Stanbridge - Program Review - Other Systems

• These study notes cover a variety of other body systems for PTA 1107 students.
• The notes focus on the etiology, risk factors, treatment, and interventions for assorted diseases and disorders.
• The objectives include Osteoporosis, Rheumatoid Arthritis, and Osteoarthritis and being able to distinguish between the three diagnoses
• Discuss the underlying pathology of lymphedema and common treatment techniques
• Identify the Addison's disease, Cushing's disease, hyperparathyroidism, hypoparathyroidism, and hyperthyroidism and being able to distinguish between all four diagnoses
• Go through the etiology, risk factors, complications and interventions for diabetes mellitus and diabetic neuropathy
• Understand common signs and symptoms of GI and urogenital system diagnoses
• Identify the major red flags for cancer and where each organ refers pain
• Understand the major cause of seizures
• Understand the various parts of vestibular system, tests and measures used for diagnosis, and treatment interventions

Types of Metabolic Bone Disease

• Osteomalacia involves the softening of bones.
• Osteopenia means too little bone or low bone mass
  • It occurs with a deficit in hormonal levels, inadequate physical activity (mechanical load), or poor nutrition.
• Osteoporosis involves decreased bone density.

Osteoporosis

• It is the most common metabolic bone disease.
• Osteoporosis develops when new bone formation fails behind resorption, caused by impaired new formation/declining osteoblast function.
• It affects structures like vertebral bodies, hip, ribs, radius, and femur, most common fracture sites.
• Risk Factors include genetics, menopause, more common in women, for aging 50 and older, inadequate physical activity, poor nutrition, excessive alcohol use and medications such as steroids and heparin.
• For treatment of osteoporosis, resistance training of 8-10 exercises targeting major muscle groups, 2-3 days per week with 8-12 reps is encouraged
• As well as aerobic exercise for 5 or more days per week for 20 min of vigorous or 30 min of moderate exercise
• Spinal precautions: Avoid spinal flexion activities and combined spinal flexion/rotation to decrease stress to discs/vertebrae.
  • Appropriate progression involves increased resistance intensity within structural capacity of the bone.
  • After fractures, do not do plyometrics until the fracture cause is identified.
  • Functional movements like stair climbing, squats, and sit to stand are allowed.

Rheumatoid Arthritis Characteristics

• Joint signs and symptoms: warmth, swelling, prolonged a.m. stiffness, and increased joint pain with activity
• Systemic signs and symptoms: sickness, fatigue, weight loss, fever, rheumatoid nodules, and possible ocular, respiratory, hematological, or cardiac symptoms
• In the Acute Inflammatory Period, educate the patient for rest, joint protection, conservation of energy, performance of ROM, and activity
• Pain relief achieved through modalities, gentle massage, immobilization/splinting, relaxation techniques, and medication
• Range of motion is maintained with PROM, AAROM in pain-free range and Grades I-II joint mobs.

Acute Inflammatory Period Management

• Minimize Joint Stiffness and Maintain range of motion via PROM or ARROM
• Grade I and II joint mobs will prevent fluid stasis and minimize pain
• Exercises:
  • Isometrics in pain-free range lead to progression as ROM tolerated
• Joint Protection and Energy Conservation
  • Use supportive and assistive equipment
  • Bed positioning during rest
  • Avoid causing stress to joint
• Precautions: Respect fatigue and increased pain, do not overstress osteoporotic bone or lax ligaments
• Contraindications: Do not stretch swollen joints, or apply resistant that stress joint

Chronic and Subacute stage Management

• Treatment continues between exacerbations, with joint protection and modification
• Improve flexibility, muscular performance, and cardiopulmonary endurance
• Introduce non-impact or low impact exercises such as swimming and bicycling
• Group activities such as water aerobics
• Diseases and medication is structurally weaken so all capsules, ligaments and tendons requires
• Any interventions need to dosage should be carefully graded
• Vigorous stretching or manipulation techniques are contraindicated

Osteoarthritis Etiology

• Etiology is not fully understood.
• Major stress to joint, repeated minor impact, poor movement of synovial fluids movement during immobilization are all factors that contributes
• Genetically related
• Risk factors include obesity, repetitive sports, quadricep weakness and work that requires kneeling, squatting and heavy lifting

Osteoarthritis characteristics

• Synovial and capsular thickening and joint effusion are characteristics
• Hypermobility or instability occur before hypomobility
• Pain and decreased will to move
• Cartilage splits and thins
  • Decreased ability to withstand stress = crepitus, loose bodies in joint
• Subchondral bone Exposed and Joints may because enlarged
• Onset Age of 40 years and develop slowly or many years mechanical process or traumatic.

Osteoarthritis Joints Signs and Symptoms

• Manifestations include cartilage generation, altered joint structure, osteophyte formation
• Joint involvement affects a few is usually asymmetrical
• DIP PIP is CMC of hands and Ist MTP is feet
• C/A C/S lips and knees
• Joint sign and symptoms is morning stiffness or joint pain lasting less than 30 minutes
• There are no systematic signs and symptoms
• Pain usually increases b/w activity and joint rest
• Stiffness often in A/N or after periods of inactivity, " gelling " of involed patients is caused by fluid stasis and need
• There needs to have the right balance b/w activity and rest.

Lymphedema

• Lymphedema is a Chronic edema that occurs in extremities in patients with damaged or missing lymphatic issues.
• Extremities in face, neck, abdomen and gentile
• Classified primary of secondary to ideology also know idiophatic
• The primary is a benign condition generally caused by conformation and lymph vessels or lymph nodes.
• Lymphedema comes developed later and life what local information comes from musculoskeletal injury, local infection, or insect bites comes with a congenital predispositions.

Secondary Lymphedema

• Occurring in absence of anatomy combination, and developing at any age.
• Malignant tumors are obstructed by lymphatic flow in traumatic injuries
• Filariasis (filarial worm infestation), can damage the lymph nodes and vessels.
• Iatrogenic lymphedema can result of medical interventions such as radiation therapy in lymph node removal, the damaging the lymphatic circulation, particularly breast cancer.
• Contraindications including infections blood clots malignancy in the involved limb CHF, acute renal failure pregnancy, kidney infection, DVT

Lymphedema Interventions

• Patients was snowed a suspected Cardiac information are greatest and fluid may be removed from edema to increase cardiac.
• The new symptoms, particularly SOB, chest pain, diaphoresis or changes in the values increase during treatment should be notified.
• Manual interventions requires complete decongestive of physical therapy CDPT in the first phase.
• Intensive phase involved a meticulous scan there in manual lymph drainage, bandaging, and exercise what the band is.
• Bandages should be short stretch and be provided twice a day that lasts 4 to 6 mins.
• Phase 1, when edema is under control patients fitted with a compression garment.
• MLD massage is intended to an increasing level, is the movement of lymphatic inner station.
• The pressure exerted during MLD is avoid compressing and closing off the lymphatic channels
• Hand positions used for MLD are based on the anatomy and function of lymphatic system
• The approach is combining strokes circle's pumping, scooping and rotary strokes all flow to the lymphatic flow.

Addison's Disease

• Also known as primary Adrenal insufficiency and lack of cortisol that is released into the adrenal gland.
• Addison's disease affect 4 in 100,000 in the United States.
• Slightly higher in women than men and appear in people from middle-age, 40 to 60 years.
• Etiology may be considered Autoimmune at surgery (including dental procedures)
  • Pregnancy is possible (especially with postpartum hemorrhage)
  • Accidents injury of salt loss
  • Infection and profuse Diahporsis from (hot water or strenuous physical exertion

Addison's Disease Manifestations and Symptoms

decreases in cortisol

• Symptoms in the resulting disease will decrease the production, the clinic deficiency causes will present with widespread.
• Glucocorticoid disturbances such as hypoglycemia and liver glycogen deficiency
• The most common signs and symptoms include emotions to certain stressors.
• fatigue to hypotension, emotional disturbances
• Diminishes resistance and electrolyte imbalances .
• And skin irritation occurs with those with chronic Adison
• Treatment, acute can be address by replacing lost fluid, and underlying problems.
• Pharmacology is used to treat chronic conditions, and mineralocorticoids is the second options.

PTA implications and Addison

• Adrenal insufficiency which should reduce stress of exercising
• Aquatic physical therapy may be contraindicated for anyone with Addison's with the humidity in heat.
• Should monitor all vital signs, especially in medication dose, and progressing exercise programs
• Adverse signs include dizziness, pain, and nausea profuse sweating, elevated heart rate, and tremors or shaking
• Patients need a braclet, for emergency kit and hydrocortisone
• Cushing Disease occurs to a large amount of ACTH in Pituatary

Cushing Disease, Etiology

• Hypercotisol results from an oversecretion in AETH and ACTH
• Clinical presentation is mainly the same for both conditions
• Increased rate with women than men and increase in peak and 20 to 40 and seen those up to age 60 year.
• Cushing diseases consist of tumors known as ACTH
• Treatment is a like for any develop medication includes Cushing diseases steroid use
• With any increased introduction of gluco corticoids physiologic responses is possible
• Distended with abdomen with purple striae in (Stretch Marks) And slow wound healing

Hyperthyroidism

• Too much Thyroid hormone, caused by an immunologic, genetic factors is affects Women more than men (4:1)
• The common form from hyperthyroidism is grave disease which comes Autoimmune
• mild symmetric enlargement of the thyroid that is a hoiter and nervousness.
• Weight loss and increased appetite. Includes heat intolerance.
• There are system includes central cardiac cardiovascular in muscular intergumentary okular and genital urinary
• Hoarseness, is difficulty swallowing and increased eyes.

Hyperthyroidism, Treatment

• The (1) anti-thyroid medication therapy use, and 12 year is therapy period
• (2) radioactive iodine (RAI) which can require long life change.
• Leaves the thyroid in order permanent replacements, requires surgery and will requires a.
• Report any PT should change. Meds used to help monitor any vital signs and temperature.
• PRN there may affect muscle weakness.
• Remain the safe while the exercise therapy is is effective.

Hypothyroidism

• Low thyroid or low thyroid hormone
• Most common disorder of thyroid peak is 30 to 60 years old
• Very in ordinary. Are mild is
• Are is the of treatment is are goals the correct thyroids

Hypothyroidsm & PTA

• PT similar the room in rheumataris
• Complains of pain.
• To address the muscular complaints address tolerance to activity and with intolerance and weakness that leads to slow tolerance, may increase.
• Important to note that patients and are constipated and low bowel -Women most likely the men and if a patient is over the age of 60 may go undetected, with a change of calcium and phosphate and it affects the one four parathyroid.
• Pathogenesis cause bone loss, and fracture easy with bone demineralization and renal issues
• Main problem of PTH, excessive bone damage
• Patients may experience muscle tremors and pain in areas close with skeletal renal. There prognosis is good.

Hyperparathyroidism (PTA implication)

• Pathologic bone fracture and treat each with caution Assist while and keeping bed rail is and help immobilized the reduce stress for muscle week recover.
• Postoperative positions Patient should have support with the head of degrees in order decrease edema
• Watch for signs of hand weakness or the hands
• Watch and assist while patients with gate training, weight barring increases, bone density Upper extremities increase for in surgical area's.

Hypoparathyroidism

• Parathyroid affect the regualte calcium in human body
• Abnormally low Ca leads to neuromuscular irritability.
• Factors: Accidental damage, from an injury with surgery autoimmune.
• Medical surgical is that's helps, and the 5 Saunders can occur and increased activity. and the fingers this increases in muscles is.

Hypoparathyroidism Prognosis

• acute intervenous (iv) that is to help reduce convulsions
• chronic management helps with pharmacologic
• Recovery is diagnosed early due to complications
• For treatment PTA is need to be careful and signs laryngospasm
• It will be less severe, but can cardiac problem

Prediabietes

• Blood sugar begin from rising
• Body may not regonize insulin
• Can lead to blood pressure Comorbidities such as type 2 diabetes. And with DM can fall to what type 1 and 2
• Type 1 is insulin dependent, and cause is hyperglycaemia production
• Type 2 non insulin and adult onset is combination of cellular resistance and poor secretion

Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus

• Type one from cell destruction caused by insulin
• Rates are rapid and infants, children and slow with adults
• Both is and adult hood
• Test for average glucose of 2 three months
• And is glucose is level blood the to are links 2 and 1 type
• It the have hours breakfast be 35 for for

Risk factors for Type 2 Diabetes Mellitus

• Postie family history
• Obesity
• Increasing age
• Physical inactivity hypertension vascular (vessels)
• HDL cholesterol
• Cig smoking

cardinal Pathophysiology and Symptoms and Diaebtic

• Can cause fluid loss weight in visula
• Type two may same have in but may be less aware of
• Visual, can cause foot and infections
• Leads to arteriosclerosis

coronary Pathophysiology and Symptoms and Diaebtic

• causes heart and the and the failure to heart in the vessel disease that can lead it it and then cardio.
• Failure leading to transplant
• Visual changes and hypoxia increases the risk
• Can be musculoskeletal 2 and 1 disorders

Pathophysiology and Symptoms and Diaebtic: Hand, Sholder

• Duputrens is the contraction. In flexor the third and fourth which cause flexation.
• Can be cause by nodules is the cause with flexion.
• More common is Women than and affects the thumb and ring
• CTS happens in one which affects the area is the for and nerves.
• Shoulders are most commonly affected and decreased external and flexion.
• Is most commonly affected by tingling/and burning due to high amount of pain all sensations with increase and of.

Neuropathy and PTA

The development to a in has from high be

• The and repetitive and the and will of be the heads, will the of the of
• And will long term a for in are
• That all the are • Medical from for help control.
• is should there be to before.

GI SYSTEM

• GERD is caused by the esophageal by the les and The reflux is may from direct damage cause alcohol decrease. These increase heart problems are some problems is right there. Laying down or being right side will create problems.
• Gastritis is inner layers for cause nausea with the Removal in reduce the risk and the meds avoid the
• Ulcers to cause to is can to monitor it be
• Is and symptoms be with bowel with with with function.

GI: Diverticulitis, Hepatitis

• Divisuliti inflammation colon or diet
• Is to can
• is cause.
• and will and is rupture Hepatitis with transmitted oral and for B is and blood treat or that in A C liver. And cause bed

GI System- Cholecystitis and Cholelithiasis

• Gallstone that inflamed
• Asytoamtic. rebound quadrant and inters
• Fat for the pain and the
• To with the surgery benefit. And help and cough.

Geniournary and The UTI's

• Can cause incontinence,
• UTI tract from be
• Increased or

Obstetrics - Diastisis Rectis and Caustion

• Separation can be caused by pregnancies
• Test line be and the with
• In and support with and help mechanics
• "CAUTION" acronym for cancer:
• Change in bowel/bladder
• A sore • Nagging Lies and with there the with level grade

Vestibular System

• Head thrust test is used to assess vestibular
• Ocular Reflex exercises

Vestibulocollic Reflex (VCR)

• Vestibulo spinal to help right and to keep up right
• BPPV (benin and vertigo
• Epley maneuver ( reposition maneuver)
• Gaze to and habitation. There eyes conditions that and and a be can be that .