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Chapter 24 Arthritis Review Arthritis is a generic term for conditions that involve inflammation of one or more joints. More than 100 different forms of arthritis, each characterized by varying degrees of joint damage, restriction of movement, functional limitation, and pain Traditionally thought th...

Chapter 24 Arthritis Review Arthritis is a generic term for conditions that involve inflammation of one or more joints. More than 100 different forms of arthritis, each characterized by varying degrees of joint damage, restriction of movement, functional limitation, and pain Traditionally thought that individuals with arthritis should avoid exercise, but that ain't the fucking case no more. ○ Osteoarthritis, rheumatoid arthritis, gout, ankylosing spondylitis ○ Osteoarthritis (most common) Degradation of joints Affects articular cartilage and subchondral bone Affects women greater than men (3:1 ratio) Rarely seen in individuals less than 40 Leads to joint space narrowing, loss of cartilage, bone-on-bone rubbing, ligament strain/weakening Hands, feet, spine, hips, and shoulders are most affected ○ Rheumatoid arthritis More likely in females (3:1 ratio) Result of chronic autoimmune disorder (MS) Systemic inflammation Typically affects synovial joints (hands and feet), followed by wrists, elbows, shoulders, and knees ○ Gout Pain and inflammation occur when too much uric acid crystallizes and deposits in joints Affects men more often (3:1) Symptoms: severe pain, redness, swelling in joints (often big toe), attacks can come suddenly (often at night) ○ Ankylosing spondylitis Chronic inflammation arthritis Autoimmune disease Occurs more in males (3:1) Earlier onset - 20-40 years old Lower spine and sacroiliac joint Over time, it affects bones fuse, causing immobility ○ Joint pain, stiffness, effusion, synovitis, deformity, crepitus ○ Exercise tolerance, muscle strength, aerobic capacity, ROM, biomechanical efficiency, proprioception ○ Acute: reversible signs and symptoms in the joint related to synovitis. Fatigue, joint pain, reduced joint tissue tensile strength, reduced joint nutrition. ○ Chronic: stable but irreversible structural damage brought on by the disease process. Permanent joint damage, pain at the end of normal ROM, stiffness at rest, poor posture and ROM, joint deformities, pain with weight bearing, abnormal gait, weakness, reduced aerobic endurance and muscle strength ○ Chronic with acute exacerbation of joint symptoms: increased pain and decreased ROM and physical function. Inflammation and joint size greater than normal, joint tenderness, warmth, swelling, joint pain at rest and with motion, stiffness, functional limitations, hips and spine affected ○ There are no definitive tests or markers for arthritis diagnosis ○ Some serum and synovial fluid tests can assist in arthritis type differentiation Special considerations associated with each form of arthritis ○ Acute: avoid activities that exacerbate joint pain ○ Chronic: perform aerobic, strengthening and ROM exercises (no joint pain), initiate walking and perform in water ○ Chronic with acute exacerbations: normalize gait, same recommendations as acute phase form of arthritis primarily affects(s) the spine and axial skeleton Ankylosing spondylitis stages of arthritis when exercise appropriate Chronic stage but all of them preferred mode for exercise testing in an individual in the chronic stage of rheumatoid arthritis with moderate lower extremity joint deformities Cycle ergometry- small increment increases in intensity, im also thinking arm ergometry would be beneficial too What is the preferred mode of strengthening for individuals with acutely inflamed joints or in the acute stage of arthritis? Anyone in acute phases should not do heavy lifting on the inflamed joint. So lighter lifts, ROM and band type lifts Why should joints not be manipulated to enhance the effects of stretching in individuals with arthritis?` Joint manipulation can cause further injury to the joint and increase risk for contractures Wedged shoe insoles are often prescribed for which condition? What purpose do they serve? Osteoarthritis. Its to help prevent knee movement What benefits are there to aquatic exercise in participants who suffer from various forms of arthritis? Reduce pain (specifically on knee joints), blood vessels dilate, increased blood circulation Are there any drawbacks to aquatic exercise? Who is affected? Tolerance to chemicals (chlorine), people with rheumatoid arthritis Fibromyalgia Chronic Pain Syndrome NOT a form of arthritis but easily confused as arthritis - chronic pain syndrome affects about 5 million adult Americans - not a form of arthritis (although widespread musculoskeletal pain and so-called trigger or tender points) - 2% of adult Americans, women more than men (7:1) - widespread pain in combination with tenderness at 19 specific tender point sites (need all 19) - may also have problems thinking/remembering, poor sleep quality/insomnia, depression, fatigue, and lower than normal pain threshold Considerations need to be taken into consideration for an individual who suffers from fibromyalgia Aerobic exercise is beneficial and can improve aerobic capacity and physical function Minimizing pain with strength training include, limiting eccentric exercise, performing upper and lower extremity training on alternate dats and resting between reps, aquatic exercise is also good for them Problems thinking/ remembering, poor sleep quality/insomnia, depression, fatigue, and lower than normal pain threshold. Exercise goals specific for the treatment of arthritis Reduce disability Restore physical activity Improve body composition Control symptoms and reduce pain Chapter 25 Osteoporosis checklist Define Osteoporosis Classically been defined for older women and men, as a pathological condition associated with increased loss of bone mass caused by increased bone resorption. This bone loss can lead to increased risk of fracture Bone mineral density (BMD) falls 2.5 standard deviations below the mean (T-score:-2.5) The two most important factors in the development of osteoporosis is the amount of peak bone mass attained and rate of bone loss What is the difference between osteoporosis and osteopenia Osteopenia Is a less severe form of the disease in which bone mass has declined below normal levels, but not to the extent seen in osteoporosis. BMD T-score is between -1 and -2.5 What is a t-score? T score compares bone density with that of a healthy person What is a z-score? Z score use the average bone density of people of the same age, sex, and size · What items are used to calculate10 year probability of fracture? Fracture risk assessment tool (FRAX) - extends beyond BMD to look at other patient risk factors (age, gender, oral glucocorticoids, history of fracture) · What purpose does this calculation serve? It uses this data and calculates ur probability of fractured base on algorithms from large populations · What are some diseases that increase the risk for “secondary” osteoporosis or fracture? Rheumatoid arthritis, malabsorption syndromes (chrons, ulcerative colitis), sex hormone deficiency, hyperparathyroidism. Chronic kidney or liver disease, diabetes, COPD, drugs used to treat breast or colon cancer · What is the estimated bone loss per year once an individual passes the age of 40? 1.3-1.5% · What is peak bone mass? How is it acquired? Peak bone mass or the highest amount of bone mass obtained during life, is attained by approximately the end of the second decade. It is influence to a certain extent by genetics but also PA diet and hormonal balance · Define o bone remodeling Continual process of bone resorption and bone formation, it maintains the architecture and strength of the bone. Regulates calcium levels and prevents fatigue damage o bone resorption Breakdown of bone by osteoclasts o bone modeling Bone formation occurs without prior bone resorption · Identify signs and symptoms for osteoporosis/osteopenia Osteoporosis is asymptomatic, consider possible risk factors, a fracture occurred from an event that would normally not cause a fracture may be a red flag. Vertebral fractures can cause height loss, protruding abdomen, hyperkyphosis, or other postural changes; however they not be noticeable until multiple vertebral fractures have occurred · What should be assessed during History and Physical examinations? Why? Medical history, medications, comorbid conditions, and contraindications to exercise Fracture risk (FRAX or CAROC) Fall risk Physical performance Standing posture Barriers to and facilitators of physical activity · What is BMD? Bone mineral density o How is it measured? Dual energy x-ray absorptiometry (DEXA) (DXA) bone mineral content per unit are · What are modifiable and non-modifiable risk factors associated with Osteoporosis? Non-Modifiable Age, female sex, parental hip fracture, (postmenopause, hypogonadism, prolonged amenorrhea, or premature menopause (Pre 45)), rheumatoid arthritis, history of fragility fracture, prolonged use of oral glucocorticoids or other high risk medications, other disorders associated with rapid bone loss or fracture Potentially modifiable Low body weight (10% of body weight at age 25 year), current smoking, high alcohol intake (three or more drinks a day), caffeine intake greater than four cups of coffee a day · Are there any contraindications to exercise or exercise testing? ACSM does not view osteoporosis as an absolute or relative contraindication With osteoporosis/penia avoid exercise testing that involves high impact skeletal loading such as jumping and stepping · What are some key components to an exercise program for an individual with osteoporosis? A multicomponent program, including aerobic training, progressive resistance training, and balance challenges should be encouraged Prolonged cardiorespiratory training can increase fitness by 10%-30% with a reduction of CVD risk. Progressive resistance training offers greatest benefits for muscle strength and bone density. And spine sparing strategies prevent undesirable spinal loading and teach good alignment during exercises · What does it mean to use spine-sparing strategies? Give some examples. Prevent undesirable spinal loading and teach good alignment during exercise Non-loaded lifts/exercises - doing core exercises on a ball vs laying on the floor (so they are not curling their vertebrae into the floor) Chapter 26 Non-Specific Lower Back Pain Review JUST FACTS · Most individuals will experience an episode of NSLBP in their lifetime. (fact) · Back problems are the most common cause of disability for Americans under the age of 45. (fact) · The majority of low back pain has an identifiable cause. (fact) · It is common to find flexibility deficits around the gluteal or hip area associated with adaptive shortening due to inactivity. (fact) What is the primary definition of nonspecific low back pain (NSLBP)? Defined as pain experienced in the lumbosacral region in the absence of major identifiable pathology, below the ribs and above the distal fold of the buttocks What does "yellow flags" (in relation to NSLBP) specifically refer to? Indicate risk of developing chronic pain Personal and psychosocial obstacles: depression, anxiety, fear, avoidance, lack of motivation Work preparedness obstacles: occupational stress, job dissatisfaction, lack of social support, low self efficacy, low work capability Environmental and social obstacles: incorrect understanding of medical problems and health management, poor organizational culture, uncertain employment statues What is the best way to determine whether or not an individual will experience an episode of NSLBP? Previous history of back pain episodes What are the various intervention strategies utilized to provide therapy for clients with NSLBP? 1.Medications, 2.exercise, 3.passive modalities (heat, massage, spinal traction), 4. Facet joint injections, 5. Surgeries: spinal discectomy, spinal decompression and spinal fusion Which intervention strategy has been shown to produce the greatest therapeutic benefit for clients with NSLBP? Resistance training What is the value of using diagnostic imaging techniques, such as MRI, radiographic films, and CT scan? To rule out serious spinal issues, help narrow the causes of an injury or illness and ensure that the diagnosis is accurate Why is the use of narcotic analgesics not common practice in patients with NSLBP? From book: although some physicians still prescribe narcotic analgesics or opioids for relief of musculoskeletal pain, these appear to have no greater benefit than safer analgesic and are generally considered a poorer choice CNSLBP What is the difference between a primary and a secondary prevention strategy? Secondary prevention strategies: which help them avoid recurrences through exercise and patient education. Primary prevention strategies: for individuals whose occupational, household, and recreational pursuits place them at a higher risk is prudent From her slides describing the difference Primary strategies: choose safe equipment, address negative lifestyle choices, initiate balance exercises, encourage position changes, educate on proper lifting techniques, and encourage physical activity Secondary strategies: identify problems early, limit bed rest, encourage return to activities, avoid aggressive spinal loading, be able to adapt programming, encourage compliance What is the hypothesized value of informing a client that pain improvements may require a considerable amount of time to take effect (potentially up to 4-6 wk)? *couldn't find a specific answer so i assume: the value of informing a client that it will take time is to make sure they don't get discouraged when they dont get immediate pain relief and give up on there rehab What are the benefits to a supervised exercise program affect the patient with NSLBP? Increased all: physical activity tolerance, pain tolerance, range of motion, physical fitness and strength, health-related QOL, functional capacity, overall physical activity participation levels What are the therapeutic benefits of unloaded exercise in patients with NSLBP? There is strong evidence that, compared with no exercise, unloaded movement facilitation exercise is effective for improving pain and function for people with non-specific chronic LBP. What are the objectives in the primary care management of patients with NSLBP? No specific answer so: obtain similar improvements in PA tolerance, physical function, and health related QOL as persons without NSLBP Chapter 27 Spinal Cord Injury –Review Define the following terms: Identify how each of the terms relate specifically to spinal cord injury? · Tetraplegia- injury to the spinal cord that results in impaired arm, trunk, and leg function · Paraplegia - injury resulting in impaired function of the trunk and legs · Autonomic dysreflexia- Autonomic dysreflexia (AD) affects individuals with SCI above the splanchnic sympathetic outflow(i.e., T6 or above) (107). AD results from a noxious afferent stimulus below the level of the lesion (e.g., overdistended bladder, urinary tract infections, ingrown toenails, cuts, bruises, and pressure sores). google-Autonomic dysreflexia (AD) is a dangerous syndrome involving an overreaction of your autonomic nervous system. It causes a sudden and severe rise in blood pressure, in addition to other symptoms. People who've had a spinal cord injury are most at risk. · Circulatory hypokinesis- reduced venous blood return to the central circulation, thus lowering stroke volume, cardiac output, and eventually blood pressure. Venous stasis, deep vein thrombosis and subsequent pulmonary embolus may occur as a result of CK · Spasticity- is a velocity dependent increase in muscle tone with exaggerated tendon jerks, it has been shown that 53-78% of persons with chronic SCI experience symptoms of spasticity. 173). Spasticity can affect exercise ability and causes significant functional impairments such as a restricted ability to carry out ADLs, pain, fatigue, inhibition of functional ambulation, increased risk of developing contractures and pressure ulcers, and difficulties with self-hygiene · Pressure sores- areas of damage to the skin and the underlying tissue caused by constant pressure or friction What are common contraindications for exercise in individuals with a spinal cord injury? · Absolute- autonomic dysreflexia resulting from recent fracture- may participate in spasms or increase the risk of fatty emboli, hypertensive crisis or cerebrovascular event. Orthostatic hypotension, with the risk of syncope. Recent deep vein thrombosis or pulmonary embolism. Pressure ulcers, which increase the risk of autonomic dysreflexia during exercise · Relative- acute tendinitis (e.g. rotator cuff, elbow flexors, wrist flexors/extensors). Chronic heterotopic ossificaiton. Peripheral neuropathy, pressure ulcers of grade 2 or less. spascitiy What is functional electrical stimulation (FES)? How is it utilized in patients who have spinal cord injury? Is a technique that uses electrical current to cause a muscle to contract. Computerized FES is a neuromuscular aid used to restore function in upper extremity, lower extremity, and truncal muscles paralyzed by upper motor neuron lesions as well as to restore bladder and respiratory function and prevent pressure ulcers (68, 85). Briefly, FES of the lower extremities can be used to do the following: stimulate skeletal muscle strength and endurance, increase energy expenditure and stroke volume, increase total body peak power, VO2 peak, and ventilatory rate, reverse myocardial disuse atrophy, increase HDL levels and improve body comp. Improve self perception, inc lower extremity BMD What is the typical peak exercise heart rate response in those with a spinal cord injury? Does the HRR change/vary by the location of the injury? How? Specifically, peak heart rate rarely exceeds 120 b ∙ min−1 in those with complete tetraplegia and T1 to T3 paraplegia. Although variable responses occur in T4 to T6 paraplegia, most persons with SCI below T7 are able to reach their age-adjusted peak heart rate. Similar trends are reported for blood pressure responses. What is the typical peak oxygen consumption value of a patient with tetraplegia and paraplegia, respectively? Exercise capacity norms have been previously published: For TP, O2 peak of 16.95 mL ∙ kg−1 ∙ min−1 is excellent (94); for PP, O2 peak of 34.4 mL ∙ kg−1 ∙ min−1 is excellent. In general, O2 peak and peak power output are significantly diminished in people with SCI (9, 18, 90, 95, 152, 153). But the lower the injury, the less the impairment. O2 peak values range from 12 mL ∙ kg−1 ∙ min−1 for individuals with tetraplegia to more than 30 mL ∙ kg−1 ∙ min−1 in persons with low-level paraplegia. In these same groups, peak power output ranges from less than 30 W to more than 100 W, respectively. What percent of heart rate reserve has been found to correspond with an exercise intensity between 50% and 85% of peak in an individual with high-level paraplegia and tetraplegia? 30% to 80% HRR What are the benefits of range of motion exercises? Perform daily, focus on all major joints with important in maintaining shoulder ROM to decrease injury risk. Range of motion exercise is necessary for all parts of the body, including those with partial or complete loss of control and feeling, to avoid contracture and reduce spasticity. What might aid in providing added balance during resistance exercise training (performed while seated in a wheelchair) in a person with a spinal cord injury? Seatbelt straps over the shoulders What is the recommended duration of aerobic exercise training in those with spinal cord injury? Specifically, if exercise intensity is moderate, then people with SCI who are categorized as intermediate clients should aim to complete a minimum of five 30 min sessions (150 min) per week; but if exercise intensity is vigorous, then 3 × 25 min (75 min) is an appropriate minimum target Why is close supervision important when using dumbbells and free weights in a patient with a spinal cord injury? Although dumbbells and free weights may be used under close supervision, paralyzed lower extremities and truncal musculature significantly reduce a person’s ability to balance even small objects when lying supine or when seated without significant truncal support. When the person is using free weights or isotonic or isokinetic machines, wheelchair brakes should be set before lifting, and care should be taken not to exceed the weight and stress limitations of the wheelchair as provided by the manufacturer. In addition to usual contraindications and exercise limitations based on age and gender, which of the following are concerns in the client with SCI? MULTIPLE SCLEROSIS https://quizlet.com/787930954/ms-flash-cards/?i=5r7i1a&x=1jqt Define MS Multiple sclerosis (MS) is an inflammatory autoimmune disease of the CNS characterized by nerve demyelination Multiple sclerosis occurs within what area of the body? Brain and spinal cord What areas of the body are affected by multiple sclerosis? (How specifically is the body affected?) Affected body area can be broad, can hear some days, others they may not be able to smell, and it can vary from day to day. Anything the nerves connect to. What are the most common symptoms of multiple sclerosis? Muscle weakness, symptomatic fatigue, numbness, visual disturbances, walking, balance, and coordination problems, bladder dysfunction, bowel dysfunction, cognitive dysfunction, dizziness and vertigo, depression, emotional changes, sexual dysfunction, pain What is the most commonly used technique to identify sclerosis (plaques)? MRI What group/population/gender is most affected by MS? Women and men are between 20 and 50 years of age, but women are affected 2x times the rate of men. What are the four main types of clinical courses that classify MS? Relapsing-remitting Primary Progressive Secondary Progressive Progressive-relapsing What are some special considerations for a patient with MS during exercise? Thermoregulation is poor; therefore → hydration, controlled temperature in the room, maybe an electric fan, consider precooling Fatigue could occur earlier in people suffering from MS Take safety precautions by watching them carefully for balance and coordination issues. What is the Kurtzke expanded disability Scale? What type of information does it provide? Kurtzke EDSS is a standardized tool to objectively rate an individual’s ability to perform specific exercises. Scored range from 0 - 10, high score = more significant disability Compared to apparently healthy individuals, you would expect the submaximal oxygen consumption of a patient with MS to be Higher A patient with MS presents with ataxia of the arms. What modification would you recommend for this individual's strength training program? Why? Ataxia (Incoordination of movement) work less free weights and more resistance bands due to the risk of injury. How can impaired thermoregulation during exercise be problematic for an individual with MS? Easily overheat or pass out from poor thermoregulation. What type of stretching should an individual with MS perform pre- & post-exercise session? Slow, gentle stretching to the point of tight or mild discomfort What is the progression rate of MS? Very slow over time, but sometimes, it won't progress. NUMBER 1 Case Study Questions Based on the medical history, what is the primary disease of concern? Are there any comorbidities? SCI Obesity, Diabetes, CVD, Respiratory disease, depression, pain management Describe the patient's diagnosis, pathology and comorbidities? Hit by drunk driver Obese, bad physical fitness, depression What major symptoms or signs are of the disease of concern? Fucked up everything Autonomic dysreflexia - abnormal reactions to CNS stimulation, homeostasis is fucked What are the recommendations for medical clearance? Is an exercise test required? Thermoregulation, balance and coordination, hypertensive responses, empty urine bag (bladder) prior to exercise. Cant do shit with her Are there any absolute or relative contraindications to exercise? Absolute - Autonomic dysreflexia from recent fracture, may not be absolute anymore- we can't do shit with her besides upper body stuff. Is it managed, can she exercise while having this shit. Make sure she empties her system before exercise so she is not incontinent during exercise. Relative - Acute tendinitis in her shoulder, aka bad shoulder because anders is assuming shit She is at risk for pressure sores Discuss medication? Doubt it because we can't google those Are there any results from physical exam that may influence recommendations? She is very deconditioned, and might need O2 during exercise Monitor shoulder pain and dizziness Occasional PVCs are normal but should be monitored Based on Ex testing results are there anything regarding safety? Thermoregulation problems No overhead exercises, she might fuck up her shoulder or not have the best motor control to perform What benefits would we observe with exercise? Mental health, weight management, breathing, VO2, BMI, basically anything and everything Anything else? They did mention occasional to frequent PVCs Shoulder pain and fatigue 12 week ex prescription Cardio 5 per week 30 min break up if necessary UBE Resistance Use bands and watch carefully ROM Daily All joints, specifically shoulder Issues affecting ability to adhere Pain tolerance and motivation Exercise progression? Symptoms, pain, any relative or absolute contraindications flare up Medical history and test results where should they be educated on? Mental therapist, nutritionist, someone to deal with motivation and paraplegic exercises Gonna need the squad for this woman NUMBER 2 She enjoys biking** It is not an absolute nor relative contraindication to exercise just avoid falling Multicomponent program with aerobic anaerobic and balance training Use spine sparing strategies to avoid broken backs What is the primary disease of concern and comorbidities? Ostenia, Parathyroidism - secondary risk for osteoporosis Postmenopausal - sex hormone deficiency osteoporosis Mild hypertension Shes asian Describe diagnosis and comorbidities >1 but