wk 9 Flashcards
pelvic joint
- 1 Pubic Joint
- 2 Sacroiliac Joints
minimal movement
SI joint mvoement
anterior and posterior rotation
symphysis pubis- gliding in inferior/superior direction
risks of SI mobilize/manip
minimal risk, hyper mobile SI joint (should strengthen muscles)
contraindications for SI manip/mobilize
- Ankylosing Spondylitis * InflammatoryArthrides * Osteoporosis
- Lumbar spine fracture * Skeletal metastases
- Cauda equina syndrome
low back pain in 20-30% of patients is from
dysfunctional SI joint mechanics
SI manip/mobilization indications
- Low Back Pain in 20-30% of all patients is a result of dysfunctional SI Joint mechanics
- Hypo-mobile SI Joints
- Hip Pain
- Elevated or Lowered ASIS
- Functional Leg Length Discrepancy
widely accepted evidence based benefit of manip
reduce pain
benefits of SI manip/mobilize
- Reduce Pain (widely accepted evidence-based)
- Restore optimal ROM of segment
- Restore quality of movement
- Improve proprioceptive function (Via vibratory nature of
oscillation activating sensory mechanoreceptors) - Segment specific via contacts placed on or close to segment
being mobilized vs Manipulation (Grade 5) tends to have
collateral effects. - Improve kinetic chain function
- Reduce muscle guarding
- Compensatory mechanical stress on adjacent structures
key actions for hypothryoid botnaical
adaptogen, alterative
herbs for hypothryoids
Withania somnifera (Ashwagandha)
Panax ginseng (Korean red ginseng)
Fucus vesiculosus (Bladderwrack)
Iris versicolor (Blue flag)
Rhodiola rosea (Rhodiola)
Rumex crispus (Yellow dock) Eleutherococcus senticosus (Siberian ginseng)
ashwaganada CI
can increase androgens and lead to acne and increased libido, avoid in PCOS
how much of communication is nonverbal
80%
door openers/ encouragers
invitation to talk i.e. tell me more
3 P of insomnia
predisposing, precipitating, and perpetuating factors
non pharm for insomnia
-stimulis control
-progressive muscle relaxation
-sleep hygiene
insomnia severity index
> 10 is insomnia
Pittsburg sleep quality index
> 5 is poor sleep
Hepworth sleepiness scale
> 10 is sleepy
STOP BANG
> 3-4 is intermediate risk of OSA
5-8= high risk
polysomnogrpahya
actigraphy
poly- OSA, movement disorder
actigraphy- circadian rhythm problems
first line treatment for insomnia
CBT I or non pharmolgocial
get out of bed if cant fall asleep in
20 mins
x
- Tx
impact intensity to hydro
temp, duration, wetness, pressure, freq3euncy, permeability
extreme temp + short duration
neutral temp + long duration
wet material
more friction and pressure
both more intense
increased area covered by heart
stronger derivative effect
smaller area covered by cold
stronger revulsive (depletion)/ retrostatic effect
reflexive vs direct
reflexive useful when
limited access to the area
local hot or cold is containdicatred
what carries temeprature well
water
closed body system in hydro
skin > nerves > vessels
direct what flow
blood and lymph
derivation
heat
-blood and lymph flow towards heat
depletion (revulsive/retrostatic)
-cold
-blood and lymph flow away from cold
alternating/ contrast
-combine heat and cold= pumping action
-decongestive
arterial trunk reflex
-apply over arterial trunk has same effect on arterila branches (superficial and deep artery)
collateral circulation
-relationship between superficial and deep branches of a vessel
-oppsite effect between branches
i.e. if put heat on superficial artery to vasodilate then the deep artery will constrict
sodium is not salt
1 gram of salt (sodium chloride) = 387 mg of sodium (approximately 40% sodium by weight)
loss of sodium via
sweat
upper limit of sodium intak
2.5 g
adequate intake= 1500mg
potassium sources
avocado, legumes, seafood, greens, dairy, banana
vitamin C for
cholesterol metabolismv
vitamin K for
vascular health and calcium homeostasisv
vitamin E for
reduce lipid peroxidation and platelet aggregation
CVD diet
-increase monounsaturated and omega 3 FA
-increase fiber
-increase Vitamin E, A, B6, B12, folate
-plant > animal protein (meditteranean)
cholesterol
only 20% from diet, 80% made in body
to reduce LDL whats best fat
replace saturated with mono and polyunsaturated fats
saturated= solid at room temp (butter, lard, coconut oil), meats
fiber reduces
LDL cholesterol
fiber amount
17-30 g (total fiber)
7-13 g (soluble fiber)
20 - 50% of people are salt sensitive (genetic)
increases in blood pressure are directly observed with salt consumption
DASH diet for hypertension
<2300mg of sodium (lower version of 1500mg)
27% fat, 18% protein, 55% carb
2100 calorie day: potassium intake of 4700 mg per day, calcium 1250 mg, magnesium 500 mg, fibre 30 g, cholesterol intake limit of 150 mg per day
daily servings in a dash diet (2100 cal)
Grains: 6 – 8
Vegetables: 4 – 5
Fruits: 4 – 5
Fat-free or low-fat dairy: 2 – 3 Lean meat, poultry, fish: 6 or less
Fats and oils: 2 - 3
Sweets/added sugars: 5 or less per week
Nuts, seeds, legumes: 4 – 5 per week
study for whole grinds: 10 gram increase in intake is associated with
4% reduction in CVD mortality
(compare to lowest intake group, highest group had 13% lower risk of mortality)
10 gram increase of red and processed meat in a day is associated with
1.8% risk of CVD mortality
highest intakes have 23% increased CVD risk
dairy on CVD
no effect
nuts on CVD
27% lower risk in highest vs lowest consumption groups
legumes
no associated with CVD mortality
10g increase causes 0.5% reduction
fruit and veg and CVD risk
28% lower risk in fruit and veg
36% reduction if higher fruit
plateau after 5 servings
Which of the following serving recommendations is consistent with a 2100 calorie/d DASH diet?
A. 2 – 3 servings of full-fat dairy per day
B. 6 – 8 servings of whole grains per day
C. 4 – 5 servings of nuts and seeds per week
D. 5 servings or less of added sugar per week
B, C , D
** not A because recommend 2-3 servings of low fat or fat free dairy
stages of behaviour change
pre contemplation (dont want to change, build awareness)
contemplation
preparation
action
maintenance
ROM in Atlanta occipital joint C0-C1
15 degrees
flex, ext, lateral flex
atlantoaxial joint C1-C2
45 degree rotation
risks of cervical manip/mobil
high risk bc vascular and nervous tissue
disc herniation, cervical artery dissection, dislocate or fracture, vertebral artery dissection
warning signs or risk factors of cervical artery disection
- sudden pain in side of neck or head
- dizzy, unsteady, vertigo
- age < 45
- migraine
- connective tissue disaese
- recent infection (URTI)
signs of vertebrobasilar ishcemia
5 Ds and 3 Ns
-dizzy (vertigo)
-drop attack (lose conscious)
-diplopia (vision)
-dysarthria
-dysphagia
-ataxia of gait,
-N/V
-unilaternal numbeness
-nystagmus
carotid artery ischemia:
-confusion, dysphasia, headache, hemianesthesia, hemiparesis
contraidincations for cervical manip
tumor
infection
diplopia
nasuea
tinnitus
dysphagia
RA
vascular disease
ankylosing spondylitis
etc
indications for cervical mobilizations
-headahce
-TMJ
-nonspecific neck pain
headaches and vitamin deficney
IDA
low ferritin
forms of iron
-hemoglobin and myoglobin (majority of iron)
-storage iron (ferritin in liver, spleen, marrow) (excess is hemosiderin)
-transport iron (bound to transferrin)
iron absorption
heme vs non heme
fe3+ vs fe2+
fe2 (fe3+ has to be reduced to Fe2+) and heme better
most of diet iron is
non heme (all plant and 60% of animals)
17% of non heme and 25% of heme
absorbed
iron deficiency enhances absorption of
heme, but not non-heme iron
absorb iron in
upper SI
amount of iron absorbed determined by
ferritin already in intestinal mucosal cells
when iron binds apoferritin or apotransferrin and forms ferritin and transferrin
when saturated these sites- halt iron absorption in SI
vitamin C and acidic envo
increase iron absorption (via reduction of Fe3+ to 2+)
animal protein
- Heme iron improves absorption of nonheme iron eaten at the same meal via peptides released from meat and fish
infection and iron absorption
decrease
binding agents affecting iron absorption
- Phosphates, phytates, and oxalates prevent absorption
- Some vegetable proteins (like soy) decrease absorption
- Polyphenols (tea and coffee) decrease nonheme iron absorption
calcium and iron
inhibit iron absorption (in supplements)
iron excretion
no system to actively excrete
filtered through kidneys and reabsorbed
blood loss
regulation occurs at absorption
food triggers of headaches
caffeine, milk, cheese, citrus, processed meats, MSG, aspartame, and alcohol
fasting
low omega 3
PICA
craving for non food item (i.e. ice, soil, hair, paint chips)
associated w iron deficiency
iron supplementation
150-200mg elemental iron
not all iron salts yield same amount of elemental iron
ferrous glyconate= 12%
ferrous fumarate = 33%
best iron salt (non heme)
ferrous fumarate
heme iron supplements vs non heme (iron salts) when to talk
heme with meals
non heme iron salts on empty stomach
what to avoid when supplementing with iron
other minerals (magnesium, calcium, zinc)
antacids
side effect of iron supplementation
constipation
diet for migraine
low glycemic index
low fat
ketogenic
DASH
IgG food sensitivity test
How long should iron therapy be continued after hemoglobin levels normalize in a patient with a history of iron-deficiency anemia?
A. 1 week
B. 4 weeks
C. 8 weeks
D. 24 weeks
C. 8 weeks
aspects of informed consent
- Nature of the intervention (or assessment) and rationale
- Expected outcomes and/or benefits
- Material risks (including financial costs, significant harm or death) * Alternatives
- Consequence of no treatment
- Right to withdraw consent at any time
cognition peaks at
30 yrs old and declines after
risk factors for dementia
Type 2 diabetes
Hypertension
Obesity
Smoking
Depression
Insufficient mental activity Insufficient exercise
muscle mass decrease with aging
Muscle mass decreases approximately 3 – 8% per decade after the age of 30 with the rate of decline higher after the age of 60
GI and age related body changes
Loss of gastric acid interferes with the absorption of vitamin B12 and reduces uptake of thiamine, folate, calcium, and iron
Neural changes result in increased transit time (constipation) and early satiety
macros in olders
high fiber- 45-65%
fat 20-35%
protein 0.8 g/kg body weight
or to reduce muscle loss do 1-1.25 g/kg body weight
mineral and electrolytes in aging
Ca2+ (bone loss)
iron lower post menopause
K+ (if on diuretic)
Na+ < 2300mg (BP and fluid retention)
vitamins in againg
folate (for preventing increased homocysteine and atherosclerosis)
b6 for muscle mass
b12 for gastric acid and absorption
vitamin D for calcium
fluids in eledrs
less thirsty, kidneys not as good
1.2 L to 2 or 3 L depending on body size and activity levels
neuroprotection
antioxidants
Pinocembrin (honey, propolis, ginger)
Naringenin (citrus)
Genistein (soy)
Orientin (tea)
Eriodictyol (citrus, peppermint)
Luteolin (radicchio, peppers) Apigenin (parsley, celery)
polyphenols
Curcuminoids
Taurine (meat, dairy, fish)
Harpagoside
Alpha lipoic acid (spinach, broccoli, tomato, organ meats)
Allicin (garlic)
diet for alzihmers
Mediterranean and Japanese and DASH
Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)
Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)
3+ servings a day of whole grains
1+ servings a day of vegetables (other than green leafy)
6+ servings a week of green leafy vegetables
5+ servings a week of nuts
4+ meals a week of beans
2+ servings a week of berries
2+ meals a week of poultry
1+ meals a week of fish
Mainly olive oil if added fat is used
Less than 5 servings a week of pastries and sweets
Less than 4 servings a week of red meat (including beef, pork, lamb, and products made from these meats)
Less than one serving a week of cheese and fried foods
Less than 1 tablespoon a day of butter/stick margarine
MIND diet and alzhimers
53% lower rate in high engagement
feeding assistance in dmentia
i.e. hard to eat
diet in elders
nutrient density if early satiety
omega 3
potassium fro muscle mass
fruit and veg for antioxidants
The MIND diet is a combination of what two therapeutic diets?
A. Low GI diet and Mediterranean diet
B. Mediterranean diet and DASH diet
C. DASH diet and ketogenic diet
D. Ketogenic diet and low GI diet
B. Mediterranean diet and DASH diet
burnout from
chronic workplace stress
compassion fatigue
cost of caring for others to relieve their suffering
in helping professions
