Dr Jayathri Jagoda Consultant Rheumatologist D G H Gampaha

INTRODUCTION TO MEDICAL REHABILITATION

Dr Jayathri JagodaConsultant RheumatologistD G H Gampaha

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

Totally dependant

Partially dependant

Partially independent

Optimally self dependant

Event

Disability

Rehabilitation provided

Rehabilitation denied

Importance of rehabilitation

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

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.

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

Impairment, disability and Handicap

Handicap society

DisabilityWhole person

Impairment organ/tissue

Handicaps

Locomotor Visual Hearing and speech Cardiopulmonary Intellectually challenged Emotionally disturbed

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

Who need rehab

Neurology Stroke Spinal injury Chronic neurological conditions

Amputees Fractures Cerebral palsy Brain injuries Disabling arthritis

The Rehabilitation Team

Diversity of problems Spectrum of work to be done

Multidisciplinary team needed to restore optimum function in a disabled person

Rehab physician

Other Specialists

PT

OT

SP T

Social worker

FAMILY

nurse

PATIENT

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

Physiotherapist

Evaluate muscle strength Maintain joint ROM Improve balance Use of PT modalities Individualized wheelchair

prescription Progressive gait training

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

OT functional assessment

Rehabilitation nurse

Skin, Bladder, bowel and stoma care Helps on transfer and ADLs Coordinates the family and rehab

team

Speech therapist

Evaluate and manage communication problems

Assess and aid swallowing Vocal re-education Training the patient on using

communication devises

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

Delivery of rehabilitation care

Institution based Homes Out patient clinics Community based

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

Goal setting

S - simple M - measurable A - achievable R - repeatable T – Trackable

Short and long term goals

Physiotherapy for rehabilitation Therapeutic exercises

Coordination ex Balance training Gait training Strengthening ex Mobilization ex Endurance ex Re-education Massage techniques

Physical modalities

Cryotherapy (cold) Heat

Superficial – IRT Deep – UST, Short wave diathermy

Currents Interferential TENS Diathermy

Mechanical Vibrati0n Massage

Hydrotherapy

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

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

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

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

What could we do

Refer more patients….

Please !

THANK YOU