Rehabilitation in Neurology Flashcards
Describe the pathway a patient takes towards Rehab
finds out nature of illness/injury
symptoms + signs
what tasks can they then do? what are their limitations
wider implications - restrictions, disability etc
rehab - how can these be improved, made easier etc
Who might need rehabilitation
long term neurological conditions
sudden onset - spinal cord injury, stroke, acquired brain injury
intermittent/unpredictable - epilepsy, early MS
static conditions - cerebral palsy, spina bifida, post-polio syndrome
progressive conditions - MN disease, parkinson’s, progressive MS
others - guillain barre syndrome, muscle diseases, huntington’s
Classifications of acquired brain injuries
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)
Physical impairments from neurological conditions
weakness loss of/abnormal sensation increased/decreased tone/spasticity pain syndrome swallowing + communication difficulties seizures fatigue
cognitive impairments after brain injury
post traumatic amnesia
confusion/disorientation
severe memory problems
poor concentration/attention
poor executive function, planning, reaction to changing events
impaired reasoning and problem solving
other cerebral functional impairments (4)
Dyspraxia and Perceptual Difficulties
Dysphasia
Visual cortical difficulties
Loss of hearing
Loss of smell and taste
Psychiatric / behavioural impairments after brain injury
depression anxiety personality change irritability behavioural problems - aggression etc
secondary complications of long term neurological conditions
pressure sores infections - urine, chest falls DVT constipation malnutrition social - relationship/family breakdown, unemployment, isolation
Activities potentially limited by LTNCs
Mobility
manual abilities - fine motor skills - hands, fingers, eyes
reading + comprehension speaking feeding personal care continence and hygiene
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
Personal factors affecting how people recover from a head injury
Premorbid health
Ideas and expectations
Motivations, psychology
Emotional health
Family support - Spouse, Children and Dependents
Environmental factors affecting how people recover from a head injury
therapy provisions - GP, info
Usual domestic arrangements - home setup, work adapations
Benefits of rehabilitation (5)
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
Assessment of the rehabilitation patient
History and Examination Physical ability - Mobility and Transferring Activities of Daily living Mood and Cognition Bladder and bowels Communication and swallow Skin, Vision and hearing
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?”
