Common Diagnosis:

Amputation: acquired condition that results in the loss of a limb, usually from injury, disease,
or surgery

Anatomy- extremities that are affected.

Neurology- Desensitation and tx for phantom limb syndrome.

The goal of rehabilitation after an amputation is to help the patient return to the highest level
of function and independence possible, while improving the overall quality of life - physically,
emotionally, and socially.

In order to help reach these goals, amputation rehabilitation programs may include the
following:

treatments to help improve wound healing and stump care

activities to help improve motor skills, restore activities of daily living (ADLs), and help
the patient reach maximum independence
exercises that promote muscle strength, endurance, and control
fitting and use of artificial limbs (prostheses)
pain management for both post-operative and phantom pain (a sensation of pain that
occurs below the level of the amputation)
emotional support to help during the grieving period and with readjustment to a new
body image
use of assistive devices
nutritional counseling to promote healing and health
vocational counseling
adapting the home environment for ease of function, safety, accessibility, and mobility
patient and family education

The success of rehabilitation depends on many variables, including the following:

level and type of amputation

type and degree of any resulting impairments and disabilities
overall health of the patient
family support

COPD: chronic obstructive pulmonary disease is a progressive disease that makes it hard to
breathe.

Anatomy- Lungs and more specifically aveoli.

 Physiology- In COPD, less air flows in and out of the airways because of one or more of
the following:

The airways and air sacs lose their elastic quality.

The walls between many of the air sacs are destroyed.
The walls of the airways become thick and inflamed (swollen).
The airways make more mucus than usual, which tends to clog the airways.

Pathology- Causes: Cigarette smoke and other irritants and in rare cases, COPD results
from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin.

CVA: A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel
breaks and interrupts blood flow to an and bleeding occurs into an area of the brain.

Every stroke is different. The symptoms and effects vary according to the type of stroke, the
part of the brain affected and the size of the damaged area. For some people the effects are
severe, for some mild. Usually the symptoms come on suddenly but they may come on during
sleep. Usually injury to one side of the brain affects the opposite side of the body.

Two types of stroke:

Ischemic: occurs when an artery carrying blood to part of the brain is blocked.
Hemorrhagic Stroke: Cerebral Hemorrhage occurs when a blood vessel ruptures within
the brain or into the space surrounding the brain
Right CVA- Causes L hemiplegia, spatial and perceptual abilities, judgment
difficulties that show up in their behavior , act impulsively, unaware of their
impairments and certain of their ability to perform the same tasks as before the
stroke, left-sided neglect, and some experience d short-term memory.
Left CVA- Causes right hemiplegia, d speech and language abilities, aphasia,
develop a slow and cautious behavior, may need frequent instruction and
feedback to finish tasks, and may develop memory problems which can include
shortened retention spans, difficulty in learning new information and problems
in conceptualizing and generalizing.
Cerebellar CVA- Controls reflexes, balance, and coordination. Can cause
abnormal reflexes of the head and torso, coordination and balance problems,
dizziness, nausea and vomiting
Brain Stem CVA- Controls involuntary functions, such as eye movements,
hearing, speech and swallowing. Since impulses generated in the brain's
hemispheres must travel through the brain stem on their way to the arms and
legs, patients with a brain stem stroke may also develop paralysis in one or both
sides of the body.
 Other effects of CVA- Depression, sudden laughing or crying for no apparent
reason, difficulty controlling emotional responses, and apparent changes in
personality.

Arthritis: inflammation of one or more joints, which results in pain, swelling, stiffness, and
limited movement. There are over 100 different types of arthritis.

Symptoms: Joint pain, joint swelling, reduced ability to move the joint, redness of the
skin around a joint, stiffness, especially in the morning, and warmth around a joint.
Treatment: Low-impact aerobic activity, ROM exercises for flexibility, strength training
for muscle tone, and energy conservation

Causes: involves the breakdown of cartilage, an autoimmune disease (the body attacks
itself because the immune system believes a body part is foreign), broken bone,
general "wear and tear" on joints, and infection (usually caused by bacteria or viruses).

INR: Prothrombin Time- evaluates the ability of blood to clot properly, used commonly
with blood thinning medication such as Coumadin. These medications are given for heart
attacks, strokes, and DVTs. INR is taken regularly to adjust medications if needed. INRs
can be ordered for patients that are not taking anti-coagulants which can range from
nosebleeds, bleeding gums, bruising, heavy menstrual periods, blood in the stool and/or
urine to arthritic-type symptoms (damage from bleeding into joints), loss of vision, and
chronic anemia.

Contraindications- Alcohol, some antibiotics, barbiturates, oral contraceptives,

hormone replacement therapy, and vitamin K can alter INR results.

Joint Contractures: Stiffness in joints that prevents full ROM. Joint contractures happen
when the joint is in the same potion for sustained period of time, this is many times due to
a prolonged stay in a hospital or an injury or disease that prevents joint mobility.

Joint Replacement: An arthritic or damaged joint is removed and replaced with an

artificial joint, called prosthesis. Can be a partial or total joint replacement.
 Possible Complications: Infection, blood clots, loosening, dislocation, wear,
prosthetic breakage, and nerve injury.

Multiple Sclerosis: an autoimmune disease that affects the brain and spinal cord (central
nervous system).

Symptoms: Symptoms vary, because the location and severity of each attack can
be different. Episodes can last for days, weeks, or months. These episodes
alternate with periods of reduced or no symptoms (remissions).
o Fever, hot baths, sun exposure, and stress can trigger or worsen attacks
o Muscle symptoms:
Loss of balance
Numbness or abnormal sensation in any area
Pain because of muscle spasms
Pain in the arms or legs
Problems moving arms or legs
Problems walking
Problems with coordination and making small movements
Slurred or difficult-to-understand speech
Tremor in one or more arms or legs
Uncontrollable spasm of muscle groups (muscle spasticity)
Weakness in one or more arms or legs
o Eye Symptoms
Double vision
Eye discomfort
Uncontrollable rapid eye movements
Vision loss (usually affects one eye at a time)
o Other brain and nerve symptoms:
Decreased attention span
Decreased judgment
Decreased memory
Depression or feelings of sadness
Dizziness and balance problems
Facial pain
 Hearing loss
Fatigue
o Bowel and bladder symptoms:
Constipation
Difficulty beginning urinating
Frequent need to urinate
Stool leakage
Strong urge to urinate
Urine leakage (incontinence)

Parkinson s disease: belongs to a group of conditions called motor system disorders,

which are the result of the loss of dopamine-producing brain cells.

Primary symptoms: tremor, or trembling in hands, arms, legs, jaw, and face;
rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of
movement; and postural instability, or impaired balance and coordination.
Prognosis: chronic and progressive. Although some people become severely
disabled, others experience only minor motor disruptions. Tremor is the major
symptom for some patients, while for others tremor is only a minor complaint
and other symptoms are more troublesome. No one can predict which
symptoms will affect an individual patient, and the intensity of the symptoms
also varies from person to person.

Reflex Sympathetic Dystrophy: Also known as complex regional pain syndrome (CRPS) is
a chronic pain condition.

Key symptom: is continuous, intense pain out of proportion to the severity of the
injury, which gets worse rather than better over time. CRPS most often affects one
of the arms, legs, hands, or feet. Often the pain spreads to include the entire arm
or leg.
Typical features: include dramatic changes in the color and temperature of the skin
over the affected limb or body part, accompanied by intense burning pain, skin
sensitivity, sweating, and swelling.
Causes: Doctors arent sure what causes CRPS. In some cases the sympathetic
nervous system plays an important role in sustaining the pain. Another theory is
that CRPS is caused by a triggering of the immune response, which leads to the
characteristic inflammatory symptoms of redness, warmth, and swelling in the
affected area.
 Prognosis: varies from person to person. Spontaneous remission from symptoms
occurs in certain individuals. Others can have unremitting pain and crippling,
irreversible changes in spite of treatment.

Tendonitis: the tendons become inflamed for a variety of reasons, and the action of
pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon
is impaired, the tendon will become inflamed and movement will become painful.

Causes: The most common cause of tendonitis is overuse. Another common cause
of symptoms of tendonitis is due to age-related changes of the tendon.
Symptoms: Pain when the tendon is under pressure, movement is restricted,
affected area is painful when moved or touched, burning sensation around the
affect area, and affected area is swollen, red, warm or lumpy

SCI: Spinal cord trauma is damage to the spinal cord. It may result from direct injury to
the cord itself or indirectly from damage to surrounding bones, tissues, or blood vessels

Symptoms: Symptoms vary somewhat depending on the location of the injury.

Spinal cord injury causes weakness and sensory loss at and below the point of the
injury. The severity of symptoms depends on whether the entire cord is severely
injured (complete) or only partially injured (incomplete).

Cervical: When spinal cord injuries occur near the neck, symptoms can affect both
the arms and the legs
o Breathing difficulties (from paralysis of the breathing muscles)
o Loss of normal bowel and bladder control (may include constipation,
incontinence, bladder spasms)
o Numbness
o Sensory changes
o Spasticity
o Pain
o Weakness, paralysis
Thoracic: When spinal injuries occur at chest level, symptoms can affect the legs
o Breathing difficulties (from paralysis of the breathing muscles)
o Loss of normal bowel and bladder control (may include constipation,
incontinence, bladder spasms)
o Numbness
o Sensory changes
o Spasticity
o Pain
o Weakness, paralysis
 Lumbar Sacral: When spinal injuries occur at the lower-back level, varying dgrees
of symptoms can affect the legs
o Loss of normal bowel and bladder control (may include constipation,
incontinence, bladder spasms)
o Numbness
o Pain
o Sensory changes
o Spasticity
o Weakness and paralysis

Critical Illness Polyneuropathy/Critical Illness Myopathy: A diffuse axon loss

sensorimotor polyneuropathy seen in severely ill patients, usually in the intensive care
unit; most patients have been on multiple drugs, and cannot be weaned from
ventilatory support; electrodiagnostic studies show evidence of an axon loss
polyneuropathy, predominantly motor; of unknown etiology.

Uremic Myopathy: The dysfunctional regulation of capillary to myofibers, yields an abn

capillary/myofiber interface which results in muscle weakness. This is commonly seen in
patients that have ESRD.

Disuse Myopathy:

Seizure Precautions: During a seizure, a person may injure himself or herself. Seizure
precautions are guidelines that a person can follow in order to minimize injury during a
seizure.

Cardiac Precautions: Pts who have undergone CABG will have to maintain certain movement
precautions for approximately 4-6 weeks post-surgery to avoid opening the sternal incision.
Do not push or pull with your arms.
Do hold onto a pillow when getting in or out of bed or up or down from a chair.
Do not raise your elbows higher than your shoulders.
Do not reach backwards.
Do bend your elbows and lower your head to groom yourself.
Do not lift greater than 5 - 10 lbs. (gallon milk = 8.5 lbs)
Do ask for help when needed.

Lyphedema/ complications that present like lymphedema:

Multiple Traumas:

Pain Syndromes:
Guillain Barre: is a disorder in which the body's immune system attacks part of the
peripheral nervous system.

Symptoms:
o The first symptoms of this disorder include varying degrees of weakness
or tingling sensations in the legs.
o In many instances, the weakness and abnormal sensations spread to the
arms and upper body.
o These symptoms can increase in intensity until the muscles cannot be
used at all and the patient is almost totally paralyzed. In these cases, the
disorder is life-threatening and is considered a medical emergency.
o Most patients, however, recover from even the most severe cases of
Guillain-Barr syndrome, although some continue to have some degree
of weakness.
o Guillain-Barr syndrome is rare.
o Usually Guillain-Barr occurs a few days or weeks after the patient has
had symptoms of a respiratory or gastrointestinal viral infection.
o Occasionally, surgery or vaccinations will trigger the syndrome.

Valley Fever: Valley fever is caused by fungi in the soil. The fungi that cause valley fever
can be stirred into the air by anything that disrupts the soil, such as farming,
construction and wind. The fungi can then be breathed into the lungs. Valley fever is a
form of coccidioidomycosis or cocci infection. Mild cases of valley fever usually go away
on their own. In more severe coccidioidomycosis infections, doctors prescribe antifungal
medications that can treat the underlying infection.

Symptoms:
o Acute: The acute form is often mild, with few, if any, symptoms. When signs
and symptoms do occur, they appear one to three weeks after exposure.
They tend to resemble those of the flu, and can range from minor to severe
Fever

Cough

Chest pain varying from a mild feeling of constriction to intense

pressure resembling a heart attack

Chills

Night sweats

Headache
 Fatigue

Shortness of breath

Joint aches

Red, spotty rash

o Chronic: Appearing as many as 20 years after the initial infection, chronic

pneumonia due to coccidioidomycosis is most common in people with
diabetes or weakened immune systems. You're likely to have periods of
worsening symptoms alternating with periods of recovery. Signs and
symptoms are similar to those of tuberculosis
Low-grade fever

Weight loss

Cough

Chest pain

Blood-tinged sputum

Nodules in the lungs

o Disseminated: The most serious form of the disease, disseminated

coccidioidomycosis occurs when the infection spreads (disseminates) beyond
the lungs to other parts of the body. Most often these parts include the skin,
bones, liver, brain, heart, and the membranes that protect the brain and
spinal cord (meninges).
Nodules, ulcers and skin lesions that are more serious than the rash
that sometimes occurs with other forms of the disease

Painful lesions in the skull, spine or other bones

Painful, swollen joints, especially in the knees or ankles

Meningitis an infection of the membranes and fluid surrounding

the brain and spinal cord and the most deadly complication of valley
fever

Causes: The fungi that cause valley fever Coccidioides immitis or Coccidioides
posadasii thrive in the alkaline desert soils of southern Arizona, northern Mexico
and California's San Joaquin Valley. They're also endemic to New Mexico, Texas and
parts of Central and South America areas with mild winters and arid summers.