1. Physical Medicine / Rehabilitation KNR 365

2. Rehabilitation Continuum of Care Rehabilitation is the process of providing those comprehensive services deemed appropriate to the need of a person with a disability in a coordinated manner in a program designed to achieve objectives of improved health, welfare and the realization of the person’s maximum potential for useful and productive activity »CARF Required coordinated comprehensive multidisciplinary approach Rehab nursesTR PhysiatristsSpeech & respiratory therapists Case managersVocational counselors PTSocial workers OTPsychologists

3. Rehabilitation Continuum of Care These services are made available to people with traditional rehab diagnosis –CVA, TBI, SCI, hip/knee replacement, amputation, chronic progressive and relenting neurological disorders, and multitrauma –Decline in functioning secondary to cardiac, pulmonary, arthritic conditions Role of case manager is to direct patients to the most effective level of care Continuum of care –Subacute care units, long-term/skilled care units, day care, rehabilitation hospitals, comprehensive outpatient care, and home health care

4. Rehabilitation Continuum of Care Subacute care is less-intense level of care than acute care provided in hospital & more that in LTC/skilled nursing facility (SNF) –Levels Transitional step-down unit, often in hospital General subacute care Chronic subacute (comatose, ventilator-dependent, little hope of recovery or functional independence) »Harris

5. Rehabilitation Continuum of Care Acute RehabSubacute Nursing Home Long-term Care Nursing Home Therapy Available5-7days/wk3-5 days/wk1-3 days/wk Therapy Intensity2-4 hrs/day1-3 hrs/day30 min – 1hr/day Avg LOS8-20 days20-35 days1-2 years MD Visits1 per day2-3/week1 per month

6. TR Services 1-1 Group Co-treatment –Co-treatment involves more than one professional providing treatment during the same session –Co-treatments are performed when therapeutic goals are similar or complimentary

7. Disabilities in Text Class Discussion Amputation & Prosthesis Back Disorders & Back Pain Chronic Obstructive Pulmonary Disease Guillain-Barre Syndrome Joint Replacement Spinal Cord Injury Traumatic Brain Injury Assignments Cardiac Conditions Multiple Sclerosis Fibromyalgia

8. Illinois Neurological Institute: Top Diagnosis on Rehab Stroke Spinal Cord Injury Traumatic Brain Injury Critical Illness Myopathy Guillain-Barre Syndrome Myasthenia Gravis Amputation Joint Replacement Multiple Sclerosis Medical Deconditioning

9. Critical Illness Myopathy What is Critical Illness Myopathy? –is not well understood –typically occurs in the intensive care unit among patients who have been treated with multiple drugs –the most common clinical signs of the disease are diffuse weakness and a failure to wean from mechanical ventilation Who gets Critical Illness Myopathy? –is a disease of limb and respiratory muscles –is observed during treatment in the intensive care unit –in addition to the critical illness (severe trauma or infection), muscle relaxant drugs and corticosteroid medications may be contributing factors

10. Critical Illness Myopathy Deficits –Developed in critically ill patients –General muscle weakness –Decreased endurance, mobility, strength, balance –Fatigue –Lethargy How is Critical Illness Myopathy treated? –Early and complete recovery may occur with successful treatment of the critical illness, and withdrawal of the medications –RT goals: Increase endurance, strength, balance »http://www.aanem.org/Education/Patient-Resources/Disorders/Critical-Illness-Myopathy.aspx

11. Myasthenia Gravis Chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body Deficits –Decreased endurance and strength (upper & lower extremities) –Decreased muscles that affect eye control, eyelid movement, facial expression, chewing, talking, swallowing, breathing dysarthria (impaired speech), blurred vision, double vision (diplopia), gait RT goals –Increase strength and endurance »http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm

12. Medical Deconditioning Loss of muscle tone and endurance due to chronic disease, immobility, or loss of function Deficits –Decreased endurance, strength, balance, mobility –Fatigue –Lethargy RT goals –Increase endurance, strength, balance, mobility

13. Amputation Performed because of limb disease, trauma, birth defects, frostbite –Peripheral arterial disease (complication of diabetes) –Cancer –Sudden blockage of an artery (embolus) causing lack of blood/oxygen to tissue….gangrene Upper: defects, trauma, tumors Lower: 70% disease Loss of limb requires more cardiopulmonary & muscular energy to perform tasks See Porter & burlingame, 2006, p. 12 for classifications

14. Amputation Secondary problems –Pain (including phantom pain) –Infection –Skin breakdown –Deconditioning –Impaired sense of self –Lack of awareness and knowledge RT interventions –Physical activity for endurance & muscle strength –Activity adaptation –Community problem solving –Community mobility skills –Community reintegration

15. Amputation

16. Back Disorders & Back Pain See text pp. 25-28

17. Chronic Obstructive and Pulmonary Disease (COPD) Chronic bronchitis, asthma, emphysema –Not reversible; damage can not be undone 4 th leading cause of death in US Primary cause is smoking Secondary problems –Poor nutrition –Poor muscle strength & endurance –Psychosocial issues (depression, anxiety, learned helplessness, loss of internal locus of control) RT interventions –Stress management –Adaptive equipment –Social support

18. Guillain-Barre Syndrome (GBS) Illness in which body’s immune system attacks its own nerve cells Affects peripheral nervous system (nerve roots that exit vertebral column to muscles & organs) but not nerves in brain or spinal cord Symmetrical muscle weakness that starts in legs & rises upward (ascending paralysis) Weakness, loss of balance, pain Decreased mobility, strength, endurance balance Increased heart rate, blood pressure Anxiety Lack of leisure RT Interventions: Stress management, exercise, energy conservation training

19. Joint Replacement Removal of diseased or damaged joint and implantation of artificial joint (prosthesis) Hip and knee are most common (could be any joint) Typically caused by rheumatoid arthritis, osteoarthritis, or trauma Total hip replacement (THR) –2/3 are older than 65, increases up to 75, then declines –62% are women Total knee replacement (TKR) Deficits –Decreased mobility, balance, endurance, strength –Social isolation, loss of healthy leisure lifestyle, increased weight

20. Joint Replacement Concerns for deep vein thrombosis & pulmonary emboli –Anti-clotting medication (bleeding concerns) –Warning signs: pain in calf, tenderness or redness above or below knee, swelling in calf, ankle, foot –Warning signs that clot has traveled to lung: sudden onset of chest pain, localized chest pain, & coughing Must be cleared to resume driving