RHS 422 Lecture 2 PDF

RHS 422 Lecture 2 Dr. Mai Aldera  Course outlines Characteristics of the rehabilitation healthcare team. Orthotists and Prosthetists: professional role and responsibility. The role of cardiopulmonary and cardiovascular systems during functional activities. Motor...

RHS 422 Lecture 2 Dr. Mai Aldera  Course outlines Characteristics of the rehabilitation healthcare team. Orthotists and Prosthetists: professional role and responsibility. The role of cardiopulmonary and cardiovascular systems during functional activities. Motor control, learning and neural plasticity in rehabilitation. Case Example & questions.  Characteristics of rehabilitation healthcare team Health professionals work in health care settings to meet the physical rehabilitation needs of diverse patient populations. The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF), provides a disablement framework that enables health professionals to maximize patient/ client participation and function while minimizing disability.  Characteristics of rehabilitation healthcare team The rehabilitation team includes physicians, prosthetists, orthotists, physical therapists, occupational therapists, nurses, and social workers. They provide the necessary knowledge and skills for effective patient management.  Orthotists and Prosthetists: professional role and responsibility. Entry into professional training programs requires completion of a bachelor’s degree from an accredited college or university, with a strong emphasis on prerequisite courses in the sciences. Professional education in orthotics or prosthetics requires an additional academic year for each discipline. Along with the necessary technical courses, students study research methodology, kinesiology and biomechanics, musculoskeletal and neuromuscular pathology, communication and education, and current health care issues Orthotists and Prosthetists: professional role and responsibility. Orthotists provide care to persons with neuromuscular and musculoskeletal impairments that contribute to functional limitation and disability by designing, fabricating, and fitting orthoses or custom-made braces. The orthotist is responsible for evaluating the patient’s functional and cosmetic needs, designing the orthosis, selecting appropriate components, and fabricating, fitting, and aligning the orthosis. The orthotist educates the patient and the care providers on appropriate use of the orthosis, care of the orthosis, and how to assess continued appropriateness of the orthosis  Orthotists and Prosthetists: professional role and responsibility. Prosthetists provide care to patients with partial or total absence of limbs by designing, fabricating, and fitting prostheses or artificial limbs. The prosthetist creates the design to fit the individual’s particular functional and cosmetic needs; selects the appropriate materials and components; makes all necessary casts, measurements, and modifications (including static and dynamic alignment); evaluates the fit and function of the prosthesis on the patient; and teaches the patient how to care for the prosthesis  The role of cardiopulmonary and cardiovascular systems during functional activities. The cardiopulmonary system plays a crucial role in the well-being of amputee patients, as it faces both challenges and adaptations following limb loss. Understanding these changes and tailoring rehabilitation strategies accordingly is crucial for optimizing their health and activity levels Challenges: Reduced cardiovascular workload: Losing a limb, particularly a lower limb, decreases the total muscle mass in the body. This translates to a decreased demand for oxygen and nutrients, leading to a lowered heart rate, stroke volume, and cardiac output at rest. While this may seem beneficial at first glance, it can reduce the body's ability to adjust to physical activity, leading to fatigue and decreased exercise capacity. Altered blood flow: Amputation disrupts the normal blood flow pattern, especially if major arteries are involved. This can lead to poor circulation in the remaining limb, increasing the risk of wound healing problems and infections. Additionally, fluid can accumulate in the residual limb, causing discomfort and swelling. Challenges: Pulmonary function changes: Reduced upper body muscle mass due to inactivity or compensatory movements can compromise respiratory function. This can limit lung capacity and oxygen intake, further impacting exercise tolerance. Psychological stress: The emotional and mental toll of amputation can influence the cardiovascular and respiratory systems. Anxiety and depression can elevate heart rate and blood pressure, while also affecting breathing patterns and lung function  The role of cardiopulmonary and cardiovascular systems during functional activities. Adaptations: Cardiovascular training: Regular aerobic exercise helps train the heart and lungs to be more efficient in oxygen delivery and utilization. This can improve exercise tolerance, reduce fatigue, and manage blood pressure. Strength training: Building muscle mass, especially in the remaining limb and upper body, increases metabolic demands and stimulates the cardiopulmonary system. This improves overall fitness and exercise capacity.  The role of cardiopulmonary and cardiovascular systems during functional activities. Adaptations: Prosthetic training: Learning to use a prosthetic limb effectively requires coordination and effort. As amputees become more proficient, their cardiovascular and respiratory systems adapt to the increased workload, leading to improved function and independence. Psychological support: Addressing the emotional and mental well-being of amputees is crucial for managing stress and anxiety, which can positively impact their physical health and cardiopulmonary function.  The role of cardiopulmonary and cardiovascular systems during functional activities. It is important to consider: Level of amputation: The extent of limb loss significantly affects the degree of cardiovascular and respiratory challenges. Above-knee amputations typically have a greater impact compared to below-knee amputations. Pre-existing conditions: Prior cardiovascular or respiratory problems can further complicate the picture, requiring personalized rehabilitation strategies. Prosthetic design: The type and quality of the prosthetic limb can influence energy expenditure and gait patterns, impacting the cardiopulmonary system.  Motor control, learning and neural plasticity in rehabilitation Why do people move? 1. Movement is goal-directed, to accomplish a task or ADL. 2. There are many different ways to accomplish any task; the CNS organizes muscles and bodies using available physiological resources in the context of the environment (there is no single best way of moving) 3. Each person develops a preferential way of moving; however, it is not always optimal. 4. People move when they have self-efficacy (movement with confidence) regarding their movement. When there are impairments of musculoskeletal, neuromuscular or cardiopulmonary systems, the recourses that an individual can bring to movement may be altered, limited or constrained.  Motor control, learning and neural- plasticity in rehabilitation Embracing Change: The loss of a limb, whether through accident or illness, presents a significant challenge for individuals. Beyond the physical and emotional impact, amputation disrupts motor control and function, requiring the brain and central nervous system to undergo drastic adaptations. This is where the concepts of motor learning and neuroplasticity become crucial forces in the rehabilitation process.  Motor control, learning and neural plasticity in rehabilitation Motor Learning: Relearning movement patterns: After amputation, the brain must remap existing motor commands to control the residual limb or manage the use of a prosthesis. This involves redefining sensory feedback, coordinating muscle recruitment, and finding new strategies for balance and locomotion. Practice makes perfect: As with any skill, motor learning in amputees relies on repetitive, task-specific practice. Rehabilitation programs focus on breaking down complex tasks into smaller, achievable steps, providing feedback and guidance to promote proper form and technique. The power of motivation: Motivation and engagement are key factors in motor learning. Successful rehabilitation incorporates activities and goals that are meaningful and relevant to the individual's needs and interests, fostering a sense of accomplishment and driving continued progress.  Motor control, learning and neural plasticity in rehabilitation Neuroplasticity: The brain's remarkable ability to change: Neuroplasticity refers to the brain’s ability to reorganize its neural connections and adapt to new experiences. In amputation, the brain reorganizes areas once devoted to controlling the missing limb, repurposing them for other functions or strengthening connections to remaining limbs. Sensory remapping: The sensory feedback from the residual limb or prosthesis is initially different from the lost limb. The brain must learn to interpret these new signals and integrate them into existing motor commands, a process known as sensory remapping. Building new connections: With appropriate training and stimulation, the brain can forge new neural connections, even in adulthood. This allows individuals to develop compensatory strategies and improve their control over the remaining limb or prosthesis.  Motor control, learning and neural plasticity in rehabilitation The. Rehabilitation Advantage: Understanding these powerful mechanisms allows therapists to design rehabilitation programs that capitalize on motor learning and neuroplasticity. Here are some key strategies: Early intervention: Starting rehabilitation as soon as possible after amputation maximizes the brain's potential for plasticity and optimizes motor learning. Task-specific training: Practice tasks that mimic real-world activities relevant to the individual's goals, from walking and grasping to using specific tools or equipment. The Rehabilitation Advantage: Variability and challenge: Introducing progressive complexity and variability into tasks keeps the brain engaged and promotes continued adaptation and skill refinement. Sensory integration: Utilizing techniques that enhance sensory feedback from the residual limb or prosthesis helps the brain better interpret and utilize these signals for improved control. Technology to the rescue: Advanced technologies like virtual reality and robotic training systems can provide immersive and challenging environments to accelerate motor learning and enhance neuroplasticity.  Remember, the journey of recovery is unique for each individual. Tailoring rehabilitation programs to individual needs and maximizing these innate capabilities is crucial for achieving optimal outcomes and empowering amputees to lead fulfilling lives. Motor control, learning and neural plasticity in rehabilitation  Case Example P.G. is a 23-year-old man admitted to a level 3 trauma center 2 weeks ago after sustaining severe crush injuries to both lower extremities and a closed-head injury in an accident involving a motorcycle and a sport utility vehicle. Initially unconscious with a Glasgow Coma Scale score of 8, P.G. was placed on life support in the emergency department. Radiographs revealed a severely comminuted fracture of the distal right femur and displaced fractures of the left tibia and fibula at midshaft. Examination revealed partial-thickness “road burn” abrasions on the left anterior thorax and thigh; these were thoroughly cleaned and covered with semipermeable dressings. A computed tomography scan of his cranium and brain revealed a subdural hematoma over the left Sylvian fissure and moderate contusion of the anterior pole and undersides of the frontal lobes. Arteriography indicated rupture of the right femoral artery 4 inches above the knee. Given the extent of the crush injuries, the trauma team determined P.G. was not a candidate for reconstructive surgery to salvage his right limb. P.G. was taken to the operating room, where a standard length transfemoral amputation was performed on the right lower extremity. Simultaneously, orthopedic surgeons performed an open-reduction internal fixation with an intramedullary rod in the tibia and used surgical plates and screws to repair the fibula. Neurosurgeons drained the subdural hematoma through a burr hole in his skull.  P.G. was started on high-dose broad-spectrum antibiotics in the operating room. He was transferred to the surgical intensive care unit for postoperative care. P.G. was weaned from the ventilator and is now functioning at a Rancho Los Amigos Scale level of 7. He is able to follow one and two-step commands but becomes easily confused and angry in complex environments and when fatigued. His postoperative pain is currently being managed with Tylenol #3 as needed. His right lower extremity has been managed with soft dressings and elastic bandages; his residual limb is moderately bulbous, with resolving ecchymosis from the accident and surgery. Moderate serosanguineous drainage continues from the medial one third of the suture line. Although most of the skin abrasions show signs of regranulation, one area on his left thigh is red and hot, with yellowish drainage. When transferred (maximum assist of two) into a bedside recliner, P.G. tolerates 30 minutes in a 45- to 60-degree reclined position. He becomes lightheaded and has significant pain when sitting upright with his left lower extremity dependent. He has been referred to physical therapy for evaluation of rehabilitation potential and initiation of mobility activities. Before his accident, P.G. was a graduate student in physics at a nearby university. He lived in a third-floor walk-up apartment with his fiance and his golden retriever. Besides his motorcycle, his interests and hobbies included long-distance running and mountain climbing. His mother and father have traveled to be with him during the acute hospital stay. QUESTIONS TO CONSIDER 1. Which clinical specialists and health professionals are required to cater to the medical needs of the patient? 2. What are the priorities, specific roles, and responsibilities for each member of the potential team? 3. How are the roles and responsibilities similar or different across the team? 4. What factors might pose a challenge to the effectiveness of the team? 5. As P.G. recuperates from his injuries, how might the roles and responsibilities of the various team members change or evolve? 6. When and how should you apply the International Classification of Functioning (ICF) disablement model for P.G.? 7. Is there an ICF Core Set that applies to this clinical situation? 8. Are there any recommended clinical practice guidelines that apply to the management of this patient? Thank you.