WCS11 Rehabilitation Medicine Flashcards
Sequelae after acute illness
Acute medical intervention
—>
1. Complete recovery
2. Residual permanent impairment (Functional + Disability)
—> Rehabilitation intervention
—> Mild / Moderate / Severe
Old classification of events after illnesses
- Impairment
- Disability
- Handicap
Rehabilitation
Combined + Coordinated use of medical, educational, vocational measures for ***training / retraining the individual to the highest possible level of functional ability
Rehabilitation medicine
- Medical specialty
- deals with human functioning:
—> evaluation
—> diagnosis
—> intervention - minimise functional loss due to sequalae of diseases
Other names:
- Physical and Rehabilitation Medicine (PRM)
- Physical Medicine and Rehabilitation (PMR)
- Physiatry
Model of the ICF (International Classification of Function, Disability and Health)
Health condition (Disorder / Disease) has effect on:
—> Impairment
—> Activity
—> Participation
All subject to Contextual factors: Environmental + Personal
Impairment
Loss / Abnormality of Structure / Physiological / Psychological function
E.g. Loss of limb, vision etc.
Activity
Nature and Extent of functioning at the level of person
Activities may be limited in nature, duration, quality e.g. taking care of itself
Participation
Nature and Extent of a person’s involvement in life situations in relation to
1. Impairment
2. Activities
3. Health conditions
4. Contextual factors (Environmental + Personal)
Participation may be restricted in nature, duration, quality e.g. participation in community activities
Medical Therapeutic models
- Biomedical model
- classical medical therapeutics direct treatment at the ***cause of disease - Biopsychosocial model
- rehabilitation produces multiple simultaneous interventions addressing both the **cause + **secondary effects of injury and illness
Matrix organisation for rehabilitation team
Rehabilitation physician (at centre)
- Nurse
- Physiotherapist
- Clinical psychologist
- Pharmacist
- Medical social worker
- Occupational therapist
- Speech therapist
- Other medical specialists
Rehabilitation vs Habituation
Rehabilitation:
- Adaptation of a new set of skills to survive
- Change of habits and behaviours after an event
Habituation:
- Accustoming to an environment (not new)
- e.g. congenital disease
***Phases in rehabilitation process
Phase 1: Evaluation —> Diagnosis + Functional limitation
Phase 2: Treatment to arrest pathophysiology process
**Phase 3: Therapy to enhance organ function
**Phase 4: Task reacquisition
Phase 5: Environmental modification
Phase 1: Evaluation —> Diagnosis + Functional limitation
Evaluation:
1. Medical history
2. Knowledge of patient’s personal life tasks, roles, aspirations
3. Quantify individual effects of disablement
4. Function and Participation —> ADL
ADL (activities of daily living)
Basic (Barthel index (BI) (total score 100), FunctionaI Independence Measure (FIM), WeeFIM):
- Personal hygiene
- Grooming
- Feeding
- Toileting
- Transfer
- Ambulation
- Stair climbing
Advanced / Instrumental (FAM, Pediatric Evaluation of Disability Inventory (PEDI)):
- Shopping
- Driving
- Gardening
Phase 2: Treatment to arrest pathophysiology process
Example:
- Spasticity
—> Botox injection
—> Phenol motor point block
- Contracture
—> Stretching exercise
—> Surgical release
***Phase 3: Therapy to enhance organ function
Example:
Therapeutic exercise
- Muscle strengthening
- Isometric exercise (constant distance) (凌空凳)
- Isotonic exercise (constant force) (Biceps dumbbell raise)
- Isokinetic exercise (constant velocity) (踩單車) —> most effective for individual muscle - CVS conditioning
- Therapeutic training for neurological patients (Neuroplasticity)
Isometric exercise (constant distance)
- Generation of muscular force ***without visible joint movement
- External resistance ***not overcome by internal force generation
- E.g. hand press, static knee extension
- Benefit for those who have joint ***immobilised in a cast
- Caution in ***hypertensive
Isotonic exercise (constant force)
Generation of muscular force ***with visible joint movement
- variable speed
- constant external force
E.g. push-up, sit-up, Thera-band
More appropriate for ***home exercise programme
Isokinetic exercise (constant velocity)
Generation of muscular force **with visible joint movement
- constant speed
- **variable external force
Can generate ***maximal force throughout its length-tension curve —> most effective for individual muscle
- E.g. Cybex machine
Only in gym / physiotherapy department
CVS conditioning
ALL individuals
- >40
- Hypertension
- Smoking
- Hypercholesterolaemia
- History of coronary artery disease
First undergo graded exercise test
Type of activity:
- **Aerobic exercise
- **Resistive exercise
- Supervised by therapist
- Teach proper techniques, including monitoring HR + Rate Perceived Exertion (RPE)
- Training heart rate: (220-Age) x 50-85% for effect
ACSM guideline for CVS conditioning
- 3-4 times per week
- 20-30 mins
- intensity: 50-85% VO2 max (moderate intensity), 50-85% HRR max
- other components:
—> warm up 5-10 mins
—> stretching
—> cool down 5-10 mins
***Benefits: HIIT (high >90%) vs MICT (moderate)
Direct better cardiac function:
- VO2 at ventilators threshold
- LV size, function
- Diastolic volume
Indirect improvement:
- Insulin sensitivity
- HDL cholesterol
- BP
Therapeutic training for neurological patients (Neuroplasticity)
Neural injury
—> Behaviour adaptations
—> **Bottom-up Training
—> **Biochemical responses (e.g. 2nd messenger, tropic factors, metabolic changes)
—> **Structural responses (e.g. regeneration, axon sprouting, dendritic pruning)
—> **Physiological responses (e.g. facilitation, potentiation, habituation, conditioning, denervation supersensitivity)
—> New behaviour adaptations (Rehabilitated)
Functional MRI to evaluate neuroplasticity
Phase 4: Task reacquisition
Total person adaptive techniques for ***residual permanent impairment + functional limitation
Example
- Compensation techniques e.g. hemiparesis
- Adaptive devices
- **Orthosis: Ankle and Foot Orthoses (AFOs) for Foot drop
- **Prosthesis
