PCM 3 Unit 2: Balance, Compression Fx, and Incontinence

Question 1

What is Osteoporosis?

Answer 1

A metabolic disease characterized by low bone mass, impaired bone quality, and increased susceptibility of low-trauma fracture

Question 2

Risk of osteoporosis increases with what?

Answer 2

The risk for osteoporosis increases with advancing age, with women having a higher risk of fracture than men

Question 3

Why is it important to know the patients risk factors for osteoporosis?

Answer 3

• May encourage you to work on fall risk reduction – balance, strengthening, etc. – or inspire some caution in asking patients to do higher risk activities that may lead to injury without safeguards
• May enable you to inform patients about the importance of bone health, nutrition, and lifestyle choices that affect bone density
• May enable you to make decisions to refer for consultations with physician specialists (e.g., endocrinologists), dieticians, etc.

Question 3

What are some medications associated with Osteoporosis?

Answer 3

• Bisphosphonates: Group of drugs that help prevent bone loss to allow time for bone renewal and is known to help prevent hip and spinal fx
• Estrogen or estrogen replacement therapy (ERT)
• Strontium ranelate (SR)

Question 4

What are some examples of Non-Modifiable Risk Factors for Osteoporosis?

Answer 4

Question 5

What are some examples of Modifiable Risk Factors for Osteoporosis?

Answer 5

Question 6

What are some clinical S/S that suggest presence of Osteoporosis?

Answer 6

• Loss of height
• Postural changes
• Back Pain
• Fracture from minor trauma (vertebral compression fracture are most common)

Question 7

What are examples of exercises that are absolute or relative contraindications (depending on the severity, overall health, and specific risk factors)?

Answer 7

• Spinal flexion and rotation exercises
• Spinal mechanical traction
• High impact loading
• Challenging balance exercise

Question 8

What is the primary goal of exercises in osteoporosis management?

Answer 8

To prevent further bone loss, optimize bone formation, and reduce the risk of falls and fractures, rather than restoring Bone Mineral Density (BMD) to baseline levels

• While exericse is beneficial, expecting return of BMD is often unrealistic

Question 9

What are Compression Fractures?

Answer 9

AKA Insufficiency Fractures

• Fractures resulting from normal or physiologic stress applied to bone that is weakened

Question 10

What is the prevalence of Compression Fx?

Answer 10

• Decreased BMD accounts for the largest number of Fx amongst older adults

Question 11

Vertebral Compression Fx can be classified based in their morphological appearance, what are some examples?

Answer 11

• Wedge {Most Common}
• Biconcave
• Crush

Question 12

Compression (Insufficiency) Fx of the spine, pelvis or sacrum can often manifest non-specific pain where?

Answer 12

• Low back
• Goin
• Pelvic pain

Question 13

What are common signs of a Vertebral Compression Fx?

Answer 13

• Height loss
• Increased thoracic kyphosis at the fracture level
• Limited range of motion (ROM)

Question 14

Are vertebral compression fractures always painful?

Answer 14

No, they can often be painless

Question 15

When pain is present with a Vertebral Compression Fx, what postures tend to aggravate it?

Answer 15

• Spinal Extension
• Standing
• Walking

Question 16

Which position is usually better tolerated in patients with a painful Vertebral Compression Fx?

Answer 16

Supine

Question 17

How can pain from a Vertebral Compression Fx be reproduced during an exam?

Answer 17

By applying pressure over the spinous process of the involved level.

Question 18

What is the imaging technique of choice when identifying pathological Fx?

Answer 18

CTs

Question 19

When doing a neurological screening to assess nerve compression/damage, what shoudl be consider?

Answer 19

• Dermatomal loss of sensation
• Respiratory dysfunction
• Loss of bowel and bladder control

Question 20

What should PTs consider when managing Fx’s (e.g., vertebroplasty, kyphoplasty, spinal fusion or other forms of stabilization)?

Answer 20

• Post-op instructions
• Surgical site integ. inspection

Question 21

For adults, what is the average healing time for Compression Fx?

Answer 21

10 - 18 weeks

Question 22

What are (+) Predictors for Recovery for those with Compression Fx?

Answer 22

• Active PLOF
• Familial Support
• Higher Functional Status

Question 23

What are (-) Predictors for Recovery for those with Compression Fx?

Answer 23

• Smoking
• Alcoholism
• DM
• Renal/Vascular Insufficiency
• Calcium channel Blockers

Question 24

What is a typical POC for Compression Fx in Acute through Subacute Phases of rehab?

Answer 24

**Protect the Spine** - Consider bracing - Reinforce precautions (NO BLT!!!!) - Teach modifications to movements that patient needs to perform within ADLs **Manage Pain** - Activity modifications, education, bracing, cyrotherapy, electrical stim. **Focus on functional need and maximize time spent in safe mobility** - Will likely include managing some fear of moving **Gradual progression of strength, balance, and aerobic training, as indicated through subacute phases of healing** - Consider strengthening of the extensor muscles groups and spinal stabalizers

Question 25

What is a Urinary Tract Infection (UTI)?

Answer 25

Infection of bladder, kidneys, urethra and ureters

Question 26

What is the etiology of UTI's?

Answer 26

Yeast or other infectious agents infiltrate via GI tract leading to infection - Urinary tract normally contains no microorganisms

Question 27

What are Risk Factors for UTI's?

Answer 27

- **Gender**: women are at a higher risk, mainly due to anatomical differences. Post-menopausal women are at higher risk due to an increase in estrogen, which can lead to changes in the urinary tract that make it more susceptible to infection - **Sexual activity** (frequent, unprotected) - **Medical Conditions**: immunocompromization, para/quadriplegia, kidney stones, enlarged prostate - **Recent surgery**, involving the urinary tract system and/or urinary catheterization - **Advancing age** - **Personal hx of UTI's**

Question 28

With UTI's, what are general infection Sx?

Answer 28

- Fever - Malaise - Chills

Question 29

With UTI's, what are some Urologic specific Sx?

Answer 29

Question 30

With UTI's, how is a diagnosis made?

Answer 30

Through urine analysis

Question 31

What are some ways to prevent UTI's?

Answer 31

- Hydration - Hygiene - Nutrition -Juices, probiotics, vitamin supplementation - research is limited but evolving - Hormone therapy

Question 32

What is Dehydration?

Answer 32

A fluid imbalance that is caused when either the extracellular fluid or intracellular fluid loses body fluids or electrolytes leading to a decreased total body fluid volume

Question 33

What are some Risk Factors that lead to Dehydration?

Answer 33

**Hot, very humid or dry weather** **Vigorous Physical Activity** **Inadequate Fluid Intake** - Busy lifestyle and/or impaired thirst response (cognition?) **Age** - Older adults naturally have a lower volume of water in their bodies and may have conditions or take medications that increase the risk. - Children often can't or don't express their thirst efficiently and can lose a higher proportion of their fluids from a high fever or diarrhea. **Illnesses and Health Conditions** - Conditions that cause increased urination (like diabetes), fever, vomiting, or diarrhea can result in significant fluid loss. Certain medications (like diuretics) and kidney diseases can also increase risk. **Diet** - Diets high in salt, protein, and sugar can increase the body's need for water. Alcohol and caffeine, which can have diuretic effects, also contribute to fluid loss

Question 34

What are S/S of Dehydration?

Answer 34

Question 35

What is the Treatment management for Dehydration?

Answer 35

Treatment is directed towards the underlying cause with **the goal of regulating the fluid imbalance within the person.** - Will include replacement of fluids and/or electrolytes by oral or IV means

Question 36

With Dehydration management, what should be done with those patients with established dehydration or in the presence of several risk factors?

Answer 36

- Monitor vital signs, as dehydration can affect CVP stability - Utilize and educate on hydration strategies - Adjust interventions and environment as necessary - Have a clear plan in place if signs of dehydration or heat related illness occur during a session