September 4 (Thu.)
Geriatric Medicine and Rehabilitation Medicine
Professor Dennis S Smith, Sydney Australia, and Salisbury England
In this presentation I will examine the relationships between the Specialties of Rehabilitation Medicine and Geriatric Medicine. I will describe the historical associations, as well as the separate evolution of the two specialties during the last forty years. I will review the concepts of Geriatric rehabilitation, rehabilitation of the frail aged, community and domiciliary rehabilitation, slow stream rehabilitation and fast stream rehabilitation. I will emphasis the importance of active collaboration between departments of rehabilitation Medicine and Geriatric medicine, and the importance of a united approach to the proper management of Disability at all ages and states.
POST-SURGICAL REHABILITATION OF THE PATIENT WITH SEVERE RHEUMATOID INVOLVEMENT OF THE CERVICAL SPINE
A.K. Clarke (Royal National Hospital for Rheumatic Diseases, Bath, U.K.)
One of the most serious complications of rheumatoid arthritis is involvement of the cervical spine, with the potential for quadriplegia. Diagnosis can be difficult because many of these patients are already weak, and it may be impossible to elicit a Babinski reflex. It is important to maintain a high index of suspicion and undertake the appropriate investigations, which will include flexion/extension plain radiographs and either C.T. or M.R.I. scanning. Surgical intervention may or may not occur. However, whatever the decision, a comprehensive rehabilitation programme will be required. What are the potential problems that need to be addressed in such a programme?
* Loss of mobility. Among the dangers associated with poor mobility is the high risk of pressure sores.
* Loss of upper limb function.
* Poor control of the arthritis. Many of these patients have advanced, active disease.
* Psychological difficulties. Many patients are aware that they have had a life-threatening complication and face serious disability.