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Systems: Neurology AB > Rehabilitation in Neurology > Flashcards

Rehabilitation in Neurology Flashcards

1
Q

Impairment

A
  • Any loss or abnormality of physiological, psychological or anatomical structure or function
  • Problems in body function or structure such as a significant deviation or loss
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2
Q

Disability/ Activity limitation (AL)

A
  • Any restriction or lack of activity to perform an activity in the manner or in the range considered normal for people of the same age, sex and culture .
  • Difficulties an individual may have in executing activities
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3
Q

Handicap/ Participation restriction (PR)

A
  • A disadvantage for a given individual that limits or prevents the fulfilment of a role that would otherwise be normal for that individual
  • Problems individual may have in involvement in life situations
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4
Q

What is rehabilitation?

A
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5
Q

What is the conceptual definition of rehabilitation

A

A process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function

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6
Q

What is the service definition of rehabilitation?

A

The use of all means to minimise the impact of disabling conditions and to assist people with activity limitation to achieve their desired level of autonomy and participation in society

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7
Q

What is rehabilitation medicine?

A

The specialty of Medicine involved with the prevention and reduction of activity limitation and participation arising from impairments, and the management of disability from a physical, psychosocial and vocational point of view.

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8
Q

What are long term neurological conditions (LTNC)?

A

Disease of, injury or damage to the nervous system which will affect the individual and their family in one way or another for the rest of their life

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9
Q

Give examples of sudden onset LTNC.

A
  • Acquired brain injury
  • Spinal cord injury
  • Stroke
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10
Q

Give examples of intermittent/unpredictable LTNC.

A
  • Epilepsy

- Early multiple sclerosis (relapses and remissions) lead to marked variation in the care need

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11
Q

Give examples of progressive LTNC

A
  • Motor Neurone Disease
  • Parkinson’s disease
  • Later stages of Multiple Sclerosis
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12
Q

Give example od stable LTNC

A
  • Post-polio syndrome
  • Cerebral palsy in adults
  • Spina bifida in adolescence/adults
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13
Q

Give examples of other neurological conditions.

A
  • Guillain Barre Syndrome
  • Muscle diseases (e.g. myotonic dystrophy)
  • Hereditary spastic paraparesis
  • Huntington’s disease
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14
Q

What physical problems can patients with LTNC experience?

A
  • Weakness (hemiparesis/paraparesis)
  • Loss of / abnormal sensation
  • Increased or decreased tone / spasticity
  • Visual disturbance, e.g. homonymous hemianopia
  • Loss of hearing
  • Loss of smell and taste
  • Swallowing and communication difficulties
  • Bladder and bowel difficulties
  • Pain Syndrome
  • Seizures / Epilepsy
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15
Q

What cognitive (thinking) problems can someone experience after brain injury?

A
  • Post-traumatic amnesia
  • Confusion / disorientation
  • Severe memory problems (especially with recent events / working memory)
  • Poor concentration/ attention
  • Slowed thinking
  • Poor “executive functioning”
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16
Q

What psychiatric/ behavioural problems may someone experience after brain injury?

A
  • Depression
  • Anxiety
  • Personality change
  • Irritability
  • “Childishness, selfishness, laziness”
  • Behavioural problems, including aggression disinhibition, apathy
17
Q

How is someone assessed in the rehabilitation setting?

A
  • History and Examination
  • Mobility
  • Activities of Daily living
  • Mood and Cognition
  • Bladder and bowels
  • Communication and swallow
  • Skin, Vision and hearing
18
Q

Describe the process of rehabilitation.

A
  • Problem lists
  • Set Goals
  • Identify barrier issues
  • Formulate management plan
  • Draw upon all relevant disciplines
  • Involve patient (family/carers)
19
Q

What are SMART goals?

A
  • Specific
  • Measurable
  • Achievable
  • Relevant
  • Time limited
20
Q

How do the MDT work in rehabilitation?

A
  • Most effectively delivered by a coordinated team of professionals
  • Work together towards same goal
  • Interventions may run parallel
  • Interdisciplinary: more integrated including joint sessions
21
Q

What is the ethos of the MDT?

A
  • A team process
  • Patient, family and/or carers the focus
  • Active partnership with others
  • Physicians: Clear and important role
  • Role not always be paramount
22
Q

Who may be part of the MDT?

A
  • Physiotherapist
  • Occupational therapist
  • Speech and Language therapist
  • Nurses
  • Dietician
  • Orthotists
  • Doctors
  • Neuropsychologist
  • Social worker
23
Q

Spasticity

A
  • Motor disorder characterised by a velocity dependent increase in tonic stretch reflexes with exaggerated tendon jerks
  • Disordered sensorimotor control resulting from an upper motor neurone syndrome (UMN) lesion, presenting as intermittent or sustained involuntary activation of muscles.
24
Q

What are some complications of spasticity?

A
  • Poor seating and lying positions
  • Sleep difficulties and fatigue
  • Dressing and hygiene issues
  • Pain, spasms and associated reactions
  • Communication and feeding problems
  • Pressure sores and contracture
  • Poor self-image and relationship issues
25
Q

How spasticity managed?

A
  • Prevention,Prevention and Prevention!
  • Multidisciplinary team approach
  • Physical therapy
  • Exclude exacerbating factors
  • Oral antispasticity agents
  • Focal treatment with Botulinum toxin
  • Drug Treatment not always necessary!
26
Q

Where does rehabilitation take place?

A
  • Acute hospital
  • Rehabilitation ward
  • Outpatient centre
  • Community facilities, e.g. local sports hall
  • Vocational rehabilitation service
  • In the patient’s home
27
Q

What are the benefits of rehabilitation?

A
  • Greater independence
  • Greater chance of getting home or remaining at home
  • Increased comfort and dignity
  • Increased chance of remaining in / returning to work
  • Improved quality of life
  • Reduced need for care / assistance
28
Q

What secondary complications can be prevented?

A
  • Pressure sores
  • Chest infections
  • Deep venous thrombosis
  • Malnutrition
  • Constipation
  • Musculoskeletal pain
  • Contractures
  • Low morale and depression
29
Q

How can acquired brain injury be classified?

A 
-Head injury (traumatic brain injury)-
Haemorrhagic (e.g. SAH)
-Hypoxic / Anoxic (e.g. out of hospital cardiac arrest
-Metabolic (e.g. hypoglycaemic)
-Infective (meningitis, encephalitis)
30
Q

What scoring system can be used to classify the severity of head injury?

A

GCS

31
Q

What are important predictors of outcome after head injury?

A

GCS, length of loss of consciousness and post-traumatic amnesia are important predictors of outcome

32
Q

How is a severe head injury classified?

A
  • GCS 3-8

- PTA 1-7 days

33
Q

How is a moderate head injury classified?

A
  • GCS 9-12

- PTA 1-24 hours

34
Q

How is a mild head injury classified?

A
  • GCS 13-15

- PTA less than 1 hour

35
Q

What specialist services must be accessible?

A
  • Spasticity management services
  • Wheelchair and seating services
  • Continence service
  • Sexual / relationship counselling
  • Vocational rehabilitation
  • Orthotics
  • Driving assessment service
  • Assessment service for people in low awareness states
36
Q

Who can people with LTNC/ABI be linked with?

A
  • Pain management
  • Neuro psychiatry / clinical psychology
  • National behavioural management service
  • National ABI service in Edinburgh
  • Carers centre
  • Brain injury group / Headway
37
Q

What evidence is there that rehabilitation works?

A
  • Stroke units provide a better outcome than management in a general medical ward
  • Inpatient rehabilitation of patients with MS leads to reduced disability
  • Brain injured patients who receive early rehabilitation are much more likely to be discharged home (94% versus 57%)
  • Brain injured patients who receive “extra therapy” can be discharged home significantly sooner

Systems: Neurology AB (51 decks)

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