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    Rehab - Notes

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    chris blac
    Rehabilitation aims to help people function at their highest level despite impairments. It is important for practitioners to understand as the elderly population grows. Rehabilitation addresses impairments, activities, and participation using two conceptual models: the ICF model which considers health conditions and environmental factors, and the ecological model which examines personal capacity and task demands. Effective rehabilitation often requires a multidisciplinary team to address complex needs, and can occur in inpatient, outpatient, or skilled nursing settings. Common interventions include exercise, cognitive training, occupational therapy, and assistive devices. Outcomes depend on the condition and how well the care setting matches individual needs.

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    Rehab - Notes

    Uploaded by

    chris blac
    450 views8 pages
    Rehabilitation aims to help people function at their highest level despite impairments. It is important for practitioners to understand as the elderly population grows. Rehabilitation addresses impairments, activities, and participation using two conceptual models: the ICF model which considers health conditions and environmental factors, and the ecological model which examines personal capacity and task demands. Effective rehabilitation often requires a multidisciplinary team to address complex needs, and can occur in inpatient, outpatient, or skilled nursing settings. Common interventions include exercise, cognitive training, occupational therapy, and assistive devices. Outcomes depend on the condition and how well the care setting matches individual needs.

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    geriatric rehab

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    Rehabilitation aims to help people function at their highest level despite impairments. It is important for practitioners to understand as the elderly population grows. Rehabilitation addresses impairments, activities, and participation using two conceptual models: the ICF model which considers health conditions and environmental factors, and the ecological model which examines personal capacity and task demands. Effective rehabilitation often requires a multidisciplinary team to address complex needs, and can occur in inpatient, outpatient, or skilled nursing settings. Common interventions include exercise, cognitive training, occupational therapy, and assistive devices. Outcomes depend on the condition and how well the care setting matches individual needs.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    450 views8 pages

    Rehab - Notes

    Uploaded by

    chris blac
    Rehabilitation aims to help people function at their highest level despite impairments. It is important for practitioners to understand as the elderly population grows. Rehabilitation addresses impairments, activities, and participation using two conceptual models: the ICF model which considers health conditions and environmental factors, and the ecological model which examines personal capacity and task demands. Effective rehabilitation often requires a multidisciplinary team to address complex needs, and can occur in inpatient, outpatient, or skilled nursing settings. Common interventions include exercise, cognitive training, occupational therapy, and assistive devices. Outcomes depend on the condition and how well the care setting matches individual needs.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 8
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    The key takeaways are that rehabilitation aims to allow people to function at the highest possible level despite impairments, and involves understanding disability through conceptual models and providing multidisciplinary care and interventions tailored to individual conditions.

    The two conceptual models for disability discussed are the International Classification of Function, Disability, and Health (ICF) model from the WHO and the ecological model.

    Benefits of coordinated multidisciplinary rehabilitation include systematically targeting multiple factors that contribute to disability through improving individual capacity, reducing task demands, or both. It has been shown to be effective for conditions like stroke, rheumatoid arthritis, falls, and frailty.

    Rehabilitation and Rehab Sites Cristian Balcescu

    Why do we need to know this? Because there is such a high incidence


    of disabling conditions in the older adult population which can be
    improved with rehab in many cases. The primary purpose of rehab is to
    allow people to function at the highest possible level despite the
    presence of physical impairment. The increasing numbers of this
    elderly population will make it important for all practitioners to be
    aware of the results possible with rehabilitation.
    How do we start? TO understand disability and where/how rehab
    services can be most effective we use on of two CONCEPTUAL MODELS
    FOR DISABILITY
    1. The International Classification of Function, Disability, and Health
    (ICF), developed by the World Health Organization- individuals
    level of function (body function, ability to execute a task
    [activity], and participate in life activities) is determined by his or
    her health condition(s) within the context of environmental and
    personal factors. Medical and surgical interventions are directed
    at the underlying health conditions causing disability;
    rehabilitation services target the impairment, activities, and
    participation levels of the disablement process, as well as
    personal and environmental contextual factors that influence
    activity and participation.

    2. The ecological Model: Disability results from a mismatch between


    individual capacity and task demands, which in turn are
    influenced by the environment and the way in which tasks are
    performed. For example, walking imposes different physical
    demands when performed atop Mt. Everest versus at sea level.

    Rehabilitation and Rehab Sites Cristian Balcescu


    Thus, the ecological model helps to explain how personal and
    particularly environmental contextual factors described in the
    WHO ICF model interact with physical limitations to result in
    disability. In the ecological model, remediation of disability
    occurs through treatments that either increase individual
    capacity or reduce task demand.
    Rehabilitation interventions may improve capacity, reduce task
    demands, or accomplish both

    Impact of comorbidities on treatment


    - comborbities can obviously delay treatment, require care plan to
    be modified, but the complications can many times be
    prevented.
    - Skin breakdown monitor patients, and modify footware,
    wheelchairs, bedding PRN
    - Incontinence(and dangers of it), catheters and infections
    - Pneumonia increased risk with inactivity, decreased swallowing
    ability, underlying lung disease
    - Anemia, mental functioning, DM(need for changes in medicine
    and diet with increased exercise), heart disease(extreme
    limitations in mobility, potential for orthostatic hypotension with
    meds)
    Who is involved?
    - Treatment by a provider in a single discipline is often sufficient
    for patients with uncomplicated conditions or with minimal
    disability (eg, physical therapy for osteoarthritis of the knee or a
    home safety evaluation by an occupational therapist for a patient
    with fear of falling). However, for more complex or catastrophic
    disability, a multidisciplinary team of providers is optimal to
    address the rehabilitation needs related to progressive disability
    and the interaction of multiple contributing conditions and
    contextual factors.
    - Multidisciplinary care is a cornerstone of rehabilitation. The
    efficacy of coordinated multidisciplinary rehabilitation for a
    number of conditions affecting older adults, including stroke,
    rheumatoid arthritis, falls, and frailty, is supported by numerous

    Rehabilitation and Rehab Sites Cristian Balcescu

    studies. Geriatric evaluation and treatment units provide


    multidisciplinary care with medical, social service, nursing, and
    rehabilitation personnel (typically physical and occupational
    therapy) working together in a coordinated fashion. Inpatient
    stroke rehabilitation teams include a variety of rehabilitation
    personnel (eg, speech therapy, occupational therapy, physical
    therapy) to target rehabilitation therapies to the specific strokerelated deficits, as well as medical, nursing, and other staff.
    Coordination of care may be achieved with weekly team
    meetings and/or scripted protocols to facilitate care coordination.
    Benefits from coordinated multidisciplinary rehabilitation accrue
    from systematically targeting the multiple factors that interact to
    cause and exacerbate disability. For example, stroke may
    adversely affect visual perception, speech, and cognition as well
    as cause paralysis. Members of the multidisciplinary team often
    have both unique and overlapping expertise, reinforcing the
    interventions of each other.

    Rehabilitation and Rehab Sites Cristian Balcescu

    Where can patients be treated?


    - effect of sites of care on rehab outcomes is not well established.
    However, each has advantages and disadvantage
    - Inpatient is most intense, but may not be endurable for frail older
    patients as it requires 3hrs daily activity. SNFs are good for those
    needing round the clock care without a round the clock caregiver
    at home. Outpatient allows pts to return home, but the support
    system may not be as strong and this requires transportation
    which can be costly and time consuming.

    Rehabilitation and Rehab Sites Cristian Balcescu


    -

    We should try to match individual patients to the care they need,


    but sometimes decision is driven by cost

    What can we do? Interventions


    Each condition has different approaches that have been studied to
    varying degress and work better for particular conditions(stroke,
    postTHA, post TKA, etc)
    Exercise

    Rehabilitation and Rehab Sites Cristian Balcescu


    -

    Exercise, a type of physical activity, is defined as a planned,


    structured, and repetitive bodily movement done to improve or
    maintain one or more components of physical fitness (eg, muscle
    strength, flexibility, balance)
    Certain types of exercise may be particularly beneficial for
    specific patient populations. As an example, resistive exercise
    and power training have been found to improve function in frail
    older adults [21]. A systematic review found that progressive
    resistance exercise (ie, weightlifting) can significantly improve
    muscle strength and, to a lesser extent, functional activities such
    as rising from a chair and ambulation [22].
    During acute hospitalization, early mobilization seems to offer
    particular benefit, improving outcomes in multiple patient
    populations, including patients with hip fracture, acute
    pneumonia, or critical illness in the intensive care unit [23-25]

    Cognitive rehab- may improve alertness and attention.


    Language therapy post CVA aphasia
    OT- repetition of tastk specific activities such as bed transfers,
    grasping, reaching, retraining in IADLs
    Research has not shown that speech, languance cognitive rehab
    improve functional deficits.
    Assistive devices:

    Rehabilitation and Rehab Sites Cristian Balcescu

    Example:
    Post THA
    - 5% mosrtality during initial hospitalization, 25% at 1 year, up to
    half will continue to need assistive devices, 25% will need lng
    term care 1 year later, 1.2 need some transient long term care
    - early repair within 24-72 hours has been shown to reduce 1 year
    mortality and complications of pressure ulcers, delirium.

    Rehabilitation and Rehab Sites Cristian Balcescu


    -

    Rehab focuses on pain management, mobilizations, prevention of


    complications(PE, delirium). Most important factors are early
    mobilization, and frequency of therapy(>once daily better
    outcomes than once a day or less)
    Anticoagulation min 10d up to 30+ day course. ASA, LMW
    heparin at a usual high-risk dose, fondaparinux, a vitamin K
    antagonist (target INR 2.5, range: 2.0 to 3.0), or rivaroxaban.
    Prevention of future fractures osteoporosis, home safety risks,
    balance training

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