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CFB > WCS11 Rehabilitation Medicine > Flashcards

WCS11 Rehabilitation Medicine Flashcards

1
Q

Sequelae after acute illness

A

Acute medical intervention
—>
1. Complete recovery
2. Residual permanent impairment (Functional + Disability)
—> Rehabilitation intervention
—> Mild / Moderate / Severe

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2
Q

Old classification of events after illnesses

A
  1. Impairment
  2. Disability
  3. Handicap
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3
Q

Rehabilitation

A

Combined + Coordinated use of medical, educational, vocational measures for ***training / retraining the individual to the highest possible level of functional ability

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4
Q

Rehabilitation medicine

A
  • 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

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5
Q

Model of the ICF (International Classification of Function, Disability and Health)

A

Health condition (Disorder / Disease) has effect on:
—> Impairment
—> Activity
—> Participation

All subject to Contextual factors: Environmental + Personal

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6
Q

Impairment

A

Loss / Abnormality of Structure / Physiological / Psychological function

E.g. Loss of limb, vision etc.

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7
Q

Activity

A

Nature and Extent of functioning at the level of person

Activities may be limited in nature, duration, quality e.g. taking care of itself

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8
Q

Participation

A

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

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9
Q

Medical Therapeutic models

A
  1. Biomedical model
    - classical medical therapeutics direct treatment at the ***cause of disease
  2. Biopsychosocial model
    - rehabilitation produces multiple simultaneous interventions addressing both the **cause + **secondary effects of injury and illness
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10
Q

Matrix organisation for rehabilitation team

A

Rehabilitation physician (at centre)
- Nurse
- Physiotherapist
- Clinical psychologist
- Pharmacist
- Medical social worker
- Occupational therapist
- Speech therapist
- Other medical specialists

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11
Q

Rehabilitation vs Habituation

A

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

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12
Q

***Phases in rehabilitation process

A

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

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13
Q

Phase 1: Evaluation —> Diagnosis + Functional limitation

A

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

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14
Q

ADL (activities of daily living)

A

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

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15
Q

Phase 2: Treatment to arrest pathophysiology process

A

Example:
- Spasticity
—> Botox injection
—> Phenol motor point block

  • Contracture
    —> Stretching exercise
    —> Surgical release
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16
Q

***Phase 3: Therapy to enhance organ function

A

Example:
Therapeutic exercise

  1. 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
  2. CVS conditioning
  3. Therapeutic training for neurological patients (Neuroplasticity)
17
Q

Isometric exercise (constant distance)

A
  • 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
18
Q

Isotonic exercise (constant force)

A

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

19
Q

Isokinetic exercise (constant velocity)

A

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

20
Q

CVS conditioning

A

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
21
Q

ACSM guideline for CVS conditioning

A
  • 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
22
Q

***Benefits: HIIT (high >90%) vs MICT (moderate)

A

Direct better cardiac function:
- VO2 at ventilators threshold
- LV size, function
- Diastolic volume

Indirect improvement:
- Insulin sensitivity
- HDL cholesterol
- BP

23
Q

Therapeutic training for neurological patients (Neuroplasticity)

A

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

24
Q

Phase 4: Task reacquisition

A

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

25
Q

Phase 5: Environmental modification

A

Environmental enhances (physical, psychological, social, political) to reduce functional limitations

26
Q

Practical approach in clinical rehabilitation

A

Evaluation
—> Planning (goal setting)
—> Intervention (care + treatment)
—> Discharge planning / Family conference
—> Re-evaluation

27
Q

Psychosocial intervention

A

Mainly in outpatient setting
1. Personal
- mood
- depression
- maladapted behaviour
- social interaction
2. Opportunities to occupy him/herself
3. Ability to adapt to change
4. Family and caregiver
- behaviour and expectation of family and significant others

CFB (43 decks)

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