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  1. 1. Intro to Physical Disabilities Kinesiotherapy Training Module
  2. 2. Disabilities•  Cerebrovascular Accident •  Diabetes Mellitus•  Head Injury •  Amyotrophic Lateral•  Spinal Cord Injury Sclerosis•  Disorders of the Spine •  Parkinson’s Disease•  Multiple Sclerosis •  Huntington’s Disease•  Guillain-Barre •  Alzheimer’s Disease•  Myasthenia Gravis •  Lupus Erythematosis•  Amputation •  Arthritis Illness, Injuries, Diseases 2
  3. 3. Cerebrovascular Accident (CVA, Stroke)•  Loss of brain functions due to oxygen deprivation •  Oxygen deprivation occurs as result of a blockage or hemorrhage •  Blockage (Ischemic type) – caused by a clot (thrombus or embolus) that occludes a blood vessel; accounts for 80% of all strokes •  Hemorrhage – blood vessel bursts, often from an aneurysm; accounts for 20% of all strokes•  Second leading cause of death worldwide•  Result in varying degrees of neurological impairment •  Ischemic strokes tend to result in greater neurologic loss, but also tend to have a higher survival rate Illness, Injuries, Diseases 3
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  5. 5. CVA•  Risk factors for stroke include: •  Advanced age •  Diabetes •  Elevated cholesterol levels •  Smoking •  Hypertension (the most modifiable risk factor)•  Stroke Characteristics: •  Left brain lesion results in right side impairment •  Right brain lesion results in left side impairment •  Speech, memory, and vision are often impaired as well Illness, Injuries, Diseases 5
  6. 6. CVA•  Terminology •  Hemiparesis – partial paralysis on one side, often resulting in diminished motor skills •  Hemiplegia – paralysis in on one side, often resulting in loss of motor skill •  Aphasia – partial or total loss of the ability to express or understand verbal or written language •  Lability - uncontrollable emotional outbursts •  Apraxia – inability to perform purposeful movements, but not accompanied by a loss of sensory function or paralysis •  Ataxia - inability to coordinate voluntary muscle movements Illness, Injuries, Diseases 6
  7. 7. Head Injury•  Closed Head Injury – an injury to the brain caused by an external source that imposes an acceleration, a deceleration, or rotational force•  Open Head Injury – an injury to the brain caused by a penetrating wound•  Symptoms depend upon the region of the brain that is injured•  Impairment as a result of brain injury: •  Physical – motor weakness, imbalance, spasticity •  Cognitive – impaired short term memory, perceptual function, and decision making •  Behavioral – emotional outbursts, impulsivity Illness, Injuries, Diseases 7
  8. 8. Spinal Cord Injury•  The spinal cord is an elongated cylindrical mass of nervous tissue that is enclosed in the spinal canal of the vertebral column •  Between 17 or 18 inches long in the average adult•  Extends from the base of the brain to about the 1st or 2nd lumbar vertebra•  Nerves descending below the ending of the spinal cord form the Cauda Equina, before exiting to periphery•  Cervical and lumbar enlargements are noted, to accommodate the cell bodies (lower motor neurons) for upper and lower extremities Illness, Injuries, Diseases 8
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  10. 10. Spinal Cord Injury•  Spinal Cord Injury (SCI) •  Results from a lesion (injury) to the spinal cord, disrupting motor function and sensation below the level of the lesion •  Classified according to the spinal level of the lesion, (i.e. injury at the 6th thoracic vertebra is classified as a T6 injury) •  Complete - injury that results in the complete loss of function below the point of injury •  Incomplete - injury in which some feeling or movement is still evident below the point of injury Illness, Injuries, Diseases 10
  11. 11. Spinal Cord Injury•  Spinal Cord Injury •  Paralysis – inability to move a body part due to injury or disease of the nerves that supply the involved muscles •  Plegia - true paralysis •  Paresis - significant weakening of the affected muscle(s)•  Causes: •  Trauma – the majority of SCI (gunshots, car/diving accident, etc) •  Infections – (viral, bacterial) polio, transverse myelitis, meningitis, etc •  Tumors – both benign and malignant •  Exposure to toxins Illness, Injuries, Diseases 11
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  13. 13. Spinal Cord Injury•  Complications: •  Motor loss •  Sensory loss •  Incontinence •  Decubitus ulcers •  Spasticity •  Urinary tract infections •  Respiratory illness•  Quadriplegia - lesion above T1 (1st thoracic vertebra) •  Involves any injury in the cervical spine •  Effects all four extremities, and trunk•  Paraplegia – lesion at T1 or lower •  Involves any injury from the 1st thoracic vertebrae down to the coccyx •  Effects both lower extremities Illness, Injuries, Diseases 13
  14. 14. Spinal Cord Injury Illness, Injuries, Diseases 14
  15. 15. Spinal Cord Nerve Levels Illness, Injuries, Diseases 15
  16. 16. Spinal Cord Dermatomes Illness, Injuries, Diseases 16
  17. 17. Disorders of the Spine•  Spinal Stenosis – progressive narrowing of the spaces in the spine, resulting in compression of nerve roots or spinal cord by bony spurs or soft tissue such as discs in the spinal canal •  Most often occurs in the lumbar spine, but can occur in the cervical region; less frequently in the thoracic region •  Can cause pain or numbness in legs, back, neck, shoulders or arms; limb weakness and incoordination; loss of sensation in extremities; problems with bladder or bowel function •  Commonly caused by age-related changes in the spine (osteo- arthritis, disk degeneration, thickened ligaments) Illness, Injuries, Diseases 17
  18. 18. Disorders of the Spine•  Spondylolysis – a defect or fracture of the pars interarticularis (posterior part of the spine) •  Pars joins together the upper and lower joints of the vertebra•  Spondyolisthesis - anterior or posterior displacement of one vertebra or vertebral segment in relation to the vertebra below •  Usually occurs because there is a spondylolysis in the vertebra on top •  Can occur anywhere in the spine, but is most common in the lower spine •  Displacement can cause pressure on spinal cord or nerve roots•  Ankylosing spondylitis - inflammation of the facet joints between vertebrae; eventually causes the affected spinal bones to fuse •  Usually begins between the ages of 20 and 40; affects men more often than women Illness, Injuries, Diseases 18
  19. 19. Disorders of the Spine Illness, Injuries, Diseases 19
  20. 20. Disorders of the Spine•  Herniated Disc - the inner disc material (nucleus), seeps through a crack in its outer shell (annulus)•  Bulging Disc - a bulge in the annulus •  Occurs when the outer shell of a spinal disc weakens to the point where pressure causes it to bulge•  Scoliosis - the sideways curvature of the spine•  Kyphosis - rounding forward of the upper spine•  Spina Bifida - incomplete closure of the bony spinal column; leaves a portion of the membranes or spinal cord exposed Illness, Injuries, Diseases 20
  21. 21. Disorders of the Spine•  Radiculitis - inflammation of a nerve root, synonymous with radicular pain•  Radicular Pain – pain which radiates along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root from its connection to the spinal cord•  Radiculopathy - chronic injury of spinal nerve roots caused by nerve compression or irritation •  Most common in lower back (lumbar radiculopathy) and neck (cervical radiculopathy) •  Numbness, tingling, weakness, loss of motor function, and radiating pain are some of the common symptoms •  Pain is often described as sharp and radiating; worsens with activity or change in position Illness, Injuries, Diseases 21
  22. 22. Multiple Sclerosis•  Multiple Sclerosis (MS) – a progressive neurologic disease characterized by a loss of myelin (demyelinization) •  Myelin – the coating of nerve fibers Illness, Injuries, Diseases 22
  23. 23. Multiple Sclerosis•  Often results in continual loss of physical functions with progressive weakness, spasticity, and impaired coordination; can also affect speech and vision•  Often marked by periods of exacerbations and remissions •  Exacerbations – symptoms worsen •  Remission – symptoms diminish or stabilize•  Excessive heat exacerbates negative symptoms•  Therapeutic exercise cannot reverse or halt the disease progression; however exercise can help maintain musculoskeletal function so that the patient can more effectively maintain functional independence•  Persons are prone to early muscular fatigue, so exercise progression should avoid over-fatigue Illness, Injuries, Diseases 23
  24. 24. Guillain-Barre Syndrome•  Guillain-Barre Syndrome – rare inflammatory disorder, causes symmetrical paralysis and loss of reflexes; usually begins in the lower extremities, then progresses upward •  An autoimmune disorder (the body’s immune system attacks itself) •  Results in destruction of the myelin sheath of the peripheral nerves •  Often occurs after a respiratory infection, or may be triggered by a vaccination •  Weakness and numbness begin in the distal extremities and progressively worsen as symptoms move toward the trunk Illness, Injuries, Diseases 24
  25. 25.   Guillain-Barre Syndrome•  Paralysis can progress to impair respiration•  If early symptoms are severe, there is a significant increase in risk for serious long-term complications•  Outcome usually very good when symptoms abate within 3 weeks of initial onset•  Complete recovery noted in 70-80% of cases, but recovery can take weeks, months, or years; 20-30% have incomplete recovery•  Up to 10 percent of people will experience a relapse Illness, Injuries, Diseases 25
  26. 26. Myasthenia Gravis•  Myasthenia Gravis – a non-progressive disease of unknown origin •  Autoimmune neuromuscular disorder •  Onset can be sudden or gradual •  No known cure but treatment efforts are often favorable •  Often goes into remission for long periods •  Results in extreme fatigue and muscular exhaustion •  Muscular fatigue worsens as the day progresses •  Patterns of weakness usually begin in the face and spread to the other body parts •  An initial symptom is ptosis ( drooping eye lid) that exacerbates as the day progresses Illness, Injuries, Diseases 26
  27. 27. Myasthenia Gravis•  Muscular fatigue worsens as the day progresses (cont.) •  Other symptoms include double vision, speech impairments, and difficulty chewing •  As symptoms spread, the shoulders and thighs become weak and can eventually impair the muscles of respiration•  Symptoms get worse with repeated use and improve with rest•  Shortness of breath can lead to respiratory failure if proper treatment is not administered Illness, Injuries, Diseases 27
  28. 28. Amputation•  Amputation – the cutting off of a limb or part of a limb•  Major causes of amputation: •  Peripheral vascular disease – leading cause •  Particularly linked to smoking and diabetes •  Seen mostly in elderly •  Trauma – second leading cause •  Most related to motor vehicle accidents and gunshot wounds •  Young males represent the largest population group•  Lower extremity amputation sites: •  Toe •  Ray - toe and part of the corresponding metatarsal •  Transmetatarsal – through the metatarsal •  Lisfranc - amputation of the foot at the tarsometatarsal joint •  Chopart - removes the forefoot and midfoot, saving talus and calcaneus Illness, Injuries, Diseases 28
  29. 29. Amputation•  Lower extremity amputation sites: •  Ankle disarticulation (Symes) – through the ankle •  Transtibial (BK - below knee) •  Knee disarticulation – through the knee •  Transfemoral (AK - above knee) •  Hip disarticulation – through the hip •  Hemipelvectomy – partial pelvis removal •  Hemicorporectomy – both lower limbs and all of pelvis removed•  Phantom Limb Sensation - any sensory phenomenon (except pain) which is felt below an amputation site •  Phantom Limb Pain - mild to extreme pain felt in the area below the amputation site; can be extremely agonizing Illness, Injuries, Diseases 29
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  31. 31. Diabetes Mellitus•  Diabetes Mellitus – A chronic disease in which the body either doesn’t produce enough insulin or can’t use its own insulin efficiently •  Insulin is a hormone produced in the pancreas, an organ near the stomach •  Insulin is needed to convert sugar and other food into energy •  This causes elevated blood glucose levels•  Type 1 Diabetes – juvenile onset, insulin dependent •  Type 1 is irreversible•  Type 2 Diabetes – Non-insulin dependent, primarily adult onset, but can affect children •  Type 2 can be reversed or minimized through diet, exercise, and weight control Illness, Injuries, Diseases 31
  32. 32. Amyotrophic Lateral Sclerosis•  Amyotrophic Lateral Sclerosis (ALS) – also known as Lou Gehrig’s Disease •  Chronic, progressive, fatal disease characterized by degeneration of both upper and lower motor neurons in the spinal cord •  As motor neurons die, the ability of the brain to initiate and control muscle movement is lost, affecting voluntary muscle action •  Generally results in total paralysis during the latter stages of the disease •  Symptoms generally appear in the 4th or 5th decade of life •  Average life span is 8 years from the onset of the disease Illness, Injuries, Diseases 32
  33. 33. Parkinsons Disease•  Parkinson’s Disease (paralysis agitans)- progressive movement disorder caused by degeneration in areas of the cerebrum resulting in a decreased production of dopamine •  Characterized by: •  Tremors •  Rigidity •  Slow voluntary movements (bradykinesia) •  Postural instability •  Muscle weakness•  Occurs when cells in one of the movement-control centers of the brain begin to die for unknown reasons Illness, Injuries, Diseases 33
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  35. 35. Huntingtons Disease•  Huntington’s Disease – inherited genetic disorder of the CNS, characterized by progressive mental and physical deterioration, eventually resulting in death •  Caused by a dominant gene, which when inherited the gene from one or both parents, causes a 50% likelihood of developing the disease •  HD is also known as Huntington’s Chorea•  Chorea (dyskinesia) - a neurological disorder causing abnormal involuntary movements •  Chorea comes from the Greek word for dance •  Chorea – restless, wiggling, turning bodily movements •  Chorea movements - uncontrollable and irregular muscle movements, especially of the arms, legs, and face Illness, Injuries, Diseases 35
  36. 36. Huntingtons Disease•  Symptoms •  Can begin at any age from infancy to old age, but usually arise between 35 and 44 years of age •  Earliest symptoms are a general lack of coordination and unsteady gait •  As the disease advances, uncoordinated jerky body movements become more apparent, and behavioral and psychiatric problems increase •  Physical abilities are gradually impeded until coordinated movement becomes very difficult to impossible •  Mental abilities generally decline into dementia Illness, Injuries, Diseases 36
  37. 37. Alzheimers Disease•  Alzheimer’s Disease – disabling neurological disorder resulting in dementia, characterized by dysfunction and death of specific cerebral neurons •  Most serious form of dementia •  Results in widespread intellectual impairment and personality changes •  A significant pathological marker for the disease is the presence of neurofibrillary tangles in specific portions of the brain •  Most important known risk factor is age •  The number of people with AD doubles every 5 years beyond age 65 •  Forgetfulness is an early sign, then short term memory loss, progressing to long term memory loss, and finally, total memory loss Illness, Injuries, Diseases 37
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  39. 39. Lupus•  Lupus – chronic inflammatory autoimmune disorder affecting the connective tissue •  Systemic lupus erythematosus (SLE) - can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system •  The course of the disease is unpredictable with periods of illness (called flares) alternating with remissions •  Common complaints include fever, malaise, muscle pain, fatigue, and temporary loss of cognitive abilities; joint pain especially in the wrists, small joints of the hands, elbows, knees, and ankles is also common •  Cutaneous (discoid) - version of the disease that is limited to the skin; characterized by a rash that appears on the face, neck, and scalp; does not affect internal organs Illness, Injuries, Diseases 39
  40. 40. Lupus•  Characterized by sensitivity to direct sunlight; must avoid overheating•  More common in women; can occur at any age, but is usually diagnosed between the ages of 15 and 40. Illness, Injuries, Diseases 40
  41. 41. Arthritis•  Arthritis - joint disorder characterized by arthralgia , swelling, stiffness, and redness •  Arthralgia – severe joint pain, extending along a nerve or group of nerves •  Involves breakdown of articular cartilage •  Cartilage - dense, elastic, fibrous connective tissue composed of collagen fibers and/or elastin fibers •  Cartilage is contained in various joint structures, the outer ear, larynx, and various other body structures •  Over 100 different types of arthritis exist; the most common types are: •  Osteoarthritis •  Rheumatoid Arthritis Illness, Injuries, Diseases 41
  42. 42. ArthritisIllness, Injuries, Diseases 42
  43. 43. Arthritis•  Osteoarthritis (OA) is the most common type •  Chronic degenerative disorder primarily affecting the articular cartilage of synovial joints •  Eventually results in bone remodeling, with spurs and lipping overgrowth at the joint margins•  Rheumatoid arthritis (RA) - an autoimmune, chronic, inflammatory, systemic disease; initially attacks the synovial membrane within a joint •  Systemic - relating to or affecting the entire body or an entire organism •  Inflammation of the synovial membrane leads to the destruction of the articular cartilage Illness, Injuries, Diseases 43
  44. 44. ArthritisIllness, Injuries, Diseases 44