Introduction to medical rehabilitation

1. Dr JayathriJagoda Consultant Rheumatologist D G H Gampaha Introduction to medical rehabilitation

3. What is medical rehabilitation • Optimizing functional capacity • Using the existing capabilities of a disabled person • So that his community participation would be optimized • His medical, physical, psychosocial, vocational and recreational needs to be addressed

4. Importance of rehabilitation Event Optimally self dependant Rehabilitation provided Partially independent Rehabilitation denied Disability Partially dependant Totally dependant

5. To make a disabled person into a “differently abled” person

7. WHO action plan 2014-2021 three objectives: • to remove barriers and improve access to health services • to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation • to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services.

8. Impairment, disability and handicap • Impairment • Any loss or abnormality of a structure or function • Disability • Any restriction or lack of ability to perform a task expected from a normal human being in the same age, sex and social circumstances • Handicap • A disadvantage for a given individual resulting from the impairment and disability

9. Impairment, disability and Handicap

10. Handicaps • Locomotor • Visual • Hearing and speech • Cardiopulmonary • Intellectually challenged • Emotionally disturbed

11. Primary and secondary disabilities • Primary • Directly caused by the disease or condition • Paraplegia • Immobility of a limb following # • Secondary • Which did not exist at the time of onset, but develop subsequently • Soft tissue contracture • Deconditioning • Pressure sores

12. Who need rehab • Neurology • Stroke • Spinal injury • Chronic neurological conditions • Amputees • Fractures • Cerebral palsy • Brain injuries • Disabling arthritis

13. The Rehabilitation Team • Diversity of problems • Spectrum of work to be done • Multidisciplinary team needed to restore optimum function in a disabled person

14. PATIENT

16. Rehab consultant • Leader of the rehabilitation team • Arrive at a functional diagnosis • Coordinates with other members and formulates a management plan • Prescribes PT,OT, orthotics and prosthetics • Performs rehab surgery • Addresses medical problems • Friend philosopher and a guide to the rest of the team

17. Physiotherapist • Evaluate muscle strength • Maintain joint ROM • Improve balance • Use of PT modalities • Individualized wheelchair prescription • Progressive gait training

18. Occupational therapist • Evaluates and trains on function related to self care and vocation • Design and provide assistive devices to improve function • Helps in environment modification • Helps vocational needs

19. OT functional assessment

20. Rehabilitation nurse • Skin, Bladder, bowel and stoma care • Helps on transfer and ADLs • Coordinates the family and rehab team

21. Speech therapist • Evaluate and manage communication problems • Assess and aid swallowing • Vocal re-education • Training the patient on using communication devises

22. Social worker • Evaluate the need of social services and guide the team • Co-ordinate between the funding organizations and the team • Help in home and environmental modification

23. Delivery of rehabilitation care • Institution based • Homes • Out patient clinics • Community based

24. Assessment of a disabled person • Special areas • Identify and prioritize urgent medical problems • Assessment of functional status • ADLs • Social history • Patient’s and carer motivation, awareness and distress • Anticipate case specific complications and plan repeated assessments at appropriate intervals • Be aware and assess cognitive-behavioral issues

25. Goal setting • S - simple • M - measurable • A - achievable • R - repeatable • T – Trackable • Short and long term goals

26. Physiotherapy for rehabilitation • Therapeutic exercises • Coordination ex • Balance training • Gait training • Strengthening ex • Mobilization ex • Endurance ex • Re-education • Massage techniques

27. Physical modalities • Cryotherapy (cold) • Heat • Superficial – IRT • Deep – UST, Short wave diathermy • Currents • Interferential • TENS • Diathermy • Mechanical • Vibrati0n • Massage • Hydrotherapy

28. Orthotics and prosthetics • Orthotic • A mechanical device fitted to the body to maintain anatomical or functional position • Prosthesis • Replaces a missing limb • Attempts to restore function • Mobility aids • Improve mobility and stability • Range from simple walking stick to motorized wheel chair • ALL DEVICES SHOULD BE CAREFULLY PRESCRIBED

30. Role of surgery in rehabilitation • Close liaison between orthopaedic surgeon and rehab physician is needed • Decision of surgery carefully discussed and individualized • Soft tissue Sx always considered before bone Sx • Tendon transfers and muscle re-education • Soft tissue lengthening procedures • Osteotomy • Arthrodesis • Joint replacement

32. What happens in Sri Lanka • Both Rehabilitation and Rheumatology handled by one consultant • Rehabilitation medicine will be branching off in future • Barrier free environment is increasingly appreciated • New buildings have better disabled access entrances and toilets • Public transport is no where near correction

33. Where Rehab is done • Ragama rehabilitation centre • Centre of excellence • Has inward facilities with good OT/PT units • Custom made prosthetic limbs manufactured and trained • Special seating programme for CP • Other centres • Digana • Galle • Anuradhapura • kurunegala • (Jayanthipura • Kendagolla) • Negambo • Gampaha

34. What could we do • Refer more patients…. Please !

36. Thank you