This document outlines objectives and content for a didactic on osteopathic considerations in treating geriatric and hospitalized patients. It compares unique aspects of care for these populations, including challenges like deconditioning and a challenging hospital environment. It describes common conditions like heart disease, pneumonia, and musculoskeletal issues. Treatment approaches discussed include the articulatory, respiratory-circulatory, neurologic, and lymphatic models. Guidelines emphasize individualized treatment, frequent but brief sessions using gentle techniques, and focusing on areas that could impede healing processes like lymphatic flow.
Physiotherapy in wards
physiotherapy in ICU
physiotherapy in Cardiology
physiotherapy in Gynecology
post operative physiotherapy
physiotherapy in PICU
Palliative patients physiotherapy
Geriatric patients
Benefits of the chest physiotherapy in ward patients
Benefits of Exercise Specific to Breast Cancer
criticalcarerehabiitiaon-180418170017 (1).pdfzahid aziz
Critical care rehabilitation is an important part of the recovery process for ICU patients. It begins with early mobilization like passive range of motion exercises and progresses to active transfers, sitting at the edge of the bed, and eventually ambulation. A multidisciplinary team approach that includes nurses, physiotherapists, and other allied health professionals comprehensively assesses patients and develops individualized rehabilitation plans and goals. Regular evaluation during the ICU stay, before discharge, and after discharge is important to optimize recovery outcomes and quality of life.
Critical care rehabilitation is an important part of the recovery process for ICU patients. It begins with early mobilization like passive range of motion exercises and progresses to active transfers, sitting at the edge of the bed, and eventually ambulation. A multidisciplinary team approach that includes nurses, physiotherapists, and other allied health professionals comprehensively assesses patients and develops individualized rehabilitation plans and goals. Regular evaluation during the ICU stay, before discharge, and after discharge is important to optimize recovery outcomes and quality of life.
1 RN or PCA
Level II Cardiac Chair
Criteria: Stable hemodynamics, no vasopressors, FiO2 < 60%, PEEP < 10
•Sit at edge of bed
•Dangle legs over edge of bed
•Transfer to Cardiac Chair
•30 minutes in Cardiac Chair
Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal process of uncertain etiology found in 12 to 18% of Indian populations above 50 years. The primary manifestations of DISH are calcification and ossification of the spinal ligaments, as well as entheseal ossification within extraspinal sites
The document discusses several factors that should be considered for syndromes associated with the geriatric population, including diminished physiological reserve, loss of complexity, and higher basal sympathetic activity. It then presents several clinical scenarios involving an elderly male with diabetes and hypertension presenting with malaise and fatigue, an elderly female who fell and injured her leg, and an elderly male with urinary incontinence. It discusses conditions like frailty, falls, pressure ulcers, urinary incontinence, and cognitive impairment that are common in geriatric patients.
1. Pre-anesthetic evaluation involves assessing the patient's medical history and conducting a physical exam to optimize the patient for anesthesia and surgery and reduce risks.
2. The evaluation identifies comorbidities, medications, and functional status to ensure safe anesthesia delivery and predict postoperative needs.
3. Relevant lab tests may be ordered depending on patient history to further evaluate organ function and bleeding risks.
This document provides information on preoperative and postoperative physiotherapy assessment for pulmonary surgery patients. The preoperative assessment involves collecting subjective and objective information on the patient's medical history and functional status to create a treatment plan and reduce complications. The postoperative assessment examines the surgery details and any complications while monitoring pain, breathing, circulation, mobility and other factors to aid the patient's recovery. Physiotherapy focuses on regaining strength, mobility and functional independence through techniques like breathing exercises and range of motion.
Physiotherapy in wards
physiotherapy in ICU
physiotherapy in Cardiology
physiotherapy in Gynecology
post operative physiotherapy
physiotherapy in PICU
Palliative patients physiotherapy
Geriatric patients
Benefits of the chest physiotherapy in ward patients
Benefits of Exercise Specific to Breast Cancer
criticalcarerehabiitiaon-180418170017 (1).pdfzahid aziz
Critical care rehabilitation is an important part of the recovery process for ICU patients. It begins with early mobilization like passive range of motion exercises and progresses to active transfers, sitting at the edge of the bed, and eventually ambulation. A multidisciplinary team approach that includes nurses, physiotherapists, and other allied health professionals comprehensively assesses patients and develops individualized rehabilitation plans and goals. Regular evaluation during the ICU stay, before discharge, and after discharge is important to optimize recovery outcomes and quality of life.
Critical care rehabilitation is an important part of the recovery process for ICU patients. It begins with early mobilization like passive range of motion exercises and progresses to active transfers, sitting at the edge of the bed, and eventually ambulation. A multidisciplinary team approach that includes nurses, physiotherapists, and other allied health professionals comprehensively assesses patients and develops individualized rehabilitation plans and goals. Regular evaluation during the ICU stay, before discharge, and after discharge is important to optimize recovery outcomes and quality of life.
1 RN or PCA
Level II Cardiac Chair
Criteria: Stable hemodynamics, no vasopressors, FiO2 < 60%, PEEP < 10
•Sit at edge of bed
•Dangle legs over edge of bed
•Transfer to Cardiac Chair
•30 minutes in Cardiac Chair
Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal process of uncertain etiology found in 12 to 18% of Indian populations above 50 years. The primary manifestations of DISH are calcification and ossification of the spinal ligaments, as well as entheseal ossification within extraspinal sites
The document discusses several factors that should be considered for syndromes associated with the geriatric population, including diminished physiological reserve, loss of complexity, and higher basal sympathetic activity. It then presents several clinical scenarios involving an elderly male with diabetes and hypertension presenting with malaise and fatigue, an elderly female who fell and injured her leg, and an elderly male with urinary incontinence. It discusses conditions like frailty, falls, pressure ulcers, urinary incontinence, and cognitive impairment that are common in geriatric patients.
1. Pre-anesthetic evaluation involves assessing the patient's medical history and conducting a physical exam to optimize the patient for anesthesia and surgery and reduce risks.
2. The evaluation identifies comorbidities, medications, and functional status to ensure safe anesthesia delivery and predict postoperative needs.
3. Relevant lab tests may be ordered depending on patient history to further evaluate organ function and bleeding risks.
This document provides information on preoperative and postoperative physiotherapy assessment for pulmonary surgery patients. The preoperative assessment involves collecting subjective and objective information on the patient's medical history and functional status to create a treatment plan and reduce complications. The postoperative assessment examines the surgery details and any complications while monitoring pain, breathing, circulation, mobility and other factors to aid the patient's recovery. Physiotherapy focuses on regaining strength, mobility and functional independence through techniques like breathing exercises and range of motion.
Margaret McMurdy presents a case study of a 31-year-old male, JQ, with a complex history including autoimmune lymphoproliferative syndrome (ALPS) and thrombocytopenia. JQ was admitted multiple times for pneumococcal pneumonia and complications including respiratory failure, gangrene, and fluctuating blood counts. He received rehabilitation at Mount Sinai focusing on mobility, self-care, and cognition. Barriers included memory deficits, fatigue, and complex medical needs. Hyperbaric oxygen treatment aimed to optimize tissue oxygenation and heal non-necrotic tissue in his limbs.
Legg-Calve-Perthes disease is a childhood condition caused by temporary loss of blood supply to the femoral head. It most commonly affects boys ages 4-8 and can cause deformity of the femoral head. Early containment of the femoral head via casts or surgery can prevent deformation and minimize long-term arthritis risk. Prognosis depends on the Herring classification, with surgery beneficial for lateral pillar group B/C cases after age 8. The goal of treatment is to maintain femoral head congruency and minimize secondary osteoarthritis.
This document discusses assessment and rehabilitation for spondyloarthropathy. It begins by defining spondyloarthropathy as a group of inflammatory disorders affecting the spine and joints. It then focuses on ankylosing spondylitis (AS) and describes its characteristics, epidemiology, signs and symptoms, diagnostic criteria, treatments including NSAIDs, DMARDs, anti-TNF therapy, exercises and rehabilitation. The goal of treatment is to reduce symptoms and maintain spinal flexibility through non-pharmacological and pharmacological approaches.
Dr. Ankita Patil and Dr. Neharica Seth discuss the goals and process of pre-anesthetic evaluation, which includes assessing a patient's medical history and physical health to ensure they can safely undergo anesthesia and mitigate perioperative risks. The evaluation involves examining all major organ systems and functions, as well as ordering relevant tests and developing a plan for managing any issues. The overall aim is to optimize patient safety and outcomes through informed risk assessment and treatment prior to surgery.
This document provides information about stroke, including its definition, types, risk factors, and the role of physiotherapy in treatment. It discusses the two main types of stroke - ischemic and hemorrhagic - and describes some common syndromes associated with different areas of brain injury, such as the middle cerebral artery syndrome. It then outlines physiotherapy techniques used in both the acute and rehabilitation stages, including positioning, improving range of motion, strengthening, balance training, and gait re-education.
This document discusses the role of physiotherapy in treating severe pediatric respiratory disease. It notes that while physiotherapy is commonly used to clear secretions in critically ill children, the evidence for its effectiveness is poor. Physiotherapy can cause significant physiological disturbances and potential harm. It may be beneficial in specific conditions like cystic fibrosis if secretions are significantly impacting lung function, but is not routinely indicated for ventilated children or those with conditions like bronchiolitis. A detailed individual assessment is required to determine if potential benefits outweigh risks for a given child. More high-quality research is still needed to establish best practices around physiotherapy in pediatric critical care.
This document provides information about acute care physical therapy in pediatrics. It discusses common admitting diagnoses, equipment, evaluations, interventions and special considerations for various medical conditions. It also presents two case studies, the first involving a child with a stroke admitted to acute care, rehabilitation and home, the second a child diagnosed with leukemia and a spinal tumor.
The document discusses various physiological, psychological, and care-related aspects of aging. It provides information on changes that occur in major body systems with aging, including the integumentary, cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, genitourinary systems, as well as psychological aspects. It also outlines principles of caring for the elderly and highlights the important role of geriatric nurses in providing quality care to address the unique needs of an aging population.
"Discover the comfort and convenience of home physiotherapy, where healing comes to your doorstep. Our dedicated team of experienced physiotherapists brings expert care right to your home, ensuring you receive personalized, one-on-one attention in an environment that's familiar and comfortable. Whether you're recovering from an injury, managing a chronic condition, or seeking to improve your mobility, our home physiotherapy services are tailored to your unique needs. Say goodbye to the hassle of
This document summarizes diabetic neuropathy and physical therapy interventions. It defines diabetic neuropathy as nerve damage caused by diabetes, affecting around 50% of type 2 diabetics. Symptoms vary but can impact mobility, sensation, and other body systems. The document outlines screening and assessment tools for neuropathy and recommends therapeutic exercises, neuromuscular re-education, pre-gait training, and modalities to improve sensation and functional mobility. The goal is to enhance somatosensory processing and reduce complications like foot ulcers.
Bones are living tissues that are constantly changing. They are composed of collagen, calcium phosphate and calcium carbonate. Osteoporosis is a disease where bones become brittle and fragile from loss of tissue, often due to calcium or bone mineral deficiency or lack of bone formation. It can cause bones to fracture from minor falls or injuries. Risk factors include age, gender, family history and medications like steroids. Diagnosis involves bone density tests and x-rays. Treatment focuses on prevention with calcium, vitamin D and medications to slow bone loss such as bisphosphonates.
Dr. Orakwele Arinze presented on cervical spondylosis. The presentation included an introduction to cervical spondylosis, relevant anatomy, epidemiology, etiology, pathophysiology, clinical features, diagnosis, differential diagnosis, management, physiotherapy management, and a case study. Cervical spondylosis is an age-related degeneration of the cervical spine that can lead to nerve root or spinal cord compression. Symptoms include neck and arm pain, weakness, and sensory changes. Physiotherapy is an effective treatment and includes modalities like TENS, traction, exercises and lifestyle advice. The case study demonstrated improvement in a patient's neck pain, range of motion and strength following physiotherapy
Presentation from the Enhanced Recovery Summit 2012 by Professor Henrik Kehlet
Enhanced recovery - future developments and transferability into acute medicine
This document discusses the benefits of early mobilization for mechanically ventilated patients in the ICU. Prolonged bed rest can lead to increased morbidity, mortality, costs, and length of stay. Early mobilization, which involves getting patients sitting up and out of bed when minimally able, provides several benefits like improving respiratory function and reducing adverse effects of immobility. Two studies presented found that early mobilization was feasible and safe for respiratory failure patients, with adverse events being rare. Transferring patients to an ICU that prioritizes early activity was also found to substantially improve patient ambulation levels.
Pulmonary rehabilitation is a comprehensive intervention for patients with chronic respiratory diseases like COPD. It involves exercise training, education, behavior changes, and promotes long-term healthy habits. Programs last 4-12 weeks with supervised sessions twice weekly. Benefits include increased quality of life, exercise tolerance, and decreased symptoms and healthcare utilization. Outcomes are assessed through measures of functional capacity, symptoms, and quality of life. Maintenance rehabilitation is important to sustain benefits long-term.
Trauma management involves initial assessment and stabilization of airway, breathing, circulation, disability and exposure (ABCDE). The primary survey assesses life threats and guides resuscitation efforts. Key priorities include spinal immobilization, hemorrhage control, and treating tension pneumothorax. Secondary survey involves full head-to-toe examination and history to identify all injuries requiring attention or monitoring. Management requires a multidisciplinary team approach. Proper preparation and coordination of care is essential for optimal trauma outcomes.
This is an overview of chiropractic care and how it fits into a paleo/Ancestral health-oriented model of health care. This was a talk that was delivered for the Boston Paleo Meetup group Nov. 15th 2014.
This document discusses cardiovascular clinical assessment. It covers taking a patient's cardiovascular history, including reviewing present illness, past medical history, risk factors, medications and family history. It emphasizes important aspects of history taking for chest pain such as quality, location, duration and relieving/worsening factors. The document also discusses performing a physical exam of the cardiovascular system, including inspection of the face, chest, abdomen and nail beds.
Margaret McMurdy presents a case study of a 31-year-old male, JQ, with a complex history including autoimmune lymphoproliferative syndrome (ALPS) and thrombocytopenia. JQ was admitted multiple times for pneumococcal pneumonia and complications including respiratory failure, gangrene, and fluctuating blood counts. He received rehabilitation at Mount Sinai focusing on mobility, self-care, and cognition. Barriers included memory deficits, fatigue, and complex medical needs. Hyperbaric oxygen treatment aimed to optimize tissue oxygenation and heal non-necrotic tissue in his limbs.
Legg-Calve-Perthes disease is a childhood condition caused by temporary loss of blood supply to the femoral head. It most commonly affects boys ages 4-8 and can cause deformity of the femoral head. Early containment of the femoral head via casts or surgery can prevent deformation and minimize long-term arthritis risk. Prognosis depends on the Herring classification, with surgery beneficial for lateral pillar group B/C cases after age 8. The goal of treatment is to maintain femoral head congruency and minimize secondary osteoarthritis.
This document discusses assessment and rehabilitation for spondyloarthropathy. It begins by defining spondyloarthropathy as a group of inflammatory disorders affecting the spine and joints. It then focuses on ankylosing spondylitis (AS) and describes its characteristics, epidemiology, signs and symptoms, diagnostic criteria, treatments including NSAIDs, DMARDs, anti-TNF therapy, exercises and rehabilitation. The goal of treatment is to reduce symptoms and maintain spinal flexibility through non-pharmacological and pharmacological approaches.
Dr. Ankita Patil and Dr. Neharica Seth discuss the goals and process of pre-anesthetic evaluation, which includes assessing a patient's medical history and physical health to ensure they can safely undergo anesthesia and mitigate perioperative risks. The evaluation involves examining all major organ systems and functions, as well as ordering relevant tests and developing a plan for managing any issues. The overall aim is to optimize patient safety and outcomes through informed risk assessment and treatment prior to surgery.
This document provides information about stroke, including its definition, types, risk factors, and the role of physiotherapy in treatment. It discusses the two main types of stroke - ischemic and hemorrhagic - and describes some common syndromes associated with different areas of brain injury, such as the middle cerebral artery syndrome. It then outlines physiotherapy techniques used in both the acute and rehabilitation stages, including positioning, improving range of motion, strengthening, balance training, and gait re-education.
This document discusses the role of physiotherapy in treating severe pediatric respiratory disease. It notes that while physiotherapy is commonly used to clear secretions in critically ill children, the evidence for its effectiveness is poor. Physiotherapy can cause significant physiological disturbances and potential harm. It may be beneficial in specific conditions like cystic fibrosis if secretions are significantly impacting lung function, but is not routinely indicated for ventilated children or those with conditions like bronchiolitis. A detailed individual assessment is required to determine if potential benefits outweigh risks for a given child. More high-quality research is still needed to establish best practices around physiotherapy in pediatric critical care.
This document provides information about acute care physical therapy in pediatrics. It discusses common admitting diagnoses, equipment, evaluations, interventions and special considerations for various medical conditions. It also presents two case studies, the first involving a child with a stroke admitted to acute care, rehabilitation and home, the second a child diagnosed with leukemia and a spinal tumor.
The document discusses various physiological, psychological, and care-related aspects of aging. It provides information on changes that occur in major body systems with aging, including the integumentary, cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, genitourinary systems, as well as psychological aspects. It also outlines principles of caring for the elderly and highlights the important role of geriatric nurses in providing quality care to address the unique needs of an aging population.
"Discover the comfort and convenience of home physiotherapy, where healing comes to your doorstep. Our dedicated team of experienced physiotherapists brings expert care right to your home, ensuring you receive personalized, one-on-one attention in an environment that's familiar and comfortable. Whether you're recovering from an injury, managing a chronic condition, or seeking to improve your mobility, our home physiotherapy services are tailored to your unique needs. Say goodbye to the hassle of
This document summarizes diabetic neuropathy and physical therapy interventions. It defines diabetic neuropathy as nerve damage caused by diabetes, affecting around 50% of type 2 diabetics. Symptoms vary but can impact mobility, sensation, and other body systems. The document outlines screening and assessment tools for neuropathy and recommends therapeutic exercises, neuromuscular re-education, pre-gait training, and modalities to improve sensation and functional mobility. The goal is to enhance somatosensory processing and reduce complications like foot ulcers.
Bones are living tissues that are constantly changing. They are composed of collagen, calcium phosphate and calcium carbonate. Osteoporosis is a disease where bones become brittle and fragile from loss of tissue, often due to calcium or bone mineral deficiency or lack of bone formation. It can cause bones to fracture from minor falls or injuries. Risk factors include age, gender, family history and medications like steroids. Diagnosis involves bone density tests and x-rays. Treatment focuses on prevention with calcium, vitamin D and medications to slow bone loss such as bisphosphonates.
Dr. Orakwele Arinze presented on cervical spondylosis. The presentation included an introduction to cervical spondylosis, relevant anatomy, epidemiology, etiology, pathophysiology, clinical features, diagnosis, differential diagnosis, management, physiotherapy management, and a case study. Cervical spondylosis is an age-related degeneration of the cervical spine that can lead to nerve root or spinal cord compression. Symptoms include neck and arm pain, weakness, and sensory changes. Physiotherapy is an effective treatment and includes modalities like TENS, traction, exercises and lifestyle advice. The case study demonstrated improvement in a patient's neck pain, range of motion and strength following physiotherapy
Presentation from the Enhanced Recovery Summit 2012 by Professor Henrik Kehlet
Enhanced recovery - future developments and transferability into acute medicine
This document discusses the benefits of early mobilization for mechanically ventilated patients in the ICU. Prolonged bed rest can lead to increased morbidity, mortality, costs, and length of stay. Early mobilization, which involves getting patients sitting up and out of bed when minimally able, provides several benefits like improving respiratory function and reducing adverse effects of immobility. Two studies presented found that early mobilization was feasible and safe for respiratory failure patients, with adverse events being rare. Transferring patients to an ICU that prioritizes early activity was also found to substantially improve patient ambulation levels.
Pulmonary rehabilitation is a comprehensive intervention for patients with chronic respiratory diseases like COPD. It involves exercise training, education, behavior changes, and promotes long-term healthy habits. Programs last 4-12 weeks with supervised sessions twice weekly. Benefits include increased quality of life, exercise tolerance, and decreased symptoms and healthcare utilization. Outcomes are assessed through measures of functional capacity, symptoms, and quality of life. Maintenance rehabilitation is important to sustain benefits long-term.
Trauma management involves initial assessment and stabilization of airway, breathing, circulation, disability and exposure (ABCDE). The primary survey assesses life threats and guides resuscitation efforts. Key priorities include spinal immobilization, hemorrhage control, and treating tension pneumothorax. Secondary survey involves full head-to-toe examination and history to identify all injuries requiring attention or monitoring. Management requires a multidisciplinary team approach. Proper preparation and coordination of care is essential for optimal trauma outcomes.
This is an overview of chiropractic care and how it fits into a paleo/Ancestral health-oriented model of health care. This was a talk that was delivered for the Boston Paleo Meetup group Nov. 15th 2014.
This document discusses cardiovascular clinical assessment. It covers taking a patient's cardiovascular history, including reviewing present illness, past medical history, risk factors, medications and family history. It emphasizes important aspects of history taking for chest pain such as quality, location, duration and relieving/worsening factors. The document also discusses performing a physical exam of the cardiovascular system, including inspection of the face, chest, abdomen and nail beds.
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ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
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Answers about how you can do more with Walmart!"
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2. DIDACTIC OBJECTIVES
1. Compare unique aspects of care for geriatric and hospitalized patients
2. Compare unique challenges faced when treating geriatric and hospitalized
patients.
3. Describe the importance of addressing cultural and social aspects of the patient
4. Describe common clinical cardiac conditions and considerations in the geriatric
and hospitalized patients.
5. Describe common clinical pulmonary conditions and considerations in the
geriatric and hospitalized patients.
6. Describe common clinical surgical conditions and considerations in the geriatric
and hospitalized patients.
7. Describe common clinical musculoskeletal conditions and considerations in the
geriatric and hospitalized patients.
8. Compare the examination and treatment of the geriatric and hospitalized
patients applying osteopathic principles and procedures for given clinical
scenarios: cardiac etiologies, pulmonary etiologies, surgical etiologies, and
musculoskeletal etiologies.
3. DIDACTIC OBJECTIVES
9. Describe the considerations of diet/nutrition, functional capacity, and
polypharmacy as they relate to the geriatric patient
10. Describe special considerations in both the geriatric and hospitalized patient.
11. Describe important anatomic structures and functions as they relate to disease
processes in the geriatric and hospitalized patient for cardiac, pulmonary,
surgical, and musculoskeletal etiologies.
12. Describe the role of the abdominal diaphragm, pelvic diaphragm and abdominal
wall to respiration, pressures, and fluid movement in the chest and abdomen.
13. Describe the articulatory treatment model
14. Describe the respiratory-circulatory treatment model
15. Describe the neurologic treatment model
16. Describe the lymphatic treatment model and lymphatic treatment protocols
17. Define appropriate treatment guidelines of osteopathic care for the geriatric and
hospitalized patient populations
4. RECOMMENDED
READING
• "Treatment of the Acutely Ill Hospitalized Patient”, by
Hugh Ettlinger, Foundations for Osteopathic Medicine,
2nd ed., pp. 1135-1142
• "The Hospitalized Patient," by Samuel Yoakum,
Somatic Dysfunction in Osteopathic Family Medicine,
pp 201-215
• "The Geriatric Patient," by K.E. Nelson, A. L.
Habenicht, N. Sergueef, & J. Allgeier, Somatic
Dysfunction in Osteopathic Family Medicine, pp 167-
182
• Special Video Interview on Blackboard
5. OUTLINE
• The Geriatric Patient
• The Hospitalized patient
• Challenges
• Special System
Considerations in both
groups
• A Treatment Approach
6. BIG PICTURE
• Looking at aspects that bridge both
groups
• Importance of addressing cultural and
social aspects to the patient.
9. CHALLENGES IN TREATING
GERIATRIC PATIENTS
• Deconditioning
• Decompensation of aging
• Challenges with self
care/compliance
• Difficult socioeconomic
status
10. THE HOSPITALIZED
PATIENT
• Acute on chronic diseases
• Often Elderly
• Multiple systems affected
• From ER to Surgical unit to
ICU
• Need for individualized
treatment and care
• Traumatic for patients and
their families
11. CHALLENGES IN TREATING
HOSPITALIZED PATIENTS
• Challenging
environment
• “Fragile” patients
• May have little time
• Big picture, what is
best?
13. CARDIAC
CONSIDERATION
S
• Acute Myocardial Infarction (MI) & post
MI care
• Congestive Heart Failure
• Open heart surgery/heart procedures
(angiography/angioplasty/stent)
• Rates of heart disease, complications, and
procedures
• Research of OMT to rib cage following
CABG procedures may increase vascular
return and potentially decrease pulmonary
congestion in the post operational period
(O-Yurvati et al., JAOA, 2005)
14. PULMONARY
CONSIDERATIONS
• COPD (w/exacerbation)
• Pneumonia
-Noll et al. studied 406 patients treated for pneumonia
across seven community hospitals.
• Decreased in length of stay
• Decreased duration of intravenous antibiotics
-MOPSE study (2007)
• Double-blinded, randomized controlled clinical trial
• Designed to evaluate the efficacy of OMT as an
adjunct to the current pharmacologic treatment of
elderly patients hospitalized for pneumonia.
• OMT groups had reduced length of hospitalization,
while in older subjects there was a reduction in
mortality
16. SURGICAL CONSIDERATIONS
• Post-thoracic surgery
• Sternotomy, lung resections,
mastectomy
• Post-abdominal surgery
• Bowel resection, cholecystectomy
• Post orthopedic surgery
• Hip and knee replacement
• Patients can be treated with OMT pre
and post operatively (*pedal pump)
20. MUSCULOSKELETAL
CONSIDERATIONS
• GERIATRIC: Deconditioning/Postural changes,
Decreased muscle tone, Compound disease
(osteoporosis, osteoarthritis, DDD)
• HOSPITALIZED: Muscle strain from altered
mechanics and being inpatient for extended
period of time. Rib/muscle dysfunction
mimicking chest pain
• Eg. Chronic conditions, even Parkinsons or
Diabetes have physical manifestations
• Use of more pain medications is problematic or
make plan to address in OP
Nelson, SDOFM, 2nd Ed.
23. SPECIAL CONSIDERATIONS
GERIATRIC PATIENT
• Functional capacity
• Assess with intake evaluation
• Diet and Nutrition
• Habits, physical mobility (food acquisition and prep),
dental health, economic disadvantages.
• Vitamin D and Calcium, encouraged to get enough
caloric intake, especially protein, adequate hydration,
multivitamins.
• Polypharmacy
• NSAID’s can cause AKI, cardiac SE, and GI upset,
nearly CI in the elderly
Nelson, SDOFM, 2nd Ed.
24. SPECIAL CONSIDERATIONS IN THE
GERIATRIC & HOSPITALIZED
• Anxiety & Depression
• Death & Dying
• Development of patient-
physician relationship and
patient-family relationship
• Simple osteopathic
procedures can have a big
impact
“Health often becomes a fragile and
intermittent state, and pain and functional
limitations are constantly present. Add to
this the fact that life’s goals may have gone
unmet, and that cherished relationships
have been lost, and it is a wonder that the
elderly are not universally depressed.”
-Nelson, SDOFM
Nelson, SDOFM, 2nd Ed.
27. ROLE OF
RESPIRATION
• Changes in intrathoracic pressure fluid
movement from head/neck and abdomen.
• Action on central venous flow and
pressure influence the emptying of the
thoracic duct & right lymphatic duct
• During Inhalation – spinal curves
straighten, sacrum rotates with base
moving posteriorly
• During Exhalation – spinal curves
enhance, sacral base moves anteriorly
28. PELVIC DIAPHRAGM AND
RESPIRATION
• During Inhalation - Descends
with the abdominal diaphragm to
create space for abdominal
viscera
• Works with anterior abdominal
wall to stabilize abdominal
pressure
• Post abdominal surgery
patients lose abdominal wall
contribution to this process
• Increased resistance reduces the
effectiveness of the diaphragm
and reduces inferior vena cava
flow
• Pelvic diaphragm and sacral
motion are essential for proper
coordination
30. TREATMENT
MODELS
ARTICULATORY
• It is important to remember that
the acute segmental facilitation
is seen in the soft tissues
• The underlying treatment is for
the tissues sending somatic
Nociceptive information back to
the spinal cord
• Paraspinal myofascial
elements of each region, due
to autonomic influences
33. Location of Ganglia:
Cervical
• Anterior to cervical articular
pillars
Thoracic
• Anterior to heads of ribs
Lumbar
• Anterior to the bodies of the
lumbar vertebrae
• Medial to edge of psoas
NEUROLOGIC TX
MODEL:
SYMPATHETIC CHAIN GANGLIA
34. TREATMENT MODEL
LYMPHATIC
• Improve extrinsic pumping
capacity
- Diaphragms create alternating
pressure gradients
- Lymph flows longitudinally, remove
horizontal strains: Abdominal &
pelvic diaphragm, thoracic inlet,
tentorium cerebelli, arches feet
- Remove muscular restrictions so
skeletal muscles can have
improved function
37. TREATMENT GUIDELINES
GERIATRIC & HOSPITALIZED
• Appropriate treatment individualized to the
patients capacity
• More Frequent treatments/Dosing
• Short time periods of treatment
• Less forceful techniques (MFR, BLT)
• Once daily is commonly appropriate
(minutes)
• Treat only areas most likely to impede the
healing process (lymphatic flow and
autonomic considerations)
• As patient improves, treatments can be
spread out with longer intervals, and longer
treatment durations
38. CONCLUSION
• The Geriatric and Hospitalized patients
• Anatomic Structure and Function relationships
Manipulative prescription
• To be complete need to be conscious about the mind
and spirit aspects of patient care
• Dosing & Contraindications
39. REFERENCES /
DISCLOSURE
1. "Treatment of the Acutely Ill Hospitalized Patient”, by Hugh Ettlinger,
Foundations for Osteopathic Medicine, 2nd ed., pp. 1135-1142
2. Drake RL, Vogl W. Gray’s anatomy for students. In: Head and Neck Back.
Churchill Livingstone; 2014.
3. "The Hospitalized Patient," by Samuel Yoakum, Somatic Dysfunction in
Osteopathic Family Medicine, pp 201-215
4. "The Geriatric Patient," by K.E. Nelson, A. L. Habenicht, N. Sergueef, & J.
Allgeier, Somatic Dysfunction in Osteopathic Family Medicine, pp 167-182
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Editor's Notes
Great chapters on specialties
highy recommend this book
WTII: 2.Social history and addressing this area is going to be very important in these groups
3. Beause these groups are complex, how you deliver healthcare will depend on capacity of patient and many times will require outside help
For example: A patient who had surgery in the hospital, what if they cant walk, how do they take care of themselves at home? What if that person is also elderly without any family? This is a basic example of what we will be discussing today and from a holistic perspective (osteopathic perspective) is part of addressing Mind/Body/Spirit, its how we deliver effective healthcare.
Tenet #1: The body is a unit; the person is a unit of body, mind, and spirit.
Tenet #4: Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
Social questions
•Have you been without a home at any time in the past year?
•Has there been a time in the past 6 months when someone in your home skipped at least one meal because there wasn’t enough money to buy food?
•Who prepares meals in your home?
•Can you safely walk in your neighborhood?
•How do you get your medications (ex: online, neighborhood pharmacy, samples) and who gets them for you?
Challenges. Decreased capacity and chornicity. Compounding medical problems over time.
An injury is recoverable when you are young, but what about decades later without full recovery.
Decreased support system
Chronicity is a manifestation of the technology and individual’s ability to compensate for stress
Many chronic medical problems concomitant
Back pain on top of everything else hard for the patient but might not be for a healthy patient.
Image:
wwwassets.rand.org
Concerns with elderly: how do they live out their days with food
Image: beginningwiththeendfilm.com
-Patient encounters in the hospital are typically quite different from those in the clinic setting,
presenting unique challenges to the clinician and a number of unique barriers to the integration of osteopathic thought processes in management.
-everything tends to be protocol based thesis days
-The presence of somatic dysfunction may also help to explain vague or suspicious sounding symptoms and avoid expensive workups of very simple situations.
*What are the look of these patients through an osteopathic eye
LANDING A PLANE AND TAKING OFF AGAIN
Image: pchonline.org
WT2
Your understanding of anatomy will be the key to helping you with your treatment. And even if you don’t do manipulation in the hospital
Image:i.ytimg.com
NOT AN ALL INCLUSIVE LIST
Pre and post surgical intervention or in the outpatient. Ederly don’t move so well after these procedures, being in the hospital and having these procedures done is draining on patients, what recommendations do you make in the post care that is to help them RECOVER, not any disease, just recover better and faster.
LYMPHATIC DRAINAGE OF THE HEART
Smoking
Image: gallery.ctsnet.org
WT2: The bigger picture.What recommendations to make to PCP
PNA, WHAT PERCENTAGE IS VIRAL
In addition to improved patient safety and satisfaction, these benefits also decrease overall cost to the system as a whole, which is an increasingly important, albeit secondary, consideration.
Chronic care - fluid movement and congestion
Smoking
Image: pearsonhighered.com
WT2: Seems straighf tforward to consider anatomy, but many times in clinical practice, for example COPD exacerbation or PNA, giving ABX and/or steroids for their condition, yes you know the problem in the lung, but you don’t consider the structure/function relationships, everything that you’ve been learning the past 2 years. How does the rib cage affect diaphragm movement and aeration of the lungs, this is why its important to keep this in your mind because if you do then you might consider OMT as an adjunct treatment.
Example: Sternotomy: think about the distruption of anatomy, that patient needs to recover, disease has been fixed but that doesn’t mean the work is done.
Muscle fatigue due to increased work of breathing which can lead to respiratory failure
A concern with people who have asthma, COPD, pulmonary edema, lung shock, and those recently off ventilators (C3-5)
Thoracic compliance
Heart in relation to sternum
Phrenic nerve compromise within the msk system
Lung relation to diaphragme and ribs
Image: copyright Grey’s Anatomy Student Edition
Nowhere more than in surgery does disrupted anatomy matter more
Anatomy is disrupted, autonomic reblaancing, causing pain (many pain syndromes are associated with all these procedures), other syndromes like ileus
OMT for autonomic reblancing and return to function, optimizing fluid drainage from area.
We tend to think that once the surgery is done or medication is given that is the end of the story, but its not, the patient isn’t back to normal yet. The whole recover process is one you will be facilitating as a doctor.
Immobilization
Ongoing studies on the effects of exercise programs pre and post op, if they can show some benefit, couldn’t OMT have some good
What surgery actually entails
Decreased gastric and intestinal motility
Pain… requiring more medications
Surgeons want patient up and moving as soon as capable. If walking is used to help post op ileus
As a surgeon “well surgery went fine” sorry your in pain” fu with pcp
Image: mmcts.oxfordjournals.org
Disruption of these anatomic points. An integrative perspective, disruption of structure and function.
Image: copyright Grey’s Anatomy Student Edition
TO HAVE AN APPRECIATION FOR DISRUPTED STRUCTURES, abdominal wall has been distrupted, diaphram has artificially moved
Image: copyright Grey’s Anatomy Student Edition
It is common knowledge that an optimized diet coupled with exercise may be employed to improve muscle tone and mass, as well as prevent osteoporosis, reduce hyperlipidemia, maintain cardiovascular health, and enhance the efficacy of medical therapies for disease processes like diabetes.
Decades of compound affect, compensation
Loss of muscle mass decreased stamina and functional capacity
Spinal mechanics/pelvic dysfunction/short leg, and decompensated posture
Postural imbalance and gait instability periph. input if decreased can affect posture (also visual labyrinthine, and somatosensory input) risk of falling, all of this combined with postural compensation for muscle weakness contributes to imbalance
his imbalance results in pelvic unleveling with compensatory type I, group lateral curve, spinal mechanics above the pelvis.
when you sit for hours or go on a breaking bad binge on the couch for hours, maybe have some strain
if you see it from patient perspective
Image: westsubpainrelief.com
Adequately convey information
Image: i.huffpost.com
Physical mobility may be impaired, further interfering with food acquisition and preparation. Energy expenditure is decreased, thereby decreasing caloric requirements,
diet and exercise increase muscle tone and mass, prevents osteoporosis, reduce hyperlipidemia, cardiovascular health and improve glucose control
Poor dental health, hyposecretion of the gastric mucosa, and senescent decrease in the production of enteric enzymes all interfere with the absorption of nutrients.
no quick changes
Physical symptoms that they might have found unacceptable in their younger days become normative, so they do not complain about them. Chronic lower urinary tract infections, low grade upper respiratory infections, and dental sepsis can result in malaise that does not necessarily present as a specifically localized complaint. —> simple ROS
GOING TO SEE PATIENTS AT THEIR WORST YOU SHOULD BE PREPARED
Possibly the most important therapeutic agent in the treatment of many older patients is the personal interest of their physician.
The basis for this is understanding and appreciation for structure and function
MIND BODY SPIRIT
Image: copyright Grey’s Anatomy Student Edition
The problem: lymph transport from below
the heart has to occur against gravity and
against a positive hydrostatic pressure
(‘uphill gradient’),
• The solution: valves, muscle contractions,
the respiratory diaphragm, motricity!
Image: Foundations of Osteopathic Medicine
Organ prolapse
Image: Foundations of Osteopathic Medicine
The basis for this is understanding and appreciation for structure and function
MIND BODY SPIRIT
If direct attention to spinal segment and treat articular tissue first thus deal directly with the facilitated segment.
Image: copyright Grey’s Anatomy Student Edition
Image: copyright Grey’s Anatomy Student Edition
Keep it simpleLymphatic Protocol – treating diaphragslymphatics take movement, in the hospital this is decreased, caution in the case of those with RF or CHF
Dosing
-Goal – promote homeostasis and self healing
-ICU - Patients may go hours, days, or even weeks without gaining consciousness, all the while increasing lymphatic and venous stasis.
-ICP and pedal pump
-Each intervention requires energy from patient
-Treat only most important dysfunctions – i.e. those that seem to most impede the homeostatic processes
-Leave unrelated problems (sometimes the longstanding problems) for outpatient care
-Short periods of treatment
-Look for changes in TTCs following treatments, for signs of improvement
-During any inflammatory process, increased capillary permeability allows an efflux of protein into the interstitial spaces, producing an exudative swelling - CAREFUL NOT TO OVERDUE IT.
the cranio-cervical junction is of importance for postural balance, mechanical perturbation, head-flexed (tilted from the erect) position has been shown to increase postural Instability
upper thoracic flexion contributes further to the head-flexed position and also necessitates low to midcervical compensatory extension, placing stress on an area of the spine that is frequently unstable and osteoarthritic;
the thoracic cage (thoracic inlet, ribs, vertebrae, and thoracoabdominal diaphragm) for efficiency of respiratory function and the return of venous blood and lymph to the heart;
the lumbar pelvic and abdominal areas to promote lower gastrointestinal regulation.
Image: copyright Grey’s Anatomy Student Edition
Image: copyright Grey’s Anatomy Student Edition
Keep it simpleLymphatic Protocol – treating diaphragslymphatics take movement, in the hospital this is decreased, caution in the case of those with RF or CHF
Dosing
-Goal – promote homeostasis and self healing
-ICU - Patients may go hours, days, or even weeks without gaining consciousness, all the while increasing lymphatic and venous stasis.
-ICP and pedal pump
-Each intervention requires energy from patient
-Treat only most important dysfunctions – i.e. those that seem to most impede the homeostatic processes
-Leave unrelated problems (sometimes the longstanding problems) for outpatient care
-Short periods of treatment
-Look for changes in TTCs following treatments, for signs of improvement
-During any inflammatory process, increased capillary permeability allows an efflux of protein into the interstitial spaces, producing an exudative swelling - CAREFUL NOT TO OVERDUE IT.
the cranio-cervical junction is of importance for postural balance, mechanical perturbation, head-flexed (tilted from the erect) position has been shown to increase postural Instability
upper thoracic flexion contributes further to the head-flexed position and also necessitates low to midcervical compensatory extension, placing stress on an area of the spine that is frequently unstable and osteoarthritic;
the thoracic cage (thoracic inlet, ribs, vertebrae, and thoracoabdominal diaphragm) for efficiency of respiratory function and the return of venous blood and lymph to the heart;
the lumbar pelvic and abdominal areas to promote lower gastrointestinal regulation.
Image: copyright Grey’s Anatomy Student Edition
If we take a neurologic approach we treat the tissues around these areas because we cant touch the ANS
Image: copyright Grey’s Anatomy Student Edition
For both populations
Decide which areas of the patient’s body are most impairing the homeostatic balance
Which techniques are best suited, or appropriate, to the individual case
Quantity of treatment tolerable to patient
Image: www.tampabay.com
Understanding of First osteopathic tenant and social aspects
How do you take care of the patient globally? Medicine is about more than just the diagnosis.
Understanding of Structure and function will help to look deeper physically
In lab we are going to review procedures that bridge both populations