Rehabilitation

Question 1

What is disability?

Answer 1

WHO - restriction or lack of ability to carry out activities in an appropriate or normal manner
Wade - The effect pathology or impairment has upon actions which have some meaning to the person.
Disability is common in older people but not the norm

Question 2

How do we measure disability in practice?

Answer 2

Barthel’s index of activities of daily living.

Question 3

Causes of Disability worldwide

Answer 3

2005 - perinatal conditions, LRTIs, HIV/AIDs, Depression, IHD
2030 - HIV/AIDs, Depression, IHD, CVA, Cataracts

Question 4

Trends in disability

Answer 4

The major causes of disability in the elderly are CVA, OA, osteoporosis, dementia, depression.
Stroke, cardiovascular disease and OA are falling but Asthma and fractures are increasing.

Question 5

Risk factors for functional status decline

Answer 5

Cognitive impairment Depression
Co-morbidities    Poor perceived health
High or low BMI    Recent weight change
Lower leg weakness    Visual impairment
Low social contact     Low physical activity
Alcohol use           Smoker

Question 6

Neurorehabilitation

Answer 6

A problem solving and educational process aimed at reducing the disability and handicap experienced as a result of disease
Problems must be addressed at physical, emotional/personal and environmental levels

Question 7

Determinants of Function

Answer 7

Personal Factors (cognition, mood, personality)
Physical factors (impairments)
Social and environmental factors

Question 8

Categories of rehabilitation

Answer 8

Specific –> specific control of underlying disease
Prevention –> prevention of secondary injury or decline
Restoration –> Restoration of function
Adaptation –> Adaptation

Question 9

Recovery after a stroke

Answer 9

Physiotherapy
Speech and language therapy
Dietetics
Medical therapy
All feeding into MDMs

Question 10

Stages of Frailty

Answer 10

A - Resilient and not frail
B - Vulnerable with poor recovery. Begining of frailty and will decompensate with minor illnesses
C - Frailty syndrome - leads to loss of independance
D - Endstage frailty leading to death.

Question 11

Barriers to rehabilitiation

Answer 11

Multiple pathologies
Cognitive impairment
Personality

Question 12

Stroke

Answer 12

Commonest cause of adult disability
Large research literature - complex but treatable
Stroke management filters into other areas of rehab work
Each person will fluctuate around a personal recovery curve.

Question 13

Organised vs general care

Answer 13

Specialized stroke wards are better than general wards.