Key points
Definitions
Key points
Rehabilitation planning
• Impairment/diagnosis
• Problem list
○ Medical/surgical
○ Functional
○ Psychosocial
○ Avocational
• Vocational
• Educational
• Rehabilitation goals
○ Problem oriented
• Review date
Components of rehabilitation
Measurement in rehabilitation
Functional
Key points
Physical
0 No contraction
1 Flicker or trace of contraction
2 Active movement with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity and resistance
5 Normal power
Measures of mobility such as the motor assessment score
add extra detail to the less sensitive FIM and Barthel index in
neurological disorders. Other tests of mobility may be very
simple such as a 6 metre (20 feet) walking speed or the
timed “up and go” (Posiadlo and Richardson 1991) test. In
this test the patient is observed as they rise from an armchair
and walk 3 metres, turn, walk back and sit down again.
Cognitive
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Heat
• Bleeding disorders.
• Sepsis
• Pregnancy.
• Decrease pain.
• Psychological benefits.
• gel pack
Key points
• It is best to bandage the bag of ice or gel pack onto
the limb.
Electrical therapy
Laser
TENS
• Cardiac pacemaker
• Pregnancy
• Larynx/Pharynx/eye
• Stretching
• Balancing, motor control and coordination
• Cardiovascular fitness
• Type of exercise
• Intensity
• Recovery interval
• Isometric
• Isotonic
• Isokinetic
Flexibility
Proprioception
Cardiovascular fitness
• Type of exercise
• Frequency
• Intensity
• Duration
• Program length
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Overview
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• Surgery
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• Wound protection
• Reduction of infection
• Anti-contracture treatment
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• Contractures
Contractures at the hip and knee form quickly with the loss of
the limb as a lever. An anticontracture program should start
within the first post-operative week. This program involves
lying prone for 30 minutes twice daily to encourage extension
at the hip. Knee exercises involve 10 second isometric
quadriceps exercises 10 repetitions every hour. An extension
stump board should be attached to the wheelchair for below
knee amputees.
• Mobilization
• Pain management
• Psychological adaptation
Overview
• Skin
Key points
• Pain
Pain frequently accompanies SCI and can significantly
impact upon a person's functional ability, ability to return to
work, psychological well-being and quality of life. At present
there are no clear links between acute pain management
and longer term outcomes. However, there is some evidence
emerging from studies in other areas such as phantom limb
pain after amputation to suggest that early treatment may be
helpful for preventing later development of chronic pain. Pain
should therefore be vigorously treated during the acute
period. Patients are more likely to be actively involved in
rehabilitation when pain is adequately controlled.
Key points
• Spasticity
• constipation
• skin ulceration
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• Psychological issues
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• Fertility
Infertility is common in males following SCI due to
anejaculation and/or poor semen quality. Since the majority
of spinal injuries occur to young, single males this is an
important issue. Two methods of semen retrieval are
commonly used, namely vibroejaculation and
electroejaculation (Linsenmeyer 1993). Vibroejaculation is
the most frequently used method in patients with lesions
above T11 level. However, electroejaculation may be used in
acute phase for collection of semen, when vibroejaculation
will be unsuccessful in the presence of spinal shock (Mallidis
et al. 1994). When this technique is performed within 7-10
days after injury, semen quality is usually normal and can be
cryopreserved for future use. Problems with reduced sperm
quality later can be overcome using assisted reproductive
technologies, such as in vitro fertilisation (IVF) and
micromanipulation techniques (Linsenmeyer 1993).
Key points
• Sudden Hypertension
• Pounding headache
• Bradycardia
• Goose bumps
• Nasal stuffiness
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• eyes closed
• Management
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Management
• <!--[if !supportLists]-->Limit
conflicting sensory stimulation and
noise
• <!--[if !supportLists]--><!--[endif]--
>Minimise changes of location
• <!--[if !supportLists]--><!--[endif]--
>Establish regular daily routine with
rest periods
• <!--[if !supportLists]-->Recognise
the patients inability to incorporate
strategies
Agitation is best managed without use of
restraints. Environment modification and
problem solving triggering factors are a
priority. Monitoring and control of the
environment requires appropriate ward
design with sensitivity to noise, patient
interactions and safety. Nursing on
mattresses on the floor or a modified, low
bed may be best for the markedly agitated
patient with impaired balance. Formal
behaviour control programs are not
indicated.
Key points
• <!--[if !supportLists]--> <!--[endif]--
>Withdraw any potentially
exacerbating medications
• <!--[if !supportLists]-->Medication in
management of extreme or
persistent agitation may be needed
to avoid unacceptable morbidity
• <!--[if !supportLists]--><!--[endif]--
>Document baseline target
behaviour, trial of medication with
titrated dosage, regular review of
effectiveness and trial of withdrawal
• <!--[if !supportLists]--><!--[endif]--
>Minimum dosage for shortest
period
• <!--[if !supportLists]-->Most
medications are associated with
negative effects on cognition and
perhaps recovery of function, with
the exception of adrenergic
agonists.
• <!--[if !supportLists]--><!--[endif]--
>Not clear that any particular
symptom complex may respond to
a particular therapy and
management is empirical
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