Rehabilitation medicine Flashcards
what the definition of capacity in rehabilitation medicine
a persons full potential
what the definition of performance in rehabilitation medicine
the level a person is at currently
what the definition of impairment in rehabilitation medicine
when a persons body functions are reduced
what is the definition of activity limitation in rehabilitation medicine
when a person cannot perform certain activities
what the definition of participation restriction in rehabilitation medicine
when the ability to participate in a society the way a person wants is lost or reduced
what is the repair model of rehabilitation
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
whats the definition of assistive technology
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
what are common reasons for amputation
Dysvascularity – 73%
Infection – 8%
Trauma – 7%
Neoplastic disease – 3%
what are the common locations for amputations
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
what are the common post-amputation painissues
Stump Pain
Phantom Pain
what are the features of stump pain
Pain in residual portion of limb
Generally resolves with would healing
15-30% report persistent pain despite apparent wound healing
Pathophysiology unclear
what are the features of phantom pain
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
what is the treatment for phantom pain
Antidepressants/anticonvulsants
Massage of contralateral limb
Psychological support
pre-op epidural has been shown to also be effective
what are the complications of prostheses in post-amputation rehab
Pressure sores
Skin rashes
Allergies
Neuromas
Contralateral joint issues
Poor patient acceptance
why isnt hopping post leg amputation promoted
Falls potential
Joint degeneration on hopping side
Increased chance of diabetic neuropathy
whats the incidence of depression/anxiety in amputees
75%
what is a global screening tool for spinal cord injury
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
what is the barthel index
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
what is neurogenic bladder
bladder dysfunction due to neurological damage
what happens to bladder function in spinal injuries above T12
Reflex bladder
No voluntary control but some autonomic control
Bladder contracts when reaching a certain level of fullness
how do you manage reflex bladder
Tapping – tapping suprapubicaly to stimulate the autonomic reflex
Intermittent catheterisation
what happens to bladder function in spinal injuries below L1
Leads to a flaccid/acontractile bladder
No tone
Clinically mimics overflow incontinence
Managed by intermittent self catheterisation
what is neurogenic bowel
abnormal bowel function due to spinal cord injury
what happens to bowel function in spinal injuries above T12
reflex bowel
rectal fullness feeling lost
causes bowel emptying at inconvenient times
what happens to bowel function in spinal injuries below L1
areflexic bowel
defecation reflex and anal sphincter contraction lost
how do you manage nerological bowel pathology
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
what spinal level damage leads to autonomic dysreflexia
T6 or above
what are clinical features of autonomic dysreflexia
Pounding headache, sweating, blotching of skin above injury, cold and clammy skin below
extremely high BP
Bradycardia
