Rehab Intro + SCI Flashcards by H ME

What is rehabilitation?

Process of returning a person to maximal physical, psychological, social and vocational functions with their physiologic or anatomic impairment, environmental limitations and desires or life plans.

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What is the role of rehabilitation medicine?

Delivers medical management and multidisciplinary therapy to address impairments, limitation in ADLs (disability) and participation restrictions in the person’s social role (handicap)

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How does medical model view disability?

Problem of the person, caused by disease / trauma / health condition which requires medical care in treatment by professionals.

Mx aimed at cure or individual’s adjustment of behaviour if cure not possible
medical care viewed as main issue

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What is the social model of disability?

Main issue is socially created problem and matter of fully integrating individual within society
Disability attribute of social environment not individual
Solution = environmental modifications required for full participation of people with disabilities

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What is the FIM score?

Functional Independence Measure: preferred tool in rehab settings. More sensitive development of Barthel scale (adds communication, social behaviour, memory and problem solving to basic domains assessed by Barthel).

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What is ICF?

International Classification of Functioning, Disability and Health.
Framework for conceptualisation, classification and measurement of disablity.

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What are impairments?

Problems in body function or structure such as significant deviation or loss

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What are activity limitations?

Activity = execution of task or action by an individual

- Activity limitation = difficulties an individual may experience executing activities

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What are participation restrictions?

Participation = involvement in a life situation

- Participation restrictions = problems an individual may experience in involvement in life situations

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What are environment factors in the context of rehab?

Physical, social, attitudinal environment in which people live and conduct their lives. Either barriers to or facilitators of the person’s functioning

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Example of impairment without limitation?

Disfigurement in leprosy has no effect on person’s capacity

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Performance and activity limitation without evident physical impairment?

Reduced performance in ADLs associated with many diseases

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Example of Participation restrictions without impairments or activity limitations

e.g. HIV +ve person, ex-patient recovered from mental illness; may face stigma or discrimination

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Activity limitations without assistance but no performance problems in current environment - example?

an individual with mobility limitations may be provided assistive technology by society to move around

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What are the criteria for suitability for a rehab program?

Medical stability i.e. pt with untreated CHF cannot participate in exercise program
Reasonable cognition, or expectation that cognition will improve
Motivation to attend therapy and participate
Expectation that program will result in performance gains within a reasonable amount of time
Availability of supportive family / carers

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What are the considerations in starting rehab?

Who - appropriate v inappropriate
What: intensity, content
When: early intervention v post acute
Where: inpatient, OP, home based, proximity to home, centre of excellence
Why: realistic expectations (pt and family)

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Group most affected by traumatic spinal cord injury?

Males (80%); 15-30y.

Small peak age 65+

Major cause of spinal cord injury?

Road traffic accidents

Aim of early management of traumatic spinal cord injury?

-Preventing secondary cord damage OR preventing cord damage at all in those with vert # w/o cord damage

Where and why are pts with spinal cord damage best managed?

Specialised acute comprehensive spinal cord service

- Minimise complications e.g. respiratory, bladder, bowel and skin problems

What must be addressed in rehab following spinal cord injury?

Psychosocial management
Bladder management
Skin care
Bowel care
Sexual function
Spasticity
Autonomic dysfunction
Pain
Gait
Respiratory function

Psychosocial aspects of rehab following traumatic spinal cord injury?

Mx psychosocial distress
Review by psych and SW after admission
Restoration personal and social structures

Bladder management SCI rehab?

Initially IDC / SPC (removed 3-6/52 post injury)
condom drainage reflex emptying (for some males)
intermittent self catheterisation

What baseline tests should be undertaken in bladder management post SCI?

IVP
CUG
Most pts: video urodynamics

Bladder Mx options for pts with LMN lesion?

Usually mobile and can void by increasing intra abdominal pressures:. If incontinent: - M: condom drainage - F: artificial external urethral sphincter and intermittent catheterisation

What is required in pts with long term IDC or SPC?

Yearly cystoscopies after 10y of catheterisation.

When does reflex bladder usually occur?

Injuries T12 or above

When does flaccid bladder usually occur?

The flaccid bladder usually occurs below spinal cord injuries of T12 to L1, where the spinal cord injury is in the cauda equina area of the spinal cord.

Why is skin care important in Mx SCI?

- Pt has no awareness of need to relieve pressure on anaesthetic skin / cannot do so - W/o pressure relief, skin, S/C tissue and muscle become anoxic and die - Other skin problems from scolds, burns, grazes, shear stresses

What must pt do post SCI regarding skin?

Twice daily skin checks using mirror to visualise areas not in direct sight

How can UMN bowel be managed?

Reflexic; can be regulated with - good diet with high fibre content - adequate fluid intake - aperients and stool softeners

When are aperients given?

~12h before bowel action intended

What is the role of aperients in SCI UMN?

Stimulate bowel function to remove colonic contents into the rectum

How can the patient stimulate rectal emptying (SCI, UMN)?

-Increasing intra abdominal pressure -gentle digital dilation of sphincter -+/- suppository ~12h after using aperient

LMN SCI bowel management?

- Empty bowel with abdominal pressure | - To prevent incontinence when rising from chair / car etc, may have colostomy

What are reflex spasms in SCI?

- Reflex spasticity often presents as spasms precipitated by movement after being in one position too long - Hypertonia may precipitate formation of contractures

How is spasticity managed in SCI?

- Movement of joints and stretching of muscles to full length - Treat irritatants (e. UTI) that might precipitate spasticity - When no precipitant and full stretches as often as practical, consider Rx baclofen +/- diazepam

Which patients are disposed to autonomic dysfunction?

High spinal cord injury patients predisposed to unstable BP, esp above T6 lesion

What is autonomic dysreflexia?

Massive rise in BP in SCI pts with autonomic dysfunction. Occurs when noxious stimuli applied below level of injury. Medical emergency

Aids for low spinal cord / incomplete SCI patients?

Aids e.g. Ankle Foot Orthosis (AFO) or Knee Ankle Foot Orthosis (KAFO)

Return to work post SCI?

- Aided by OT and SW - Aim to return to same position or different position with same company - Some may require retraining

What are major late complications of SCI?

- Severe osteoporosis. Not uncommon to break a long bone with relatively minor trauma. - Post traumatic syrinx: SC may heal with small cyst. 2% cases expand, cause further neuro damage. Emergency.