Rehabilitation Medicine Flashcards
What is the ICF?
International classification of functioning, disability and health
What is the ICF definition of capacity?
A person’s fullest potential
What is the ICF definition of performance?
The level a person is currently at
What is the ICF definition of impairment?
When a person’s bodily functions are reduced
What is the ICF definition of activity?
Activities of daily living e.g. walking, cooking a meal, driving a car etc.
What is the ICF definition of activity limitation?
When a person cannot perform certain activities
What is the ICF definition of participation?
Participating in society the way the person wants
What is the ICF definition of participation restriction?
When participation is lost/reduced
What is the ICF definition of rehabilitation?
Development of a person to their fullest potential, within the limitations of their underlying condition & the resources available
What is the REPAIR model?
MDT approach to identifying interventions that could take place to enable rehabilitation
What areas make up the REPAIR model?
Review of pathology/impairment Environment Participation Activity Important others Risk
What is an orthosis?
Externally applied device used to control motion of a body segment
What are the common indications for lower limb amputation?
Dysvascularity (73%)
Infection (8%)
Trauma (7%)
Neoplastic disease (3%)
What are the two major amputation levels?
Transfemoral (above-knee, common in severe vasc)
Transtibial (below-knee, twice as common)
What is the goal of amputation?
Amputate at most distal level to remove diseased tissue while preserving functional residual limb length & creating the best environment for the rapid return of mobility/function
How many patients will walk post amputation?
Transtibial (70%)
Transfemoral (40%)
What is stump pain?
Pain in residual portion of limb
-resolves w/ wound healing (70-85%)
What is phantom pain?
Painful sensation of missing limb
- occurring in 55-85%
- develops a few days post amputation
- usually improves w/ time
What are the management options for phantom pain?
Prevention = pre-op epidural
Antidepressants/established anticonvulsants
Massage of contralateral limb
Psychological support
What is a prosthesis?
A device which replaces a missing limb or segment
What factors determine suitability for prosthetic rehabilitation?
Cognitive ability Motivation Expectations/goals Physical strength Co-morbidities
What are the associated complications of prosthesis?
Pressure sores Skin rashes/allergies Neuroma development Contralateral joint issues Poor pt acceptance
What is the ASIA?
Scoring system that helps determine whether a spinal cord injury is complete/incomplete
-assesses myotome/dermatome function
What factors suggest an incomplete spinal cord injury?
Preservation of myotome/dermatome function in S4/S5
- anal tone/feeling of pressure
- potential for recovery
What is the Barthel Index?
Scale used to assess performance in 10 ADLs, including feeding, grooming, transfers & mobility
What is neurogenic bladder?
Bladder dysfunction due to neurological damage
-presents w/ a range of sx
What type of bladder problem does injury above T12 cause?
Reflex/spastic bladder
What is a reflex/spastic bladder?
Autonomic control but no voluntary control
-bladder contracts when reaching a certain level of fullness
How should a reflex/spastic bladder be managed?
Regular tapping/intermittent catheterisation
What type of bladder problem does injury below L1 cause?
Flaccid (acontractile) bladder
What is a flaccid bladder?
No bladder tone
Looks like overflow incontinence
How should a flaccid bladder be managed?
Intermittent self-catheterisation
What is neurogenic bowel?
Bowel dysfunction due to neurological damage
-presents w/ a range of sx
What type of bowel problem does injury above T12 cause?
Reflex bowel
What is reflex bowel?
Feeling of rectal fullness lost
-reflex movements causing bowel emptying at inconvenient times
What type of bowel problem does injury below L1 cause?
Areflexic bowel
What is areflexic bowel?
Defecation reflex & sphincter contraction lost
How are reflex & aflexic bowel managed?
Keep correct stool consistency Routine defecation at set times of the day -enema -digital stimulation -postural changes -abdominal massage
What is Autonomic Dysreflexia?
Potentially dangerous clinical syndrome, developing in individuals w/ spinal cord injury at T6 or above. Results in acute, uncontrolled HTN due to sympathetic overactivity
What can cause Autonomic Dysreflexia?
Any noxious stimulation below level of injury
What are the sx of Autonomic Dysreflexia?
Pounding headache
Sweating
Blotching of skin (above injury)
Cold, clammy skin (below injury)
What are the signs of Autonomic Dysreflexia?
HTN (200/100)
Bradycardia
What is a pressure ulcer?
Localised injury to skin/underlying tissue, usually over a bony prominence as a result of pressure +/- shear
What are the four grades of pressure ulcers?
Grade 1 = Non-blanching erythema
Grade 2 = Partial thickness skin loss
Grade 3 = Full thickness skin loss
Grade 4 = Full thickness tissue loss
What are the intrinsic risk factors for pressure ulcers?
Sensory impairment Malnutrition Immobility Vascular disease Multiple co-morbidities
What are the extrinsic risk factors for pressure ulcers?
Pressure
Shear
Friction forces
What are the exacerbating risk factors for pressure ulcers?
Skin moisture
Medications (diuretics/steroids)
What is the SSKIN bundle?
Five-step model to promote pressure ulcer prevention
- surface
- skin inspection
- keep moving
- incontinence/moisture
- nutrition/hydration
What are the common causes of brain injuries?
Trauma Stroke Tumour Infection Hypoxia Drugs/alcohol
How are traumatic brain injuries classified?
Mild - GCS 13-14, LoC <15mins
Mod - GCS 8-12, LoC <6hrs
Sev - GCS <8, LoC >6hrs
What are the physical consequences of brain injuries?
Pressure ulcers Heterotropic ossification Pain Neuro-endocrine dysfunction Fatigue Epilepsy
What are the cognitive-behavioural consequences of brain injuries?
Memory/concentration difficulties Executive dysfunction Mood changes Disinhibition Sleep disorders
