Week 1: Foundations Of Neurological Physiotherapy Flashcards
(29 cards)
What is neurological rehabilitation ?
A process that assists an individual with a neurological condition to improve or maintain their level of function to ensure they can do they ADLs and health.
What is the neurofaciltaion approach? (1950 time line)
Physiotherapist moves patient through patterns of movement (passive range of motion)
What are the main concepts of motor learning
Patients have to be active participants
Skill is task specific
Goal attainment
When was the motor learning approach implemented?
2000
What do we currently know about evidence based practice (EBP) in relation to neuro rehab ?
Uses a mix of components from different approaches to improve function and mobility. Works by early intervention and facilitating motor learning via practice.
What are the 5 fundamental principles of EBP
ICF Patient Centred care Clinical reasoning Skill acquisition Therapeutic interventions
What is the flow chart of the ICF?
Health condition
Body function + structure, activity, participation
Environmental factors, personal factors
What ICF components does Physiotherapy interventions target
Body function + structure, activity, and participation
How to improve teamwork in rehabilitation?
- share goals
- work towards similar/ shared goals to ensure best rehabilitation for patient (not working against each other)
- follow plans and protocol
- share notes
- have good communication
Characters of patient centred care?
- respect patients values, priorities and perspectives
- respect the patients rights to choose
- seek to realign and equal power between patient and therapist
- enables imformed choices
- enables patient to identify their needs and goals
- facilities patient participation in rehabilitation
- collaborate to achieve patient goals
- individualise delivery of treatment
- outcomes related to patient
- useful and relevant
Why is prediction literature important
- predictors of recovery are generally condition specific
- enables us to express optimism to patients who exhibit positive predictors
- guides selection of assessment and interventions
- enhances recovery by encouraging interventions to focus on motor responses expected to be achieved
- leads to clearer patient expectations
Where do you collect information in the assessment?
Subjective
- chart (medical and bed)
- medical team
- patient interview
- family interview if needed
Objective
- identify impairments
- function restrictions
- limitations to participation
Outcome measures
With the information collected in the assessments, what do you do?
Interpret, formate a hypothesis
- establish a problem list
- set goals with patient
- form a treatment plan
How do you implement a plan?
- reeducation of movement and function
- introduce self management
- consider maintenance, prevention and health promotion
Things to consider when evaluating, reassess and review:
- measure outcome and progress towards hoals
- consider modifications to the plan, transfer of care, or discharge
- plan next review
What levels of the ICF need to be considered when establishing a problem list?
All levels:
Level 1: disorder or disease
Level 2: body function & structure, activity limitations and participation limitations
Level 3: environmental and personal factors
What are common neurological impairments?
Weakness- UMN weakness, LMN weakness
Fatigue- general fatigue, motor fatigue
Disorders of muscle tone- hypertonus, hypotonus, spasm, dystonia, dyskinesia, rigidity
Disorders of coordination- cerebellar ataxia, sensory ataxia, resting tremor, loss of dexterity
Disorders of motor planning- apraxia, bradykinesia, akinesia, freezing of gait
Vestibular disorders- central vestibular disorders, peripheral vestibular disorders
Disorders of visuospatial perception- hemianophia, unilateral spatial neglect, contraversive pushing
Disorders of sensation- sensory loss, paraesthesia/ dyseathesia, pain
Secondary complications- contraction, physical inactivity, deconditioning, learning non-use
Characteristics of SMART goals:
- patient centred
- relevant
- challenging but realistic
- achievable
- specific
- identify progress
Who and when should SMART goals be created
Health professionals initiate the goals however the patient and their families should be involved in choosijg the goals. The hoals should be set after the initial assessment and throughout the rehabilitation
When develping a treatment plan for a patient with a neurological deficit what needs to be considered?
Its likely to be multifacet due to the complexity of nervous system
When developing a treatment plan there are 4 areas that need to be considered, what are they?
- Treatment aims
- Treatment strategy
- Identify interventions for impairments
- Establish parameters for functional task training
With treatment aims, what should you consider?
-assessment findings
-patient goals
-overall aims of neurological Physiotherapy
(RAMP (restore, adapt, maintain, prevent))
What does RAMP stand for?
Restore- identify function defects and impairments and design interventions to restore them
Adapt- minimise impact of functional deficits through adaption, movement tasks and environmen
Maintain- maintain function ability despite functional impairments
Prevent- focus on prevention of secondary complications
What are the 4 treatment strategies?
- neural adaption- repeative attended practice to drive neuroplastic changes, targeting changes in the CNS or PNS structure
- habituation training- symptom reduction through repeated activity based reduction symptom provocation
- substitute training- substituting different muscle groups or sensory groups for loss of function
- compensation training- assistive technologies for permanent loss of functional or impairment
