Therapy Ed Chapter 9

Front 1

Dysphagia & Swallowing Disorders

Back 1

-Facial paralysis

-Praxis/motor planning deficits

-Sensory impairment of motor cavity

-Weakness of tongue/base of tongue structures

-Weakness of elevation of pharynx during swallowing

-vocal cord paralysis

-Clinical aspiration

-Diminished esophageal mobility

Front 2

Facial Paralysis

Back 2

Incomplete closure of the mouth

loss of bolus out of front of oral cavity

Front 3

Praxis/motor planning deficits

Back 3

Inability to effectively chew

-Cannot propel bolus toward base of tongue

-difficulties w/ creating smoother consistencies

Front 4

Sensory impairment of oral cavity

Back 4

Lack of awareness of residual food on the side of the mouth that has decrease sensation

- timing of swallow is off

-spilling of food into airway

Front 5

Weakness of the tongue/base of tongue structures

Back 5

Inefficient propulsion of bolus at an efficient rate of speed

lack of closuer at the crycopharyngeal junction

- Aspiration

-swallowing sequence is out of sync/ off-time

Front 6

Weakness of the elevation of the pharynx during swallow

Back 6

incomplete triggering (diminished neural stimulation) of the pharyngeal phase of swallowing

Front 7

What is vocal cord paralysis

Back 7

Inefficient closure of the vocal folds during pharyngeal phase of swallow

- if fail to close aspiration may occur

Front 8

When does Clinical Aspiration occur?

Back 8

Food enter the airway:

-Can be cleared by coughing (reflex intact)

If a person silently aspirates:

- bolus enters lung and person does not react

- bolus enters lungs & person exp. resp. distress w/out a cough

- cough is to weak to raise bolus in order to expel

Front 9

Diminished esophageal motility is...?

Back 9

Bolus sits in esophagus can slowly move toward stomach or pharynx

- sensation of food stuck in esophagus

- aspirates when food propels upward

Front 10

What are the clinical exams and functions findings for Dysphagia & swallowing disorders?

Back 10

1. Person coughs during or after drinking water or other thin liquids

2. Face's change color during or after eating

3. Gasps for breath but no partial or complete airway obstruction

4. Bedside swallowing evaluations

5. Modified Barium Swallows (MBS)

6. Flexible endoscopic esophageal swallow (FEES)

Front 11

Bedside swallowing evaluations

Back 11

1. Assess level of alertness, orientation to activity

2. Assess sensory/motor component of swallowing

3. Assess ability to manage own secretions (via Clin. Obs.)

4. Assess swallowing function using trial boluses (diet modifications)

Front 12

Modified Barium swallow

Back 12

1. Diagnostic X-rays

2. Trial variety boluses laced with barium

3. Video records moving X-ray of swallow

4. X-ray shots taken if aspiration is observed

Front 13

Flexible endoscopic esophageal swallow (FEES)

Back 13

Checks if the swallow is intact or impaired.

Uses camera through nasal cavity and food laced with green food coloring.

Front 14

How can life & ones occupations be impacted due to a swallowing dysfunction?

Back 14

1. Ability to comfortably eat therefore affect dinner times w/ family

2. Disrupt ability/decreased comfort level for eating out in public

3. Alteration of self-concept concerning life roles & appearance.

Front 15

Interventions for dysphagia & swallowing disorders are...?

Back 15

1. Provide family-centered intervention to determine acceptable dinner table alternative to interact.

2. Work towards developing new roles and occupations.

3.Educate/inform family regarding person's feeding/nutrion

Front 16

Gastric Esophageal Reflux Disease (GERD)

Back 16

1. Involves lower esophageal and gastric sphincters

2. Inefficient closure of esophageal sphincter leading to acid from stomach into esophagus

3. Heartburn, indigestion, dull chest pains or regurgitation

Front 17

Tests and Interventions for Gastric Esophageal Reflux Disease

Back 17

Test: Barium Swallow or Flexible endoscopy

Intervention: Elevation of head while sleeping

drug therapy

diet modification (less spice, smaller meals)

Stress management

Front 18

Small bowel obstructions

Back 18

1. from secondary scar tissue, radiation of abdomen (long term effect), or result of tumor obstruction

2. Surgical treatment required: closed abdominal surgery or resection w/ open stoma (colostomy)

3. Rehabilitation issues:

- self care aspects with a stoma

- decrease gross movement mobility (bending, stooping, foot/lower leg related self-care)

Front 19

Neurogenic bowel

Back 19

1. Sympathetic nerve impairment, generally occurs in spinal cord injury above T-6

2. Loss of control of anal sphincter

3. Sensory loss of bowel movements; and ability to self-initiate/control a bowel movement

4. Flaccidity of muscles results in incontinence

5. Autonomic dysreflexia

Front 20

Renal-Genitourinary System:

Kidney Disease

Back 20

Risk factors: diabetes, HTN, Lupus

Treatments: Diet, Meds, Exercise, Stress reduce

- Med treatment of lupus,

- " " nephrotic syndrome,

- " " acute renal failure

- " " end state renal disease

Front 21

Impact of Kidney disease on performance skills and client factors in:

Back 21

Motor dysfxn- fatigue, muscle pain, edema limits mobility, weakness

Sensory system fxn -Neuropathy (diabetes related, toxicity related); - vision loss (diabetes related)

Cognitive: Alteration of body image due to dialysis, delusions due to sepsis/toxicity; dementia, multi-infract or metabolic

Front 22

Impact of Kidney disease on performance areas in occupation: ADL's

Back 22

Self care: cleaning self, alteration in urination, strict adherence to diet, alterations to sexuality (impotence), need for use of adaptive tech, altered mobility, fatigue issues.

Front 23

Impact of Kidney disease on performance areas in occupation: IADL's

Back 23

Housekeeping

community mobility

Meal preparation

Management of personal finances (abilities to do banking, budget, etc)

Leisure/sport activities (ability to participate with reduced risk)

Front 24

Impact of Kidney disease on performance & cultural context:

Back 24

Performance

- Social context = how affects role in family, workplace, community, groups, friends

Cultural: how cultural group accepts condition/treatment. Acceptance of individual in view of impairment/disease

Front 25

Immunological System Disorders include what?

Back 25

-Cancer

-Scleroderman

-Acquired Immunodeficiency Syndrome (AIDS)

-Hepatitis

-Turberculosis

-Methicillin resistant Staphylococcus aureus (MSRA)

Front 26

Cancer: Risk factors & Prevention, early intervention, control:

Back 26

Heredity, Environmental (pollutants), Habit or lifestyle related (smoking, drinking, obesity)

Depends on the form/type of cancer:

-Mammograms, Prostate & testicular checks, Skin checks, family history.

-Avoid environmental contributing factors

-Avoid contributory habits

Front 27

What are the diagnostic staging of cancer?

Back 27

Stage1: tumor present, no perceived spread of dz.

Stage 2: localized spread of tumor

Stage 3: extensive evidence of a primary tumor that has spread to other organs in the body.

Stage 4: inoperable primary lesion

Front 28

Medical treatments for cancer include:

Back 28

1. Surgery

2. Chemotherapy

3. Radiation

4. Immunotherapy

Front 29

Rehabilitation for Cancer

Back 29

1. pre-operative include:

- functional ax's & prep for post op phase/care

2. Post-operative include:

-depends on procedure & location of tumor.

3. Convalescences

4. Hospice

Front 30

Convalescences Rehab for Cancer

Back 30

Rehab of:

Motor impairment

Sensory Impairment

Cognitive impairment

Neurobehavioral impairments

Psychosocial support to enhance coping abilities:

- Occupational role/ body image adjustment

- Obtain social support

-Liminality: self recognition of vulnerability and self sense of mortality

Develop of health supporting behaviors w/ follow-up support

Front 31

Hospice

Back 31

End of life care

- supports QOL as disease advances

- Provides client w/ as much control as possible before the end

- Empower life celebration & life reflection

- refer to legal support if needed & requested

Front 32

What is Scleroderma?

Back 32

Rheumatic, Connective tissue disease associated w/ impaired immune response.

Three main components:

1. Vascular

2. Fibrotic

3. Autoimmunity

2 Basic types of the disease

1. Limitied

2. Systemic

Front 33

Vascular scleroderma

Back 33

Raynaud's Phenomenon

constant recurrent constriction of small blood vessels leading to pulmonary HTN.

Decreased esophageal motility

Front 34

Fibrotic Scleroderma

Back 34

Scar tissue resulting from excess collagen causing thickness of skin and a burning sensation in the skin

Fibrosis of the lungs causing restrictive lung disease

Front 35

Autoimmunity Scleroderma

Back 35

B Cell-produced antibodies (anti-centromere, anti-topoisomerase I antibodies)

Front 36

Scleroderma risk factors and prevention

Back 36

Genetic & Environment

Prevention is to control symptoms of Raynaud's Phenomenon, stop smoking, and screen echocardiograms to rule out Pulmonary HTN.

Front 37

What interventions are there for Scleroderma?

Back 37

Depending on the problem area:

- all utilized drug therapy (specific to area)

Splinting for contractures in Sequela of Scleroderma

Front 38

Acquired Immunodeficiency Syndrome (AIDS)

Back 38

Acquired by infection by HIV + human

Risk factors = contact w/ blood/body fluids

Prevention: avoid contact w/ body fluids, unprotected sex

Front 39

Human immunodeficiency virus (HIV) infection

Back 39

Retrovirus that attacks the lymphatic system (system that protects body's immunity to opportunistic infections)

4 stages of infection:

-acute infection: flu like response to initial contact

-Asymptomatic dz: HIV replicates & affects immune system; blood abnormalities detected, no other visible signs.

-Symptomatic HIV: signs & symptoms appear

-Advanced disease or Aids

Front 40

What is hepatitis?

Back 40

A viral infection which has 3 types (A,B,C)

Type A: contaminated seafood

Type B,C : body/blood borne exposure

Immunizations Possible for Type A,B

Sequelae = fever& fatigue; both contribute to decreased tolerance for activity participation and lack of energy

Front 41

Methicillin resistant Staphylococcus aureus (MSRA)

Back 41

An infection of skin that may be mild or severe or an infection in surgical wound. Infection = localized or systemic)

Risk factors: weakened immune system, confinement, living in close quarters, direct skin contact w/ an infected body part, secondary skin contact used by someone w/ an infection.

Front 42

What are the signs / symptoms of MSRA?

Back 42

Redness accompanied by swelling & pain in the area of the wound.

Drainage such a pus in the area of wound

fever

skin abscess

chest pain

cough

fatigue

head ache

muscle ache

rash

shortness of breath

Front 43

Medical treatment for MSRA

Back 43

Draining of a skin sore by an MD

Antibiotic treatment

Depending on severity/location

- IV

-Oxygen

- Dialysis (if kidney failure occurs)

Front 44

Rehabilitation for Immunological System Disorders

Back 44

Overall goals & approaches can be preventive, restorative, support and/or palliative depending on treatment setting, diagnosis, stage of illness, and expected outcomes.

Front 45

Interventions for impairment level problems

Back 45

Counsel ppl to be compliant w/ screenings and invest in one's health.

Provide support to those dealing with immunological system disorders that are chronic

Front 46

Interventions for activity level problems

Back 46

Self-care: train to do self care while conserving energy

Work: eval work capacity, mod if necessary, counsel/ intervene for transition to disability status when work no longer possible

Leisure/sports: mod specific tasks/acitivities; eval interest and skills to introduced new interests that may be less physically demanding

Front 47

Interventions for participation problems

Back 47

Needs assessment to determine individual issues person has (mobility, social, home, community env.)

ID/facilitation of procurement of system changes to allow person access and ability to participate as contributing member of society

Front 48

Diabetes

Back 48

Type 1- insulin dependent

risk factors: autoimmune, genetic and environmental factors

Type 2- risk factors: older age, obesity, fam. history, physical inactivity, certain race/ethnicity, prior history of gestational diabetes

Front 49

Gestational diabetes

Back 49

only occurs during pregnant

Usually resolves after pregnancy and occurs higher in ppl in race/ethnicity risk groups.

Obesity is another high risk factor.

Front 50

Signs & symptoms of diabetes

Back 50

frequent urination

-Excessive thirst

-Unexplained weight lost

-Extreme hunger

-Visual changes

-Sensory changes (tingling/numbness) in the hands or feet)

-Fatigue

-very dry skin

-slow healing wounds

-increased rate of infections

Front 51

Sequelae/complications of diabetes

Back 51

-fatigue/decreased activity tolerance

-urinary disturbance

-visual loss, low vision, blindness

-amputation

-hypoglycemia: low blood sugar

-hyperglycemic crisis: high blood sugar

Front 52

hyperglycemic crisis entails...

Back 52

Ketoacidosis: signs include dehydration, rapid & weak pulse and acetone breath

Hyperosmolar coma: signs include stupor, thirst, polyuria & neurologic abnormalities

Front 53

Rehab for diabetes include

Back 53

-Preventive exercise

-Education of client & family

-Psychological/emotional support to improve self

-Lifestyle readjustments to complications when/if occur

-Early attention to wound management

Front 54

Obesity & Bariatric Issues

Back 54

BMI is a formula for determining obesity.

Range: 25-29.9 = overweight

>30 Obesity

>40 Morbidly obese

Obesity = increased mortality rate

Waist circumference used to determine distribution of body fad.

Front 55

Etiology of obesity & bariatric issues

Back 55

Social: education and SES, occupation & family background

Cultural: Food & love cultures, larger body size is more highly valued, post depression ear eating, restaurant culture (larger portions size & higher fat content.

Environmental: lack of time to meal plan/cook, lack of time to exercise, lack of access to resources (no personal trainers or facilities to use.

Physiological: Poor diet/nutrition, processed foods, excessive food consumption; side affects of atypical second generation anti-psychotic medication)

Front 56

Prevention of obesity & bariatric issues

Back 56

Education regarding health promotion/wellness

Habit intervention w/ occupations & activities

Front 57

Sequelae of Obesity & Bariatric issues

Back 57

Sequelae = decreased ability in performance areas of occupationals (BALD,IADL, mobility);

Symptomatology related to larger body sizes: muscuoskeletal pain, limited mobility, lower activitiy tolerance

Front 58

Lyme Disease

Back 58

Attained from tick bites.

Prevention: full clothing on hikes, insect repellent, skin checks after hiking, changing of clothes after hiking.

Sequelae: impairs immune response & affects neurological & orthopedic systems.

Early Sx: fatigue, headache, chills/fever, muscle/join pain, swollen lymph nodes, rash

Late SX: arthritis (knees most commonly affected); nervous system abnormalities (numbness, pain, bell's palsy, meningitis)

Front 59

Rehabilitation for Lyme Disease include...

Back 59

1. treat joint pain/swelling = rest, anti-inflame meds, splinting or wrapping, teach econs.

2. Treat nervous system abnormalities

Pain: use physical agent modalities, stress management techniques, neutral warmth, adapted techniques to avoid trigger of movements that cause pain.

3. Bell's Palsy: make facial splint to prevent long term asymmetry of facial muscles. E-Stim to stimulate denervated muscles, teach person to use fingers to assist w/ buccal closure

4. Meningitis: positioning, splinting, supportive care

5. Heart rate irregularities:

Front 60

Pressure/Decubitis Ulcers

Back 60

-Pressure that interrupts normal circulation causing localized area of necrosis.

-Greatest risk over bony prominences

-Intensity, duration of pressure determines severity.

-Predisposing factors: immobility or altered mobility, weight loss, edema, incontinence, sensory deficiencies, circulatory abnormalities, dehydration, inadequate nutrition, obesity, pathological conditions, changes in skin in aging.

Front 61

Stages 1 pressure ulcer

Back 61

intact skin w/ visible nonblanchable redness over a localized area

area may be soft or firm and/or cooler or warmer compared to adjacent skin.

Area may be painful or itchy

Stage may indicate "at risk" persons but can be difficult to detect.

Front 62

Stage II Pressure Ulcer

Back 62

-Involves dermis w/ partial thickness loss; shallow open ulcer (shiny or dry).

-May present as a blister

-Would is red pink colour without slough or bruising

Front 63

Stage III Pressure Ulcer

Back 63

-Involves full thickness tissue loss w/ subcutaneous fat possibly visible

-Range from shallow to deep depending on area affected.

Front 64

Stage IV Pressure Ulcer

Back 64

-Involves full thickness tissue loss w/ bone, tendon, or muscle visible or directly palpable.

-Ranges from shallow to very deep depending on area affected.

Osteomyelitis = stage IV ulcer extends into muscle, fascia, ,tendon and/or the joint capsule.

Front 65

Unstageable pressure ulcers

Back 65

Last stage; involves full thickness loss in which the wound has slough and/or eschar which covers the base of the ulcer.

Front 66

Evaluation of Ulcers

Back 66

1. Early assessment is critical

2. Persons determined to be high risk should be re-eval every 12 hours.

3. Persons determined to be low risk should be re-eval whenever there is change in status

Front 67

Intervention for Ulcers

Back 67

1. Prevention is the most effective intervention

Use pressure-reducing devices:

- Group 1: cushions or mattresses to distribute weight

-Group 2: dynamic, electric powered devices for persons w/ full thickness ulcers or those at moderate to high risk.

-Group 3: dynamic, electric powered devices for persons w/ non-healing full thickness ulcers.

Weight shifts should occur every 30 mins. for 30 secs or every 60mins for 60secs.

Front 68

Heat syndromes/hyperthermia

Back 68

Types: Heat cramps, heat exhaustion, heat stroke

Intervention Heatstroke: medical service, lower person's body temp, hypothermia blankets, IV infusions and medications

Intervention Heat cramps/exhaustion: loosen clothing and lie in cool place, replenish fluid/electrolytes, massage muscles if cramps are severe, IV infusion & O2 maybe needed if severe case.