1. Unit 1 Pathology for the
Chapters Physical Therapist
1-4
Assistant
Catherine Goodman
Kendra Fuller
Kelly King, PT, MA
Carrington College
2. OBJECTIVES
• Explain and differentiate between concepts of health,
illness and disability
• Describe genetic aspects of disease
• Describe and compare the systemic and local effects
of commonly encoutered pathologic conditions
3. Introduction to Concepts of Pathology
• Pathology is defined as the branch of medicine
that investigates the essential nature of
disease
• Changes in body tissues and organs
• Cause or caused by disease
• Why study Pathology?
4. Introduction to Concepts of Pathology
Terms:
• Clinical Pathology
• Pathology applied to the solution of clinical problems
• Laboratory methods and clinical diagnosis
• Pathogenesis
• The development and progression of each pathologic
(disease) condition
• Cellular changes
• Manifestation of clinical signs and symptoms
5. Introduction to Concepts of Pathology
• Pathogenesis
• Idiopathic disease
• Arising spontaneously or from an obscure or unknown cause
• Iatrogenic
• Induced inadvertently by a physician or surgeon or by medical
treatment or diagnostic procedures
• Endogenous
• Originating within the body or cell (autoimmune or impaired immune
system)
• Exogenous
• Originating outside the body or cell (most infections)
6. Pathology for the PTA
• Clinical pathology
• The effects of pathologic processes on the individual’s
functional abilities and limitations or impairments
• The relationship between impairment and functional limitation
is the focus of therapy
• Most patients have multiple medical pathologies. This
requires knowledge of the impact diseases and
conditions have on the neuromusculoskeletal system
in order to provide safe, effective treatment.
7. Concepts of Health, Illness, and
Disability
• Health – no universally accepted definition
• Absence of illness
• Physical, mental, and social well-being
• Either - or (healthy or ill)
• Health – dynamic process dependent on
internal and external environments
• Homeostasis
• Biologic, psychologic, spiritual, and sociologic state
• Wellness incorporates all these aspects
8. Concepts of Health, Illness, and
Disability
• Illness – often defined as opposite of health, sickness
• Disease – biologic or psychologic alteration that
results in malfunction
• Manifests with specific signs and symptoms (i.e. fever when
infection is present)
• Cause and effect
• Incidence and Prevalence
• Natural History
9. Concepts of Health, Illness, and
Disability
Terms
• Acute
• Chronic
• Disability – a physical or mental condition that limits
a person’s movements, senses, or activities, specific
impairment(s)
10. Classification Models for Disability
• Nagi Disablement Model
• System to classify the impact of disease or trauma
• Pathology produces pain and impairments
• Leads to functional limitations and disability
• Components
• Disease or pathology
• Impairment(s)
• Functional limitations
• Disability
11. Nagi - Disability
• Not all disease leads to impairment
• Not all impairment leads to disability
• Functional limitations are the result of
impairments
• Inability to perform the tasks and roles that constitute
usual activities for that individual
• Disability is patterns of behavior that emerge
over long periods of time when functional
limitations cannot be overcome
12. International Classification of
Functioning, Disability, and Health (ICF)
• International Classification of Functioning, Disability, and
Health
• The international standard to describe and measure health and
disability
• Established in 2001
• Focus on life vs mortality
• How people live with illness and disease
• How to provide increased productivity and quality of life
• Components:
• Body functions (b)
• Body structures (s)
• Activities and participation (d)
• Environmental factors (e)
• Personal factors –race, gender, age, education
13. Cognitive Disability
• Dependent on the location of lesion (local change in
cells causing abnormal tissue)
• Lesions have many etiologic factors
• Head injury
• Disease
• Alcohol abuse
• Anoxia or hypoxia (absence or decrease in oxygen)
15. Implications for the PTA
• Physical disability
• Cognitive disability
• Treatment must be adapted specifically to each
patient’s underlying pathology
• Treatment areas may need to be modified
• Learning styles need to be assessed
16. Health Promotion and Disease Prevention
• Practicing healthy behaviors to decrease
precipitating factors
• Health Promotion
• Self-responsibility
• Nutritional awareness
• Vit D and Calcium for bone health
• Folic Acid and Prenatal vitamins
• Stress reduction
• Physical fitness
17. Health Promotion and Disease Prevention
• Disease Prevention
• Healthy People 2000
• Healthy People 2010
• Healthy People 2020
• Encompass the entire lifespan
• Principles:
• Self-responsibility
• Nutritional awareness
• Stress reduction
• Physical fitness
19. Implications for the PTA
• Screening programs
• Health Promotion
• Prescriptive exercise programs to improve health and
wellness
• Understanding how individual variables affect patient
outcomes
20. Genetic Aspects of Disease
• Most illnesses are caused by acquired gene mutations
• May be the result of exposure to harmful (toxic) substances
• Errors in replication are usually repaired by the body
• When the repair process fails, disease or illness results
• Acquired gene mutations are not inherited
21. Genetic Aspects of Disease
• Genes are also chemical messengers of heredity
• Mutations on the X and Y Chromosomes are passed
on to offspring as genetic disorders
• Genetic disorders are often manifested in neonatal
period
• The Human Genome Project allowed complete
mapping of DNA sequence and increased
understanding of susceptibility to disease, prenatal
diagnosis
22. Genetic Aspects of Disease
• Genes are the chemical messengers of heredity
• Gene therapy
• Introduction of normal genes into living target cells to return cell
activity to normal
• Requires a vector that can pass the bodies defenses
• Genetic engineering
• Laboratory practices of manipulating genes
• Goal is to remove defective gene and supply a normal one to
eliminate genetic defects
• Ethical concerns
25. Genetic Aspects of Disease
• Gene Testing
• Identifies people who have inherited a faulty gene
• The gene may or may not lead to a particular disorder
• Results in earlier monitoring, preventive treatment, and long-
term planning
• Psychologic implications
• Ethical issues and privacy concerns
27. Implications for the PTA
• Important to eliminate factors in disease susceptibility
• Regular exercise can help control diabetes, bone
density, immune function, psychologic function and obesity
• Understanding of genetic disorders can help therapists
understand patient response to interventions and
develop individualized plans of care
28. Review of Terms - Acute Illness
• An illness or disease that has a rapid onset and short duration
• Often responds to a specific treatment
• Usually self-limiting
• Return to previous level of functioning
29. Review of Terms
• Subacute Illness
• Between acute and chronic.
• Present for longer than a few days but less than several
months
30. Review of Terms
Chronic Illness – characteristics
• Permanent impairment or disability
• Residual physical or cognitive disability
• Need for special rehabilitation and/or long term medical
management
31. Review of Terms
• Diagnosis
• Identification of disease through evaluation of signs and
symptoms, laboratory tests (diagnostic tests), or other tools
• Etiology
• Causative factors in a particular disease
32. Review of Terms
• Incidence
• The number of new cases of a disease in a given population
noted within a stated time period
• Mortality
• Measurement of the number of deaths related to a disease
• Epidemic
• Higher than expected number of cases within a given area
33. Review of Terms
• Pandemic
• Higher than expected number of cases within many regions of
the globe
• Medical History
• Personal and family history of current and prior illness essential
for planning appropriate interventions
• Predisposing factor
• Inherent trait may or may not lead to disease or illness
(predisposition to blood clots due to inherited trait)
34. Review of Terms
• Precipitating factor
• Causes or contributes to the occurrence of a disorder (long
flight – DVT)
• Iatrogenic
• Disease or illness caused inadvertently by a physician or
surgeon or by medical treatment
• Complication
• New secondary or additional problems that arise after the
original disease begins
• Prognosis
• The probability or likelihood for recovery, expected outcome
35. Review of Terms
• Signs
• Objective indicators (manifestations) of disease (fever, rash or
lesions)
• Symptoms
• Subjective indicators (pain, nausea, dizziness)
• Exacerbation
• Change or increase in severity of chronic condition
36. Application for the PTA
• CJ is having surgery next week to remove a malignant
breast tumor, following discovery of a lump in the
breast and a biopsy. Her mother and aunt have had
breast cancer. CJ is taking medication for high blood
pressure.
• Match the significant information above to the
appropriate term: diagnosis, medical history, etiology,
prognosis, neoplasm, signs, complication, treatment,
examination of living tissue. Some terms may not be
used or may be used more than once.
37. Application for the PTA
• Malignant breast tumor and high blood pressure:
diagnosis
• High blood pressure and family cancer: medical
history
• Biopsy: examination of living tissue
• Medication: treatment
• Surgery: treatment and diagnosis
40. Problems Affecting Multiple Systems
• It is important for the PTA to understand
systemic, local and functional effects
associated with pathological conditions
• Why?
• What does it mean if something is
Systemic?
41. Inflammation
• Acute Inflammation – systemic effects include fever,
tachycardia (rapid heart rate)
• Can cause changes in blood – elevated serum protein
• Can lead to abscess formation
• Progressive tissue damage and loss of function
42. Systemic Effects of Inflammation
• Chronic Inflammation – low grade fever, malaise,
weight loss, anemia, fatigue, leukocytosis,
lymphocytosis, increased erythrocyte sedimentation
rates (ESR)
• Leukocytosis
• Increased white blood cells
• Lymphocytosis
• Increased lymphocytes (type of white blood cell, disease fighting cells)
• ESR
• Erythrocyte – red blood cell, high sed. rate indicates inflammation
somewhere in body
44. Other Systemic Factors
• Consequences of Immunodeficiency
• Failure of the immune system
• Predisposed to infection
• AIDS
• Effects of Neoplasm
• Encroaches on healthy tissue
• May cause pain, swelling
• Symptoms may include muscular weakness, anorexia,
anemia, bruising, bleeding, cachexia (wasting)
45. Implications for the PTA
• Careful and close monitoring of vital signs, especially
for the patient with multiple system involvement
• Modification of physical therapy to minimize risk
• Individualized treatment programs
• Understanding of the disease process, possible risks
for secondary disease, and prognosis
46. Adverse Drug Reactions (ADRs)
• Most patients are taking multiple prescription or over-
the-counter (OTC) medications
• It is important to know the clinical manifestations of
ADRs
47. Adverse Drug Reactions
• ADRs
• Unwanted and potentially harmful effects produced by
medications or prescription drugs
• Mild – no treatment needed
• Moderate – may require medication or treatment
changes
• Severe – potentially life threatening
• Lethal – leads to death
• Side effects
• Predictable effects that can occur within therapeutic dose
ranges
51. Risk Factors for ADRs
• Age – most prevalent • Dosages
effect • Herbals
• Gender • Duration of treatment
• Ethnicity • Noncompliance
• Alcohol consumption • Small stature
• New drugs • Other conditions
• Number of drugs
55. Implications for the PTA
• Exercise can cause sudden changes in the way drugs
are metabolized by the body
• Monitor for signs and symptoms of ADRs
• Report any suspected ADR to the PT and/or physician
• Documentation
• Follow the facilities policies for notification of ADRs
• May be appropriate to schedule treatment sessions
during peak pain relief (2 hrs after oral administration)
56. Drug Categories:
Nonsteroidal Antinflammatory Drugs
• NSAIDS
• Reduce inflammation, decrease pain, reduce fever
(ibuprofen, Aspirin, Advil, Naproxen)
• Tylenol (acetaminophen)
• NOT an NSAID – analgesic and antipyretic only
• Potential adverse effects of NSAIDs
• GI
complications, dyspepsia, bleeding, ulcers, per
foration
57. Nonsteroidal Antinflammatory Drugs
• Interact with high blood pressure medications
• Anti-coagulant, single dose of aspirin limits clot
formation for 5-7 days
58. Implications for the PTA
• Widespread use both OTC and prescription
• Post op, fever, musculoskeletal pain, arthritis
• PTA must observe for any side effects or adverse
reactions, especially among elderly
• Easy bruising, bleeding
• Elevated blood pressure
• GI symptoms
59. Immunosuppressive Agents
• Used with organ and bone marrow transplantation
• May be used with chronic conditions like
RA, psoriasis
• Serious side effects and adverse reactions are
common
• Anaphylactic reactions, renal failure, liver
toxicity, neurotoxicity, prone to infection – both fungal and
bacterial
60. Implications for the PTA
• Handwashing is essential before contact with
immunosuppressed patient
• Use of Mask may be appropriate
• Do not work with this patient if you are ill
61. Corticosteroids
• Naturally occurring hormones in the body
• Glucocorticoids (cortisol)
• (hydrocortisone, prednisone, dexamethasone) which
affect carbohydrate and protein metabolism
• Mineralocorticoids (aldosterone)
• Which regulate electrolyte and water metabolism
• Androgens
• (testosterone) causes masculinization
62. Glucocorticoids
• Effective anti-inflammatory agents
• Side effects:
• Change in sleep and mood, mild anxiety to psychosis
• GI irritation
• Hyperglycemia
• Fluid retention
• Susceptibility to infection
63. Glucocorticoids
• Side effects:
• Thinning of subcutaneous tissue
• Delayed wound healing
• Steroid myopathy: muscle weakness and atrophy
• Growth retardation
• Osteoporosis
64. Glucocorticoids
A patient with MS has been on prednisolone for the past 4
years. The medication is now being tapered off. This is the
third time this year that the patient has received this treatment
for an MS exacerbation. The PTA recognizes that possible
adverse effects of this medication are:
• 1. weight gain and hyperkinetic behaviors
• 2. nausea and vomiting
• 3. muscle wasting, weakness, and osteoporosis
• 4. spontaneous fractures with prolonged healing
65. Anabolic - Androgenic Steroids
• ―Roids‖
• Synthetic derivatives of the hormone testosterone
• Used to enhance sports performance or personal
(masculine) appearance
• Side effects:
• HTN
• Left ventricular hypertrophy
• Liver dysfunction
• Sudden and premature death
66. Implications for the PTA
• Harmful side effects of glucocorticoids can be delayed
or reduced by exercise
• Monitor vital signs due to risk of increased blood
pressure both with exercise and with steroid use
• Increase use of calcium and vit D
67. Implications for the PTA
• Psychologic considerations
• Mood change and irritability
• Notify PT or physician when intense changes are seen
• Anabolic steroids
• Frequent or recurrent tendon or muscle strain
• Male pattern baldness
• Gynecomastia
• Personality changes, ―Roid rage‖
• Depression
68. Chemotherapy and Radiation
• Common treatments for cancer (also other diseases that
are non responsive to treatment)
69. Radiation
• Increased risk of cancer after medical radiation: X-ray, CT
scan
• Radiation can cause:
• Causes mutations or alterations in DNA
• Damages blood vessels
• Bone marrow depression with decreased leukocytes,
platelets, and erythrocytes
• Epithelial cell damage, erythema, alopecia
• Mucosal lining of Digestive tract damaged resulting in
nausea and vomiting, diarrhea, bleeding
• Fatigue, lethargy, mental depression
70. Chemotherapy
• Chemotherapy
• Anti-neoplastic drugs
• Interfere with protein synthesis and DNA replication of
the tumor cells
• Specific drugs are designed for specific types of tumor
cells
71. Chemotherapy and Radiation
• Adverse effects of chemotherapy:
• Bone marrow suppression
• Alopecia
• Mucosal inflammation with nausea and vomiting
• Fibrosis in lungs
• Damage to heart myocardial cells
• Neuropathy
• Chemicals stimulate the emetic centers of the brain causing
vomiting
72. Implications for the PTA
• Patients have a high risk of infection, handwashing is
essential
• Notify PT or physician of any sigh of infection
• Mood swings
• Fatigue
73. Implications for the PTA
• Monitor for complaints of pain, burning, numbness, pins
and needles, motor deficits (neuropathy)
• Possible effects on cardiac and other organs manifests
months to years after treatment
• Closely monitor patient tolerance to exercise and other
physical therapy interventions
74. Implications for the PTA
• Mrs. B.N. is 67 years old and has just completed her recent
chemotherapy treatment. She has returned to physical
therapy due to her weakness and difficulty walking.
• 1. Explain why handwashing is essential when treating Mrs.
B.N.
• 2. Describe what clinical signs may be expected with Mrs.
B.N.
• 3. Mrs. B.N. complains of fatigue and requests that her
therapy be placed on hold. What is the proper response by
the PTA?
75. Implications for the PTA
• Fatigue is common but should not be discounted
(consider dehydration, malnutrition, anorexia, sleep
disturbances)
• Lack of exercise can lead to CRF( cardiac-related
fatigue)
• PT and PTA team must determine the balance of
exercise and rest that is effective for the patient
77. Fluid and Electrolyte Imbalances
• Water composes 45-60% of the adult human body (70%
for the infant)
• Water is the medium in which metabolic reactions and
other processes take place
• Water is the transportation system for the body
• Carries nutrients into cells
• Removes wastes from cells
• Transports enzymes in digestive secretions
• Moves blood cells around the body
78. Fluid and Electrolyte Imbalances
• Fluid is distributed between intracellular fluid (ICF) and
extracellular fluid (ECF)
• Cell membranes are water permeable
• Equal concentrations of dissolved particles on each side of the
membrane
• Maintaining equal volumes of ECF and ICF
• Homeostasis – stable internal environment
• What causes the shift of water?
• Shifts of water occur due to changes in concentration of ions like
sodium
79. Fluid and Electrolyte Imbalances
• The amount of water entering the body must equal the
amount of water leaving the body.
• Water enters through the ingestion of fluids in liquids and
solids
• Water exits the body through
urine, perspiration, feces, exhaled air
• Too much fluid = hypervolemia
• Too much fluid loss = dehydration
80. Implications for the PTA
• Patients with CHF should monitor weight gain/loss
frequently. Any increase in weight should be reported to
PT or physician
• Generally, water should be available and offered to
patients during rehab, special considerations should be
followed for CHF or renal diseased patients
• Educate patient on using urine as a gauge for adequate
hydration
• Dehydration degrades endurance and exercise
performance
81. Electrolyte Imbalances
• Sodium • Sodium influences blood
volume and
pressure, fluid loss or
gain
• is the primary cation in
extracellular fluid
• Calcium
• Calcium is important for
neuromuscular
activity, skeletal
• Magnesium muscle, bones, kidneys,
and GI tract
• Magnesium plays a role
82. Electrolyte Imbalances
• Sodium and potassium are essential for producing the
membrane potential providing the means for
transmission of electrochemical impulses
• Sodium influences blood volume and pressure, fluid
loss or gain
• Potassium is necessary for normal muscle contraction
and relaxation (heart, intestines, respiration, neural
stimulation of skeletal muscles)
84. Implications for the PTA
• Educate the patient to maintain prescribed sodium
restrictions
• Elderly have higher incidence of hypokalemia due to
the use of diuretics resulting in fatigue, cramping,
dizziness, etc.
• Ongoing assessment of fluid and electrolyte balance
(subjective and objective findings)
• Be alert to complaints of headache, thirst, nausea,
shortness of breath, muscle strength
• Ask about fluid intake and output, body weight
changes
85. Implications for the PTA
Assessment of Fluid and Electrolyte Imbalance
Area Fluid Excess and Electrolyte Fluid Loss and Electrolyte
Imbalance Imbalance
Head and neck Distended neck veins, facial Thirst, dry mucous membranes
edema
Extremities Dependent pitting, edema Muscle weakness, tingling,
tetany
Skin Warm, moist, taut, cool feeling
when edematous Dry, decreased turgor
Respiration Dyspnea, orthopnea,
productive cough, moist breath Changes in rate and depth of
Circulation breathing sounds
Hypertension, atrial
arrhythmias Pulse rate irregularities,
arrhythmia, postural
hypotension, tachycardia
Abdomen
Increased girth, fluid wave Abdominal cramps
86. Acid-Base Imbalances
• Normal function of the body depends on regulation of
hydrogen ion concentration, pH
• Three systems act to maintain normal pH
• Blood buffer systems – immediate buffering by excretion of excess
acid
• Lungs – excretion of acid (occurs within hours)
• Kidneys – Excretion of acid or reclamation of base (occurs within
days)
87. Acid-Base Imbalances
• Normal pH level is 7.35 to 7.45
• Cell function is impaired when pH falls below 7.2 or
rises to 7.55 or higher.
• Below 7.4, more hydrogen ions are
present, considered acidic
• Above 7.4, fewer hydrogen ions present, considered
basic
88. Acid-Base Imbalances
• Acidosis
• Excess acid in the body
• Acidemia
• Excess acid in the blood
• Alkalosis
• Excess base in the body
• Alkalemia
• Excess base in the blood
92. Implications for the PTA
• Fruity breath = increased acid levels
• Hyperventilation – re-breathing in bag helpful to prevent
alkalosis
• COPD diagnosis may have frequent changes in O2 and
CO2 levels with associated symptoms
• CHF- diuretics cause potassium depletion
• Notify PT/ MD if signs and symptoms of acid base
imbalance develop
94. Risk Factors of UTI
• Age
• Immobility, inactivity (impaired bladder emptying)
• Catheterization
• Increased sexual activity
• Use of diaphragm or condom
• Uncircumcised penis (first year of life)
• Female
• Partner of Viagra User
• Previous UTI
95. Chronic Kidney Disease (CKD)
• Alteration in kidney function for greater than 3 months
• Etiology
• Diabetes
• Glomerulonephritis
• Glomeruli filter waste and fluids from blood
• Blood and protein lost in urine
• Excessive aspirin or acetaminophen use
96. End Stage Renal Disease (ESRD) -
Renal Failure
• Final stage of CKD
• May be due to circulatory disruption to kidneys, toxic
substances, acute obstruction and trauma
• SLE
• Uncontrolled hypertension
• Uremia – end stage toxic condition
97. Renal Failure – Red Flags
• Multi-system abnormalities and failures
• Dizziness, headaches, anxiety, memory loss, inability to
concentrate, convulsions and coma
• Hypertension, dyspnea on exertion, heart failure
• Chronic pain- leg pain and cramps
• Edema – peripheral edema
• Muscle weakness – peripheral neuropathy
• Osteoporosis
• Skin pallor, pruritis, dry skin
• Anemia, bleeding tendencies
98. Dialysis
• Removal of toxic substances, maintain fluid, electrolyte
and acid-base balance
• Peritoneal or renal (hemodialysis)
• Signs and symptoms often encountered:
• Nausea, vomiting, drowsiness, headache, seizures
• Dementia – speech difficulties, confusion
• Infection at shunt site
• Multisystem dysfunction
100. Implications for the PTA
• Renal disease may be induced by interactions of
NSAIDS and other analgesics, especially in the elderly
• Musculoskeletal changes, osteoporosis, atrophy
• Fluid shifts during dialysis
• Depression
• Susceptibility to infection
101. Implications for the PTA
• Monitor for multisystem dysfunction
• Vital signs
• Strength
• Sensation
• ROM
• Function
• Endurance
• Locate shunt – BP at shunt site contraindicated
• Locate peritoneal catheters (avoid trauma to these
areas)
102. Implications for the PTA
• Functional mobility training as needed
• Sit to stand transfers
• Ambulation
• Toileting
• Environmental modifications
• Toilet rails, raised toilet seat, etc.
103. Implications for the PTA
• A patient with chronic renal failure is being seen in PT for
deconditioning and decreased gait endurance. The patient
has been scheduled around dialysis. The patient is also
hypertensive and requires careful monitoring. What is the
best approach to take blood pressure?
• 1. before and after activities, using the nonshunted arm
• 2. after activity
• 3. before activity
• 4. every few minutes during the activity
104. Urinary Incontinence
• Inability to retain urine
• Loss of sphincter control
• Acute - cystitis
• Persistent – stroke, dementia
105. Urinary Incontinence
• Types:
• Stress incontinence – cough, laugh, sneeze, weakness and
laxity of pelvic floor muscles
• Post partum, menopause, nerve damage
• Urge incontinence – inability to delay voiding after the bladder is
full
• Stroke, hypersensitive bladder
• Overflow incontinence – leaks due to urinary retention
• Functional incontinence – inability or unwillingness to toilet
• Dementia, stroke, environmental barriers
106. Implications for the PTA
• Bladder training
• Prompted voiding, schedule, intermittent catheterization
• Pelvic floor exercises
• Kegel exercises – incorporate into every day life, with
lifting, coughing, changing positions, etc.
• Behavioral training
• Record keeping, education on anatomy, muscle
weakness, avoiding valsava during activity
• Adult diapers, pads
• Psychosocial support
108. Objectives
• Discuss cell injury and compare/ contrast the factors
causing this injury
• Differentiate the components of the inflammation reaction
• Discuss factors that affect tissue healing and phases of
healing
109. Cell Injury
• Understanding cell injury, inflammation and tissue
healing serves as a solid foundation for clinical decision
making
110. Injury
• Structural and functional changes produced by
pathology start with injury to the cells that make
up the tissues
• Injury can occur as a result of
• Ischemia
• Infection
• Immune reactions
• Genetic factors
• Nutrition
• Physical factors
• Chemical factors
111. Injury
• Ischemia: limited blood flow
• Decrease in oxygen and nutrients
• Decrease in removal of waste products
• Causes of ischemia
• Atherosclerosis
• Clot
• MI and Stroke are the leading causes of death
(lack of blood flow to heard and brain)
112. Injury
• Infectious agents
• Bacteria and viral agents most common
• Sepsis occurs when infectious agents are present
throughout the body in the blood
113. Injury
• Immune Reactions
• Mild allergy to life-threatening anaphylactic reactions
• Genetic Factors
• Mutations or alterations in DNA
• Inherited or acquired
114. Injury
• Nutritional factors
• Imbalances can lead to cell injury and death
• Iron deficiency can lead to anemia
• Vitamin C deficiency
can cause scurvy
116. Injury
• Mechanical factors
• Soft tissue stress
• Repetitive or forceful tasks
• Chemical Factors
• Chemotherapy and other toxins, topical and metabolic
• Taken in large amounts most medications can be toxic
117. Cell Injury
• Reversible
• Cell injury or stress is short duration and cell is able
to recover
• Chronic
• Sub lethal stress remains present over a period of
time causing the cell to adapt but survive (atrophy,
hypertrophy, hyperplasia, metaplasia, and dysplasia)
• Irreversible
• Results in cell death and necrosis
118. Cell Injury
• Tissue Calcification
• Calcium is deposited into the area of damaged tissue,
T.B, atherosclerosis, calcific tendinitis – can be treated
with pulsed US
119. Implications for the PTA
• Signs and symptoms differ depending on the stage
of cell injury and the type of organ or tissue
involved
• Understanding injury processes and implications
120. Tissue Healing
• Resolution
• Minimal tissue damage, cells recover and tissue
returns to normal (sunburn)
• Regeneration
• Damaged tissue restored to original form, replaced by
same type of cell (liver)
• Repair
• (Replacement)- functional tissue replaced by highly
collagenous scar tissue, loss of function
• Collagenous scar tissue forms when the injury is
extensive, extends beneath the epidermis or cells are
unable to undergo mitosis (brain, cardiac cells)
121. Components of Tissue Healing
• Collagen: most important protein, provides
structural support and tensile strength for
almost all tissues
• Tendon strength
• Flexibility of skin
• Rigidity of bone
• Elasticity of blood vessels
122. The Healing Process
• Four phases of healing for acute wounds
caused by trauma or surgery
• Hemostasis and degeneration
• Inflammatory phase
• Proliferation and migration
• Remodeling and maturation
• Phases often overlap and can take months to
years to complete
123. The Healing Process - Hemostasis
• Hemostasis:
• blood clotting
• Platelets clump together forming a loose clot
• Platelets release chemical
messengers, growth factors that summon
inflammatory cells promote cell healing
124. The Healing Process - Hemostasis
• Degeneration: formation of hematoma, necrosis
of dead cells, and start of inflammatory process
• Repair of tissue occurs after the removal of
dead cells
125. Defense Mechanisms
• Non-specific:
• First line of defense:
• Skin/ mucous membranes
• Block entry of bacteria or other harmful substances
• Saliva, tears have enzymes and chemicals that inactivate or
destroy pathogens
• Second line of defense:
• Phagocytosis
• Process by which neutrophils (a leukocyte, WBC) and
macrophages engulf and destroy bacteria, cell debris and
foreign matter (pathogens)
• Inflammation limits the effects of injury
126. Defense Mechanisms
• Specific
• Third line of defense
• Immune system
• Specific immune cell responses
• Lymphocytes, macrophages, etc.
• Provides protection by stimulating the production of
antibodies
127.
128. Inflammation
• Initial response of vascularized living tissue to
injury
• After cell injury, the body reacts with the
process of inflammation
• Normal defense mechanism in the body
intended to localize and remove an injurious
agent
• Not the same as infection, but infection is one
cause of inflammation
• Disorders are named using the ending –itis
140. Clinical Manifestations of Inflammation
• Redness and warmth
• Due to increased blood flow (vasodilation) to damaged
area
• Swelling (edema)
• Shift of protein and fluid into the interstitial space
• Pain
• Increased pressure of fluid on nerves; release of
chemical mediators – i.e., bradykinins
• Loss of function
• May develop if cells lack nutrients; edema may interfere
with movement
141. Acute Inflammation
• Three major components
• Dilation of blood vessels and increased blood flow
• Mast cell changes allowing proteins to leave the cell
• Migration of proteins to the area of injury
142. Acute Inflammation
• Events that occur
• Vascular events – blood vessels
• Cellular events – mast cells
• Chemical events - mediators and complement
factors (proteins)
143. Inflammation (Cont’d)
• Acute inflammation
• Self-limiting
• Essential part of the healing process (not a disease)
• Lasts 3-7 days
• Edema and blood clotting usually occur
• Platelets are activated
• Platelet plug is formed and stabilized
• Thrombus (blood clot) formed
• Increased capillary permeability causes protein and
water to escape into compartment or tissue causing
edema
144. Inflammation (Cont’d)
• Edema
• Fluid and protein in tissue causes leukocytes (WBC) to
accumulate
• Lukocytes are attracted to site of inflammation
• (WBC)
• Leukocytosis – increased WBC count in blood
145. Inflammation (Cont’d)
• Acute inflammation
• Bacteria killed by neutrophils
• White blood cells that clean up and eliminate
pathogens, dead cells and other cellular debris
• Limited number of Monocytes/macrophages
• Also provide phagocytosis but with increased role in
chronic inflammation
146. Inflammation (Cont’d)
• Chronic inflammation
• Fibrocytes/fibroblasts - play a critical role in wound
healing, create collagen and other cellular material
• Endothelial cells – important role in controlling
inflammation, release cytokines (Stimulate the
release of inflammatory mediators from other cells),
line blood vessels and create lymphatic drainage
147. Inflammation (Cont’d) Page 66
Factors affecting bloodflow Vasodilation +
Histamine increased vascular
Serotonin permeability =
Bradykinins
Edema
Leukotrienes/prostaglandins
Factors leading to
inflammation
Lack of adequate bloodflow Production of
Damaged tissue inflammatory Acute inflammation cellular
Cancer infiltrate
mediators Platelets
Infectious biologic organisms
Foreign material Neutrophils
Chemicals Monocyte/macrophage
Physical agents Fibrocytes/fibroblasts
Factors attracting and Endothelial cells
Heat stimulating cells
Cold C5a
Radiation Lipooxygenase products Chronic inflammation cellular
Lymphokines infiltrate
Monokines Monocyte/macrophage
Lymphocyte
Fibrocytes/fibroblasts
Endothelial cells
148. Inflammation (Cont’d)
• Chronic inflammation
• Not self-limiting
• Must be resolved and replaced by acute
inflammation for healing to occur
• Production of specific antibodies or cell-mediated
immunity
149. Local Effects of Inflammation
• Effusion
• General term referring to the escape of fluid into a
compartment or tissue (edema)
• Exudate
• Any fluid that filters from the circulatory system into
lesions or areas of inflammation
• Serous exudate
• Watery, generally clear, contains small amounts of
protein and white blood cells (common with allergies,
runny nose, etc.)
• Fibrous exudate
• Thick and sticky, high cell and fibrin content
150. Local Effects of Inflammation
• Purulent exudate
• Thick , yellow-green in color, contain leukocytes, cell
debris and microorganisms. (Bacterial infection,
referred to as ―pus‖)
• Abscess
• Localized pocket of purulent exudate in a solid tissue
(around a tooth, in the brain)
• Hemorrhagic exudate
• Blood, present if blood vessels are damaged
151. Systemic Effects of Inflammation
• Fever – pyrexia
• Common if inflammation is extensive. If caused by
infection, fever can be severe depending on the
microorganism.
• High fever can be beneficial. Impairs the growth and
reproduction of pathogenic organisms.
• Caused by release of pyrogens – fever
producing substances
• Pyrogens circulate in blood, cause hypothalamus to
reset temperature control system at higher level
• Malaise
• Feeling unwell, fatigue, headache
• Anorexia
• Loss of appetite
152. Potential Complications of
Inflammation
• Infection
• Microorganisms can more easily penetrate
edematous tissues.
• Deep ulcers
• Result of severe or prolonged inflammation
• Skeletal muscle spasm
• Protective response to pain
• Local complications
• Depend on site of inflammation but may include
obstruction, loss of sensation, and decreased cell
function
155. Danger Signs
• Base of wound becomes increasingly moist,
changes from healthy red or pink to yellowish
or grey tissue
• Discharge changes from clear to purulent
• Unpleasant odor is present
156. The Healing Process
• Epithelial cells are activated, undergo mitosis
and extend across the wound from the outside
edges inward
• Fibroblasts enter and produce collagen (basic
component of scar tissue)
• Fibroblasts and macrophages produce growth
factors (cytokines), stimulate epithelial cell
growth, development of new blood vessels
(angiogenesis)
159. The Healing Process
• Healing by first (primary) intention
• Clean wound, free of foreign material and necrotic
tissue, edges are held close together, minimal gap
between edges
• Healing by second (secondary) intention
• Large break in tissue, more inflammation, longer
healing period, formation of more scar tissue
160.
161.
162.
163. Fracture Healing
• Immediate vascular response with hematoma
and inflammation
• Granulation tissue and fibrocartilage formation –
soft callus
• Bony callus replaces soft callus to immobilize
the fracture site
• Repair – bone union occurs when hard callus
replaces soft callus
• Non-union occurs without proper immobilization
• Remodeling occurs until the bone returns to
normal
• Time frame varies – minimum 6 weeks
164.
165. Tendon and Ligament Injury
• Sprain
• Stretching or tear in a ligament
• Strain
• Stretching or tear in a musculotendinous unit
• Tear – inflammation – granulation tissue – collagen -
repair
166. Tendon and Ligament Injury
• Most tendons and ligaments require surgical
intervention
• Adhesions are common
• Aggressive motion and muscle contraction should be
avoided after surgical repair for at least 8 weeks
• High rate of impaired function, re-injury, joint
osteoarthritis
167. Tendon and Ligament Injury
• Not all heal at the same rate
• ACL does not heal as well as the MCL
• Tensile strength is only 50-70% of original strength 1
year later
• Torn ligament ends must be in contact with each other
to heal
168. Tendon and Ligament Injury
• Surgical vs. nonsurgical
• Depends on degree of injury
• Involvement of supporting tissues
• Heal by way of scar tissue proliferation and not ligament
regeneration
• Untreated ligament tears are biomechanically inferior
169. Tendon and Ligament Injury
• Progressive, controlled stress must be applied to the
healing tissues during healing
• However, must be protected against excessive forces
during remodeling phase
170. Tendon and Ligament Injury
• Grades of Injury
• Grade I: microscopic tearing of the ligament without producing
joint laxity
• Grade II: Tearing of some ligament fibers with moderate laxity
• Grade III: complete rupture of the ligament with profound
instability and laxity
171. Tendon and Ligament Injury
• Grades of Injury
• Grade I and II are most common
• Can be treated with protective bracing and rehab with
strengthening to provide dynamic muscular support and
proprioception
• Usually good to excellent results anticipated in 90% of cases
treated non-surgically
172. Tendon and Ligament Injury
• Grades of Injury
• Grade III
• 15% of all knee sprains
• Frequently requires repair of associated tissues
• Cartilage (meniscus) and MCL, LCL, or PCL injury often seen
with ACL grade III injury
173. Ligament andTendon Injury– Phases of
Healing
• Inflammatory phase 3-5 days
• Proliferative phase 2-3 weeks
• Protection, immobilization, irregular collagen formation
• Maturation phase and remodeling occur around 3
weeks post injury
• Irregular and immature collagen replaced by mature collagen
aligned along lines of stress
• Final phase - 8-12 weeks
• Maximum muscle contraction forces should be avoided for at
least 8 weeks
174. Tendon and Ligament Injury -
Treatment
• For a Grade 1-2 sprain, use R.I.C.E (rest, ice,
compression and elevation):
• Rest your ankle with weight bearing as
tolerated
• Ice should be immediately applied. It keeps
the swelling down.
• Compression dressings, bandages or ace-
wraps immobilize and support the injured
ankle.
• Elevate your ankle above your heart level for
48 hours.
175. Tendon and Ligament Injury -
Treatment
• For a Grade 3 sprain/strain
• Treatment similar to grade 2 but over a
longer period
• Remodeling can take 8-12 weeks (some
reports say 16 weeks) before higher levels of
stress can be applied
• May require surgical reconstruction
• Normal strength 40-50 weeks postoperatively
181. Scar Formation
• Loss of function
• Result of loss of normal cells and specialized
structures
• Hair follicles
• Nerves
• Receptors
• Contractures and obstructions
• Scar tissue is non-elastic
• Can restrict range of movement
• Adhesions
• Bands of scar tissue joining two surfaces that are
normally separated
182. Scar Formation (Cont’d)
• Hypertrophic scar tissue
• Overgrowth of fibrous tissue
• Leads to hard ridges of scar tissue or keloid formation
• Ulceration
• Blood supply may be impaired around scar
• Results in further tissue breakdown and ulceration at a future time
184. Factors Promoting Healing
• Youth
• Good nutrition: protein, vitamins A and C
• Adequate hemoglobin
• Effective circulation
• Clean, undisturbed wound
• No infection or further trauma to the site
185. Factors Delaying Healing
• Advanced age (reduced cell development,
mitosis)
• Poor nutrition, dehydration
• Anemia (low hemoglobin)
• Circulatory problems
• Presence of other disorders such as
diabetes or cancer
• Irritation, bleeding, or excessive mobility
• Infection, foreign material, or exposure to
radiation
• Chemotherapy treatment
• Prolonged use of glucocorticoids
186. Implications for the PTA
• Inflammation is necessary for healing but
must be controlled for recovery to proceed
• Edema causes muscle inhibition so must be
effectively treated
• Client education needed regarding weight
bearing and activity level to promote
healing
187. Implications for the PTA
• Prevention of re-injury
• Understanding healing time-lines
• Immobilization followed by mobilization, DVT
assessment
• Modalities: pain control
• Physician approved surgical protocols
188. Case Study
• M.H., age 6, fell while running down stairs
and hurt his wrist and elbow. His are was
scraped and bleeding slightly, and the elbow
became red, swollen, and painful. Normal
movement was possible, although painful.
• 1. Explain why the elbow is red and swollen.
• 2. Suggest several reasons why movement
is painful.
• 3. State two reasons why healing may be
slow in this scraped area on the arm, and two
factors that encourage healing in this boy.
190. Objectives
• Compare/ contrast the different types of immunity
• Discuss the effect of physical activity and exercise on the
immune system
• Compare immunodeficiency diseases
191. Immunology
• The study of the physiologic mechanisms that allow
the body to recognize materials as foreign and to
neutralize or eliminate them.
• The immune system protects the body from infection
and disease
• Excessive immune system activity can result in
hypersensitivity (i.e. allergies)
192. Immunity
• Natural (innate) immunity
• Species specific
• The viruses that cause leukemia in cats or distemper in
dogs don't affect humans. Innate immunity works both
ways because some viruses that make humans ill —
such as the virus that causes HIV/AIDS — don't make
cats or dogs sick
193. Active or Passive Immunity
• Active innate immunity
• Natural exposure to pathogen—chicken pox
• Development of antibodies or immunoglobulins
• Active artificial immunity
• Pathogen purposefully introduced to body
• Stimulation of antibody production
• Immunization----measles
• Booster immunization
194. Immunity (Cont’d)
• Passive innate immunity
• Transferred from mother to fetus
• Across placenta
• Through breast milk
• Protection of infant for the first few months of life or until
weaned
• Passive artificial immunity
• Injection of antibodies----antiserum
• Short-term protection
195. Immunity (Cont’d)
• Primary immune response
• First exposure to antigen
• 1 to 2 weeks for antibody titer to be effective
• Secondary immune response
• Repeat exposure to the same antigen
• More rapid response with effectiveness in 1 to 3 days
196. Components of the Immune System
• Lymphoid structures
• Lymph nodes
• Spleen
• Tonsils
• Intestinal lymphoid tissue
• Lymphatic circulation
• Immune cells
• Lymphocytes
• Macrophages
198. Components of the Immune System
(cont'd)
• Tissues involved in immune cell development
• Bone marrow
• Origination of immune cells
• Thymus
• Maturation of immune cells
199. Components of the Immune System
(Cont’d)
• Spleen – large lymphatic organ
• Generates response to bloodborne antigens
• Removes foreign matter and old or defective blood cells
• Lymph vessels – filters fluids to lymph nodes
200. Components of the Immune System
(Cont’d)
• Lymph nodes
• Help body recognize and fight germs, infections, and other
foreign substances, dependent on type of problem and
body parts involved. Contain lymphocytes
• Tonsils
• Part of the immune system to filter germs, bacteria and
viruses when they enter the body through the nose and
mouth
201. Components of the Immune System
(Cont’d)
• Thymus
• Responsible for development of T lymphocytes (T cells)
• Bone Marrow
• Source of stem cells, leukocytes, and the maturation of B
lymphocytes (B cells)
• Lymphocyte
• WBC, determine the immune response to foreign
substances (B and T cells)
202. Pathogen
• Infectious organism that causes disease
• Recognized as being foreign by the body
• Single celled microorganisms
• Virus
• Bacteria
• Yeast – unicellular fungus
• Multicellular parasites
• Fungi
• Worms
203. Pathogen
• Antigen
• Protein on the surface of a cell
• Pathogens have antigens on their surface
• Antigens trigger the immune response and the production
of antibodies
204. Pathogenesis
• How pathogens (infectious organisms) cause
disease
• Secretion of toxins
• Endotoxins
• Direct killing of host cells
• Physical blockage
205. Pathogenesis
• Secretion of toxins
• Bacteria produce toxins which cause pathology and
disease
• Neurotoxin from Clostridum bacteria causes tetanus
• Shigalla dysenteria bacteria causes dysentery
206. Pathogenesis
• Endotoxins
• Located in cell wall of pathogens
• Cause fever, lower blood pressure, inflammation
• Direct killing of host cells
• Replication within the cell by pathogens can kill the cell,
causes release of replicated pathogens to infect other
cells
• Physical blockage
• Size of pathogen can block tissues
207. Pathogenesis
Pathogenesis of Rheumatoid Arthritis
209. Immunoglobulins—Y shaped proteins
• IgG – most common antibody in the blood,
crosses placenta producing passive immunity in
newborn
• IgM – bound to B lymphocytes, forms natural
antibodies, first antibody secreted by B cells
• IgA – found in tears, saliva, colostrum, provides
protection for newborn
• IgE – Binds to mast cells, causes release of
histamine resulting in inflammation
• IgD – attached to B cells, activates B cells
(Humoral Immunity)
210. Cells - Macrophage
• Macrophage – mature from monocytes
• Means large eaters
• Essential first step in immune system is
engulfment of pathogen by macrophage
• Pathogen is introduced to lymphocytes by
macrophage
211. Cells - Lymphocytes
• Primary cells of the immune system are Lymphocytes
• B Lymphocytes
• Responsible for production of antibodies - humoral immunity
(immunoglobulins)
• Mature in bone marrow
• Become plasma cells producing specific antibodies
• B-memory cells are also formed and provide repeated
production of antibodies
212. Cells - Lymphocytes (Cont’d)
• T-Lymphocytes
• From bone marrow stem cells
• Further differentiation in thymus
• CMI – cell mediated immunity
• T-killer cells –cytotoxic, release enzymes or chemicals to
destroy foreign cells
• Helper T cells – activate B and T cells, control or limit specific
immune response
• Memory cells – remember antigen and quickly stimulate
immune response on re-exposure
215. Factors That Alter Immunity
• Aging
• Sex and hormonal influences
• Nutrition and malnutrition
• Environmental pollution
• Exposure to toxic chemicals
• Trauma
• Sleep disturbances
216. Factors That Alter Immunity
• Presence of concurrent illness and diseases:
• Malignancy
• Diabetes mellitus
• Chronic renal failure
• Human immunodeficiency virus (HIV) infection
• Medications, immunosuppressive drugs
• Hospitalization, surgery, general anesthesia
• Splenectomy
• Stress, psycho spiritual well-
being, socioeconomic status
218. Implications for the PTA
• Intense or strenuous exercise may be detrimental to
the immune system in young subjects
• It takes 6 to 24 hours for the immune system to
recover from the acute effects of severe exercise
• A lifetime of moderate exercise and physical activity
enhances immune function
219. Implications for the PTA
• Intense or strenuous exercise has no detrimental
effect on immune function or rate of infections in older
adults.
• Relatively intense exercise programs may be
prescribed to maximize cardiopulmonary and
musculoskeletal function without impairing immune
function in frail elderly people.
• Intense exercise during any
infections episode should be
avoided
220. Immunodeficiency
• Partial or total loss of one or more immune system
components
• Increased risk of infection and cancer
221. Immunodeficiency (Cont’d)
• Primary deficiencies
• Basic developmental failure somewhere in the system
• Secondary or acquired immune deficiencies
• Loss of the immune response due to specific causes
• Can occur at any time during the lifespan
• Infections, splenectomy, malnutrition, liver
disease, immunosuppressant
drugs, radiation, chemotherapy (cancer)
222. Immunodeficiency (Cont’d)
• Predisposition to the development of opportunistic
infections
• Caused by normal flora
• Usually difficult to treat due to immunodeficiency
• Prophylactic antimicrobial drugs may be used prior to
invasive procedures
223. Acquired Immunodeficiency Syndrome
(AIDS)
• AIDS – chronic infectious disease caused by the
human immunodeficiency virus (HIV)
• HIV destroys helper T-cells - lymphocytes
• Loss of immune response
• Increased susceptibility to secondary infections
and cancer
• Development may be suppressed by antivirals
224. AIDS (Cont’d)
• HIV positive
• Virus is known to be in the body.
• No evidence of immune suppression
• AIDS
• Marked clinical symptoms, multiple complications
• Individual is often identified as HIV positive
before the development of AIDS.
• Current therapies start if HIV infection is diagnosed in
the early stages.
225. Clinical Manifestations of AIDS
• Musculoskeletal
• Myalgia and arthralgia
• Musculoskeletal pain and wasting
• Pelvic pain
• Tuberculosis
• Delayed healing
226. Clinical Manifestations of AIDS
• Cardiopulmonary
• SOB
• Cough
• Frequent infections of respiratory system
• Cardiomyopathy
• Integumentary
• Alopecia
• Basal cell carcinoma
• Mucocutaneous ulcers
• Rash
• Delayed wound healing
227. Clinical Manifestations of AIDS
• Neurologic and Neuromuscular
• HIV encephalitis:
• Gait disturbance
• Intention tremor
• Dementia
• Behavioral: Apathy, lethargy, social withdrawal, irritability,
depression
• Cognitive: Memory impairment, confusion, disorientation
• Motor: Ataxia, leg weakness, los of fine motor,
incontinence, paraplegia
• Radiculopathy
228. Treatment of AIDS
• No cure
• Antiviral drugs reduce the replication of viruses but do
not kill the virus (AZT)
• Frequent mutations require ―cocktails‖ of additional
drugs
• HAART therapy (highly active antiretrovirus therapy)
• With treatment, the prognosis is much
improved, decades
• Without treatment, death occurs within several years
230. Implications for the PTA
• Primary role of Physical Therapy is assisting the
patient with the management of physical
dysfunctions common with this chronic disease
• Strength training
• ADL and energy conservation
• Treatment of neuropathy or radiculopathy
• Balance and gait training
• Body mechanics and posture
• Breathing exercises
• Individualized exercise based on stage of disease
231. Implications for the PTA
• Hand washing, standard precautions, disinfection
important for all patients
• Critical for the immuno-deficient patient
• Pulmonary complications common
• Susceptibility to infection
• Often debilitated and easily fatigued
• Frequent mobility and body positioning enhance
gas respiration and promote comfort while
maintaining strength
• Individualized programs
232. Chronic Fatigue Syndrome (CFS)
• Result of a combination of factors
• Unexplained fatigue of greater than 6 months
• Thought to be result of neuroendocrine system
abnormality
• No known cure
233. Implications for the PTA
• Monitor vital signs
• Because blood pressure and pulse remain low
• Avoid overexertion, reduce stress, gentle
stretching
• Borg Scale of Perceived Exertion can be helpful
in grading exercises at the sub-maximal level
234. Borg Rate Perceived Exertion Scale
• 6 No exertion at all
• 7
Extremely light (7.5)
8
• 9 Very light
• 10
• 11 Light
• 12
• 13 Somewhat hard
• 14
• 15 Hard (heavy)
• 16
• 17 Very hard
• 18
• 19 Extremely hard
• 20 Maximal exertion
9 corresponds to "very light" exercise. For a healthy person, it is like
walking slowly at his or her own pace for some minutes
13 on the scale is "somewhat hard" exercise, but it still feels OK to continue.
17 "very hard" is very strenuous. A healthy person can still go on, but he or
she really has to push him- or herself. It feels very heavy, and the person is
very tired.
19 on the scale is an extremely strenuous exercise level. For most people
this is the most strenuous exercise they have ever experienced.
237. Anaphylaxis/Anaphylactic Shock
• Severe, life-threatening
• Systemic hypersensitivity reaction
• Decreased blood pressure due to release of
histamine
• Airway obstruction
• Severe hypoxia
• Can be caused by:
• Latex materials
• Insect stings
• Nuts or shellfish; various drugs
238. Anaphylaxis (Cont’d)
• Signs and symptoms
• Generalized itching (pruritus)or tingling especially in oral
cavity
• Coughing
• Difficulty breathing
• Feeling of weakness
• Dizziness or fainting
• Sense of fear and panic
• Edema around eyes, lips, tongue, hands, feet
• Hives
• Collapse with loss of consciousness
240. Treatment for Anaphylaxis
• Requires first aid response:
• Administer EpiPen if available
• Call 911 (many paramedics can start drug treatment
and oxygen)
• Treatment in Emergency Department:
• Epinephrine
• Glucocorticoids
• Antihistamines
• Oxygen
• Stabilize BP
241. Type II – Cytotoxic Antibody-Dependent
Hypersensitivity
• Blood typing depends on the particular glycoprotein
• 3 variants A, B and O
• Individual can be O, A, B, or AB
• Will have antibodies to the type of glycoprotein they do
not have
242. Type IV – Cell-Mediated or Delayed
Hypersensitivity
• Occurs only after exposure to antigen
• Delayed response by sensitized T-lymphocytes
• Release of lymphokines - help regulate the immune
system and activate macrophages
• Inflammatory response
• Destruction of the antigen
• Examples:
• Tuberculin test
• Contact dermatitis
• Allergic skin rash
243. Autoimmune Disorders
• Development of antibodies against own cells/tissues
• Auto-antibodies are antibodies formed against self-
antigens – loss of self-tolerance
• Disorder can affect single organs or tissues or can be
generalized
246. Systemic Lupus Erythematosus (SLE)
• Chronic inflammatory disease
• Affects a number of organ systems
• Characteristic facial rash – ―butterfly rash‖
• Affects primarily young women
• Incidence is higher in African Americans,
Asians, Hispanics, Native Americans
248. ―Butterfly Rash‖ Associated
with SLE
Rash can vary from a
rosy blush to thickened
epidermis with scaly
patches
249. SLE (Cont’d)
• Signs and symptoms vary due to organ
involvement but commonly include:
• Arthralgia, fatigue, and malaise
• Cardiovascular problems
• Polyuria – increased production of urine
• Diagnostic test
• Serum antibodies; other blood work
• Treatment
• Usually treated by a rheumatologist
• Prednisone (glucocorticoid)
• Non-steroidal anti-inflammatory drugs
250. Implications for the PTA
• Functional limitations of patients with SLE vary
according to severity of the disease
• Exercise may be limited during exacerbation of
disease
• Gradual resumption of activities must be balanced
with rest periods
• Energy conservation, pacing of activities
• Joint protection
• Prevention of skin breakdown
• Observe for complications of high dose
corticosteroids – avascular necrosis of hip, knee
251. Fibromyalgia
• Disorder characterized by pain and
stiffness affecting
muscles, tendons, and surrounding
soft tissues
• Eighteen specific tender or trigger
points
• No obvious signs of inflammation or
tissue degeneration
253. Fibromyalgia
• Diagnosis made after elimination and
review of medical history
• Patients often told their pain is ―all in
their head‖
• Chronic and complex condition often
recognized in physical therapy after
multiple prior interventions
254. Implications for the PTA
• Primary treatment for fibromyalgia is exercise (to
tolerance)
• Increased cardiovascular fitness has been shown to
decrease pain and improve function
• Stretching exercises reduce fatigue
• Aquatic therapy often very helpful
• May initially require short exercise sessions with the
goal of 30 minutes daily
• Avoid pushing through the pain
257. Challenge Question
• Explain three reasons why the immune
system might not respond correctly to foreign
material in the body.
The immune system does not recognize the
foreign material:
• Deficit of lymphocytes, stem cells or macrophages
• Antibody is not produced
• Lymphoid tissue is damaged
• Genetic immune deficiency is present
Notas del editor
In addition, how the person with the pathologic condition is able to participate in his or her family and community is paramount. Current clinical practice must include an emphasis on the person’s activity level, participation, level of supports, and environment. Not just the disease itself.
Incidence – number of new cases in a specific time periodPrevalence measures all cases of a condition among those at riskNatural History – how it’s progressed over time
Rapid onset, short durationIllnesses that include one or more of the following: permanent impairment or disability, residual physical or cognitive disability, need for long term management – may fluctuate in intensity
For example, diabetes can result in impairment (decreased circulation) but not all people with diabetes sustain a disability (vision loss, or amputation).
World Health Organization
Table 1-1 in your text highlights types of cognitive deficits associated with lesions in specific areas of the brain
Most illness, including most cases of cancer are caused by acquired mutations or major change in the DNA of multiple genes. Ethical concerns: concerns have been raised including the use of genes to improve ourselves cosmetically, Increase intelligence, designer babies, or cause permanent changesin the gene pool Genetic engineering is the process where specific malfunctioning cells are targeted and repaired or replaced with correct genes. Gene therapy is being researched for a wide variety of hereditary disorders and diseases, helping injuries heal (i.e. replacing worn out tissue, reducing scar tissue), and to treat patients with inoperable diseases.
Biopsychosocial – multiple organs, multiple co-morbidities (SES, genes, social, access to healthcare)Single injury or disease can predispose a person to associated secondary illness
Acute - Initial response of tissue to injury or illness
Result of persistent injury or repeated episodes of acute inflammation, infection, or foreign body reactionEG: Arthritis, Lupus,
What is immunodeficiency? Congenital or acquired failure of one or more functions of the immune system - Acquired: alcoholism, malnutrition, aging, diabetes, steroid therapy, cancer chemo and radiationNeoplasm: malignant tumors produce many locsl and sytemic effects
Which would heal more rapidly, a surgical incision in which the edges have been stapled closely together, or a large jagged tear in the skin and subcutaneous tissue? Why?A surgical incision heals rapidly because there is less tissue trauma, less interference with blood vessels, no foreign matter, and the edges are pulled closely together, leaving only a small gap of tissue to be filled in.
At the time of fracture tiny blood vessels are torn at the fracture site.Fracture hematoma develops. Fibroblasts, platelets, and other mediators are delivered to the area via the blood secreting growth factors and cytokines. Classified with acute inflammation, evidenced by pain, swelling, heatB. Granulation tissue forms, fibrin meshwork develops and allows the in growth of fibroblasts. C. The reparative phase includes the formation of the soft callus seen around 2 weeks on X-ray, which is eventually replaced by a hard callus. During this phase bone macrophages (osteoclasts) clear away necrotic bone.Once the callus is sufficient to immobilize the fracture site, repair occurs.D. The remodeling phase returns the bone to normal.
