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Pathology is used when medicine is looking at what was wrong with a particular cell. Looking to see what is normal and abnormal. Diagnosis is made based on cellular pathology. Refers to cellular level.
What is an Impairment
When pathology creates a problem for the system of which it is a part, when something is wrong at the system level it is an impairment
What is a Functional Limitation?
what someone cannot do. Ex. if I break my little toe, I will hobble. The fracture site is the pathology, impairment is it impedes walking, and the functional limitation is I can’t wear my regular shoe.
Cell Pathology → system impairment → FL → Disability
what are the risk factors and why are they important?
Biology/genetics good or vulnerable genes. The overall state of someone’s health. Even if you have leukemia, how is the rest of your body.
Environment: access to healthcare. Example disabling process would be greater for amputee in Haiti than in US
Psychology of it all: coping, each person will be different.
therapist job to understand and keep in gmind when meeting a new client
what is the role of biology
Biology: What are the signs symptoms and lab findings that characterize this disease
What are signs, symptoms, and lab findings?
- Signs – walking with a cane.
- Symptoms- what she experiences in her head, being tired, when the nervous system is tired and you just can’t make your body move.- neuro-genic fatigue. We can’t see it but she experiences its.
Lab findings- x-rays, MRI’s EMG’s, blood tests, etc. ery objective.
what is psychol-social typology and its components?
what do i know about: onset, course, outcome, and incapacitaiton? this is the point when strategy changes dependent on these factors
What is onset? and include factors
onset can be either sudden or slow. it affects the fandlingn of diesease and your approach as a therapist. it it was an accident you would be in in crisis mode.
what is course?
- aggressive, constant, relapse, episodic. as a counselor, if aggressive you must know it will get worse and you will have to provide more supportive counseling as it goes on.
- For constant it usually happens once and now you have to help them deal with it.
- For episodic, you usually have multip progressive occurences so you have to do levels of adaptations and adjustments.
What is outcome?
initial anticipatory gried regardless of diagnosis is very important as an indicator in terms of how the person is going to do and what your tasks as a therapist are going to be. takes into account the prognosis of the disorder.
what is incapacitation?
extent and kind. ex. persistent vegetative state vs. quadripalegic who still can speak and has personality
discuss the developmental timeframe as it relates to disability
- affects both the person and the family. tasks are either:
- 1) building, harder to work with
- 2) maintaining
Discuss aspects of the assessment of functional capacity
- functions help us at home and in environements to carry out work and tasks.
- assessing is usually job of physical therapist bu we must eestimate it.
- Functional capacity for what? no everything, but take it one at a time.
Residual Funcational Capacities
- what is left after an impairment has run its course, or done extent of impairment.
- problem is rarely the illness or diability, but in terms of functional limitations, consequences of limiations, implicaitons, and meanings they have for client.
- things that are named after people.
- Giullian Barre
- Tetrology Fallot
- Meniere's Disease
- Graye's disease
- Abbreviations in medical field
- EKG - heart
- EEG - brain
- EMG - muscle
- a/ab - away from
- Ad - moving toward
- Hemi half ex. hemiplegia - 1/2 paralyzed
- Diplo - double - diplopia - double vision
- Hetero - differet
- homo- sameness
- Micro- small microcephaly - small head
- macro- large macrocephaly- big head
- bracy - short bracycardia short heartbeat
- Mal - bad malacia bad softening
- Eu- good euphoria happiness
- iole - diminutive size. baby. areteriole
- entomy - to remove. appedndectomy
- oscopy- visual exam. Gastoscopy
- osis - diesase process. halitosis
- itis- inflammation- gastritis, rhinitis- nose, fursistis - joint
words denoting place or location
- cranial enceph- brain
- myo- muscle. myocitis - inflammaiton of muscle
- cardi - heart cardiomyopathy
- Osteo - osteomylitis bone
- Hepat liver, hepatitis
what is the musculoskeletal system composed of?
hard (bone) and soft (msucles, tendons, ligaments, cartialge etc)
discuss the role of the soft parts
ex. nose and ears are cartilage and there is cartilage between ribs and vertebra. acts like shock absorbers and gives shapes to things. if something hapens and the cartilage looses shapen, then it must be reshaped and restored
- have some pliability, flexibility
- bind skeletal parts together. bone to bone
- damage is called a sprain. differing degrees, 3rd is worst and requires surgery
- will impact movement if impaired
- attach muscle to bone.
- don't stretch, not as pliable.
- damage is called a strain
- will impact movement if impaired
- bladder, stomach, instestine, blood vessels
- does its job on its own
only found in the heart
- looks like a group of stings.
- 80% of body muscle.
- makes up 40-50% of weight.
- exercising that loses fat and adds muscled will make you weigh more but be thinner and firmer.
- made of calcium, phosphorous and magnesium, but also lot of water
- have serveral hundred
- biggest is feumr, littlest in ear
- shape they take depends on what they do
- Ex. strength and flexibility- long tubes
- movement and flexibility - small cylindicral like macaroni, toes and fingers allow for fine dexterity
- the more work expected, the more sophisticated it is.
- many pieces fit just so, and harder to put back together when broken
ribs - cuved and elliptical, allow flexibility and movement but dont't move too much and aren't weight bearing.
roles of skeletal system
- weight bearing
- shape and support
- and occassionally storage: sternum, iliac crest store bone marrow
Causes of skeletal impairment
- trauma - kids and elders (bones soft and growing or old and deteriorating)
- congenital anomalies - disease, illness
- infectious diseases - osteomyolitis
- non-infectious diseases- bow legged
- nutritional - ED, secondary osteoperosis, gout,
- Endocrine disorders
- degenerative diseases - arthritis
- vascular or ciruculatory- blood supply cut off - vascular necrosis
diagnosis of moskuloskeletal impairments
xrays, MRI, muscle functions (EMG), nerve functions (nerve velocity studies), physical therapists look at range of motion
how to fix muskuloskeletal impairments
- surgers - corrects the problem
- non-open fixes, non surggical, prosthetics or orthotics, casting, rehab, mobility aides.
- reduce functional impairment & disability
Funcitional Impairment of Muskuloskeletal system
- Movement and Strength
- *can't measure residual until healing is finished
Symptoms of musculoskeletal impairments
generalized - fatigue, morning stiffness, weight loss or gain, fever depression, obesity, pain management, mobility, difficulty with daily tasks, sexual, relational or employment problems.
- longer bones take 6-8 weeks
- little - 3-4 weeks
- hard part heals faster than soft
- for every day of immobility, it takes 3 days to get the function back
types of fractures
- compoud comminuted
- crush or compression
- stress or shin splints
- simple - looks like line across bone, parts fit together, need to fill with new cells, usually gets casted.
- Compound - bones separate and parts not alighned, usually need open reduction and internal fixation. doesn't have residual disability
- Compoud comminuted piece of bone splinters and comes through skin.requires surgery to piece together, my add cement to keep.
Crush or compression
Stress or shin splints
- crush or compression- ex falls of roof, osteoperosis, vertebrae collapses and disintigrates. not correctable w/ surgery
- Stress or shin splints- line develops in bone, parts aren't displaced, like hairline space
- Greenstick- what kids get. looks like old toothbrush, can fracture through endplate. rarely seen in older than child
Type 1 osteoperosis
- predominantly affects women ages 50-70. estrogen related. swiss cheese.
- Treatment: biophosphinates - actinel, phosimax, boneva
Type 2 osteoperosis
effects both men and women. after age 70. indication of metbolic functions of the body. age, body wears out
- not sure of origin.
- ED, athletes w/o body fat
- develop brittle bones at young age. not reversible.
- other diseases can contribute or cause.
- steroids can cause secondary osteoperosis
- bone desity teste measure, reccommended after 50, more often for women.
- usually if old people fall and fracture.
- considered above/below knee, elbow and hemi-pelvectomy (lower 1/2 of body removed at pelvis)
- prostheses- expensive and wear out but many. last 5-10 years. $20K
- special types, new materials, for kids, light weight.
- changes sense of midline and center of gravity. sense of body position in place and weight and mass of body changes.
- limbs weighted so you don't fall over.
- must learn how to use
Reasons for amputations
- Tumors (bone or muscle cancer)
- Vascular insufficiency (diabetes)
- some congenital deformity
comlications of amputations
- bone spurs in stump (hook)
- swelling and ulceration at stump
- Contractures - body thinks more bone is needed to make up for loss, bone deposited at ampu. site.
- wearing prosthesis takes enegery- get tired, lower capacity for carrying and walking.
- involve all parts of the joints.
- may be systematic and go into other parts of body
sac where 2 bones meet. synovial membrane, inside is synovial flued allows joint to move freely.
- wear and tear. everyone gets it.
- cartilage on ends of bones wears away, bones don't slide, get craters, touch and cause pain, wears down bones.
- creaky joints. inflamation. (bursitis, tendonitis) treated by NSAIDS. treat symptoms, make comfortable. morning stiffness, discomfort to go to pain killers.
- common in knees, hips, hands. gradually progressive on stable even course
Rheumatoid, lupus, limes disease -impairment in synovial membrane. cause unclear. auto-immune. body attacks itself. membrane infected and swells, painful, flud gets think, gunky so things don't move well. redness and heat at site. big knuckles, point to side. RA affects any age, more disabiling than osteoarthritis, destroys tisse. can reach lungs, eyes, heart, brain. comes and goes. can be acute.
treatment for arthritis
- dietary changes (low carbs, strong proteins) Medications- DMARDDS.
- new meds help treat and prevent acute stages. more meds to treat osteoa than auto-immune
more in women ober 40 than men. rare but has large impact. smotth muscle, fibrosis, scar tissue develops gets hard. muscles aren't able to perform taks. Terminal illness. drugs used to delap progression
striated and cardiac muscles. inflames and very weak, ragdoll. elders. cause unknow. unusual in young people. considered autoimmune
- like shingles on roof, fit over each other. not much movement between each, but allows for much as a hole.
- disk inbetween each. like shock absorver. compressesion squishes out and herneation occurs.
- nerves go into vertabrae top half is sensation, botton is movement
nerves in back/neck/spine
- 33 pairs of spinal nerves.
- vertebrae in neck are cervical.
- chest to waist is thoracic
- above butt is lumbar and end is sacrum and coccyx.
- injuries usually strain, sprain, mot commin in neck and lumbar.
- treat with compression and ice.
- s curve. more likely female. runs in families. starts age 10-12. watch and brace with 3 points to move back. bones still malleable. many won't wear brace though.
- at 30 degrees- surgery. rod and bailing wire to gradually pull spine over. rod can break.
- everything gets pulled E or W. deformities in vital organs, limits breathing, cardiac problems. expensive to treat but kids charity hospitals will treat for free.
- hunch back.
- spine pulls out from upper back, ribs clse in, and everything in ribcage gets compressed and squeezed. more male than female, nobody immune
recurrent - pain that goes on and on. persistend and has a set cause
chronic- no etiology, variable course, seeking medical care and prescriptions.
- genetic component.
- food (coffee, ice cream, chocolate)
- spasming in all of brain muscle.
- Meds prevent or reduce spasming when starteds
- nero-therapy and LENS- lessends effect and frequency
commonalities in pain disabilites
- over stressed muscle groups
- treated in similar fashions - botulin injections, accu-pressure, massage, heat or cold, low car and low sugar diets.
cummulative trauma (pain)
- more than half of worker's comp. repetitive motion syndromes.
- upper extremity.
- repetitive motions in the fine parts/bones
- burning and aching
- correct the nutritional deficit.
- persitent and recurrne tpain syndrome, depression, inactivity - leads to more pain
- hands, arms, feet, legs.
Reflex sympathetic dystrophy
- complex regional pain syndrome
- controversial (if and what it is)
- could follow surger. may develop swelling and burning pain.
- don't use to aoid pain, leads to more pain. break out it localized sweat. muscles contract and become sensitive to tough.
- nerve block, or extreme surger to cut nerve.
- after removal of limb
- stabbing pain.
- EMDR accupressure
Neruma and scar pain
scar tissue builds up and entraps the brances of the nerve. inject the neruoma itself with form fo anesthetic to stop pain. laser.
dependency is not a problem in cancer patients
MS and neuromuscular disorders
- intense burning feeling coming from deep within.
- death rate slowed but numer living longer with it has increased.
- smoking, obesity, sedentary lifestyle, high blood pressure, high cholesterol.
- 1/3 of adults have high blood pressure alone which makes you 3-4x more likely to develop coronary heart disease and greater risk of stroke.
- women have different sympoms, likely to die when at hospital, smae diets and exercise routines don't work.
Veins and arteries
- veins - not as muscular, has gates like turnstiles. go one but not back. slow rate, more liek ooze. Vena Cava- big vein. many systmeic veins. 2-3x more than we need. closer to surface.
- arteries- deeper. deliver oxygen to brain an dbody and carry off waste.
blood flow through lungs.
- enters as low pressure but exits left ventricle and atria and goes into body as high pressure.
- problems like heart attacks occur in left ventricle - wear and tear
- mitrovalves on L side wear out sooner.
- causes pain.adequate blood and oxygen not getting to heart. due to problems in coronary arteries. R and L anterior descending, Cicumflex that goes around the heart and branhes. job is to take in nutrients and oxygen and carry out waste.
- inner wall of artery gets rough. velcro- things stick to it. builds up, can break off and go bad places. or can harden and build up narrowing space for blood flow.
- tissue underneath won't get enough o2 and nutrients.
- in heart-miochartial infarction - heart attack.
sub endocardial infarctions
- less than the full thinckness of the heart wall.
- transmural - goes through the full thickness of the heart muscle.
- hard to bypass and open b/c very thin.
- stint-looks like spring. push gunk back against walls and create more room for bloodflow.
bypass- take other vein and connect to route around blockage. the closer it is to the aorta, the harder to do. symptomatic fix that must be redone in 10 years.
blockage can lead to amputation. after surgery, go on meds, statins and ace inhibitors.
- virally induced
- problems with conduction, causes irregularities
- Heart wave PQRST. look for uncharacteristic squiggleys.
- when they flood the system signal that heart is trying to repair itslef - heart attack
- electrical circuits of heart responisbile for heartbeat.
- can be too fast, slow, hiccup.
- disrupt how heart is beating.
- can be mild, come and go. or fatal
- death of young athletes
- conduction defects
artrial flutter and shake
ventricles flutter and shake
bradycardia or tackacardia
slows down and speeds up
stoppage incidents in the heart
- wolf-parkenson-white syndrome. born with it but doesn't show until hera exerted, conduction defect.
- can be a block in perkinge fibers on r side.
- r bundle branch block, or L short circuit. like power going of on one side of heart.
- trouble breathing or shock.
how to fix blockages
- ablations - laser or freeze the short circuit fibers, they develop collateral and bypass the problem.
- pace maker- when heart rate too slow
- for quivers or fribulations that don't go back into rhythm, install defribulators that shock heart.
congestive heart failure
starts as simple problem of high blood pressure (dangerous when lower number over 100) leads to pressure on brain, lungs, eyes, kidneys (end organs) can damage them, stroke, retinopoty, failing kidneys.
hypertention or hypertensive cardiovascular disease
- primary- result of pressure process
- secondary- if something is wrong in kidney, there is backup causing blood pressure to go up. (begins in another organ)
- pulmonary- medication induced.
- some races genetically predisposed.
venus insufficiency problems
veins have gates that break down over time or genetic vulnerability. can lead to phlebitis, varicose veins. use lasers and local andesthtic to shrink into place.
broken heart syndrome
real physical problem. body releases massive enzmes and heat can't cope and begins to shut don. bottom 3rd contracts but middle and upper don't. like heart attack. returns to normal in ten days
- bypass, valve replacement, heart transplant.
- most insurance plans limit number of rehab visits.
- goal to build up arobically the hearts capacity to use oxygen.
- physical training, patient and fam edu, lifestyle changes, vocational issues, psychological counseling.
reactions to hear conditions by gender
- more likely to have angina equivalent.
- heart rupture. 3x more likely to die. rehab standardized on men. doesn't work well for women so likely to drop out.
- Men have crushing heart pain.
rate of death
congestive heart failure- likely to die within 5 years. Used to be 12 months. babies are now surviving with defects.
- 37.4 lifetime expectancy, but in 1955 didn't live past elementary school.
- Genetic - body produces abnormally thick mucus.
- persistent coughing, chronic lung infections, poor weight gain, diabetes, polyps, lung transplant. link to GI issues. exists in every cell
CF and new medical advances
- 1989 gene discovered. opened gene therapy opportunities.
- Advanced anticiotics
- aerosol sprays
- ThAIRapy Vest
- gene therapy
- pancreatic enxypes
- lung transplants
CF and case management
- continuing to become adults and age
- may need assitance
- meds and treatment very expensive
- difficulty getting healthcare
- treatments not covered by insurance
- med complications increase with age
Goal of case management and CF
- decrease cost of inpaitent hospital stays through providing outpatient services.
- reduce # of adults ho use financial resources in order to qualify for aid.
- maintain and achieve higher level of autonomy and QoL
- reduce # of hospitalizations, provide access to care, equipment, and meds
What is a Pulmonary Function Study?
- Hom much you can exhale in one push.
- Vital capacity - how much you can pull in. depends on body size.
- muscles between ribs and neck affect, how tall you are, atmospheric pressure.
- bring in 02 expel CO2.
- right lung slightly larger. R has 3 lobes, L has 2. space between them is the media steinum that llos wthem to separate. L is smaller so heart can fit.
soft tissue, long eslastic and spongy
slippery lining, allows to slip and slide when expanding so they don't get caught
- main breathing tubes. brance, b ronchila and at the end are the aveoli - like a hari net of grapes, spread out thin. where the oxygen and carbon dioxide exchange occurs.
- up until bronicholes, air si coming in, than at exchange is diffusion.
- aveoli very sensitive
- any type of upper body deformity will affect respiration
symptoms of pulminary impairments
- dyspnea - difficulty breathing, pain
- Chest pain- runnign hard, trying to take a deep breath
- fatigue, headaches, sleep problems.
- Anxiety - feel like out of air
- trouble concentrating, brain not getting enough oxygen
- couging up blood
more symptoms of pulmonary
- syanosis - bluish coloraiton, fingernails and lips have bluish cast, translucent sking.
- finger clubbing
- common infection
- bacterial/viral and many other causes. (strep, staph, bacteria, sources of flu, chlamydia_
- vaccines available for elders and compromised but only cover 5 common strains
- infection of pleura lining of the lungs
- caused by infection, trauma, collagen related diseases like lups or RA, pneumoconiosis- diesease cause by occupational dusts.
Processes that cause repiratory impairment
Obstructive - higher amount, results of obstruction of the bronchial tree. and blockage (asthma, chronic bronchitis)
Restrictive- restrict the lungs, take away parts of lungs able to be used. loss of lung tissue available for breathing. restrics vital capacity.
with advanced conditions you can get both
restrictive respiratory impairment
- surgical removal of part of lung
- Lung Cancer
- TB - bacillus - eats tissue, swiss cheese, cavitations. scarred/dead tissue not functional, medications won't stop sometimes and have to have resection. may remove rib to get to lung which restricts function more.
- Chronic Bronchitis
- Chronic Asthma - child and adult
- all three make up COPD
- being w/ cough. in 40's. problem at aveoli - collapse and form a bullie, trap air and not exchanged. take air in but not get it out. take short fast breaths.
- shriveling of bronchial trees. lose elasticity. develop R side heart failure. muscle hypertrophys heavier and harder to pump
Treatment for COPD
- symptomatic in early stages. remove irritant
- meds - dilate bronchial tree. liquify the mucus.
- retrain to breath.
- bird machines - breathe in meds.
how to determine O2 levels in blood
- white finger clamp.
- arterial blood gasses - hard to get, examine arterial blood under microscope. helps to know degree of efficiency and plan treatments.
- infection or leukotriennes (allergen)
- smooth muscle in bronchial tree spasms in reaction to allerfen. if sever can block and obstruct breathing.
- short fast breaths, can't breath reclining, use accessory msucles around chest. can affect heart rate and blood pressure. bloos o2 sat low.
- meds to stop spasms cortico steroids to reduce swelling.
rehab considerations for respiratory
remove irritant, how often having attacks, consider capacity and efficiency of system. control episodes with prescribed meds.
genetic proclivity. childhood infections. cough, sputum, can't control. recurrent infections. cough up blood. scarring lower lobes. bronchus gets wider and shorter.
creeping critter diseases
- treated first with antibiotics- expensive
- 1st and 2nd line
- never cured, held in remission.
class of respiratory issues due to dust/gasses/pollutants. ingesting the irritants causes inflammation in the lungs which leads to obstructive process
chemical giving buttery flavor, causes popcorn lung. irreversible, creates disease called bronchiolitis obliterans - termincal but not life limiting.
in FL, bioslime in showerhead. symptoms like TB- poor appetite, shortness of breath, cough, may cough up blood. affects women more than men. life-limiting and terminal.
blacks, esp women. immune system response that can affect multiple organs in the body buy settles first in the lungs, then heart and kidneys. causes dry eyes. lesions on arms and legs, face. looks like cauliflower. frequent infections and hospitalizations
Pain and generalized theories
- an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
- Physiological - pattern, specificity, gate, endorphin
- Cognitive - imagery, sociocultural
- behavioral - respondent, operant.
classification of pain
- 1)mild or severe, few days duration
- 2) mild or sever, days to weeks, not emergent
- 3) episodic fron cocicptive input. etiology unknow
chronic intractable benign pain syndrome
- 1) persistne over months, continued nociceptive input, etiology my be neoplastic
- 2) longer than 6 months, etiology unknown
- 3) no know nociceptive source, poor coping behavioral disorganization.
Components of the pain experience
- Pathological - disorders of structure and function, physiological component
- Perceptual- sensory characteristics
- Psychological- affect state and mood
- Cognitive - knowledge, understanding and beliefs, significance of condition
- behavioral- adaptive strategies
Physical impact of pain
- limitied ability to carry on routine daily activities
- effects of medications on behavior (sensory and motor)
- decreased mobility and endurance
- changes in physical appearance (weight loss or disfigurement)
- development of pain behaviors (adaptive and maladaptive)
Psychological nad Psychosocial Impact of pain
- time removed from work force
- # of surgical interbentions and hospitalizations
- Forces changes in lifestyle (ADL)
- perception that life is out of control
- sense of helplessness in intervening on own's behalf
- disruption of personal and family relationships
- loss of self-esteem and sense of self-worth
- health care costs and financial uncertainties.
Component operations of sensory systems
- Transduction - converting to nerve impulses
collection of nerve cells inolved in the operations of the sensory systems.
Charactersitics of chronic pain.
- impossible to predict when it will end.
- often gets worse rather than better
- lacks positive meaning
- frequently expands to dominate patient's attention
- isolates patient from others and the world around him
Chronic Pain syndrome
- complaints our of proportion to physical findings
- persistent efforst to seek medical helo
- little change in overall symptomatology
- willingness to submit to multiple or repeat therapies
- significant alteration in lifestly and interpersnal relationships.
common characteristics of chronic pain patients
- reported pain of months to years
- description similar to a previous acute episode
- lengthy med history of failed Tx
- Hx of polypharmacy with little success
- pain described as incapacitating or unbearable
- complaints viewed as urgent requiring emergency care
- expressed willingness to undergo any treatment
- report no problems other than pain
Psychological Regression in the Chronic Pain Patient
- marked increase in egocentricity
- reduced scope of interest
- preoccupation with bodily perceptions
- notable increase in dependency
- demading or manipulative insistence on attention
Factors motivating behavior in chronic pain patient
- acutely sick patients are expected to seek medical help
- patients expected to cooperatie with medical management
- sick are expected to want to get better
- privilege of the sick is exemption from responsibility
- sick are entiteled to be cared for.
Treatment goals for chronic pain
- reduce pain signals
- reduce functional impairment
- reduce pain related health care usage
- reurtn to well behaviors