REHABILITATION

MEDICINE 1.1
INTRODUCTION TO REHABILITATION MEDICINE


09/16/2020 – Asynchronous (CANVAS Lecture)

WHAT IS REHABILITATION? WHAT IS REHABILITATION MEDICINE?

• Rehabilitation of people with disabilities – process • Branch of medical science that focuses on Health
aimed at enabling them to reach and maintain and function and the reintegration of patient to the
their optimal physical, sensory, intellectual, community.
psychological and social functional levels.
• Provides disabled people with the tools they need Components of Rehabilitation
to attain independence and self-determination. • Medical Rehabilitation

Definitions (based on ICF) • Social Rehabilitation

• Impairment
- Any loss or abnormality of psychological,
physiological or anatomical structure or
function
- Any loss or abnormality of body structure or of
a physiological or psychological function
• Disability
- 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
• Handicap
- Disadvantage for an individual resulting from
an impairment or a disability that limits or
prevents the fulfillment of a role that is normal
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
ICF Framework of Functioning and Disability
• Vocational Rehabilitation
Medical Rehabilitation Team
Composed mainly of:
• Physiatrist
o Team leader
o Coordinates the various members to
achieve the goal set
o Manages the medical aspects and
medical complications that arise during
rehabilitation
• Physical Therapist
o Use of physical agents for treatment
o Assist patient in functional restoration
especially for gross motor functions
o Train use of LE prostheses
• Occupational Therapist
o Evaluate and train patients in ADL’s and
IADL’s
o Explore vocational and avocational
interest
o Evaluates the patient’s skill within the
community
o Train patients in use of modified
environment, assistive devices and UE
prostheses
o Educate the patient’s family to maintain
independence
• Rehabilitation Nurse
o Direct personal care of patients
o Addresses the ADL’s
o Assist in medication management
o Educate families on the related disabilities
o Assist in use of adaptive devices
• Psychologist
o Helps the patient and significant others to
prepare psychologically for full
participation
o Testing for intelligence, personality,
psychological status
o Counseling
• Speech and language therapist
o Evaluates and treats patients with
neurogenic disorders such as aphasia,

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 dysarthria, apraxia, cognitive- 2 – Full range of motion with gravity
communication impairments, dysphagia eliminated
o Educates patients/families on care of 3 – Full range of motion with gravity
tracheostomy tubes, dysphagia, 4 – Full range of motion with gravity
alternative communication. and slight resistance
• Orthotist/prosthetist 5 – Full range of motion with gravity
o Evaluates, designs and fabricates and full resistance
orthoses and/or prostheses o Neurological Examination
o Follow up and educate users of care and
maintenance of such devices Modified Ashworth scale for Spasticity
• Social worker 0 No increase in tone
o Evaluates the patient’s total living 1 Slight increase in muscle tone, manifested by a
condition, including: catch and release or by minimal resistance at the
§ Lifestyle end of the ROM when the affected part is moved
§ Finances in flexion or extension
§ Employment history 1+ Slight increase in muscle tone, manifested by a
§ Community resources catch followed by minimal resistance throughout
o Assess the impact of disability with the the remainder (less than half) of the range of
above mentioned factors motion
o Facilitate assistance to cope with such 2 More marked increase in muscle tone through
impact. most of the ROM but affected parts easily moved
• Other team members 3 Considerable increase in muscle tone, passive
o Vocational Counselor movement difficult
o Recreation therapist 4 Affected parts rigid in flexion or extension
o Spiritual counselor
o Rehabilitation Engineer Activities of Daily Living
• Patient • Mobility
o Bed mobility
The Team Approach o Wheelchair mobility
o Transfers
o Ambulation
• Self Care
o Dressing
o Self feeding
o Bathing
o Grooming
• Communication
o Writing
o Typing/computer use
o Telephone use
o Use of special communication devices
The Physiatric Approach • Environmental Hardware
• Physiatric History o Keys
o Chief complaint o Faucets
o HPI o Light switches
o Fxnal History o Use of windows and doors
§ ADL
§ Community activities Instrumental Activities of Daily Living
§ Vocational activities • Home Management
§ Functional Goals o Shopping
o Psychosocial History o Meal planning
o Past Medical History o Meal preparation
o Review of Systems o Cleaning
o Functional Examination o Laundry
o Musculoskeletal Examination o Child care
0 – No contractions o Recycling
1 – Palpable contractions noted
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 • Community Living Skills Stance Phase
o Money / Financial management
o Use of public transport
o Driving
o Shopping
o Access to recreational activities
• Health Management
o Handling medication
o Knowing health risks
o Making medical appointments
• Safety Management
o Fire safety awareness
o Response to dangerous situation
o Response to alarms
• Environmental Hardware
o Vacuum cleaner
o Stove/oven Refrigerator • Covers 60 % of the gait cycle
o Microwave ovens • Loading response (heel strike)
• Midstance (foot flat)
Gait Analysis • Terminal stance (heel off)
• Preswing (toe off)

Six Determinants of Gait

• Important physiatric tool

• May help show functional weakness
• Divided into 2 major phases:
o Stance phase
o Swing phase

Swing Phase
• 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

Nomenclature

• Covers 40 % of the gait cycle

• Initial swing (acceleration)
• Midswing Terminal swing (deceleration)

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 • Stride – step or stage in progress wherein the
lower limb completes one whole gait cycle
• Cadence – rhythm of walking. Number of steps
per minute (average: 110-115 steps per minute)

WHAT DO WE REALLY TREAT?

• Prevent complications of Immobilization
o Atrophy and muscle weakness
o Contractures skin deterioration such as
pressure sores
• Prevent complications of the disease
o Spasticity
o Bladder and bowel changes
o Effects of cardiac, pulmonary changes
o Hormonal changes
o Psychological/psychiatric
• Adapt/ compensate for disability
• Decrease impact of disability

CONSIDERATIONS IN REHABILITATION
• Goal setting
• Understanding the functions of the team members
• Autonomy of each member
• Understanding the needs of the patient

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