Multisystems Flashcards
What is hemophilia
A bleeding disorder in which a person’s blood does not clot normally leading to delays in coagulation after an injury
What is the most common manifestation of hemophilia
Hemarthrosis
Which is bleeding into the joint space
What is obesity and how is it diagnosed?
excess body fat that may impair health
BMI = kg (mass) / m2 (height)
*does not take into account body comp
What are the main values for BMI?
very severely underweight <15
Normal 18.5-25
Overweight 25-30
Obese >30
What is the etiology of obesity?
Diet
Sedentary lifestyle - burning and not enough muscle mass
Medications
Genetics
Secondary to other illness (hypothyroidism)
What are the associated health problems of obesity?
Cancers
CVD
gall bladder dysfunction
metabolic syndrome
obstructive sleep apnea
OA
type II DM
What are some bariatric considerations?
Bariatric equipment
care environment
patient, family, caregiver training
physical assistance
ulceration risk
overheating
What are some obesity interventions?
Lifestyle modification
Diet
exercise
bariatric surgery
pharmacological management
What are the exercise parameters?
F = >5 days/ week
I - moderate (40-60% HRR) to vigourous (50-75% HRR)
T - 30-60 minutes
T - aerobic, large muscle groups - consider overheating and impact on joints
What is HIV?
A virus attacks the immune system, specifically T cells with CD4 receptors - progressively weakens the host systems
increases susceptibility to opportunistic infections and cancers
What is the mode of transmission for HIV? Including body fluids not infectious
unprotected sex
shared needles or equipment
mother to child (in utero, during birth, breast milk)
occupational exposure
blood and blood products
feces, urine, salvia, sweat and tears
What are the universal precautions for HIV?
Use for all patients with risk of blood exposure - do not use unnecessary precautions
use gloves (and change) may come in contact with blood, body fluids, mucous membranes, non-intact skin
use mask and eye protection for droplets of blood or other body fluids
use gown with splashes of blood or other body fluids
refrain from direct patient care if you have open wound or skin lesions
How do you diagnose HIV
blood antibody tests - ELISA or western blot test
CD4 test (normal 500-1500)
Viral load test - 50-500,000/mL
*6- 12 weeks to be detectable
What is AIDS?
advanced HIV progression
CD4 count <200 and 1 or more of 26 indicators
What is the medical management of HIV?
HAART - highly active antiretrociral therapy
-interferes with virus life cycle
-decreases viral load
-preserves CD4 count
*needs high compliance - lifetime commitment or else drug resistance forms
What are the side effects to HAART?
mitochondrial toxicity
-redistribution of fat store to abdomen, posterior cervical spine (buffalo hump) or viscera
-increase risk of CVD
-increase risk of acue pancreatitis
mitochondrial myopathy
cardiomyopathy
hepatic steatosis (fatty liver)
peripheral neuropahty - distal to proximal, symmetrical
hyperlacatemia
cytopenia
skin rash
GI - diarrhea, nausea, abdominal pain
Dyslipidemia
osteopenia / OP
osteonecrosis
What is the PT management for HIV?
education - energy conservation, expectations, pain
symptoms management
management secondary complications - deconditioning, weakness, fatigue
exercise prescription - rom, aerobic, resistance
What is fibromyalgia syndrome? Including epidemiology and etiology
A syndrome characterized by widespread chronic pain and increased pain response to pressure with no other cause
F>M, onset during reproductive years
Unknown, genetic and environmental factors
What are the S + S of fibromyalgia?
Chronic widespread pain
allodynia
headache
fatigue
sleep disturbances
cognitive dysfunction “fibro fog”
anxiety and/or depression
IBS
How do you diagnose fibromyalgia?
through exclusion
What are the ACR 1990 diagnosis criteria for fibromyalgia?
widespread chronic pain >3 months affected all 4 quadrants
occiput
low cx (anterior)
trapezius
supraspinatus
2nd rib
lat epicondyle
gluteal
greater trochanter
knee (medial)
*doesn’t go below knee
What is the 2010 ACR revised diagnosis for fibromyalgia?
widespread pain index and symptoms severity scare instead of tender points
What are the interventions for fibromyalgia?
medical - analgesics (nsaids, opiods), antidepressants, anticonvulsants
PT - education ,CBT, exercise, sleep hygiene
*active treatment as much as possible
What is lymphedema?
Abnormal accumulation of lymph fluid in tissue sapce
What is the job of the lymphatic system?
Collect and transport fluid from interstitial space back into venous circulation
also involved with immune function
What are the types of lymphedema?
Primary - congenital and insufficient develop
Secondary - surgical dissection of lymph nodes, inflammation and infection, obstruction or fibrosis, chronic venous insufficiency
What is dependent edema?
in the line of gravity (below the level of the heart) - fluid moves downward
What are the qualitative observations of edema?
Pitting, brawny and weeping
What are the S + S of lymphedema?
Increase size of limb
sensory disturbances
decrease ROM
skin changes (fibrosis / brownish pigment)
What are the interventions for lymphedema?
Manual lymphatic drainage
compression - low stretch / compression garments
elevation
exercise - arom, stretching, low intensity resistance, low intensity CV/ pulmonary endurance
skin and nail care
What are the two phases for complex decongestive therapy program
Phase I
-manual lymphatic drainage
-compression - low stretch
-exercise
-skin and nail
Phase II
-self manual lymphatic drainage
-compression - compression garment during day, low stretch at night
-exercise
-skin and nail care
What is the etiology of breast cancer related lymphatic dysfunction?
-surgical - mastectomy, breast conserving (lumpectomy, segmental mastectomy)
-radiation
What are impairments and complications related to breast cancer treatment?
Postop pain - incisional, post cervical and shld girdle apin
post op complications - DVT, pneumonia, atelectasis
Lymphedema
chest wall adhesions
decrease shld mobility
weakness of involved UE
postural malalignment
fatigue and decreased endurance
What are some interventions for breast cancer related lymphedema
complex decongestive therapy
postural education
shoulder and UE ROM and strengthening- avoid excess tension on incision or blanching of scar during shld ROM, avoid exercises of arms in dependent position, progress graded exercise program slowly
gentle massage of scar and adhesions
aerobic exercise and functional activities
What may pregnancy related back pain be due to?
postural changes
hormonal influences (up to 3 to 5 months postpartum)
increased ligament laxity
decreased abdominal muscle function
What are the characteristics of pregnancy related back pain?
worse with muscle fatigue (static postures or as day progresses)
relieved with rest or change of position
physically fit women have less
What are the postural changes associated with pregnancy?
COG shifts upwards and forwards due to enlargement of breasts and uterus (also get widened BOS and ext rot at hip)
increase lx and cx lordosis
increased APT
scapular protraction and UE IR
SOM tightness
genu recurvatum at knees (bc of lx lordosis and ant belly - reestablish Cog)
What are the interventions for pregnancy related back pain?
traditional LB exercises
proper body mechanics
posture instructions
What are sleeping positions for pregnancy related back pain?
supine - with pillow to tilt R side (offload vena cava) and under back (offload LB)
L side lying (bc of vena cava) and pillows between knees - prevent rot at Lx
What are the precautions and C/I for pregnancy related back pain modalities?
precautions
-heat
-laser (local)
C/I
-deep heating agents
-electrical stim (local)
-traction
-US (local)
What is diastasis recti?
separation of rectus abdominis muscles at the linea alba (midline) - larger than two fingers width
commonly seen in childbearing women (less common if good ab tone)
What is the etiology of diastasis recti?
unknown
may be as a result of hormonal effect on connective tissue and biomechanical changes
may develop during labour
What are the S + S of diastasis recti?
LBP
decreased functional activiity
herniation
What do you do for examination for diastasis recti?
all preg patients - repeated throughout pregnancy
0-3 day post delivery - not valid
procedure - crook ly - raise head and shld off floot, reaching towards knees - fingers horziontally across midline of the abs at the umbilicus - repeated above and below
Positive - fingers sink into gap between rectus muscle - number is documented
What are the interventions for diastasis recti?
Separation <2cm
only head lift
head lift with pelvic tilt (diastasis recti corrective exercises)
TA activation without breath holding
Once corrected can advance abs exercsies
Head lift
-crook ly - hands crossed over midline - exhale and ilft head while approximate the rectus muscles, lower head
-sheet can be used
-used in combo with PPT
What are the classifications for pelvic floor dysfuncion?
prolapse
urinary or fecal incontinence
pain and hypertonus
What is the risk factors for pelvic floor dysfunction?
Child birth
>30
multiple deliveries
forced pushing
use of forceps
vacuum extraciton
oxytocin
perineal tears
birth weight >8 Ibs
other
excessive straining
chronic constipation
obesity
chronic cough
smoking
hysterectomy
What are the intervention for pelvic floor dysfunction?
patient education
NM re-ed
pelvic floor exercises
biofeedback
manual treatment and modalities (intravaginal / rectal techniques)
Who most commonly gets amputations and why?
M>F
-PVD and trauma
What is the etiology of amputation?
PVD - diabetes, arteriosclerosis, and embolism
Trauma
Malignancy
Infection
Congenital deficiency
What is the #1 predictor of ambulation in amputees?
Prev amp function
What are the common levels of amputations in LE?
See chart
What are the advantages and disadvantages of transtibial amp?
advantage
-greater pot for ambulation
-decrease energy expenditure
disadvantage
-not a weightbearing end (on patellar tendon)
-bony prominences are at increased risk for skin breakdown
What are the advantages and disadvantages of transfemoral amp?
advantage
-greater healing in vascular amps
disadvantage
-not a weight bearing end
-lower potential for ambulation
-increased energy expenditure
-external knee control
What is a rotational plasty?
treat bone tumours
remove leg and rotated and reattach
ankle is the knee joint
DF = knee flexion, PF = knee extension
What are the post surgical dressings for amps
rigid - non-removal, removable
semi-rigid - unna’s paste, PPAM
soft - elastic wraps, elastic shrinkers
What are the goals of post-surgical dressings?
control edema
prevent infection
protect limb from external trauma
shape residuum in preparation for prosthesis
What are the advantages and disadvantages of rigid dressings?
adv
excellent for edema control, pain, protection, enhances healing, prevent knee flexion contracture
dis
cannot inspect incision with IPOP
more expensive
How long does IPOP stay on for?
10-14 days
What are the advantages and disadvantages of Unna’s paste
adv
good edema control
can remove and reapply easily to inspect incision
superior to soft dressing in enhancing healing
dis
may loosen
frequent changing
takes time to dry
What are the advantages and disadvantages of elastic wraps?
adv
can remove and reapply easily
inexpensive
dis
poor edema control
minimal protection
requires frequent rewrapping
movement of residuum will cause slippage and change in pressure and pressure distribution
What are the advantages and disadvantages of elastic shrinkers?
adv
easy to apply
inexpensive
good edema control and stump shaping
dis
requires changing of size as residuum shrinks
not used until incision has healed and sutures have been removed
What are the phases of care for amputees?
Post surgical
Preprosthetic
Prosthetic
What are common contractures for TT and TF amp
TT - knee, hip flexion
TF - hip flexion, abd, ER
Which leg do you lead with for amputations?
unamputated leg
Can you do resisted exercises in post surgical phase of amp
No -
What are the normal and abnormal shapes of the stumo?
Normal : cylindrical, conical, bulbous
Abnormal: dog ears, skin folds, edematous
What causes prosthogenic pain?
abnormal fit of prosthesis
What is the most effective method of stretching to prevent contractures?
pnf
What are the key muscles for ambulations for a prosthetic?
TT - hip extensors, add, abs
TF - hip extensors, abd, add, knee flex, knee ext
What don’t you do with avascular amputee during balance
shoes off
What are the pressure sensitive structures and pressure tolerant structures
sensitive
end of bone cut
bony prominences
nerve or neuromas
cord like tendons
NWB bone surfaces
tolerant
flat bone surfaces
flat tendon
normal WB surfaces
muscle fat
How do you donn a prosthesis?
roll iner over
wear socks as needed
fit prosthetic leg
stand on prosthesis and bear weight
continue to until locked (extend knee for TT)
What are common gait deviations for amputees?
too big - pistoning
no PF - circumduct, valut to clear foot
What are the 7 broad categories of cancer?
Carcinoma
Sarcoma
Leukemia
Lymphoma
Myeloma
Melanoma
Glioma
What are the red flag characteristics of cancer?
pain worsens at night
constant unrelenting pain
unexplained weight loss
loss of appetite
unusual lumps or growths
unwarranted fatigue
bone pain that is worse at night
What are the side effects of chemotherapy? And why do they happen
fatigue, neuropathies, chemo brain (cognitive deficits and memory problems), myelosuppression, dehydration, nausea, vomiting, immunosuppression, skin and nail changes
chemo affects other healthy rapidly dividing cells
What is chemo?
use of drugs to destory rapidly dividing cells
What are the side effects of radiation therapy?
fatigue, myelosuppression, nausea, vomiting, local skin problems (red, irritated swollen, blistered)
healthy cells within the area may also be affected
What is the medical interventions for cancer?
chemo
radiation
blood and bone marrow transplantation
immunotherapy
hormone therapy
surgery
How do you decrease pain in those with cancer?
TENS (C/I over malignancy)
cold pack
relaxation therapy
gentle movement
exercise
What are the 5 P’s in energy conservation techniques
planning
pacing
prioritizing
positioning
proficiency
What are the special considerations for treatment of those with cancer?
avoid resistance testing and exercise in patients with bone metastasis due to high risk of pathological fractures
avoid manual therapy on or near areas with bone metastasis due to high risk of pathological fractures - be aware there may be bone metastasis in other areas
minimize rotation activities in patients with bone metastasis
avoid modalities in area of tumour (still used in non-cancer affected areas)
check sensation
avoid exposure to chlorine, hands on techniques, use of topical ointments or creams over irradiated skin until medically approved
alter, adapt or delay treatments if patient’s blood counts are too low
What is hemophilia? Including epidemiology
a bleeding disorder in which a person’s blood does not clot normally leading to delays in coagulation after injury
M>F - because x-linked recessive
What is the clinical manifestations of hemophilia?
hematoma formation
excessive bruising from minor trauma
delayed hemorrhage after a minor injury
persistent bleeding after cuts
hemarthrosis (bleeding into joints)
episodes of spontaneous bleeding into joints, muscles and internal organs
What is hemarthrosis? including most common joints and S + S
bleeding into joint space - affects synovial joints
Knee but also happens at ankle, elbow, hip, shoulder, wrist
swelling, pain, warmth, stiffness
blood can irritate synovium = synovitis, lead to erosive damage of cartilage
What is intramuscular hemorrhage including S +S
bleeding into muscles
pain, swelling, limitations of motion, protective spasm, warmth, palpable hematoma, neuro signs (numbness and tingling)
What is the medical management of hemophilia?
factor replacement therapy
pain meds (no aspirin or ibuprofen)
corticosteroids to treat chronic synovitis
What is the rehab management for an active bleed in hemophilia?
see chart
What is the rehab management for post -bleed in hemophilia?
education
isometri s
progress strength pain free, through range
progressive return to weight bearing
proprioception
What are rehab considerations for hemophilia?
use of heat is c/i
joint manipulation is c/i
contact sports are not recommended
activities with high risk of falls or serious trauma are not recommended
heavy weight lifting and power lifting is not recommended
eccentrics (esp heavy) are not recommended
