Rehabilitation Medicine

Question 1

What is the ICF?

Answer 1

International classification of functioning, disability and health

Question 2

What is the ICF definition of capacity?

Answer 2

A person’s fullest potential

Question 3

What is the ICF definition of performance?

Answer 3

The level a person is currently at

Question 4

What is the ICF definition of impairment?

Answer 4

When a person’s bodily functions are reduced

Question 5

What is the ICF definition of activity?

Answer 5

Activities of daily living e.g. walking, cooking a meal, driving a car etc.

Question 6

What is the ICF definition of activity limitation?

Answer 6

When a person cannot perform certain activities

Question 7

What is the ICF definition of participation?

Answer 7

Participating in society the way the person wants

Question 8

What is the ICF definition of participation restriction?

Answer 8

When participation is lost/reduced

Question 9

What is the ICF definition of rehabilitation?

Answer 9

Development of a person to their fullest potential, within the limitations of their underlying condition & the resources available

Question 10

What is the REPAIR model?

Answer 10

MDT approach to identifying interventions that could take place to enable rehabilitation

Question 11

What areas make up the REPAIR model?

Answer 11

Review of pathology/impairment
Environment
Participation
Activity
Important others
Risk

Question 12

What is an orthosis?

Answer 12

Externally applied device used to control motion of a body segment

Question 13

What are the common indications for lower limb amputation?

Answer 13

Dysvascularity (73%)
Infection (8%)
Trauma (7%)
Neoplastic disease (3%)

Question 14

What are the two major amputation levels?

Answer 14

Transfemoral (above-knee, common in severe vasc)

Transtibial (below-knee, twice as common)

Question 15

What is the goal of amputation?

Answer 15

Amputate at most distal level to remove diseased tissue while preserving functional residual limb length & creating the best environment for the rapid return of mobility/function

Question 16

How many patients will walk post amputation?

Answer 16

Transtibial (70%)

Transfemoral (40%)

Question 17

What is stump pain?

Answer 17

Pain in residual portion of limb

-resolves w/ wound healing (70-85%)

Question 18

What is phantom pain?

Answer 18

Painful sensation of missing limb

• occurring in 55-85%
• develops a few days post amputation
• usually improves w/ time

Question 19

What are the management options for phantom pain?

Answer 19

Prevention = pre-op epidural
Antidepressants/established anticonvulsants
Massage of contralateral limb
Psychological support

Question 20

What is a prosthesis?

Answer 20

A device which replaces a missing limb or segment

Question 21

What factors determine suitability for prosthetic rehabilitation?

Answer 21

Cognitive ability
Motivation
Expectations/goals
Physical strength
Co-morbidities

Question 22

What are the associated complications of prosthesis?

Answer 22

Pressure sores
Skin rashes/allergies
Neuroma development
Contralateral joint issues
Poor pt acceptance

Question 23

What is the ASIA?

Answer 23

Scoring system that helps determine whether a spinal cord injury is complete/incomplete
-assesses myotome/dermatome function

Question 24

What factors suggest an incomplete spinal cord injury?

Answer 24

Preservation of myotome/dermatome function in S4/S5

• anal tone/feeling of pressure
• potential for recovery

Question 25

What is the Barthel Index?

Answer 25

Scale used to assess performance in 10 ADLs, including feeding, grooming, transfers & mobility

Question 26

What is neurogenic bladder?

Answer 26

Bladder dysfunction due to neurological damage | -presents w/ a range of sx

Question 27

What type of bladder problem does injury above T12 cause?

Answer 27

Reflex/spastic bladder

Question 28

What is a reflex/spastic bladder?

Answer 28

Autonomic control but no voluntary control | -bladder contracts when reaching a certain level of fullness

Question 29

How should a reflex/spastic bladder be managed?

Answer 29

Regular tapping/intermittent catheterisation

Question 30

What type of bladder problem does injury below L1 cause?

Answer 30

Flaccid (acontractile) bladder

Question 31

What is a flaccid bladder?

Answer 31

No bladder tone | Looks like overflow incontinence

Question 32

How should a flaccid bladder be managed?

Answer 32

Intermittent self-catheterisation

Question 33

What is neurogenic bowel?

Answer 33

Bowel dysfunction due to neurological damage | -presents w/ a range of sx

Question 34

What type of bowel problem does injury above T12 cause?

Answer 34

Reflex bowel

Question 35

What is reflex bowel?

Answer 35

Feeling of rectal fullness lost | -reflex movements causing bowel emptying at inconvenient times

Question 36

What type of bowel problem does injury below L1 cause?

Answer 36

Areflexic bowel

Question 37

What is areflexic bowel?

Answer 37

Defecation reflex & sphincter contraction lost

Question 38

How are reflex & aflexic bowel managed?

Answer 38

``` Keep correct stool consistency Routine defecation at set times of the day -enema -digital stimulation -postural changes -abdominal massage ```

Question 39

What is Autonomic Dysreflexia?

Answer 39

Potentially dangerous clinical syndrome, developing in individuals w/ spinal cord injury at T6 or above. Results in acute, uncontrolled HTN due to sympathetic overactivity

Question 40

What can cause Autonomic Dysreflexia?

Answer 40

Any noxious stimulation below level of injury

Question 41

What are the sx of Autonomic Dysreflexia?

Answer 41

Pounding headache Sweating Blotching of skin (above injury) Cold, clammy skin (below injury)

Question 42

What are the signs of Autonomic Dysreflexia?

Answer 42

HTN (200/100) | Bradycardia

Question 43

What is a pressure ulcer?

Answer 43

Localised injury to skin/underlying tissue, usually over a bony prominence as a result of pressure +/- shear

Question 44

What are the four grades of pressure ulcers?

Answer 44

Grade 1 = Non-blanching erythema Grade 2 = Partial thickness skin loss Grade 3 = Full thickness skin loss Grade 4 = Full thickness tissue loss

Question 45

What are the intrinsic risk factors for pressure ulcers?

Answer 45

``` Sensory impairment Malnutrition Immobility Vascular disease Multiple co-morbidities ```

Question 46

What are the extrinsic risk factors for pressure ulcers?

Answer 46

Pressure Shear Friction forces

Question 47

What are the exacerbating risk factors for pressure ulcers?

Answer 47

Skin moisture | Medications (diuretics/steroids)

Question 48

What is the SSKIN bundle?

Answer 48

Five-step model to promote pressure ulcer prevention - surface - skin inspection - keep moving - incontinence/moisture - nutrition/hydration

Question 49

What are the common causes of brain injuries?

Answer 49

``` Trauma Stroke Tumour Infection Hypoxia Drugs/alcohol ```

Question 50

How are traumatic brain injuries classified?

Answer 50

Mild - GCS 13-14, LoC <15mins Mod - GCS 8-12, LoC <6hrs Sev - GCS <8, LoC >6hrs

Question 51

What are the physical consequences of brain injuries?

Answer 51

``` Pressure ulcers Heterotropic ossification Pain Neuro-endocrine dysfunction Fatigue Epilepsy ```

Question 52

What are the cognitive-behavioural consequences of brain injuries?

Answer 52

``` Memory/concentration difficulties Executive dysfunction Mood changes Disinhibition Sleep disorders ```