Rehabilitation in Neurology Flashcards
definition of rehabilitation
Conceptual Definition:
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.
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 is rehabilitation medicine?
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.
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
who might need rehabilitation?
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
Sudden Onset Conditions Acquired brain injury Spinal cord injury Stroke Intermittent / Unpredictable Epilepsy Early multiple sclerosis (relapses and remissions) Care needs change according to the nature of the illness
Static Conditions Care needs changing according to person’s development and ageing Post-polio syndrome Cerebral palsy in adults Spina bifida in adolescence/adults Progressive Conditions Motor Neurone Disease Parkinson’s disease Progressive Multiple Sclerosis (primary or secondary)
what are the classifications of acquired brain injury?
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 physical impairments form neurologival 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
cognitive 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
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
psychiatric/behavioural impairments after brain injury
Depression Anxiety Personality change Irritability “Childishness, selfishness, laziness”
Behavioural problems Aggression Disinhibition Apathy Anhedonia
secondary complications of LTNC?
Pressure sores Infections Urine, Chest Falls and other secondary injury Deep venous thrombosis Malnutrition Constipation Pain and Spasticity Contractures Low morale and depression
activities potentially limited by LTNC
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
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
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
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
management of spasticity
Prevention, Prevention and Prevention! Multidisciplinary team approach Physiotherapy Exclude exacerbating factors Full medical examination, relevant investigations
Oral antispasticity agents
Focal treatment
Botulinum toxin
Intrathecal therapy
