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Veterinärmedicinsk rehabilitering > Rehabilitering för neurologisk/kritiskt sjuk patient > Flashcards

Rehabilitering för neurologisk/kritiskt sjuk patient Flashcards

1
Q

Ge exempel på vanliga neurologiska sjukdomar där rehab kan behövas

A
  • Intervertebral disc disease (IVDD)*
  • Fibrocartilaginous embolism (FCE)* & Acute non-compressive nucleus pulposus extrusion (ANNPE)*
  • Feline aortic thromboembolism or saddle thrombus (FATE)
  • Caudal cervical spondylomyelopathyor Wobbler syndrome
  • Lumbosacral disease
  • Spondylosis
  • Degenerative myelopathy
  • Peripheral nerve injury
  • Trauma
  • Vestibular & balance disorders
  • Cancer/neoplasia
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2
Q

Vad är Intervertebral disc disease (IVDD) och vad kan det ge för symptom? Vilken typ av rehab kan vara lämplig här?

A

Vad?
-Degeneration with potential, eventual herniation of intervertebral disc resulting in compression of spinal nerve, nerve root, &/or spinal cord

Signs:

  • Pain, soreness, stiffness
  • Changes in/loss of sensation -> weakness/paralysis -> loss of deep pain
  • Tends to occur at “transitional” areas of spine

Rehab:

  • NMES
  • LLLT
  • Functional therapeutic exercises with facilitation techniques
  • Aquatic therapy (swimming  waterwalking)
  • Balance & proprioceptive therapeutic exercises
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3
Q

Vad är FIBROCARTILAGINOUS EMBOLISM (FCE) & ACUTE NON-COMPRESSIVE NUCLEUS PULPOSUS EXTRUSION (ANNPE) och vad kan det ge för symptom?

A
  • FCE: “spinal cord stroke,” a blood vessel feeding the spinal cord becomes blocked by a piece of cartilage originating from the intervertebral disc, causing neurons to malfunction
  • ANNPE: a portion of healthy intervertebral disc suddenly shoots out through its encasement and collides with the spinal cord at a high velocity, causing bruising of (& sometimes significant bleeding inside) the spinal cord

Signs:

  • Abrupt gait dysfunction (often when running or jumping)
  • Focal, asymmetric lesion
  • Rarely progresses after 12 hours
  • No spinal pain
  • Tends to improve over a few weeks
  • Poor prognosis, if no deep pain perception
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4
Q

Vilken rehab kan vara lämplig vid FIBROCARTILAGINOUS EMBOLISM (FCE) & ACUTE NON-COMPRESSIVE NUCLEUS PULPOSUS EXTRUSION (ANNPE)?

A
  • NMES
  • LLLT
  • Functional therapeutic exercises with facilitation techniques
  • Corrective manual therapies
  • Aquatic therapy (swimming  water walking)
  • Balance & proprioceptive therapeutic exercises
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5
Q

Vad är FELINE AORTIC THROMBOEMBOLISM (FATE)

AKA saddle thrombus, och vad kan det ge för symptom?

A

Vad?
Clot in left atrium, dislodged, & descends to ”saddle” (area where aorta meets iliac arteries) where circulation is blocked to one or both hind limbs

Signs (sudden):

  • Pain
  • Hyperventilation
  • Vocalization
  • Paralysis of hindlimb(s)
  • Temperature changes (cold paws)
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6
Q

Vad är målet med rehab av FELINE AORTIC THROMBOEMBOLISM (FATE), vilken typ av rehab kan vara lämplig?

A

• Goals

  • Restore circulation, sensation
  • Independent, symmetrical ”community ambulation” without ataxia, frequently monoparetic
  • Independent sit to stand
  • Independent ADL/”toileting”
  • Return to prior (or highest) level of function
  • Reduced compensatory movement strategies

• Strategies/Tactics

  • Manual therapies
  • NMES
  • LLLT
  • Functional therapeutic exercises with facilitation techniques
  • Corrective manual therapies
  • Aquatic therapy (swimming  water walking)
  • Balance & proprioceptive therapeutic exercises
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7
Q

Vilka symtom kan CAUDAL CERVICAL SPONDYLOMYELOPATHY OR WOBBLER SYNDROME ge?

A

• Signs

  • Mild ataxia of forelimbs progressing to weakness of hind limbs progressing to tetraplegia
  • Caudal cervical pain with flexed neck posture
  • Acute or slowly progressive
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8
Q

Vad är målet med rehab av CCSM eller wobblers, vilken typ av rehab kan vara lämplig?

A

Goals
• Independent ”community ambulation” without ataxia
• Independent down to sit to stand
• Independent ADL/”toileting”

Strategies/Tactics
• NMES
• LLLT
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (water walking), avoiding cervical extension
• Balance & proprioceptive therapeutic exercises

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9
Q

Vad är spondylos och vad kan det ge för symptom?

A

Vad?
Degeneration due to osteoarthritis of the vertebral column (ie. vertebral bodies, neural foramina, & facet joints)

Symptom:

  • Myelopathy
  • Global weakness
  • Gait dysfunction
  • Balance issues
  • Bowel & bladder issues
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10
Q

Vad är målen med rehab vid sponylos och vilken typ av rehab kan vara lämplig?

A

Goals
• Pain management
• Restore mobility/flexibility
• Independent ”community ambulation” without ataxia

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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11
Q

Vad är DEGENERATIVE LUMBOSACRAL STENOSIS och vad kan det ge för symptom?

A

Vad?
Narrowing of lumbosacral vertebral canal or intervertebral foramina -> compression of cauda equina or nerve roots

Signs:

  • Difficulty using pelvic limbs progressing to pelvic limb lameness, tail weakness, & incontinence
  • Pain on palpation or extension of LS joint
  • Proprioceptive deficits, muscle atrophy, with weak flexor reflexes in pelvic limbs
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12
Q

Vad är målen med rehab vid DEGENERATIVE LUMBOSACRAL STENOSIS och vilken typ av rehab kan vara lämplig?

A

Goals
• Pain management
• Restore mobility/flexibility, improve stability at LS region
• Independent ”community ambulation” without ataxia
• Continence
• Improve balance

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimmingor water walking)
• Balance & proprioceptive therapeutic exercises
• Stabilization exercises

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13
Q

Vad är målen med rehab vid perifera nervskador och vilken typ av rehab kan vara lämplig?

A 
Goals
•	Pain management
•	Restore active mobility
•	Protect weak limb
•	Independent functional mobility

Strategies/Tactics
• NMES
• LLLT
• Manual therapies (sensory stimulation)
• Assistive device fabrication/prescription
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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14
Q

Vad är DEGENERATIVE MYELOPATHY och vad kan det ge för symptom?

A

Vad?
Painless, chronic, slowly progressive, degenerative radiculomyelopathy

Signs

  • Pelvic limb paresis & ataxia progressing to thoracic limbs
  • Spinal reflexes normal or exaggerated
  • Progressing to flaccid tetraparesis & hyporeflexia (LMN signs)
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15
Q

Vad är målen med rehab vid DEGENERATIVE MYELOPATHY och vilken typ av rehab kan vara lämplig?

A

Goals
• Maintain independence with functional mobility
• Maintain independent ”community ambulation” without ataxia

Strategies/Tactics
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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16
Q

Vad är målen med rehab vid trauma (tex skalltrauma) och vilken typ av rehab kan vara lämplig?

A 
Goals
•	Pain management
•	Restore mobility/flexibility
•	Independent functional mobility & ”community ambulation”
•	Reduce risk of complications

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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17
Q

Vad är VESTIBULAR DISORDERS, symptom?

A

Vestibular system maintains balance, posture, orientation in space
Vestibular disease is a sudden, non-progressive disturbance in balance

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18
Q

Mål med rehab av VESTIBULAR DISORDER och vilken typ av rehab kan vara lämplig?

A

Goals
• Improve tolerance of upright postures (without ataxia or nystagmus)
• Restore active/independent mobilityoIndependent ”community ambulation” without ataxia
• Reduce head tilt

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Vestibular “procedures”
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercisesoStabilization exercises

19
Q

Mål med rehab vid cancer/neoplasi (tex i hjärnan), vilken rehab kan lämpa sig?

A

Goals
• Pain management
• Restore/maintain independent mobility
• Restore/maintain independent ”community ambulation”

Strategies/Tactics
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises
• Stabilization exercises

20
Q

Vad har UPPER MOTOR NEURON (UMN) för funktion?

A

UMN
• In cerebrum or brain stem
• Transmits signals down spinal cord (efferent)
• Reacts/responds to sensory input (afferent)

21
Q

Vad har lower motor neuron för funktion?

A

LMN
• In spinal cord or brain stem
• To cranial or peripheral nerves

22
Q

Vid utvärdering vid neurorehab, vad vill man observera av position, funktionell rörlighet samt rörelsemönster?

A

• Postures

  • Lateral
  • Sternal
  • Sitting
  • Standing
  • ADL (urination, defecation, grooming, eating, drinking)

• Functional mobility/independence

  • Rolling lateral to sternal
  • Recumbent to sitting
  • Recumbent to standing
  • Sitting to standing
  • ADL (in/out of car, on/off couch)

• Gait

  • Walk, trot, & gallop
  • Turn & circle
  • Sidestep
  • Back up
  • Wheelbarrowing, dancing, hemistanding, & hemiwalking
  • Stair climbing
  • Obstacle negotiation
  • Sport (run, fetch, jump)
23
Q

Komponenter inom position och rörelse?

A 
•	ROM
•	Flexibility
•	Muscle – strength, muscle tone, atrophy
•	Symmetry of postures & movement
•	Rotation of trunk & dissociation of limbs from trunk
•	Posture & Base of Support (BOS)
•	Motor control
•	Motor planning
-	Initiation of movement
-	Assume posture
-	Maintain posture
-	Transition to another posture
•	Balance
-	Static & dynamic
-	Stability & mobility
•	Coordination
•	Proprioception
24
Q

Nämn några spinal reflexes och postural reflexes?

A

Spinal:

  • Flexor or withdrawal reflex
  • Babinski reflex
  • Deep tendon reflexes

Postural:

  • Placing
  • Hopping
  • Righting
  • Eye reflex…
25
Q

Vad är PROPRIOCEPTION?

A

Awareness of position (kinesthesia) & movement (proprioception)

26
Q

Vad kan man göra för terapeutiska övningar inom neurorehab?

A 
•	Rolling
•	Assisted standing
-	Standing frame
-	Cart
-	Physioroll (lift weakest component over roll then roll to standing)
•	Standing balance
-	Physioroll
•	Gait training
-	Assistive devices (harness, slings…)
-	Hydrotherapy
•	Sit to stands
27
Q

Vad bör man tänka på vid val av assistive devices/hjälpmedel, vad finns att välja mellan?

A 
Consider:
•	Progression
•	Wear/use schedule
•	Fitting
•	Safety
Options:
•	Carts & standing frames
•	Slings &harnesses
•	Orthotics, splints & braces
•	Booties
•	Tape
28
Q

Vad vill man kommunicera till DÄ innan rehabpatient kommer hem/fortsatt rehab hemma?

A

• Controlled, restricted, or modified activity
- Eliminate running, jumping, slipping, sliding, playing as much as possible in early rehab
• Environmental modifications
• Orthotic, prosthetic, & assistive device instruction
• Body mechanics instruction
• Home exercise programs – make it fun, anpassa

29
Q

Vad bör man tänka angående anpassad miljö hemma för rehabpatient?

A
  • Flooring surfaces
  • Throw rugs
  • Yoga mats
  • Stair surfaces
  • Bedding
  • Ramps
  • Baby gates, kennels, corrals
30
Q

INDICATIONS FOR REHABILITATION IN CRITICAL CARE?

A

• Medically “stable”
• Hospitalized &/or immobilized >48 hours
• Presence of edema &/or swelling
• Presence of pain
• Wound
- Road rash, surgical wound, fecal/urinary scald/dermatitis, pressure sore/”injury”
• Multi-system involvement/instability (or potential for development)
• Requiring more continuous monitoring by staff

31
Q

COMMON CRITICAL CARE DIAGNOSES BENEFITTING FROM REHABILITATION?

A 
•	Geriatric
-	Dogs >7 years old
-	Cats >11 years old
•	“Table pets”
-	Patient on a ventilator or requiring more continuous monitoring by staff (ie. respiratory distress/failure)
•	Post-operative
-	Thoracotomy
-	Abdominal surgery
•	Multi-trauma or multi-system involvement/instability or potential
-	Hit by car
•	Pneumonia
•	Neurologic diagnosis
•	Orthopaedic diagnosis
32
Q

BE AWARE OF THESE PATIENT-SPECIFIC CONCERNS

A
  • The patient’s problem list
  • Any previous or current major body system instability
  • The potential for any deterioration or improvement in the patient’s disease process(es)
  • Potential disease-related complications that could develop
  • Possible adverse reactions to therapies
  • How improvement, deterioration, complications & adverse reactions are recognized
  • Vital sign “limits”
  • Ability to be treated in cage, out of cage, out of ICU/CCU, etc.
  • Mobility limitations
  • Precautions/contraindications
  • Can the patient be offered food or water?
  • Need for personal protective equipment (ie. gloves, mask, gown)
  • Pain status
  • Best time for rehabilitation sessions (ie. When is the patient medicated? When is the patient alert?)
33
Q

Vad finns det för konsekvenser vid immolisering för muskuloskeletala systemet?

A
  • Atrofi
  • Decreased muscle weight, sarcomere number, fiber area, aerobic capacityoLoss of muscle protein, decrease in protein synthesis rate, loss of muscle volume
  • If the muscle is in a “shortened” position, there is loss of sarcomere number & shortening of muscle length
  • Loss of calcium in bones
34
Q

Vad finns det för konsekvenser vid immolisering för INTEGUMENTARY SYSTEM (huden)?

A
  • Pressure, shear, friction
  • Sensory deficits
  • Malnutrition
  • Dehydration
  • Hypotension
35
Q

Vad finns det för konsekvenser vid immolisering för CARDIOVASCULAR/RESPIRATORY SYSTEM?

A
  • Reduction in functional capacity, changes in lung volume, atelectasis
  • Pooling of respiratory secretions, depressed cough reflex
  • Infection/pneumonia
  • Increase in pro-coagulation factor synthesis, fibrinolysis
  • Reduced thromboplastin time
  • Decrease in RBC
  • Reduced excretion cycle of sodium, calcium leaches from bone, impaired renal excretion of calcium
  • Blood volume increases to cranium & thorax
36
Q

Vad finns det för konsekvenser vid immolisering för ENDOCRINE SYSTEM?

A 
Disruption in:
•	Circadian rhythms 
•	Insulin cycles (resulting in glucose intolerance)
Reduction in:
•	Activity of pancreas
•	Androgen levels
Increase in:
•	Thyroid hormone activity
37
Q

Vad finns det för konsekvenser vid immolisering för GASTROINTESTINAL SYSTEM?

A
  • Anorexia
  • Suppression of gastric secretions
  • Reduction in peristalsis
38
Q

Vad finns det för konsekvenser vid immolisering för immunsystemet?

A
  • Impairment in T-cell activity
  • Slowing of neutrophilic phagocytosis
  • Pooling of secretions (increasing risk of bacterial colonization)
39
Q

Rehabtekniker vid immobilisering?

A

Initially
• PROM
• Stretching
• Positional changes (turning every 4-6 hours)

Progressing to
•	AROM
•	Therapeutic exercise (with support)
•	Functional mobility activities (with support)
•	Gait activities (with support)
40
Q

Vad är syftet med att jobba med positionering vid rehab, vilka hjälpmedel kan vi använda?

A

Mål:
• Prevention of pressure “injury”
• Improved circulation
• Improved respiratory function

Modaliteter:
• Foam cushions, air/water-filled cushions, tempurpedic cushions, blankets, pillows, & bolsters

41
Q

Vad kan vi använda för rehabtekniker vid pain management?

A

• Positioning changes, PROM, retrograde massage, LLLT, kinesiology taping, IFC, PEMF, etc

42
Q

Vad vill vi göra med respiratorisk rehab (mål) samt hur?

A

Goals
• Assist in elimination of secretions
• Re-expand lung segments
• Reduce incidence of pneumonia

Includes
•	Positioning/postural drainage – in general, head down 20 degrees from horizontal will increase drainage by 40%
•	Supplemental oxygen &/or nebulizer
•	Percussion/coupage
•	Vibration
•	Cough stimulationo +/-suction
43
Q

Vad är PERCUSSION/COUPAGE TECHNIQUE och hur görs det?

A

Vad?
Pressure wave created can help to loosen excess secretions from lungs

Technique:
• Position in postural drainage position
• Place a towel or sheet over chest as buffer
• Hands in “cup” shape (fingers & thumb close together)oWrists loose, flex & extend
• Pat chest rhythmically, alternately (if chest is large enough) for 30-60 seconds
• Add vibration (shaking chest wall during expiration) at end of percussion session for 4-6 expirations
• Attempt to stimulate cough at the end of a cycle

44
Q

Viktigt vid rehab av kritiskt sjuk patient?

A
  • Team approach & communication is critical
  • Do no harm
  • Monitor, document, assess, reassess
  • Consider the whole patient
  • Go slow

Veterinärmedicinsk rehabilitering (13 decks)

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