The Immune System

Question 1

Human Immunodeficiency Virus (HIV)

Answer 1

• Patho:
  
  • reduction in CD4+ helper T cells resulting in lymphocytopenia
  • a retrovirus replicates in reverse fashion and code is transcriibed into DNA
  • transmission through blood, saliva, genital fluids, or breast milk (not human waste)
  • risks: unprotected sex, contamin. needles, maternal-fetal transmission
• Sympto
• Diagnosis
  
  • CD4 count 500-1200 cells.mm³
  • HIV-1 Antibody test (ELISA)
  • plasma HIV RNA test
  • Rapid HIV antibody test
  • Western Blot test
  • aids:
    
    • +HIV blood test >200 cells/mm3
    • AIDS related complex (ARC)
• Medical:
  
  • Antiretroviral Therapies (ART)
• Treatment:
  
  • education to prevent spread of infection
  • treat opportunistic infections
  • supportive care
  • respiratory if needed
  • functional mobility/safety
• PT
  
  • standard precuations
  • aerobic/resistance exercise
  • activity pacing
  • energy conservation
  • stress management
  • neurological rehab

Question 2

Chronic Fatigue Syndrome

Answer 2

Complex chronic syndrome characterized by overwhelming fatigue and other symptoms

• diagnosis by exclusion
  
  • new onset of persistent or relapsing fatigue;
  • must be present for atleast 6 months
  • does not resolve with bed rest
  • reduction in daily activity by 50%
• Symptoms
  
  • profound fatigue
  • sore throats
  • tender lymph nodes
  • myalgia
  • sleep that is not refreshing
  • HA
  • multijoint pain
  • impaired STM or concentration
• Medical intervention
  
  • no cure,
  • treat symptoms
  • nutrition
  • psychological support

Question 3

CFS PT Evaluation and Treatment

Answer 3

• Evaluation
  
  • exercise tolerance levels
  • posture and movement patterns
  • activity levels/degree of fatigue
  • depression
• Treatment
  
  • activity reduction when fatigue is maximal
  • exercise recommendations prevent deconditioning
    
    • F: 3-5 days/wk
    • I: low to mod (RPE 9-12/20)
    • T: 5 min/session to 40-60 min
  • maintain flexibility
  • maintain/improve ms strength
  • maintain/improve function
• avoid over exertion
• activity pacing
• energy conservation
• stress management

Question 4

Fibromyalgia

Answer 4

disorder characterized by widespread musculoskeletal pain, fatigue with sleep, memory and mood disturbance

• myalgia
• generalized aching
• multiple tender points
• additional signs
  
  • visual problems
  • mental and physical fatigue
  • spasm
  • cold intolerance
  • HA
  • irritable bowel or bladder
• atypical patterns of numbness

Question 5

FIbromyalgia Treatment

Answer 5

• see chronic fatigue syndrome
• focus on aerobic training mild to moderate intensities 2-30 min 2x/wk
• protection strategies
• aquatic therapy
• stress management
• tai chi and yoga**
• support groups