Rehabilitering för neurologisk/kritiskt sjuk patient Flashcards by Filippa Jonsson

Ge exempel på vanliga neurologiska sjukdomar där rehab kan behövas

Intervertebral disc disease (IVDD)*
Fibrocartilaginous embolism (FCE)* & Acute non-compressive nucleus pulposus extrusion (ANNPE)*
Feline aortic thromboembolism or saddle thrombus (FATE)
Caudal cervical spondylomyelopathyor Wobbler syndrome
Lumbosacral disease
Spondylosis
Degenerative myelopathy
Peripheral nerve injury
Trauma
Vestibular & balance disorders
Cancer/neoplasia

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Vad är Intervertebral disc disease (IVDD) och vad kan det ge för symptom? Vilken typ av rehab kan vara lämplig här?

Vad?
-Degeneration with potential, eventual herniation of intervertebral disc resulting in compression of spinal nerve, nerve root, &/or spinal cord

Signs:

Pain, soreness, stiffness
Changes in/loss of sensation -> weakness/paralysis -> loss of deep pain
Tends to occur at “transitional” areas of spine

Rehab:

NMES
LLLT
Functional therapeutic exercises with facilitation techniques
Aquatic therapy (swimming  waterwalking)
Balance & proprioceptive therapeutic exercises

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Vad är FIBROCARTILAGINOUS EMBOLISM (FCE) & ACUTE NON-COMPRESSIVE NUCLEUS PULPOSUS EXTRUSION (ANNPE) och vad kan det ge för symptom?

FCE: “spinal cord stroke,” a blood vessel feeding the spinal cord becomes blocked by a piece of cartilage originating from the intervertebral disc, causing neurons to malfunction
ANNPE: a portion of healthy intervertebral disc suddenly shoots out through its encasement and collides with the spinal cord at a high velocity, causing bruising of (& sometimes significant bleeding inside) the spinal cord

Signs:

Abrupt gait dysfunction (often when running or jumping)
Focal, asymmetric lesion
Rarely progresses after 12 hours
No spinal pain
Tends to improve over a few weeks
Poor prognosis, if no deep pain perception

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Vilken rehab kan vara lämplig vid FIBROCARTILAGINOUS EMBOLISM (FCE) & ACUTE NON-COMPRESSIVE NUCLEUS PULPOSUS EXTRUSION (ANNPE)?

NMES
LLLT
Functional therapeutic exercises with facilitation techniques
Corrective manual therapies
Aquatic therapy (swimming  water walking)
Balance & proprioceptive therapeutic exercises

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Vad är FELINE AORTIC THROMBOEMBOLISM (FATE)

AKA saddle thrombus, och vad kan det ge för symptom?

Vad?
Clot in left atrium, dislodged, & descends to ”saddle” (area where aorta meets iliac arteries) where circulation is blocked to one or both hind limbs

Signs (sudden):

Pain
Hyperventilation
Vocalization
Paralysis of hindlimb(s)
Temperature changes (cold paws)

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Vad är målet med rehab av FELINE AORTIC THROMBOEMBOLISM (FATE), vilken typ av rehab kan vara lämplig?

• Goals

Restore circulation, sensation
Independent, symmetrical ”community ambulation” without ataxia, frequently monoparetic
Independent sit to stand
Independent ADL/”toileting”
Return to prior (or highest) level of function
Reduced compensatory movement strategies

• Strategies/Tactics

Manual therapies
NMES
LLLT
Functional therapeutic exercises with facilitation techniques
Corrective manual therapies
Aquatic therapy (swimming  water walking)
Balance & proprioceptive therapeutic exercises

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Vilka symtom kan CAUDAL CERVICAL SPONDYLOMYELOPATHY OR WOBBLER SYNDROME ge?

• Signs

Mild ataxia of forelimbs progressing to weakness of hind limbs progressing to tetraplegia
Caudal cervical pain with flexed neck posture
Acute or slowly progressive

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Vad är målet med rehab av CCSM eller wobblers, vilken typ av rehab kan vara lämplig?

Goals
• Independent ”community ambulation” without ataxia
• Independent down to sit to stand
• Independent ADL/”toileting”

Strategies/Tactics
• NMES
• LLLT
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (water walking), avoiding cervical extension
• Balance & proprioceptive therapeutic exercises

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Vad är spondylos och vad kan det ge för symptom?

Vad?
Degeneration due to osteoarthritis of the vertebral column (ie. vertebral bodies, neural foramina, & facet joints)

Symptom:

Myelopathy
Global weakness
Gait dysfunction
Balance issues
Bowel & bladder issues

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Vad är målen med rehab vid sponylos och vilken typ av rehab kan vara lämplig?

Goals
• Pain management
• Restore mobility/flexibility
• Independent ”community ambulation” without ataxia

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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Vad är DEGENERATIVE LUMBOSACRAL STENOSIS och vad kan det ge för symptom?

Vad?
Narrowing of lumbosacral vertebral canal or intervertebral foramina -> compression of cauda equina or nerve roots

Signs:

Difficulty using pelvic limbs progressing to pelvic limb lameness, tail weakness, & incontinence
Pain on palpation or extension of LS joint
Proprioceptive deficits, muscle atrophy, with weak flexor reflexes in pelvic limbs

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Vad är målen med rehab vid DEGENERATIVE LUMBOSACRAL STENOSIS och vilken typ av rehab kan vara lämplig?

Goals
• Pain management
• Restore mobility/flexibility, improve stability at LS region
• Independent ”community ambulation” without ataxia
• Continence
• Improve balance

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimmingor water walking)
• Balance & proprioceptive therapeutic exercises
• Stabilization exercises

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Vad är målen med rehab vid perifera nervskador och vilken typ av rehab kan vara lämplig?

Goals
•	Pain management
•	Restore active mobility
•	Protect weak limb
•	Independent functional mobility

Strategies/Tactics
• NMES
• LLLT
• Manual therapies (sensory stimulation)
• Assistive device fabrication/prescription
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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Vad är DEGENERATIVE MYELOPATHY och vad kan det ge för symptom?

Vad?
Painless, chronic, slowly progressive, degenerative radiculomyelopathy

Signs

Pelvic limb paresis & ataxia progressing to thoracic limbs
Spinal reflexes normal or exaggerated
Progressing to flaccid tetraparesis & hyporeflexia (LMN signs)

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Vad är målen med rehab vid DEGENERATIVE MYELOPATHY och vilken typ av rehab kan vara lämplig?

Goals
• Maintain independence with functional mobility
• Maintain independent ”community ambulation” without ataxia

Strategies/Tactics
• LLLT
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises

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Vad är målen med rehab vid trauma (tex skalltrauma) och vilken typ av rehab kan vara lämplig?

Goals
•	Pain management
•	Restore mobility/flexibility
•	Independent functional mobility & ”community ambulation”
•	Reduce risk of complications

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Vad är VESTIBULAR DISORDERS, symptom?

Vestibular system maintains balance, posture, orientation in space
Vestibular disease is a sudden, non-progressive disturbance in balance

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Mål med rehab av VESTIBULAR DISORDER och vilken typ av rehab kan vara lämplig?

Study These Flashcards

Goals
• Improve tolerance of upright postures (without ataxia or nystagmus)
• Restore active/independent mobilityoIndependent ”community ambulation” without ataxia
• Reduce head tilt

Strategies/Tactics
• TENS or NMES
• LLLT
• Manual therapies
• Vestibular “procedures”
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercisesoStabilization exercises

Mål med rehab vid cancer/neoplasi (tex i hjärnan), vilken rehab kan lämpa sig?

Study These Flashcards

Goals
• Pain management
• Restore/maintain independent mobility
• Restore/maintain independent ”community ambulation”

Strategies/Tactics
• Manual therapies
• Functional therapeutic exercises with facilitation techniques
• Aquatic therapy (swimming or water walking)
• Balance & proprioceptive therapeutic exercises
• Stabilization exercises

Vad har UPPER MOTOR NEURON (UMN) för funktion?

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UMN
• In cerebrum or brain stem
• Transmits signals down spinal cord (efferent)
• Reacts/responds to sensory input (afferent)

Vad har lower motor neuron för funktion?

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LMN
• In spinal cord or brain stem
• To cranial or peripheral nerves

Vid utvärdering vid neurorehab, vad vill man observera av position, funktionell rörlighet samt rörelsemönster?

Study These Flashcards

• Postures

Lateral
Sternal
Sitting
Standing
ADL (urination, defecation, grooming, eating, drinking)

• Functional mobility/independence

Rolling lateral to sternal
Recumbent to sitting
Recumbent to standing
Sitting to standing
ADL (in/out of car, on/off couch)

• Gait

Walk, trot, & gallop
Turn & circle
Sidestep
Back up
Wheelbarrowing, dancing, hemistanding, & hemiwalking
Stair climbing
Obstacle negotiation
Sport (run, fetch, jump)

Komponenter inom position och rörelse?

Study These Flashcards

•	ROM
•	Flexibility
•	Muscle – strength, muscle tone, atrophy
•	Symmetry of postures & movement
•	Rotation of trunk & dissociation of limbs from trunk
•	Posture & Base of Support (BOS)
•	Motor control
•	Motor planning
-	Initiation of movement
-	Assume posture
-	Maintain posture
-	Transition to another posture
•	Balance
-	Static & dynamic
-	Stability & mobility
•	Coordination
•	Proprioception

Nämn några spinal reflexes och postural reflexes?

Study These Flashcards

Spinal:

Flexor or withdrawal reflex
Babinski reflex
Deep tendon reflexes

Postural:

Placing
Hopping
Righting
Eye reflex…

Vad är PROPRIOCEPTION?

Awareness of position (kinesthesia) & movement (proprioception)

Vad kan man göra för terapeutiska övningar inom neurorehab?

``` • Rolling • Assisted standing - Standing frame - Cart - Physioroll (lift weakest component over roll then roll to standing) • Standing balance - Physioroll • Gait training - Assistive devices (harness, slings…) - Hydrotherapy • Sit to stands ```

Vad bör man tänka på vid val av assistive devices/hjälpmedel, vad finns att välja mellan?

``` Consider: • Progression • Wear/use schedule • Fitting • Safety ``` ``` Options: • Carts & standing frames • Slings &harnesses • Orthotics, splints & braces • Booties • Tape ```

Vad vill man kommunicera till DÄ innan rehabpatient kommer hem/fortsatt rehab hemma?

• Controlled, restricted, or modified activity - Eliminate running, jumping, slipping, sliding, playing as much as possible in early rehab • Environmental modifications • Orthotic, prosthetic, & assistive device instruction • Body mechanics instruction • Home exercise programs – make it fun, anpassa

Vad bör man tänka angående anpassad miljö hemma för rehabpatient?

* Flooring surfaces * Throw rugs * Yoga mats * Stair surfaces * Bedding * Ramps * Baby gates, kennels, corrals

INDICATIONS FOR REHABILITATION IN CRITICAL CARE?

• Medically “stable” • Hospitalized &/or immobilized >48 hours • Presence of edema &/or swelling • Presence of pain • Wound - Road rash, surgical wound, fecal/urinary scald/dermatitis, pressure sore/”injury” • Multi-system involvement/instability (or potential for development) • Requiring more continuous monitoring by staff

COMMON CRITICAL CARE DIAGNOSES BENEFITTING FROM REHABILITATION?

``` • Geriatric - Dogs >7 years old - Cats >11 years old • “Table pets” - Patient on a ventilator or requiring more continuous monitoring by staff (ie. respiratory distress/failure) • Post-operative - Thoracotomy - Abdominal surgery • Multi-trauma or multi-system involvement/instability or potential - Hit by car • Pneumonia • Neurologic diagnosis • Orthopaedic diagnosis ```

BE AWARE OF THESE PATIENT-SPECIFIC CONCERNS

* The patient's problem list * Any previous or current major body system instability * The potential for any deterioration or improvement in the patient's disease process(es) * Potential disease-related complications that could develop * Possible adverse reactions to therapies * How improvement, deterioration, complications & adverse reactions are recognized * Vital sign “limits” * Ability to be treated in cage, out of cage, out of ICU/CCU, etc. * Mobility limitations * Precautions/contraindications * Can the patient be offered food or water? * Need for personal protective equipment (ie. gloves, mask, gown) * Pain status * Best time for rehabilitation sessions (ie. When is the patient medicated? When is the patient alert?)

Vad finns det för konsekvenser vid immolisering för muskuloskeletala systemet?

* Atrofi * Decreased muscle weight, sarcomere number, fiber area, aerobic capacityoLoss of muscle protein, decrease in protein synthesis rate, loss of muscle volume * If the muscle is in a “shortened” position, there is loss of sarcomere number & shortening of muscle length * Loss of calcium in bones

Vad finns det för konsekvenser vid immolisering för INTEGUMENTARY SYSTEM (huden)?

- Pressure, shear, friction - Sensory deficits - Malnutrition - Dehydration - Hypotension

Vad finns det för konsekvenser vid immolisering för CARDIOVASCULAR/RESPIRATORY SYSTEM?

* Reduction in functional capacity, changes in lung volume, atelectasis * Pooling of respiratory secretions, depressed cough reflex * Infection/pneumonia * Increase in pro-coagulation factor synthesis, fibrinolysis * Reduced thromboplastin time * Decrease in RBC * Reduced excretion cycle of sodium, calcium leaches from bone, impaired renal excretion of calcium * Blood volume increases to cranium & thorax

Vad finns det för konsekvenser vid immolisering för ENDOCRINE SYSTEM?

``` Disruption in: • Circadian rhythms • Insulin cycles (resulting in glucose intolerance) Reduction in: • Activity of pancreas • Androgen levels Increase in: • Thyroid hormone activity ```

Vad finns det för konsekvenser vid immolisering för GASTROINTESTINAL SYSTEM?

* Anorexia * Suppression of gastric secretions * Reduction in peristalsis

Vad finns det för konsekvenser vid immolisering för immunsystemet?

* Impairment in T-cell activity * Slowing of neutrophilic phagocytosis * Pooling of secretions (increasing risk of bacterial colonization)

Rehabtekniker vid immobilisering?

Initially • PROM • Stretching • Positional changes (turning every 4-6 hours) ``` Progressing to • AROM • Therapeutic exercise (with support) • Functional mobility activities (with support) • Gait activities (with support) ```

Vad är syftet med att jobba med positionering vid rehab, vilka hjälpmedel kan vi använda?

Mål: • Prevention of pressure “injury” • Improved circulation • Improved respiratory function Modaliteter: • Foam cushions, air/water-filled cushions, tempurpedic cushions, blankets, pillows, & bolsters

Vad kan vi använda för rehabtekniker vid pain management?

• Positioning changes, PROM, retrograde massage, LLLT, kinesiology taping, IFC, PEMF, etc

Vad vill vi göra med respiratorisk rehab (mål) samt hur?

Goals • Assist in elimination of secretions • Re-expand lung segments • Reduce incidence of pneumonia ``` Includes • Positioning/postural drainage – in general, head down 20 degrees from horizontal will increase drainage by 40% • Supplemental oxygen &/or nebulizer • Percussion/coupage • Vibration • Cough stimulationo +/-suction ```

Vad är PERCUSSION/COUPAGE TECHNIQUE och hur görs det?

Vad? Pressure wave created can help to loosen excess secretions from lungs Technique: • Position in postural drainage position • Place a towel or sheet over chest as buffer • Hands in “cup” shape (fingers & thumb close together)oWrists loose, flex & extend • Pat chest rhythmically, alternately (if chest is large enough) for 30-60 seconds • Add vibration (shaking chest wall during expiration) at end of percussion session for 4-6 expirations • Attempt to stimulate cough at the end of a cycle

Viktigt vid rehab av kritiskt sjuk patient?

* Team approach & communication is critical * Do no harm * Monitor, document, assess, reassess * Consider the whole patient * Go slow

Rehabilitering för neurologisk/kritiskt sjuk patient Flashcards

(44 cards)