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  <head>
    <title>072-01 Models of function, adaptation, recovery, impairment, and rehabilitation trajectories</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Rehabilitation foundations and presentation">
      <outline text="Scope of rehabilitation medicine">
        <outline text="Disease, injury, environment, personal factors interact"/>
        <outline text="Target: activity, participation, adaptation, quality of life"/>
        <outline text="Recovery routes">
          <outline text="Repair, plasticity, compensation"/>
          <outline text="Technology, environment, redefined goals"/>
        </outline>
      </outline>
      <outline text="Biopsychosocial model of function">
        <outline text="International Classification of Functioning">
          <outline text="Weakness: impairment"/>
          <outline text="Difficulty dressing: activity limitation"/>
          <outline text="No return to work: participation restriction"/>
        </outline>
        <outline text="Relationships are bidirectional">
          <outline text="Inaccessible transport magnifies modest impairment"/>
          <outline text="Support and technology enable participation"/>
        </outline>
        <outline text="Medical model: pathology and treatment"/>
        <outline text="Social model: barriers, discrimination, exclusion"/>
        <outline text="Function is task- and context-specific">
          <outline text="Clinic walk does not prove road, stairs, work"/>
        </outline>
      </outline>
      <outline text="Immobilisation and activity">
        <outline text="Bed rest">
          <outline text="Loses plasma volume, aerobic capacity, strength"/>
          <outline text="Atrophy, bone resorption, tissue shortening"/>
          <outline text="Pressure injury, thrombosis, delirium"/>
          <outline text="Older and critically ill lose reserve fastest"/>
        </outline>
        <outline text="Strength">
          <outline text="Early resistance gains neural, then hypertrophy"/>
          <outline text="Disuse lowers synthesis, raises breakdown"/>
        </outline>
        <outline text="Aerobic training">
          <outline text="Mitochondria, capillaries, stroke volume"/>
          <outline text="Specific to intensity, duration, mode"/>
          <outline text="Excess load without recovery harms"/>
        </outline>
        <outline text="Dynamic exercise physiology">
          <outline text="Cardiac output and oxygen extraction rise"/>
          <outline text="Systolic pressure up, resistance down"/>
          <outline text="Ventilation rises beyond thresholds"/>
        </outline>
        <outline text="Recovery kinetics">
          <outline text="Slow heart-rate recovery: less vagal reactivation"/>
          <outline text="Symptoms may appear after the session"/>
        </outline>
        <outline text="Bone remodels to strain"/>
        <outline text="Tendons adapt slower than fitness"/>
      </outline>
      <outline text="Recovery, compensation, substitution">
        <outline text="Restitution restores original function"/>
        <outline text="Compensation does the task differently"/>
        <outline text="Substitution uses equipment or assistance"/>
        <outline text="Early compensation may limit recovery"/>
        <outline text="Neuroplasticity">
          <outline text="Repetition, salience, intensity, sleep, mood"/>
          <outline text="Maladaptive: spasticity, pain, phantom"/>
        </outline>
        <outline text="Motor learning">
          <outline text="Cognitive, associative, automatic stages"/>
          <outline text="Variable practice improves transfer"/>
          <outline text="Fade feedback for independent control"/>
        </outline>
      </outline>
      <outline text="Impairment across functional systems">
        <outline text="Weakness: central to deconditioned"/>
        <outline text="Upper motor neuron: hyperreflexia, spasticity"/>
        <outline text="Lower motor neuron: atrophy, fasciculation"/>
        <outline text="Spasticity">
          <outline text="Velocity-dependent resistance"/>
          <outline text="May support standing or transfers"/>
          <outline text="Treat function, not tone alone"/>
        </outline>
        <outline text="Ataxia, apraxia, neglect"/>
        <outline text="Aphasia, dysarthria, dysphonia differ"/>
        <outline text="Dysphagia">
          <outline text="Aspiration may be silent"/>
          <outline text="Balance safety, nutrition, enjoyment"/>
        </outline>
      </outline>
      <outline text="Pain, fatigue, cognition as modifiers">
        <outline text="Pain alters control, sleep, willingness to move">
          <outline text="Fear and sensitisation perpetuate avoidance"/>
          <outline text="Graded exposure, never imaginary"/>
        </outline>
        <outline text="Fatigue has many causes">
          <outline text="Post-exertional exacerbation needs pacing"/>
        </outline>
        <outline text="Cognition affects safety, learning, work"/>
      </outline>
      <outline text="Common rehabilitation trajectories">
        <outline text="Stroke">
          <outline text="Early: reperfusion, oedema, network change"/>
          <outline text="Test plateau is not a functional ceiling"/>
        </outline>
        <outline text="Spinal cord injury">
          <outline text="Level and completeness"/>
          <outline text="Spinal shock, then spasticity"/>
          <outline text="Autonomic dysreflexia causes hypertension"/>
        </outline>
        <outline text="Traumatic brain injury">
          <outline text="Physical recovery can conceal cognitive loss"/>
        </outline>
        <outline text="Amputation">
          <outline text="Prosthesis is a tool, not an endpoint"/>
        </outline>
        <outline text="Cardiac, pulmonary, cancer rehabilitation"/>
      </outline>
      <outline text="Goals, participation, identity">
        <outline text="Specific, measurable, time-linked goals"/>
        <outline text="Identity, culture, roles define relevance"/>
        <outline text="Living well with persistent impairment"/>
        <outline text="What prevents doing what matters"/>
      </outline>
    </outline>
  </body>
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