REHABILITATION MEDICINE IN NEUROLOGICAL DISEASE

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REHABILITATION MEDICINE IN NEUROLOGICAL DISEASE
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PHILOSOPHYOF REHABILITATION MEDICINE
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DEFINITION

• (1) THE DEVELOPMENT OF A PERSON TO
• THE FULLEST PHYSICAL, PSYCHOLOGICAL,
• SOCIAL, VOCASIONAL AND EDUCATIONAL
• POTENTIAL CONSISTENT WITH HIS OR HER
• PHYSIOLOGICAL OR ANATOMICAL
• IMPAIRMENT AND ENVIRONMENTAL
• LIMITATION

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DEFINITION

• (2) THE RESTORATION OF FUNCTION SO
• THAT THE PERSONS CAN PERFORM TO
• THEIR FULLEST PHYSICAL, EMOTIONAL,
• SOCIAL AND VOCATIONAL POTENTIAL.

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TERMS ASSOCIATED WITH REHABILITATION WHO 1980

• IMPAIRMENT ANY LOSS OR ABNORMALITY OF
  PSYCHOLOGICAL, PHYSIOLOGICAL, OR ANATOMICAL
  STRUCTURE OR FUNCTION
• DISABILITY ANY RESTRICTION OF LACK RESULTING
  FROM AN IMPAIRMENT OF THE ABILITY TO PERFORM AN
  ACTIVITY IN THE MANNER OR WITHIN THE RANGE
  CONSIDERED NORMAL FOR A HUMAN BEING
• HANDICAP A DISADVANTAGE FOR A GIVEN INDIVIDUAL,
  RESULTING FROM AN IMPAIRMENT OR A DISABILITY,
  THAT LIMITS OR PREVENTS THE FULFILLMENT
  (DEPENDING ON THE AGE, SEX AND SOCIAL-CULTURE
  FACTORS) OF A ROLE THAT IS NORMAL FOR THAT
  INDIVIDUAL

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TERMSWHO -1997

• IMPAIRMENT ANY LOSS OR ABNORMALITY OF BODY
  STRUCTURE OR OF A PHYSIOLOGICAL OR PSYCHOLOGICAL
  FUNCTION (ESSENTIALLY UNCHANGED FROM 1980
  DEFINITION)
• ACTIVITY THE NATURE AND EXTENT OF FUNCTIONING
  AT THE LEVEL OF THE PERSON
• PARTICIPATION THE NATURE AND EXTENT OF A
  PERSONS INVOLVEMENT IN LIFE SITUATIONS IN
  RELATIONSHIP TO IMPAIRMENTS, ACTIVITIES, HEALTH
  CONDITIONS, AND CONTEXTUAL FACTORS

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COMPARISON OF THE MEDICAL AND REHABILITATION
MODELS OF HEALTH CARE
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PROBLEM ORIENTATION

• THE GENERAL ORIENTATION OF THE MEDICAL MODEL IS
  TOWARD DISEASE, WHILE THAT OF REHABILITATION
  MEDICINE IS TOWARD DISABILITY
• DISEASE INTERACTION OF A
• PATHOLOGICAL PROCESS WITH INDIVIDUAL
  MOLECULES, CELLS AND ORGANS (BIOLOGICAL EVENT)

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PROBLEM ORIENTATION..

• DISABILITY, HOWEVER , IS ESSENTIALLY A HUMAN
  EVENT
• ? HOW THE DISEASE CAN AFFECT THE HUMAN LIFE?

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PATIENT
ENVIRONMENT DISEASE
SOCIAL PSYCHOLOGICAL
VOCATIONAL RESPONSE TOTAL
DISABILITY
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THE PHYSICIANS ROLE

• REHABILITATION MODEL
• ALSO ENCOMPASS THESE FUNCTION BUT EXTENDS
  TO INCLUDE HELPING THE PATIENTS ADJUST TO THE
  DISABILITY AND PROBLEM SOLVING TO MINIMIZE THE
  FUNCTIONAL LOSS FROM A LONG TERM, CHRONIC
  CONDITION

• MEDICAL MODEL
• TENDS TO BE ACTIVE

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PATIENTS ROLE

• MEDICAL MODEL
• PATIENT OFTEN PASSIVE AND UNINFORMED, WITH
  DIAGNOSTIC AND THERAPEUTIC MEASURES DONE OR GIVEN
  TO HIM

• REHABILITATION MODEL
• PATIENTS IS ENCOURAGE TO BE AN ACTIVE, INFORMED
  PARTICIPANT

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THERAPEUTIC APPROACH

• MEDICAL MODEL
• ON TREATMENT

• REHABILITATION MODEL
• ON THE MANAGEMENT

MANAGEMENT IS DEFINED AS EFFECTING RELIEF FROM
ILLNESS OR DISABILITY AND ENHANCING FUNCTION,
USING THE FULL RESOURCES OF THE HEALTH CARE SYSTEM
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EVALUATION OF DIAGNOSING DISEASE VERSUS DISABILITY
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• IN THE MEDICAL SPECIALTY OF PHYSICAL MEDICINE AND
  REHABILITATION, DIAGNOSING THE DISEASE IS ONLY
  THE FIRST STEP IN EVALUATING A PATIENT.
• THIS DIAGNOSIS DOES NOT REVEAL WHAT FUNCTIONS ARE
  LOST AS THE RESULT OF THE DISEASE OR INJURY

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PRINCIPLES

• THE SYMPTOMS AND SIGNS REQUIRED FOR THE DIAGNOSIS
  OF DISABILITY DIFFER FROM THOSE REQUIRED FOR THE
  DIAGNOSIS OF DISEASE
• THERE IS NOT A ONE TO ONE CORRELATION BETWEEN A
  DISEASE AND THE RANGE OF ASSOCIATED DISABILITY
  PROBLEMS, THE DISABILITY IS DEPENDENT ON THE
  PATIENTS TOTAL DAILY NEEDS

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PRINCIPLES

• THERE IS NOT A ONE- TO- ONE RELATIONSHIP BETWEEN
  A DISEASE AND THE AMOUNT OF RESIDUAL DISABILITY ,
  DISABILITY CAN BE REMOVED WITHOUT ALTERING THE
  COURSE OF THE DISEASE
• THE ABILITY OF THE PATIENT AND THE PHYSICIAN TO
  REMOVE DISABILITY IN THE FACE OF CHRONIC DISEASE
  IS DEPENDENT ON THE RESIDUAL CAPACITY OF THE
  PATIENT FOR PHYSIOLOGICAL AND PSYCHOLOGICAL
  ADAPTATION

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PRINCIPLES

• DISABILITY MEANS LOST OF FUNCTION, NOT ONLY
  PHYSICAL BUT ALSO PSYCHOSOCIAL-VOCATIONAL

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EVALUATION IN REHABILITATION

• THE DISABILITY IS DEPENDENT ON THE PATIENTSS
  TOTAL REQUIREMENTS.
• THE PATIENTS RESIDUAL STRENGTH MUST BE EVALUATED
  AND BUILT UPON TO WORK AROUND IMPAIRMENT TO
  REMOVE DISABILITY

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MEDICAL AND REHABILITATION PROBLEM LIST
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WEEDS PROBLEM ORIENTED APPROACH

• PHASE 1 HISTORY, PHYSICAL EXAMINATION AND THE
  INITIAL LABORATORY STUDIES
• PHASE 2 SPECIFIC PROBLEM LIST

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PROBLEM ORIENTED..

• PHASE 3 IDENTIFIES A SPECIFIC TREATMENT PLAN
  FOR EACH OF THE PROBLEMS
• PHASE 4 EFFECTIVENESS OF EACH OF THE PLANS AND
  DESCRIBES SUBSEQUENT ALTERATIONS IN EACH,
  DEPENDING ON THE PATIENTS PROGRESS

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PROBLEM ORIENTED APPROACH

• THE FOLLOWING CASE HISTORY WILL ILLUSTRATES THE
  APPLICATION OF THE PROBLEM ORIENTED APPROACH.

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EXAMPLE CASE-HISTORY

• 69 YEAR OLD MALE
• SUDDEN RIGHT-SIDED WEAKNESS
• SECONDARY TO OCCLUSION OF THE LEFT MIDDLE
  CEREBRAL ARTERY
• HE IS RETIRED
• LIVING WITH HIS WIFE
• BEFORE THE ONSET OF THE DISEASE HE HAD BEEN
  INDEPENDENT IN ALL FUNCTIONAL ACTIVITIES

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PHYSICAL EXAMINATION

• HAS MINIMAL TO MODERATE APHASIA
• A SEVENTH CRANIAL NERVE CENTRAL PALSY ON THE
  RIGHT
• DEEP TENDON REFLEXES ARE HYPERACTIVE, POSITIVE
  BABINSKI AND INCREASED MUSCLE TONE IN THE RIGHT
  SIDE AND NORMAL ON THE LEFT SIDE
• ROM WITHIN NORMAL LIMITS, BUT THERE IS A WEAKNESS
  IN THE RIGHT EXTREMITY

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FUNCTIONAL EXAMINATION

• MOBILIZATION
• BALANCE STATIC AND DYNAMIC SITTING AND STANDING
• TRANSFERS TURNING IN BED, SITTING UP, STANDING
  UP, MOVE TO A CHAIR OR MAT
• AMBULATION PROPEL WHEELCHAIR, WALK USING A
  FUNCTIONAL AND EFFICIENT GAIT PATTERN
• ACTIVITIES OF DAILY LIVING (ADL)
• DRESSING, FEEDING, GROOMING, BATHING, PERSONAL
  HYGIENE

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FUNCTIONAL EXAM.

• COMMUNICATION SKILL
• ECONOMIC ASSET
• FAMILY AND COMMUNITY SUPPORT
• MENTAL / PSYCHOLOGICAL STATUS AND COPING SKILLS

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PROBLEM LIST

• MEDICAL
• Right hemiparesis
• Spasticity
• A seventh cranial nerve palsy
• Aphasia

• REHABILITATION
• Mobilization
• Activities of daily living
• Mobilization
• Activities of daily living
• Social interaction
• Psychological status
• Communication

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ALTHOUGH THE PATIENTS PRIMARY MEDICAL PROBLEM,
RIGHT HEMIPARESIS, COULD NOT BE RESOLVED, MANY OF
THE REHABILITATION PROBLEMS CAN BE RESOLVED
FURTHER DECREASED DISABILITY
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LEVEL OF DEPENDENCE

• INDEPENDENT PATIENT CAN PERFORM ACTIVITIES
  WITHOUT VERBAL OR PHYSICAL ASSISTANCE
• SUPERVISION NEEDED PATIENT MAY REQUIRE VERBAL
  INSTRUCTION OR STANDBY ASSISTANCE TO PERFORM
  FUNCTIONAL ACTIVITIES

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LEVEL OF DEPENDENCE..

• ASSISTANCE NEEDED PATIENT REQUIRES ASSISTANCE OF
  ANOTHER PERSONS AT MINIMAL, MODERATE, OR MAXIMAL
  LEVEL TO PERFORM THE FUNCTIONAL ACTIVITY
• DEPENDENT PATIENT CANNOT PERFORM THE ACTIVITY
  EVEN WITH THE ASSISTANCE OF ADAPTIVE EQUIPMENT OR
  ANOTHER PERSON AND THE FUNCTIONAL ACTIVITY MUST
  PERFORMED TOTALLY BY SOMEONE OTHER THAN THE
  PATIENT

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MANAGEMENT OF REHABILITATION MEDICINE

• DONE BY THE TEAM OF REHABILITATION MEDICINE
• THE TEAM CONSIST OF
• PHYSICIAN (PHYSIATRIST)
• PSYCHOLOGIST
• PHYSIOTHERAPIST
• OCCUPATIONAL THERAPIST
• SPEECH THERAPIST
• REHABILITATION NURSE
• SOCIAL WORKERS
• ORTHOTICS PROSTHETIST

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Thank you