Rehabilitation

the action of restoring someone to health or normal life through training and therapy after
imprisonment, addiction, or illness. Rehabilitation nursing is a specialty practice that is committed
to improving the quality of life for individuals with a disability or a chronic illness.

What makes a good caregiver?

Here are some of the traits that make someone a great caregiver: Empathy and compassion. ... By
showing both empathy and compassion caregivers will let the person they are caring for know that
they care about the person and want to do what they can to help them. Patience.

aphasia

loss of ability to understand or express speech, caused by brain damage.

Family members and friends can use the following tips when communicating with a person with
aphasia:

 Simplify your sentences and slow your pace.

 Keep conversations one-on-one initially.
 Allow the person time to talk.
 Don't finish sentences or correct errors.
 Reduce distracting noise in the environment.
 Keep paper and pencils or pens available.
 Write a key word or a short sentence to help explain something.
 Help the person with aphasia create a book of words, pictures and photos to assist with
conversations.
 Use drawings or gestures when you aren't understood.
 Involve the person with aphasia in conversations as much as possible.
 Check for comprehension or summarize what you've discussed.

Dementia
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and
behavioral abilities to such an extent that it interferes with a person's daily life and activities. These
functions include memory, language skills, visual perception, problem solving, self-management,
and the ability to focus and pay attention. Some people with dementia cannot control their emotions,
and their personalities may change. Dementia ranges in severity from the mildest stage, when it is
just beginning to affect a person's functioning, to the most severe stage, when the person must
depend completely on others for basic activities of living.

What are the Different Types of Dementia?

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and
thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with the
disease—those with the late-onset type—symptoms first appear in their mid-60s. Early-onset
Alzheimer’s occurs between a person’s 30s and mid-60s and is very rare. Alzheimer’s disease is the
most common cause of dementia among older adults.

What Does Alzheimer’s Disease Look Like?

Memory problems are typically one of the first signs of Alzheimer’s, though initial symptoms may
vary from person to person. A decline in other aspects of thinking, such as finding the right words,
vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of
Alzheimer’s disease. Mild cognitive impairment (MCI) is a condition that can be an early sign of
Alzheimer’s, but not everyone with MCI will develop the disease.

People with Alzheimer’s have trouble doing everyday things like driving a car, cooking a meal, or
paying bills. They may ask the same questions over and over, get lost easily, lose things or put them
in odd places, and find even simple things confusing. As the disease progresses, some people become
worried, angry, or violent.

What Are Frontotemporal Disorders?

Damage to the brain’s frontal and temporal lobes causes forms of dementia called frontotemporal
disorders.

Frontotemporal disorders are the result of damage to neurons (nerve cells) in parts of the brain called
the frontal and temporal lobes. As neurons die in the frontal and temporal regions, these lobes
atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally
controlled by these parts of the brain. Many possible symptoms can result, including unusual
behaviors, emotional problems, trouble communicating, difficulty with work, or difficulty with
walking.

rontotemporal disorders affect the frontal and temporal lobes of the brain. They can begin in the
frontal lobe, the temporal lobe, or both. Initially, frontotemporal disorders leave other brain regions
untouched, including those that control short-term memory.

The frontal lobes, situated above the eyes and behind the forehead on the right and left sides of the
brain, direct executive functioning. This includes planning and sequencing (thinking through which
steps come first, second, third, and so on), prioritizing (doing more important activities first and less
important activities last), multitasking (shifting from one activity to another as needed), and
monitoring and correcting errors. Symptoms are determined by which part of the lobe is affected
first. The frontal lobe is responsible for decision making, so the first symptom might be trouble
managing finances.

What Is Lewy Body Dementia?

Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein called alpha-
synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose
changes, in turn, can lead to problems with thinking, movement, behavior, and mood. Lewy body
dementia is one of the most common causes of dementia.

LBD causes changes in thinking abilities. These changes may include:

 Dementia—Severe loss of thinking abilities that interferes with a person's capacity to

perform daily activities. Dementia is a primary symptom in LBD and usually includes trouble
with attention, visual and spatial abilities (judging distance and depth or misidentifying
objects), planning, multitasking, problem solving, and reasoning. Unlike in Alzheimer's
dementia, memory problems may not be evident at first but often arise as LBD progresses.
Dementia can also include changes in mood and behavior, poor judgment, loss of initiative,
confusion about time and place, and difficulty with language and numbers.
 Cognitive fluctuations—Unpredictable changes in concentration, attention, alertness, and
wakefulness from day to day and sometimes throughout the day. A person with LBD may
 stare into space for periods of time, seem drowsy and lethargic, or sleep for several hours
during the day despite getting enough sleep the night before. His or her flow of ideas may be
disorganized, unclear, or illogical at times. The person may seem better one day, then worse
the next day. These cognitive fluctuations are common in LBD and may help distinguish it
from Alzheimer's disease.
 Hallucinations—Visual hallucinations—seeing things that are not present—occur in up to 80
percent of people with LBD, often early on. They are typically realistic and detailed, such as
images of children or animals. Nonvisual hallucinations, such as hearing or smelling things
that are not present, are less common than visual ones but may also occur. Hallucinations that
are not disruptive may not require treatment. However, if they are frightening or dangerous
(for example, if the person attempts to fight a perceived intruder), then a doctor may
prescribe medication.

Movement Problems and Lewy Body Dementia

Some people with LBD may not experience significant movement problems for several years. Others
may have them early on. At first, movement symptoms, such as a change in handwriting, may be
very mild and easily overlooked. Parkinsonism is seen early on in Parkinson's disease dementia but
can also develop later on in dementia with Lewy bodies. Specific signs of parkinsonism may include:

 Muscle rigidity or stiffness

 Shuffling walk, slow movement, or frozen stance
 Tremor or shaking, most commonly at rest
 Balance problems and repeated falls
 Stooped posture
 Loss of coordination
 Smaller handwriting than was usual for the person
 Reduced facial expression
 Difficulty swallowing
 A weak voice

Lewy Body Dementia and Sleep

Sleep disorders are common in people with LBD but are often undiagnosed. A sleep specialist can
help diagnose and treat sleep disorders. Sleep-related disorders seen in people with LBD may
include:

 REM sleep behavior disorder (RBD)—A condition in which a person seems to act out
dreams while asleep. It may include vivid dreaming, talking in one's sleep, violent
movements, or falling out of bed. RBD may be the earliest symptom of LBD in some people,
appearing many years before other LBD symptoms.
 Excessive daytime sleepiness—Sleeping 2 or more hours during the day.
 Insomnia—Difficulty falling or staying asleep, or waking up too early.
 Restless leg syndrome—A condition in which a person, while resting, feels the urge to move
his or her legs to stop unpleasant or unusual sensations. Walking or moving usually relieves
the discomfort.

Behavioral and Mood Symptoms of Lewy Body Dementia

Changes in behavior and mood are possible in LBD and may worsen as cognition declines. These
changes may include:

 Depression—A persistent feeling of sadness, worthlessness, or inability to enjoy activities,

often with trouble with sleeping or eating.
 Apathy—A lack of interest in normal daily activities or events; less social interaction.
 Anxiety—Intense apprehension, uncertainty, or fear about a future event or situation. A
person may ask the same questions over and over or be angry or fearful when a loved one is
not present.
 Agitation—Restlessness, as seen by pacing, hand wringing, an inability to get settled,
constant repeating of words or phrases, or irritability.
 Delusions—Strongly held false beliefs or opinions not based on evidence. For example, a
person may think his or her spouse is having an affair or that relatives long dead are still
living. Capgras syndrome, in which the person believes a relative or friend has been replaced
by an imposter, may also appear.
 Paranoia—An extreme, irrational distrust of others, such as suspicion that people are taking
or hiding things.

Other Symptoms of Lewy Body Disease

People with LBD can also experience significant changes in the part of the nervous system that
regulates automatic functions such as those of the heart, glands, and muscles. The person may have:

 Changes in body temperature

 Problems with blood pressure
 Dizziness
 Fainting
 Frequent falls
 Sensitivity to heat and cold
 Sexual dysfunction
 Urinary incontinence
 Constipation
 A poor sense of smell

Types of Lewy Body Dementia

Lewy body dementia (LBD) refers to either of two related diagnoses—dementia with Lewy bodies
(DLB) and Parkinson's disease dementia. Both diagnoses have the same underlying changes in the
brain and, over time, people with either diagnosis develop similar symptoms. The difference lies
largely in the timing of cognitive (thinking) and movement symptoms. In dementia with Lewy
bodies, cognitive symptoms develop within a year of parkinsonism—any condition that involves the
types of movement changes, such as tremor or muscle stiffness, seen in Parkinson's disease. In
Parkinson's disease dementia, cognitive symptoms develop more than a year after the onset of
movement symptoms.

A Diagnosis of Dementia with Lewy Bodies

People with dementia with Lewy bodies have a decline in thinking ability that may look somewhat
like Alzheimer's disease. But over time they also develop movement and other distinctive symptoms
that suggest dementia with Lewy bodies.

Symptoms that distinguish this form of dementia from others may include:

 Visual hallucinations early in the course of dementia

 Fluctuations in cognitive ability, attention, and alertness
 Slowness of movement, tremor, difficulty walking, or rigidity (parkinsonism)
  REM sleep behavior disorder, in which people physically act out their dreams by yelling,
flailing, punching bed partners, and falling out of bed
 More trouble with mental activities such as multitasking and problem solving than with
memory early in the course of the disease

A Diagnosis of Parkinson's Disease Dementia

Parkinson's disease dementia starts as a movement disorder, with symptoms such as slowed
movement, muscle stiffness, tremor, and a shuffling walk. These symptoms are consistent with a
diagnosis of Parkinson's disease. Later on, cognitive symptoms of dementia and changes in mood
and behavior may arise.

Not all people with Parkinson's disease develop dementia, and it is difficult to predict who will.
Many older people with Parkinson's develop some degree of dementia.

Other types of progressive brain disease include:

 Vascular contributions to cognitive impairment and dementia

 Mixed dementia, a combination of two or more types of dementia

Vascular Contributions to Cognitiv e Impairment and Dementia

Vascular contributions to cognitive impairment and dementia (VCID) are conditions arising from
stroke and other vascular brain injuries that cause significant changes to memory, thinking, and
behavior. Cognition and brain function can be significantly affected by the size, location, and
number of brain injuries. Two forms of VCID—vascular dementia and vascular cognitive
impairment (VCI)—arise as a result of risk factors that similarly increase the risk for cerebrovascular
disease (stroke), including atrial fibrillation (a problem with the rhythm of the heartbeat), high blood
pressure, diabetes, and high cholesterol.

Symptoms of VCID can begin suddenly and progress or subside during one's lifetime. VCID can
occur along with Alzheimer's disease. People with VCID almost always have abnormalities in the
brain on magnetic resonance imaging scans. These abnormalities include evidence of prior strokes,
often small and asymptomatic, as well as diffuse changes in the brain's "white matter"—the
connecting "wires" of the brain that are critical for relaying messages between brain regions.
Microscopic brain examination shows thickening of blood vessel walls called arteriosclerosis and
thinning or loss of components of the white matter.

What are the Different Types of VCID?

Vascular dementia refers to progressive loss of memory and other cognitive functions caused by
vascular injury or disease within the brain. Symptoms of vascular dementia may sometimes be
difficult to distinguish from Alzheimer's disease. Problems with organization, attention, slowed
thinking, and problem solving are all more prominent in VCID, while memory loss is more
prominent in Alzheimer's.

Vascular cognitive impairment involves changes with language, attention, and the ability to think,
reason, and remember that are noticeable but are not significant enough to greatly impact daily life.
These changes, caused by vascular injury or disease within the brain, progress slowly over time.

Post-stroke dementia can develop months after a major stroke. Not everyone who has had a major
stroke will develop vascular dementia, but the risk for dementia is significantly higher in someone
who has had a stroke.

Multi-infarct dementia is the result of many small strokes (infarcts) and mini-strokes. Language or
other functions may be impaired, depending on the region of the brain that is affected. The risk
for dementia is significantly higher in someone who has had a stroke. Dementia is more likely when
strokes affect both sides of the brain. Even strokes that don't show any noticeable symptoms can
increase the risk of dementia.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and

leukoencephalopathy (CADASIL) is an extremely rare inherited disorder caused by a thickening of
the walls of small- and medium-sized blood vessels, which reduces the flow of blood to the
brain. CADASIL is associated with multi-infarct dementia, stroke, and other disorders. The first
symptoms can appear in people between ages 20 and 40. CADASIL may have symptoms that can be
confused with multiple sclerosis. Many people with CADASIL are undiagnosed.

Subcortical vascular dementia, previously called Binswanger's disease, involves extensive

microscopic damage to the small blood vessels and nerve fibers that make up white matter in the
brain. Cognitive changes include problems with short-term memory, organization, attention, decision
making, and behavior. Symptoms tend to begin after age 60, and they progress in a stepwise manner.
People with subcortical vascular disease often have high blood pressure, a history of stroke, or
evidence of disease of the large blood vessels in the neck or heart valves.

Cerebral amyloid angiopathy is a buildup of amyloid plaques in the walls of blood vessels in the
brain. It is generally diagnosed when multiple tiny bleeds in the brain are discovered using magnetic
resonance imaging.

How is VCID Treated?

Vascular contributions to cognitive impairment and dementia are often managed with drugs to
prevent strokes or reduce the risk of additional brain damage. Some studies suggest that drugs that
improve memory in Alzheimer's might benefit people with early vascular dementia. Treating the
modifiable risk factors, such as high blood pressure, can help prevent additional stroke.

What Is Mixed Dementia? Causes and Diagnosis

It is common for people with dementia to have mixed dementia—a combination of two or more
types of dementia. A number of combinations are possible. For example, some people have
both Alzheimer's disease and vascular dementia.

Some studies indicate that mixed dementia is the most common cause of dementia in the elderly. For
example, autopsy studies looking at the brains of people who had dementia indicate that most people
age 80 and older probably had mixed dementia caused by a combination of brain changes related to
Alzheimer's disease, vascular disease-related processes, or another neurodegenerative condition.
Some studies suggest that mixed vascular-degenerative dementia is the most common cause of
dementia in older adults.

In a person with mixed dementia, it may not be clear exactly how many of a person's symptoms are
due to Alzheimer's or another disease. In one study, researchers who examined older adults' brains
after death found that 78 percent had two or more pathologies (disease characteristics in the brain)
related to neurodegeneration or vascular damage. Alzheimer's was the most common pathology but
rarely occurred alone.

Researchers are trying to better understand how underlying disease processes in mixed dementia
influence each other. In the study described above, the researchers found that the degree to which
Alzheimer's pathology contributed to cognitive decline varied greatly from person to person. In other
 words, the impact of any given brain pathology differed dramatically depending on which other
pathologies were present.

Delirium

What is delirium?

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember
clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

 Hypoactive, where you are not active and seem sleepy, tired, or depressed
 Hyperactive, where you are restless or agitated
 Mixed, where you change back and forth between being hypoactive and hyperactive

What causes delirium?

There are many different problems that can cause delirium. Some of the more common causes
include

 Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol
withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after
years of alcohol abuse.
 Dehydration and electrolyte imbalances
 Dementia
 Hospitalization, especially in intensive care
 Infections, such as urinary tract infections, pneumonia, and the flu
 Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be
withdrawal after stopping a medicine.
 Metabolic disorders
 Organ failure, such as kidney or liver failure
 Poisoning
 Serious illnesses
 Severe pain
 Sleep deprivation
 Surgeries, including reactions to anesthesia

Who is at risk for delirium?

Certain factors put you at risk for delirium, including

 Being in a hospital or nursing home

 Dementia
 Having a serious illness or more than one illness
 Having an infection
 Older age
 Surgery
 Taking medicines that affect the mind or behavior
 Taking high doses of pain medicines, such as opioids

What are the symptoms of delirium?

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come
and go. The most common symptoms include

 Changes in alertness (usually more alert in the morning, less at night)

 Changing levels of consciousness
 Confusion
 Disorganized thinking, talking in a way that doesn't make sense
 Disrupted sleep patterns, sleepiness
 Emotional changes: anger, agitation, depression, irritability, overexcitement
 Hallucinations and delusions
 Incontinence
 Memory problems, especially with short-term memory
 Trouble concentrating

How is delirium diagnosed?

To make a diagnosis, the health care provider

 Will take a medical history

 Will do physical and neurological exams
 Will do mental status testing
 May do lab tests
 May do diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also
occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better
or worse and can last for hours or weeks. On the other hand, dementia develops slowly and does not
cause hallucinations. The symptoms are stable and may last for months or years.

What are the treatments for delirium?

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify
the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time -
weeks or sometimes even months. In the meantime, there may be treatments to manage the
symptoms, such as

 Controlling the environment, which includes making sure that the room is quiet and well-lit, having
clocks or calendars in view, and having family members around
 Medicines, including those that control aggression or agitation and pain relievers if there is pain
 If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

Can delirium be prevented?

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help
lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm,
and well-lit. It can also help to have family members around and to have the same staff members
treat the person.
Human’s Degistive System

Human is a living being that’s always active to move wich of course requires energy. Human obtains
energy by eating foods that are digested through the digestive system, wich is composed from the
oral cavity, esophagus, stomach and intestines,

1. Mouth/Oral Cavity(Cavum Oris)

First food will be digested in the mouth. In the mouth occurs mechanical digestion by the teeth and
tongue also chemical digestion by ptyalin enzyme that contained in saliva. Teeth serves to soften the
food into smaller ones so that can be easily digested by stomach. Tongue serves to adjust the food in
the mouth while chewing the food and help to swallow the food. Then ptyalin enzyme function is to
breakdown the strach/carbohydrates into simpler sugar/maltose, it evident when we chew rice little
bit longer, it becomes a sweet taste.

2. Esophagus (kerongkongan)

After the food digested by the mouth, the food will enter and pass trough the channel toward stomach
that called esophagus. In the neck there are 2 channels that are the throat and the esophagus. The
throat connecting the mouth to the lungs and the esophagus connects mouth to the stomach,
therefore, in the pharynx there are 2 intersections whose path is set by the epiglottis, when we are
breathing the epiglottis will open and air comes into the throat, so the food doesn’t get into the lungs.
When the food passing through the esophagus, the food will be pushed automaticly into the stomach
by gastric peristaltic.
3. Stomach (Ventricles)(lambung)

Stomach is digestive organ, it shapes bag, it also occurs mechanical digestions by squeezing the food
by stomach’s muscles and chemical digestions with enzyme. There are 3 enzymes in the stomach,
there are Pepsin, Renin, and Hydrochloric Acid. Pepsin is the result of the reaction of pepsynogen
and hydrochloric acid, pepsin serves to covert protein into peptone, renin serves to percipitate milk
protein into casein and the last is hydrochloric acid serves to activate pepsynogen into pepsin and kill
germs and bacteria that entered along with food.

4. Small Intestines (usus kecil)

After the food have been processed in the stomach for 3-4 hours, the food will be carried into small
intestine wich consist of 3 parts, they’re doudenum, jejenum, and ileum. First, food enter to
duodenum and jejenum then into ileum. In the duodenum and jejenum occurs chemical digestion
using 3 enzymes, they’re lipase, amylase, and trypsin that produced by the pancreas. Lipase serves to
convert fat into fatty acid/gliserol, amylase serves to breakdown the strach/carbohydrates into
simpler sugar/maltose, trypsin is the result of reaction of trypsinogen and enterokinase, Trypsin
serves to convert protein into amino acid. Then the food enter into ileum. Around the walls of this
intestine contained villi for absorb the nutrients from the food except water, vitamins, and minerals.
Carbohydrates are absorbed in the form of glucose, fat are absorbed in the form of fatty acid/gliserol,
and protein are absorbed in the form of amino acid.

5. Large Intestine (colon) (usus besar)

The next, the leftovers that have been digested in the small intestine will enter into large intestine. In
this intestine occurs absorbtion process to absorb water, vitamins and minerals and decay process of
leftovers into stool with help of E-Coli bacteria, the stool will stainel with the dye bile named
bilirubin, then the stool will acomodated in a shelter rectum stool while before discharged through
the anus.