Scleroderma Case Study: Difference between revisions
No edit summary |
No edit summary |
||
Line 264: | Line 264: | ||
== Intervention == | == Intervention == | ||
*Phases of Interventions | *Phases of Interventions | ||
<u>Edematous Stage: </u> | <u>Edematous Stage: </u> | ||
Patient Education (About the disease | Patient Education (About the disease; treatment of Raynaud's disease - dress in layers, monitor temperature changes, avoid air conditioning if possible, avoid things that cause vasoconstriction like smoking, cold temperatures and emotional stress) | ||
Orthotic and adaptive equipment needs | |||
Light range of motion exercises | Light range of motion exercises | ||
Joint protection strategies (light weight splints) | Joint protection strategies (light weight splints) | ||
<br> | |||
<u>Sclerotic Stage: </u> | <u>Sclerotic Stage: </u> | ||
Paraffin/heat modalities for hands and fingers | Paraffin/heat modalities for hands and fingers | ||
Passive range of motion exercises progressing to active-assisted range of motion, then to active range of motion | Passive range of motion exercises progressing to active-assisted range of motion, then to active range of motion, can add a sustained stretch for five seconds at end range (finger flexion/extension and abduction/adduction, wrist flexion/extension - can use hand clasp with wrist extension stretch) | ||
Soft tissue mobilizations | Soft tissue mobilizations | ||
Line 292: | Line 294: | ||
Aquatic therapy (Upper and lower extremity range of motion and strengthening exercises, walking, squatting, marching, etc) | Aquatic therapy (Upper and lower extremity range of motion and strengthening exercises, walking, squatting, marching, etc) | ||
<br> | |||
<u>Atrophic Stage: <br></u> | |||
<u>Atrophic Stage: | |||
*Dosage and Parameters | *Dosage and Parameters | ||
*Rationale for Progression | *Rationale for Progression | ||
*Co-interventions if applicable (e.g. injection therapy, medications) | *Co-interventions if applicable (e.g. injection therapy, medications) | ||
<u>Occupational Therapy </u> | |||
Joint preservation principles | |||
Devices for independent living | |||
<u>Medications </u> | |||
Disease modifying drugs (Penicillamine) - treatment of disease processes | |||
ACE inhibitors - treatment of acute hypertension/pulmonary hypertension and renal complications | |||
Nonsteroidal anti-inflammatory drugs (NSAIDs) - treatment of joint inflammation | |||
Antibiotics/Oral Tetracyclines (Minocycline, doxycycline) - treatment for disease by reduction of pain, severity of condition and quality of life | |||
Analgesics - treatment of pain | |||
Calcium channel blockers - treatment of Raynaud's | |||
Immunosuppressants - treatment during the acute phase of the disease | |||
== Outcomes == | == Outcomes == |
Revision as of 02:05, 28 March 2015
Author/s[edit | edit source]
Catelin Infante, Jessica Frederick, Kristin Casagrand, Jarrod Smith from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.
Abstract[edit | edit source]
100 word limit, non-structured description
Patient Characteristics[edit | edit source]
- Demographic Information: (occupation/vocation, gender, age, etc.)
Native American
Female
Born and raised in Oklahoma
Works in a factory
Thirty-five years old
Family history of rheumatoid arthritis on mother's side
- Medical diagnosis if applicable
Scleroderma
- Co-morbidities
Hypertension, Type II Diabetes
- Previous care or treatment
Previous physical therapy for low back pain
Examination[edit | edit source]
Subjective
Mrs. Smith comes into the clinic complaining of joint pain and muscle weakness, especially in her hands, hips and shoulders1. She explains that she has been having trouble making it through a full day of work because her body feels limited and she just cannot reach as well for boxes at her job because “her arms won’t go up that far.” She also has noticed that she gets out of breath and sometimes has chest pain when she lifts a lot too quickly2. Mrs. Smith indicates that her fingers often feel very swollen and stiff and sometimes feel “stuck” in a bent position1. She reports that for several months she has been getting a really cold, numb feeling in her fingers throughout the day, especially when she is sitting in the air conditioning at her office3. Overall, she has just not felt well for the past few months either. When she eats, she has trouble fully opening her mouth to put food in2. Then, when she lies down at night after dinner, she gets a feeling of heartburn and sometimes feels like she has to vomit1. However, she says she has been eating poorly lately, so it’s probably her fault she hasn’t felt well. Additionally, Mrs. Smith reports losing 20 pounds in the past month without any lifestyle changes. Her goals for therapy are to decrease her joint pain and to get her muscles stronger so she doesn’t struggle at work any longer. Her focus is on getting her hands and arms “back to normal” because they are what she uses most in her job.
Self Report Outcome Measures
· Health Assessment Questionnaire Disability Index (HAQ-DI)4: 1.1
· Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH)5: 34
· Verbal Pain Intensity Scale: “Severe pain”
Physical Performance Measures
· Grip strength (R)6: 20.7 kg
· Grip strength (L)6: 19.18 kg
· Pinch strength (R)6: 4.27 kg
· Pinch strength (L)6: 3.98 kg
· Oral aperture7: 28 mm
Objective
· MMT: WNL except for the following
o 4/5- finger and thumb abduction, adduction, flex, ext
o 4/5- wrist flex and ext
o 3+/5- shoulder flex and abduction
o 3+/5- hip flex and abduction
· ROM: WNL except for the following
o decreased flexion and extension in all finger MCP and IP joints
o decreased wrist flexion and extension
o decreased hip extension and abduction
· Reflexes: WNL
· Sensation:
o Decreased facial sensation
ICF Findings
· Impairments1,2,8
o Patient is has stiffening around fingers and what appears to be finger flexion contractures developing
o Patient has noticeable hard deposits palpated around UE joints
o Patient has slurred speech due to difficulty fully opening mouth. The skin around the face is thickened and has begun to cause puckering.
o Patient has dyspnea and chest pain upon exertion.
· Activity limitations1,2,8
o Patient is unable to complete activities in supine secondary to reflux symptoms
o Patient is unable to complete overhead activities due to decreased shoulder ROM.
o Patient is unable to complete more than 30 minutes of repetitive movements due to fatigue, muscle weakness, and joint pain.
· Environmental factors8
o Patient is employed as a packer at a plastics company.
o Patient is a smoker of 20 years.
Clinical Impression[edit | edit source]
Summarization of Examination Findings[edit | edit source]
Working Diagnosis and Targeted Interventions
Intervention[edit | edit source]
- Phases of Interventions
Edematous Stage:
Patient Education (About the disease; treatment of Raynaud's disease - dress in layers, monitor temperature changes, avoid air conditioning if possible, avoid things that cause vasoconstriction like smoking, cold temperatures and emotional stress)
Orthotic and adaptive equipment needs
Light range of motion exercises
Joint protection strategies (light weight splints)
Sclerotic Stage:
Paraffin/heat modalities for hands and fingers
Passive range of motion exercises progressing to active-assisted range of motion, then to active range of motion, can add a sustained stretch for five seconds at end range (finger flexion/extension and abduction/adduction, wrist flexion/extension - can use hand clasp with wrist extension stretch)
Soft tissue mobilizations
Traction
Kabat's method to improve mouth opening (activation of orbicularis oris, zygomaticus, levator labii, nasalis, frontalis and corrugator muscles by exaggerated facial movements) - progress from active-assisted ROM to active ROM
Soft tissue massage
Aquatic therapy (Upper and lower extremity range of motion and strengthening exercises, walking, squatting, marching, etc)
Atrophic Stage:
- Dosage and Parameters
- Rationale for Progression
- Co-interventions if applicable (e.g. injection therapy, medications)
Occupational Therapy
Joint preservation principles
Devices for independent living
Medications
Disease modifying drugs (Penicillamine) - treatment of disease processes
ACE inhibitors - treatment of acute hypertension/pulmonary hypertension and renal complications
Nonsteroidal anti-inflammatory drugs (NSAIDs) - treatment of joint inflammation
Antibiotics/Oral Tetracyclines (Minocycline, doxycycline) - treatment for disease by reduction of pain, severity of condition and quality of life
Analgesics - treatment of pain
Calcium channel blockers - treatment of Raynaud's
Immunosuppressants - treatment during the acute phase of the disease
Outcomes[edit | edit source]
Findings Over time
Discussion[edit | edit source]
Summary Statement which should include related findings in the literature, potential impact on clinical practices
Related Pages[edit | edit source]
add links to related pages here
References[edit | edit source]
References will automatically be added here, see adding references tutorial.