Rehabilitation Medicine

Question 1

What is rehabilitation medicine? (4 types)

Answer 1

A medical speciality

• Neurological rehabilitation
• Spinal cord injury rehabilitation
• Limb loss or deficiency rehabilitation and prosthetics
• Musculoskeletal rehabilitation

Question 2

What is rehabilitation medicine about?

Answer 2

Medical conditions or injuries that can impair and disable

• Prevention
• Diagnosis
• Treatment
• Rehab management

Question 3

Key Principles of Rehab Medicine

Answer 3

Patient centred, goal orientated, multi and inter disciplinary, holistic
Can be applied to any age
Aims usually are to:
- Increase participation and function
- Reduce dependance / promote independence
- Prevent and manage complications / consequences
- Improve quality of life

Question 4

International Classification of Functioning, Disability and Health (ICF) - what is it?

Answer 4

The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors.

ICF is the WHO framework for measuring health and disability at both individual and population levels.

Question 5

ICF applied to stroke

Answer 5

Question 6

Person with acquired brain injury

• Incontinence
• Fatigue
• Communication/language - aphasia, alexia, acalculia, agraphia, cognitive-communication disorder
• Cognitive impairment - memory, attention, executive function
• Weakness - limb, trunk, facial swallow
• Spasticity - limb trunk
• Sensory and perceptual impairment - tactile sensation, proprioception/joint position sense, visual impairment

Answer 6

• Incontinence
• Fatigue
• Communication/language - aphasia, alexia, acalculia, agraphia, cognitive-communication disorder
• Cognitive impairment - memory, attention, executive function
• Weakness - limb, trunk, facial swallow
• Spasticity - limb trunk
• Sensory and perceptual impairment - tactile sensation, proprioception/joint position sense, visual impairment

Question 7

Incontinence

• Infections
• Skin breakdown
• Dignity - may affect mental health
• Activities - require assistance to toilet/ commode/ change pads and catheter care
• Participation - limit participation in rehab - less independence, restricted to home environment

Answer 7

• Infections
• Skin breakdown
• Dignity - may affect mental health
• Activities - require assistance to toilet/ commode/ change pads and catheter care
• Participation - limit participation in rehab - less independence, restricted to home environment

Question 8

Neurogenic control of bladder

Answer 8

Question 9

Goal setting in rehab - be able to go home

• Manage … in home environment
• predictably open bowels … a day in mornings, with fewer than 1 episode of bowel incontinence per week by date x / within next 4 weeks
• diet, laxatives, location, abdo massage, diet, morning routine, assisstance required, suppositories

Answer 9

• Manage incontinence in home environment
• predictably open bowels once a day in mornings, with fewer than 1 episode of bowel incontinence per week by date x / within next 4 weeks
• diet, laxatives, location, abdo massage, diet, morning routine, assisstance required, suppositories

Question 10

Goal setting in rehab - be able to go home

• Manage … in home environment
• predictably open bowels … a day in mornings, with fewer than 1 episode of bowel incontinence per week by date x / within next 4 weeks
• diet, laxatives, location, abdo massage, diet, morning routine, assisstance required, suppositories

Answer 10

• Manage incontinence in home environment
• predictably open bowels once a day in mornings, with fewer than 1 episode of bowel incontinence per week by date x / within next 4 weeks
• diet, laxatives, location, abdo massage, diet, morning routine, assisstance required, suppositories

Question 11

“Care for my affected arm without pain”

• … pain - desensitisation, medication
• … pain - support/ splint, exercises, ultrasound + injections, medication
• … - stretches, splinting, medication, botulinum toxin injections
• Washing and dressing technique
• Positioning in standing/transfers /sitting /lying

Answer 11

• Neuropathic pain - desensitisation, medication
• MSK pain - support/ splint, exercises, ultrasound + injections, medication
• Spasticity - stretches, splinting, medication, botulinum toxin injections
• Washing and dressing technique
• Positioning in standing/transfers /sitting /lying

Question 12

“Care for my affected arm without pain”

• Neuropathic pain - …, medication
• MSK pain - support/ splint, exercises, ultrasound + injections, medication
• Spasticity - stretches, splinting, medication, … toxin injections
• … and … technique
• … in standing/transfers /sitting /lying

Answer 12

• Neuropathic pain - desensitisation, medication
• MSK pain - support/ splint, exercises, ultrasound + injections, medication
• Spasticity - stretches, splinting, medication, botulinum toxin injections
• Washing and dressing technique
• Positioning in standing/transfers /sitting /lying