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PTA - Neuro Peds > Neuro Peds - 02 - Women's Health > Flashcards

Neuro Peds - 02 - Women's Health Flashcards

1
Q

What constitutes women’s health?

A 
Breast & Ovarian Cancer
Osteoporosis
Pregnancy
Post-Partum
Female Athlete Triad
Pelvic pain
Lymphedema
Incontinence
Aging
Domestic Violence & Abuse
Arthritis
Menopause
Eating Disorders
Autoimmune Disorders
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2
Q

‘A woman’s health encompasses all functions related to her mental and physical wellness from ____

A

___ puberty through old age’

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3
Q

what are Considerations Across the Lifespan?

A 
Teenager - Female-athlete triad
20’s and 30’s - Pregnancy & Post-Partum
40’s & 50’s - Menopause
60’s & Beyond - Osteoporosis
Across the lifespan - Depression, Arthritis, Breast Cancer, etc
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4
Q

why is Women’s Health important to PTA?

A
  • Time spent with patients = insight
  • Knowledge of important screening questions
  • Necessity of recognizing when a referral is appropriate
  • Prevalence3
  • > NAFC estimates 25 million Americans are incontinent
  • > 50% of nursing home residents are incontinent
  • > 1 in 5 adults over 40 yoa experience OAB
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5
Q

there are differences between male and female pelvis

A

yep. go look them up.

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6
Q

name the three ligaments in the pelvic area

A

pubovesical
round
uterosacral

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7
Q

how many layers of the pelvic floor?

A

three layers

three functions

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8
Q

what are the voiding phases of micturition?

A

Filling – transition – voiding

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9
Q

what is the neurologic control of the bladder?

A
  • via Bradley’s Loops I-IV

Brain = Loop I, II, IV; Spinal Cord = Loop III

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10
Q

what is there to know about the Storage of Urine?

A
  • Initial urge at 150-200 mL
  • 400-600 mL normal capacity
  • Detrusor relaxes & internal urethral sphincter contracts via sympathetics
  • External urethral sphincter & PFMs contract via somatic motor control
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11
Q

how does the Emptying of Urine happen?

A
  • Sensory receptors cause micturition reflex (involuntary)
  • Detrusor contracts & internal urethral sphincter relaxes via parasympathetics
  • External urethral sphincter & PFMs relax via somatic motor control
  • Normal 20 seconds
  • Normal post-void residual (PVR) 5-50 mL
  • 2-3 hour intervals, 5-8x/day
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12
Q

what is the Storage Dysfunction?

A

Damage to Bradley’s Loop IV = involuntary control of external sphincter during filling

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13
Q

what are the Emptying Dysfunctions?

A
  • Damage to Bradley’s Loop I = no awareness of voiding
  • Damage to Bradley’s Loop II = increased PVR
  • Damage to Bradley’s Loop III = involuntary relaxation of external sphincter, dyssynergia with detrusor
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14
Q

what are subjective considerations for the pelvic floor evaluation?

A
  • Medications: side effects!
  • Obesity
  • Childbirth: vaginal deliveries
  • Chronic increased intra abdominal pressure
  • Lifecycle: hormonal contributions
  • Trauma: surgeries
  • Frequency of Voiding/Incontinence
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15
Q

what is included in the pelvic floor evaluation?

A 
Postural Evaluation
Manual Muscle Testing
- Hips & Abdominals
- Intravaginal and/or Intrarectal
Musculoskeletal Considerations
- Thoracic & Lumbar Spine
- Sacroiliac Joint
- Hips
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16
Q

what is Stress Urinary Incontinence?

A

SUI

  • Involuntary loss of urine due to an increase in intra-abdominal pressure6
  • Associated with physical exertion
  • Caused by:
  • -Intravesical pressure > maximum urethral pressure
  • –Decreased extrinsic urethral support
  • –Insufficiency of intrinsic urethra
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17
Q

what is the treatment of the SUI?

A 
Pelvic Floor Exercise Strengthening
- Pelvic floor contractions: kegels
- Biofeedback: pelvic floor uptraining
- Vaginal weights: 20 to 70 grams
- Electrical stimulation: 35-50 Hz to facilitate muscle awareness, strength
Synergist Strengthening
Functional Application
- Avoiding valsalva & straining
- PFM strengthening with functional activities
18
Q

What is Urge Urinary Incontinence?

A 
UUI
Involuntary loss of urine accompanied by an intense sense of urgency6
Bladder is overactive, irritable
Caused by:
- Detrusor instability
- Faulty behavioral habits
19
Q

what is Overactive Bladder?

A

OAB
Symptoms of frequency, urgency without loss of urine6
60% of population with urgency frequency (vs. 40% UUI)
Caused by:
- Incomplete emptying of the bladder
- Detrusor instability
- Faulty behavioral habits

20
Q

what are treatments of UUI and OAB?

A

Behavioral Modification

  • Dietary
  • Voiding schedules: bladder diary, timed voiding
  • Urge suppression techniques
  • Poor bladder habits: JIC, hovering

Neuromuscular Approach

  • Electrical Stimulation: 12.5 Hz, detrusor inhibition reflex7
  • Re-education: biofeedback for PFM down training
  • Physiologic quieting: diaphragmatic breathing
21
Q

name 4 additional types of incontinence

A
  • Mixed Urinary Incontinence-Combination of stress and urge urinary incontinence
  • Overflow Incontinence-Loss of urine due to over distension of the bladder, failure to empty
  • Functional Incontinence-Loss of urine due to impaired mobility
  • Fecal Incontinence-Involuntary loss of feces
22
Q

what is Pelvic Organ Prolapse?

A

POP

Descent of anterior, posterior vaginal wall, apex of the vagina

23
Q

name 4 POPs

A

Cystocele: bladder
Rectocele: rectum
Uterine: uterus
Enterocele: peritoneum or small bowel

24
Q

what are the symptoms of Prolapse?

A

Incomplete emptying of bowel and bladder

Pressure

25
Q

what causes Prolapse?

A

Decreased support of vaginal wall tissues

26
Q

what treats Prolapse?

A
  • Strengthening of pelvic floor muscles comparable to program for SUI - Focus on gravity assisted positions
  • Splinting with voiding
  • Pessary (MD prescription, fitting)
27
Q

name Organ Based Pelvic Pain (4)

A
  • Irritable Bowel Syndrome-Increased sensitivity of the intestines contributing to abdominal pain, changes in BMs
  • Interstitial Cystitis or Painful Bladder Syndrome-Chronic inflammation of the bladder contributing to frequent and urgent urination, pelvic pain
  • Endometriosis-Endometrial cell growth outside of uterus contributing to painful menstruation, abdominal and pelvic pain
  • Dysmenorrhea-Painful menstruation
28
Q

name Musculoskeletal Pelvic Pain (5)

A
  • Chronic Pelvic Pain10
  • Pelvic Floor Tension Myalgia-PFM spasm and pain
  • Coccygodynia-Coccygeal pain
  • Levator Ani Syndrome-Chronic pain and aching in the perivaginal and/or perirectal muscles
  • Vaginismus-Vaginal muscle spasm preventing penetration
29
Q

name Pelvic Pain with unknown cause or multi-system etiology (4)

A
  • Vulvodynia-Burning, stinging of the vulvar tissues
  • Prostatodynia (Male)-Chronic nonbacterial prostatitis contributing to pain and urinary symptoms
  • Proctalgia Fugax-Sharp, fleeting rectal pains
  • Pudendal Neuralgia-Inflammation of the pudendal nerve contributing to pelvic pain, sexual dysfunction, and urinary/defecatory symptoms
30
Q

how is Pelvic Pain treated?

A
  • Therapeutic Exercise-Stretching and/or strengthening of the pelvic floor and pelvic girdle muscles
  • Neuromuscular Approach-Biofeedback: relaxation, down training of pelvic floor; Diaphragmatic breathing
  • Postural education-Corrected alignment with activities of daily living
  • Modalities- Electrical Stimulation: TENS, IFC, Heat, ice, Ultrasound
  • Manual Therapy - Joint mobilization, Scar massage, Trigger point release, muscle energy techniques, Myofascial release
31
Q

postural changes associated with pregnancy:

A

Uterus becomes abdominal organ from pelvic organ14
COG moves forward
Base of support shifts
Increased lumbar lordosis
Abdominal muscles lengthen and can separate (diastasis recti)
Excessive work on gastrocnemius and soleus causes cramping
Weight bearing on metatarsals instead of heel

32
Q

pregnancy effect on joints

A 
Pelvic girdle instability14
SI joint malalignment
Symphysis pubis – separates up to 12mm
Trochanteric bursitis and radicular pain
Lumbo-sacral pain
Peripheral joints less stable
33
Q

pregnancy effect on muscles and nerves

A 
Diastasis recti14
PFM traumatized causing 
	incontinence, prolapse and 
   post-partum pelvic pain
Nerve compression and 
   stretching
34
Q

treatments for pregnancy effects on joints, muscles, nerves

A 
Positioning and use of pillows14
Postural education
PFM strengthening
sEMG to coordinate and re-train PFMs (peri-anal)
Manual therapy techniques
Support belts
Stretching and stabilization exercise
Ice or heat to sore muscles and joints
35
Q

contraindications for treatments for pregnancy effects

A 
Multiple gestation14
Preterm labor
Pre eclampsia
DM with vascular disease
Pulmonary hypertension
Renal disease with HTN
Vaginal bleeding
Incompetent cervix
Chronic hypertension
Sick cell anemia
Heart disease
36
Q

guidelines for exercise during pregnancy

A

Maternal HR < 140 BPM14
< 15 minutes of strenuous exercise at a time
Proper clothing for heat dissipation important after first trimester
Positioning: supine after 4th month
Adequate calorie intake
Proper fluid intake
3x/week exercise

37
Q

name surgical intervention for breast cancer

A 
Lumpectomy15
Mastectomy
- Quadrantectomy
- Modified Radical
- Radical
Sentinel Node Biopsy
Axillary Lymph Node Dissection
Reconstruction
38
Q

name adjuvant therapies to surgical interventions for breast cancer

A 
Chemotherapy15
Radiation Therapy
Hormone Therapy
- Tamoxifen
- Aromatase Inhibitors
39
Q

associated diagnoses and impairments to breast cancer

A 
Shoulder Pain & ROM Limitations
Axillary Web Syndrome
Myofascial Pain Syndrome
Cervical Pain
Lymphedema
Fatigue
Osteoporosis
40
Q

treatments of associated diagnoses and impairments to breast cancer

A

Manual Therapy

  • Myofascial release
  • Scar & Joint mobilization

Therapeutic Exercise & Neuromuscular Re-Education

  • Normalization of scapulo humeral mechanics
  • Restoration of flexibility & strength
  • Postural education
  • Endurance training
  • Weight-bearing exercise
  • Balance training
41
Q

considerations and contraindications to treatments for associated impairments to breast cancer

A

ROM & Lifting Restrictions

  • Post-operatively
  • JP drains
  • Reconstruction

Decreased Tissue Integrity
- Radiation induced

Risk of Infection
- Incision healing

Lymphedema
- Lymph node removal +/- radiation

Fall Risk & Neuropathy
- Chemotherapy induced

Fracture Risk
- Adjuvant therapy induced osteoporosis

Fatigue & Blood Counts
- Chemotherapy induced

PTA - Neuro Peds (14 decks)

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