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78 Cards in this Set
- Front
- Back
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Metabolic syndrome |
Central obesity (based on waist circumference/BMI) + 2 additional findings: Raised TGs, BP, or fasting plasma glucose, reduced HDL. |
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Optimal waist cirumference |
Women- less than 80cm (31in), high risk is more than 88cm (35in). Men- less than 94cm (37in), high risk is more than 102cm (40in). |
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5As of lifestyle change/management |
1. ASK permission to explore, 2. ASSESS their situation, 3. ADVISE on pros/cons of change, 4. AGREE on realistic changes to be made, and 5. ARRANGE follow-ups/ASSIST in identifying/addressing barriers. |
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Stages of change model |
Precontemplation->contemplation->preparation/determination->action (greatest chance of relapse here*)->maintenance->relapse. |
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Topics used to address to use in those unsteady to quit towards cessation (5 R's) |
Relevance (why?), Risks (cons), Rewards (pros), Roadblocks (potential barriers), and Repetition (may take more than 1 attempt). |
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Poor self management in patients with chronic illness |
Missing appointments or follow-up referrals, not follow diet/exercise recommendations, take meds that interfere with prescribed therapies, ignore/not recognize signs of adverse events or disease progression, behave in ways that put them at risk including not adhering with prescribed medical therapies. |
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Chronic Illness Self-Management |
Encouraging a more active lifestyle, help patient acquire knowledge about the condition, effective use of medications, effective use of health care providers. |
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Self-management |
Individual's ability to maintain the symptoms, treatment, physical, and psychosocial consequences and lifestyle changes inherent in living with a chronic illness. |
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Efficacious self-management |
Encompasses the ability to monitor* one's conditon and to effect the cognitive, behavioural, and emotional responses necessary to maintain a satisfactory QoL. |
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Dr. Pratt's research re: distress level |
Found that as your K6 score increased, your hazard ratio also increased. The higher the score, the higher your odds of death. People in the 11-24 category K6 score were 2.6x more likely to have died. Bottom line: stress affects your health! |
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Neuroplasticity |
The property of the brain that enables it to change it's own structure and functioning in response to activity and mental experience. |
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5 Stages of neuroplastic change |
1. General cellular repair (healthy underlying brain cell functions), 2. Neurostimulation (apply energy to initiate change in existing brain patterns), 3. Neuromodulation (boosting parasympathetic activity by balancing out the ANS and reducing hyperarousal) 4. Neurorelaxation (balanced ANS for >4wks) and 5. Learning (building new brain habits through regular practice and repetition). |
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Ventral Vagal Complex (myelinated mammalian vagus) |
Enable social interactions* to regulate physiology and promote health, growth, and restoration (sleep) by balancing the unmyelinated vagus and the SNS. |
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Neuroception |
Sensing of safety, danger, or life threat triggering adaptive neural circuits. The brain is constantly reassessing which level of circuitry is needed to manage the situation that you're in. |
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The Face-Heart Connection |
A critical component of a social engagement system. From birth all mammals have a bidirectional communication between the face and the heart. |
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Fusiform facial area (FFA) |
Makes people feel safe and tells the amygdala things are safe and good. |
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Coaching |
The art of creating an environment, through conversation and a way of being, that facilitates the process by which a person can move toward desire goals in a fulfilling manner (it is NOT being an expert or DOING the therapy). The heart of coaching is the relationship. |
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Three Core Coaching Skills |
Mindful listening, open-ended inquiry, and preceptive reflection |
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Screening questions for stresses |
Any unexpected or overwhelming stresses in the past year? Any persistent stresses at work or home in the past year? Do you have persistent financial distress? Screen for psychiatric problems with the PrimeMD. |
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Screening protocol for sleep disturbances |
Bedtime and awake time, Excessive daytime sleepiness, Awakenings from sleep, Regularity of schedule, and Snoring (B.E.A.R.S). |
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Screening protocol for Obstructive Sleep Apnea (OSA) |
Snore? Tired? Observed that your stop breathing by spouse/awake with choking? Pressure (high)? BMI >35, Age >50, Neck circ.>17, G-ender (male) (S.T.O.P.B.A.N.G). |
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Social supports to consider |
Do you know who could help your patient? Involve supports whenever possible. Encourage the patient to discuss their treatment goals with their supports, and help the patient to understand that their social supports are part of their overall quality of life. |
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How to improve communication during treatment |
Introduce one treatment element at a time, avoid jargon, link every treatment element to outcome, write down instructions, and encourage questions. |
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How to increase patient motivation |
Reinforce all efforts the patient reports, problem solve any barriers, identify and acknowledge their positive efforts, and help them develop strategies for handling interfering factors. |
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Providing a course of action |
Outline choices clearly, discuss pros/cons, help them to understand what they're committing to, and set realistic goals |
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Patient education |
Most effective when individualized, QoL goals taken into account, feedback is immediate, expectations are explicit and repeated, motivation is increased, and the link b/w what is done and why is emphasized. |
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Planning for relapse |
Start early! Set out possible negative outcomes, discuss how to detect "back-sliding", emphasize early action, and review their understanding of their options. |
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Three strategies to working with a pain patient |
Build rapport, recovery is a dynamic process, and use a screening tool for identifying the psychosocial risks (i.e. Bournemouth Questionnaire +yellow flags). |
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Acute phase of care (0-4 weeks) |
Triage for red flags, reassure patient, and begin modalities and SMT. State patient responsibilities clearly with your activity modification advice, select exercises to help improve patient's sense of control over their health care, forecast goals for 2 week period, and use Bournemouth Questionnaire. |
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Subacute phase of care (5-12 weeks) |
SMT, light activity, education about hurt vs. harm, track risk factors (B.Q. as always...), set a return to work goal early in this process. Encourage housework and ADLs. |
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Shifting AWAY from chronicity |
Affects (fear, frustration, anger, depression), Behaviours (avoidance), Cognitions (beliefs and self concept), and Drugs and disability (Active vs. Passive Coping) (A.B.C.D's). |
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Shifting TOWARDS healing |
Healthy behaviours, restorative sleep, self-efficacy, and social connectedness. |
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Bournemouth Questionnaire |
7 questions- 7 elements that can derail recovery. Anything higher than a 3 indicates a clinical need, tune into it, and give it attention! |
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Yellow Flags |
Believe that hurt=harm, fear avoidance behaviours, low mood/social withdrawal, prefers passive treatment, home or work environment concerns. |
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Chronic phase of care (>12 weeks) |
Emphasizing active care, include fitness instruction component, periodically reassess risks, document flags (if any), review behaviours to ensure barriers have been addressed, and referral if need be. |
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7 Barriers to target for helping pain patients (PASAD-RC) |
Pain intensity, ADLs, Social-recreational activity, Anxiety, Depression***, Return to normal activity, Control over pain (PASAD-RC). |
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A clinical tool for empowering pain patients |
Motivation, Intention, Relentlessness, Reliability, Opportunity, and Restoration (M.I.R.R.O.R). |
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Gradual progression of neuroplastic changes |
3 weeks- minimal improvement*, 6 weeks- noticeable reduction in pain, but only for a few hours to 1 day, 2 months- some pains disappear, and 4 months- normal life activities. |
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5 Commandments of rehabilitation |
1. Only make accurate comparisons, 2. Learn new ways of doing old things, 3. Thou shall not beat thyself up, 4. view progress as a series of small steps, and 5. Expect challenge and strive to beat it. |
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4 Components to excellence in patient care |
1. Knowledge of bio-psycho-social processes, 2. screening and assessment tools, 3. timely response to patient problems, and 4. effective use of a referral network. |
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Psychiatrists |
Have a medical degree and have specialized in managing mental disorders. Areas of competence include: diagnostic assessment of patients, pharmacological treatment, and disability application. |
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Psychotherapy |
The treatment of mental disorders by psychological methods. Based on 2 assumptions; perceptions, evaluations, expectation, and coping strategies play a role in the development of mental symptoms and that people with psychological problems can change and learn more adaptive patterns. |
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ACRM definition of mTBI |
A traumatically induced physiological disruption of brain function, as manifested by at least one of the following: LOC; any loss of memory for events immediately before or after the event; any alteration in mental state at the time of the accident; and focal neurological deficit(s) that may or may not be transient; but where the severity does the exceed: LOC<30 sec or less, after 30 minutes a GCS of 13-15; PTA not greater than 24 hrs. |
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Must be clarified following injury |
Injury description, cause (what forces), presence of retrograde or anterograde amnesia, any LOS, + other symptoms. |
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3 Components of (ACE) Acute Concussion Evaluation |
Characteristics of the injury, types/severity of symptoms, and risk factors for protracted recovery. |
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Cognitive deficits post mTBI |
Ability to attend and concentrate, communication skills, ability to learn and recall new information, organizing materials spatially, and ability to reason/problem solve. |
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Glasgow Coma Scale (GCS-/15) |
Mild is 13-15 (conky), moderate is 9-12) and severe is <8 or post-traumatic amnesia beyond one week. |
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3 M.C. experienced emotional problems after TBI |
Depression (10x community), Anxiety (2x community) and substance abuse/dependancy. |
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Sleeping and emotional processing |
Ensuring adequate sleep is important for modulation of mood. Medial pre-frontal cortex allows us to reason and objectively evaluate emotions' is highly sensitive to sleep deprivation. With reduced sleep there is loss of functional connectivity b/w limbic and MPFC. Results in irritability, anxiety, heightened emotional lability, and errors in judgement. |
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Post-TBI sleep epidemiology |
46% TBI have sleep disorders, 23% OSA (high BMI/obese patients), 11% post-traumatic hypersomnia, 6% narcolepsy, 25% excessive daytime sleepiness. |
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Sleepiness |
OBJECTIVELY measurable physiological process due to sensitive balance of neurotransmitters. Results in a build-up of sleep pressure (process S) throughout the day. Characterized by increased propensity to sleep & increased sleep time proportional to period of sleep debt. |
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Fatigue |
SUBJECTIVE feeling of weariness or exhaustion. Sense of feeling drained of energy. Fatigue in neurological populations different from general population. Does not respond to sleep or rest. Not accompanied by desire to sleep. |
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Grade I Concussion |
"Having your bell rung" is mild bruising of brain tissue, most common form of head injury. Most difficult to recognize. No LOS but may be briefly confused. Must be removed from comp. for at least 20 mins and examined every 5 mins to rule out any postconcussive symptoms. S/S: H/A, dizziness, impaired orientation, concentration, and memory. |
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5 main themes in fatigue & sleep/wake disturbance |
1. Alterations of cognitive function (attention, concentration, errors, difficulty processing instructions), 2. Emotional reactions (Irritability, crying, euphoria, reactive), 3. Bodily signs (slow movements, postural changes, H/As, yawning/sleepiness), 4. Endurance (decreased performance/dynamism, need for rest) and 5. Communication (difficulty w/speech and following a conversation) |
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Grade II Concussion |
Presence of post-traumatic amnesia (loss of memory after the injury). Athletes must be removed from competition for the day and (if no neurological symptoms) must be monitored over the next 24 hours. |
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Grade III Concussion |
Easily recognized and applies to any athlete who loses consciousness. Are checked for neck injuries/immobilized and taken to hospital by ambulance. If neuro/mental status is normal, can go home as long as he/she is not alone. |
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Factors Complicating mTBI Recovery |
History of prior concussion, history of headaches (migraines), developmental history (learning disabilities, ADHD), psychiatric disorders (anxiety/depression), presence of sustained sleep and fatigue problems. |
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Return to activity/sport |
The most, highest quality evidence is for encouraging the patient to gradually return to normal activity based upon their tolerance. Individuals with mTBI should be encouraged to gradually return to normal activity based upon their tolerance. 1 week(ish) graduate protocol. |
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Post-Concussion Syndrome |
Symptoms persisting >3 months and become chronic or even continue to deteriorate. Patients vulnerable to chronicity are those with anxiety, depression, and sleep disorders. Criteria: Hx of head trauma w/LOC preceding symptoms onset by maximum of 4 weeks + symptoms in 3 or more of the H/A, dizziness, malaise, etc.... |
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Warrants patient referral |
Insomnia severity index score of 8 or more, fatigue severity score of 25 or more and not responding to behavioural and environmental interventions, fatigue/sleepiness are interfering with therapy, community integration, and QoL, any mention of excessive snoring or leg twitching, patient falls asleep routinely during the day, you are concerned that depression and or pain may be affecting sleep and wakefulness. |
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Neuroplastic Treatment Options |
Laser treatment, portable neuromodulation stimulator (PoNs), matrix repatterning, and neurofeedback. |
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TBI impact on women's health |
68% 5-10 years post-TBI reported irregular cycles after injury, 46% experienced amenorrhea, no significant differences in conception but more post partum difficulties, and significantly more mental health issues. |
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Hallmark of brain injury |
Slow speed information processing. |
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Persistent Vegetative State |
Follows the most severe TBI. Destroys forebrain cognitive functions but spares brain stem. Can last for years but few patients recover past 3 months and none after months. |
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Posttraumatic Epilepsy |
Can begin years after TBI and follow: 10% of severe, closed head injuries and 40% of penetrating head injuries. |
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Epidural Hematoma |
Blood between the skull and the dura mater- usually middle meningeal artery. Usually due to temporal blow to the head. Accounts for only 1% of severe head injuries. S/S: H/As, deterioration of consciousness, motor dysfunction and pupillary changes. Prompt attention can prevent fatality. |
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Acute Subdural Hematoma |
Blood b/w dura and arachnoid mater. Develops in 5-20% of head injuries. Accounts for most* fatalities. S/S: severe H/A, widening pulse pressure, seizures, change in vision or speech, pupils (midposition, dilated, or fixed), hyperreflexia, quadrispasticity, decorticate/decerebrate rigidity. |
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Chronic Subdural Hematoma |
Symptoms start 2+ weeks after trauma (but not necessarily due to trauma). S/S: daily H/A, delayed neurologic deterioration, ***more common in alcoholics and patient >50 (also those on blood thinners), fluctuating drowsiness/confusion, mild to moderate hemiparesis. |
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Chronic Muscle Contraction Headache |
Aka chronic tension-type headache. M/C (80%), steady, non-throbbing ache affecting both sides; daily or almost daily. Frontal or occipital regions. Worse on awakening, slight->moderate intensity. Improves in afternoon then worsens again in late afternoon. Lasts months to years. Likely due to neck trauma + c-spine irritation. |
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Trauma Triggered Migraine |
Reported with many sporting injuries, like soccer and rugby. Resembles classic migraine with aura. Usually resolves within 48 hours. |
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Mixed tension/migraine headache |
When classic migraine starts to present with light sensitivity, etc. More common in women. Triggers like hormonal changes, missed meals, stress, etc. Gets worse with activity. Lasts 4-72 hours. Overuse of pain medicines cause rebound headaches. |
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Traumatic Dysautonomic Cephalgia |
Nonthrobbing, persistent headache. Signs of pupillary dilation* and sweating. Between attacks, presence of Horner's syndrome. Thought to be caused by sympathetic fibre injury in neck. |
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Second-Impact Syndrome |
Athlete has minor head trauma. First trauma has not resolved when a second injury occurs. Failure of autoregulation of cerebral blood flow. Results in rapid swelling. 50% chance of mortality. |
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Treatment for post-traumatic headache(s) |
Pharmacological, recommend exercising every other day, eliminate nicotine, alcohol, caffeine, and learning relaxation. Resistant cases may require referral for psychological intervention (biofeedback). |
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General tips for treating TBI(s) |
Get lots of rest, focus on better sleep patterns, do not return back to riskier activities, do not drink alcohol, use lists while memory is poor. |
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Post-Traumatic Stress Disorder (PTSD) |
Re-experiencing symptoms (intrusive recollection, nightmares, distress at reminders, and flashbacks), Avoidance and numbing symptoms (avoid thoughts/beliefs/behaviours, loss of interest, estrangement, emotional numbing, foreshortened future), and hyperarousal (difficulty concentrating, irritability/anger, sleep disturbance, exaggerate startle, and hypervigilance). |
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PC-PTSD Scale |
Any experience in your life that you now: have/had nightmares about it or thought about it when you did not want to? Tried hard not to think about it or went out of your way to avoid situations that reminded you of it? Were constantly on guard, watchful, or easily startled? Felt numb/detached from others, activities, or your surroundings? |
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Cognitive disturbances reported in WADIII |
Were NOT related to: poor performance on memory tests, radiological findings, neurological findings, or sleep disruption. They WERE related to emotional distress, poor support system, pain interference with daily activities. |
