Rehabilitation in Neurology Flashcards
What is rehabilitation?
The active participation of a disabled person and others to reduce the impact of disease and disability on daily life
Looking at the problems the disabling condition is causing and try reduce that to improve their daily life
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 are the aims of rehabilitation?
- Enabling and supporting you
- Adjusting to your new situation
- Achieving your best possible potential
- Living life as fully and actively as possible
- Becoming as independent as possible
a
pathology
b
impairment
c
limitation
d
restriction
Who needs rehabilitation?
Patients with 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
Examples of Long Term Neurological
Conditions: sudden onset conditions
- Acquired brain injury
- Spinal cord injury
- Stroke
Examples of Long Term Neurological
Conditions: Intermittent/Unpredictable
Epilepsy
Early multiple sclerosis (relapses and remissions) - Care needs change according to the nature of the illness
Examples of Long Term Neurological
Conditions: static conditions
Care needs changing according to person’s development and ageing
Post-polio syndrome
Cerebral palsy in adults
Spina bifida in adolescence/adults
Examples of Long Term Neurological
Conditions: progressive conditions
Motor Neurone Disease
Parkinson’s disease
Progressive Multiple Sclerosis (primary or secondary)
Examples of Long Term Neurological
Conditions: Other important neurological conditions
Guillain Barre Syndrome
Muscle diseases (myopathies and muscular dystrophies) e.g. myotonic dystrophy
Hereditary spastic paraparesis
Fascio-Scapular-Humeral Dystrophy
Huntington’s disease
What is 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 traumatic brain injury?
(make sure to scroll down and up)
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
When they start to form new memories and retain them then they are out of PTA
What is impairment?
Any loss or abnormality of physiological, psychological or anatomical structure or function
Problems in body function or structure such as a significant deviation or loss
What are physical impairments from neurological conditions?
Weakness (hemiparesis/paraparesis)
Loss of/abnormal sensation
Increased or decreased tone/spasticity
Autonomic dysfunction- Bladder instability, Bowel disturbance, Difficulty in bowel and bladder sensation and recognition
Swallowing and communication difficulties
Pain Syndrome - Somatic, Neuropathic
Seizures
Neuroendocrine disturbance
Physical fatigue
What are some cognitive (“thinking”) impairments after brain injury?
Post-traumatic amnesia
Confusion/disorientation - Time, Place, Person
Severe memory problems - recall of recent events, working memory
Poor concentration/attention
Slowed thinking and mental fatigue
Poor executive function, planning, reaction to changing events
Impaired reasoning and problem solving
What are some other cerebral functional impairments?
Dyspraxia and Perceptual Difficulties
Dysphasia - Expressive, Receptive, Impaired language skills
Visual cortical difficulties - Hemianopia/Quadrantanopia
Loss of hearing
Loss of smell and taste
What are some psychiatric/behavioural impairments after brain injury
Depression
Anxiety
Personality change
Irritability
“Childishness, selfishness, laziness”
Behavioural problems - aggression, disinhibition, apathy
Anhedonia (inability to feel pleasure in normally pleasurable activities)
What are some secondary complications of long term neurological conditions?
- Pressure sores
- Infections - Urine, Chest
- Falls and other secondary injury
- Deep venous thrombosis
- Malnutrition
- Constipation
- Pain and Spasticity
- Contractures
- Low morale and depression
What is the definition of activity limitation (“disability”)?
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 activities
What are some activities potentially limited by LTNCs?
Mobility - outdoor mobility
Manual abilities - fine motor skills
Thinking and Planning
Reading and Comprehension
Speaking
Nonverbal communication
Feeding self
Continence and hygiene
Personal care
Activities of Daily living - Food preparation, Driving, Housework
Self medicating
What is the defnition of participation restriction (“handicap”)?
A disadvantage for a given individual that limits or prevents the fulfilment of a role that would otherwise be normal for that individual
Problems individual may have in involvement in life situations
What is the social impact of neurological illness and injury?
Family role complications
Relationship breakdowns
Childcare and dependents issues
Employment and Financial implications - retirement
Legal implications, guardianship
Social isolation
Recreational restrictions
What are important personal factors in the social/functional histroy?
- Premorbid health
- Ideas and expectations
- Motivations, psychology
- Emotional health
- Family support
- Spouse
- Children and Dependents
What are important environmental factors in the social/functional histroy?
- Therapy provisions - GP/community services, Information
- Usual Domestic Arrangements - Home setup, Work adaptations
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
What is the evidence basis of rehabilitation?
- Stroke units vs. general medical ward
- Inpatient rehabilitation of patients with MS
- Early rehabilitation = more likely to be discharged home
- Dose-Response effect of extra therapy
- Cost effectiveness: care costs, economic productivity
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
Describe the process/timepline of rehabilitation?
How do you do an assessment of a rehabilitation patient?
- History and Examination
- Physical ability - Mobility, Transferring
- 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
- Identify barrier issues
- Formulate management plan
- Draw upon all relevant disciplines
- Involve patient (family/carers)
- “What can you do?”
- “What do you find difficult?”
What is involved in goal setting?
- Relevant to patient’s priorities
- Aiming to restore/preserve independence
- Multiple goals in multiple areas
- Personalised, important to the patient
- Showing progression
- Set with patient, family, MDT, patient personal involvement
- Barriers to goals
Goals should be……….
SPECIFIC
MEASURABLE
ACHIEVABLE
REALISTIC
TIMELY
What are some specialist services that may be involved in rehabilitation?
Posture & Movement
Wheelchair and seating services
Continence service
Sexual/relationship counselling
Vocational rehabilitation
Orthotics - provision and use of artificial devices such as splints and braces
Driving assessment service
Assessment service for people in low awareness states
Rehabilitation: reducing impact of _______ and _______
disease and disability
What is a multidisciplinary team approach?
A team process
Patient, family and/or carers the focus
Most effectively delivered by a coordinated team of professionals
- Work together towards same goal
- Interventions may run parallel
Interdisciplinary: more integrated including joint sessions
