Rehabilitation System: Principles, Goals, and Stages

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*** Constituent Parts of Rehabilitation System: Principle Goals....

- Rehab is the treatment designed to facilitate recovery from injury/disease

- Can be: physical/psychological/social/educational

  • Legal part
  • Medical rehabilitation
  • Vocational rehabilitation
  • Education
  • Compensatory technical, orthopedic means
  • Environmental adaptation
  • Culture, sports, recreation, religion
  • Information
  • Transport
  • Social care and services
  • Income compensation
  • Training of specialists
  • Medical social expertise


^^ Stages of Rehab:

  • I----. Hospital Setting, Hospital Staff
  • II----> In Sanatorium/Outpatient
  • III----> Home Setting, Practitioner or Family Member


^^ Principles, Goals & Task of Rehab:

  • Treatment of Pathology
  • Decrease Impairment
  • Prevent and Treat Complications
  • Increase Activity
  • Physiological Support


**** Rehab Principle:

  • Stages of Rehab: I. Hospital Setting, Hospital Staff II. In Sanatorium/Outpatient III. Home Setting, Practitioner or Family Member

**** Composition of Rehab Team for CVS Disease in Rehab Phases?

Step 1:
  • Physician
  • Nurse
  • Physical therapist
  • Family member
  • Psychologist (sometimes)
Step 2:
  • Physician (cardiologist/radiologist)
  • Nurse
  • Physical therapist
  • Psychologist
  • Family member
Step 3:
  • Home setting
  • Family member
  • Patient GP


**** Stages of Rehab of CVS, Contraindication:

(composition of rehab team)

^^ Step I:

  • Hospital setting & after patient is out of life-threatening situation
  • Team: Physician, Nurse, Therapist, Family Members, Psychologist
  • Goals: Treatment for Patient, Prophylaxis of Complications, Increase Strength

^^ Stage II:

  • 2-3 after Stage I
  • For Diagnosis, Code of Pathology, General Status & Risk
  • If there are risk factors, rehab can be conducted at home
  • Team: (SAME) + Ergo Therapist, Dietitian, Social Worker
  • Goals: Increase Coronary Function, Education, Training Plan, Family Involved
  • Can be In Sanatorium/Outpatient Sanatorium

^^ Stage III::

  • Home setting
  • Major lifestyle changes
  • Family member involved
  • Goals: Maintain Healthy Lifestyle, Continue Step II

**** CI for Rehab:

  • Uncorrected metabolic disorder
  • Malignancy
  • Hepatic/pancreatic insufficiency
  • Anemia or bleeding disorder
  • Protozoal infections
  • Echinococcosis
  • Acute infectious diseases
  • Active TB
  • Evidence of STD
  • Psychological diseases and type A personality
*** How are the physical training programs formed for cardiovascular patients after
considering the degree of risk?
  • Physical examination
  • Clinical history
  • ECG
  • Cardiac imaging
  • Blood testing
  • Physical capacity level
  • Peak exercise capacity
  • Education
Mild Risk:
  • MET > 7
  • No angina
  • EF > 50%
Moderate Risk:
  • MET < 7
  • Moderate exertion angina
  • EF 35 - 45%
  • 40 - 60% of max. HR
  • Slow physical activity
  • Intermittent breaks
High Risk:
  • MET < 5
  • Mild exertion angina
  • EF < 35%
  • < 40% of max. HR
  • Mild physical activity
  • Bed-ward regimen

**** Exercise Tolerance Test for Rehab of CVSD Patient:

  • Function: allow evaluation of Physical work Capacity
  • Continue test till Symptoms of Exhaustion appear
  • ^^ 6 min Step test:
  • + : cheap No electricity
  • - : Not all patient, Difficult BP measurement
  • ^^ Bicycle Test:
  • - Wide spectrum of evaluation
  • + : facilities BP & ECG recording performed upright or supine
  • - : Requires frequent calibration
  • ^^ Treadmill Test:
  • Evaluation of physical capacity
  • + : Adjusted Intensity
  • - : expensive, Patient Fall
  • ^^ Types of loads:
  • - Single Level Load
  • - Increasing Loads:
  • 1-continuous
  • 2-Continuous with steady stage
  • 3-Continuous with Intermittent Rest Period




***(Disturbance Biological, Psychological, Social).

^^ Biological Factor:^^ Psychological Factors:
^^ Social Function:
  • Mental Status
  • CNS disorder
  • Cardio-Resp-Digestive system Abnormalities
  • GI
  • Depression
  • Anxiety Disorder
  • Fear of Death
  • Financial Job loss
Impairment in
  • Learning
  • Task doing
  • Communication
  • Mobility
  • Self Care


**** Intensity of Everyday Life .....

  • MET
  • Daily life Recreational activity Determined by MET (metabolic equivalent)
  • Indicate how much O2 is consumed during physical activity
  • MET M > Female
  • 1 MET = 3.5 ml
  • MET 1--> Poor: walking, dressing
  • MET (5-7)---Moderate: mild house work
  • MET >10: Excellent: intensive sport
NYHA class+ Activity:MET
I :
  • Unlimited
  • No Symptoms on great exertion
7
II:
  • Slightly↓
  • Symptoms Present on Moderate Exertion
5-6
III:
  • Evidently↓
3-4
IV:
  • Constant discomfort
  • Symptoms present at rest
1-2

**** Determination of Disability, The Residual Working Capacity ....

  • Disability to WHO:
  • Impairment: problem with body function or structure
  • Activity limitation: difficult executing a task
  • Participation Limitation: problem in live situation
  • Can be: physical/cognitive/emotional/sensory/developmental
  • The ICF produced a WHO 9 domains:
  • Leaning & Knowledge application
  • General Task & Demand
  • Mobility
  • Self Care
  • Domestic Life
  • Major life Area
  • Interpersonal interactions
  • Major life areas
  • Community, social and civil life

^^ Qualification of Disability :

  • 0-----> No problem 0-4%
  • 1-----> Mild problem 5-35%
  • 2-----> Moderate Problems 25-49%
  • 3-----> Severe Problem 50-95%
  • 4------> Complete problem 96-100%
  • ^^ Determining Working Capacity :
  • 1- Medical criteria: DM, Renal hepatic insufficiency
  • 2- Functional criteria: hours the individual can work
  • 3- Professional: Profession prior to disability
  • 0-25% = Incapable to work
  • 30-55% = Partly capable of work
  • 60-100% = Capable to Work
Stage

I =100%II=80-50%III=50-20%IV=20-0%

^^ Special Devices:
Wheelchair
Karma: 6%
Visits: 0

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Tags:
goals principles exercise tolerance test rehabilitation team CVS disease disability determination rehabilitation system stages