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year 2 neuro - Robbie > Rehabilitation in Neurology > Flashcards

Rehabilitation in Neurology Flashcards

1
Q

What is rehabilitation?

A

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

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2
Q

What are the aims of rehabilitation?

A
  • 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
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3
Q

a

A

pathology

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4
Q

b

A

impairment

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5
Q

c

A

limitation

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6
Q

d

A

restriction

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7
Q

Who needs rehabilitation?

A

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

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8
Q

Examples of Long Term Neurological
Conditions: sudden onset conditions

A
  • Acquired brain injury
  • Spinal cord injury
  • Stroke
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9
Q

Examples of Long Term Neurological
Conditions: Intermittent/Unpredictable

A

Epilepsy

Early multiple sclerosis (relapses and remissions) - Care needs change according to the nature of the illness

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10
Q

Examples of Long Term Neurological
Conditions: static conditions

A

Care needs changing according to person’s development and ageing

Post-polio syndrome

Cerebral palsy in adults

Spina bifida in adolescence/adults

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11
Q

Examples of Long Term Neurological
Conditions: progressive conditions

A

Motor Neurone Disease

Parkinson’s disease

Progressive Multiple Sclerosis (primary or secondary)

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12
Q

Examples of Long Term Neurological
Conditions: Other important neurological conditions

A

Guillain Barre Syndrome

Muscle diseases (myopathies and muscular dystrophies) e.g. myotonic dystrophy

Hereditary spastic paraparesis

Fascio-Scapular-Humeral Dystrophy

Huntington’s disease

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13
Q

What is acquired brain injury classified as?

A
  • 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)
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14
Q

What are the different classifications of traumatic brain injury?

(make sure to scroll down and up)

A

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

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15
Q

What is impairment?

A

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

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16
Q

What are physical impairments from neurological conditions?

A

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

17
Q

What are some cognitive (“thinking”) impairments after brain injury?

A

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

18
Q

What are some other cerebral functional impairments?

A

Dyspraxia and Perceptual Difficulties

Dysphasia - Expressive, Receptive, Impaired language skills

Visual cortical difficulties - Hemianopia/Quadrantanopia

Loss of hearing

Loss of smell and taste

19
Q

What are some psychiatric/behavioural impairments after brain injury

A

Depression

Anxiety

Personality change

Irritability

“Childishness, selfishness, laziness”

Behavioural problems - aggression, disinhibition, apathy

Anhedonia (inability to feel pleasure in normally pleasurable activities)

20
Q

What are some secondary complications of long term neurological conditions?

A
  • Pressure sores
  • Infections - Urine, Chest
  • Falls and other secondary injury
  • Deep venous thrombosis
  • Malnutrition
  • Constipation
  • Pain and Spasticity
  • Contractures
  • Low morale and depression
21
Q

What is the definition of activity limitation (“disability”)?

A

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

22
Q

What are some activities potentially limited by LTNCs?

A

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

23
Q

What is the defnition of participation restriction (“handicap”)?

A

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

24
Q

What is the social impact of neurological illness and injury?

A

Family role complications

Relationship breakdowns

Childcare and dependents issues

Employment and Financial implications - retirement

Legal implications, guardianship

Social isolation

Recreational restrictions

25
Q

What are important personal factors in the social/functional histroy?

A
  • Premorbid health
  • Ideas and expectations
  • Motivations, psychology
  • Emotional health
  • Family support
  • Spouse
  • Children and Dependents
26
Q

What are important environmental factors in the social/functional histroy?

A
  • Therapy provisions - GP/community services, Information
  • Usual Domestic Arrangements - Home setup, Work adaptations
27
Q

What are the benefits of rehabilitation?

A
  • 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
28
Q

What is the evidence basis of rehabilitation?

A
  • 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
29
Q

Where does rehabilitation take place?

A
  • Acute hospital
  • Rehabilitation ward
  • Outpatient centre
  • Community facilities, e.g. local sports hall
  • Vocational rehabilitation service
  • In the patient’s home
30
Q

Describe the process/timepline of rehabilitation?

A
31
Q

How do you do an assessment of a rehabilitation patient?

A
  • History and Examination
  • Physical ability - Mobility, Transferring
  • Activities of Daily living
  • Mood and Cognition
  • Bladder and bowels
  • Communication and swallow
  • Skin, Vision and hearing
32
Q

What is the process of rehabilitation?

A
  • 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?”
33
Q

What is involved in goal setting?

A
  • 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
34
Q

Goals should be……….

A

SPECIFIC

MEASURABLE

ACHIEVABLE

REALISTIC

TIMELY

35
Q

What are some specialist services that may be involved in rehabilitation?

A

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

36
Q

Rehabilitation: reducing impact of _______ and _______

A

disease and disability

37
Q

What is a multidisciplinary team approach?

A

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

year 2 neuro - Robbie (48 decks)

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