Rehab Guidelines for Arterial Disease

Question 1

limb protection

Answer 1

• avoid excessive strain, protection of extremities from injury, extremes of temperature

Question 2

when is bed rest required?

Answer 2

when gangrene, ulceration, acute arterial disease are present

Question 3

what can exercise training for patient with PAD result in?

Answer 3

improved functional capacity, improve peripheral blood flow via collateral circulation and muscle oxidative capacity

Question 4

what should you consider for pts with PAD

Answer 4

• interval training with frequent rests

Question 5

walking with patients with PAD

Answer 5

• walk until pt cannot tolerate pain
• more effective for collateral circulation to walk at a level of 2 or 3 on claudication scale, but most pts cannot tolerate this level
• use interval program with tops until pain subsides for total of 30-60 mins, 3-5 days/week
• record time of pain onset and duration

Question 6

non weight bearing exercise in patient with PAD

Answer 6

• may be necessary in some patients
• less effective in producing a peripheral conditioning effect

Question 7

what may decrease time to claudication or worsen symptoms?

Answer 7

beta blockers or cardiac disorders

Question 8

what can improve time to claudication

Answer 8

• pentoxifylline, dipyridamole, aspirin, and warfarin

Question 9

patients with PAD are at a high risk for…

Answer 9

CAD

Question 10

what is the most effective method of increasing blood flow

Answer 10

resistive calf exercises

Question 11

modified Buerger-Allen exercises

Answer 11

• postural exercises to promote blood flow
• 3 positions: supine with LE elected to 45-90 degrees and supported until feet blanch, sitting with LE in dependent position until feet turn red/pink, supine for a few minutes
• can add plantar and dorsiflexion of ankle in each position

Question 12

medical treatment of PAD

Answer 12

• medications to decrease blood viscosity, prevent thrombus formation (heparin)
• vasodilators are controversial
• calcium channel blockers in vasospastic disease

Question 13

surgical management of PAD

Answer 13

1. atherectomy, thromboembolectomy, laser therapy
2. revascularization: angioplasty or bypass grafting
3. sympathectomy: results in permanent vasodilation, improvement of blood flow to skin
4. amputation when gangrene is present