Rehabilitation in Neurology Flashcards
What is rehabilitation?
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 is rehabilitation medicine?
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
What does rehabilitation lead to?
- 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
What are the principles of rehabilitation?
Pathology
Impairment
Limitation
Restriction
What is the spectrum of illness?
- 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
Who are some people who may 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 (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
- Sudden onset conditions
What are the different classifications of acquired brain injury?
- 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)
What are important predictors for the outcome of traumatic head injury?
Initial GCS
Length of loss of consciousness
Post-traumatic amnesia
What is impairment?
Problems in body function or structure such as a significant deviation or loss
What are examples of 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 examples of autonomic dysfunction that can occur?
- Bladder instability
- Bowel disturbance
- Difficulty in bowel and bladder sensation and recognition
What are examples of cognitive (thinking) impairments that can pccur after a 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 examples of psychiatric/behavioural impairments that can occur after brain injury?
- Depression
- Anxiety
- Personality change
- Irritability
- “Childish, selfishness, laziness”
- Behaviour problems
- Aggression
- Disinhibition
- Apathy
- Anhedonia
What are some examples of cerebral impairments that can occur after brain injury?
- Dyspraxia and perceptual difficulties
- Dysphasia
- Excessive
- Receptive
- Impaired language skills
- Visual cortical difficulties
- Hemianopsia/quadrantanopia
- Loss of hearing
- Loss of smell and taste
What are some secondary complications of long term neurological conditions (LTNC)?
- 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
What does LTNC stand for?
Long term neurological condition
What is activity limitation (disability)?
Difficulties an individual may have in executing activities
What are some examples of activities that are potentially limited by LTNCs?
- 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 participation restriction (handicap)?
Problems individual may have in involvement in life situations
What are some examples of 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 some personal factors that impact rehabilitation?
- Premorbid health
- Ideas and expectations
- Motivations, psychology
- Emotional health
- Family support
- Spouse
- Children and dependents
What are some environmental factors that limit rehabilitation?
- Therapy provisions
- GP/community services
- Information
- Usual domestic arrangements
- Home setup
- Work adaptations
What are some of the benefits of rehabilitation?
- 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
Describe the evidence basis for 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 can rehabilitation take place?
- Acute hospital
- Rehabilitation ward
- Outpatient centre
- Community facilities such as local sports hall
- Vocational rehabilitation service
- In the patient’s home
Describe the process of rehabilitation?
1) Admission
2) Assessment
3) Goal setting -> disharge aims -> rehab objectives -> rehab tasks -> review
4) Back to goal setting or discharge planning
What is done for the 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
Describe the process of rehabilitation?
- 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”
How should you do goal setting for rehabilitation?
- 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 what?
SMART:
- specific
- measureable
- achievable
- realistic
- timely
What does MDT stand for?
Multidisciplinary team
Who is in the MDT for rehabilitation?
What are some specialist services that relates to the MDT for rehabilitation?
