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intro & history of rehab, epidemiology.pptx

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intro & history of rehab, epidemiology.pptx

  2. 2. • Physical medicine and rehabilitation (PM&R), or physiatry, is a medical specialty focused on prevention, diagnosis, rehabilitation, and therapy for patients who experience functional limitations resulting from injury, disease, or malformation. • The history of Physical Medicine & Rehabilitation crosses many cultures and geographic boundaries. • The word “therapy” comes from the ancient Hebrew word refua which means (healing). Rehabilitation therapy, an essential component of the PM&R treatment approach, has a long history.
  3. 3. • Thousands of years ago the ancient Chinese employed Cong Fu, a movement therapy, to relieve pain. • The Roman physician Galen described interventions to rehabilitate military injuries in the second century. • The Greek physician Herodicus described an elaborate system of gymnastic exercises for the prevention and treatment of disease in the fifth century. • During the Middle Ages, the philosopher-physician Maimonides emphasized principles of healthy exercise habits, as well as diet, as preventive medicine in Medical Aphorisms, published between 1187-1190.
  4. 4. • In the eighteenth century, Niels Stenson explored the biomechanics of human motion and Joseph Clement Tissot’s 1780 Medical and Surgical Gymnastics promoted the value of movement as an alternative to bed rest for patients recovering from surgery, facing neurological conditions, and recuperating after strokes. • In the nineteenth century, the concept of neuromuscular re-education was proposed by Fulgence Raymond (1844-1910).
  5. 5. • According to various estimate about 5-10 percent of the world population is affected by one or more disabiliies. • In our country the national sample survey estimated nearly about two percent of population, who experience difficulty in walking or suffer from visual, hearing and mental impairement.
  6. 6. • The incidence of disabiility is reported to be just over two percent in rural areas and 1.6 percent in urban areas. • In modern society acting independently is of supreme importance – be it in the area of personal care, day to day activities, cooking, studies or anything that requires human persuit. It is these areas that a disabled person suffer most; socially, economically, psychologically and emotionally.
  7. 7. • Due to physical or medical handicap a disabled person cannot act independently in many spheres of life and hence faces many problems in his social adjustment. • His incapacity generates emotional problems like apathy, self pity and he tends to isolate himself from society. • It is the collective responsibility of the abled body to rehabilitate these handicapped individuals. • The role of rehabilitation is to minimize disability and handicap, and help a handicapped person lead a useful life within his limitation. • In other words to make a disabled person into a “differently abled” person.
  8. 8. • Rehabilitation is the utilization of the existing capacities of the handicapped person, by the combined and co- ordinated use of medical, social, educational and vocational measures to the optimum level of his functional ability. • It makes his life more meaningful, more productive and therefore worthwhile living. • It is the third phase of medical care; after preventive and curative phase.
  9. 9. • Rehabilitation must be started at the earliest possible time in order to ensure the best results. It is administered in conjunction with specific medical and surgical treatment of disease. • Rehabilitation may be medical or sociovocational. • Medical rehabilitation is the utilization of medical and paramedical skills to help treat the patient. • The role of medical rehabilitation is to limit disability.
  10. 10. • Socio-vocational rehabilitation follows, or sometimes is delivered simultaneously along with medical rehabilitation. • It is a team effort, which aims at providing the disabled a vocation and reducing his handicap and empower the person not just economically but in a more basic and meaningful sense. • It makes a person stand on his own legs. • It does not bind him to a job, it sets him free.
  11. 11. • The word epidemiology is derived from greek word epidemios; meaning “among the people”. • In the early 20th century Stallybross defined epidemiology as “the science which considers infectious disease – their course, propagation and prevention”. • The fundamental purpose of epidemiology is the prevention and eradication of disease through a better understanding of its causation.
  12. 12. • If complete prevention or total eradication is not possible, containment is the second choice. • W H Welch defined epidemiology as “the study of the natural history of disease”. • Lillienfeld described it as the study of “the distribution of a disease or condition in a population and of the factors that influence this distribution”.
  13. 13. • The definition of health put out by the WHO as follows : “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. • The fundamental goals of medical science is not to produce an immortal being but to maintain him in optimum health as long as possible, ideally until death. • The fundamental goal of rehabilitation is to “ add life to years, not years to life”.
  14. 14. The world health organisation’s international classification of impairement, disability and handicap (ICIDH 1980) defines these terms as follows :
  15. 15. Any loss or abnormality of psychological, physiological or anatomical structure or function, e.g. loss of finger, loss of conduction of impulses in the heart, or loss of certain chemicals in the brain leading to parkinsonism. Not all impairement lead to disability; for example the loss of the pinna of the ear would not lead to loss of hearing but merely result in a cosmetic deficiency.
  16. 16. Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being resulting from an impairement, e.g. difficulty in walking after lower limb amputation. It must be noted here that strenous or rarely indulged in feats like rock climbing or wind surfing are not included in activities to be considered for disability. To be considered disabled a person should not be able to perform day to day activities considered normal for his age, sex or physique.
  17. 17. • Disabilities that are direct consequences of a disease or condition are called primary disability. Paraplegia following spinal cord injury, inability to walk following hip fracture are example of primary disability. • On the other hand, disabilities that did not exist at the onset of the primary disability but develop subsequently are called secondary disability. Secondary disability is indirectly related to the disease or condition that is responsible for the primary disability. Example are joint contracture in poliomyelitis, subluxation of shoulder joint in hemiplegia and pressure sores in paraplegia
  18. 18. • Elderly people and those who have had a primary disability for an extended period are most susceptible to a secondary disability. • Further, when pain or spasticity accompanies the disease or condition causing the primary disability, the prevalence of secondary disability increases. • Negligence or ignorance on the part of paramedical personnel or family members results in placing the person with disability in positions that promote secondary disability.
  19. 19. • Any attempts to halt a person‘s slide down the slope of the health status scale is termed as prevention. • And any attempt to push it up towards the peak, i.e. optimum health is called therapeutic health care. • This total spectrum is classified into three levels of prevention by WORLD HEALTH ORGANISATION. • Primary prevention • Secondary prevention • Tertiary prevention
  20. 20. • Primary prevention : it is explained as a measure taken prior to the onset of any disease. E.g. immunization against childhood infection or chlorination of drinking water. It is designed to promote general health and improve the quality of life. This is the first phase of medicine, i.e. preventive medicine. • Secondary prevention : it is explained as a measure taken to arrest the development of a disease while it is still in the early asymptomatic stage of the disease. It involves early diagnosis and immediate treatment. E.g. ergonomic intervention to prevent clinical symptoms in a patient with spondylosis. This is the second phase or curative aspect of medicine
  21. 21. • Tertiary prevention :- it is explained as a measure taken to minimize the consequences of a disease or injury once it has become clinically manifested, e.g. prevention of pressure sores by turning the patient over regularly. This is the third phase or rehabilitation medicine.
  22. 22. • Prevention of disability does not start only at birth, at the onset of disease or after a primary disability occurs. • Sometimes it may be done even before the child is born, by anticipating disability due to genetic defects and can be prevented by means of genetic counselling. • Current population growth, particularly aged, naturally would result in a sharp rise in people with disability in the near future. Because of tremendous strides that medical science taken, the number of patients surviving a potentially fatal condition like brain injury is much more. • Therefore it follows that with a fall in mortality level there is a rise in morbidity level.
  23. 23. • Rehabilitation deals with morbidity; it deals with quality of life. • Unless more effective method of prevention are developed to protect the population from primary disability in the future, the newly detected person with disability will face a critical situation. • The shortage of health manpower will cause them to be without benefit of rehabilitation services and superimposed secondary disabilities will render them totally dependent on society for everything.
  24. 24. • This will result not only in personal tragedy, but will create infinite economical problems for families, community and nation. • The medical community must act to prevent epidemics of disability in much the same manner that we are now able to prevent communicable disease.
  25. 25. • All specialities in therapeutic medicine require early and precise diagnosis in order to institute the most effective treatment. • The same logic applies to rehabilitation and the disabled should be given early evaluation and intensive treatment to prevent permanent disability. • The total person physically, emotionally, vocationally and socially must be considered in the diagnosis. • The Patient is evaluated as a human being and not as a case.
  26. 26. • Diagnosis of disability may be expressed either in terms of the amount of disability or in terms of the amount of remaining function. • The expression of disability evaluation or functional diagnosis varies according to the method used.
  27. 27. The functional diagnosis should be : • Simple enough, so that rapid evaluation is possible. • Reproduced, so that constancy may be maintained. • Objective, using measurable factors so that the results are statistically more reliable. • Descriptive, so that the actual situation is accurately reflected. • Comprehensive, so that the diagnosis is complete and specifically utilized in the direct care of the patient.
  28. 28. An example would be in the diagnosis of cerebral palsy. While the diagnosis of cerebral palsy, conveys very little or no meaning, it would be ideal to functionally diagnose a child so that following question are answered : • How many limbs are affected – i.e. diplegic or quadriplegic ? • Type of CP – spastic or some other ? • Mental abnormality – present ? • Communication impairement – present ? • Hearing and visual impairement – present ?
  29. 29. • A disadvantage for a given individual in his or her social context resulting from an impairement or a disability that limits or prevent the fulfillment of a role that is normal (depending on age, sex, social and cultural factors) for that individual. • Many socio-economic factors like family background, skills achieved and financial stability come into play while determining handicap.
  30. 30. • The WHO has identified six handicaps : 1. Locomotor (which forms 60 % of all handicaps) 2. Visual 3. Hearing and speech 4. Cardiopulmonary 5. Intellectually challenged 6. Emotionally disturbed • The person with locomotor disability are the largest in number (60-70%) followed by those with hearing and speech and visual impairement.
  31. 31. • Many patient suffer from multiple handicaps, which include combinations of any of the six given above. • Above 12 % of individuals with disability suffer from more than one type of disability. • For example, a child with cerebral palsy, would probably have, in addition to the delayed milestones and motor problem, damage of the part of the brain responsible for sight and hearing.
  32. 32. Such handicapped individuals have problems with : • Orientation • Physical independence • Mobility • Occupational integration • Social integration and • Economic self sufficiency No person is said to be fully rehabilitated unless all the above criteria have been looked into.