Unit 2 - Introduction to Some Conditions
An individual has a rare disorder where the immune system suddenly attacks the nerves. It typically presents as a rapidly progressive, symmetrical muscle weakness that starts in the legs and moves upwards. Symptoms peaked within 4 weeks. The overall prognosis is typically favorable, with the majority of patients eventually making a full recovery. What condition do you suspect based on this description?
Guillain-barre syndrome (GBS)
You are working in a hand clinic and get to work with some famous athletes who have received injuries to their hands during sports. You are currently working with a famous tennis player (and know you can not share the name with anyone, due to HIPAA, even though you want to). The client is upset because when they play they are experiencing pain on the lateral epicondyle of their humerus and along the extensor muscles that run down toward the wrist from the lateral epicondyle. You do some testing and note that the client experiences pain when they do activities that require wrist extension and gripping of objects (which typically requires the wrist to stabilize in slight extension). You suspect THIS overuse soft tissue condition.
Lateral epicondylitis
You are working with a 50 year old female client who has the most common form of arthritis. They experience pain, aching, stiffness, decreased joint motion, and swelling in their left hip and knee, and some fingers of their right hand (dominant hand) with some observable bony nodules at the PIP of D4 and DIP of D2. What condition do you suspect?
Osteoarthritis
You are working with a 2-year-old client with arthritis. Which of the three main types we explored would you be most likely to suspect?
Juvenile Arthritis / Juvenile idiopathic arthritis (JIA)
S/S & Pharm tx - You are working with a client with Amyotrophic Lateral Sclerosis (ALS). You want to focus your therapeutic interventions around promoting quality of life, as life expectancy after diagnosis is a brief 1-5 years. You also know your client is taking a medication to support with the S/S of this condition. You understand this condition impacts both the upper motor neurons and lower motor neurons of the motor pathway. You expect the medication they are taking to help slow the progression of ______ ______ degeneration and prolong functional abilities.
Motor neuron
With a ______-sided stroke, the left side of the body can be weak and lose sensation. They may also have left-side visual field deficits (left quadrantanopia, left homonomous hemianopia). In addition, the individual may experience an inability to perceive or pay attention to stimuli (visual, tactile, or body awareness) that occurs on the left side (left-neglect/hemineglect).
Right
You have a pediatric client with a unique facial appearance. You note that they have a flat facial profile, upward slanted eyes, and small ears. This describes the most commonly recognizable features for someone with _____ ______ .
Down Syndrome
You are working with a client who reports "pins and needles" sensation in their thumb, index finger, middle finger, and half of the ring finger. They also share that they sometimes feel a burning sensation that travels up from the wrist toward the elbow. They shared that it feels like their hand is getting weaker, they are starting to drop things more often and it is hard to grab onto something tightly. You suspect compression of ______ nerve.
Median
Your 60 year old client is working on dressing so she can discharge home from a skilled nursing facility (SNF) and accidentally bumps her forearm on the table. You note that the arm starts swelling, and she reports a lot of pain if she tries to move it at all. You immediately report this to the nurse nearby. The nurse at the SNF initiates emergency medical protocols and they receive acute hospital care. An X-ray is used and a radial fracture is identifies. It is also identified that this fracture happened so easily because they have a bone condition where new bone formation cannot keep up with bone breakdown causing fragile and weak bones, called _________.
Osteoporosis
There is a school-based referral for you to do observations of a 5-year-0-month-old child in transitional kindergarten (TK), who appears "clumsy."
The teacher and parent report that the child does not alternate their feet when climbing the stairs on the playground (3 y/o milestone), but instead holds onto the railing tightly and steps up to each step with one foot at a time (typical for 2 y/o), stepping both feet on the same step before moving to the next step. When throwing a ball, it seems like the child flings the ball with no control (18 months; NOTE: some control 2 years, improved accuracy 3-5 years). The teacher also added that the child can make snips on a page with scissors (age 2-3), but is unable to cut simple shapes like a circle or square (age 4-5). The mom shared that she dresses the child completely since it takes too long for the child to do any part of this task and they are always in a hurry (expected 3-5 years for dressing and undressing themselves).
You do a chart review and notice that the parent shared that the pediatrician had a concern and was closely monitoring motor development and recommended a re-evaluation of milestones after the 5th birthday to determine where the child is currently at. Based on the difficulty with coordination, daily living skills, and milestones, you suspect _____ ______ ______.
Developmental coordination disorder (DCD)
You are working with a 17-year-old client who was racing his friends on their ebikes and ended up crashing into a tree, causing a traumatic brain injury (TBI). You understand that the population most at risk for this type of injury is males between 15 and 24 years old. You also understand that identifying who is most vulnerable for a type of injury based on data gathered about the rate of new injuries is part of the focus of the ________ of injury.
Options: Course, Incidence, Prevalence, Prognosis, Signs & Symptoms
Incidence - number of new cases of a condition in a specific population during a defining period. Identifying "at-risk" groups helps track incidence to help prevent new injuries.
Prevalence - total number of individuals living with a condition at a given time
When thinking about the direction of flow of blood through the heart, you understand that deoxygenated blood from the body enters the heart through the right atrium, then enters the right ventricle, exits the heart to be re-oxygenated in the lungs, then enters again through the left atrium to the left ventricle. The job of the left ventricle is to then pump the oxygenated blood out through the atrium to the body. This is a very demanding job for your the left ventricle as it must work to pump through the arterial system, which has a normally high pressure. If someone has high blood pressure, the left ventricle will have to work even harder! Because the left side of the heart works the hardest, it is often the first side to wear out. This is why ____ congestive heart failure is the most common.
Left
S/S - You are working in a school-based setting. During classroom observations. The class is walking in from recess and going to their desks to do work. You notice a student is unsteady and has difficulty with balancing while walking. This client has _______ cerebral palsy.
Ataxic
ataxia - a = without; taxia = order
Without order of movement = lack of coordination of movement; if someone is unfamiliar with this, they may refer to the individual as "clumsy"
See Unit 2 and Mentimeter Week 2 for discussion on additional types.
The rotator cuff group has 4 muscles (SITS) to help stabilize this very mobile joint. They also do other motions based on the direction of fibers and attachments to the bones.
Supraspinatus (superior to the spine of the scapula, runs to the lateral superior humerus) - shoulder abduction
Infraspinatus (inferior to the spine of the scapula, runs to the posterior superior humerus) - shoulder external rotation
Teres minor (inferior to the infraspinatus - infraspinatus' little buddy!!! - shoulder external rotation
Subscapularis (deep to the scapula in the subscapular fossa, runs to the anterior superior humerus) - shoulder internal rotation
Which one of these rotator cuff muscles runs deep to the acromion process and is most at risk for sheering or compression, and damage?
Supraspinatus
Your client has had a total hip arthroplasty (THA). You know that they should avoid "90 pigeons crossing." No bending/flexing the hip past 90 degrees (no hip flexion over 90 degrees), don't stand pigeon-toed (no internal rotation), no crossing your legs (no hip adduction). Your interventions focus on helping them get dressed and bathe without breaking these precautions. Based on these precautions, you determine the surgeon took a ____ approach for hip replacement.
Posterior
You are working in the early intervention setting. You have received a referral to do an evaluation in the home of an infant who was born with joint contractures of the right elbow, right and left wrist, and right ankle. During the evaluation you have determined that these contractures limit function and you begin to create goals to support mobility for increased function. What condition do you suspect this individual has been diagnosed with?
Arthrogryposis
rare, congenital condition - contractures of 2 or more joints at birth)
A client with spina bifida has complete paralysis of the legs and is unable to feel most types of sensory input against their legs. They are experiencing significant urinary dysfunction and are considered to be incontinent. They have received a catheter to help drain the urine into a bag. You understand they are at a risk of cerebrospinal fluid buildup in the brain (hydrocephalus) and have a shunt placed to drain the fluid. For safety, you keep in mind that if you notice neurological changes with the client like extreme fatigue or sleepiness, or if they have a bad headache, vomiting or seizures something might have gone wrong with the shunt and this is a medical emergency. This client has the most severe type of spina bifida, called ______.
Myelomeningocele
Myelo- "spinal cord"
Meningo- "meninges" (protective layer around brain and spinal cord)
-cele- "swelling" or "pouch"
A blood clot can cause blockage of blood flow to important parts of the body, like the brain or lungs. Blood clots can be a thrombosis, which blocks flow at the location it forms or a embolism, which has broken off and traveled to a new location to block flow.
You are working with a client who had a stroke caused by insufficient blood flow, due to a blood clot. You understand they have had a ________ stroke
Ischemic stroke, blood flow and oxygen supply to a part of the body are restricted.
Consider the other main type: Hemorrhagic stroke, weak blood vessel ruptures, and blood damages surrounding tissue
Gower's maneuver or Gower's sign
You are in a hands clinic working with a famous baseball player. You don't watch baseball, so you don't realize how awesome this person is in the baseball world.
Because of his years in baseball, the impact of the ball on the bat has created forces that caused a carpal bone to fracture and the palmaris longus tendon has been used to anchor the bones into place for repair.
Another patient fractured this same carpal bone falling on an outstretched hand (FOOSH) and landing against this part of the wrist. This is a common way this bone will be fractured.
THIS carpal bone is the most commonly fractured.
scaphoid
After a total knee arthroplasty, clients typically have no range of motion limitations and THIS weight-bearing status.
Weight-bearing as tolerated - You may put as much weight on the limb as is comfortable. If it causes significant pain, you should reduce the weight.
You are working with a client with JIA. The following are ALL examples of ________ strategies for health management.
Encouraging clients to use larger joints to carry items can help improve safety and comfort during occupations.
Encouraging clients to alternate heavy/light activities, and avoid sustained grip, can help minimize clumsiness and dropping of items thus improving safety.
Some steroid medicines can compromise bone stability, so be aware of bone fragility in clients while completing activities.
Remember that pain is an indication that something is wrong to follow joint protection and energy conservation techniques.
Safety
You are working with a client with a spinal cord injury (SCI) at C7.
They report a sudden pounding headache and shared that their vision is blurred. You notice they are profusely sweating (diaphoresis) and have goosebumps above the level of injury. The vital signs monitor shows a slow heart rate (bradycardia) and high blood pressure (hypertension).
What medical emergency do you suspect?
Autonomic dysreflexia
When a stimulus occurs below the injury (e.g., irritating sensory input against skin, bowel impaction), the body initiates a sympathetic response that constricts blood vessels and severely raises blood pressure. Normally, the brain would send signals down the spinal cord to lower the heart rate and dilate blood vessels. Because the spinal cord is damaged at or above T6, these inhibitory signals from the brain are blocked, leaving the sympathetic nervous system hyperactive.
C7 is above T6 (at or above T6 - at risk for autonomic dysreflexia "AD")
Someone who has had an L MCA (left middle cerebral artery stroke) may have different types of communication difficulties. They may have difficulty talking due to weakness of the muscles of the face and mouth (dysarthria) and impact on the motor homunculus related to the head (lateral primary motor cortex). They may have difficulty with language due to damage to the language centers of the brain (Broca's area and Wernicke's area, both language areas are on the left side). Difficulty producing language or getting the words out is called Broca's aphasia, and is often called non-fluent language because the words don't come out smoothly. An individual with Broca's aphasia understands that they are having this difficulty and they do comprehend what is being asked of them. Difficulty comprehending language, including the words they speak, is called Wernicke's aphasia. This is also referred to as fluent aphasia because words come out smoothly and with good tone, however the words do not make sense or demonstrate understanding.
You are doing an initial evaluation with your client to see how the L MCA impacted this individual and you note that their speech is slurred, but it seems like they can otherwise get out the words they want to say and they understand what you are asking, since they are able to answer your questions. Which communication deficit do you suspect?
Dysarthria due to weakness of muscles of the right mouth and face.