Rehab Elective Presentation

8/22/2019 Rehab Elective Presentation

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DO ALL ROADS ACTUALLY LEAD

TO REHAB?


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YES! THEY DO!

Internal Medicine

Surgery

Pediatrics

Veterinary Medicine

REHAB!


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INTERNAL MEDICINE- NEUROPATHY &

DIABETES MELLITUS

What is DM? A group of common metabolic

disorders that share the phenotype of

hyperglycemia= classified based on pathogenic

processes that lead to hyperglycemia (used to be

based on age of onset or type of therapy)

Multiple types of DM caused by different interactions

between genetics and environmental factors

Factors causing hyperglycemia include reduced insulin

secretion, decreased glucose utilization and increasedglucose production


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Types of DM:

Type 1: due to complete or near total insulin deficiency

Type 2: heterogenous groups of disorders characterized by variable

degrees of insulin resistence

Gestational DM: glucose intolerance that develops during pregnancy

Others

Criteria for diagnoses

Symptoms of diabetes plus random blood glucose concentration

11.1 mmol/L or

Fasting plasma glucose 7.0 mmol/L or

A1C > 6.5% or Two hour plasma glucose 11.1 mmol/L during an oral glucose

tolerance test


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Condition 2 hour glucose Fasting glucose HbA1c

mmol/l(mg/dl) mmol/l(mg/dl) %

Normal


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RISK FACTORS

Family history Obesity (BMI 25kg/m)

Physical inactivity

Race/ethnicity

Previously identified with IFG, IGT or an A1C of 5.7-6.4%

History of GDM or delivery of a baby > 9lbs

Hypertension (BP 140/90 mmHg)

HDL cholesterol levels 250 mg/dL

PCO or acanthosis nigricans

History of cardiovascular disease


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DIABETIC NEUROPATHY

Diabetic polyneuropathy: affects multiple sensory andmotor nerves in distal parts of the limbs or

Diabetic mononeuropathy: affects one nerve at a time

Diabetic autonomic neuropathy: primarily affects the

autonomic nerves Most common form: distal symmetric polyneuropathy

Presents with distal sensory loss, hyperethesia, parasthesia

(unusual sensations), dysesthesia

Symptoms: numbness, tingling, sharpness, or burning thatstarts in their hands and feet, weakness of the muscles in the

feet and hands

PE: sensory loss, loss of ankle reflexes, abnormal position

sense


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PATHOLOGY MULTIFACTORIAL

Advanced glycation end products

excess glucose + proteins, nucleotides and lipids(nonenzymatic reaction) these end products

interfere with nerve cell metabolism and axonal

transport

Polyol Pathway

excess sorbitol and fructosereduced nerve

myoinositol, decreased membrane

Na+/K+/ATPase activity, impaired axonal

transport and structual breakdown of nerves

leading to abnormal AP propagation

Microvascular dysfunction

Damage to blood vessels vasoconstrictiondecreased oxygen tension and hypoxia

neuronal ischemia (nerves needs adequate blood

flow)


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HOWCAN REHAB HELP?

Most important: getting blood sugar under control (metformin,insulin, alpha glucosidase inhibitors, thiazolidinediones,sulfonylurea )

Medications:

Antidepressants: TCAs (start with these), SSNRIs(Duloxetine)

Anticonvulsants: Gabapentin, pregabalin

Aldolase reductase inhibitors to improve nerve conduction

Complementary therapies such as acupuncture

Physical therapy such as exercises (low impact, non-weight

bearing), stretching, and massage Transcutaneous electrical nerve stimulation (TENS): type of

therapy that reduces pain by applying brief pulses of electricityto nerve endings in the skin


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SURGERY- FEMUR FRACTURES

Proximal femur fractures Hip fractures

Femoral neck fractures

Intertrochanteric femur fractures

Femoral shaft fractures Winquist and Hansen classification

Supracondylar Femur Fractures

Most common causes: car accidents, falls,osteoporosis

Other causes: cancer


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HOWDOESREHABHELP?

Strengthening Exercises Involves moving hip and knee

joints against resistance torestore the strength to the hipand thigh

Starts with simple muscularcontractions to get musclesused to working again andprogresses to exercises usingbody weight as resistance

Can add resistance bands,free weights or weightmachines to increase theresistance to muscles


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HOWDOESREHABHELP?

Range of MotionExercises

forces hips to flex,

extend, abduct and

adduct


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HOWDOESREHABHELP?

Stabilization exercises

Helps restore balance and

strengthen the muscles

surrounding the injury

core stabilization exercises helpstrengthen the musculature

around the hips, muscles of

your abdomen, thighs and

knees


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VETERINARY MEDICINE- SNICKERS


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Hansen Type I intervertebral disk disease is a

progressive disorder characterized by degeneration ofthe outer layer and mineralization (or hardening) of the

inner layer of affected disks

He was also tetraparetic (all four of his limbs were weak)

Lesion was surgically decompressed but he still had

pattern motor generation issues

He had passive range of motion, laser therapy,

stretching, then balancing, then underwater treadmill

After 6 weeks he can now get up and walk on his own!

Type 1 IVDD at C4-C5


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SO

ALL ROADS

REALLY DO

LEAD TOREHAB!


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THE END!

http://diabetes.webmd.com/peripheral-neuropathy-8/nerve-pain-treatment?page=2

http://my.clevelandclinic.org/default.aspx

http://www.diabetes.org/

http://www.ama-assn.org/

http://www.mayoclinic.com/

http://en.wikipedia.org/wiki/Diabetes_mellitus

Harrisons Internal Medicine Volume 1 & 2

Documents

Rehab Elective Presentation