Ind Study, Case studies
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| migraine S&S | before pn: flashing lights, intolerance to light (photophobia), ringing or buzzing in ears (tinnitus),unusual thirst, craving for sweet foods, unusual energy peaks, and alterations in mood and mental clarity. once pn begins, usually w/nausea, vomiting
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| migraine etiology | foods: chocolate, aged cheese, red wine, caffeine & monosodium glutamate. hormonal changes in women, sensory stimuli, odors, changes in wx & medications
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| migraines are... | changes in the cerebral blood flow, presumable due to vasoconstriction & subsequent vasodilation of cerebrocranial arterioles
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| most common type of HA | tension
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| tension headache | triggered by stress, resulting in mm tension, esp suboccipital mm's. contributing factors: fwd head posture, work @ desk
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| PT rx includes: | modalities, posture training, stretch pecs, strengthen back ext, massage, deep breathing, work ergonomics
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| enchephalitis is... | a viral infection of gray matter of the brain (often transmitted by vector mode, ticks)
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| symptoms of encephalitis are similar to... | meningitis
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| enchephalitis dx | CT, MRI
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| enchephalitis rx is primarily... | supportive & preventative
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| enchephalitis prognosis | residual neurological problems are most likely with infants
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| PPS is... | PostPolio syndrome, loss of ant horn cells of giant motor units due to normal aging (its faster with PPS)
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| S&S of PPS | fatigue, new weakness, overuse & high energy cost, decreased function & deconditioning
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| if there is infantile paralysis w/ PPS | may have collateral sprouting w/recovery of giant motor units
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| PPS rx | lifestyle change, maybe AD or orthotics, jt protection, work modification, energy conservation, power WC, ex @ submax level, aerobics w/ decreased RPE
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| seizure | finite event, the result of paroxymal excess discharge of cerebral neurons resulting in temp impairment or LOC
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| epilepsy | chronic disorder of various causes characterized by recurrent sz
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| types of seizures | generalized absence (aka Petit Mal), tonic-clonic (aka Grand Mal), infantile spasms, febrile convulsions
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| generalized absence (aka Petit Mal) | sudden cessation of ongoing consciousness, staring into space
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| tonic-clonic (aka Grand Mal) | 2 phases: a rigidity phase (tonic) followed by rapid jerking (tonic) of the whole body. often followed by LOC, falls/injuries w/ onset possible
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| infantile spasms | non-specific rx on the part of the brain, associated with cessation of psychological development
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| febrile convulsions | seizures resulting from high fever, between ages 6 mos-5 yrs
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| seizure dx | EEG
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| seizure rx | meds: phenobarbatol, dilantinin... and clear the area
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| etiology of meningitis | mainly bacterial & viral
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| bacterial meningitis includes... | inflammation & infection
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| rx for viral meningitis | treat symptoms
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| rx for bacterial meningitis | antibiotics- on isolation
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| some results of meningitis | neuro damage, hearing loss, retardation & sz
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| Guillain-Barre Syndrome | most frequent cause of acute generalized weakness due to a lower motor lesion
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| 3 forms of Guillain-Barre Syndrome | acquired inflammatory demyelinating polyradiculoneuropathy (AIDP), acute axonal neuropathy (AMAN) & Miller Fisher syndrom
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| acute phase of Guillain-Barre Syndrome | symmetrical ascending progressive loss of motor function beginning distally and progresses proximally, 80% experience paresthesia, 70% areflexia, 60% wkness in all limbs, lasts 4 weeks
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| plateau phase of Guillain-Barre Syndrome | stabilization of symptoms, 4 wks
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| recovery phase of Guillain-Barre Syndrome | begins to improve, can last up to a year
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| initial/chief complaint of Guillain-Barre Syndrome | respiratory or gastrointestinal illness, followed by weakness & sensory changes
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| dx tests for Guillain-Barre Syndrome | electromyogram (EMG), NCV, spinal tap (lumbar puncture)
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| mental status w/Guillain-Barre Syndrome | fearful, anxious
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| pain w/Guillain-Barre Syndrome | muscular in nature, sore to touch
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| appearance w/Guillain-Barre Syndrome | flaccid paralysis, bilateral facial wkness
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| sensation w/Guillain-Barre Syndrome | paresthesias (burning/tingling) or hypesthesia (abnormal sensitivity to touch)
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| jt mob/ROM w/Guillain-Barre Syndrome | decreased
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| strength w/Guillain-Barre Syndrome | acute generalized wkness, diplopia (double vision) from eye mm wkness, facial wkness, diaphragm wkness
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| mm tone/reflexes w/Guillain-Barre Syndrome | absent, areflexia is a core feature
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| cardiopulmonary w/Guillain-Barre Syndrome | fluctuating BP, poor venous return, (causes blood pooling), tachycardia, arrythmias, ventilator
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| balance/coordination w/Guillain-Barre Syndrome | fall risk due to decreased strength & eventual paralysis
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| functional mob w/Guillain-Barre Syndrome | acclamation to upright
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| gait w/Guillain-Barre Syndrome | ataxia, paralysis, none
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| ADL/Functional Assessment w/Guillain-Barre Syndrome | oral motor wkness, dysphasia, dysarthria
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| rx for Guillain-Barre Syndrome | pain meds aren't always effective, plasmaphersis (blood removed & only blood celss removed, no plasma), infusion of immunoglobins
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| prognosis for Guillain-Barre Syndrome | good, over 80% recover in a year- safeguard the musculoskeletal and cardiopulmonary systems and improve function without causing overuse damage
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| problem list for Guillain-Barre Syndrome | skin, breakdown, contractures, pulmonary function, intolerance to upright, decreased strength
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| precautions/contras Guillain-Barre Syndrome | avoid overwork wkness, extra care when performing ROM because of damaged mm
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| how does osteomyelitis get to the bone | directly thru wound or blood carries to bone
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| pn w/osteomyelitis | doesn't develop until infection has gotten to periosteum, is deep, trobbing, constant ache, even @ rest & @ night, worse w/ mvmt & WB
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| dx osteomyelitis | MRI & bone scan
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| meds osteomyelitis | IV antibiotics for 3-4 wks
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| dx test osteoporosis | DXA (dual x-ray absorptioniometry- measure bone mineral density before fx), QUS (quantitative
US), CT, RA, bone density test, biochemical markers for bone turnover
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| osteoporosis meds | Biophosphanates (fosamax, actonel, boniva
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| osteoporosis precautions/contras | flexion ex & eval or rx w/pressure techniques on thorax
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| PMH septic knee | HIV, DM, preexisting arthritis, IV drug abuse, trauma to jt
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| septic knee dx | arthrocentesis (aspiration of jt fluid), WBC, PE, MRI, ESR (erythrocyte sedimentation rate)
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| septic knee posture | increased varus or valgus in knee (common in children)
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| septic knee med rx | IV antibiotics in hospital, oral antibiotics 2-3 wks after hospital stay, tidal irrigation, arthroscopy, or arthrotomy
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| septic knee precautions/contras | modalities that can't be used during infection phase, overuse of jt in early stages
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| septic knee PT course | in acute phase-rest & splint to prevent infection from getting worse. once infection has cleared use more vigorous ex to restore functional mob, strength & stability
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| 2 routes infection can enter the hip | 1)hematogenous: bacterium may occur from dentogingival infections, pyogenic skin processes & genitourinary or GI infections. 2) direct implantation during sx 60%
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| infected THA PMH | DM, RA, previous sx @ hip, poor nutritional status, obese, low albumin, comorbities, suppressed immune system
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| infected THA dx | arthrocentesis (aspiration of jt fluid) main one
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| infected THA medical rx | 6 wk IV antibiotic after new jt replacement (or lifelong antibiotics if no add't sx), sx drainage, prosthesis removal followed by surgical debridement of surrounding tissue & replacement of new prosthesis impregnated w/antibiotics
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| infected THA precautions/contras | US, HP, compression, massage, AROM w/pn. also keep universal hip replacement precautions in mind
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| fibromyalgia | chronic mm pn syndrome; not a dx; auspice of rheumatology; possibly associated w/neurohormonal dysfunction of the ANS; most common musculoskeletal disorder in US
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| fibromyalgia PMH | prolonged anxiety, emotional stress, trauma, hypothyroidism, viral or nonviral infections, ruptured silicone breast implants
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| fibromyalgia dx | no definitive test. if pn is widespread in 4 quadrants above & below the waist for at least 3 months & 2 reports of pn when pressure applied to 11-18 common tender pts on body sometimes using dolorimeter, r/o other conditions
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| fibromyalgia medical rx | analgesics, antidepressants, metabolic rehab (triodothyroine, T3)
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| fibromyalgia precautions/contras | intense ex, overuse of mm relaxers, heavy lifting, stress
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| fibromyalgia is associated w/ | decreased mob in AM, Reynauld's phenomenon
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| ALS (amyotrophic lateral sclerosis) or Lou Gehrig disease | most common form of adult-onset progressive motor neuron dx affecting the ant horn cells & corticospinal tracts. characterized by degeneration & scarring of upper &/or lower motor neurons in lat aspect of spinal cord, brain stem, & cerebral cortex
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| initial/chief complaint ALS or Lou Gehrig disease | involuntary mm contr & mm atrophy, wkness, twitching (esp in extremities), probs w/speech, chewing, swallowing, breathing
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| PMH ALS or Lou Gehrig disease | 90% idiopathic. 10% autosomal inherited traits
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| dx tests ALS or Lou Gehrig disease | combination of clinical presentation & electromyogram (EMG), nerve conduction test, mm biopsy, MRI to r/o other dx
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| ALS or Lou Gehrig disease is associated w/ | drooping head, decreased strength of ext mm in UE & flex mm in LE, asymmetric wk in distal aspect of 1 limb progressing to wk of contiguous mm, dorsiflex lost before plantarflex, + Babinski, Clonus & Hoffman
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| ALS or Lou Gehrig disease medical rx | no effective rx, just rx symptoms. Riluzole (Rilutek)slows dx by 10-15%. myotrophin promotes survival of motor neurons & regenration of motor nerves. Vit E controls free rads. anticholinergic drugs for drooling. baclofen or diazepam for spasticity
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| ALS or Lou Gehrig disease prognosis | death usually occurs 2-10 yrs after onset, resulting mainly from pneumonia or respiratory failure. relentlessly progressive
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| ALS or Lou Gehrig disease precautions/contras | don't overwork or fatigue, rotate shd during ABD & accessory motions (subluxation of shd), watch for feeding tube w/gt belt
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| multiple sclerosis | chronic, autoimmune, progressive & irreversible dx characterized by destruction of the lipid & protein layer, the myelin sheath, that insulates & protects the axons of certain nerve cells. the demyelination process occurs at scattered sites
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| multiple sclerosis initial/chief complaint | varies due to the scattered sites of dymyelination thru-out the CNS may include sudden & transient motor & sensory disturbances, impaired or total loss of vision, mm wkness, paralysis, incontinence, fatigue, balance probs, numbness & mood swings
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| multiple sclerosis PMH | genetics have been linked to MS, along w/acute infection, trauma, serum injections, pregnancy, stress & fever
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| multiple sclerosis dx tests | no definitive test, MRI(MOST USED) r/o other possibilities w/ neurological exam, CSF analysis & cranial CT scan
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| multiple sclerosis is associated w/ | exacerbations, cognitive deficit, pn, tremors, poor tolerance to heat, ataxia, spastic mm, overshooting targets, ataxic & antalgic gt, eventual loss of bowel & bladder, ability to speak & swallow,
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| multiple sclerosis meds | interferon-beta products are injected to reduce # of exacerbations & slow progress of physical disability. avonex (taken wkly), betaseron (every other day),rebif (3x wk), copaxone (daily orally) to decrease inflammation, corticosteroids
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| multiple sclerosis precautions/contras | no HP, only low to mod intensity ex, avoid overwork, avoid overheating
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| alzheimer's disease | most common form of dementia, type of progressive, chronic, ultimately fatal organic brain syndrome characterized by the death of neurons in the cerebral cortex w/resultant neurofibrillary tangles, a tangled mass of nonfunctioning neurons & plaques
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| alzheimer's disease dx | comprehensive hx & PE that includes mental & functional health status, cranial CT & MRI, PET scan, depression scale & cognitive functioning test, lab tests of urine & blood, EEG, SPECT (single proton emission tomography)
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| alzheimer's disease is associated w/ | sundowner's, agression, rigidity, decreased ability to do ADL's
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| alzheimer's disease med rx | 1)cholinesterase inhibitors 2)memantine, regulates glutamate 3)tacrine & donepezil to control symptoms 4) anti-inflammatories
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