Rehabilitation medicine

Question 1

what the definition of capacity in rehabilitation medicine

Answer 1

a persons full potential

Question 2

what the definition of performance in rehabilitation medicine

Answer 2

the level a person is at currently

Question 3

what the definition of impairment in rehabilitation medicine

Answer 3

when a persons body functions are reduced

Question 4

what is the definition of activity limitation in rehabilitation medicine

Answer 4

when a person cannot perform certain activities

Question 5

what the definition of participation restriction in rehabilitation medicine

Answer 5

when the ability to participate in a society the way a person wants is lost or reduced

Question 6

what is the repair model of rehabilitation

Answer 6

Review of pathology and impairment
What comorbidities are there
What systems do they effect

Environment
What physical environment does the person live/work in
What societal and legislative environments do people live in
How do these interact with their condition

Participation
What are the persons roles and goals
Whats important to them

Activity
How does the person do their ADLs

Important others
Who is important to the person
How do these people impact on the condition

Risk
From your knowledge what future risks are there and how can they be avoided

Question 7

whats the definition of assistive technology

Answer 7

Technology used by individuals with impairments to help them improve performance closer to their capacity

Examples:
Orthoses
External devices
Used to control the movement of a body segment
Usually compensating for weakness, due to muscles or dynamic deformities

Walking aids
Canes
Walkers

ADL-assisters
Usually used by OTs to help with many ADLs

Question 8

what are common reasons for amputation

Answer 8

Dysvascularity – 73%

Infection – 8%

Trauma – 7%

Neoplastic disease – 3%

Question 9

what are the common locations for amputations

Answer 9

Transfemoral - ‘above knee’ (33%)
Commonly for more severe vascular disease
40% walk afterwards

Transtibial - ‘below knee’ (67%)
Markedly reduced peri-operative mortality
70% walk afterwards

Question 10

what are the common post-amputation painissues

Answer 10

Stump Pain

Phantom Pain

Question 11

what are the features of stump pain

Answer 11

Pain in residual portion of limb

Generally resolves with would healing

15-30% report persistent pain despite apparent wound healing

Pathophysiology unclear

Question 12

what are the features of phantom pain

Answer 12

Painful sensation in the missing limb

55-85% feel this

Develops a few days after the amputation and usually improves over time – but may be permanent

Question 13

what is the treatment for phantom pain

Answer 13

Antidepressants/anticonvulsants

Massage of contralateral limb

Psychological support

pre-op epidural has been shown to also be effective

Question 14

what are the complications of prostheses in post-amputation rehab

Answer 14

Pressure sores

Skin rashes

Allergies

Neuromas

Contralateral joint issues

Poor patient acceptance

Question 15

why isnt hopping post leg amputation promoted

Answer 15

Falls potential

Joint degeneration on hopping side

Increased chance of diabetic neuropathy

Question 16

whats the incidence of depression/anxiety in amputees

Answer 16

75%

Question 17

what is a global screening tool for spinal cord injury

Answer 17

ASIA Index

Scoring system used to determine if a spinal cord injury is complete or not

Myotome/dermotome function recorded In the upper/lower limb

Preservation of myo/dermotome function in S4/5 represents an incomplete spinal cord injury with potential for recovery

Doesn’t give a one number score, used to measure progress mostly

Question 18

what is the barthel index

Answer 18

measurement of disability

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

Each aspect is rated out of 10 or 15 depending on the level on independence

Question 19

what is neurogenic bladder

Answer 19

bladder dysfunction due to neurological damage

Question 20

what happens to bladder function in spinal injuries above T12

Answer 20

Reflex bladder

No voluntary control but some autonomic control

Bladder contracts when reaching a certain level of fullness

Question 21

how do you manage reflex bladder

Answer 21

Tapping – tapping suprapubicaly to stimulate the autonomic reflex

Intermittent catheterisation

Question 22

what happens to bladder function in spinal injuries below L1

Answer 22

Leads to a flaccid/acontractile bladder

No tone

Clinically mimics overflow incontinence

Managed by intermittent self catheterisation

Question 23

what is neurogenic bowel

Answer 23

abnormal bowel function due to spinal cord injury

Question 24

what happens to bowel function in spinal injuries above T12

Answer 24

reflex bowel

rectal fullness feeling lost

causes bowel emptying at inconvenient times

Question 25

what happens to bowel function in spinal injuries below L1

Answer 25

areflexic bowel

defecation reflex and anal sphincter contraction lost

Question 26

how do you manage nerological bowel pathology

Answer 26

Management of both is keeping correct stool consistency with routine defecations at set times of the day, triggered by multiple methods : 
Enemas 
Digital stimulation 
Postural changes 
Abdominal massage

Question 27

what spinal level damage leads to autonomic dysreflexia

Answer 27

T6 or above

Question 28

what are clinical features of autonomic dysreflexia

Answer 28

Pounding headache, sweating, blotching of skin above injury, cold and clammy skin below

extremely high BP
Bradycardia