Rehabilitation Medicine

Question 1

What is the ICF?

Answer 1

Combines biological, environmental and psychosocial models of health

Terminology

• Capacity
• Performance
• Impairment
• Activity
• Activity Limitation
• Participation
• Participation restriction

Question 2

What is the REPAIR model?

Answer 2

Getting the patient to their fullest potential within the limitations of their underlying condition

Review of pathology and impairment
Environment
Participation
Activity
Important others
Risk

Question 3

What are the principles of rehabilitation following lower limb amputation?

Answer 3

Prosthesis to replace limb
prosthetic rehab depends on cognitive ability, expectations, goals, physical strength and co-morbidities

Associated complications include pressure sores, skin rashes, joint issues, patient poor acceptance

Question 4

What is the ASIA tool for measuring disability?

Answer 4

System that helps to determine if a spinal cord injury is complete or not

Myotome and dermotome function recorded in upper and lower limb

Any preservation in S4/5 means incomplete

Question 5

What is the Barthel index for measuring disability?

Answer 5

Scale used to assess performance in 10 ADLs such as feeding, grooming and mobility

Question 6

How is neurogenic bladder managed?

Answer 6

Injury above T12

• autonomic control but no voluntary control
• bladder contracts when certain level of fullness reached
• managed by tapping suprapubically to stimulate autonomic reflex or intermittent catheterisation

Injury below L1

• leads to flaccid bladder
• no bladder tone
• appears like overflow incontinence
• managed by intermittent catheterisation

Question 7

How is neurogenic bowel managed?

Answer 7

Injury above T12

• leads to reflex bowel
• rectal fullness lost
• causes emptying of bowel at inconvenient times

Injury below L1
-causes areflexic bowel
defecation reflex and anal sphincter contraction lost

Management

• routine defacation at set times of day
• triggered by enema, digital stimulation, postural changes or abdo massage

Question 8

What are physical consequences of brain injury?

Answer 8

Pressure ulcers
Heterotropic ossification 
Pain
Neuroendocrine dysfunction
fatigue 
Epilepsy

Question 9

What are cognitive/behavioural consequences of brain injury?

Answer 9

Memory/concentration difficulties
Executive dysfunction
Mood changes
Disinhibition
Sleep disorders