Question 22

What do ADLs stand for?

Answer 22

Activities of daily living

Question 23

Process of rehabilitation

Answer 23

Problem lists
Set goals
Identify barrier issues
Formulate management plan 
Draw upon all relevant disciplines
Involve patient (family/carers)

Question 24

What are “smart goals”?

Answer 24

Specific
Measurable
Achievable 
Relevant 
Time limited

Question 25

Definition of spasticity

Answer 25

Motor disorder characterised by a velocity dependent increase in tonic stretch reflexes with exaggerate tendon jerks
Disordered sensorimotor control resulting from a UMN lesion presenting as intermittent or sustained involuntary activation of muscles

Question 26

Complications of spasticity

Answer 26

Poor seating and lying positions
Sleep difficulties and fatigue
Dressing and hygiene issues
Pain, spasms and associated reactions
Communication and feeding problems 
Pressure sores
Contracture
Poor self image and relationship issues

Question 27

Treatment of spasticity

Answer 27

Physical therapy
Exclude exacerbating factors
Oral antispasticity agents
Focal treatment with botulinum toxin

Question 28

Secondary complications of head injury

Answer 28

Pressure sores
Chest infections 
DVT
Malnutrition 
Constipation 
MSK pain 
Contractures
Low morale and depression
Social