Rehabilitation Medicine Flashcards
What is rehabilitation?
A two way interactive process between the disabled person and others to achieve their optimum physical, psychological, social and vocational well being.
The restoration of structure, function, self- confidence and self-esteem.”
Interactive process
Restoration of physical, psychological, social, self confidence, self esteem.
What psychosocial factors can affect rehab?
Injury is a source of stress and psychological factors are important in rehabilitation and recovery
Rehabilitation is ongoing process in which stressors are continuously appraised and responded to
External and internal resources influence coping and adjustment
Various psychological models predict adherence
Draw out leys model of adherence,
Theory of reasoned action/planned behaviour
The self regulatory model
Stages of Change Model
PLEASE LEARN THE PSYCHOLOGICAL RESPONSE TO INJURY MODEL (DRAW IT OUT)
It is important to engage the patient rather than the theory.
Thinking abou the THE PSYCHOLOGICAL RESPONSE TO INJURY MODEL .. list the things involved/
Personal Factors:
Injury and prognosis e.g. amputation, spinal injury
Demographic e.g. gender, age, socioeconomic status
Psychological e.g. tough mindedness, pain tolerance, task involvement (Brewer,2001)
Situational factors:
Social support – how much the injury impacts on support available; types and timing: too much support? (Evans, 1998)
Social attitudes – sports, combat injury?
Economic situation and financial concerns
Employment – career ending injury
Physical environment- e.g. use of wheelchair?
Cognitive Appraisal:
Belief and faith in the medical team
Controlled cognition and appraisal/response to stressors
Ability to adjust
Attribution theory: “those that look at past success and failures will shape their future”
Avoidant/Approach Coping mechanisms.
Behavioural:
Concordance with the Treatment
Emotional:
Depression over time
Anxiety and develop avoidance behaviours
Mood affected
Denial, Anger, Bargaining, Depression, → eventual acceptance.
How can Tx be optimised?
3 things that are the most important
By there being partnership between patient and MDT- concordance
- Recognise cognition, emotion, social functioning and behaviour are inter-linked and should be addressed in rehabilitation process- individualised care. (it is important that you do not just take into account the physical needs of the patient but these also.
- Utilise technological advances eg prosthetics
- Use goal setting in planning and implementation (SMART goals, what does the pt want?)
•On-going:
monitoring of outcomes
promotion of adherence
use of psychological interventions
•No one model or framework addresses all problems → it’s about ENGAGING the pt.
Why monitor Rehab (draw model)
- Rehabilitation progress needs to be regularly monitored
- MDT feedback improvements – increases confidence and motivation of the pt
- Can modify programme to accommodate problems identified by team or patient
- Counter-productive behaviour can be modified and problems in motivation addressed
By making subjective and objective assessments, you can evaluate the outcomes of the patients and their perception of the outcomes.. This will help to maximise the intrinsic motivation and adherence, but it may also frustrate them if they don’t think they are achieving.
Why is promoting adherence important?
Poor adherence – may have an adverse effect on recovery?
Problems of under and over-adherence - accurate appraisal of severity important ( you don’t want them to think they gonna walk again if they ain’t!)
Measurement- What is patient adhering to?
Adherence higher in supervised settings with opportunities for social comparison
Setbacks trigger re-appraisal as they will impact on mood, perceptions of progress and adherence.
What is CBT and why may it be useful?
Helps challenege rational and irrational beliefs pt may have
Able to give yourself SELF WORTH
Reduces Anxiety and Depression
What is SMARTER GOALS?
SPECIFIC
MEASURABLE
ATTAINABLE
REALISTIC
TIME BASED
EVALUATED
RECORDED
(helps w/ e.g. amuptee process)
Things to take from this lecture:
THINGS TO TAKE FROM THIS LECTURE:
- Understanding the patient perspective is important in the planning of effective rehabilitation.
- Rehabilitation can be optimised by the inclusion of psychological interventions (psychological intervention, motivation and promotion of adherence)
- A multi-disciplinary approach to rehabilitation is important in the promotion of patient adjustment and well-being
