Aspiration Precautions (post stroke reference)
Dysphagia can lead to aspiration and can be assessed at bedside. Aspiration is more likely to occur w/ thin liquids
- liquids are aspirated more easily than solids
- moist, warm food is easier to swallow than cold
- to facilitate swallowing, posture should be aligned with the chin tucked.
- 1.44
Muscle Strength after pregnancy
- hip flexors are shortened from lordotic posture and are more likely to need length than strength
- Weak = trunk flexors, buttock muscles, pelvic floor (can begin 24 hours after delivery)
Nail Pathology as related to disease
Renal Failure
Lung Pathology
Liver Dysfunction
- Renal Failure
- Mees Lines - short transverse lines
- Half and Half nails - brownish distal 1/3
- LUNG PATHOLOGY/Hypoxia
- clubbing
- Liver Dysfunction
- Beau Lines - transverse depressions
- Terry Nails - white & extends 2/3 length
Interventions Appropriate for management of a joint w/ Heterotopic Ossification
- Maintaining available ROM w. gentle stretching
- Avoiding “vigorous” stretching
- Achieve/Maintaining “Optimal Wheelchair Positioning”
Incontinence: Define and Population Susceptible:
Stress Incontinence
Sudden release of urine due to:
- increase in intra-abdominal pressure - coughing, laughing, exercise, straining, obesity
- Weakness and laxity of pelvic floor ms, sphincter weakness
- post-pardum incontinence
- menopause
- damage to PUDENDAL NERVE
- weak PUBOCOCCYGEUS
Incontinence: Define and Population Susceptible:
Urge Incontinence
bladder begins contracting and uring is leaking after sensation of bladder fullness is perceived; inablity to delay voiding to reach toilet in time
- DETRUSOR MS instability/hyperreflexia - STROKE
- Sensory Instability: hypersensitive bladder
Incontinence: Define and Population Susceptible:
Overflow Incontinence
Bladder continuously leaks 2nd to urinary retention (overdistended bladder or incomplete emptying)
- Anatomical Obstruction - Prostate Enlargement
- Acontractile Bladder - SCI, DM
- Neurogenic Bladder - MS, suprasacral spinal lesion, Herpes Zoster
Incontinence: Define and Population Susceptible:
Functional Incontinence
leakage assoc/w. inability or unwillingness to toilet
- impaired cognitition - dimentia, Alzheimers
- impaired functioning - STROKE
- Environmental barriers
Management Incontinence: Medical Management:
Drug Therapy:
Control Medications:
Catheterization:
Surgery:
Bladder training:
- Drug Therapy:
- urge, stress, overflow incontinence (estrogen w/ phenylpropanolamine
- Control Medications:
- diuretics - CHF, anticholinergis, psychotropic
- Catheterization:
- OVERFLOW incontinence or skin threatened
- Surgery:
- bladder neck suspension, removal of prostate, obstructions, suprapubic cystomy
- Bladder training:
- restore pattern, schedules, intervals
PT Goals and Outcomes w/ Stress and Urge Incontinence
- Kegel’s Pelvic floor exercise (pubococcygeus)
- Type I: 10 sec hold, 10 sec relax
- Type 2: quick contract - cut off flow of uring
- 10-80 repititions daily
- FES/NMES
- Biofeedback to RELAX bladder
- Progressive strengthening - weighted vag cones
- Kegels in everyday life!!
- lifting
- coughing
- changing positions
AROM vs. AAROM vs. Functional Activity Post Op Skin Graft
If patient is already able to perform partial AROM… initiate AAROM, continuing self AROM will not help improve
Using a functional technique such as bed mobility to encourage use of UE may be appropriate in SOME cases - But rememer DOCTOR GOALS AND SURGICAL ACUITY
Thermal Agents: Aquatic Therapy - Contraindications
- Unprotected open wounds
- Unstable blood pressure
- Bowel or bladder incontinence
- Severe kidney disease - unable to adjust to fluid loss during immersion
- Severe epilepsy - IF NONCOMPLIANT/MEDS
- Severe cardiac disease
- Severe PVD
- Bleeding or hemorrhage
- Water or airborne infections
Thermal Agents: Aquatic Therapy - Precautions
- Open wounds and skin infections must be covered (venous insufficiency)
- Fear of water
- Inability to swim
- Heat intolerance
- Pts w/ advanced peripheral neuropathy w/ heat intolerance (MS) may fatigue w/ immersion in temps > 33 C - aquatic therapy is typically done in temps > 33C
- Waterproof dressings on small open wounds*
Hypoesthesia Distribution:
CTS
Herpes Zoster
Diabetic Neuropathy
Brachial Plexus Injury
- CTS = median nerve distribution
- Herpes Zoster - peripheral nerve root distribution
- Diabetic Neuropathy - glove distribution hands/ft
- Brachial Plexus Injury - variable patterns from nerve root, cord, to peripheral nerve
Treatment of Diastasis Recti (>2 cm separation)
associated w/ loss of abdominal wall support & increased back pain
- teach protection of abdominal ms - avoid full abdominal exercises (sit ups, bilateral SLR)
- Resume abd exercise when separation is <2cm - begin SAFE exercises
- partial sit ups
- _pelvic tilts _
- _hands/splinting to support abd wall _
- PEAT ANSWER - Dont do NOTHING, modalities make no difference, use splinting and post pelvic tilts
- NOT a CONTRAINDICATION
Signs that Scar is NOT healing Correctly
- > 2mm in height (more than “slight raise”)
- poor approximation
- not fully granulating or epithelialized
- signs of inflammation
- red color, warmth, induration (firm, inflexible)
- Keloid formation = firm/inflexible, highly raised, and outside of wound borders
