Rehabilitation in Neurology Flashcards

1
Q

What is rehabilitation?

A

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 is rehabilitation medicine?

A

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

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3
Q

What does rehabilitation lead to?

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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4
Q

What are the principles of rehabilitation?

A

Pathology

Impairment

Limitation

Restriction

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5
Q

What is the spectrum of illness?

A
  • Trivial (self-limiting)
  • Minor ailments
  • Serious illness, with quick and complete recovery
  • Major illness or accident where recovery is very slow, incomplete and absent
  • Degenerative illness
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6
Q

Who are some people who may need rehabilitation?

A
  • 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 (Care needs change according to the nature of the illness)
      • Epilepsy
      • Early MS (relapsed and remissions)
    • 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 neuron disease
      • Parkinson’s disease
      • Progressive multiple sclerosis (primary or secondary)
    • Other important neurological conditions
      • Guillain Barre Syndrome
      • Muscle disease (myopathies and muscular dystrophies)
        • Such as myotonic dystrophy
      • Hereditary spastic paraparesis
      • Fascio-scapular-humeral dystrophy
      • Huntington’s disease
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7
Q

What are the different classifications of acquired brain injury?

A
  • Head injury (traumatic brain injury)
  • Haemorrhagic (such as SAH)
  • Hypoxic/anoxic (such as out of hospital cardiac arrest)
  • Metabolic (such as hypoglycaemia)
  • Infective (such as meningitis, encephalitis)
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8
Q

What are important predictors for the outcome of traumatic head injury?

A

Initial GCS

Length of loss of consciousness

Post-traumatic amnesia

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9
Q

What is impairment?

A

Problems in body function or structure such as a significant deviation or loss

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10
Q

What are examples of 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
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11
Q

What are some examples of autonomic dysfunction that can occur?

A
  • Bladder instability
  • Bowel disturbance
  • Difficulty in bowel and bladder sensation and recognition
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12
Q

What are examples of cognitive (thinking) impairments that can pccur after a 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

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13
Q

What are some examples of psychiatric/behavioural impairments that can occur after brain injury?

A
  • Depression
  • Anxiety
  • Personality change
  • Irritability
  • “Childish, selfishness, laziness”
  • Behaviour problems
    • Aggression
    • Disinhibition
    • Apathy
  • Anhedonia
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14
Q

What are some examples of cerebral impairments that can occur after brain injury?

A
  • Dyspraxia and perceptual difficulties
  • Dysphasia
    • Excessive
    • Receptive
    • Impaired language skills
  • Visual cortical difficulties
    • Hemianopsia/quadrantanopia
  • Loss of hearing
  • Loss of smell and taste
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15
Q

What are some secondary complications of long term neurological conditions (LTNC)?

A
  • Pressure sores
  • Infections
    • Urine, chest
  • Falls and other secondary injury
  • Deep venous thrombosis
  • Malnutrition
  • Constipation
  • Pain and spasticity
  • Contractures
  • Low morale and depression
  • Social complications such as relationship and family breakdown, childcare issues, unemployment and social isolation
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16
Q

What does LTNC stand for?

A

Long term neurological condition

17
Q

What is activity limitation (disability)?

A

Difficulties an individual may have in executing activities

18
Q

What are some examples of activities that are potentially limited by LTNCs?

A
  • 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
19
Q

What is participation restriction (handicap)?

A

Problems individual may have in involvement in life situations

20
Q

What are some examples of 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
21
Q

What are some personal factors that impact rehabilitation?

A
  • Premorbid health
  • Ideas and expectations
  • Motivations, psychology
  • Emotional health
  • Family support
    • Spouse
    • Children and dependents
22
Q

What are some environmental factors that limit rehabilitation?

A
  • Therapy provisions
    • GP/community services
    • Information
  • Usual domestic arrangements
    • Home setup
    • Work adaptations
23
Q

What are some of the benefits of rehabilitation?

A
  • Greater independence
  • Greater chance of getting home or remaining at home
  • Increased comfort and dignity
  • Increased change of remaining in/returning to work
  • Improved quality of life
  • Reduced need for care/assistance
24
Q

Describe the evidence basis for 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
25
Q

Where can rehabilitation take place?

A
  • Acute hospital
  • Rehabilitation ward
  • Outpatient centre
  • Community facilities such as local sports hall
  • Vocational rehabilitation service
  • In the patient’s home
26
Q

Describe the process of rehabilitation?

A

1) Admission
2) Assessment
3) Goal setting -> disharge aims -> rehab objectives -> rehab tasks -> review
4) Back to goal setting or discharge planning

27
Q

What is done for the 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
28
Q

Describe the process of rehabilitation?

A
  • Problem lists
  • Set goals
  • Identify barrier issues
  • Formulate management plan
  • Draw upon all relevant disciplinaries
  • Involve patient (family/carers)
  • “What can you do”
  • “What do you find difficult”
29
Q

How should you do goal setting for rehabilitation?

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
30
Q

Goals should be what?

A

SMART:

  • specific
  • measureable
  • achievable
  • realistic
  • timely
31
Q

What does MDT stand for?

A

Multidisciplinary team

32
Q

Who is in the MDT for rehabilitation?

A
33
Q

What are some specialist services that relates to the MDT for rehabilitation?

A