Anatomia 20iv 20torace
Anatomia 20iv 20torace
Anatomia 20iv 20torace
ABMS 1947
¡ Physical Medicine (Thermal, E-stim, U/S)
¡ Rehabilitation (WWII)
Physiatry / Physiatrist
¡ “fizzy AT” trist vs. fizz EYE” uh trist”
¡ PM&R
PM&R: What do they do?
• Stroke
• Spinal cord injury
• Congenital deformity
• Amputation
• Major multiple trauma
• Hip fracture
• Brain injury
• Neurological disorders (e.g., Multiple Sclerosis, Parkinson’s)
• Burns
• 3 different arthritis conditions for which appropriate, aggressive, and
sustained outpatient therapy has failed, and
• Joint replacement
Theory Behind Early Stroke Rehab
Neuroplasticity:
Modifications in neural networks are use
dependent
www.omkararetreats.com
Timing for Inpatient Rehabilitation after Stroke?
-Independence
-Lifestyle
-Dignity
www.aaritcare.com
Stroke Rehabilitation: Team Approach
NEUROREHABILITATION
Rehabilitation for the body
§ Motor assessment should include strength, active and passive range
of motion, tone, gross and fine motor coordination, balance, apraxia,
and mobility.
Wells, George A., et al. "Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke
Rehabilitation." Topics in Stroke Rehabilitation 2006; 13(2), 1-269. DOI: 10.1310/3TKX-7XEC-2DTG-XQKH
Technology in Rehabilitation
www.biodex.com
http://www.umrehabortho.org/programs/outpatient/services/
lokomat
http://www.gizmag.com/armassist-stroke-rehabilitation-with-video-games/19282/
Technology in Rehabilitation
www.intechopen.com
www.fitness-gaming.com
• This therapy involves placing a mirror in
Mirror the mid-sagittal plane, allowing the
Therapy patient to visualize the reflection of the
non-paretic limb as if it were the paretic
limb.
www.recoverfromstroke.blogspot.com
• CIMT is performed by restricting the
unaffected limb for 90% of waking hours for
Constraint 14 days, while intensively training the use of
the affected arm.
-induced
• A number of studies have shown that CIMT
Movement induces a use-dependent increase in cortical
Therapy reorganization of the areas of the brain
controlling the more affected limb.8,9
http://faculty.valpo.edu/bmorriso/
Rehabilitation for the mind
www.reddit.com
Cognitive Language Impairments
www.braininjury-explanation.com
Impairment of the ability to
utilize language due to brain
Aphasia injury
• Pts with neglect took longer to recover than other stroke patients with
similar stroke pathology and impairment.
• Pts with neglect required more therapy input and have longer rehab LOS
Neglect Treatment
Scanning
Trunk rotation therapy
Eye Patching, Prism
glasses
Constraint-Induced
Therapy
Mirror Therapy
Neurostimulation
medications
http://blogs.discovermagazine.com/loom/2010/09/
Innovations in Noninvasive Brain
Cognitive Stimulation (NIBS) -
Rehab Transcranial magnetic and
direct current stimulation:
Mild magnetic/electric
stimulation applied to the scalp.
Theory: Neuromodulation of
plasticity and cortical excitability.
NIBS has been shown to improve
motor function, gait, language
(aphasia) and cognitive (neglect)
deficits, and mood.
Other Common Complications
after Stroke
Subluxation
Traction neuropathy
Bicipital tendinitis
RTC/Impingement
Frozen shoulder
• Estim
• Armboard/trough
for wheelchair
• ROM excercises
• Injections
Dependent Edema
http://www.foot-pain-explained.com/edema.html
Spasticity after Stroke
www.informahealthcare.com
Spasticity after Stroke: Treatment
www.rehabmart.com
DVT after Stroke
Prophylaxis:
Subcutaneous heparin or LMWH
SCDs
TED hose
Bladder Dysfunction
www.compassionfatigue.ca
Depression
¡ Aphasia
Neuropsychological testing
Functional Capacity Evaluation
Return to work with restrictions
www.guyanachronicle.com
How to prepare a patient for inpatient
rehabilitation