Rehabilitation Medicine Flashcards
Stroke:
- Describe TACS & PACS
Total anterior circulation stroke: large cortical stroke: MCA/ACA territory. 3/3 of following
Partial anterior circulation stroke: cortical stroke: MCA/ACA territory 2/3 of following
- unilateral weakness and/or sensory disturbance of arm or leg
- Homonymous Hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Stroke:
- Describe POCS and LACS
Posterior Circulation stroke: brain stem, cerebellum, occipital lobe. One of:
- cerebella or brainstem syndrome
- LOC
- Isolated homonymous hemianopia
LACS: Lacunar stroke: subcortical stroke.One of:
- unilateral weakness (+- sensory deficit) ro face & arm, arm & leg or both
- Pure sensory stroke
- Ataxic hemiparesis
Name types of professionals in a rehabilitation multidisciplinary team
physios occupational therapists nurses psychologist speech and language therapist dieticians
Rehabilitation History
- What is the diagnosis?
- Identify the impairment (visual, weakness)
- Activitys of daily living:
- washing
- dressing
- walking
- climbing stairs
- transferring of and on toilet/chair
- cooking - What could they do before
- Consequence of lifestyles
- Patient hobbies/interests
- employment - Environmental factors: stairs in house
- Patients expectations.
Discuss the differences in rehabilitation management for acute or long term conditions.
In acute cases such as stroke, major trauma or spinal cord injury:
- Preserve function and prevent complications
- Assessment of physical impairment & assessment of functional activities: stepwise approach (rolling in bed →standing…) then near discharge assess home & ability to do activities of daily living.
Long term conditions: MS, COPD, HF- focus is disability management.
- Identify period changes due to modifiable factors (e.g UTI)
- Additional care or environmental support during deterioration. Talks about prognosis, future care planning, advanced directives.
- Identify patient at final stage and refer to palliative care specialist.
What are the limitations of AMTS and MMSE?
What other tests can be used?
AMTS & MMSE = both weighted to memory impairment (alzheimers) may fail to detect more subtle impairments.
Montreal Cognitive Examination (MoCA) or Addenbrookes cognitive examination III (ACE III): test visuospatial, executive function, attention, language, short term memory & orientation
Describe the terms agnosia and apraxia
agnosia is the inability to process sensory information: sounds, shapes, objects, smells, people
apraxia: disorder of motor planning: unable to perform tasks or movements when asked despite understanding the request
OSCE point for assessing consent
- introduction
- ask what known
- explain clinical issue
- explain need for consent (informed)
- ask about relatives understanding
- ask about relatives retention/memory
- ask about relatives reasoning
- ask about relatives communication decision
- no jargon
- ICE
- recognise will need to assess mother to reach decision about capacity
- thanks
circumstances that cause impaired mental capacity
delirium acute intoxication dementia unconsious patient physchotic illness, brain injury to brain tumour
Capacity decisions
refusal of treatment
self-discharge against medical advice
leaving ward e.g smoke
mental capacity is …. and …. specific
time + decision
Who assess capacity.
What 3 questions do they ask
If no to all 3?
Ward team.
- Does the patient have a impairment to the functioning og the mind or brain that affects their ability to make the decision in question?
- Can they understand, retain, weigh, communicate?
- Likely to regain capacity? Can the decision be deferred?
Best interests decision
When a best interests decision must be taken what must be considered
- Power of attorney?
- Valid advanced directive?
- ‘Best interest’: patient best interest, take into account patients previously expressed views (ask family), least restrictive course, human rights
What is deprivation of liberty safeguards? when used?
person with mental disorder can be temporarily deprived of some aspect of their liberty.
- detaining to medical ward
- restricting persons movements
- restrict freedom to act (mittens, sedative)
- specify where they live
- who they can see
Always discuss with senior
Safeguarding vulnerable adults
- when can disclose information about abuse?
- when cannot? what can you do?
- if they do not gave capacity to consent to disclosure or risk to child
- patient has capacity and does not wish to report abuse. signpost them to support to which they can self report and document
consult senior
