Neuro Rehabilitation

Rehabilitation in Neurology/ Stroke
gait
balancing
personnel hygiene

1. Neuro. Rehabilitation Dr. Mohabbat Ali Coordinator, Advanced Rehabilitation Services, AKUH

2. What is Neuro Rehabilitation? Roles of Neuro Rehabilitation? How to improve the physical activity/fitness level How to maintain the physical activity/fitness U Should Know After The Session

3. “ An active process by which those disabled by injury or disease achieve a full recovery or when a full recovery is not possible realise their optimal physical, mental and social potential and are integrated into their most appropriate environment.” What is Neuro Rehabilitation

4.   Aims of Rehabilitation Maximize independence and functional potential Minimize  secondary complications Minimizing restrictions and limitations Removing environmental barriers / providing facilitators

5. Types of problems Body Functions & Structures Activities & Participation Environmental

6. Compare with rehabilitation following: Specialist enters picture to solve a problem and leaves when the problem is solved Rehabilitation is an ongoing process in chronic neurological conditions Challenges of Neuro rehabilitation

7. Begins at time of diagnosis before appearance of impairment Importance of education and general good health from outset Nature of interventions change as the disease progresses Different interventions required depending on circumstances of each person Continue…..

8. Rehabilitation Phases Phase 1 ( Inpatient) Phase 2 ( Outpatient)

9. Rehabilitation Phases Phase 3 Advanced Rehabilitation Phase 4 Maintenance phase

10. Rehabilitation Strategies Restorative Preventive

11. Educational Active process Patient centred Minimize disease impact Facilitate self management Evaluation Rehabilitation Key components

12. Depression is common in any type of neuro disorder Rehabilitation can only succeed if the person is an active participating member Adequate assessment, diagnosis and treatment of depressive symptoms essential Problems in Rehabilitations

13. • Cognitive dysfunction, • Mood disturbance • Reduced mobility; weakness , • Spasticity • Ataxia • Fatigue, Heat intolerance • Pain, sensory disturbance • Bladder, bowel and sexual dysfunction • Visual disturbance • Speech, swallowing dysfunction Symptoms

14. Family Careers •Relationship difficulties •Loss of job •Need for life of own •Need for respite Professionals •Take control •Adverse effects of interventions •Don’t recognise strengths of people with MS and carers •Ascribe unrelated symptoms to MS The Difficult World of the Person with MS”

15. Person wiith MS • Loss of control •Poor self image •Need for fulfilling role •Disturbed thought processes •Conflict •Financial problems Wiider Publliic •Negative perceptions •Lack of understanding of people with MS and needs •Discrimination Environment •Information difficult to access •Difficult to obtain services •Inadequate transport •Inadequate public facilities Continue…..

16. • Team concept is crucial. • MS strikes at the peak years of career development and family life • MS can affect so many different physical and psychological functions. • Interdisciplinary team working with person with MS and his or her family and carers . The Rehabilitation team

17. • Neurologist/Rehabilitation Consultant •Orthotics service • Physiotherapy services • Occupational Therapy services • Clinical Psychology / Psychiatric Services • Speech and language therapy The Multidisciplinary Mullti disciplinary team

18. • Low vision services • Driving assessments • Information Services • Employment Counseling • Housing Modification • Care Attendant • Assisted Transport • Residential Care • Respite and Holiday care • Day Centre Attendance • Aids and Appliances • DLA • Mobility • Care Neuro rehabilitation services

19. • Community integration • Comprehensive assessment • Care giver support • Cooperation • Communication • Coordination • Continuity Who coordinates these services?

20. • MS rehab not always evidence based. • No data to guide optimal management of medical complications. • No consensus on outcome measurements • Unable to predict response to rehabilitation therapies • HOWEVER –there are studies suggesting that intensive multidisciplinary programs benefit people with MS( Larocca NG Kalb RC 1992) Does rehabilitation work?

21. • DIFFICULT • Disease course varies greatly • Different types of MS ie RRMS SPMS • Triggers of relapses and progression unpredictable • Poor clinical-pathological correlation. • Does the degree of benefit merit the cost and effort. Evaluation of Rehabilitation

22. 1 . Rehabilitation process 2. Specific therapies 3. Different settings 4. Different functions What to evaluate?

23. • Physiotherapy • 48RCTs • 2521 patients What is the evidence?

24. How physical therapist can help ? Design an exercise program to meet your particular needs. Evaluate and treat problems of mobility and walking. Evaluate and treat joint or muscle pain which interferes with the activities of daily living. Help with poor balance or frequent falling. Treat difficulties accomplishing activities of daily living. Recommend and teach the correct use of adaptive equipment.

25. Essential PD rehabilitation components Breathing control. Stretching knowledge. Strength training. Aerobic activity. Balance training. Posture correction. Speech and Swallowing Rehab. Role of adaptive and assistive devices.

26. GAIT MANAGEMENT Visual clues – step over cracks, cue-cards Verbal cues – one/two, heel/toe, metronome, music, rhythm Proprioceptive clues – for freezing, heel down, rock backwards/forwards, take step back Turn in wide arc, forward

27. Neuro -rehabilitation Assessment Measurement Planning Treatment Evaluation Reassessment

28. Risk Factors Non-modifiable Disease related Modifiable Increasing Age Male Sex Heredity and Race Obesity Family History

29. Risk Factors Non-modifiable Disease related Modifiable High Blood Pressure Diabetes Mellitus Carotid Artery Disease Heart Disease Polycythemia Transient Ischemic Attacks Heart disease risk factors related with stroke Prior Stroke

30. Risk Factors Non-modifiable Disease related Modifiable Cigarette Smoking High Dose OCPs Heart disease risk factors related with stroke

31. Phase 1- Acute stroke rehabilitation Maintain ROM and prevent deformity Promote awareness, active movement and use of hemiplegic site Improve trunk control, symmetry and balance Initiate self care activity Improve functional mobility and cardiopulmonary endurance

32. Phase 2 rehabilitation Prevent 2ndry complications Promote selective movement to control trunk and maintain postural tone and balance Develop independent functional mobility skills Develop independent ADLS

33. Phase 3 rehabilitation Improve gait training Strengthening exercise Improve mobility without support

34. Physiotherapy Physical status Working capacity Vocational status Emotional get up Psychological status Social security Improve

35. Neuro Rehabilitation Occupational Therapy

36. Role of Occupational Therapy Assess Performance Equipment Needs Intervention Patient and Family Training Recommendations

37. Assessing Performance Functional Independence Measure (FIM) Universal Standard Multidisciplinary Severity of Disability Track Changes Analyze Outcomes

38. FIM Scores 7 Independent 6 Modified Independent 5 Supervision/Set-up 4 Minimal Assistance 3 Moderate Assistance 2 Maximal Assistance 1 Total Assistance

39. No Helper Required Independent Normal method, performance Modified Independent Equipment Extended time Saftey risk

40. Helper Required No physical contact required Supervision Set-up Cuing Orthosis

41. Helper Required Physical Contact Required Patient does: 75-100% Minimal Assistance 50-74% Moderate Assistance 25-49% Maximal Assistance 0-24% Total Assistance

42. Role of Occupational Therapy Assess Performance Equipment Needs Intervention Patient and Family Training Recommendations

43. Equipment Needs Durable Medical Equipment Adaptive Equipment Orthotics

44. Durable Medical Equipment Tub Transfer Bench Shower Chair Bedside Commode

45. Adaptive Equipment Long-Handled Sponge Reacher Sock Aid Built-Up Handles Inspection Mirror

46. Orthotics Splint Wrist-Hand Orthosis

47. Role of Occupational Therapy Assess Performance Equipment Needs Intervention Patient and Family Training Recommendations

48. Role of OT Intervention Hemi Dressing Techniques Patient/Family Training Assistance Recommendation Equipment

49. Basic ADL’s (BADL) Self-Care Mobility Communication

50. Self-Care Feeding Grooming Dressing Bathing Toileting

51. Mobility Gross Motor function

52. Mobility Fine motor function

53. Communication Writing Using a telephone

54. HOUSE HOLD AIDS

55. Instrumental ADL’s (I-ADL) Home Management Community Living Skills Health Management Safety Management

56. Self-Care Activities Skills for Restoring: Function Independence Dignity

57. Feeding Set-up Handling utensils and cups Chewing and swallowing

58. Grooming & Hygiene Oral Care Brushing the hair Washing the face Washing the hands (Shaving, makeup)

59. Dressing Retrieving Clothing Dressing/Undressing

60. Bathing Washing & Drying Excludes neck, back Transfer not included Adding up the parts

61. Implementation