1. REHABILITATION MEDICINE IN NEUROLOGICAL DISEASE

2. PHILOSOPHY OF REHABILITATION MEDICINE

3. DEFINITION
(1) THE DEVELOPMENT OF A PERSON TO THE FULLEST PHYSICAL, PSYCHOLOGICAL, SOCIAL, VOCASIONAL AND EDUCATIONAL POTENTIAL CONSISTENT WITH HIS OR HER PHYSIOLOGICAL OR ANATOMICAL IMPAIRMENT AND ENVIRONMENTAL LIMITATION

4. DEFINITION (2) THE RESTORATION OF FUNCTION SO
THAT THE PERSONS CAN PERFORM TO
THEIR FULLEST PHYSICAL, EMOTIONAL,
SOCIAL AND VOCATIONAL POTENTIAL.

5. TERMS ASSOCIATED WITH REHABILITATION – WHO 1980
IMPAIRMENT : ANY LOSS OR ABNORMALITY OF PSYCHOLOGICAL, PHYSIOLOGICAL, OR ANATOMICAL STRUCTURE OR FUNCTION
DISABILITY : ANY RESTRICTION OF LACK RESULTING FROM AN IMPAIRMENT OF THE ABILITY TO PERFORM AN ACTIVITY IN THE MANNER OR WITHIN THE RANGE CONSIDERED NORMAL FOR A HUMAN BEING
HANDICAP : A DISADVANTAGE FOR A GIVEN INDIVIDUAL, RESULTING FROM AN IMPAIRMENT OR A DISABILITY, THAT LIMITS OR PREVENTS THE FULFILLMENT (DEPENDING ON THE AGE, SEX AND SOCIAL-CULTURE FACTORS) OF A ROLE THAT IS NORMAL FOR THAT INDIVIDUAL

6. TERMS……WHO -1997
IMPAIRMENT : ANY LOSS OR ABNORMALITY OF BODY STRUCTURE OR OF A PHYSIOLOGICAL OR PSYCHOLOGICAL FUNCTION (ESSENTIALLY UNCHANGED FROM 1980 DEFINITION)
ACTIVITY : THE NATURE AND EXTENT OF FUNCTIONING AT THE LEVEL OF THE PERSON
PARTICIPATION: THE NATURE AND EXTENT OF A PERSON’S INVOLVEMENT IN LIFE SITUATIONS IN RELATIONSHIP TO IMPAIRMENTS, ACTIVITIES, HEALTH CONDITIONS, AND CONTEXTUAL FACTORS

7. COMPARISON OF THE MEDICAL AND REHABILITATION MODELS OF HEALTH CARE

8. PROBLEM ORIENTATION
THE GENERAL ORIENTATION OF THE MEDICAL MODEL IS TOWARD DISEASE, WHILE THAT OF REHABILITATION MEDICINE IS TOWARD DISABILITY
DISEASE : INTERACTION OF A
PATHOLOGICAL PROCESS WITH INDIVIDUAL MOLECULES, CELLS AND ORGANS (BIOLOGICAL EVENT)

9. PROBLEM ORIENTATION………..
DISABILITY, HOWEVER , IS ESSENTIALLY A HUMAN EVENT
 HOW THE DISEASE CAN AFFECT THE HUMAN LIFE?

10. PATIENT ENVIRONMENT DISEASE SOCIAL PSYCHOLOGICAL VOCATIONAL RESPONSE
TOTAL
DISABILITY

11. THE PHYSICIAN’S ROLE REHABILITATION MODEL : MEDICAL MODEL :
TENDS TO BE ACTIVE
REHABILITATION MODEL :
ALSO ENCOMPASS THESE FUNCTION BUT EXTENDS TO INCLUDE HELPING THE PATIENTS ADJUST TO THE DISABILITY AND PROBLEM SOLVING TO MINIMIZE THE FUNCTIONAL LOSS FROM A LONG TERM, CHRONIC CONDITION

12. PATIENT’S ROLE MEDICAL MODEL :
PATIENT OFTEN PASSIVE AND UNINFORMED, WITH DIAGNOSTIC AND THERAPEUTIC MEASURES DONE OR GIVEN TO HIM
REHABILITATION MODEL:
PATIENTS IS ENCOURAGE TO BE AN ACTIVE, INFORMED PARTICIPANT

13. THERAPEUTIC APPROACH MEDICAL MODEL ON TREATMENT
REHABILITATION MODEL ON THE MANAGEMENT *
* MANAGEMENT IS DEFINED AS EFFECTING RELIEF FROM ILLNESS OR DISABILITY AND ENHANCING FUNCTION, USING THE FULL RESOURCES OF THE HEALTH CARE SYSTEM

14. EVALUATION OF DIAGNOSING DISEASE VERSUS DISABILITY

15. IN THE MEDICAL SPECIALTY OF PHYSICAL MEDICINE AND REHABILITATION, DIAGNOSING THE DISEASE IS ONLY THE FIRST STEP IN EVALUATING A PATIENT.
THIS DIAGNOSIS DOES NOT REVEAL WHAT FUNCTIONS ARE LOST AS THE RESULT OF THE DISEASE OR INJURY

16. PRINCIPLES
THE SYMPTOMS AND SIGNS REQUIRED FOR THE DIAGNOSIS OF DISABILITY DIFFER FROM THOSE REQUIRED FOR THE DIAGNOSIS OF DISEASE
THERE IS NOT A ONE TO ONE CORRELATION BETWEEN A DISEASE AND THE RANGE OF ASSOCIATED DISABILITY PROBLEMS, THE DISABILITY IS DEPENDENT ON THE PATIENT’S TOTAL DAILY NEEDS

17. PRINCIPLES…………
THERE IS NOT A ONE- TO- ONE RELATIONSHIP BETWEEN A DISEASE AND THE AMOUNT OF RESIDUAL DISABILITY , DISABILITY CAN BE REMOVED WITHOUT ALTERING THE COURSE OF THE DISEASE
THE ABILITY OF THE PATIENT AND THE PHYSICIAN TO REMOVE DISABILITY IN THE FACE OF CHRONIC DISEASE IS DEPENDENT ON THE RESIDUAL CAPACITY OF THE PATIENT FOR PHYSIOLOGICAL AND PSYCHOLOGICAL ADAPTATION

18. PRINCIPLES………………………
DISABILITY MEANS LOST OF FUNCTION, NOT ONLY PHYSICAL BUT ALSO PSYCHOSOCIAL-VOCATIONAL

19. EVALUATION IN REHABILITATION
THE DISABILITY IS DEPENDENT ON THE PATIENTS’S TOTAL REQUIREMENTS.
THE PATIENT’S RESIDUAL STRENGTH MUST BE EVALUATED AND BUILT UPON TO “WORK AROUND” IMPAIRMENT TO REMOVE DISABILITY

20. MEDICAL AND REHABILITATION PROBLEM LIST

21. WEED’S PROBLEM ORIENTED APPROACH
PHASE 1 : HISTORY, PHYSICAL EXAMINATION AND THE INITIAL LABORATORY STUDIES
PHASE 2 : SPECIFIC PROBLEM LIST

22. PROBLEM ORIENTED………..
PHASE 3 : IDENTIFIES A SPECIFIC TREATMENT PLAN FOR EACH OF THE PROBLEMS
PHASE 4 : EFFECTIVENESS OF EACH OF THE PLANS AND DESCRIBES SUBSEQUENT ALTERATIONS IN EACH, DEPENDING ON THE PATIENT’S PROGRESS

23. PROBLEM ORIENTED APPROACH
THE FOLLOWING CASE HISTORY WILL ILLUSTRATES THE APPLICATION OF THE PROBLEM ORIENTED APPROACH.

24. EXAMPLE CASE-HISTORY 69 YEAR OLD MALE SUDDEN RIGHT-SIDED WEAKNESS
SECONDARY TO OCCLUSION OF THE LEFT MIDDLE CEREBRAL ARTERY
HE IS RETIRED
LIVING WITH HIS WIFE
BEFORE THE ONSET OF THE DISEASE HE HAD BEEN INDEPENDENT IN ALL FUNCTIONAL ACTIVITIES

25. PHYSICAL EXAMINATION HAS MINIMAL TO MODERATE APHASIA
A SEVENTH CRANIAL NERVE CENTRAL PALSY ON THE RIGHT
DEEP TENDON REFLEXES ARE HYPERACTIVE, POSITIVE BABINSKI AND INCREASED MUSCLE TONE IN THE RIGHT SIDE AND NORMAL ON THE LEFT SIDE
ROM WITHIN NORMAL LIMITS, BUT THERE IS A WEAKNESS IN THE RIGHT EXTREMITY

26. FUNCTIONAL EXAMINATION
MOBILIZATION
BALANCE: STATIC AND DYNAMIC; SITTING AND STANDING
TRANSFERS :TURNING IN BED, SITTING UP, STANDING UP, MOVE TO A CHAIR OR MAT
AMBULATION : PROPEL WHEELCHAIR, WALK USING A FUNCTIONAL AND EFFICIENT GAIT PATTERN
ACTIVITIES OF DAILY LIVING (ADL)
DRESSING, FEEDING, GROOMING, BATHING, PERSONAL HYGIENE

27. FUNCTIONAL EXAM………. COMMUNICATION SKILL ECONOMIC ASSET
FAMILY AND COMMUNITY SUPPORT
MENTAL / PSYCHOLOGICAL STATUS AND COPING SKILLS

28. PROBLEM LIST MEDICAL REHABILITATION Mobilization Right hemiparesis
Spasticity
A seventh cranial nerve palsy
Aphasia
REHABILITATION
Mobilization
Activities of daily living
Social interaction
Psychological status
Communication

29. ALTHOUGH THE PATIENT’S PRIMARY MEDICAL PROBLEM, RIGHT HEMIPARESIS, COULD NOT BE RESOLVED, MANY OF THE REHABILITATION PROBLEMS CAN BE RESOLVED FURTHER DECREASED DISABILITY

30. LEVEL OF DEPENDENCE
INDEPENDENT : PATIENT CAN PERFORM ACTIVITIES WITHOUT VERBAL OR PHYSICAL ASSISTANCE
SUPERVISION NEEDED: PATIENT MAY REQUIRE VERBAL INSTRUCTION OR STANDBY ASSISTANCE TO PERFORM FUNCTIONAL ACTIVITIES

31. LEVEL OF DEPENDENCE……………..
ASSISTANCE NEEDED; PATIENT REQUIRES ASSISTANCE OF ANOTHER PERSONS AT MINIMAL, MODERATE, OR MAXIMAL LEVEL TO PERFORM THE FUNCTIONAL ACTIVITY
DEPENDENT; PATIENT CANNOT PERFORM THE ACTIVITY EVEN WITH THE ASSISTANCE OF ADAPTIVE EQUIPMENT OR ANOTHER PERSON AND THE FUNCTIONAL ACTIVITY MUST PERFORMED TOTALLY BY SOMEONE OTHER THAN THE PATIENT

32. MANAGEMENT OF REHABILITATION MEDICINE
DONE BY THE TEAM OF REHABILITATION MEDICINE
THE TEAM CONSIST OF
PHYSICIAN (PHYSIATRIST)
PSYCHOLOGIST
PHYSIOTHERAPIST
OCCUPATIONAL THERAPIST
SPEECH THERAPIST
REHABILITATION NURSE
SOCIAL WORKERS
ORTHOTICS PROSTHETIST

33. Thank you