Presentations
Rehabilitation after a neurological condition focuses on maximising activity and participation of the person and promoting community reintegration. Rehabilitation physicians work with patients to set short- and long-term goals, and recognise that presentations and complications will vary based on the stage of the condition.
To maximise functional outcomes, tailored interventions focus on impairment, activity, and participation, while optimising physical environments and personal factors that impact on the person. Prevention, early recognition, and management of complications are important parts of the process.
Rehabilitation as a process can occur in a variety of settings, including in hospital on acute or specialised rehabilitation wards, in the home, or in community outpatient settings. It is important to recognise that different aspects of care are best suited to specific settings, while others occur across the continuum and alter in importance according to patient factors and the neurological condition.
Conditions
- Aneurysm/vascular malformations
- Anoxic brain injury
- Disorders of muscle
- Functional neurological disorders
- Hereditary spastic paraplegia
- Infections/Inflammatory:
- encephalitis
- multiple sclerosis (MS)
- post-polio syndrome
- vasculidities
- Infectious/Inflammatory encephalopathies
- Meningitis
- Movement disorders:
- Parkinson disease
- Parkinsonism
- Neoplasm/tumour
- Neurodegenerative:
- motor neurone disease (MND)
- Other upper motor neurone lesions
- Peripheral nervous system disorders:
- brachial plexus disorders
- chronic inflammatory demyelinating polyneuropathy (CIDP)
- common neuropathies
- Guillain–Barré syndrome
- ICU neuropathy/myopathy
- Subarachnoid haemorrhage (non-focal)
- Subdural hematoma
- Toxic/Metabolic conditions
- Tumours/Malignancies
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Motor neurone disease
- Muscular dystrophy
- Myasthenia gravis/Lambert Eaton myasthenic syndrome
- Post-polio syndrome
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Aetiology and risk factors for neurological diseases
- Anatomy and pathophysiology of neurological conditions
- Clinical patterns of illness
- Diagnostic criteria
- Epidemiology, incidence and prevalence, mortality and morbidity of stroke and other neurological conditions in Australia and Aotearoa New Zealand
- Factors associated with good and poorer prognoses
- Natural history
- Nature and consequences of neurological disorders that result in major disability and activity limitation or participation restriction
- Neuroanatomical correlation with specific deficits
- Patterns of dysfunction with neurological disease
- Signs and symptoms
Examinations
- Functional and cognitive assessment
- Neurological examination
- Other relevant systems examination, e.g. cardiovascular, respiratory, skin
Investigations
- Blood tests associated with diagnosis and prevention of neurological conditions
- Carotid ultrasonography and contrast carotid angiography
- Cerebrospinal fluid (CSF)
- CT, MRI, and PET scans
- Neurophysiological studies and electroencephalography
- Radiological and endoscopic assessment of swallowing
- Single photon emission computed tomography (SPECT)
- Tools for measurement of neurological disability, e.g. Kurtzke Expanded Disability Status Scale (EDSS), Modified Rankin Scale (MRS), National Institute of Health Stroke Scale (NIHSS)
- Transoesophageal and transthoracic echocardiography
- X-ray and ultrasound
Activities of daily living
- Assessment of level of assistance required for activities of daily living and mobility
- Counselling and patient education
- Equipment and aids – indications/benefits
- Home modifications:
- funding sources and costs
- options and indications
- short term and permanent options
- Pregnancy and family planning
- Resumption of family and social roles
- Self-care and domestic activities skills retraining
- Techniques of energy conservation and task simplification
Acute management
- Deep venous thrombosis or pulmonary embolism
- Early mobilisation
- Falls risk assessment
- Hydration
- Neuroprotection
- Palliative care
- Pharmacotherapy
- Pressure injuries
- Secondary prevention
- Surgical interventions
Chronic/Long-term management issues
- Advanced care planning
- Disuse complications, e.g. osteoporosis
- Emerging therapies
- Health maintenance and exercise principles
- Immunisation recommendations
- Palliative care techniques in late-stage neurological diseases
- Secondary stroke prevention
- Relevant pharmacological therapies
- Role of non-traditional therapies
Common complications – types of dysfunctions
- Bladder and bowel:
- assessment of bladder dysfunction
- assessment of bowel dysfunction
- behavioural management strategies
- incidence and types of bladder dysfunction
- indications for and complications associated with catheter use
- long-term management strategies
- management of bowel dysfunction, including:
- dietary management, including fluid and fibre medication, including stool softeners and suppositories
- education
- pelvic floor exercises
- pharmacological management
- surgical and interventional management
- types of bowel dysfunction
- types of catheterisation
- Cognition and perception:
- assessment tools, including bedside assessments, clinical tools, and comprehensive neuropsychological evaluation
- cognitive fatigue and its management
- evidence based strategies for management of cognitive and perceptual dysfunction
- prevalence and impact of functional outcomes
- techniques for management and retraining
- types of impairment, e.g. apraxia, agnosia, perceptual, and visual
- visual disturbances:
- compensatory strategies
- other management techniques
- patterns of visual disturbance
- Communication:
- assessment tools
- augmentative and alternative communication options
- common presentations
- evidence based strategies for management of communication difficulties
- speech and language therapy for swallowing and communication difficulties, e.g. remedial exercises
- types of impairment – aphasia, apraxia, cognitive communication changes, dysarthria, dysphonia
- Mood and behaviour:
- assessment and management of behavioural changes
- other non-pharmacological therapies
- pharmacological management
- psychiatric issues, e.g. anxiety, adjustment, depression
- psychological therapies – components of therapy, indications
- Nutrition and swallowing:
- control of saliva
- dysphagia/swallowing disorders
- management of nutrition problems, including:
- indications for percutaneous endoscopic gastrostomy (PEG) feeding
- medical monitoring
- postural and dietary modification
- rehabilitation strategies for swallowing disorders
- Physical deficits:
- ataxia and coordination changes
- dizziness/vertigo
- fatigue:
- common symptoms
- environmental, pharmacologic, symptomatic approaches to management
- impact of sensory changes on physical function
- joint contractures
- pressure area care and the management of pressure sores
- prevention and management strategies
- sensory disturbance and pain (refer to KG11)
- spasticity
- upper and lower limb deficits
Common neurological complications and their management
- Cardiac complications and autonomic dysfunction
- Falls
- Gastrointestinal complications
- Heterotopic ossification
- Pain
- Respiratory dysfunction/Sleep-disordered breathing
- Secondary infections
- Seizures and epilepsy
- Sleep disturbances
- Spasticity
- Venous thromboembolism (VTE)
Community reintegration
- Disability income support options
- Fitness for driving
- Peer and family support groups/resources
- Return to work principles
- Sport and leisure activities
- Vocational resettlement and assessment of work capacity
Functional neurological disorders
- Patient and family education
- Principles of assessment and diagnosis
- Rehabilitation techniques
- Triggers and perpetuating factors
- Types of presentations
Rehabilitation settings
- Components of inpatient, outpatient, and community rehabilitation
Respiratory and cardiovascular
- Chest physiotherapy techniques
- Indications for airways suction
- Indications for and types of respiratory support systems
- Monitoring of respiratory function
