Bed rest leads to detrimental physiological changes in multiple body systems within hours or days:
1) Cardiovascular changes include decreased blood volume, stroke volume and cardiac output, leading to hypotension and tachycardia.
2) Respiratory changes include decreased lung volumes and gas exchange due to pooling of secretions and reduced mobility.
3) Musculoskeletal changes include rapid loss of muscle mass, bone density, and tendon/ligament strength due to inactivity.
4) Other changes include fluid shifts, electrolyte imbalances, decreased appetite and digestion, impaired skin integrity, and increased risk for medical complications. Close monitoring and early mobilization are important to mitigate these effects of bed rest.
1) The document discusses various pleural surgeries including pleurectomy, pleurodesis, and decortication. Pleurectomy involves removing the parietal layer of pleura through a thoracotomy, while pleurodesis uses chemical or mechanical means to cause the pleural layers to adhere. Decortication removes thickened pleura layers due to chronic inflammation.
2) Pre-operative physiotherapy for these surgeries focuses on improving lung function and mobility. Post-operative care involves techniques like percussion and breathing exercises to clear secretions and expand the lungs while preventing complications. Mobility exercises also aim to restore shoulder and spinal movement.
3) Specific procedures for each surgery are described
Neurophysiological facilitation of respiration [npf]Rekha Marbate
NPF involves using selective external stimuli to reflexively assist respiration in unconscious patients. It can be used for those who are unconscious, have neurological deficits, are partially breathing, or on a ventilator. Contraindications include fractures to the rib cage or spine, children, and respiratory failure. Techniques include perioral stimulation to initiate epigastric movement, thoracic vertebral pressure over T2-T4 to increase abdominal excursion and over T9-T11 to increase thoracic movement, anterior stretch lift of the basal area to increase rib movement, intercostal stretching to increase epigastric movement and general respiration, co-contraction of abdominal pressure to increase excursion and stimulate coughing
A treatment intervention employs positioning, chest percussion, vibration, and manual hyperinflation to mobilize secretions in the lungs and assist in their expulsion. It is used prophylactically for high-risk surgery patients and those unable to cough effectively, and therapeutically for conditions like atelectasis and retained secretions. The techniques aim to prevent accumulation and improve drainage of secretions while promoting relaxed breathing.
Types of techniques:
Airway clearance techniques
Facilitating airway clearance technique with effective coughing techniques
Technique to facilitate ventilation pattern
Mobilization and Exercises
Airway clearance technique:
Postural drainage
Percussion
Vibration/shaking
Manual hyperinflation
Active cycle of breathing technique
Autogenic drainage
Positive expiratory pressure
High frequency chest compression
Exercises for airway clearance
Indications and cautions:
Cystic fibrosis
Atelectasis
Asthama
Respiratpry muscle weakness
Bronchiectasis
Mechanical ventilation
Neonatal respiratory distress syndrome
Contraindications:
Intracranial pressure (ICP) > 20 mm Hg
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Recent spinal surgery (e.g .• laminectomy) or acute spinal injury
Active hemoptysis Empyema
Bronchopleural fistula
Large pleural effusions
Pulmonary embolism
Aged, confused, or anxious patients
Rib fracture. with or without flail chest
Surgical wound or healing tissue
Orthosis principle #orthosis #biomedical #orthosis
an external medical device (such as a brace or splint) for supporting, immobilizing, or treating muscles, joints, or skeletal parts which are weak, ineffective, deformed, or injured a lower extremity orthosis spinal orthoses ,lumbar ,cervical orthosis.
This document discusses physiotherapy treatment for various pulmonary surgeries. It describes different types of thoracotomy incisions and their indications. It also discusses postoperative physiotherapy protocols for procedures like pneumonectomy, lobectomy, wedge resection and others. The goals of physiotherapy are to clear secretions, retain lung expansion, prevent complications and restore mobility. It covers management of chest drains and tubes as well as potential complications of pulmonary surgeries.
The document discusses the role of physiotherapy in the pediatric intensive care unit (PICU). The PICU treats extremely sick pediatric patients with conditions like respiratory, neurological, and cardiovascular disorders. Physiotherapy is important for critically ill PICU patients to prevent long-term muscle weakness, facilitate weaning from ventilation, and promote safe discharge. Key physiotherapy techniques discussed include positioning, percussion and vibrations to clear secretions, breathing exercises like active cycle of breathing, and airway suctioning. The goals are both short-term maintenance of muscle function and long-term rehabilitation and reintegration into society.
The core muscles can be categorized as stabilizers or mobilizers. Stabilizers like the transversus abdominis and multifidus are deeply placed, have slow twitch fibers, and help provide stability. Mobilizers like the rectus abdominis are more superficial and have fast twitch fibers for movement. Chronic low back pain is associated with weakness in the transversus abdominis and multifidus as well as decreased flexibility. A core strengthening program focuses on training these local stabilizer muscles in three stages: 1) local segmental control, 2) closed chain exercises, and 3) open chain exercises and functional progression. Exercises target the transversus abdominis, multifidus, and glute
1) The document discusses various pleural surgeries including pleurectomy, pleurodesis, and decortication. Pleurectomy involves removing the parietal layer of pleura through a thoracotomy, while pleurodesis uses chemical or mechanical means to cause the pleural layers to adhere. Decortication removes thickened pleura layers due to chronic inflammation.
2) Pre-operative physiotherapy for these surgeries focuses on improving lung function and mobility. Post-operative care involves techniques like percussion and breathing exercises to clear secretions and expand the lungs while preventing complications. Mobility exercises also aim to restore shoulder and spinal movement.
3) Specific procedures for each surgery are described
Neurophysiological facilitation of respiration [npf]Rekha Marbate
NPF involves using selective external stimuli to reflexively assist respiration in unconscious patients. It can be used for those who are unconscious, have neurological deficits, are partially breathing, or on a ventilator. Contraindications include fractures to the rib cage or spine, children, and respiratory failure. Techniques include perioral stimulation to initiate epigastric movement, thoracic vertebral pressure over T2-T4 to increase abdominal excursion and over T9-T11 to increase thoracic movement, anterior stretch lift of the basal area to increase rib movement, intercostal stretching to increase epigastric movement and general respiration, co-contraction of abdominal pressure to increase excursion and stimulate coughing
A treatment intervention employs positioning, chest percussion, vibration, and manual hyperinflation to mobilize secretions in the lungs and assist in their expulsion. It is used prophylactically for high-risk surgery patients and those unable to cough effectively, and therapeutically for conditions like atelectasis and retained secretions. The techniques aim to prevent accumulation and improve drainage of secretions while promoting relaxed breathing.
Types of techniques:
Airway clearance techniques
Facilitating airway clearance technique with effective coughing techniques
Technique to facilitate ventilation pattern
Mobilization and Exercises
Airway clearance technique:
Postural drainage
Percussion
Vibration/shaking
Manual hyperinflation
Active cycle of breathing technique
Autogenic drainage
Positive expiratory pressure
High frequency chest compression
Exercises for airway clearance
Indications and cautions:
Cystic fibrosis
Atelectasis
Asthama
Respiratpry muscle weakness
Bronchiectasis
Mechanical ventilation
Neonatal respiratory distress syndrome
Contraindications:
Intracranial pressure (ICP) > 20 mm Hg
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Recent spinal surgery (e.g .• laminectomy) or acute spinal injury
Active hemoptysis Empyema
Bronchopleural fistula
Large pleural effusions
Pulmonary embolism
Aged, confused, or anxious patients
Rib fracture. with or without flail chest
Surgical wound or healing tissue
Orthosis principle #orthosis #biomedical #orthosis
an external medical device (such as a brace or splint) for supporting, immobilizing, or treating muscles, joints, or skeletal parts which are weak, ineffective, deformed, or injured a lower extremity orthosis spinal orthoses ,lumbar ,cervical orthosis.
This document discusses physiotherapy treatment for various pulmonary surgeries. It describes different types of thoracotomy incisions and their indications. It also discusses postoperative physiotherapy protocols for procedures like pneumonectomy, lobectomy, wedge resection and others. The goals of physiotherapy are to clear secretions, retain lung expansion, prevent complications and restore mobility. It covers management of chest drains and tubes as well as potential complications of pulmonary surgeries.
The document discusses the role of physiotherapy in the pediatric intensive care unit (PICU). The PICU treats extremely sick pediatric patients with conditions like respiratory, neurological, and cardiovascular disorders. Physiotherapy is important for critically ill PICU patients to prevent long-term muscle weakness, facilitate weaning from ventilation, and promote safe discharge. Key physiotherapy techniques discussed include positioning, percussion and vibrations to clear secretions, breathing exercises like active cycle of breathing, and airway suctioning. The goals are both short-term maintenance of muscle function and long-term rehabilitation and reintegration into society.
The core muscles can be categorized as stabilizers or mobilizers. Stabilizers like the transversus abdominis and multifidus are deeply placed, have slow twitch fibers, and help provide stability. Mobilizers like the rectus abdominis are more superficial and have fast twitch fibers for movement. Chronic low back pain is associated with weakness in the transversus abdominis and multifidus as well as decreased flexibility. A core strengthening program focuses on training these local stabilizer muscles in three stages: 1) local segmental control, 2) closed chain exercises, and 3) open chain exercises and functional progression. Exercises target the transversus abdominis, multifidus, and glute
The goals of physical therapy in the ICU are to improve cardiopulmonary, musculoskeletal, neurological, and functional status. PT involves assessing these systems along with the respiratory, cardiovascular, renal, hematological and gastrointestinal systems. Techniques include positioning, chest mobilization like percussion and vibration, manual hyperinflation, airway suctioning, and mobilization ranging from frequent repositioning to progressive ambulation depending on stability. The aims are to clear secretions, improve lung function, exercise tolerance, and accelerate recovery through early mobilization.
Humidity therapy adds moisture to air delivered to patients and is used to overcome humidity deficits when the upper airway is bypassed or for humidifying dry medical gases. It helps maintain normal humidity levels in the airways and can assist in managing conditions like thick secretions or hypothermia. Various humidifiers actively add heat or water to air or passively recycle exhaled heat and moisture, with different types suited to invasive or non-invasive ventilation.
Artificial intelligence (AI) is the ability of machines to perform tasks that normally require human intelligence, such as visual perception, speech recognition, and decision-making. AI is an area of computer science that includes general problem solving, natural language processing, reasoning, learning, and many other activities. The goal is to create machines that can learn from experience, adjust to new inputs and perform human-like tasks.
This document discusses chest physiotherapy techniques for managing critically ill patients from a physiotherapist's perspective. It describes techniques like positioning, chest percussion, vibration and manual hyperinflation which help mobilize secretions in the lungs. The goals of these techniques are to prevent accumulation of secretions, improve drainage and promote better breathing patterns and respiratory function. Specific techniques covered include various positioning methods, chest tapotements like clapping, vibration and rib springing, as well as manual hyperinflation and airway suctioning. Evidence on the benefits of positioning include increased lung volumes and compliance and improved ventilation.
This document defines peripheral vascular disease and describes the differences between peripheral arterial and venous disorders. It lists various risk factors for PVD like age, smoking, hypertension, and diabetes. Tests for assessing arterial insufficiency include ankle brachial index, treadmill testing, and skin perfusion pressure measurement. Tests for venous insufficiency include venous filling time, Homan's sign, and Trendelenburg test. Signs and symptoms of arterial disease include pale skin, absent pulses, and painful ulcers. Venous disease presents with warm skin, edema, and less painful ulcers. Grading scales assess severity of venous disease based on symptoms and ulcer characteristics.
This document discusses biomechanics and activities of daily living. It defines biomechanics as the study of mechanics in the human body. Functional biomechanics looks at the link between the human body and its environment. Biomechanics consists of kinematics, the description of motion, and kinetics, the forces producing motion. Common activities like running, lifting, and walking are analyzed in terms of joint motion and ground reaction forces. Proper form and muscle engagement can reduce stresses, as seen in squat lifting versus stoop lifting.
What is chest physiotherapy?
Chest physiotherapy is a group of physical techniques that improve lung function and help you breathe better. Chest PT, or CPT expands the lungs, strengthens breathing muscles, and loosens and improves drainage of thick lung secretions. Chest PT helps treat such diseases as cystic fibrosis and COPD (chronic obstructive pulmonary disease). It also keeps the lungs clear to prevent pneumonia after surgery and during periods of immobility.
Nerve Gliding Exercises - Excursion and Valuable Indications for TherapySarah Arnold
This document discusses nerve gliding exercises and their benefits for therapy. It describes how nerve glides can help increase nerve mobility and blood flow. Specific nerve glides are presented for common nerve entrapment syndromes like cubital tunnel syndrome (ulnar nerve) and carpal tunnel syndrome (median nerve). The document emphasizes performing glides symptom-free and using sliding techniques over tensioning. Nerve glides are recommended to prevent nerve adhesions after injuries or surgery.
Pathomechanics of thoracic spine diseaseranjan mishra
The thoracic spine is the longest region of the spine, and by some measures it is also the most complex. Connecting with the cervical spine above and the lumbar spine below, the thoracic spine runs from the base of the neck down to the abdomen. It is the only spinal region attached to the rib cage.
The active cycle of breathing technique (ACBT) uses three phases to loosen and clear airway secretions: breathing control to relax airways, thoracic expansion exercises to get air behind mucus, and huffing or forced expiratory techniques to force mucus out. It is effective for various respiratory conditions like asthma, chronic bronchitis, and cystic fibrosis. The technique involves deep breathing, held breaths, and controlled coughing or huffing in set cycles while maintaining proper posture. ACBT sessions typically last 10 minutes and are usually performed once or twice weekly but can be done more often if needed.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
The document discusses outcome measures of functional capacity, specifically the 6-minute walk test (6MWT) and incremental shuttle walk test (ISWT). It provides background on each test, how they are implemented, evidence on their validity, reliability and responsiveness. Both tests are described as suitable measures for cardiopulmonary patients, though some evidence suggests the ISWT may better correlate to physiological measures like heart rate and dyspnea. Further research is still needed to establish the tests' validity across specific patient populations.
This document discusses humidification during mechanical ventilation. It begins by outlining the objectives and introducing humidification as a way to artificially condition inspired gas. It then covers the indications for humidification when the upper airway is bypassed and describes how inadequate humidification can cause clinical signs. The document delves into the physiology of normal heat and moisture exchange and how this is disrupted during mechanical ventilation. It describes different types of humidifiers including passive heat and moisture exchangers and active bubble through, passover and nebulizer humidifiers. It outlines principles of humidifier function and discusses indications, contraindications and hazards of humidification. It concludes by assessing the need for different humidifiers and common problems.
This document discusses several theories of motor control including reflex theory, hierarchical theory, dynamical systems theory, motor programming theory, system theory, and ecological theory. It provides details on the key aspects and proposals of each theory as well as examples and criticisms of each approach to understanding human movement and motor control.
SI Joint a stable joint , it is the cause of pain during pregnancy in many women during antenatal and postnatal period ,in this slideshare some exercises for SI joint during pregnancy ,the assesment and the basic relaxation exercise is given
This orthopedic assessment document contains sections on the patient's demographic details, chief complaints, medical history, vitals, physical examination findings, investigations, differential diagnosis, diagnosis, and treatment goals. The physical examination includes assessing the patient's posture, gait, range of motion, muscle strength, reflexes, and limb measurements. The diagnosis and problem list are provided based on integrating the history and examination findings. Short and long-term treatment goals are outlined.
The 6-minute walk test (6MWT) is a sub-maximal exercise test used to assess functional capacity over 6 minutes. It requires a 30-meter unimpeded walkway and is scored based on the total distance walked in 6 minutes. The 6MWT can be used to evaluate patients with various cardiopulmonary and musculoskeletal conditions. It provides information on cardiopulmonary, circulatory and metabolic function during physical activity. The test is self-paced but involves continuous encouragement to walk as far as possible within 6 minutes while allowing for rests. Interpretation compares the distance walked to reference values based on age, gender, height and other factors.
Ultrasound therapy is a treatment used by physical therapists or occupational therapists to relieve pain and to promote tissue healing. While ultrasound therapy is not effective for all chronic pain conditions, it may help reduce your pain if you have any of the following: Osteoarthritis. Myofascial pain syndrome.
The document discusses the biomechanics of different swimming strokes and common shoulder injuries in swimmers. It describes the phases and muscle activity involved in the freestyle, butterfly, backstroke, and breaststroke strokes. It notes that the shoulders are most vulnerable to injury due to the repetitive overhead motion required. Swimmers with painful shoulders often have decreased activity of the serratus anterior and teres minor muscles, resulting in a less stable scapula. Maintaining proper technique can help reduce humeral hyperextension and risk of injury.
Immobilization and prolonged bed rest can lead to significant physiological changes and health risks. It causes fluid shifts, reduced cardiac function, muscle and bone loss, increased risk of infection and blood clots. Specific problems include dehydration, low blood pressure with standing, muscle and joint stiffness, lung function decline, and bone loss or fractures over time. Those who are already ill or elderly are most vulnerable to the negative effects of immobilization.
The document discusses different types of shock and their pathophysiology. It defines shock and describes classifications proposed by Blalock and others. Types include hemorrhagic, cardiogenic, obstructive, distributive, and endocrine shock. The body responds to shock through neuroendocrine and physiological changes aimed at maintaining perfusion. These include activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, and antidiuretic hormone among others. Clinical assessment and management of shock are also covered.
The goals of physical therapy in the ICU are to improve cardiopulmonary, musculoskeletal, neurological, and functional status. PT involves assessing these systems along with the respiratory, cardiovascular, renal, hematological and gastrointestinal systems. Techniques include positioning, chest mobilization like percussion and vibration, manual hyperinflation, airway suctioning, and mobilization ranging from frequent repositioning to progressive ambulation depending on stability. The aims are to clear secretions, improve lung function, exercise tolerance, and accelerate recovery through early mobilization.
Humidity therapy adds moisture to air delivered to patients and is used to overcome humidity deficits when the upper airway is bypassed or for humidifying dry medical gases. It helps maintain normal humidity levels in the airways and can assist in managing conditions like thick secretions or hypothermia. Various humidifiers actively add heat or water to air or passively recycle exhaled heat and moisture, with different types suited to invasive or non-invasive ventilation.
Artificial intelligence (AI) is the ability of machines to perform tasks that normally require human intelligence, such as visual perception, speech recognition, and decision-making. AI is an area of computer science that includes general problem solving, natural language processing, reasoning, learning, and many other activities. The goal is to create machines that can learn from experience, adjust to new inputs and perform human-like tasks.
This document discusses chest physiotherapy techniques for managing critically ill patients from a physiotherapist's perspective. It describes techniques like positioning, chest percussion, vibration and manual hyperinflation which help mobilize secretions in the lungs. The goals of these techniques are to prevent accumulation of secretions, improve drainage and promote better breathing patterns and respiratory function. Specific techniques covered include various positioning methods, chest tapotements like clapping, vibration and rib springing, as well as manual hyperinflation and airway suctioning. Evidence on the benefits of positioning include increased lung volumes and compliance and improved ventilation.
This document defines peripheral vascular disease and describes the differences between peripheral arterial and venous disorders. It lists various risk factors for PVD like age, smoking, hypertension, and diabetes. Tests for assessing arterial insufficiency include ankle brachial index, treadmill testing, and skin perfusion pressure measurement. Tests for venous insufficiency include venous filling time, Homan's sign, and Trendelenburg test. Signs and symptoms of arterial disease include pale skin, absent pulses, and painful ulcers. Venous disease presents with warm skin, edema, and less painful ulcers. Grading scales assess severity of venous disease based on symptoms and ulcer characteristics.
This document discusses biomechanics and activities of daily living. It defines biomechanics as the study of mechanics in the human body. Functional biomechanics looks at the link between the human body and its environment. Biomechanics consists of kinematics, the description of motion, and kinetics, the forces producing motion. Common activities like running, lifting, and walking are analyzed in terms of joint motion and ground reaction forces. Proper form and muscle engagement can reduce stresses, as seen in squat lifting versus stoop lifting.
What is chest physiotherapy?
Chest physiotherapy is a group of physical techniques that improve lung function and help you breathe better. Chest PT, or CPT expands the lungs, strengthens breathing muscles, and loosens and improves drainage of thick lung secretions. Chest PT helps treat such diseases as cystic fibrosis and COPD (chronic obstructive pulmonary disease). It also keeps the lungs clear to prevent pneumonia after surgery and during periods of immobility.
Nerve Gliding Exercises - Excursion and Valuable Indications for TherapySarah Arnold
This document discusses nerve gliding exercises and their benefits for therapy. It describes how nerve glides can help increase nerve mobility and blood flow. Specific nerve glides are presented for common nerve entrapment syndromes like cubital tunnel syndrome (ulnar nerve) and carpal tunnel syndrome (median nerve). The document emphasizes performing glides symptom-free and using sliding techniques over tensioning. Nerve glides are recommended to prevent nerve adhesions after injuries or surgery.
Pathomechanics of thoracic spine diseaseranjan mishra
The thoracic spine is the longest region of the spine, and by some measures it is also the most complex. Connecting with the cervical spine above and the lumbar spine below, the thoracic spine runs from the base of the neck down to the abdomen. It is the only spinal region attached to the rib cage.
The active cycle of breathing technique (ACBT) uses three phases to loosen and clear airway secretions: breathing control to relax airways, thoracic expansion exercises to get air behind mucus, and huffing or forced expiratory techniques to force mucus out. It is effective for various respiratory conditions like asthma, chronic bronchitis, and cystic fibrosis. The technique involves deep breathing, held breaths, and controlled coughing or huffing in set cycles while maintaining proper posture. ACBT sessions typically last 10 minutes and are usually performed once or twice weekly but can be done more often if needed.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
The document discusses outcome measures of functional capacity, specifically the 6-minute walk test (6MWT) and incremental shuttle walk test (ISWT). It provides background on each test, how they are implemented, evidence on their validity, reliability and responsiveness. Both tests are described as suitable measures for cardiopulmonary patients, though some evidence suggests the ISWT may better correlate to physiological measures like heart rate and dyspnea. Further research is still needed to establish the tests' validity across specific patient populations.
This document discusses humidification during mechanical ventilation. It begins by outlining the objectives and introducing humidification as a way to artificially condition inspired gas. It then covers the indications for humidification when the upper airway is bypassed and describes how inadequate humidification can cause clinical signs. The document delves into the physiology of normal heat and moisture exchange and how this is disrupted during mechanical ventilation. It describes different types of humidifiers including passive heat and moisture exchangers and active bubble through, passover and nebulizer humidifiers. It outlines principles of humidifier function and discusses indications, contraindications and hazards of humidification. It concludes by assessing the need for different humidifiers and common problems.
This document discusses several theories of motor control including reflex theory, hierarchical theory, dynamical systems theory, motor programming theory, system theory, and ecological theory. It provides details on the key aspects and proposals of each theory as well as examples and criticisms of each approach to understanding human movement and motor control.
SI Joint a stable joint , it is the cause of pain during pregnancy in many women during antenatal and postnatal period ,in this slideshare some exercises for SI joint during pregnancy ,the assesment and the basic relaxation exercise is given
This orthopedic assessment document contains sections on the patient's demographic details, chief complaints, medical history, vitals, physical examination findings, investigations, differential diagnosis, diagnosis, and treatment goals. The physical examination includes assessing the patient's posture, gait, range of motion, muscle strength, reflexes, and limb measurements. The diagnosis and problem list are provided based on integrating the history and examination findings. Short and long-term treatment goals are outlined.
The 6-minute walk test (6MWT) is a sub-maximal exercise test used to assess functional capacity over 6 minutes. It requires a 30-meter unimpeded walkway and is scored based on the total distance walked in 6 minutes. The 6MWT can be used to evaluate patients with various cardiopulmonary and musculoskeletal conditions. It provides information on cardiopulmonary, circulatory and metabolic function during physical activity. The test is self-paced but involves continuous encouragement to walk as far as possible within 6 minutes while allowing for rests. Interpretation compares the distance walked to reference values based on age, gender, height and other factors.
Ultrasound therapy is a treatment used by physical therapists or occupational therapists to relieve pain and to promote tissue healing. While ultrasound therapy is not effective for all chronic pain conditions, it may help reduce your pain if you have any of the following: Osteoarthritis. Myofascial pain syndrome.
The document discusses the biomechanics of different swimming strokes and common shoulder injuries in swimmers. It describes the phases and muscle activity involved in the freestyle, butterfly, backstroke, and breaststroke strokes. It notes that the shoulders are most vulnerable to injury due to the repetitive overhead motion required. Swimmers with painful shoulders often have decreased activity of the serratus anterior and teres minor muscles, resulting in a less stable scapula. Maintaining proper technique can help reduce humeral hyperextension and risk of injury.
Immobilization and prolonged bed rest can lead to significant physiological changes and health risks. It causes fluid shifts, reduced cardiac function, muscle and bone loss, increased risk of infection and blood clots. Specific problems include dehydration, low blood pressure with standing, muscle and joint stiffness, lung function decline, and bone loss or fractures over time. Those who are already ill or elderly are most vulnerable to the negative effects of immobilization.
The document discusses different types of shock and their pathophysiology. It defines shock and describes classifications proposed by Blalock and others. Types include hemorrhagic, cardiogenic, obstructive, distributive, and endocrine shock. The body responds to shock through neuroendocrine and physiological changes aimed at maintaining perfusion. These include activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, and antidiuretic hormone among others. Clinical assessment and management of shock are also covered.
The document summarizes blood flow to different parts of the body, including the brain, heart, skeletal muscles, skin, lungs, and gastrointestinal system. It describes how blood flow is controlled and changes in each area, such as increasing during exercise in muscles or decreasing to conserve heat in the skin. Blood flow to the brain remains constant across a wide range of conditions through autoregulation and is sensitive to carbon dioxide levels.
This document discusses shock, which is an inadequate tissue perfusion that can lead to cell death if not addressed promptly. It defines shock and outlines its pathophysiology, including cellular, microvascular, systemic, and reperfusion events. It also classifies shock into hypovolaemic, cardiogenic, obstructive, distributive, and endocrine types. The document emphasizes that shock is a leading cause of death among surgical patients and stresses the importance of understanding its diagnosis and management.
1. The document discusses different types of shock including hypovolaemic, cardiogenic, neurogenic, anaphylactic shock.
2. Hypovolaemic shock is due to diminished blood volume from blood or fluid loss. Cardiogenic shock is caused by inefficient myocardial function. Neurogenic shock is caused by loss of sympathetic tone leading to vasodilation.
3. Anaphylactic shock occurs due to an allergic reaction causing histamine release and widespread vasodilation.
Increases in tissue metabolism and decreases in oxygen availability lead to increases in local blood flow. The two major theories for local blood flow control are the vasodilator theory and oxygen demand theory. Local blood flow is closely related to and regulated by the metabolic rate and oxygen needs of each tissue.
This document discusses the local and humoral regulation of tissue blood flow. It begins by outlining the specific needs of tissues for blood flow, including delivery of oxygen and nutrients and removal of waste. It then describes the mechanisms by which changes in tissue metabolism or oxygen availability alter blood flow, including the vasodilator and oxygen demand theories. The document also discusses acute responses like active and reactive hyperemia, as well as long-term regulation through changes in vascularity and remodeling of blood vessels. Finally, it outlines various humoral factors that can cause vasoconstriction or vasodilation, such as sympathetic nerves, angiotensin, bradykinin, and ions like calcium, potassium, and hydrogen ions
This document discusses factors that impact mobility and appropriate nursing interventions. It identifies factors like immobility, circulatory and respiratory issues, pain, and neurological impairments that can decrease mobility. Nursing interventions to improve mobility include positioning, range of motion exercises, ambulation, and assistive devices. The goal is to prevent complications and promote optimal functioning.
1. The Monroe-Kellie doctrine states that the volume of intracranial contents (brain, blood, CSF) must remain constant since the skull is a rigid container. An increase in one component must be compensated by a decrease in another to avoid rises in intracranial pressure.
2. Arterial blood pressure is regulated in the short term by the autonomic nervous system and baroreceptors, which detect changes in pressure and modulate heart rate and vascular tone. Long term regulation involves the renin-angiotensin-aldosterone system and vasopressin.
3. The cardiac cycle involves repeated cycles
The document provides an overview of acute kidney failure, including its anatomy, physiology, causes, symptoms, diagnosis, treatment and complications. Some key points:
- The kidneys are located in the back, protected by the ribs. They filter waste from the blood to produce urine.
- Acute kidney failure is the sudden reduction of kidney function, causing waste to accumulate in the blood. It can be caused by dehydration, medications, infections and more.
- Symptoms include reduced urine output, swelling, fatigue, shortness of breath and more. Diagnosis involves medical history, physical exam, blood and urine tests.
- Treatment aims to correct fluid and electrolyte imbalances through IV fluids
1. Prolonged immobility can lead to serious physical and psychological complications for older adults due to deconditioning and loss of mobility.
2. Key physical risks include muscle atrophy, bone loss, skin breakdown, cardiovascular deconditioning, pulmonary issues, and functional decline.
3. Interventions like range of motion exercises, proper positioning, ambulation assistance, and pain management can help mitigate risks while immobilization is necessary. Regular mobility is important for overall health in older adults.
Lec 5a circulati on exercise physiologyangelickhan2
This document summarizes circulatory responses to exercise. It discusses how the cardiovascular system increases oxygen delivery to active muscles during exercise through two adjustments: increased cardiac output from higher heart rate and stroke volume, and redistribution of blood flow from inactive organs to active muscles. The heart is divided into four chambers that pump deoxygenated blood to the lungs and oxygenated blood to the body tissues through separate pulmonary and systemic circuits.
Prolonged immobility and bed rest can lead to serious physical and psychological complications affecting nearly every system of the body. Physically, it can cause muscle atrophy and weakness within days, as well as bone loss and fractures over weeks. Other issues include skin breakdown and pressure ulcers, pulmonary complications like pneumonia, thrombus formation and cardiovascular deconditioning, and gastrointestinal issues like constipation. Psychologically, immobility is linked to depression and loss of independence. Preventing and addressing immobility is important for overall health and well-being.
'age related cardiopulmonary changes.pptx'.pptxdevanshi92
This document provides a review of literature on age-related cardiopulmonary changes. It summarizes research showing that aging leads to structural and functional changes in both the cardiovascular and respiratory systems. For the cardiovascular system, changes include increased stiffness of arteries and valves, decreased compliance of heart walls, and alterations in the electrical conduction system. For the respiratory system, aging causes a loss of elastic recoil in the lungs, decreased compliance of the chest wall and ventilatory muscles, and a decline in both diffusion capacity and maximal aerobic power. The integration of cardiovascular and pulmonary systems during exercise is also impacted by aging.
Hydrostatic pressure is exerted by a liquid at rest and is directly proportional to the height and density of the liquid column. The hydrostatic pressure of a liquid depends on its density and the local gravity. As hydrostatic pressure increases with height, the stream of water from a hole at the bottom of a container will travel farther than one at the top.
1. The document discusses the pathology, signs, symptoms, diagnosis and treatment of myocardial infarction (MI). It describes the different types of MIs based on location and extent of necrosis in the heart muscle.
2. Diagnosis involves electrocardiograms, cardiac enzyme levels, imaging modalities and angiography. Signs and symptoms can range from chest pain to dyspnea, sweating or nausea.
3. Treatment goals are to restore blood flow and salvage heart muscle. This involves medications, fibrinolytics, percutaneous coronary intervention or bypass surgery depending on the individual case.
The document provides an overview of the human cardiovascular system. It describes the structure and function of the heart, including the layers of the heart wall, valves, conduction system, and heart sounds. It discusses the role of arteries, veins, and capillaries in circulating blood throughout the body and exchanging gases and nutrients at the tissue level. It also covers cardiac cycle, heart rate regulation by the autonomic nervous system, effects of ions like potassium and calcium on heart function, and factors influencing blood pressure.
The document summarizes several aspects of regional circulations, including the coronary, cutaneous, cerebral, skeletal muscle, splanchnic, and renal circulations. Specific details provided on the coronary circulation include its high blood flow even at rest, regulation of flow through metabolic and neural mechanisms, and implications for conditions like myocardial infarction and heart failure. Key aspects of the cutaneous circulation discussed are its role in temperature regulation through sympathetic nervous system control of arterioles and anastomoses, and local vasodilation or constriction in response to heating and cooling.
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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App e deleterious effects of bedrest
1. Sandra Hess RN BSN CCRN
University of Iowa Hospitals and Clinics
2. “Teach us to live that we may
dread unnecessary time in
bed. Get people up and we
may save our patients from an
early grave.”
Richard Asher
1947
3. Cardiovascular Effects of Bed rest
Decreased
total blood
volume
relative to
bed rest
Decreased Decreased
maximal O2 stroke
uptake volume
Hypotension Tachycardia
4. After 12 hours of bed rest, fluid shifts to the thorax
Increased central blood volume stretches the atria to stimulate
the release of atrial natriuretic peptide.
Diuresis results in decreased plasma volume
Filling pressures and central blood volume decrease.
Baro-receptors become deconditioned and less responsive to
vascular volume changes
Average loss of 600 ml of plasma volume contributes to
hypotension when on bed rest.
Orthostatic hypotension occurs after 3-5 days of bed rest.
Must allow for hemodynamic equilibrium when moving a patient.
(Sciacky, 1994)
5. Increase in the cardiac response to circulating
norepinephrine
Decrease in threshold for arrythmias
Increase in myocardial O2 consumption.
Decrease in vagal tone.
Beta adrenergic receptors become more
sensitive
Heart rate increases but cardiac output still
decreases due to the decrease in plasma volume,
preload, and stroke volume.
Prolonged bed rest can result in a 9% reduction in
red blood cell mass
O2 carrying capacity is compromised.
( Stuemple & Drury, 2007)
6. Stroke volume reduction
Not due to change in contractility.
Contractility and EF increase due to increased
sensitivity to beta adrenergic receptors.
Primary mechanism for decreased stroke volume is
decreased preload due to the reduction in plasma
volume.
Rapid diuresis occurs in the first 24-48 hours of
bedrest
Results in 10-20% reduction in plasma volume.
Venous compliance increases by 20-25% resulting in
venous pooling in a lower extremities.
(Allen & DelMar, 1999)
7. Orthostatic hypotension is experienced with
position changes on prolonged bed rest
Due to:
Decreased circulating blood volume
Decreased stroke volume
Increased venous pooling
Autonomic reflex function
Impaired carotid-cardiac baroreflex responses
Impaired vascular vasoconstrictive reserve
All result in profound orthostatic intolerance to the
upright position.
( Malone, 1994)
8. Decreased O2 uptake due to
--- Decreased blood volume, decreased stroke
volume, cardiac output , and decreased red
blood cell mass.
---Deconditioned muscles develop lactic acid
interfering with O2 delivery.
---Reduction in baseline and maximal blood flow
to skeletal muscles.
---Decreased capillarization of skeletal muscles
during immobility.
(Convertino, 1999)
9. Lung Volume Changes
Decreased tidal volume due to:
Supine position, body weight and decreased
movement of the rib cage.
Rib cage movement accounts for
---78% tidal exchange in upright position
--- Drops to 32% tidal exchange in supine position
Drop in residual volume increases risk of lung collapse.
Due to:
---Increased pulmonary blood volume when supine.
---Pressure of abdominal organs on the diaphragm.
( Manning et al, 1999)
10. Upright position:
Cilia continually trap particles and sweep mucus
upward
Bed rest:
Ciliary escalator swamped by pooled secretions
Dehydration causes pooled mucus to thicken
Airway diameters constrict in bed rest.
Breathing more labored and deep breaths difficult.
Small pockets of atelectasis develop.
Gas exchange is reduced. (Corcoran, 1981)
Changes are more pronounced in elderly, smokers and
overweight. (Dean, 1985)
11. Forced vital capacity is the amount that is
forced from the lungs after a maximum
inspiration--Normally 4.5 L
Forced expiratory volume is measured over one
second at end exhalation
Reductions in both due to:
---Airway obstruction due to mucus pooling
---Decreased elastic recoil and increased
resistance in the airways.
(Manning et al, 1999)
12. Kidneys drain by peristalsis and gravity in the upright position.
When recumbent, gravitational forces lost and urine collects in
the lower renal calices in small stagnant pools.
Bladder doesn’t respond to reflex to void due to loss of urine
pressure on the walls, bladder neck and sphincter.
Loss of abdominal organ downward pressure also contributes to
urinary retention.
Urinary retention causes small tears in the bladder wall and
leads to colonization of bacteria.
Prolonged bed rest causes urinary solutes to crystalize. Bladder
wall sloughs .
Boney demineralization increases serum levels of calcium and
phosphates causing renal stone formation.
Indwelling catheters provide superhighway for bacteria to
invade the bladder.
Bed rest stimulates the renin- angiotensin- aldosterone
cascade.
13. After 10 hours of
bed rest: plasma
volume drops due
to diuresis. Sodium
goes with water
Sodium is retained but Blood pressure falls
potassium is lost. If and kidneys release
not corrected by fluids renin which catalyzes
and lyte replacement, angiotensinogen into
cycle continues. angiotensin I
(Montague et al, 2005)
Angiotensin II increases
Angiotensin I is
blood pressure by
converted to angiotensin
vasoconstriction, and
II by angiotensin-
stimulates the adrenals
converting enzyme in
to release aldosterone
the lungs
to retain sodium
14. During Bed rest:
Reduced sense of taste and smell
Loss of appetite
GI tract disuse leads to GI mucosal lining atrophy and shrinkage
of glandular structures
Gastric bicarbonate secretion decreases.
Gastric contents become more acidic. When recumbent, gastric
contents regurgitate into the lower esophagus.
Circulating glucocorticoids increase risk of stress ulcers.
GI bacteria migrates to tracheo-esophageal junction
Transit time for fluid increases.
( Bortz, 1984)
Fluid loss, opiates, and decreased peristalsis contribute to
ileus and bowel obstruction.
( Jordan, 2008 )
15. Muscles
Average atrophy and loss of muscle strength is 12% per week.
Feet don’t bear weight-Skeletal muscles lose tone.
Weight bearing muscles first to weaken.
Extensor muscles ( e.g. quadriceps) atrophy more than flexors
(e.g. hamstrings)
Muscle shortening results in contractures.
Mitochondria decrease with atrophy-muscles fatigue easily.
O2 extraction decreases
Increased protein synthesis and muscle breakdown results in
muscle wasting.
Fully deconditioned muscles can’t recruit the motor unit ;
coordination of muscle function is lost.
Postural and locomotive muscles lose tension generating
capacity. Disuse atrophy causes backache and fatigue.
16. Two types of cells:
Osteoblasts build boney matrix. Osteoclasts break down boney
matrix. Balance depends on stress of mobility and weight
bearing.
Bed rest
Osteoblasts don’t build bone but osteoclasts still break it down .
Loss of bone density leads to disuse osteoporosis.
Urinary calcium levels rise and can result in renal stones.
Two types of boney tissue:
Trabecular-”spongy” bone is in the ends of the long bones, vertebrae and
pelvis.
Cortical “ compact” bone is found in the shaft of the long bones.
Bed rest
Both types lose mass. The vertebral column decreases by 1% per week of
bedrest-50 times the rate of normal aging.
In post-menopausal women, bone loss is most rapid in the femoral neck.
17. Tendons, ligaments and articular cartilage need motion
to stay functional.
Structure of collagen fiber alters.
Tendons soften and lose ability to produce dynamic
force. Patient experiences weakness and exhaustion
Ligaments are affected biochemically, biomechanically
and morphologically.
Ligament load bearing capacity drops up to 69% below
normal.
Ligament changes persist up to one year after
recovery.
Fibro-fatty infiltration of joints develops strong
adhesions and destroys cartilage.
18. During sleep, we shift weight and position every 11.6 minutes
The only area of the body where skin is designed to bear weight is the soles
of the feet.
During bed rest a large areas of the skin bear weight.
(Gulanik&Myers, 2006)
Repositioning causes the forces of friction and shear over boney
prominences.
If capillary pressure exceeds 32 mmhg, ischemia of underlying tissues
results.
(Wilkinson, 2000)
Inflammatory processes that promote vasodilation and extravasation of fluid
into the interstitial tissues worsen edema.
If external pressure exceeds 70mmhg for greater than 2 hours, irreversible
damage results.
Prolonged lying in one position causes nerve compression and contributes
to neuropathy.
(Dinsdale, 1974)
19. Increased Blood Viscosity
Initially there is an increase in HCT due to loss of body water with
diuresis.
Gradually there is a drop in HGB due to decreased O2 demand and
resulting decrease in erythropoesis.
( Kaplan, 2005)
Virchow’s Triad
Increases the chance of developing DVT and emboli
3 Factors
---Venous stasis
---Hypercoagulability- Blood is thickened.
Clotting factors are slow to clear from the liver.
---Damage to the endothelial lining of the blood
vessels resulting in platelet aggregation.
(Montague, 2005)
20. Bed rest causes WBC levels increase
Due to increased secretion of catecholamines and cortisol under
stress.
Interleukin -2 levels decreased. Responsible for growth,
proliferation and activation of T and B lymphocytes.
Interleukin 1B levels increase-responsible for inflammatory
changes and may be involved in boney mineral loss.
Bed rest is instrumental in the reactivation of latent
viruses
Epstein Barr
CMV
Varicella zoster
( Taylor, 1999)
21. Cycle of Insulin Resistance
Cortisol is released under
stress and immobility
. promoting
gluconeogenesis
Skeletal muscles
Endogenous insulin
become sensitized
levels rise and blood
to the catabolic
glucose rises.
effect of cortisol
(Winkelman, 2009)
Insulin receptor
sites are lost from Skeletal muscle
the atrophied atrophy increases
muscles
22. Critical illness plus immobility leads to a pro-
inflammatory state
Pro-inflammatory cytokines increase
Systemic inflammatory state causes greater muscle
damage and loss.
Reactive Oxidative Species are increased
Oxidative defenses decrease.
ROS cause oxidization of myofilaments and result in
contractile dysfunction and atrophy
Balance between muscle protein synthesis and
proteolysis is disrupted.
There is a net loss of muscle protein and an increase
in muscle weakness.
23. Defined as a diffuse symmetrical sensorimotor axonal
neuropathy
Electrophysiological changes can occur within 24 hours of the onset
of critical illness
Axonal injury is multifactoral
Microcirculatory dysfunction in peripheral nerves due to sepsis
and/or hyperglycemia
Cytokine induced changes in microvasculature permeability leads to
increased edema of the endoneural sites
Resulting cellular hypoxemia and energy depletion occur
Increased glucose uptake results in reactive oxidative species
production and mitochondrial dysfunction
Cytokines exert direct toxic effect on peripheral nerves resulting in
primary axonal degeneration.
( Fann et al, 2009)
24. Results from decreased oxygen and nutrient delivery to the muscles
Up-regulation of protein catabolism by proinflammatory cytokines
Decrease in myofibrillary repair
Imbalance in anabolic and catabolic hormones
Result is increased loss of muscle mass above that already
occurring with bed rest alone
Functional muscle inactivation from alterations in ion channels
Muscle denervation provides a link between critical illness
myopathy and critical illness polyneuropathy
As a result of this process, muscles become more susceptible to
steroid induced myopathy
Both CIP and CMP are increased by immobility
( Fann et al, 2009)
25. Both entities share many pathological mechanisms. Referred to
collectively as Critical Illness Neuromyopathy ( CIMN)
Recent studies suggest that the diaphragm can also be affected
by CIM and result in functional denervation and atrophy after as
few as 7 days of mechanical ventilation.
Risk Factors for CIMN
- Hyperglycemia -NMS agents
-Sepsis/systemic inflammation -ICU LOS
• -Corticosteroids -Hyperosmolar state
-Parenteral nutrition -Duration of mechanical
ventilation
( Fann et al, 2009)
26. Tight glycemic control
Avoidance of steroids and neuromuscular
blocking agents
Early Mobility because….
Activity produces anti-oxidants
It decreases oxidative stress and inflammation
It increases the production of anti-
inflammatory cytokines.
It gives people hope
27. Finally, bed rest negatively impacts the sense of
self, composed of self concept and self-esteem.
Due to
Changes Body image
Loss of Achievement
Impaired Social functioning
Loss of Self identification
Imposed dependency
Loss of privacy
Mobility lifts the spirit, gives hope and positively
affects motivation ( Taylor, 1999)
28. We can choose to work to increase mobility from
the moment our patients are intubated to the
moment they are discharged from MICU.
…Or we can choose to continue the status quo of
standard care.
We don’t know what the path to rehabilitation is
for any of our patients. We guide them through
the storms of critical illness and transfer them
out to the floor.
We can give them a head start toward functional
recovery and improved quality of life. What
would you want if it were your family member?
30. Allen, C., Glaziou P., DelMar C: Bedrest: a potentially harmful
treatment needing more careful evaluation. Lancet
1999;354:1229-1233
Convertino V. :Cardiovascular consequences of bed rest: effects
on maximal oxygen uptake: Medicine and Science in Sports and
Exercise 1997 29(2) 191-196
Sciacky A. :Mobilizing the intensive care unit patient
:pathophysiology and treatment .Physical Therapy Practice 1994
3(2) 69-80
Malone, D. Lindsay, K. Physical Therapy in Acute Care: a
Clinicians Guide 2006 94-97