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

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

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

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

WHO action plan 2014-2021 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.

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

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

Handicaps Locomotor Visual Hearing and speech Cardiopulmonary Intellectually challenged Emotionally disturbed

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

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

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

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

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

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

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

OT functional assessment

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you