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*Neurological Physiotherapy > Week 1: Foundations Of Neurological Physiotherapy > Flashcards

Week 1: Foundations Of Neurological Physiotherapy Flashcards

1
Q

What is neurological rehabilitation ?

A

A process that assists an individual with a neurological condition to improve or maintain their level of function to ensure they can do they ADLs and health.

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2
Q

What is the neurofaciltaion approach? (1950 time line)

A

Physiotherapist moves patient through patterns of movement (passive range of motion)

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3
Q

What are the main concepts of motor learning

A

Patients have to be active participants
Skill is task specific
Goal attainment

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4
Q

When was the motor learning approach implemented?

A

2000

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5
Q

What do we currently know about evidence based practice (EBP) in relation to neuro rehab ?

A

Uses a mix of components from different approaches to improve function and mobility. Works by early intervention and facilitating motor learning via practice.

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6
Q

What are the 5 fundamental principles of EBP

A 
ICF
Patient Centred care 
Clinical reasoning 
Skill acquisition 
Therapeutic interventions
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7
Q

What is the flow chart of the ICF?

A

Health condition
Body function + structure, activity, participation
Environmental factors, personal factors

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8
Q

What ICF components does Physiotherapy interventions target

A

Body function + structure, activity, and participation

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9
Q

How to improve teamwork in rehabilitation?

A
  • share goals
  • work towards similar/ shared goals to ensure best rehabilitation for patient (not working against each other)
  • follow plans and protocol
  • share notes
  • have good communication
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10
Q

Characters of patient centred care?

A
  • respect patients values, priorities and perspectives
  • respect the patients rights to choose
  • seek to realign and equal power between patient and therapist
  • enables imformed choices
  • enables patient to identify their needs and goals
  • facilities patient participation in rehabilitation
  • collaborate to achieve patient goals
  • individualise delivery of treatment
  • outcomes related to patient
  • useful and relevant
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11
Q

Why is prediction literature important

A
  • predictors of recovery are generally condition specific
  • enables us to express optimism to patients who exhibit positive predictors
  • guides selection of assessment and interventions
  • enhances recovery by encouraging interventions to focus on motor responses expected to be achieved
  • leads to clearer patient expectations
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12
Q

Where do you collect information in the assessment?

A

Subjective

  • chart (medical and bed)
  • medical team
  • patient interview
  • family interview if needed

Objective

  • identify impairments
  • function restrictions
  • limitations to participation

Outcome measures

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13
Q

With the information collected in the assessments, what do you do?

A

Interpret, formate a hypothesis

  • establish a problem list
  • set goals with patient
  • form a treatment plan
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14
Q

How do you implement a plan?

A
  • reeducation of movement and function
  • introduce self management
  • consider maintenance, prevention and health promotion
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15
Q

Things to consider when evaluating, reassess and review:

A
  • measure outcome and progress towards hoals
  • consider modifications to the plan, transfer of care, or discharge
  • plan next review
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16
Q

What levels of the ICF need to be considered when establishing a problem list?

A

All levels:

Level 1: disorder or disease
Level 2: body function & structure, activity limitations and participation limitations
Level 3: environmental and personal factors

17
Q

What are common neurological impairments?

A

Weakness- UMN weakness, LMN weakness
Fatigue- general fatigue, motor fatigue
Disorders of muscle tone- hypertonus, hypotonus, spasm, dystonia, dyskinesia, rigidity
Disorders of coordination- cerebellar ataxia, sensory ataxia, resting tremor, loss of dexterity
Disorders of motor planning- apraxia, bradykinesia, akinesia, freezing of gait
Vestibular disorders- central vestibular disorders, peripheral vestibular disorders
Disorders of visuospatial perception- hemianophia, unilateral spatial neglect, contraversive pushing
Disorders of sensation- sensory loss, paraesthesia/ dyseathesia, pain
Secondary complications- contraction, physical inactivity, deconditioning, learning non-use

18
Q

Characteristics of SMART goals:

A
  • patient centred
  • relevant
  • challenging but realistic
  • achievable
  • specific
  • identify progress
19
Q

Who and when should SMART goals be created

A

Health professionals initiate the goals however the patient and their families should be involved in choosijg the goals. The hoals should be set after the initial assessment and throughout the rehabilitation

20
Q

When develping a treatment plan for a patient with a neurological deficit what needs to be considered?

A

Its likely to be multifacet due to the complexity of nervous system

21
Q

When developing a treatment plan there are 4 areas that need to be considered, what are they?

A
  1. Treatment aims
  2. Treatment strategy
  3. Identify interventions for impairments
  4. Establish parameters for functional task training
22
Q

With treatment aims, what should you consider?

A

-assessment findings
-patient goals
-overall aims of neurological Physiotherapy
(RAMP (restore, adapt, maintain, prevent))

23
Q

What does RAMP stand for?

A

Restore- identify function defects and impairments and design interventions to restore them
Adapt- minimise impact of functional deficits through adaption, movement tasks and environmen
Maintain- maintain function ability despite functional impairments
Prevent- focus on prevention of secondary complications

24
Q

What are the 4 treatment strategies?

A
  1. neural adaption- repeative attended practice to drive neuroplastic changes, targeting changes in the CNS or PNS structure
  2. habituation training- symptom reduction through repeated activity based reduction symptom provocation
  3. substitute training- substituting different muscle groups or sensory groups for loss of function
  4. compensation training- assistive technologies for permanent loss of functional or impairment
25
Q

What to consider when designing intervention?

A
  • all levels of ICF
  • be in line with goals

– Specific therapeutic interventions (e.g. manual therapy, exercise, equipment prescription)
– Resting positions (bed/ chair)
– Independence with mobility and ADLs
– Handling/ assistance requirements for health professionals or family/ carer during bed mobility, transfers, sitting, standing and mobility
– Self management
– Health promotion and secondary prevention

26
Q

What are key aspects of any treatment plan?

A
  • functional movement reeducation (sit-to-stand, gait ect)
  • strengthening (target areas of weakness, with consideration to optimise neuropasticity)
  • physical activity exercise/ cardio respiratory (prevent secondary complications)
  • interventions to specific impairments and complications as required
  • flexiblity (mangement and prevention)
27
Q

What is a key aspect required throught a treatment?

A

Evaluation of the treatment by using outcome measures and modifying the treatment if and when required

28
Q

Important things to remember in discharge planning?

A
  • Crucial for successful reintegration into the community and effective and efficient use of limited hospital resources
  • evidence recommends supportive discharge not early discharge
  • refer to appropriate rehab services if required
  • Ensure careful consideration given to discharge location to ensure accommodation and services are appropriate eg home or respite
  • all patients and their family and carers are given vital information
  • home assessments if heading home
  • comprehensive rehab plan
29
Q

What are the 4 discharge locations and the consideration for each?

A

Home

	- Independent/ dependent function with level of care able to be supported at home (family/ friends/ community)
	- HEP prescription (progressive) 
	- Link with local/ state neurological support groups

Nursing home

	- Poor functional outcomes/ prognosis
	- Dependent function with level of care not able to be supported at home (family/ friends/ community services)
	- Liaise with social worker

Community rehabilitation

	- Designed to improve functional independence and confidence, 
	- Health service, transition care, NGOs, private services
	- Transition vs ongoing rehabilitation requirements (Transition care is goal orientated, time limited and therapy focused)
	- Home vs community rehabilitation vs residential transition
	- Must consider specific eligibility and funding (Private health, NDIS, MAC, Medicare, privately funded)

Independent rehabilitation

	- All patient types benefit from rehabilitation, particularly those severely affected by acute neurological condition
	- No generic criteria selecting those who will most benefit from ongoing active rehabilitation
	- Complex decision based on patient attributes and prognosis made by MDT in conjunction with patient
	- Standard vs slow stream
	- CHIP nurse/ discharge planner will usually facilitate process

*Neurological Physiotherapy (6 decks)

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