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NEUROLOGICAL DISORDER
PATIENTS
Rehabilitation
Definition of neuro rehabilitaiton
Principles of rehabilitation
Goals of rehabilitation
Types of rehabilitation
Approach of rehabilitation
Neurorehabilitation team
Factors affecting quality of life and coping
Bobath neurodevelopmetal treatment
approach
Positioning
Sitting
Mobility
Transfer
Physical therapy
Range of motion exercise
Other exercises
Treatment of pain and inflammation
Heat therapy
Cold therapy
Electrical stimulation
Traction
Massage
Acupuncture
biofeedback
Sensory perceptual deficit
Communication deficit
Speech therapy
Swallowing difficulty
Bladder dysfunction and retraining
Neurological disorder and its rehabilitation
Stroke
Head injury
Spinal cord injury
Parkinsonism
Gullaine barre syndrome
Nurses role in rehabilitation
Summary
Conclusion
Rehabilitation is a dynamic process through
which a person is assisted to achieve
optimal physical, emotional, psychological,
social, and vocational potential and to
maintain dignity, self-respect, and a quality
of life that is as self-fulfilling and satisfying
as possible.
Neurorehabilitation is a complex medical
process which aims to aid recovery from a
nervous system injury, and to minimize
and/or compensate for any functional
alterations resulting from it.
Rehabilitation should begin during the
intial contact with the patient.
Restoring the patient to independence or to
regain his/ her preillness
Maximizing independence within the limits
of the disability.
Realize goals based on individual patient
assessment and to guide the rehabilitation
program
Must be an active participation
Activities of daily living are facilitated.
Motivate the patient and helps him/her to
attain social independence.
Physical independence
Mobility
Social integration
Occupational integration
Psychological support
Medical rehabilitation :
restoration of structure and
function.
Vocational
rehabilitation:
restoration of the capacity
to earn a useful and decent
livelihood
Social rehabilitation:
restoration of family
and social relationships
Psychological rehabilitation :
restoration of personal dignity
and confidence
Institution based : the services are
delivered in an institution for the disabled.
Outreach based : professional travel to the
community
Community based :
where resources for
rehabilitation are
available in the
community and
services are delivered
in community area.
Medical team Ophthalmologist
Physiatrist Paramedical members
Orthopaedic surgeon Physiotherapist
Neurologist Occupational therapist
Neurosurgeon Creative movement
Plastic surgeon therapist
Psychiatrist Recreation therapist
Paediatrician Prosthetist
Obstetrician Rehabilitation nurse
Geneticist
Cardiologist
Cardiac surgeon
General surgeon
Oncologist
Speech pathologist
Psychologist Non governmental
Play and drama organization
therapist Community
Music therapist Family members
Social worker
Vocational counsellor
Nature of disease
Severity of disease
Economical stability
Access to education
Sexual dysfunction
Bobath Neurodevelopmental
Treatment Approach
Flacidity- occurs from the time of injury to
2 to 3 days after(decreased or no tendon
reflexes or resistance to passive movement)
Trochanter
Side-Lying Position
Favourable for unconscious patient
head of the bed elevated 10 to 30 degrees.
head should be placed in a neutral position.
soft collar or towel roll is useful to maintain the
neutral position
head turned slightly to facilitate drainage of oral
secretions and to maintain a patent airway.
The conscious patient may sit on the side of the bed,
using the over bed table and pillows for support.
arm or shoulder.
Swing the unaffected leg over the side of the bed, and use the
unaffected hand to push up.
Uses
Chronic low back pain
Neuralgia
Contusion
Traction
Used for extrinsic muscle spasm and to
keep bony surfaces aligned while fracture
heal.
E.g cervical traction, lumbar traction
Massage
Acupuncture
Biofeedback
Electromyogram
Lip reading
Sign board
Muscle exercise
E.gMasako Maneuver (Place the tip of your
tongue between your front teeth or gums
and swallow)
Swallowing is a complex process of
ingesting solid or liquid food while
protecting the airway.
four phases of swallowing:
Oral preparatory phase: food is taken into
the mouth and chewed, forming a bolus.
Oral phase: the bolus of food is centered and
moved to the posterior oropharynx.
Pharyngeal phase: the swallowing reflex
carries the bolus through the pharynx.
Esophageal phase: peristalsis carries the bolus
to the stomach.
Feed or eat in the upright, sitting position at a 90-
degree angle.
Tilt the head forward and tuck the chin in to prevent
food from moving into the posterior oropharynx
before it has been chewed
Encourage taking small bites and thorough chewing.
For patients with hemiplegia or hemiparesis, place
food on the unaffected side.
If “pocketing” of food is a problem, have the
patient sweep the mouth with his or her
finger after each bite to clear the food.
The speech therapist can be helpful by
suggesting an adaptive cup and special
techniques to ensure swallowing.
If oral feeding is contraindicated, a feeding tube
or gastrostomy tube can be considered
If cognitive deficits are present, the patient
may have poor impulse control and may stuff
the mouth hurriedly with food (manage the
behavior and controlling distractions from the
focus of eating. This patient requires mealtime
supervision and verbal and nonverbal cues)
Bladder control is an integrated function of
the brainstem, spinal, and cerebral level.
Alterations in urinary elimination patterns
can be classified generally into urinary
incontinence (UI) and urinary retention
Urinary incontinence can be associated
with various problems, such as a
diminished level of consciousness; cerebral
injury, especially to the frontal lobe; or
spinal cord injury.
Four major categories
Urge incontinence: the involuntary loss of urine
associated with an abrupt and strong desire to void
(urgency).
Stress incontinence : the involuntary loss of urine
during coughing, sneezing, laughing, or other
physical activities that increase abdominal pressure.
Overflow incontinence : the involuntary
loss of urine associated with overdistension
of the bladder.
Functional incontinence : urine loss
caused by factors outside the lower urinary
tract; this category includes UI
Urinary retention is often associated with
spinal cord–injured patients.
Bladder Training. Bladder training, also called
bladder retraining, includes several variations.
Three primary components of education,
scheduled voiding, and positive reinforcement.
The patient needs to be educated to understand
the physiology,pathophysiology, technique, and
desired outcome.
A bladder retraining program assists the
patient to learn to resist or inhibit the
sensation of urgency, postpone voiding, and
urinate according to a timetable rather than
the urge to void.
The initial goal interval may be 2 to 3 hours,
although it is not followed during sleep
Prompted Voiding.
Prompted voiding is a technique used primarily with dependent
or cognitively impaired people.
Monitoring: the person is checked by caregivers on a regular
basis.
Prompting: the person is asked (prompted) to try to use the
bathroom to void.
Praising:the person is praised for maintaining continence and
attempting to use the toilet
Pelvic Muscle Exercises.
also called Kegel exercises, comprise a
behavioral technique that requires repetitive
active exercise of the pubococcygeus muscle to
improve urethral resistance and urinary
control by strengthening the periurethral and
pelvic muscles in women.
contracted to a count of 10 and then relaxed
to a count of 10.
About 50 to 100 of these exercises must be
done daily to be effective. It takes about 4 to
6 weeks to notice improvement.
Bladder-Triggering Techniques
A few bladder-triggering techniques facilitate
bladder emptying.
They include suprapubic stimulation,
Valsalva’s maneuver, and Credé’s maneuver.
Suprapubic stimulation
suprapubic stimulation
activates the sacral-lumbar dermatomes by manually tapping
the suprapubic area, pulling pubic hairs, or stroking the
medial thighs.
Valsalva’s maneuveris
straining against a closed epiglottis while contracting the
abdominal muscles and bearing down on the bladder. The
straining is sustained or the breath held until the urine flow
ceases..
Credé’s maneuver
placing the hands flat just below the
umbilical area and pressing firmly down and
inward toward the pelvic arch. The purpose
of this maneuver is to express urine from the
bladder
Catheters and Catheterizations
Intermitten catheterization
Suprapubic catheterization
indwelling catheterization
The act of bowel evacuation is called
defecation.
The anus, the terminal end of the large bowel,
is controlled by two sphincters: the
involuntary proximal anal sphincter (smooth
muscle) and the voluntary distal anal sphincter
(striated muscle).
Defecation is a coordinated reflex involving
sacral segments S-3, S-4, and S-5, which is
initiated by stimulated stretch receptors
located in the anus that initiate peristaltic
waves.
Types of Altered Bowel Function Patterns
Constipation
Diarrhea
Incontinence
Constipation: fluid restriction, prolonged
immobility, nothing by mouth status as a result
of swallowing deficits or unconsciousness,
decreased bulk in diet, drugs known to
decrease peristalsis (e.g., codeine), spinal
nerve compression, paralytic ileus, lack of
sensation, lack of privacy, interruption of usual
bowel routine, and failure to respond to
defecation stimuli
Diarrhea: intolerance to tube feeding,
antibiotic therapy, and fecal impaction .
Incontinence: altered consciousness, cognitive
deficits (e.g., social disinhibition, lack of impulse
control, inability to recognize and respond to
defecation impulses), impaired communication, and
neurogenic bowel without sensation or control
(related to spinal cord injury above T-11 or
involving sacral reflex arc S-2 to S-4)
Make sure the lower bowel is empty; an enema may
be necessary before beginning the training program.
Establish a time of day for a bowel movement based
on the patient’s previous pattern; adhere to this
designated time of day rigidly.
Encourage a diet high in roughage (whole-grain
bread and cereal, fresh fruits, and vegetables).
Unless contraindicated by a fluid
restriction, increase fluid intake to 2000 to
2500 mL/d.
Insert a suppository on the first day. If it
does not work, you may wait until the next
day.
The patient should be seated on the commode or
taken into the bathroom to defecate.
Year of publication:2017,jan
glenohumeral subluxation
METHODS:
publisher.p.13-40
medical surgical nursing, 12th ed. Newdelhi: Lippincot wolter’s kluwer; p.113-
Journals
Mahmoud H, Qannam H, Zbogar D.Spinal cord injury rehabilitation in Riyadh,
Saudi Arabia: time to rehabilitation admission, length of stay and functional
independence. Spinal cord.2015 jan. 4(1)
VAN Bladel A, Lambrecht G, Oostra KM, Vanderstraeten. A randomized controlled
trial on the immediate and long-term effects of arm slings on shoulder
subluxation in stroke patients.eur j physrehab med.2017 jan.6(2).
Internet
https://en.wikipedia.org/wiki/Pain_management
https://en.wikipedia.org/wiki/Rehabilitation
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