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30 Cards in this Set
- Front
- Back
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The goal setting process :- |
Has been described as an active patient - family – therapist relationship incorporating opportunities for feedback, whereby patient take as much responsibilities as possible for developing their own goals. |
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Guidelines for goal-setting :- |
● involve the patient early in the process of goal-setting and goal-revising. ● respect the patient’s preference, as long as there are no safety concerns. ● inform the patient about possible anticipated needs. ● negotiate goals with the patient and restructure the goals when necessary. ● use clear and open communication. ● encourage the patient to consider the values of his or her social framework and the impact of the decision upon family members |
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Long term goals :- |
-Etiology and clinical manifestation of the condition. → likely prognosis and anticipated recovery. → patient’s objectives and perceived needs → patient’s personal circumstances → directly or indirectly beneficial to the patient → agreed between the patient and the rehabilitation team or therapist. → feasible → within the scope of the term |
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Short term goals :- |
● relevant to the long term goals. ● functionally based ● not typically confined to a specific professional activity ● capable of objective confirmation ● agreed by the rehabilitation team and the patient. ● feasible within the time-span of rehabilitation. |
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Principles of physiotherapy assessment and outcome measures :- |
It’s possible to determine whether the goal has been met, or whether the goal posts have been moved. One formal method of goal-setting is that of “Goal Attainment scaling (GAS)”, where the goal-setting process is made objective through discussion with the patient |
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Goal Attainment scaling (GAS)”, |
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Scoring of GAS |
-Zero on the GAS scale. -If the outcome is somewhat better or much better than expected, the score assigned is 1 or 2, respectively. -If the scale is somewhat worse or much worse than expected, the score assigned is -1 or-2, respectively. -In a small study of stroke rehabilitation adopting this approach, it was found that the GAS method was acceptable to patients and physiotherapists and that it helped clarify the expectations of physiotherapy. |
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Factors determine nature of rehabilitation environment :- |
-preference of patient “back seat” -his/ her culture, values and self-identit -his/ her participation. -dissatisfaction about time of therapy/goal -family and all significant. -acute or chronic illness -experience of patient during acute hospitalization -education and share same stories. -formal/ informal meetings (discuss or test hidden assumption, values, and perspectives) - too simple-minded (elderly rejection) -the team function, neurophysiologic, functional, cognitive, psychological, social, educational, and vocational needs of the patient. |
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Sample patient satisfaction |
Questions for inpatient rehabilitation Answered on a likert scale 1) Did your progress meet your expectations ? 2) Did you meet your goals ? 3) Did the program prepare you to return home ? 4) Did the program enable you to take better care of yourself and train the family in your care? 5) Did you interact well with your therapists, nurses, physician ? 6) Did the nurses respond in reasonable time to your needs ? 7) Did your doctor answer your medical questions ? 8) Do you understand how to use your medicines ? 9) Was the discharge planning satisfactory ? 10) Did you learn to use the equipment ordered by your therapists ? 11) Do you understand your home and outpatient therapy schedule and goals ? 12) Would you recommend this program to others who need rehabilitations ? |
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Rehabilitation Team |
-Physician -Nurses -Physical Therapists |
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Physician Responsibilities |
:- → Anticipating and managing the medical complications. → Educate patients and families about the consequences and overall prognosis and management of the nervous system disease and of new disabilities. → Explain to both patient and primary care doctor the indications for medications, measures for secondary prevention of complications, management of risk factors for recurrence or exacerbation of the diseases, and the type and duration of rehabilitative interventions. → Articulate the impact of disability to employers and government agencies so that patients can obtain equipment, services, and pertinent disability reports → Leads a weekly team conference that reviews the progress of the patient in reaching the functional goals that will permit a discharge to the home. → Team conference leads to discuss nervous system anatomy and physiology, effect of medications and motor and behavioral disorders effect |
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Nurses Responsibilities |
Inpatient rehabilitation 1) Nurses initiate passive ROM of paretic limbs. 2) Turn an immobile patient every 2 hours 3) They protect patients from being pulled across the bed 4) Work out ways to prevent incontinence 5) Educate ancillary hospital personnel who might tug and sublux a paretic shoulder. 6) Assessments for sleep disorders such as apneic spells, respiratory function, swallowing, nutrition, and bowel and bladder function ; training in self catheterization. 7) Nurses check supine and sitting or standing blood pressure and pulse rate when indicated 8) Teach hypertensive patients and their families how do use a digital blood pressure cuff for home monitoring. 9) Diabetics are taught about diet, exercise, medications, and glucose self-monitoring techniques. A great asset to the physician and team on a busy inpatient service, especially in a university hospital, where patients tend to have complex medical illness and needs. |
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Physical Therapists Responsibilities |
● The rehabilitation of disabilities associated with bed mobility, transfers to a chair or toilet, stance, and ambulation. ● assessments emphasize measures of voluntary movement, sensory appreciation, ROM, strength, balance, fatigability, mobility, gait, functional status. ● managing musculoskeletal and radicular pain, contractures, spasticity, and deconditioning. ● Re-education and reingraming for skilled action. |
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Physical Therapists do the following |
1) Compensatory exercise and reeducation 2) Muscle strengthening 3) Neuro-facilitation approach 4) Proprioceptive neuromuscular facilitation 5) Bobath 6) Brunnstrom 7) Task-oriented trainingOther physiotherapy approaches :- 8) motor learning 9) blocked and random practice 10) biofeedback 11) mental practice 12) electromyogram trigger stimulation 13) virtual reality 14) orthotics 15) adaptive aids 16) wheelchairs |
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1) Compensatory exercise and reeducation |
→ repetitive passive and active joint-by-joint exercises and resistance exercises (immobilization complications) → train residual motor skills, often of the uninvolved side, to compensate for impairments. → breathing and general conditioning exercises and energy conservation techniques, particularly to reduce the energy cost of a pathological gait. |
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Muscle strengthening |
→ neuro-facilitation of muscles in NMNL and impaired tone and loss of motor control. → strength exercises : - avoid excessive resistant “due to increase tone imbalance as : flexors in hemiplegia” - long not high resistance “endurance” strengthening as : bicycle and walking (to improve cardiovascular system). |
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○ fibrillation :- |
contraction of one muscle fibers. |
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○ fasciculation :- |
contraction of group of muscle fibers |
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Who invented Neuro-facilitation approach |
Sherrington neurophysiology |
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Neuro-facilitation approach, The approaches involve :- |
● hands-on interaction between the therapist and the patient (sensory stimuli and reflexes to facilitate or inhibit muscle tone and patterns of movements). ● elicit mass flexor or extensor patterns “synergies” , activate or suppress a stretch reflex, the asymmetric and symmetric tonic neck reflexes, the tonic labyrinthine reflex, and withdrawal and extensor reflexes ● they use stimuli that include muscle or tendon vibration, joint compression, skin stroking, and other sensory inputs that elicit reflexive movement and positive & negative supporting reactions |
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Babinski sign →It is a pathological reflexes (true or false) |
False |
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) Proprioceptive neuromuscular facilitation . |
Facilitates mass movement patterns against resistance in a spiral or diagonal motion during flexion and extension. It is based on the belief that since anterior horn cells for synergistic muscles are near each other, an appropriate level of resistance will bring about changes in muscle tone by overflow to these motor neurons. -The therapist utilizes proprioceptive sensory stimuli and brain stem reflexes to facilitate the desired movement and inhibit unwanted movements |
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6) Brunnstrom
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It’s training procedures facilitate synergies by using cutaneous & proprioceptive sensations and toinc neck & labyrinthine reflexes |
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Brunnstrom Approach emphasizes the use of :- |
● specific sensory stimuli to facilitate tonic and then phasic muscle contractions. ● 39 high threshold receptors are thought to increase tonic responses and low threshold receptors activate phasic ones. ● sensory stimuli include fast brushing, light touch, stroking, icing, stretching, taping, applying pressure, resistance, truncal rocking and rolling. ● the response to cutaneous and other sensory inputs is used. |
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Who invented Task-oriented training |
Shumway-cook y woollacott |
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Speech therapist :- . |
Reeducate of human communication, development and orders |
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Aphasia |
→ trouble speaking, reading, writing, and understanding language |
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Dysarthria |
→ difficult articulation of speech |
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Social workers :- |
Support patients and there families (modification workplaces, home and others) |
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Psychiatrist |
:- Mental health (depression, anxiety ……) |
