Week 1 Flashcards
Approach to neurorehab 1900
orthopedic approach
corrective exercise and muscle re-education
focus on structural anatomy and principles of exercise
Emphasis placed on regaining function by compensating with unaffected limb
Approach to neuro rehab 1950
Neurofacilitation approach = physiotherapist moving patients through patterns of movement
patient passive recipient
Approach to neuro rehab 1980
Therapeutic approaches of Bobath and Knott and Voss dominated
improved access to scientific literature, physiotherapy postgraduate courses and technology resulted in an increase in clinically relevant research related to movement (biomechanics and neuroscience)
Experimental work focused on how humans acquire skill in movement (motor learning) muscle biology, muscle adaptability and psychology
Carr and Shepherd proposed motor learning approach
Conflicts in clinical practice due to substantial differences in theories and approaches
Evidence based practice increasingly emphasised
Approach to neurorehab 1990
therapeutic approach of Bobath dominated in australia
Hybridisation
-integration of new methods with old at times of major change
-attractive when there is a reluctance to let go of familiar therapeutic methods
-competing theories have philosophical and conceptual differences
Increasing preference for motor learning
- patients active participants in rehab
skill is task specific - task orientated training
goal attainment
approach to neurorehab 2000
Motor learning approaches =skill acquisition
patient active recipient
Approach to neurorehab 2010
Pragmatic eclectic approach = EBP
EBP
select treatment components based on assessment and consideration of the physios skills and expertise
implement evidence based rehab with critical evaluation and awareness of the current evidence that demonstrates that no one approach is superior to any other
EBP cont’
neurorehab using a mix of components from different approaches, is effective for recovery of function and mobility
treatment sessions of 30-60 mins five to seven days a week provide beneficial effect, with more frequent sessions providing added benefit
early intervention is important
no one approach to physical rehab is more or less effective in promoting recovery of function and mobility
EBP cont’ 2
Fundamental principles
- patient centred care
- goal setting
- task specificity
- exercise
Physiotherapy assessment
first, most important step in the rehab
- clinical reasoning will be based and upon which decision is reliant
efficacy of treatment can only be as good as the assessment on which it is based
ongoing and continuous process which leads to the identification of patient problems, setting of patient centred goals and ultimately a tailor made treatment plan for the individual
Holistic assessment
clinical presentation of a patient with neurological deficit is likely to be multifaceted due to the complexity of the nervous system
consideration of the patient as a whole during assessment (and treatment) is imperative to a successful outcome
ICF promotes a framework for a comprehensive assessment of the individual, providing a holistic view of health from biological, individual and social perspectives
PT Ax
evidence of best practice related to assessment protocols is limited
by convention, as per other core physiotherapy areas, neurological assessment is divided into two sections
- subjective assessment
-objective assessment
ICF framework should be utilised as basis to ensure all aspects of the patient are considered
Subjective Examination overview
involves gaining information about the patient and how their condition affects them as a person
personal to a particular patient but may originate from individuals other than the patient (relatives, carer, member of MDT)
May be gathered through various communication methods including medical notes, conversations/meetings and patient interview
in terms of the ICF, the subjective examination gains information relating to activity, participation, environmental and personal factors
Aim and purpose
find out patient’s main problems as perceived by themselves
Assists in development of treatment plan
build rapport with the patient
Information from medical record
personal details
diagnosis
date of admission to hospital: date of admission to rehab unit
History of presenting illness (CVA/SCI/progressive neurological disorder) including specific diagnostic information
CVA: location and type of lesion
SCI : level of lesion, complete/incomplete
TBI: location and type of lesion
Progressive neurological condition: type, progression
info from medical record cont’
relevant PMH - particularly co morbidities that may impact physiotherapy management
Surgical history
results of investigations - x-rays, CT scans, MRI, US/Doppler
Meds
SH
Previous level of function
info from medical record cont’ #2
Medical entries: current interventions and plans
Speech therapy entries: status of swallowing and communication
Occupational therapy entries : result of cognitive and ADL assessment
Nursing entries: bladder and bowel, nursing cares
Info from bed charts
recent observations ( HR, BP, O2 sats, temp) Current meds (especially cardiovascular, sedation and pain management)