LEC 1 REHABILITATION MEDICINE 4/23/13

REHABILITATION

Process of helping the person to

the fullest physical, psychological,
social, vocational, avocational and
educational potential consistent
with his or her physiological or
anatomical impairment,
environmental limitations, desires
and plans.

REHABILITATION MEDICINE

Branch of medical science

concerned with the comprehensive
evaluation and management of
patients with impairment and
disability arising from
neuromuscular, musculoskeletal,
cardiovascular and pulmonary
disorder and with psychological,
social and vocational disruption
concomitant with them.

Most efficient use of evolving

health care system
Improved quality of life

CLASSES OF TREATMENT STRATEGIES:

1. Prevent or correct additional
disability
2. Enhance system unaffected by the
pathologic process
3. Enhance functional capacity of
systems affected by the disease
4. Use of adaptive equipment to
promote function
5. Modify social and vocational
environment
6. Psychological techniques to
enhance patient performance and
patient education
IMPAIRMENT

CLASSICAL MEDICAL THERAPEUTICS

REHAB MED

BIOPSYCHOSOCIAL MODEL treat

the cause and secondary aspects
of injury and illness.
Brach of medicine that is involved
in the use of physical agents such
as light, heat, sound, water,
electricity and other mechanical
agents in the management of a
disease.

ANTICIPATED OUTCOME

BIOMEDICAL MODEL treat the

cause of the disease.

Increase independence
Shortened length of stay

any loss or abnormality

psychological, physiological or
anatomical structure or function.
Clinical feature or
manifestations of the disease or
condition
E.G. paralysis, loss of vision,
DOB

DISABILITY

Any restriction or lacy resulting

from an impairment of ability to
perform an activity in a manner
within the range considered normal
for a human being.
E.g. inability to walk, unable to
appreciate color/describe things
that are usually seen

TRUE DISABILITY = (NFC CFC) X 100 /

NFC
SIGNIFICANT DISABILITY = (RFC CFC) X
100 / RFC

HANDICAP

Disadvantage for a given individual

resulting from an impairment or a
disability that limits or prevents the
fulfillment of a role that is normal
(depending on the age, sex and
social and cultural factors) for the
individual.
* Extrinsic limiting factor
e.g. Diagnosed to have diabetic
retinopathy who wants to apply
renewal of drivers license but was
denied due to the current condition
Diagnosed to have scoliosis,
applying for janitor but was not
accepted due to his condition
WHO
DEFINITION
HANDICAP
DISABILITY
IMPAIRMENT

LEVEL
SOCIAL
WHOLE PERSON
ORGAN/TISSUE

CLINICAL EVALUATION OF FUNCTIONAL

DIABILITIES:
1. Determine current and required
levels of function
2. Identify severity of the limitation
3. Identify limiting factors
MANAGEMENT OF DISABILITY
1. Ensure that the degree of
significance is appropriate
2. Minimize extrinsic limiting factor
3. Minimize intrinsic limiting factor
4. Change the nature of the task
MEMBERS OF THE REHAB TEAM:
1.
2.
3.
4.
5.
6.
7.

MD
Rehab nurse
PT
OT
Speech therapist
Chaplain
Orthotist/ Prosthetist

8. Social worker
9. Patient advocate
10.
Psychologist
11.
Vocational counselors
HISTORY/SIGNS AND SYMPTOMS

Residual function to address

Identify systems not affected
(compensation)
Identify and treat primary
impairment to maximize
performance

PSYCHIATRIC HISTORY

FUNCTIONAL history
Physical defects and functional
impact
Implied or stated problem
Rapport
MD as an facilitator
Sources (reliable)
CHIEF COMPLAINT: functional loss
and its reason

HISTORY OF PRESENT PROBLEMS:

Date of onset
Character and severity
Location or radiation
Associated complaints
Aggravating and alleviating factors
Previous medical and rehab
treatment outcomes

FUNCTIONAL HISTORY
1. MOBILITY ACTIVITY
a. Bed mobility
b. Transitional movements
c. Sitting
d. Standing
e. Ambulation
f. Stair climbing
g. Wheel chair activities
2. ACTIVITIES OF DAILY LIVING
a. Feeding
b. Grooming

3.

4.

5.

6.
7.

8.

c. Dressing
d. Bathing
e. toileting
HOUSEHOLD ACTIVITIES
a. Cooking
b. Cleaning
c. Lawn work
d. laundry
COMMUNITY ACTIVITIES
a. Driving
b. Shopping
c. Going to church
d. Social activities
COGNITION
a. Orientation
b. Memory
c. Judgment
d. Abstract reasoning
COMMUNICATION
a. aphasia
VOCATIONAL ACTIVITIES
a. Premorbid vocation
b. Job requirements
c. Patients capability
PATIENTS OWN FUNCTIONAL GOAL
a. Motivation/cooperation
b. List of functional devices

PERSONAL/SOCIAL HISTORY
1. SUBSTANCE ABUSE
a. Alcohol
b. Illegal drugs
c. smoking
2. FAMILY/ FRIEND SUPPORT
3. LIVING SITUATION
4. VOCATIONAL HISTORY
5. AVOCATIONAL HISTORY
6. PSYCHIATRIC HISTORY
a. Depression
b. Anxiety
c. Suicidal/homicidal ideation
7. SEXUAL HISTORY
a. MALE: ED, ejaculation
difficulty, decrease libido
b. FEMALE: irregular menses,
dysmenorrheal, dyspareunia,
decreased libido
8. FINANCES
PHYSIATRIC HISTORY

1. Medications/ allergies
2. Diet
3. Past medical/surgical history
a. Cardiovascular
b. Pulmonary
c. Rheumatic
d. Neurological
e. Musculoskeletal
PHYSICAL EXAM
1. CONVENTIONAL P.E
a. Inspection
b. Palpation
c. Percussion
d. auscultation
2. FUNCTIONAL SKILLS
3. FUNCTIONAL EXAMINATION
a. Mobility activities
b. Activities of daily living
c. Household
d. Driving
MUSCULOSKELETAL EXAMINATION:
1. INSPECTION
2. PALPATION
3. RANGE OF MOTION
a. Cervical
flexion/extension/rotation
b. Shoulder
flexion/extension/abduction/i
nternal rotation/external
rotation
c. Elbow flexion
d. Forearm supination/pronation
e. Wrist flexion/extension/radial
and ulnar deviation
f. 2nd-5th metacarpophalangeal
joint flexion
g. 2nd-5th proximal
interphalangeal joint flexion
h. Hip flexion (knee
flexed/extended)
i. Hip
abduction/adduction/internal
rotation/external rotation
j. Knee flexion
k. Ankle
dorsiflexion/plantarflexion

4. CONTRACTURE
5. MANUAL MUSCLE TESTING (MMT)
a. Screening test for muscle
weakness
b. Grip strength
c. Deep knee bends
d. Heel or toe walking
e. Sit-ups with knees extended,
hips flexed and extended
FORMAL MMT:
- Break Test (if with
pain)
- Caution: breakaway
weakness substitution
NEURO EXAM
1. Level of Consciousness: Glasgow
coma scale
2. Mental status: Orientation,
attention span, memory,
general, info., calculation,
abstract reasoning, judgment
3. Communication: comprehension,
verbal communication,
reading, writing, gestural
communication
4. Cranial Nerve examination (CN 112)
5. Motor control: muscle strength
(postural challenges
tandem walking, rhombergs
test, one-leg stance),
dynamic balance test,
coordination, involuntary
movements (spasticity,
ballismus, tremors, chorea,
ahtetosis, dystonia), apraxia
MOTOR REFLEXES (SUPERFICIAL)
1. Corneal
2. Pharyngeal
3. Palatal
4. Scapular
5. Epigastric
6. Abdominal
7. Cremasteric
8. Gluteal
9. Bulbocavernosus/Clitocavernosus
10.
Superfical Anal Wink reflex

ABNORMAL REFLEXES: Babinski, Hoffman

MUSCLE STRETCH REFLEX:
1. BICEPS
2. Pronator teres
3. Triceps
4. Flexor digitorum profundus
5. Patellar
6. Medial hamstring
7. Achilles
DERMATOMES Sensory evaluation
COLD MODALITIES VASOCONSTRICTION
(for 1st 24 hours after traumatic event)
HEATING MODALITIES VASODILATION
(24-48 hours after)
ACUTE INJURY:
M MEDICATION
P PROTECTION
R REST
I ICE
C COMPRESSION
E ELEVATION
TRANSFER OF HEAT:
1. CONDUCTION
2. CONVECTION (use of gel, inert
substance)
3. CONVERSION
DEEP HEATING MODALITIES:
1. ULTRASOUND
Sound waves
.75 1.5 w/cm2
Metal implant (NOT
contraindicated)
Can lyse bone cement
(Contraindicated to patients
with Cement hip
arthroplasty)
Contraindications: infections,
Cancer (increase cell turn
over rate), bleeding
problems, tissues with fluid
(eyes, pregnant uterus,

heart) BUT can be used over

the joint
Use MEDIUM gel
For iontophoresis (steroids)
For tendonitis and de
quervain
2. SHORT WAVE DIATHERMY
Radio wave
Can also lyse cement
3. MICROWAVE DIATHERMY
SUPERFICIAL HEATING MODALITIES:
1. HOT MOIST PACKS (HMP)
SILICON DIOXIDE (GEL)
4 layers of towel (hindi
morning glory towel haha)
15 to 20 minutes application
2. HEAT LAMPS
35 45 INCHES away
3. PARAFFIN WAX BATH
1:7 (OIL:PARRAFIN)
HYDROTHERAPY
Ex: LOWBOUY, HIGHBOUY and
HUBBARD TANK whole body
immersed
Convection
Agitator
Wound debridement (slough
off necrotic tissue)
Hyperhydrosis
Can be used with Ultrasound
FOR SHOULDER MOBILITY:
Overhead pulley
Finger ladder
Shoulder wheel
CRUTCHES
BILATERAL AXILLARY CRUTCHES
FOREARM CRUTCHES
2-point gait, 4 point gait
CANES
On the side of the lesion
Stair ambulation: GOOD leg goes to
heaven, BAD leg goes to hell (going
up: good leg 1st going down: bad
leg 1st)

WALKER
QUADRIPED
More stable
Cannot facilitate narrow or small
hallways
LEG RESTORATOR FOR strength and
endurance
WOBBLE BOARD for balance,
proprioception and ankle sprains
TRACTION (CERVICAL AND LUMBAR)
For spondylosis
Muscle relaxation
Contraindicated to: severe
osteoporosis, cancer
TENS (TRANSCUTANEOUS ELECTRICAL
NERVE STIMULATION)
For pain
Gate-control theory stimulation of
fast conducting nerve fibers and
inhibition small unmyelinated
(pain) nerve fibers would result to
decreased pain sensation
ENDOLAMP uses UV light, determine
Minimum Erythematous Dose (MED), for
wound healing
ELECTRICAL STIMULATION (ES) AND
FUNCTIONAL ELECTRICAL NERVE
STIMULATION (FES)
Use ES if muscle grade is 0 to 2
Use FES if muscle grade is 3/5
JOBST INTERMITTENT COMPRESSION
UNIT (JICU)
FOR edema, swelling, postmastectomy lymphedema
BIOFEEDBACK
MOST simple: mirror
Amplifier
Bells palsy