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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