Preview Before our Course
Overview of rehabilitation medicine (Preview Page 1 12)
Development Across the Life Span
Evaluation and assessment (Preview Page 12 46)
Physical agent modalities and Electrotherapy (Preview Page 47 74)
Manipulation, massage, traction  (Preview Page 75 100)
Joint Mobilization and Therapeutic exercise (Preview Page 101 126)
Activities of daily living and Occupational Therapy concept (Preview Page 129 146)
Stroke Rehabilitation (Preview Page 156 214, 262 284)
Orthoses and prosthesis (Preview Page 225 260, 306 312)

 

 

Introduce to Rehabilitation Medicine
QU YUN
MD, MSC, MOT
What is rehabilitation
                   1.
Rehabilitation the restoration of someone to a useful place in society
restoration the act of restoring something or someone to a satisfactory state
What is rehabilitation
                                     2
Rehabilitation the treatment of physical disabilities by massage, training, electrotherapy and exercises.
physiatrics, physical therapy, physiotherapy therapy that uses physical agents: exercise and massage and other modalities
What is rehabilitation
                                     3
Rehabilitation vindication of a person's character and the reestablishment of that person's reputation
vindication, exoneration the act of vindicating or defending against criticism or censure etc.; "friends provided a vindication of his position"
What is Rehabilitation
                  4
Rehabilitation the treatment of disabilities by therapeutic methods to help they improve function or regain living abilities.
(such as massage, training, electrotherapy and exercises, etc.)
What is Rehabilitation
Rehabilitation Restoration, following disease, illness, or injury, of the ability to function in a normal or near normal manner.
Pronunciation: (re'ha bil i ta'shun)
What is Rehabilitation program
Rehabilitation program a program for restoring someone to good health
program, programme a system of projects or services intended to meet a public need; "he proposed an elaborate program of public works"; "working mothers rely on the day care program"
How many Rehabilitation therapy
Physical therapy (PT)
Occupational therapy (OT)
Speech therapy (SP)(ST)
Othoses and Prosthesis (OP)
Psychological therapy (PST)
Social work (SW)
TCM therapy
Etc ……………………
Clinic Classification of Rehabilitation
Alcohol and Drug Abuse Rehabilitation
Neuropsychological rehabilitation*
Osteological rehabilitation*
Pediatric rehabilitation
Etc……
Clinic Classification of Rehabilitation
Physical rehabilitation *
Sensory and cognitive rehabilitation
Vocational rehabilitation
Etc….
vocational rehabilitation providing training in a specific trade with the aim of gaining employment
Physiatric history and physical examination
The physiatric history and physical examination are the basis for all therapeutic decision making.
The physiatric history and physical examination are quite different and are in many respects unique.
Physiatric history
The physiatric history and examination emphasize functional capacity in both the home and the community. The physiatrist determines not only physical deficits but also the functional impact of these deficits. The identification of functional problems allows for the assignment of functional goals that become the basis for development of the therapeutic management plan.
Outline of the Physiatric History
Physiatric history
Chief complaint
History of present problem 

Outline of the Physiatric History
Functional history
    Mobility activities
    Activities of daily living
    Household activities
    Community activities
    Cognition
    Communication
    Vocation
    Assistive devices
Outline of the Physiatric History
 sychosocial history
     Substance abuse
     Family/friend support
     Living situation
     Vocational history
     Avocational history
     Psychiatric history
     Sexual history
     Finances

Outline of the Physiatric History
 Medications/allergies
 Diet
 ast medical/surgical history
 Family history
 Review of systems

Description of the Levels of Function and Their Scores: (FIM)
Independent
Another person is not required for the  activity (NO HELPER).

Page 4 R T1 5
FIM
                  7

Complete independence All of the tasks  described as making up the activity are  performed safely; without modification,  assistive devices, or aids; and within a  reasonable amount of time.

FIM
                  6

Modified independence One or more of the following may be true: The activity requires an assistive device, the  activity takes more than reasonable  time, or there are safety  considerations.
FIM
Dependent
The patient requires another person for  either supervision or physical  assistance for the activity to be  performed (REQUIRES HELPER).
FIM
                  5
Supervision or setup Patient requires  no more help than standby or cueing  without physical contact, or the helper  sets up needed items.
FIM
                  4
Minimal contact assistance Patient  requires no more help than touching  and expends 75% or more of the'  effort.
FIM
                  3
Moderate assistance Patient requires  more help than touching and expends  50% to 75% of the effort.
FIM
                  2

Maximal assistance Patient expends  25% to 50% of the effort.
FIM
                  1
Total assistance Patient expends less  than 25% of the effort.
Functional Activities
That Should be Discussed in the Functional History
Mobility activities
  Bed mobility
  Transitional movements
    Supine to sitting
    Sitting to standing
P4 R T1 6
 
Sitting
  Standing
  Ambulation
  Stair climbing
  Wheelchair activities
     Propulsion
     Parts management
  Transfer activities

Activities of daily living

  Feeding
  Grooming
  Dressing
  Bathing
  Toileting
  Etc.
Household activities

  Cooking
  Cleaning
  Lawnwork
Community activities

 Driving
 Shopping
 Social outings
Functional Activities
Cognition
Communication
Vocational activities
WHO (ICIDH)
The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was published by the World Health Organization (WHO) in 1980 as a tool for the classification of the consequences of disease and of their implications for the lives of individuals.
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ICIDH
The ICIDH reaches beyond the conventional medical model, and therefore complements the International Statistical Classification of Diseases and Related Health Problems (ICD), in its emphasis on how societal and environmental norms are related to the disablement process.
Definition of Impairment, Disability, and Handicap

  Impairment: Any loss or abnormality of psychological, physiological, or anatomical structure or function.
Definition of Impairment, Disability, and Handicap
  Disability: Any restriction or lack resulting from an impairment of the ability to perform an activity in the manner or within the range considered normal for a human being.
Definition of Impairment, Disability, and Handicap
  Handicap: A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal for that individual.
ICF
The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was first published by the World Health Organization in 1980. A revision process has taken place since the middle of the 1990s. The ICIDH 2 is now in the last phases of revision and will be available in its final form in May 2001.
International Classification of Functioning, Disability and Health (ICF)
ICF
ICF describes how people live with their health condition. ICF is a classification of health and health related domains that describe body functions and structures, activities and participation. The domains are classified from body, individual and societal perspectives. Since an individual's functioning and disability occurs in a context, ICF also includes a list of environmental factors.
ICF
ICF  is useful to understand and measure health outcomes. It can be used in clinical settings, health services or surveys at the individual or population level.
ICF
International Classification of Functioning, Disability and Health (ICF) available in six languages (English, French, Spanish, Arabic, Chinese and Russian)
http://www3.who.int/icf/icftemplate.cfm
THE NEED FOR ICF

Studies show that diagnosis alone does not predict service needs, length of hospitalization, level of care or functional outcomes.

Components of ICF
Body Structures are anatomical parts of the body such as organs, limbs and their components.
Body Functions are physiological functions of body systems (including psychological functions).
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Components of ICF
Activity Limitations are difficulties an individual may have in executing activities.
Environmental Factors make up the physical, social and attitudinal environment in which people live and conduct their lives..
Participation Restrictions are problems an individual may experience in involvement in life situations.

World Health Organization Classification Assessment Surveys & Terminology Group
ICF
Basic Messages
ICF has been systematically revised in the last decade
large international and multidisciplinary participation
extensive field testing
guided by scientific principles
taxonomic guidelines: logic and terminology
practical utility: feasibility, ease of use, ethical guidelines
reliability, validity and comparability

WHO Family of International Classifications
ICD: An International Public Good
WHO Family of International Classifications
Primary Aim: International comparability of health information
Basic principles: scientific and transcultural
Interrelated use: Coherent, agreed and appropriate
Versatility: responds to current or developing health information needs of different users
Foundation classes: categories of conceptual & metric equivalence
Coding Rules: Transparent and reliable
Standards: Uniform and meets ISO standards

 

Aims
to provide a scientific basis for consequences of health conditions
to establish a common language to improve communications
to permit comparison of data across:
 countries
 health care disciplines
 services
 time
to provide a systematic coding scheme for health information systems

ICIDH 1         ICF
Conceptual transformation
User needs
Advocacy          science
Service Outcomes: measure to manage
Health Measures: evidence to inform policy
Causality: multi linear web
Foundations of ICF
Human Functioning       not    merely  disability  
Universal Model            not    a minority model
Integrative Model         not    merely medical or social
Interactive Model         not    linear progressive
Parity                           not    etiological causality
Context inclusive       not    person alone
Cultural applicability     not    western concepts
Operational                  not    theory driven alone
Life span coverage      not    adult driven
Human Functioning    not disability alone
Body functions vs  impairments
Body Structures

Activities  vs  activity limitation
             1980 disability

Participation vs  handicap

Universal Model vs. Minority Model
Medical versus Social Model
PERSONAL problem  vs   SOCIAL problem
medical care    vs   social integration
individual treatment   vs   social action
professional help    vs individual & collective       responsibility
personal    vs   environmental                     adjustment     manipulation
behaviour    vs attitude  
care     vs  human rights
health care policy   vs  politics 
individual adaptation  vs  social change 
Sequence of Concepts ICIDH 1980 

Equity / Parity
 Loss of limb
landmines  =  diabetes  = thalidomide

 Missed days at usual activities
flu = depression  = back pain = angina

 Stigma
leprosy = schizophrenia = epilepsy = HIV

Contextual Factors
Person
gender
age
other health conditions
coping style
social background
education
profession
past experience
character style
Cultural Applicability
Comparability:  equivalence across cultures
ICF Field Testing
7 years 1994 2001
61 countries
ICF drafts translated into / tested in 27 languages
38 National Consensus Conferences
7 International Consensus Conf.
2000 Live Case evaluations
3500 Case Summary evaluations
Structure
ICF Components

Activities and Participation
1 Learning &Applying Knowledge 
2 General Tasks and Demands 
3 Communication 
4 Movement 
5 Self Care 
6 Domestic Life Areas 
7 Interpersonal Interactions 
8 Major Life Areas 
9 Community, Social & Civic Life 
Environmental Factors
1. Products and technology
2. Natural environment and human made   changes to the environment
3. Support and relationships
4. Attitudes
5. Services, systems and policies
ICF Applications
Health sector
Social security
Education sector
Labour sector
Economics & development sector
Legislation & law
Other ….
ICF in health & disability statistics
Common Domains
Mobility   Cognition   Mood
Self Care   Usual Activities  ...
link data from both health and disability
Multiple Components
overcomes the “impairment” focus
Environmental Factors
Comparability
ICF in clinical practice & management
Needs assessment
Outcome assessment
Utilization patterns

Comparison of different interventions

Consumer satisfaction

Service performance
outcomes
cost effectiveness

Electronic records
Clinical terminology
ICF in policy making
assessment of population health
impact of disability
economic
social
evidence base for policy makers on different policy interventions
responsiveness of services
efficiency
performance assessment
ICF research  applications
joint assessment of disease and functioning
description of association
intervention response &  synchrony of change
explanatory power on:
utilization
needs
costs
outcomes
Cost effectiveness of interventions
Unified approaches
ICF Domains used in International WHO Surveys
Health Domains

Vision
Hearing
Speech
Digestion
Bodily excretion
Fertility
Sexual activity
Skin & disfigurement
Breathing
Pain
Affect
Sleep
Energy / vitality
Cognition
Communication
Mobility and Dexterity
Prepare for group 1
Joint in a group
Choice one disease
Write down the relationship with physiatric history
Microsoft Word, 2 pages and print with A4 paper, Times New Roman Font 16, 1.5 interline, 2.5cm board
Prepare for 10 minutes oral presentation (next lecture)
Hand in one copy of answer paper

Outline of the Physiatric History
Physiatric history
Chief complaint
History of present problem
Functional history
    Mobility activities
    Activities of daily living
    Household activities
    Community activities
    Cognition
    Communication
    Vocation
    Assistive devices
Psychosocial history
     Substance abuse
     Family/friend support
     Living situation
     Vocational history
     Avocational history
     Psychiatric history
     Sexual history
     Finances
Medications/allergies
 Diet
 ast medical/surgical history
 Family history
 Review of systems
Disease
Stroke
Low back pain
Shoulder pain
Loss of limb
UE Fracture
LE Fracture
Spinal Fracture
Burning
Spinal cord injury
Traffic brain injury
My Dpt： 3rd in patient building, 2ed floor

Prepare for practice 1
Prepare a rule and a protractor (angle meter, protractor; anglegauge; clinometer; anglegauge; goniometer; goniasmometer)
Puncture a hole in the middle of rule and angle meter.

 

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