Mobility Flashcards
Genetics/Lifespan Considerations
- bones and muscles adapt as you age
- some bones fuse during infancy while others grow as child develops
- growth is then turned off in adulthood (bones undergo remodeling)
- OA undergo physiologic changes: decrease strength and mobility
Alterations to Mobility
- back problems
- fractures
- multiple sclerosis
- OA
- Parkinson
- spinal cord injury
- amputations
Back pain
most common medical problem in America
-may result in: decreased quality of life, decreased mobility, increased pain and frustration, loss of work hours
Possible causes of back pain
- bas posture and sleeping habits
- low fitness level
- pregnancy
- obesity
- athletic injury
- degenerative disorders
- occupational risk factors
- referred pain from GI/GU/AAA
- backpack use
Prevention of back pain
- posture
- lifting
- body mechanics
- rest
- exercise
Herniated disc
- refers to a problem of the rubbery cushions between the individual bones that make up your spine
- occurs when nucleus pulpous ruptures and protrudes
- allowing fluids to leak out and irritate nerves
- compression of the nerve roots and cord shrinking the disc
- results in pain, numbness or weakness in arm or leg
- most people do not need surgery
Abrupt Disc Herniation
- nerve root compression
- severe pain
- muscle spasms
Gradual Disc Herniation
- slow onset pain
- associated with neurological symptoms (weakness/tingling)
Risk Factors for Back Pain
- most common between 30-50
- heavy lifting
- bending/twisting improperly
- overweight
- previous back problems
- smoking
- genetic factors
Clinical Manifestations of lumbar back pain
- low back pain
- radiating down the buttock and below the knee
- sciatic nerve pain
- weakness of the leg, foot, or toes
- bowel and bladder incontinence
- impotence
CES
Cauda Equina Syndrome
- latin for horse’s tail
- compression of the nerve roots of this part of the spine
- may be permanent neurological impairment
- urinary incontinence and paralysis
- caused by massive lumbar disc herniation, spinal stenosis and trauma
***Medical emergency
Straight Leg Test
-back or leg pain may be reproduced by raising the leg and flexing at 90 degrees
Diagnostic Studies
- L spine xray
- MRI
- CT
- EMG
- Myelogram
- Blood tests
Tx for Chronic Low Back Pain
- low back exercises/PT
- Rest
- Local heat/cold application
- pain relievers
- weight reduction
- surgery
Non-Pharm Tx for Back Pain
- brace
- massage
- traction
- PT
Pharm Tx
- Salicylates
- NSAIDs
- Skeletal muscle relaxants
- Neuropathic pain meds
- Corticosteroids
- Epidural Injections
Skeletal Muscle Relaxants
- baclofen
- methocarbamol
Neuropathic Pain Meds
- gabapentin
- pregabalin
- duloxetine
Intrathecal Morphine Pain Pump Implant
- risks for the intrathecal pain pump procedure are low
- method of giving medication directly to your spinal cord
- symptoms can be controlled with a much smaller dose than is needed with oral meds
- goal: better control your symptoms and to reduce oral meds; thus reducing their associated side effects
Laminoectomy
surgical removal of part of the posterior arch of the vertebrae to allow for removal of the disk
Disectomy
-micro surgical procedure that allows the surgeon to visualize the disk and disk space better for easier removal of the herniated portion
Laser Disectomy
- outpatient procedure
- laser is used on the herniated portion of the disk
Spinal Fusion
- used for unstable spinal areas by creating a connecting vertebrae with a bone graft
- fibula or iliac crest
- rods, plates, and screws
- infuse bone graft/cage (regeneration)
- TLSO while OOB
- Surgical and graft site if used
- Avoid sitting or standing for long periods of time
- encourage walking, lying down, and shifting weight
- no twisting the spine
Vertebroplasty
- outpatient
- used to stabilize vertebral bone fractures
Postop Care
- VS
- Signs of circulation
- signs of bleeding
- position
- pain
- emotional support
- safety
- sterile technique
- signs of infection
- compression dressings
- paralytic ileus common, start PO intake slowly
- proper alignment at all times
- log rolling
- pain control
- pillows under legs
- neuro checks q 2-4 hours
- paralytic ileus
- TCDB/IS Q1 while awake
Neurovascular assessment: Circulation
- color/temp
- cap refill
- pulses
- edema
Neurovascular assessment: Motor Function
- flexion
- extension
- abduction
Discharge instructions
- bathing/incision care
- discomfort
- restrictions
- activity
- when to call the doctor
Scoliosis
- diagnosed if the sideway curvature measures more than 10 degrees
- congenital, acquired, idiopathic
Clinical manifestations of Scoliosis
- spinal curve to one side
- uneven shoulders
- differences in leg length
- tiredness of spine
- prominent shoulder blade and rib bump
- severe scoliosis, heart and lung problems
Diagnostic Tests
- school screening for children age 10-15: adam forward bend test
- observation
- xray, cobb method
Mild Scoliosis
- Cobb angle of less than 20 degrees
- Observation every 3-6 months
Moderate Scoliosis
- Cobb angle between 25-45 degrees
- bracing 12-23 hrs a day
- TLSO/Milwaukee brace
Severe Scoliosis
- Cobb angle greater than 50 degrees
- surgical correction
Surgery for Scoliosis
- involves spinal fusion with insertion of metal rod
- infections can compromise outcome of the deformity correction and delay recovery
Post op care for Scoliosis
- TLSO Brace - Thoracolumbar Sacral Orthosis
- Limit activity for 6-8 months post surgery
- Learn to perform simple task without bending or twisting
