human conditions

7/29/2019 Human Conditions

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Cores Values of Occupational

TherapyAltruism

Dignity

Equality

Freedom

Justice

Truth

Prudence


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Cerebral Palsy

A grouping of disorders involving the brainnervous system and affects muscle movement,learning, hearing, seeing and thinking

Types of CP include Spastic (most common) Hemiplegia, Diplegia,

Quadriplegia

Athetoid

Ataxia

Mixed

Generally caused by injury or abnormalities in thebrain usually due to low oxygen (cause unknown)


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CP Symptoms

Can affect one or both sides of the body; just

arms or just legs, possibly both

Tight muscles and joints

Muscle weakness

Loss of coordination

Inability to walk or issues with gait Nervous system symptoms

Speech/vision/hearing issues, pain, seizures


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CP Treatment

Reduce spasticity

Improve function and prevent deformities

Protect joints Ultimately making the individual as

independent as possible


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Autism Spectrum Disorders

Neurobiological disorder disrupting socialinteractions, communication and behaviorexact; cause is unknown

Symptoms can be observed between 12 and36 months and vary in terms of severity, onsetand development

Incurable but helped with intervention Types: Retts, Aspergers, Childhood

Disintegrative, Pervasive Developmental


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ASD Symptoms

Communication and Social Interactions

Affected both verbally and nonverbally, problems with

eye contact, expressing oneself clearly emotionally or

verbally, unable to read others emotions, pointing,poor posture

Visual perception and processing usually a strong suit

Ie: auditory processing, echolalia

Behaviors

Repetitive routines, repeating words and behaviors


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Mental Retardation

Diagnosed before the age of 18; most cases no definedcause but can be associated with gene disorders orchromosomal abnormalities Environmental factors (maternal infections, smoking, poor

nutrition)

Includes general intellectual function and lack of skills fordaily living

Occupational Therapists main concern is with adaptivebehavior (conceptual, social, practical skills)

Most common cases: Down Syndrome & fragile X syndrome

Be mindful of hypotonia (poor muscle tone) and seizures relating toDown Syndrome


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Schizophrenia

Mental Disorder where the individualexperiences difficulties with:

Thinking logically

Differentiating real from unreal Behaving in social situations

Having normal emotional responses

Cause unknown but may be related to geneticfactors

Environmental triggers


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Schizophrenic Symptoms

Symptoms may be gradual, can have many all at once or only a few at atime

Difficulties functioning in public whether its with friends, at work or other

Anxiety, depression, suicidal thoughts

Initial signs: problems with sleeping, concentrating, feeling irritable

More intense symptoms: delusions, hallucinations, loose associations

Positive symptoms: Hallucinations, delusions (grandeur and persecution), fixedideas, ideas of reference, disordered thinking

Negative symptoms (deficits): Alogia, anhedonia, avolition, flat affects,reduced movement

Types: Paranoid- anxious, angry, false beliefs

Disorganized- problems with thinking and expressing oneself, childlikebehaviors, mute emotional responses

Catatonic rigid muscles/posture, negative aggressive demeanor

Undifferentiated combination of symptoms from other types

Residual continued negative symptoms


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Schizophrenia Treatments

Medication

Treatment

Educating family members and friends

Learning how to alter the environment in ways that

support the individual to make up for deficits and

increase participation in all areas of life

Life training skills

Focus on meaningful values and interests of engagement


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Mood Disorders

Disturbances in mood Cause dependent on disorder but thought to be a mixture of

certain factors including genetic, environment, stress factors

Often reoccurrent and lifelong

MDD episode lasting for at least 2 weeks Anhedonia = inability to experience pleasure

Waking up early, loss of appetite, depression, psychomotoragitation

Catatonia = bizarre motor behavior/immobility

BPD one or more episodes of mania, hypomania, ormixed moods Flight of ideas, racing thoughts, lack of sleep, unrealistic

productivity


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Mood Disorder Treatments

Medication paired with treatment for

biological, physical and social needs

Ots need to acknowledge the many factors

influencing the individuals condition and QoL

Support system

Economic status

Age

Roles


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Anxiety Disorders

apprehension of danger, and dread

accompanied by restlessness, tension,

tachycardia and dyspnea unattached to a clearly

identifiable stimulus Caused by neurochemical and physical pathways

Types:

Combinations of panic with/out agoraphobia, socialanxiety, OCD, PTSD (symptoms longer than 1 month

andhave significant impairment), generalized anxiety


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Anxiety Disorder

Symptoms: Phobias (irrational fears),obsessions/compulsions, panic attacks

Treatment

OT should be focused toward the development of orreestablishment of meaningful daily routines

Facilitated engagement

Assess functioning abilities in all areas to see what will

provoke conditions Address diet and exercise, prioritizing activities

Be mindful of physical conditions


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Dementia

Characterized by cognitive deficits most

significantly in the area of memory

Delirium

Caused by fever or medication; rapid onset

Anixety, restlessness, sleep disturbance, irritable

Apraxia, dysgraphia (inability to write), dysnomic

aphrasia ( difficulty naming objects), motor deficits

Sundowning

Help with nutrition/hydration, providing a safe

environment


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Dementia

Recent memory is the first thing affected

Aphasia (struggles with language), apraxia (loss ofskilled purposeful movement), agnosia (Impacton sensory impressions), distrubances inorientation

AD no known cause; progressive Early stage: short term memory significantly impaired

and beginning of long term memory; language still

intact with problems with word retrieval, saying thewrong word; visuospatial declining; IADLs start to beaffected


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Middle Stage: remote memory declines (stuck inthe past) and new information is not retained;language is becoming more limited in expression

and understanding; visuospatial in continualdecline; psychiatric symptoms and behavioraldisturbances emerge

Late Stage: Loss of new memories; speech limited

to one/two words; extreme physical limitations(bed bound), paratonia (involuntary resistance),dysphagia (inability to swallow)


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Dementia Treatment

Discussion with family and support groups

early on

Analysing environment making it suitable for

patient


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Cerebrovascular Accident

May be caused by lifestyle choices and genetic/personalfactors

Location of infarct determines what functions are affected

Stroke caused by interruption of bloodflow to the brain due

to lack of oxygen or nutrients Ischemic - blockages cause tissue to die

Thrombosis blood clot

Embolism clot forms elsewhere, breaks off and gets stuck inan artery not large enough for clot to pass

Hemorrhagic aneurysm or rupture in blood vessel TIAs to be differentiated from strokes; temporary blockage,

duration is shorter and less permanent effects


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Neurological Effects

Impaired sensation

Trouble with language

Difficulties with muscle control/tone

flaccidity = floppy, spasticity =hyperactive

Loss of memory

Restrained personality

Vision impairments

Emotional instability


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Cardiopulmonary Disorders

COPD = Permanent and progressive airflow obstruction thatinterferes with gas exchange and functional capacity

Dyspnea, fatigue, chronic cough, chest tightness

Treatment : client centered approach, active participant in eval andintervention; graded activities to improve cardiopulmonary strength

and endurance for ADLs; emphasis on activity; reinforce diaphragmaticbreathing (pursed lip breathing)

Pneaumonia = infection (bacterial, viral, mycoplasmal)

Cough, headache, muscle pain, chills

Drug therapy/antibiotics

TB = infectious and chronic disease transmitted in the air

Coughing, spitting up blood (Hemoptysis), fever, weight loss, nightsweats

DOT important, infection control procedures; work simplification andenergy conservation


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Cardiopulmonary Disease

Coronary Artery Disease

Maintain functions of CV system

MI = heart attack, when blood is restricted from

entering a section the heart Cardiac rehabilitation, treatment focused on maximum

independence, exercise

CHF = progressive condition with no cure; heart

can no longer pump blood Hypertension = blood pressure stays elevated

Lifestyle modifications


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Diabetes

Metabolic condition where the regulation of glucose if hindered bythe lack of insulin

Body ends up using its own fats and lipids as a result of thedecreased insulin which hinders intake of nutrients for organs andmuscles/tissues

Type 1 autoimmune; sudden rapid onset

Type 2 obesity

Hyperglycemia too-little insulin

Hypoglycemia too much insulin

Diabetic foot trauma causes foot ulcers which can ultimately lead

to gangrene Diet and exercise are important

ADLs impacted as a result of motor skill impairments


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Traumatic Brain Injury

External physical force to the brain that resultsin disturbances in both physical, mental andemotional functions

Coordination, speaking, reasoning, remembering Mild, Moderate and Severe TBI based on how long

patient is unconscious/in a coma

Focal and diffuse lesions

Multiple stages of recovery over a long period oftime; Ranchos Los Amigos Level of CongitiveFunctioning Scale


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TBI

Motor and coordination deficits

Disturbances with sight, sense of smell and hearing

Headaches, dizziness, fatigue, memory and problemsolving difficulties but symptoms generally gradually

get better Amnesia and procedural learning should gradually

improve

Responses and recovery highly individual

Goals of therapy are to restore the person to anoptimal level of functioning in all areas, and tominimize additional physical or psychosocial disability Employment is a big contributing facto to an increased QoL


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Burns

Largest organ of the body that protects against infection, prevention ofloss of body fluid, control of body temperature, functioning as anexcretory organ, production of vit D, helping to determine personalidentity

Temperature and duration of burning two determining factors to level ofburn

Depth of burn influences survival rates, healing time, treatment and scarformation Superficial only epidermal layers of skin; redness and pain

Partial-thickness burn blisters that will increase in size, usually a deep redwaxy color, 7 20 days to heal

Full thickness burn penetrates epidermal and dermal layers of skin causing a

layer of small possibly multicolored blisters that have ultimately hit nerves;will scar and need skin donor to determine healing

Other systems affects: pulmonary and cardiac


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Burns

With open wounds, need to keep them as clean aspossible; can be done through debridement,hydrotherapy, can also use allograft to close wound

Autograft (sometimes cultured epithelium) transplant

of new skin to replace the old Treatment preservation of joint function and

maintaining appropriate positioning of affected area Splints

prevent scaring, compression garments, surgery, massage,ointment/injections

Help with psychological and social education for individualand family members


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Progressive Neurological Disorders

No known cause but may be related to thecombination of genetic predisposition, viruses andenvironmental influences

Multiple Sclerosis

Progressive, immunological and neurodegenerativedisease

Body attacking myelin sheath the surrounds the brain andspinal cord; demyelination of neurons scar tissue

Symptoms: optic neuritis, dysesthesia, urinaryincontinence, muscle weakness, gross/fine motorincoordination, fatigue, ataxia, dysphagia, dysarthia, andcognitive/emotional disturbances


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Parkinsons Disease Progressive neurological disorder

Deficits in speed and quality of motor movements, postural stability,cognitive and affective expression

Symptoms: resting tremor, muscle rigidity, bradykinesia (slowness of

all voluntary movement and speech), and postural instability Preclinical, prodromal, symptomatic periods

Amyotrophic Lateral Sclerosis

Fatal, progressive and degenerative motor neuron disease leavingscars on neurons

Atrophy of muslces, loss of strength, difficulty speaking and

swallowing, loss of emotional control, reducedbody temperature For all conditions ADLs, IADLs, education, work, play and leisure and

social participation will all be areas of concern and focus


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Rheumatoid Arthritis

Inflammation of the joints Stiff, aching, fatigued muscles

Chronic, inflammatory, systemic disease

Genetic and environmental factors control progression, extent,and patterns (not inherited)

Leading cause of disability in the US

RA may be progressive for some and not for others andgenerally affects more than one joint

Systemic Juvenile Rheumatoid Arthritis May involve stomach pain, anemia, weakness, weight loss,

fatigue

Late onset and early onset

Usually involves large joints


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Joint Manisfestations

Hand ie: Swan neck, boutonniere

Wrist ie: Carpal tunnel (median nerve compressed, swelling)

Elbow ie: tennis elbow

Shoulder may be hard to identify initially because swelling willoccur under rotator cuff but limitations and pain in movement can

be detected during ADLs Hip, knee, ankle, foot

RA may result in other conditions such as pulmonarymanifestations, nodules, Feltys Syndrome, Cardiac Manifestations,nervous system, eye manifestations

Treatment: relief of pain, reduce inflammation, preserve musclestrength and function, maintainence of normal lifestyle, promotionof normal growth/development; not curative! Top-down approach!


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Spinal Cord Injury

Brain and spinal cord = CNS Nerve tissue: Gray matter center, white matter

periphery

Motor and sensory information paired with spinal nerves

C1- C8 (cervical) carry impulses to and from the head, neck,diaphragm, arms, and hands

T1-T2 (thoracic) chest and upper abdominal musculature

L1-L5 (lumbar) legs and portion of the foot

S1-S5 (sacral) remaining foot, bowel, bladder, sexual functions

Complete: all pathways are interrupted and there is a totalloss of muscle control and sensation below level of theinjury

Incomplete: still room for voluntary movement andsensations below the level of injury


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Quadriplegia lost or limited function in all extremeties Tetraplegia loss in the cervical segments

Paraplegia loss or limited function in the lower extremeties and trunk

Spinal shock

Other complications

Respiratory; C4 and above usually need ventilator Hyperreflexia responses of ANS (fight or flight, thermal regulation); T6 or

above

Decubitus ulcers

Hypotension blood pooling in lower extremeties

Deep vein thromboses reduced circulation caused by decreased tone

Spasticity

Heterotopic Ossification

Bladder infections

Condition impacts all areas of life and each activity should be analyzed


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Orthopaedics

Injury of bones, joints, related structures

Generally caused by an accident or disease ie:osteoarthritis (deterioration of cartilage) osteoporosis (lowbone density)

Fractures: closed, open/compound, greenstick Functional outcomes dependent on age, type of fracture,

fracture location, severity, motivation, and health status

Therapist be mindful of complex regional pain syndrome

Fractures may require open/closed reduction, replacement,

braces, immobilizers, etc.; initially try to immobilize andalign fracture


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