Rheumatoid Arthritis Dr Dia Shehab

ROLE OF REHABILITATION IN RHEUMATOID ARTHRITIS Shehab,D. MB BCH, FRCPC Associate prof, Consultant physical medicine Rehabilitation Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait Role Of Rehabilitation In Rheumatoid Arthritis Disease/pathology Impairment Disability Handicap Rehabilitation • Medical interventions focus on causation and disease processes, while rehabilitation is concerned with the consequences of disease. • Rehabilitation is the management of disease consequences, which includes: impairments (pain, ROM), functional limitations (grip, reach) and disability (household activities) RA and Rehabilitation The impact of a chronic inflammatory disease like RA pain muscle weakness deformities functional loss (mobility, ADLs) ↓quality of life Rehabilitation options are to: • • • • Treat impairment to avoid disability and handicap To improve functional level & Overcome functional limitations Prevent further impairment and disability Promote independence and competence Functional Status in RA Class 1: Completely able to perform usual ADL’s; selfcare, vocational and a vocational. Class 2: Able to perform usual self- care and vocational activities, but limited in a vocational activities. Class 3: Able to perform usual self- care activities, but limited in vocational and a vocational activities. Class 4: limited in ability to perform usual ADL’s, vocational and a vocational activities. Main Goals • To maintain and maximize function and prevent & minimize disability and handicap resulting from underlying disease.It is recommended to begin early and continue throughout the disease course • • • • • Pain relief Increase ROM Increase strength and endurance Prevention and correction of deformities Counseling and educational services RA and Rehabilitation Contents of Rehabilitation Program Education Physical modalities Exercise program Joint protection technique + Energy conservation 1. Education Rehabilitation Program 2. Physical modalities Heat Cold Hydrotherapy Electrical stimulation , TENS ultrasound … 3. Exercise Exercise or not? What type of exercise?? Exercises in RA The primary goal of exercise therapy: Improve joint mobility muscle strength, and Functional capacity Rehabilitation Program: 4. Assistive Devices Mobility Walking aids:Cane, walker, crutches Rehabilitation Program 4. Assistive devices(ADL ) 5. Splints: static, dynamic finger splint,wrist splint 6. Foot Orthotics 7. Braces: cervical, lumbar Rehabilitation Program: What to do In Acute RA? local rest (orthotics / splints) cold modalities, cold packs ( acute stage) ROM exercises (actively) isometric exercises/ then add Dynamic exercises Teach energy conservative and joint protection techniques Rehabilitation Program: What to do In Chronic RA? 1. improve pain (phys modalities) 4. modify environment 2. muscle weakness (dynamic exercises) 3. ROM Exercises 5. vocational counseling Conclusion The role of rehabilitation in RA is extremely important with the a. interdisciplinary team, b. aiming at maximizing function and minimizing disability & handicap. c. It is recommended that rehabilitation should begin early and continue throughout the disease course. Individually designed treatment program guided by the treatment goals including the patients goals. Rehabilitation • To maintain and maximize function and prevent & minimize disability and handicap resulting from underlying disease.It is recommended to begin early and continue throughout the disease course • Pain relief • Increase ROM • Increase strength and endurance • Prevention and correction of deformities • Counseling and educational services Physical Modalities Hydrotherapy Heat& Cold TENS REHABILITATION Shehab,D. MB BCH, FRCPC Associate prof, Consultant physical medicine Rehabilitation Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait