Physical Medicine / Rehabilitation

1. Physical Medicine / Rehabilitation KNR 365

2. Rehabilitation Continuum of Care • Rehabilitation is the process of providing those comprehensive services deemed appropriate to the need of a person with a disability in a coordinated manner in a program designed to achieve objectives of improved health, welfare and the realization of the person’s maximum potential for useful and productive activity • CARF • Required coordinated comprehensive multidisciplinary approach

3. Rehabilitation Continuum of Care • These services are made available to people with traditional rehab diagnosis • CVA, TBI, SCI, hip/knee replacement, amputation, chronic progressive and relenting neurological disorders, and multitrauma • Decline in functioning secondary to cardiac, pulmonary, arthritic conditions • Role of case manager is to direct patients to the most effective level of care • Continuum of care • Subacute care units, long-term/skilled care units, day care, rehabilitation hospitals, comprehensive outpatient care, and home health care

4. Rehabilitation Continuum of Care • Subacute care is less-intense level of care than acute care provided in hospital & more that in LTC/skilled nursing facility (SNF) • Levels • Transitional step-down unit, often in hospital • General subacute care • Chronic subacute (comatose, ventilator-dependent, little hope of recovery or functional independence) • Harris

5. Rehabilitation Continuum of Care

6. TR Services • 1-1 • Group • Co-treatment • Co-treatment involves more than one professional providing treatment during the same session • Co-treatments are performed when therapeutic goals are similar or complimentary

7. Disabilities in Text Class Discussion Assignments Cardiac Conditions Multiple Sclerosis Fibromyalgia • Amputation & Prosthesis • Back Disorders & Back Pain • Chronic Obstructive Pulmonary Disease • Guillain-Barre Syndrome • Joint Replacement • Spinal Cord Injury • Traumatic Brain Injury

8. Illinois Neurological Institute:Top Diagnosis on Rehab • Stroke • Spinal Cord Injury • Traumatic Brain Injury • Critical Illness Myopathy • Guillain-Barre Syndrome • Myasthenia Gravis • Amputation • Joint Replacement • Multiple Sclerosis • Medical Deconditioning

9. Critical Illness Myopathy • What is Critical Illness Myopathy? • is not well understood • typically occurs in the intensive care unit among patients who have been treated with multiple drugs • the most common clinical signs of the disease are diffuse weakness and a failure to wean from mechanical ventilation • Who gets Critical Illness Myopathy? • is a disease of limb and respiratory muscles • is observed during treatment in the intensive care unit • in addition to the critical illness (severe trauma or infection), muscle relaxant drugs and corticosteroid medications may be contributing factors

10. Critical Illness Myopathy • Deficits • Developed in critically ill patients • General muscle weakness • Decreased endurance, mobility, strength, balance • Fatigue • Lethargy • How is Critical Illness Myopathy treated? • Early and complete recovery may occur with successful treatment of the critical illness, and withdrawal of the medications • RT goals: • Increase endurance, strength, balance • http://www.aanem.org/Education/Patient-Resources/Disorders/Critical-Illness-Myopathy.aspx

11. Myasthenia Gravis • Chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body • Deficits • Decreased endurance and strength (upper & lower extremities) • Decreased muscles that affect eye control, eyelid movement, facial expression, chewing, talking, swallowing, breathing dysarthria (impaired speech), blurred vision, double vision (diplopia), gait • RT goals • Increase strength and endurance • http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm

12. Medical Deconditioning • Loss of muscle tone and endurance due to chronic disease, immobility, or loss of function • Deficits • Decreased endurance, strength, balance, mobility • Fatigue • Lethargy • RT goals • Increase endurance, strength, balance, mobility

13. Amputation • Performed because of limb disease, trauma, birth defects, frostbite • Peripheral arterial disease (complication of diabetes) • Cancer • Sudden blockage of an artery (embolus) causing lack of blood/oxygen to tissue….gangrene • Upper: defects, trauma, tumors • Lower: 70% disease • Loss of limb requires more cardiopulmonary & muscular energy to perform tasks • See Porter & burlingame, 2006, p. 12 for classifications

14. Amputation • Secondary problems • Pain (including phantom pain) • Infection • Skin breakdown • Deconditioning • Impaired sense of self • Lack of awareness and knowledge • RT interventions • Physical activity for endurance & muscle strength • Activity adaptation • Community problem solving • Community mobility skills • Community reintegration

15. Amputation

16. Back Disorders & Back Pain See text pp. 25-28

17. Chronic Obstructive and Pulmonary Disease (COPD) • Chronic bronchitis, asthma, emphysema • Not reversible; damage can not be undone • 4th leading cause of death in US • Primary cause is smoking • Secondary problems • Poor nutrition • Poor muscle strength & endurance • Psychosocial issues (depression, anxiety, learned helplessness, loss of internal locus of control) • RT interventions • Stress management • Adaptive equipment • Social support

18. Guillain-Barre Syndrome (GBS) • Illness in which body’s immune system attacks its own nerve cells • Affects peripheral nervous system (nerve roots that exit vertebral column to muscles & organs) but not nerves in brain or spinal cord • Symmetrical muscle weakness that starts in legs & rises upward (ascending paralysis) • Weakness, loss of balance, pain • Decreased mobility, strength, endurance balance • Increased heart rate, blood pressure • Anxiety • Lack of leisure • RT Interventions: Stress management, exercise, energy conservation training

19. Joint Replacement • Removal of diseased or damaged joint and implantation of artificial joint (prosthesis) • Hip and knee are most common (could be any joint) • Typically caused by rheumatoid arthritis, osteoarthritis, or trauma • Total hip replacement (THR) • 2/3 are older than 65, increases up to 75, then declines • 62% are women • Total knee replacement (TKR) • Deficits • Decreased mobility, balance, endurance, strength • Social isolation, loss of healthy leisure lifestyle, increased weight

20. Joint Replacement • Concerns for deep vein thrombosis & pulmonary emboli • Anti-clotting medication (bleeding concerns) • Warning signs: pain in calf, tenderness or redness above or below knee, swelling in calf, ankle, foot • Warning signs that clot has traveled to lung: sudden onset of chest pain, localized chest pain, & coughing • Must be cleared to resume driving