Final: Special Populations

Question 1

What is the goal of treatment in patients with treatment considerations?

Answer 1

Allow people to function better in their daily lives
-Improve function or maintain function

Basically improve Quality of Life

Question 2

Pt comes in with diplopia and blurred vision. He has also been having more frequent numbness and tingling in his hands and toes. In addition, he admits to having more incidences of impotence than in the past. Dx?

Answer 2

Multiple Sclerosis

• due to demyelination of his nerves
• -progressive weakness, tremor, fatigue, bladder function

Question 3

What are some common MSK issues that people with MS have?

Answer 3

Joint, tendon, ligament strains
-due to overuse from shifting patterns

Reduced Diaphragm movement and tension
-reduced flow of lymph!

Question 4

What is the goal of treatment in MS?

Answer 4

Modify positional compensation patterns
Improve lymph flow
Reduce pain

Question 5

Sudden onset of slurred speech and facial paralysis or full sided hemi-paralysis would be indicative of?

Answer 5

Stroke

-hemorrhagic or ischemic

Question 6

How does a CVA lead to MSK issues?

Answer 6

Unilateral Paralysis creates:

• Spastic paralysis
• Decreased balance issues (sensory and motor)
• Edema (loss of tissue tension)
• Contralateral Compensation (overuse injury)

Question 7

Should you treat a stroke with OMT within the first 24 hours?

Answer 7

No, re-perfusion of blood flow can lead to worse prognosis

Question 8

Can acute treatment (during hospitalization) improve stroke outcomes?

Answer 8

Maybe? (no real OMM studies)

• improved movement and sensorimotor
• increased cerebral profusion
• reduce head associated strain patterns
• reduced Sym tone

Question 9

What does subacute (rehab after 1 week-months) treatment of stroke help with?

Answer 9

Maintain ROM and reduce contracture

Question 10

If you want to reduce tissue reorganization after stroke, when should you start treatment?

Answer 10

First 7 days after!

Question 11

What is the goal of post-subacute (at home) Tx of stroke?

Answer 11

Improve sensorimotor function
Improve ROM, balance, strength, gait
Reduce strain patterns
Reduce Sym tone

Question 12

What phase of recovery (hyperacute, acute, subacute) had most benefit from treatment?

Answer 12

Acute phase

-overlap with OT, PT, neurology tx

Question 13

What OMM modality has been shown to improve outcome in stroke pts?

Answer 13

MFR

-mild tension applied over a longer period of time helped

Question 14

What is the goal of OMM tx for those in wheelchairs specifically?

Answer 14

Most seek treatment for pain

• UE and Core: reduce strains and stress
• LE: increase tissue mobility from prolonged lack of motion
• -reduce pain, ulcers, edema

Question 15

What should you, as a physician, be mindful of when scheduling for a patient in a wheelchair?

Answer 15

Schedule more time for the pt

-could have trouble gaining access to or getting to the building

Question 16

What is the biggest factor in determining treatment after trauma?

Answer 16

Timing after injury

Question 17

How does tissue heal after injury? (7 days, 21 days, 4 weeks)

Answer 17

7 days of swelling–>
21 days of collagen deposition–>
4 weeks of major remodeling

Question 18

What is important when treating after trauma?

Answer 18

1. Reduce Tension
2. Maintain proper alignment
3. ROM exercises
4. Neuromuscular re-education exercises

Question 19

Best treatments for after trauma?

Answer 19

joint release (for alignment/ROM)
-articulatory, BLT

MFR
-CS

Lymphatic

Question 20

What should be considered (anatomically) when treating Ehler-Danlos?

Answer 20

Skin
-bruise easily and have poor healing

Joint
-laxity and dislocation

Blood vessels

Question 21

What are the treatment goals for treating Ehler-Danlos?

Answer 21

Soft tissue
Correct muscle imbalances
Educate strengthening muscles
Educate on Injury avoidance

Question 22

Can tylenol, pregabalin, and gabapentin help with Ehler-danlos symptoms?

Answer 22

Nope, they may worsen

Question 23

What should you focus on when treating oncology pts?

Answer 23

Decrease Pain
Increase ROM
Improve ability to achieve activities of daily living

Question 24

If a patient has a possibility of metastatic bone cancer, what should you be aware of when treating with OMT?

Answer 24

Concern for pathologic fracture and spinous processes may be more tender

Question 25

Should HVLA be done on oncology pts?

Answer 25

No, generally avoid

Question 26

Did OMM help with breast cancer pts with Nausea/Vomiting after chemo?

Answer 26

No, but it did help with diarrhea/constipation

Question 27

How did OMM help geriatric pateints pain?

Answer 27

Decreased pain, but did not improve QOL

Question 28

Goal of treating Cerebral Palsy Pts?

Answer 28

Decrease Pain, limit progression of contractures
Improve functionality and QOL
-reduce constipation and URI

Question 29

What techniques can you use for CP patients?

Answer 29

MFR (both direct and indirect) and stills
-maybe MET/BLT

NOT HVLA

Question 30

What autoimmune condition is associated with ascending paralysis that has numbness, tingling, or deep muscle pain. Can be caused by microbes, ie campylobacter (thanks sketchy).

Answer 30

Guillian-Barre

-microbes appear similar to myelin, so the body attacks myelin

Question 31

What is the goal of treating Guillian Barre?

Answer 31

Prevent infections
Promote healing
Help with Pain

Question 32

What techniques can be used for Guillian Barre?

Answer 32

MET, ST, MFR

Autonomics: rib raising, paraspinal inhibition, suboccipital release, sacral rocking