1. Introduction to medical rehabilitation
Dr Jayathri Jagoda
Consultant Rheumatologist
D G H Gampaha
Introduction to medical rehabilitation

3. 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

4. Importance of rehabilitation
Totally dependant
Partially dependant
Partially independent
Optimally self dependant
Event
Disability
Rehabilitation provided
Rehabilitation denied

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

7. WHO action plan
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.

8. Impairment, disability and handicap
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

9. Impairment, disability and Handicap
society
Disability
Whole person
Impairment organ/tissue

10. Handicaps Locomotor Visual Hearing and speech Cardiopulmonary
Intellectually challenged
Emotionally disturbed

11. Primary and secondary disabilities
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

12. Who need rehab Neurology Amputees Fractures Cerebral palsy
Stroke
Spinal injury
Chronic neurological conditions
Amputees
Fractures
Cerebral palsy
Brain injuries
Disabling arthritis

13. The Rehabilitation Team
Diversity of problems
Spectrum of work to be done
Multidisciplinary team needed to restore optimum function in a disabled person

14. PATIENT Rehab physician Specialists Other PT OT SP T Social worker
FAMILY
nurse
PATIENT

16. 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

17. Physiotherapist Evaluate muscle strength Maintain joint ROM
Improve balance
Use of PT modalities
Individualized wheelchair prescription
Progressive gait training

18. 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

19. OT functional assessment

20. Rehabilitation nurse Skin, Bladder, bowel and stoma care
Helps on transfer and ADLs
Coordinates the family and rehab team

21. Speech therapist Evaluate and manage communication problems
Assess and aid swallowing
Vocal re-education
Training the patient on using communication devises

22. 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

23. Delivery of rehabilitation care
Institution based
Homes
Out patient clinics
Community based

24. 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

25. Goal setting S - simple M - measurable A - achievable R - repeatable
T – Trackable
Short and long term goals

26. Physiotherapy for rehabilitation
Therapeutic exercises
Coordination ex
Balance training
Gait training
Strengthening ex
Mobilization ex
Endurance ex
Re-education
Massage techniques

27. Physical modalities Cryotherapy (cold) Heat Currents Mechanical
Superficial – IRT
Deep – UST, Short wave diathermy
Currents
Interferential
TENS
Diathermy
Mechanical
Vibrati0n
Massage
Hydrotherapy

28. Orthotics and prosthetics
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

30. 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

32. 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

33. 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

34. Refer more patients…. Please !
What could we do
Refer more patients…. Please !

36. Thank you