Terminology, anamnesis, pain, orientation
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
[email protected] +420721190157
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Definition
Rehabilitation
-habilitas= ability (habilis= able)
re= return
-1969 WHO:
„Combined and coordinated utilization of medical, social, educational and
vocational means for training of restoration of the highest degree of
functional capability.“
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Health
-“the state of being free from illness or injury“?
-WHO- „complete physical, mental and social well-being“
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Definition
Physical therapy
-fysis= force of nature
therapeia= treatment
-kinesiotherapy
-kinetic energy
-occupational therapy
-physiatry
-physical stimuli
(thermal, electric, light, mechanical,…)
-balneotherapy
-natural resources
(mineral waters, peloids, hot-spring gases, clima)
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Terminology according to WHO
-disease- manifested by impairment
-impairment- a loss or abnormality of a body function
-↓MS, amputation, HD
-disability- activity restricted by impairment
-gait, ADL..
-handicap- disadvantage that limits full, normal life activity
-participation- integration
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Function of rehabilitation
-diagnostics
-therapy
-prevention
-primary
(prevention from getting a disease)
-secondary
(prevention of secondary changes)
-tertiary
(improve quality of life- crutches, orthoses,…)
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Rehabilitation treatment plan
-short-term treatment rhb plan of care
-treatment approaches and coordination in a time-limited period
-documentation, therapy progress and effect, continuous and exit
examination,…
-long-term treatment rhb plan of care
-additional medical approaches to fulfill the process of treatment
rehabilitation- termination or extension of RHB process, other
RHB institutions, …
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Clinical assessment
-preliminary history
-palpation
-observation
-auscultation
-anthropomentric assessment
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Patient preliminary case history
ANAMNESIS
-patient´s interview
-nonessential!!!
-onset of the condition
-lifting an object, sudden movement, gradual onset,…
-symptoms, pain
-night, pain/movement relationship, radiation,…
-injuries
-mind minor and micro injuries!
-social info, living condition, emplyment, contruction
barriers,…
-do not ask „leading questions“!
-evaluation in context with clinical assessment
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
PERSONAL ANAMNESIS
-illnesses
-past and current, treated or not
-injuries
-surgeries
-gynecological anamnesis
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
FAMILY ANAMNESIS
-medical conditions of close relatives
-parent/ sibling injuries
-children- number of siblings
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
OCCUPATION HISTORY
-demands of a job
-work conditions in greatest possible detail
-stereotypical or diverse in nature
-most frequent position/ movement
-static or constrained positions, lifting
-stressful moments
-lighting and temperature conditions
-work satisfaction
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
SOCIAL HISTORY
-spouse/partner and family relationships
-number of children
-financial situation
-intimate life satisfaction
-leisure activities
-sports
-chronic strain
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
ALLERGY HISTORY
-medical and contrast media
-type of allergic reaction
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
PHARMACOLOGIC HISTORY
-long-term medication
-name, dosage, regularly/as needed
-prescriber
-changes of medication
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
TOXICOLOGIC ANAMNESIS
-abuse of addictive substances
-tobacco, drugs, alcohol, black coffee
-past and present
-reality vs. claim
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Components of anamnesis
CURRENT ILLNESS ANAMNESIS
-PAIN
-most frequent source locomotor system
-onset
-sudden, gradual, fisrt occurance, recurrence
-recurring pain
-initial presentation, rate, duration, length between recurrences
-early in the movement, during, after loading
-rest at night, sleep disturbance
-type of pain
-sharp, dull, constant, projection
-relief positions, circumstances that bring relief- heat, cold
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Pain
RADICULAR PAIN
-acute- sharp, intense, worse with movement and
↑ intra-abdominal pressure
-dermatomal nerve root pattern, tingling
-diminished sensation
REFERRED PAIN
-similar character
-not typical dermatomal pattern
-projection not distal
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Pain
PAIN WITH SPINAL CANAL STENOSIS
-back pain, refers to both LE
-no root characteristics
-neurogenic intermittent claudication
ambulation over certain distance
↓
stop
↓
pain-alleviating position
↓
continue
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Pain
PAIN DURING INFLAMMATION
-present at rest
-night
-temperature, fatigue?
-general inflammatory illness?
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
PAIN
PAIN WITH FUNCTIONAL IMPAIRMENTS
-usually no structural basis
-non-specific- no dg. after organic pathological
changes
-change in function→ change in muscle tone/
decreased joint mobility
-hypertonicity→ nociception, micro-spasms (TrPs)
-time→ structural impairment
-typical anamnesis, psychological condition?
-chronic-intermittent course
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Human body plains
sagittal/ medial
coronal/ frontal
transverse
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Orientation distalis proximalis
cranialis/ caudalis
proximalis/ distalis
superior/ inferior
anterior/ posterior
ventralis/ dorsalis
distalis proximalis
internus/ externus
dexter/ sinister
superficialis/ profundus
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Orientation
lateralis medialis
fibular tibial
plantaris/ dorsalis
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
Movement
-flexion/ extension
-abduction/ adduction
-elevation/ depression
-supination/ pronation
-circumduction
Mgr. Marta Dus, Department of Clinical Rehabilitation, Faculty of Health Sciences
