Patients in medical rehabilitation (such as for stroke or spinal cord injury) often have many medical problems that reduce their energy and cognition. If their team decides they are 'psychologically unmotivated' they are discharged prematurely to nursing homes. Appropriate medical intervention can restore 'motivation' as well.
Any rehabilitation team is comprised of different types of specialists who deal with the physical, emotional and spiritual needs of the patient. Find here a description of a few of them along with their responsibilities.
Physiotherapy intervention in rehabilitation is aimed at the prevention of activity limitations for the promotion and maintenance of the quality of life. Here is a PPT of the role of physiotherapy in the rehabilitation of elderly patients. Hope it enriches you.
the term vocational rehabilitation means that part of the continuous and co-ordinated process of rehabilitation which involves the provision of those vocational services, e. g. vocational guidance, vocational training and selective placement, designed to enable a disabled person to secure and retain suitable ...
Rehabilitation : Principle and its types Palash Mehar
Rehabilitation-
According to WHO “Rehabilitation or rehab is the combined and coordinated use of the medical, social, educational, and vocational measures for training and re-training the individual to the highest possible level of functional ability”.
Principles of Rehabilitation
Aspects of Rehabilitation
Types of Rehabilitation :-
There are too many types rehab to list here but some common types of therapy include,
Physical therapy
Occupational therapy
Speech/swallow therapy
Cognitive rehabilitation therapy
Vocational rehabilitation
Any rehabilitation team is comprised of different types of specialists who deal with the physical, emotional and spiritual needs of the patient. Find here a description of a few of them along with their responsibilities.
Physiotherapy intervention in rehabilitation is aimed at the prevention of activity limitations for the promotion and maintenance of the quality of life. Here is a PPT of the role of physiotherapy in the rehabilitation of elderly patients. Hope it enriches you.
the term vocational rehabilitation means that part of the continuous and co-ordinated process of rehabilitation which involves the provision of those vocational services, e. g. vocational guidance, vocational training and selective placement, designed to enable a disabled person to secure and retain suitable ...
Rehabilitation : Principle and its types Palash Mehar
Rehabilitation-
According to WHO “Rehabilitation or rehab is the combined and coordinated use of the medical, social, educational, and vocational measures for training and re-training the individual to the highest possible level of functional ability”.
Principles of Rehabilitation
Aspects of Rehabilitation
Types of Rehabilitation :-
There are too many types rehab to list here but some common types of therapy include,
Physical therapy
Occupational therapy
Speech/swallow therapy
Cognitive rehabilitation therapy
Vocational rehabilitation
disability, impairment, rehabilitation, rehabilitation council of india, prosthsis, orthosis, vocational , occupational rehabilitation, causes, definition,
CBR is a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities
The rehabilitation team conventionally includes the physiatrist, rehabilitation nurse, physical and occupational therapist, speech pathologist, rehabilitation psychologist, and social worker or case manager, with availability of other services such as nutrition and respiratory therapy.
UNIT-VII REHABILITATION M.SC II YEAR.pptxanjalatchi
he action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.
"she underwent rehabilitation and was walking within three weeks"
This topic is meant for the study purpose, for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
Telerehab - Clinical Research & Practical Experiences, CanRehab 2019Subodh Gupta
Presentation on Tele-Rehabilitation made at Tata Memorial Centre at 2nd International Conference on Cancer Rehabilitation (Can Rehab 2019). The presentation discusses technology and clinical research for telerehabilitation, and practical experiences while treating patients online.
Psychological Factors influence on healthAQSA SHAHID
“Psychosocial” factors such as stress, hostility, depression, hopelessness, and job control seem associated with physical health—particularly heart disease.Being in a good mental state can keep you healthy and help prevent serious health conditions. A study found that positive psychological well-being can reduce the risks of heart attacks and strokes. On the other hand, poor mental health can lead to poor physical health or harmful behaviors. Chronic diseases.
Examples of psychosocial factors include social support, loneliness, marriage status, social disruption, bereavement, work environment, social status, and social integration.
Psychosocial factors that may affect pain include things like marital status, social support, bereavement, home and work environment, social status, and social integration. For example, someone who is under great stress due to their family life or work stress might have a lower threshold for pain.
disability, impairment, rehabilitation, rehabilitation council of india, prosthsis, orthosis, vocational , occupational rehabilitation, causes, definition,
CBR is a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities
The rehabilitation team conventionally includes the physiatrist, rehabilitation nurse, physical and occupational therapist, speech pathologist, rehabilitation psychologist, and social worker or case manager, with availability of other services such as nutrition and respiratory therapy.
UNIT-VII REHABILITATION M.SC II YEAR.pptxanjalatchi
he action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.
"she underwent rehabilitation and was walking within three weeks"
This topic is meant for the study purpose, for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
Telerehab - Clinical Research & Practical Experiences, CanRehab 2019Subodh Gupta
Presentation on Tele-Rehabilitation made at Tata Memorial Centre at 2nd International Conference on Cancer Rehabilitation (Can Rehab 2019). The presentation discusses technology and clinical research for telerehabilitation, and practical experiences while treating patients online.
Psychological Factors influence on healthAQSA SHAHID
“Psychosocial” factors such as stress, hostility, depression, hopelessness, and job control seem associated with physical health—particularly heart disease.Being in a good mental state can keep you healthy and help prevent serious health conditions. A study found that positive psychological well-being can reduce the risks of heart attacks and strokes. On the other hand, poor mental health can lead to poor physical health or harmful behaviors. Chronic diseases.
Examples of psychosocial factors include social support, loneliness, marriage status, social disruption, bereavement, work environment, social status, and social integration.
Psychosocial factors that may affect pain include things like marital status, social support, bereavement, home and work environment, social status, and social integration. For example, someone who is under great stress due to their family life or work stress might have a lower threshold for pain.
CONCEPT ANALYSIS I select the word Stressor for my Concept AnalLynellBull52
CONCEPT ANALYSIS
I select the word: Stressor for my Concept Analysis Paper Project from Betty Neuman’ System Model. A concept analysis paper for nursing involves conducting a literature review, identifying the key characteristics or attributes of the concept, identifying its antecedents and consequences and apply them to a model case.
Introduction
The exposure to stressful situations is the most common human experiences, the severity of these situations, many times unexpected, elicits a stress response. The impact of stress is different from one individual to other. The various types of emotional, physical, social, and spiritual responses that a person has to stress are set in close relation by stress hormones. Anything that poses a challenge or a threat to our wellbeing is a stress. Some stresses get you going and they are good for you, however, when the stresses undermine both our mental and physical health they are bad. In this Concept Analysis Paper, I will be focusing on stress that is bad for us.
Stressor Self Concept
The term stress, from my perspective, better describe a disruption of the harmony or equilibrium cause by a stimulus, phenomenon or event that trigger a response: emotional, physical, mental or spiritual. Stress can be a positive or negative response, as a consequence of a stimulus. Every response is different and unique, even in from of the same stimulus. The stressor sources vary from internal and external.
Related Words
Literature Review
Psychology Definition of Stress:
Stress refers to the emotional and physiological reactions experienced when an individual confronts a situation in which the demands go beyond their coping resources.
Medical Definition of Stress:
In a medical or biological context stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure).
Definition of stress by Merriam-Webster Dictionary:
Stress is a constraining force or influence: such as
a: a force exerted when one body or body part presses on, pulls on, pushes against, or tends to compress or twist another body or body part; especially: the intensity of this mutual force commonly expressed in pounds per square inch
b: the deformation caused in a body by such a force
c: a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
d: a state resulting from a stress; especially: one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium.
e: strain, pressure <the environment is under stress to the point of collapse.
Chemical Definition of stressor:
A substance that forces change, usually damage, on living organisms or ecosystems, or reduces their ability to cope with environmental changes. This occurs when the substance is released unplanned and unwanted into an envi ...
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Surname 1
Student’s Name
Professor’s Name
Course
Title
Mindfulness Among Healthcare Professionals
Currently, cases of disrespect, stress, prejudgment, reduced concentration at work, poor conflict resolution skills, reduced resilience, reduced engagement in physical activities, and reduced expression of creative arts, among others, have increased significantly among various professionals. These actions have derailed the reputation of various professionals. They have also compromised the professionals’ deliverables, thus leaving their clients unsatisfied. This study, therefore, is specific to healthcare professionals. Healthcare is a very vital service in the life of humans, such that the people providing it must always be keen and sober when on duty. This argumentative essay will aim to teach healthcare professionals on the importance of mindfulness and how such knowledge can improve the quality of the delivery of healthcare services.
Shea (2016) states that “The present defines the future. The future builds on the foundation of the past” (15). Mindfulness has a history chronologically describing how it came about. The practice of mindfulness practice was employed in various religious and philosophical teachings such as Buddhism, Hinduism, and Yoga. More recently, the practice has expanded into non-religious meditation. Mindfulness was mainly popular in the religious and spiritual communities of the East. Its spread in the Western world can only be linked to particular people and secular institutions. It is important to note that some commentators argue that the history of mindfulness should not only be confined to Buddhism and Hinduism, as the practice also has origin in Islam, Judaism, and Christianity (Shea 20). Depending on people’s thoughts, many theories can be applied to explain the history of mindfulness, leading to conflicting conclusions.
The possible arguments of the theories can be traced to its origin in the field of medicine, Christianity, and Islam. Mindfulness might indeed have been much applied in the Christian, Islam, and the medicine set up. However, at the time of this research, there existed no material pieces of evidence to support that. The available materials show that mindfulness was popularly used in Buddhism and Hinduism. The modern western world later came to learn the practice of mindfulness from the traditions of Buddhists and Hindus. Therefore, this paper will focus on mindfulness from a Buddhist and Hindu perspective. In the succeeding paragraphs, we will get to know the different mental and emotional issues that healthcare professionals struggle with, the general definition of mindful practices, specific mindful practices that may help the healthcare professionals. The paper will address any opposing arguments and, finally, offer opportunities for future research.
From the resources employed to develop this paper, there is significant evidence that shows that the increase in anxiety disorders, sleep diso ...
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
2. Nancy Hansen Merbitz, PhD
Clinical Assistant Professor
Department of PM&R
University of Michigan
The planners, editors and faculty of this activity
have no relevant financial relationships to
disclose.
3. Learning Objectives
At the conclusion of this course participants will be able to:
Describe a variety of medically-related causal factors that can
overlap and have cumulative effects on behavior, emotions,
thoughts and cognitive abilities
Distinguish that medical and psychological factors are not
“either-or”
Identify that a patient’s ability to follow through with goal-
directed behavior arises from the highest levels of brain
function and can easily be disrupted by factors separate from
the person’s baseline personality & desire to get better
4. To obtain credit you must:
– Be present for the entire session
– Complete an evaluation form
– Return the evaluation form to staff
Certificate will be sent to you by e-mail.
Rush designates this live activity for 1 (one) AMA PRA Category 1 Credit™
Rush University Medical Center is accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education for physicians.
Rush University (OH-390, 8/25/2014) is an approved provider of continuing education by the Ohio
Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing
Center’s Commission on Accreditation. Rush University designates this live activity for one (1)
Continuing Education contact hour(s).
Rush University is an approved provider for physical therapy, occupational therapy, respiratory therapy,
social work, nutrition, speech-audiology, and psychology by the Illinois Department of Professional
Regulation. Rush University designates this live activity for one (1) Continuing Education credit(s).
5. Many rehab inpatients come from critical care
Growing evidence of persisting cognitive
impairments after critical illness (e.g. ARDS, sepsis)
Pandharipande, P. P., et al. "Long-term cognitive impairment
after critical illness." New England Journal of Medicine
369.14 (2013): 1306-1316.
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term
Cognitive Impairment and Functional Disability Among
Survivors of Severe Sepsis. JAMA 2010; 304(16): 1787-1794.
6. Many rehab inpatients come from critical care…
Growing evidence of persisting emotional
impairment after critical illness (e.g. depression;
anxiety, PTSD)
Davydow, Dimitry S., et al. "Psychiatric morbidity in survivors
of the acute respiratory distress syndrome: a systematic
review." Psychosomatic medicine 70.4 (2008): 512-519.
De Miranda S, Pochard F, Chaize M, et al: Postintensive care
unit psychological burden in patients with chronic
obstructive pulmonary disease and informal caregivers: A
multicenter study. Crit Care Med 2011; 39:112-118.
7. Impact of prior critical care
These experiences have lingering effects on their
participation in rehabilitation.
Arousal, alertness
Trust
Mood, emotional regulation
Cognition: Orientation and new learning abilities
This may give rise to questions about their
motivation for rehab.
8. How do we think about “motivation”?
There is a human tendency to lapse into tautology
regarding explanations of behavior:
“If the patient did something, he was motivated to do it.
If he didn’t do something, he was unmotivated to do it.”
Interestingly, we are less likely to explain our OWN
behavior in this way.
9. A consistent finding from
Social Psychology research
re our perceptions of
less-than-optimal behavior is:
the “Fundamental Attribution
Error”.
10. The Fundamental Attribution Error
When I do something (or fail to do something), it’s
due to circumstantial factors, such as “I was tired. I
was stressed by others. I have too much going on. I
didn’t get enough sleep.”
11. The Fundamental Attribution Error
When someone else does something (or fails to do
something), it is because of his or her motivation.
i.e. various internal factors such as mood, fear, lack of
determination, avoidance, poor work ethic, etc.
These may or may not be relevant in a particular case, but
the point is, we infer these internal psych factors re:
OTHERS’ behavior more than we do re: our own behavior.
12. Of course our patients do come to us with many
psychological factors influencing their behavior.
Their previous personal history converges with their
current struggles with dependence and vulnerability,
and most of this takes place in connection with a team
of people, formerly strangers, who in many respects
become more intimate than family.
This is powerful stuff, which has a great impact on
behavior during rehabilitation and beyond.
But today I want to point you toward some factors that
are closer to the traditional medical bailiwick, but which
can present as problems of “motivation”.
13. Main ideas for today: #1
The effects of medical conditions, medications,
hospitalization, pain, and sleep deprivation on brain
functioning can fall far short of “delirium”,
presenting instead as problems with energy, mood, new
learning and recall, emotional self-regulation and
maturity of coping.
As one pt put it, “It’s like I’m going to therapies
with my brain tied behind my back.”
14. #2
Acute rehabilitation provides a unique, extended
opportunity to observe behavior (broadly defined
to include learning, moving, interacting with others,
expressing emotions) in an environment that is
both challenging and supportive.
15. #3
Viewing problems of behavior as problems in
“motivation” may cause us to miss opportunities to
improve what we are doing and get better
outcomes.
It may lead to overtreatment with psychotropic
medications.
16. #4
Conversely, viewing behavior over time, as a
phenomena in itself, may allow us to discover and
correct barriers to optimal functioning, medical or
environmental.
17. Rehab patients’ medical and psychological
experiences are intertwined, not either/or
May have had a long hx of medical problems
With many prior setbacks, struggling to cope w/ decline
May have had an unusual disorder that wasn’t
diagnosed for years,
while the pt worried about his/her credibility in reporting
symptoms.
May have distrust, anxiety w/ Dr and other medical
providers
18. Medical complications frequently
interrupt rehab participation
One study (Siegler et al 1994) found that, of 1075
patients admitted to rehab, 359 (33.4%) had acute
medical complications on rehabilitation considered
severe enough to interrupt treatment.
Of the 359 patients, 158 (44%) required an unexpected
transfer off rehabilitation.
This may include critical care …
19. Further analyses revealed major risk factors for
complications leading to transfer off-unit:
a primary diagnosis of deconditioning or nontraumatic
spinal cord injury
severity of initial disability
number of comorbid conditions
(Siegler, Stineman & Maison, 1994)
Sounds like a lot of our patients …
Nevertheless, we know that pts w/ medical
comorbidities can make reasonable gains during
rehab …
20. For example, in a retrospective database
review of 175 rehabilitation patients with
comorbidities,
Lee, Lee, Date, Zeiner (2002) concluded:
“Except for life-threatening medical emergencies,
patients may benefit by staying on the acute rehab
unit, where both medical management and a
comprehensive rehabilitation program are provided
with continuity.”
21. Given the medical complexity
of our patients…
What are some things to keep in mind that may
present barriers to optimum participation and
benefit from rehabilitation?
How can we avoid the Fundamental Attribution
Error in our work with patients?
22. Given the medical complexity
of our patients…
Bottom line: If we ascribe behavior solely to
psychological/motivational factors, this can lead to
over-treatment with psychotropics,
while underestimating the impact of medical
complications & current environmental factors.
23. Because rehabilitation is so demanding of
patient’s behavioral capacities, and because it all
takes place under close observation over an
extended period of time…
The rehabilitation unit is a goldmine of
behavioral data to inform us:
not only about the person’s progress
but about the great sensitivity of the human organism
to changes in lab values or medication regimens that
may not usually be considered as having a clinical
impact.
24. You know this already, but it’s often
overlooked or under-rated…
We’ll see in the clinical example later:
++++++++++++++++++++++++++++++++++++
Behavior (and changes in behavior) can be a highly
sensitive indicator, even a prodrome, for medical
complications AND for response to medical interventions.
++++++++++++++++++++++++++++++++++++++++++
25. Rehabilitation places large demands on
higher level cognition and coping:
A switch from passive mode to active mode
Learning the names and roles of a large team
Learning how to do activities in a different way
Learning equipment. Learning routes in the hosp.
Being around a lot of people (this may be a big change for
some)
Being watched and evaluated
Waiting, and being on the unit’s schedule
Functioning adequately while SLEEP DEPRIVED!
26.
27. A sample of co-morbidities with greater
impact on behavior than you might suppose:
Anemia
Hypo and hyperglycemia
Hypo and hyperthyroid
UTIs
COPD
Hyponatremia
Sleep apnea
and the ubiquitous sleep deprivation
plus medication side effects …
28. Note: the issue is not just delirium…
Side effects and co-morbidities that are far short of
causing frank delirium can significantly interfere with
higher level psychological and neuropsychological
functions that are required for a good response to
rehabilitation.
Plus, could it be that non-severe comorbidities and mild
side effects have cumulative, unexpected impact on
higher functions?
29. Anemia
The hypoxic condition caused by even mild anemia
can negatively affect physical function, cognitive
performance, mood, and quality of life,
as found in a large community sample of individuals aged
65–84 years, comparing persons with mild anemia and a
randomly selected sample of non-anemic controls
Mild anemia was defined as a hemoglobin
concentration between 10.0 and 11.9 g/dL in
women and between 10.0 and 12.9 g/dL in men.
Lucca, Ugo, et al. (2008)
30. Hypo and hyperglycemia
Hypoglycemia’s impact on cognition is well-
recognized.
But also can cause or exacerbate depressed mood and
feelings of anxiety and panic
Less well-known are the effects of
hyperglycemia, often experienced acutely by our
pts even without h/o diabetes, e.g.
Sommerfield, Deary and Friar (2004):
During acute hyperglycemia, cognitive function was
impaired and mood state deteriorated in a group of
people with type 2 diabetes.
31. Prior experience of delirium
Patients coming from critical care units may be
especially likely to have undergone some episode of
delirium.
Jones et al (2001) found that for some, delusional
memories persisted and this predicted longer-term,
clinically significant anxiety.
Patients who have experienced delirium are more
likely to show some degree of long-term cognitive
deficit relative to pre-delirium baseline
32. ARDS: A common pre-rehab admission
experience (MANY of our pts)
Hopkins, et al. (2005): Their study, following 74
ADRS pts (w/ no prior neurological disease) for 2
years, found cognitive deficits at hospital DC, 1 yr
and 2 yr follow-ups.
ARDS resulted in significant neurocognitive and
emotional morbidity and decreased quality of life
that persisted at least 2 years after hospital
discharge.
33. They concluded:
The cognitive impairments in the patients with ARDS
appear to be under-recognized by ICU and
rehabilitation providers.
Education regarding cognitive sequelae after ARDS is
needed to enhance referral of patients to
rehabilitation, not only for physical debilitation and
weakness, but also for cognitive impairments.
34.
35. Hyponatremia is fairly common in hospitalized patients,
especially elderly.
Different published articles describe different levels of
hyponatremia associated with symptoms. There can be
subtle effects at mild levels of derangement.
Symptoms can be more notable when drop in sodium is
rapid versus slow.
In rehab setting we may get a clearer picture of subtle
symptoms because of close observation in a demanding
environment.
36. Neurological signs
At different severity levels, there may be:
Mild (125 and 130 mmol/l)
○ anorexia, headache, nausea, vomiting, lethargy.
Moderate (115 and 125 mmol/l)
○ personality change, muscle cramps and weakness,
confusion, ataxia.
Severe (<115 mmol/l )
○ drowsiness; seizures, coma
37. When the cause is SIADH
(as was concluded for our Case Example)
SIADH is a clinical manifestation of a wide range of
clinical disorders and drug therapies.
Etiology may be medications:
Various literature has pointed to a wide variety of
medications, including but not limited to antidepressants,
antiseizure medications, quinolones, haloperidol and many
others, as well as combinations
(SIADH is also commonly associated with intracranial
diseases, particularly traumatic brain injury)
38. Our patient, Mr. C
“An 80+-year-old man with a history of:
coronary artery disease,
chronic systolic heart failure,
type 2 diabetes mellitus,
stage III chronic kidney disease,
hypertension,
hyperlipidemia,
GERD, possible esophageal dysmotility,
depression, and
recent posterior spinal fusion for cervical stenosis.”
39. He was admitted to Acute Rehab in
February from the Neurosurg unit,
where his sodium level had fluctuated.
It continued downward after his admit
to our unit.
Various measures were taken to correct
it, and ultimately these were successful.
41. As his sodium went down…
He appeared more lethargic, depressed and
anxious.
His minutes of therapy dropped to zero.
Psychotropic remedies were attempted, to no
avail, along with ongoing efforts to address his
hyponatremia.
He developed swallowing problems as sodium
dropped further, and became disoriented.
Discharge to SAR was planned.
43. “Tell them I’m not usually like
this.
I want to get up. I want to get
better.
I’m not lazy. I don’t feel right.”
I just can’t do it.”
44. Once the etiology of Mr. C’s hyponatremia was
determined to be SIADH, he was put on strict fluid
restriction plus salt tablets.
Held: diazepam (3/7), and furosemide (3/2 ).
DC’d: citalopram & tamsulosin (3/12).
47. Sodium levels rose steadily, and held WNL. Mood,
alertness, and minutes of therapy rose as well. Even
swallowing improved to “within functional limits”.
Mood, alertness, minutes of therapy and swallowing
maintained even as fluid restriction was lifted and
furosemide was re-started.
Conclusion was: “SIADH 2/2 medications; likely
citalopram, tamsulosin”
He discharged to home with his daughter.
48. Importance of tracking info related
to risk of future delirium
If we have observed acute changes in mental
status, this charted information should carry
forward for future reference in the pt’s subsequent
medical records.
For whatever reason that it occurred, it represents
a greater risk for future delirium, which perhaps
could be forestalled with closer monitoring of
prodromal symptoms.
50. Bibliography (not all were cited)
Anderson RJ, Chung HM, Kluge R & Schrier RW. Hyponatremia: a prospective analysis of its
epidemiology and the pathogenetic role of vasopressin. Annals of Internal Medicine 1985 102
164–168.
Cox, Daniel J., et al. "Relationships between hyperglycemia and cognitive performance among
adults with type 1 and type 2 diabetes." Diabetes Care 28.1 (2005): 71-77.
Davydow, Dimitry S., et al. "Psychiatric morbidity in survivors of the acute respiratory distress
syndrome: a systematic review." Psychosomatic medicine 70.4 (2008): 512-519.
De Miranda S, Pochard F, Chaize M, et al: Postintensive care unit psychological burden in patients
with chronic obstructive pulmonary disease and informal caregivers: A multicenter study. Crit
Care Med 2011; 39:112-118.
Duppils, G. S. and Wikblad, K. (2004), Delirium: behavioural changes before and during the
prodromal phase. Journal of Clinical Nursing13: 609–616. doi: 10.1111/j.1365-2702.2004.00898.
Gankam Kengne F, Andres C, Sattar L, Melot C & Decaux G. Mild hyponatremia and risk of
fracture in the ambulatory elderly. Quarterly Journal of Medicine 2008 101 583–588.
51. Gonder-Frederick, Linda A., et al. "Cognitive Function Is Disrupted by Both Hypo-and
Hyperglycemia in School-AgedChildren With Type 1 Diabetes: A Field Study." Diabetes Care
32.6 (2009): 1001-1006.
Hopkins, R, Jackson et al. Two-year cognitive, emotional, and quality-of-life outcomes in
acute respiratory distress syndrome. American journal of respiratory and critical care
medicine 171.4 (2005): 340-347.
Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney
Jr LM. A multicomponent intervention to prevent delirium in hospitalized older patients. N
Engl J Med 1999; 340: 669–76
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term Cognitive Impairment and Functional
Disability Among Survivors of Severe Sepsis. JAMA 2010; 304(16): 1787-1794.
Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, Ely EW. Six-month
neuropsychological outcome of medical intensive care unit patients. Crit Care Med
2003;31:1226–1234.
Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and development of
acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med.
2001 Mar;29(3):573-80.
52. Lew HL, Lee E, Date ES, Zeiner H: Influence of medical comorbidities and complications on
FIM™ change and length of stay during inpatient rehabilitation. Am J Phys Med Rehabil
2002;81:830–837.
Lucca, Ugo, et al. "Association of mild anemia with cognitive, functional, mood and
quality of life outcomes in the elderly: the “Health and Anemia” study." PLoS One 3.4
(2008): e1920.
Lundstrom M, Edlund A, Lundstrom G, Gustafson Y. Reorganization of nursing and medical
care to reduce the incidence of postoperative delirium and improve rehabilitation
outcome in elderly patients treated for femoral neck fractures. Scand J Caring Sci 1999;
13: 193–200.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture:
a randomized trial. J Am Geriatr Soc 2001; 49: 516–22.
McNicoll, L., Pisani, M.A., Ely, E.W., Gifford, D., & Inouye, S. K. (2005). Detection of
delirium in the intensive care unit: Comparison of confusion assessment method for the
intensive care unit with confusion assessment method ratings. Journal of the American
Geriatrics Society, 53, 495–500.
Olofsson B, Lundström M, Borssén B, Nyberg L, Gustafson Y. Delirium is associated with
poor rehabilitation outcome in elderly patients treated for femoral neck fractures.
Scandinavian Journal Of Caring Sciences [serial online]. June 2005;19(2):119-127.
53. Pandharipande, P. P., et al. "Long-term cognitive impairment after critical illness." New
England Journal of Medicine 369.14 (2013): 1306-1316.
Renneboog B, Musch W, Vandemergel X, Manto MU & Decaux G. Mild chronic
hyponatremia is associated with falls, unsteadiness, and attention deficits. American
Journal of Medicine 2006 119 71e1–71e8.
Robinson, T. N., & Eiseman, B. (2008). Postoperative delirium in elderly: Diagnosis and
management. Clinical nterventions in Aging, 3, 351–355.
Siegler, Eugenia L., Margaret G. Stineman, and Greg Maislin. "Development of
complications during rehabilitation." Archives of internal medicine 154.19 (1994): 2185.
Thomas, R. I., Cameron, D. J., & Fahs, M. C. (1988). A prospective study of delirium and
prolonged hospital stay: Exploratory study. Archives of General Psychiatry, 45, 937–940.
Torpy, J. M., Burke, A. E., & Glass, R. M. (2008). Delirium. Journal of the American
Medical Association, 300(4), 2936.
Truman, B., & Ely, E. W. (2003). Monitoring delirium in critically ill patients. Using the
confusion assessment method for the intensive care unit. Critical Care Nurse, 23, 25–
38.
Woo MH, Smythe MA. Association of SIADH with selective serotonin reuptake
inhibitors. Ann Pharmacother. 1997;31:108–10