Drop it [pelvis]
like it's Hot
like it's Hot
This is the type of stool we ideally want according to the Bristol Stool chart.
What is type 4?
A persistent sense of physical, emotional, or cognitive tiredness related to cancer and cancer treatment.
What is cancer related fatigue (CRF)?
The CDC defines Long COVID as the continuation of symptoms, or emergence of new ones, how many weeks or more after infection.
What is 4 weeks or more?
This depth of burn is the most painful.
What is superficial partial thickness?
Your patient comes in after having recovered from the flu. They complain of intermittent swelling in the L forearm that they've found resolves overnight if they keep their arm elevated. You observe no redness, grade 1 pitting edema, and no other abnormal skin changes. What stage is the patient MOST likely in?
Stage1
Stage 0 usually is associated with no signs/sx
Stage 2 would present with swelling that does not resolve with elevation and skin changes.
Stage 3 would present with severe swelling (Elephantiasis) and skin thickening/scarring
This is a type of urinary incontinence in which a physical or external factor prevents the patient from getting to the bathroom.
BONUS 100: Define urinary incontinence
What is functional?
BONUS: The involuntary loss of urine that is objectively demonstrated and a social or hygienic problem.
Name two recommended assessment tools for CRF.
Any two:
- Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
- PFS-Revised
- Patient-Reported Outcome Measures Information System Fatigue Short Form (PROMIS- short form)
This is a possible clinical presentation where symptoms worsen after physical or mental activities.
What is Post Exertional Malaise (PEM)?
These are the places where scar contractures most often form.
BONUS 100: How long does it usually take for loss of ROM from a burn scar contracture?
What are the axilla, elbow, and hand?
BONUS: 1-4 days
Name 4 symptoms with activity that indicate the Pt should slow down or rest.
HAFNTS
Heaviness
Aching
Fatigue
Numbness
Tingling
Swelling
This is a constant contraction of a sarcomere.
BONUS 100: Name one intervention commonly used for this.
What is a myofascial trigger point?
BONUS: MFR, manual therapy, NMR, or dry needling
Name three barriers to exercise from a PT perspective.
BONUS 100: Name one facilitator to exercise.
- Lack of knowledge/understanding of evidence-based guidelines
- Families and friends encouraging rest
- Poor adherence to prescribed exercise
- Limited time with patients
- Lack of physician referral
BONUS: Supervision by a trained professional for better adherence, guidance, and to address concerns/fears. OR Exercise with groups of similar patients for peer support, shared experience, and a sense of belonging.
If you were given a chest x-ray for a patient with Long COVID, what do you expect to see?
Most characteristic of Long COVID would be bilateral "white out" pneumonia. There can still be many different abnormal imagings even in asymptomatic cases, however.
Name three objective measures used for scar assessment AND what they're measuring.
- Colorimeters = color of scar vs normal skin
- Laser Doppler = perfusion at scar
- Pneumatonometers = pliability of scarred skin
- Cutometers = elasticity of scarred skin
- Ultrsound = thickness of skin at scar
What are the four components of the decongestion/reduction phase of CDT?
Skin care
Reduction/Compression/Garments or Wraps
Exercises
Manual Lymphatic Drainage
This is a possible physiological change during pregnancy due to an increase in CT laxity where the rectus abdominis separates at midline.
BONUS 200: Why is this important to screen for?
What is diastasis recti (abdominis)?
BONUS: It's important to note the presence of this because it may indicate the need for core stabilization/motor control interventions. If the rectus abdominis separates during contraction, then it will affect intra-abdominal pressures which may in turn affect viscera.
A patient with cancer and hx of HTN and smoking is being considered for an exercise program. This patient is known to have SOB with mild activities and mild ache in the L UE with more intense activities.
What is something to consider screening for this patient?
Given the risk factors and symptoms of this patient, there is concern for their CV system. It is recommended that the patient undergo an exercise test such as the Par Q.
You're designing an exercise program for a patient recovering from Long COVID. What is the recommended intensity for light aerobic activity?
50-70% HR max
You can also use other symptoms guide the intensity, such as O2 saturation (stay above 90%) or the Borg Scale of Dyspnea (stay around 2-4/10).
This is otherwise known as "Symptom-titrated physical activity"
Your patient has an immature scar. What is one possible form of scar management you could provide?
Pressure therapy
- Within 2 weeks of wound closing
- Worn 23hr/day until scar maturation
Silicone pad
- Hydration, pressure, warmth
Scar massage
- With water-based lotion (no perfumes or alcohol)
Your patient was referred for compression therapy at your clinic. After subjective interview and physical exam, you find that the patient has an ABI of 0.8, limited ROM at the ankle joint, grade 1 pitting edema at the ankle that appears “shiny” with no hair, and pallor when the ankle is elevated with redness returning after the ankle is brought down. Do you proceed with your intended therapy tx? Why or why not?
Since there are some signs of arterial disease (ABI is less than normal range which is 0.9-1.3; trophic changes to the skin; and pallor during elevation) compression therapy is contraindicated at this time.
It would be best to confirm whether arterial disease is a part of the paitnet’s diagnosis (ie does their PCP know about this?) and confirm it is being managed.
Exercises can help to improve perfusion by stimulating angiogenesis, so this would be a more appropriate course of treatment.
Your patient comes in with complaints of urinary incontinence over the past month. They have recently been given more responsibilities at work due to a colleague having to take a sudden medical leave of absence about 6 weeks ago. They eat well and exercise when possible (walks), however due to the extra work they report resorting to Celcius to get things done and grabbing whatever snacks they find in the office.
Give two pieces of Pt education.
You can educate about stress urinary incontinence (what it is and why it relates to their current complaints). As well as nutritional education since caffeine is a bladder irritant. They are most likely grabbing whatever snacks they can find, so also mention other bladder irritants to avoid (spicy foods, acidic foods, citrus fruits, artificial sweetners, etc.)
Some possible follow-up questions:
- How much water are you getting nowadays?
- How often are you voiding?
- What strategies do you use to address this added stress at work?
A 64yo patient with cancer is beginning an aerobic exercise program. They were screened for CV risk and are at a low risk. What HR should you aim for at the beginning of the program? What dosage and frequency?
ACSM recommends beginning at a low to mod intensity to ease them in:
50-70% HR max
11-13 RPE
Start with 15min, 3-5 days/week and then slowly progress to 30min, 7 days/week.
Name two outcome measures that measure activity tolerance, two that measure gait speed, and one self-report questionnaire for patients with Long COVID.
(Not a full list, just some possible options presented in lecture)
Activity tolerance:
- 5xSTS
- 30sec STS
- 6MWT/2MWT
Gait speed:
- TUG
- 10mWT
Self-report:
Post COVID-19 Functional Status Scale
Your patient has burns from a terrible accident involving a hot pot of coffee… :’(
Their burns are on the anterior neck, dorsal L hand/fingers, and L axilla.
What is the best position for this patient to prevent scar contractures?
Preventative positions:
Anterior neck → extension
Axilla → Shoulder abduction
Dorsal hand/fingers → MCP flexion, IP extension, thumb abduction
Your patient is 2 weeks post TKA. They came in today complaining of residual swelling in their operated knee. You observe no redness or increased temperature. They report sharp intermittent pain at the incision site when flexing their knee, but it resolves when they straighten their knee. Their operated knee measures 1cm larger in girth than their uninvolved side. What is your next course of action?
Treat the patient. Possibly with education about elevating the leg when resting and the importance of exercises to help with returning fluid back into circulation.
This does not have any red flags that would raise suspicion of differential dx like a DVT or infection. The swelling is most likely a normal course of the recovery process from the operation.