Week 1

Question 1

what is the WHO ICF

Answer 1

■ The world health organisation (WHO) developed a framework for describing disability in 2001.
■ It was developed to move from the previous model (based on the medical model of healthcare) to a more social based model – it shifted the focus from impairment and disability to health and functional ability
■ It is universally accepted for use in describing neurological disability
■ Composed of five categories that relate to the health condition and impact on the ability of the person

Question 2

What are the main principles of neurorehabilitation (13)

Answer 2

The ICF
Teamwork
Person-centered care
Prognosis
Neural Plasticity
The systems model of motor control
Functional movement Re-education
Skill acquisition
Exercise prescription
Self-management
Health promotion
Mindset
Behaviour change

Question 3

What is Teamwork

Answer 3

Central to all work with neurological patients – you cannot do this alone! Who are the members of the team?

Question 4

what is person centered care

Answer 4

The patient and their wishes and situation have to be at the heart of everything that we do, Feeds into neuroplasticity (we will come to this!), Everyone is an individual

Question 5

what is prognosis

Answer 5

Our ability to understand the course and prognosis of the disease/injury, Based on understanding of pathology, anatomy, physiology and neuroplasticity, Often dealing with people with a life limiting condition (MS, PD, MND), Or people who may not make a ‘full recovery’/will be affected permanently (Stroke, brain injury, spinal cord injury), Some people do get better! (GBS), Often involved in decisions around end of life/feeding/moral and ethical as well as medical debates, Based on the best available evidence

Question 6

what is Neural plasticity

Answer 6

The ability of the CNS to reorganise following injury or disease, Task specific, Salient, Reps (#1000 reps), Intensity – suitably challenging

Question 7

what is the systems model of motor control

Answer 7

The most accepted model of how we move

Question 8

Functional movement re-education

Answer 8

Basis of treatment is the ability to practice functional tasks or movement (e.g. rolling, lying, sit to stand, walking, balance), In order to re-educate movement, you need to be able to analyse and recognise normal movement patterns, You also need to know kinematic ranges of normal movement patterns and the anatomy and biomechanics that go along with this, Training of movement rather than pure ‘exercise’

Question 9

what is skill acquisition

Answer 9

motor learning - In order to learn or relearn a motor skill, Reps!

Question 10

what is Exercise prescription

Answer 10

Improving cardiovascular endurance, muscular fitness or flexibility, FITT

Question 11

what is self-management

Answer 11

Most neurological conditions will have ongoing consequences – therefore people with neurological diagnoses need to be supported to manage their own disease, E.g. checking skin if poor sensation, Managing their own catheters, Home exercises, Fatigue management, Self-efficacy

Question 12

what is health promotion

Answer 12

Many people with neurological conditions do not meet the recommendations for a healthy lifestyle advocated by the chief medical officer for many reasons, Many individuals with neurological conditions have cardiovascular risk factors and secondary prevention is an important component of their long-term management, Many will face additional barriers, due to their neurological condition, to active healthy lifestyle that may require support in overcoming, Need to support exercise, diet, smoking cessation, mental health/wellbeing

Question 13

what s Mindset

Answer 13

Thoughts, beliefs and expectations that influence recovery, Adopting strategies to foster motivation, resilience and hope with service users and therefore bring about a positive mindset, Communication – active listening, Goal Setting, Self-management, Praise, Plus, many more

Question 14

what is behaviour change

Answer 14

Facilitating behaviour change to enable individuals to live with a neurological condition, Health promotion, Self-management, Habit formation

Question 15

what is body structure or function (WHO ICF)

Answer 15

■ Relates to the impairment caused by a health condition which may or may not impact on activity
■ E.g Loss of strength, Loss of sensation, Loss of range of motion, Spasticity – more next year, Decreased balance, Pain

Question 16

what is activity (WHO ICF)

Answer 16

■ Relates to the activities performed by an individual
■ E.g Walking, Transferring, Washing and Dressing, Feeding, Toileting, Grooming, Taking Medication, Stairs

Question 17

what is participation (WHO ICF)

Answer 17

■ Relates to the areas of life in which the individual encounters societal opportunities or barriers
■ E.g Work, Volunteering, Practising a religion, Parenting, Shopping, Finances,

Question 18

what is environmental factors (WHO ICF)

Answer 18

■ Factors in the environment that impact on the ability of a person to carry out activities/participation
■ E.g Steps and stairs, Kerbs, Lack of beeps on a pedestrian crossing, Written work not available in audio or braille, Written captions on a film, Background colours

Question 19

what is personal factors (WHO ICF)

Answer 19

■ Personal factors that impact on the ability of an individual to carry out activities/participation
■ E.g Marital status, Wealth, Educational Level, Previous experience, Family situation

Question 20

What is neuro clinical reasoning

Answer 20

• We take the information that we gather from the subjective and objective assessment and the individual
• We apply our knowledge of anatomy, physiology and the pathology of the disease
• We apply our knowledge of the guiding principles of neurological physiotherapy and the evidence for our treatments
  This allows us to develop:
• Problem lists (so we know what we are trying to address)
• Goals (so we know what we want to achieve)
• Treatment plans (so we know how we are going to achieve it)

Question 21

What is part of neuro clinical reasoning

Answer 21

Subjective Ax, Objective Ax, develop problem lists, person centered goals, treatment

Question 22

what are the factors that influence neuro clinical reasoning

Answer 22

■ Individual patient - their wants, needs and beliefs
■ Assessment findings
■ Fluctuation and variability in clinical presentation over time
■ Long-term nature of most neurological conditions
■ Psychological impact of neurological disease
■ Underpinning knowledge of anatomy, pathology, normal movement and physiology.
■ Evidence base within field of Neurosciences and Neurorehabilitation

Question 23

what is SMART goal setting

Answer 23

Specific
Measurable
Achievable
Realistic
Timely

Question 24

what is an example of a longer term goal

Answer 24

1) To return to football training and play for 5 minutes without crutches within 4 months

Question 25

what is examples of short term goals

Answer 25

1) To be able to walk 10m with 2 crutches indoors using a 4-point pattern within 2 weeks 2) To be able to climb 2 steps using 2 rails leading with his left leg within 1 week.

Question 26

what is an example of a medium term goals

Answer 26

1) To be able to walk 50m outdoors with supervision of 1 person and 2 crutches within 4 weeks

Question 27

what is a treatment plan

Answer 27

■ The interventions that you propose to enable a patient to achieve their goals. ■ Not all treatments will be restorative, some may be compensatory, and some may be related to broader management, but they should all be focused on the shared goal. ■ Based on your problem list you can begin to consider what you are going to do address each problem – this is your treatment plan ■ Remember you need to be able to explain your treatment choice in relation to the assessment findings and your understanding of the pathology. This is clinical reasoning.