Introduction to

Rehabilitation Medicine
 What is Rehabilitation?
 The process of helping a
person to reach the fullest
physical, psychological,
social, vocational,
avocational and educational
potential consistent with his
or her physiologic or
anatomic impairment,
environmental limitations
and desires and life plans
 Definitions:
 Pathology
is a disease or trauma that causes changes in
structure or function of a specific body tissue or organ
 Impairment
 Occurs at the organ system level & is defined as a loss or
abnormality of psychological, physiologic or anatomic
structure or function resulting from pathology
 Disability
 Occurs at the personal level & is defined as any restriction or
lack (resulting from an impairment) of ability to perform an
activity in the manner or within the range considered normal
for a human being
 Definitions
 Handicap
 occurs at the societal level & is defined as a
disadvantage for a given individual that limits or
prevents fulfillment of a role that is normal
(depending on age, gender, social, cultural factors)
for that individual
 Activity
 The nature and extent of functioning at the level
of the person.
 Participation
 The nature and extent of a person’s involvement
in life situations in relationship to impairments,
activities, health conditions and contextual
factors.
 Components of Rehabilitation
 Medical Rehabilitation

Social Rehabilitation
Vocational Rehabilitation
 What is Rehabilitation
Medicine?
 Branch of medical science concerned with the
comprehensive evaluation and management of
patients with impairment and disability arising
from neuromuscular, musculoskeletal,
cardiovascular and pulmonary disorders; also
concerned with the medical, social, vocational
and psychological aspects arising from them.
 Medical Rehabilitation Team

 Composed mainly of:

 Physiatrist
 Physical Therapist
 Occupational Therapist
 Rehabilitation Nurse
 Psychologist
 Speech and language therapist
 Orthotist/prosthetist
 Social worker
 Patient
 Physiatrist
 Team leader
 Coordinates the various
members to achieve the
goal set.
 Manages the medical
aspects and medical
complications that arise
during rehabilitation
 Occupational Therapist
 Evaluate and train patients in
ADL’s and IADL’s
 Explore vocational and
avocational interests
 Evaluates the patient’s skill
within the community
 Train patients in use of modified
environment, assistive devices
and UE prostheses
 Educate the patient’s family to
maintain independence
 Physical Therapist
 Use of physical
agents for treatment
 Assist patient in
functional restoration
especially for gross
motor functions
 Train use of LE
prostheses
 Psychologist
 Helps the patient and
significant others to
prepare psychologically
for full participation
 Testing for intelligence,
personality, psychological
status
 counseling
 Rehabilitation Nurse
 Direct personal care of
patients
 Addresses the ADL’s
 Assist in medication
management
 Educate families on the
related disabilities
 Assist in use of adaptive
devices
 Speech and Language
Therapist
 Evaluates and treats patients
with neurogenic disorders
such as aphasia, dysarthria,
apraxia, cognitive-
communication impairments,
dysphagia
 Educates patients/families on
care of tracheostomy tubes,
dysphagia, alternative
communication.
 Social Worker
 Evaluates the patient’s total
living condition, including:
 Lifestyle
 Finances
 Employment history
 Community resources
 Assess the impact of disability
with the above mentioned
factors
 Facilitate assistance to cope
with such impact.
 Orthotist/Prosthetist
 Evaluates, designs
and fabricates
orthoses and/or
prostheses.
 Follow up and
educate users of care
and maintenance of
such devices
 Other team members
 Vocational Counselor
 Recreation therapist
 Spiritual counselor
 Rehabilitation
Engineer
The Team Approach

Physiatrist

P. T. O.T.

patient S.&L. T.
Ortho./
Prosthe.

Social Psych.
Nurse
Work
 The Physiatric Approach
 Physiatric History
 Chief complaint
 HPI
 Fxnal Hx
 ADL
 Community activities
 Vocational activities
 Functional Goals
 Psychosocial Hx
 •The Physiatric Approach
 Past Medical History
 Review of Systems
 Functional
Examination
 Musculoskeletal
Examination
 Neurological
Examination
 Musculoskeletal examination
 0 – no contractions
 1 – palpable contractions
noted
 2- full range of motion with
gravity eliminated
 3 – full range of motion with
gravity
 4 – full range of motion with
gravity and slight resistance
 5 – full range of motion with
gravity and full resistance
 Modified Ashworth scale for
Spasticity
 0 – no increase in tone
 1 – slight increase in muscle tone, manifested by a catch and release
or by minimal resistance at the end of the ROM when the affected part
is moved in flexion or extension
 1+ - slight increase in muscle tone, manifested by a catch followed by
minimal resistance throughout the remainder (less than half) of the
range of motion
 2 - more marked increase in muscle tone through most of the ROM but
affected parts easily moved
 3 –Considerable increase in muscle tone, passive movement difficult
 4 – affected parts rigid in flexion or extension
 •Activities of Daily Living
 Mobility
 Bed mobility
 Wheelchair mobility
 Transfers
 Ambulation
 Self Care
 Dressing
 Self feeding
 Bathing
 grooming
 Activities of Daily Living
 Communication
 Writing
 Typing/computer use
 Telephone use
 Use of special communication
devices
 Environmental Hardware
 Keys
 Faucets
 Light switches
 Use of windows and doors
 Instrumental Activities of Daily
Living
 Home Management
 Shopping
 Meal planning
 Meal preparation
 Cleaning
 Laundry
 Child care
 recycling
 Instrumental Activities of Daily
Living
 Community Living
Skills
 Money/financial mgt
 Use of public transport
 Driving
 Shopping
 Access to recreational
activities
 Instrumental Activities of Daily
Living
 Health Mgt.
 Handling medication
 Knowing health risks
 Making medical
appointments
 Safety Mgt
 Fire safety awareness
 Response to dangerous
situations
 Response to alarms
 Instrumental Activities of Daily
Living
 Environmental
Hardware
 Vacuum cleaner
 Stove/oven
 Refrigerator
 Microwave ovens
 Gait Analysis
 Important physiatric
tool
 May help show
functional weakness
 Divided into 2 major
phases:
 Stance phase
 Swing phase
 Swing Phase
 Covers 40 % of the
gait cycle
 Initial swing
(acceleration)
 Midswing
 Terminal swing
(deceleration)
 Stance phase
 Covers 60 % of the
gait cycle
 Loading response
(heel strike)
 Midstance (foot flat)
 Terminal stance (heel
off)
 Preswing (toe off)
 Six determinants of Gait
 Pelvic rotation in the
horizontal plane
 Pelvic tilt in the frontal plane
 early Knee flexion
 Weight transfer from heel to
foot flat
 Late knee flexion
 Pelvic lateral displacement
Considerations in Rehabilitation
 Goal setting
 Understanding the
functions of the team
members
 Autonomy of each
member
 Understanding the
needs of the patient
 Physiologic response to Heat
Heat

Decreased Increased Increased

Blood viscosity tissue temp Local sweating

Increased Arteriolar
Phagocytosis Dilatation

Increased
Increased Increased
Capillary
Capillary Flow Capillary Pressure
Permeability

Increased
Increased
Clearingof
Supply of nutrients
Metabolic waste
 CRYOTHERAPY
Cold

Decreased
Tissue Temp.

Increased
Blood Viscosity Decreased
And Metabolism
Vasoconstriction

Decreased Decreased Decreased

Decreased
Removal of Production of Leucocyte Phagocyte
Bleeding
By Products Metabolites Activity

Retard Healing
 Rehabilitation of Orthopedic
Patients
 Why rehabilitate?
 Resolve the clinical symptoms
 Return to activity
 General fitness
 From rehabilitation to prehabilitation
 Decreases the chance of injury
 Why rehabilitate?
 Resolve clinical symptoms
 Use of modalities
 Use of appropriate medications
 Protect, Relative Rest, Icing, Compression
and Elevation (PRICE)
 Surgical Indications
 Why Rehabilitate?
 Return to Activity-Restoration of Function
 Retard muscle decline in strength and mass
 Deter complications brought about by
immobility
 Maintain or improve flexibility
 Why Rehabilitate?
 General Fitness
 Improve Cardiovascular fitness
 Overall strength is improved
 Improve tolerance and endurance
 Why Rehabilitate?
 From Rehabilitation to Prehabilitation
 Prevent reinjury
 Improve proprioception
 Prevent Immobility due to apprehension
 What is being Rehabilitated?
 Discovering the type of
injury
 Microtrauma
 Chronic cases
 Due to repetitive
disruption of the
structures
 Macrotrauma
 Often acute cases
 Due to specific events
 What is being Rehabilitated?
 Method of injury  An acute exacerbation
of a chronic injury
presentation  Subclinical adaptations
 Injury classified as of activity
 Acute  May be asymptomatic
 Episode usually easily
recalled
 Chronic
 Gradual onset of
symptoms
What is being Rehabilitated?
 Accurate Diagnosis of the
injury:
 Identifies areas that are in
need for Rehabilitation
 Evaluates the effects of
injury to:
 Function and physiology
 Adaptation
 anatomy
 Principles of Rehabilitation In
Orthopedic patients
 Treatment Planning
 Based on 3 stages of rehabilitation
 Acute
 Recovery stage
 Functional stage
 Acute stage
 Focus of treatment
 Clinical symptom
 Tissue injury
 Tools for rehabilitation
 Rest and/or
immobilization
 Physical modalities
 Medications
 Manual therapy
 Initial exercise
 surgery
 Acute Stage
 Criteria for
advancement
 Pain control
 Adequate tissue
healing
 Near normal ROM
 Tolerance for
strengthening
 Recovery stage
 Focus of treatment;
 Tissue overload complex
 Functional biomechanical
deficit complex

•Tools:
Manual therapy
Flexibility
Proprioception
/neuromuscular
control
Specific exercise
 Recovery Stage
 Criteria for
advancement:
 No pain
 Complete tissue healing
 Essentially pain free
ROM
 Good flexibility
 75 to 80 % strength
 Functional Stage
 Focus of treatment
 Functional biomechanical
deficit complex
 Subclinical adaptation
complex
 Tools
 Exercises
 Technique/skills
instructions
 Specific functional
program
 Functional Stage
 Criteria for return to
play or function
 No pain
 Full pain free ROM
 Normal strength and
balance
 Good general fitness
 Normal mechanics
 Conclusion
 Rehabilitation of patients rests on accurate
diagnosis, proper identification of roles,
cooperation among the different
disciplines and a potent but practical goal
setting.
 The patient is always the focus of
treatment, and should have a quality of life
that is deemed most acceptable.