Pathology for the Physical Therapist Assistant 1st Edition by Penelope J. Lescher, ISBN-13: 978-0803607866

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Pathology for the Physical Therapist Assistant 1st Edition by Penelope J. Lescher, ISBN-13: 978-0803607866

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• Publisher: ‎ F.A. Davis Company; First Edition (March 2, 2011)
• Language: ‎ English
• 672 pages
• ISBN-10: 0803607865
• ISBN-13: ‎ 978-0803607866

With other texts written at either too high or too low a level, this book meets the needs of PTA students for usable, understandable pathology related to clinical application. Extensively illustrated, this book allows students to more easily comprehend and maintain interest in otherwise complicated pathological processes. The fourteen chapter format effectively fits within a chapter per week course structure, or each chapter may be used as a stand alone module within any course.

Table of Contents:

Front Matter

DEDICATION

PREFACE

ACKNOWLEDGMENTS

REVIEWERS

CHAPTER 1 Inflammation and Healing

LEARNING OBJECTIVES

KEY TERMS

Introduction

Why Does the Physical Therapist Assistant Need to Know About Normal Cell Anatomy and Physiology?

Normal Cell Anatomy and Physiology

FIGURE 1.1 The cell.

FIGURE 1.2 The cell plasma membrane.

Nucleus

Cytoplasm

Plasma Membrane

Cell Injury

Table 1.1 Cytoplasmic Organelles and Their Functions

Cell Injury—Reversible

FIGURE 1.3 Reversible and irreversible cell injury.

FIGURE 1.4 Sodium pump. Sodium ions (Na+) are higher in concentration in the extracellular spaces than in the cell. Thus, NA+ ions continually try to pass into the cell, together with chlorine ions (CL–), through the process of osmosis. Potassium ions (K+) are higher in concentration inside the cell. The sodium pump is driven by ATPase and shunts Na+ out of the cell to maintain homeostasis.

Cell Injury—Irreversible

FIGURE 1.5 Pyknosis, karyorrhexis, and karyolysis.

NECROSIS

Table 1.2 Causes of Cell Injury

FIGURE 1.6 Gangrene of toes.

Table 1.3 Types of Growth Changes of Cells

Cellular Responses to Damage or Stimuli

ATROPHY

FIGURE 1.7 Abnormal cellular growth patterns: atrophy, hypertrophy, hyperplasia, metaplasia.

HYPERTROPHY

HYPERPLASIA

INVOLUTION AND HYPOPLASIA

METAPLASIA

Why Does the Physical Therapist Assistant Need to Know About Inflammation?

Inflammation

Causes of the Inflammatory Response

CELLS INVOLVED IN THE INFLAMMATORY RESPONSE

Polymorphonucleocytes

Eosinophils

Monocytes and Macrophages

Table 1.4 Cells of Inflammation

FIGURE 1.8 Polymorphonuclear neutrophils.

Platelets

Basophils

Lymphocytes and Plasma Cells

Classification of Inflammation

ACUTE INFLAMMATION

SUBACUTE INFLAMMATION

CHRONIC INFLAMMATION

ACUTE ON CHRONIC INFLAMMATION

Table 1.5 Types of Inflammation

Physical Therapy Treatment for Inflammation

Why Does the Physical Therapist Assistant Need to Know About the Healing Process?

Healing

Hints on the Use of the Guide to Physical Therapist Practice (1-1)

Cells Involved in the Healing Process

MYOFIBROBLASTS

ANGIOBLASTS

FIBROBLASTS

FIGURE 1.9 Granulation tissue in the base of a wound.

Types of Healing

Table 1.6 Types of Collagen

FIGURE 1.10 Healing in skin wounds.

It Happened in the Clinic

Complications of Wound Healing Other Than Delayed Healing

FIGURE 1.11 Keloid Scar.

Special Aspects Regarding Pressure Ulcers

Physical Therapy Intervention for Wounds

Table 1.7 Stages of Pressure Ulcers

GERIATRIC CONSIDERATIONS

FIGURE 1.12 Wound with necrotic tissue.

Bone Healing

FIGURE 1.13 Stages of bone healing.

Ligament Healing

Muscle and Tendon Healing

Why Does the Physical Therapist Assistant Need to Know About Pain?

Pain

Pain Control Theories

Physical Therapy Interventions

Table 1.8 Causes of Chronic Pain

Pain Assessment

FIGURE 1.14 Visual analog scale. Instruction to patient: Mark on the line where your pain is with 0 being no pain and 10 being the highest possible pain.

CASE STUDY 1.1

CASE STUDY 1.2

STUDY QUESTIONS

USEFUL WEB SITES

REFERENCES

CHAPTER 2 Immunopathology, Neoplasia, and Chromosome Abnormalities

LEARNING OBJECTIVES

KEY TERMS

INTRODUCTION

Why Does the Physical Therapist Assistant Need to Know About Immunopathology?

Immunopathology

Cells of the Immune Response

LYMPHOCYTES

Hypersensitivity Reactions

Type I Hypersensitivity

Table 2.1 Hypersensitivity Reactions

Bronchial Asthma

FIGURE 2.1 A person experiencing anaphylactic shock.

Allergic Rhinitis

Anaphylactic Shock (Anaphylaxis)

It Happened in the Clinic

Type II Hypersensitivity

Type III Hypersensitivity

Type IV Hypersensitivity

Vaccination

Effects of Exercise on the Immune Response

Why Does the Physical Therapist Assistant Need to Know About Infection?

Infections

Types of Microorganisms

FIGURE 2.2 Bacteria.

Development of Infection

FIGURE 2.3 Viruses come in many shapes and sizes.

Treatment of Infection

Why Does the Physical Therapist Assistant Need to Know About Neoplasia and Oncology Treatments?

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE 2-1

Neoplasia

Table 2.2 Characteristics of Benign and Malignant Tumors

FIGURE 2.4 Kaposi’s sarcoma.

Carcinogens

Risk Factors for Malignant Tumors

Table 2.3 Some Tumors and Their Locations/Classifications

FIGURE 2.5 Common sites of lymphatic nodes affected by breast cancer.

Box 2.1 Warning Signs for Cancer May Include:

GERIATRIC CONSIDERATIONS

Treatment Interventions for Cancer

Table 2.4 Examples of Chemotherapy Medications With Their Classification

PHYSICAL THERAPY INTERVENTION

It Happened in the Clinic

Why Does the Physical Therapist Assistant Need to Know About Chromosome Abnormalities and Genetic and Hereditary Diseases?

Genetic and Hereditary Chromosome Diseases

The Normal Chromosome

FIGURE 2.6 Normal complement of chromosomes

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE 2-2

Overview of Genetic and Hereditary Chromosome Diseases

Table 2.5 Exogenous Teratogens and Their Possible Effects on the Fetus

FIGURE 2.7 Signs and symptoms of congenital rubella syndrome.

FIGURE 2.8 Signs and symptoms of fetal alcohol syndrome.

Chromosome Abnormalities

FIGURE 2.9 Examples of chromosome abnormalities due to breakage and rearrangement. a) Deletions are loss of a part of a chromosome. b) Translocations occur when part of a chromosome is transferred to another chromosome. c) Inversion occurs when there is a break in two places and the chromosome reconnects in the wrong order. d) Robertsonian translocation occurs when the breakage is close to the centromere of the chromosome. e) A ring chromosome is the result of a breakage in the chromosome and the two ends joining together to form a ring.

DETECTION OF CHROMOSOME ABNORMALITIES

Chromosome Abnormality Conditions

Down Syndrome (Trisomy 21)

FIGURE 2.10 Down syndrome and associated karyotype showing trisomy of chromosome 21.

Fragile X Syndrome

Klinefelter Syndrome (47 X-X-Y syndrome)

Patau Syndrome

FIGURE 2.11 Signs and symptoms of Patau syndrome

Turner Syndrome

Why Does the Physical Therapist Assistant (PTA) Need to Know About Developmental Diseases and Birth Injuries?

Developmental Diseases/Birth Injuries

FIGURE 2.12 Signs and symptoms of Turner’s syndrome

Cerebral Palsy

Erb’s Palsy

Prematurity

Rhesus Disease/Hemolytic Disease of the Newborn

Scoliosis

It Happened in the Clinic

Spina Bifida

FIGURE 2.13 Examples of spina bifida include spina bifida occulta, meningocele, and myelomeningocele.

Why Does the Physical Therapist Assistant Need to Know About Genetically Linked Diseases?

Genetically Linked Diseases

Hemophilia

Muscular Dystrophy

Sickle Cell Disease

Spinal Muscular Atrophy

Tetralogy of Fallot

CASE STUDY 2.1

STUDY QUESTIONS

USEFUL WEB SITES

REFERENCES

CHAPTER 3 Cardiovascular Pathologies

LEARNING OBJECTIVES

KEY TERMS

INTRODUCTION

Why Does the Physical Therapist Assistant Need to Know About the Anatomy and Physiology of the Cardiovascular System?

Anatomy and Physiology of the Cardiovascular System

The Heart

FIGURE 3.1 Heart showing internal structures.

FIGURE 3.2 Heart showing major blood vessels.

Neural Control of the Heart

Nerve Conduction System of the Heart

FIGURE 3.3 Electrocardiogram (ECG) showing normal data.

Coronary Circulation

Cardiac Cycle

Heart Sounds

Table 3.1 Normal Heart Sounds

Pulse

Cardiac Output

Table 3.2 Abnormal Heart Sounds

Blood Pressure

Blood Vessels

ARTERIES

FIGURE 3.4 Systemic arteries, anterior view.

VEINS

FIGURE 3.5 Structure and connections of the vessels of the arterial and venous systems.

FIGURE 3.6 Anterior view of the venous system.

CAPILLARIES

Lymphatic System

FIGURE 3.7 Anterior view of lymph vessels and the major groups of lymph nodes.

FIGURE 3.8 Relationship of lymphatic vessels to the cardiovascular system.

Why Does the Physical Therapist Assistant Need to Know About Pathology of the Cardiovascular System?

Hints on the Guide to Physical Therapy Practice

Pathology of the Cardiovascular System

Table 3.3 Normal Adult Heart Values

General Signs and Symptoms of Cardiac Disease

Table 3.4 The Borg Rate of Perceived Exertion Scale

ATRIAL FIBRILLATION

CYANOSIS

DYSPNEA

EDEMA

FATIGUE

HEART BLOCK

INTERMITTENT CLAUDICATION

PAIN

Box 3.1 Routine for Buerger-Allen Exercises

PALPITATIONS

PREMATURE VENTRICULAR CONTRACTIONS

REDUCED EJECTION FRACTION

SYNCOPE

VENTRICULAR FIBRILLATION

Diagnostic Tests Performed for Cardiac Patients

CARDIAC CATHETERIZATION AND ANGIOGRAPHY

ECHOCARDIOGRAPHY

ELECTROCARDIOGRAM

Table 3.5 Characteristics of Electrocardiogram Graph With Associated Activity

HOLTER MONITORING

LABORATORY STUDIES (BLOOD AND URINE)

POSITRON EMISSION TOMOGRAPHY

STRESS TEST

Why Does the Physical Therapist Assistant Need to Know About Disorders and Pathological Conditions of the Heart?

Disorders and Pathological Conditions of the Heart

Angina Pectoris

Aortic Atherosclerosis

Atherosclerosis and Arteriosclerosis

FIGURE 3.9 Atherosclerosis of a vessel

Table 3.6 Risk Factors, Location, and Associated Problems of Atherosclerosis

Cardiac Arrest and Myocardial Infarction

Cardiac Shock, Cardiac Failure, Heart Failure

Cardiomyopathy

Congestive Heart Failure

Table 3.7 Causes and Effects of Congestive Heart Failure

GERIATRIC CONSIDERATIONS

Endocarditis

FIGURE 3.10 Bacterial endocarditis showing splinter hemorrhages in the nail.

Heart Infarct Rupture

Hypertension and Hypertensive Heart Disease

It Happened in the Clinic

Ischemic Heart Disease

Myocarditis

Pericarditis

Rheumatic Heart Disease and Rheumatic Fever

Valve Diseases

Why Does the Physical Therapist Assistant Need to Know About Cardiac Surgeries and Rehabilitation?

Cardiac Surgeries and Cardiac Rehabilitation

Coronary Artery Bypass Graft

Heart Transplant

Open Heart Surgery

Pacemaker Insertion

Percutaneous Transluminal Coronary Artery Angioplasty

Why Does the Physical Therapist Assistant Need to Know About Arterial Diseases?

Arterial Diseases

Arteritis

Cerebrovascular Disease

Patent Ductus Arteriosus

Peripheral Vascular Disease

MAJOR ASPECTS OF PVD FOR THE PTA

Polyarteritis Nodosa

Raynaud’s Disease or Syndrome

FIGURE 3.11 Hands of a patient affected by Raynaud’s disease.

Thromboangiitis Obliterans (Buerger’s Disease)

Why Does the Physical Therapist Assistant Need to Know About Venous Diseases?

Venous Diseases

Thrombophlebitis and Deep Venous Thrombosis

Varicose Veins

Why Does the Physical Therapist Assistant Need to Know About Blood Disorders?

Blood Disorders

Anemias and Other Disorders of Red Blood Cells

Leukemias

Lymphatic Disorders

Hodgkin’s Disease and Hodgkin’s Lymphoma

Lymphangitis and Lymphadenitis

Lymphedema

FIGURE 3.12 Patient with lymphedema of the arm.

Why Does the Physical Therapist Assistant Need to Know About Cardiovascular System Failure?

Cardiovascular System Failure

Hypovolemic Shock and Organ Failure

Physical Therapy Treatment and the Role of the PTA in Cardiac and Circulatory Conditions

Other Considerations

Home Health Physical Therapy

Outpatient Cardiac Rehabilitation

CASE STUDY 3.1

CASE STUDY 3.2

STUDY QUESTIONS

USEFUL WEBSITES

REFERENCES

CHAPTER 4 Respiratory Diseases

LEARNING OBJECTIVES

KEY TERMS

Introduction

Why Does the Physical Therapist Assistant Need to know About the Anatomy and Physiology of the Respiratory System?

Anatomy and Physiology of the Respiratory System

The Thoracic Cage and Its Contents

FIGURE 4.1 Sagittal section of the head and neck.

FIGURE 4.2 Thoracic cage with contents.

MOVEMENTS OF THE THORAX

THE LUNGS

Table 4.1 Surface Marking for the Respiratory System

FIGURE 4.3 Lobes of the lungs.

Table 4.2 Bronchopulmonary Segments of the Lungs

FIGURE 4.4 Bronchial tree showing bronchial branches to all segments of the lungs.

FIGURE 4.5 Bronchopulmonary segments of lungs: 1) apical (UL), 2) posterior (UL), 3) anterior (UL), 4) right lateral (ML), 4) left superior lingular (UL), 5) right medial (ML), 5) left inferior lingular (UL), 6) right and left superior or apical (LL), 7) right only medial basal (LL) (cardiac), 8) anterior basal (LL), 9) lateral basal (LL), and 10) posterior basal (LL).

Physiology of Ventilation and Respiration

BREATHING PATTERNS

VENTILATION CONTROL

LUNG CAPACITIES AND VOLUMES

Table 4.3 Lung Capacities in the Healthy Adult Male

GASEOUS EXCHANGE AND OXYGEN TRANSPORT

Muscles of Ventilation

DIAPHRAGM

EXTERNAL AND INTERNAL INTERCOSTAL MUSCLES

Why Does the Physical Therapist Assistant Need to Know About Tests for Respiratory Function?

Tests for Respiratory Function

Subjective Findings

Objective Findings

EXCURSION

INTERCOSTAL INDRAWING

BREATH SOUNDS

FIGURE 4.6 Pattern of stethoscope positions for listening to breath sounds.

Lung Function Tests

SPIROMETRY

FIGURE 4.7 Incentive spirometer in use.

FIGURE 4.8 Electronic spirometer.

PEAK EXPIRATORY FLOW

Table 4.4 Four Stages of Classification of Chronic Obstructive Pulmonary Disease (COPD) Related to Spirometry Values

Arterial Blood Gases

FIGURE 4.9 Spirometry flow/volume curves showing normal (A) and abnormal (B and C) forced expiratory volume in 1 second (FEV1) and vital capacity (VC) value.

ACID/BASE BALANCE OF BLOOD

Table 4.5 Normal Levels in Arterial Blood Gas Samples

CHEST RADIOGRAPHS

FIGURE 4.10 Pulse oximeter.

COMPUTED TOMOGRAPHY

MAGNETIC RESONANCE IMAGING

PULMONARY ARTERIOGRAPHY OR ANGIOGRAPHY

BRONCHOSCOPY

EXERCISE CAPACITY AND TOLERANCE

HEMATOLOGICAL TESTS

MICROBIOLOGY

Table 4.6 Hematology Interpretation and Normal Values

Table 4.7 Hematology Electrolyte and Lipoprotein Interpretation and Normal Values

Table 4.8 Explanation of the Abbreviations Used for the International System of Units (SI Units).

Why Does the Physical Therapist Assistant Need to Know About Diseases of the Respiratory System?

Diseases of the Respiratory System

General Signs and Symptoms of Pulmonary Diseases

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

COUGH

DYSPNEA

Table 4.9 Types of Sputum, Appearance, and Causes

CYANOSIS

CHEST PAIN

CHEST SHAPE AND REDUCED THORACIC MOBILITY

PULMONARY EDEMA

FIGURE 4.11 Clubbing of fingers.

ATELECTASIS

BRONCHIOLITIS

PNEUMOTHORAX AND PLEURAL EFFUSION

Why Does the Physical Therapist Assistant Need to Know About Pathological Conditions of the Respiratory Tract?

Pathological Conditions of the Respiratory Tract

Lung Abscess

FIGURE 4.12 Bronchiectasis in the lung.

Chronic Bronchitis and Emphysema

Chronic Bronchitis

FIGURE 4.13 Characteristic “pink puffer” and “blue bloater” appearance in chronic obstructive pulmonary disease.

Table 4.10 Clinical Picture of COPD Conditions

It Happened in the Clinic

Emphysema

FIGURE 4.14 Emphysema in the lung.

It Happened in the Clinic

Asthma

Pneumonia

Table 4.11 Clinical Picture of Some Pulmonary Conditions

GERIATRIC CONSIDERATIONS

Cystic Fibrosis

Tuberculosis

Lung Cancer, Benign Lung Tumors, and Malignant Lung Tumors

Pulmonary Infarction

Pneumoconioses

Sarcoidosis

Adult Respiratory Distress Syndrome

Bronchopulmonary Dysplasia in Pediatric Respiratory Distress Syndrome

Pulmonary Surgery

FIGURE 4.15 Thoracotomy incision with related muscles.

Pneumonectomy

FIGURE 4.16 Hand and arm position to support incision after pneumonectomy.

Lobectomy

Hemothorax and Pneumothorax

Post—pulmonary Surgery Complications

Tracheotomy

FIGURE 4.17 Photograph of Pleurovac unit.

Lung Transplant

Classes of Medications Used to Treat Respiratory Diseases

The Role of the PTA in Interventions for Patients With Respiratory Diseases

Specific Physical Therapy Treatment Interventions for Patients With Respiratory Pathologies

POSTURAL DRAINAGE AND AIRWAY CLEARANCE TECHNIQUES

FIGURE 4.18 Position for (A) chest clapping/percussion and (B) vibration of a patient for assisted airway clearance techniques.

FIGURE 4.19 Various bronchopulmonary segment postural drainage positions.

COUGHING AND HUFFING TECHNIQUES

Table 4.12 Contraindications and Precautions of Postural Drainage

BREATHING EXERCISES

FIGURE 4.20 Initial relaxed position for diaphragmatic breathing exercises.

VENTILATORS, LIFE SUPPORT SYSTEMS, AND INTERMITTENT POSITIVE PRESSURE BREATHING

PEDIATRIC CONCERNS AND SPECIAL CONSIDERATIONS

4.1 CASE STUDY

4.2 CASE STUDY

STUDY QUESTIONS

USEFUL WEB SITES

REFERENCES

CHAPTER 5 Degenerative Joint Diseases and Bone Pathologies

LEARNING OBJECTIVES

KEY TERMS

Introduction

Why Does the Physical Therapist Assistant Need to Know About Normal Joint Structure?

Normal Joint Structure

FIGURE 5.1 A synovial joint.

Why Does the Physical Therapist Assistant Need to Know About the Normal Anatomy and Physiology of Bone?

Normal Anatomy and Physiology of Bone

FIGURE 5.2 Structure of a long bone.

Why Does the Physical Therapist Assistant Need to Know About Degenerative Diseases of the Joints?

Degenerative Diseases of Joints

Hints on the Use of the Guide to Physical Therapist Practice (OA, Gout, and Infective Arthritis)

Osteoarthritis (Osteoarthrosis)

FIGURE 5.3 Effects of osteoarthrosis (OA) in a synovial joint.

Table 5.1 Characteristics of Osteoarthritis (Osteoarthrosis)

Clinical Picture of OA

OA of the Hip

Closed kinetic chain

OA of the Knee

It Happened in the Clinic

OA of the Hands

OA of the feet

FIGURE 5.4 Osteoarthrosis (OA) of the hands.

GERIATRIC CONSIDERATIONS

Spondylosis

Clinical picture and characteristics of spondylosis

Spondylolysis

FIGURE 5.5 A pair of lumbar vertebrae showing the pars interarticularis and related structures.

Spondylolisthesis

FIGURE 5.6 Spondylolisthesis of the lumbosacral spine.

Infective (Septic) Arthritis

Hemophilic Arthritis

Lyme disease

FIGURE 5.7 The bull’s-eye rash of Lyme disease.

Gout

FIGURE 5.8 Gouty tophi in the hand.

Surgical Intervention for Arthritis

ARTHRODESIS

HEMIARTHROPLASTY

MENISCECTOMY

FIGURE 5.9 Hemiarthroplasty of the hip.

OSTEOTOMY

RESECTION ARTHROPLASTY

TOTAL JOINT ARTHROPLASTY

TOTAL HIP ARTHROPLASTY

FIGURE 5.10 Total hip arthroplasty (THA).

TOTAL KNEE ARTHROPLASTY

FIGURE 5.11 Total joint arthroplasty of the knee (TKA).

TOTAL SHOULDER ARTHROPLASTY

FIGURE 5.12 Total joint arthroplasty of the shoulder.

OTHER JOINT ARTHROPLASTY

FIGURE 5.13 Total joint arthroplasty of the elbow.

Why Does the Physical Therapist Assistant Need to Know About Diseases of the Bone?

Diseases of Bone

Hints on the Use of the Guide to Physical Therapist Practice (5-2): Osteoporosis and Paget’s disease

Osteoporosis

FIGURE 5.14 Osteoporotic bone.

GERIATRIC CONSIDERATIONS

Rickets

Osteomalacia

Legg-Calvé-Perthes Disease

Slipped Capital Femoral Epiphysis

Paget’s Disease

FIGURE 5.15 Paget’s disease of bone.

Osteomyelitis

Bone Diseases Associated With Hyperparathyroidism and Hypoparathyroidism

Tuberculosis in the Bone

Syphilis

Gonococcal Arthritis (Disseminated Gonococcal Infection)

HIV/AIDS-Related Arthritic Symptoms

Bone Tumors

Osteosarcoma

Osteoma, Osteoid Osteoma, and Osteoblastoma

Osteochondroma

Giant cell tumor of bone

Ewing’s sarcoma

Fibrous Dysplasia

Multiple Myeloma

Bone Metastases

Cartilage Tumors

Chondroma

Chondrosarcoma

Joint Abnormalities

Genu valgum (Knock-Knee)

Genu Varum (Bow Legs)

FIGURE 5.16 Genu valgum and Genu varum deformities of the knees.

Genetic Bone Abnormalities

Talipes Equinovarus (Clubfoot)

Developmental Dysplasia of the Hip

FIGURE 5.17 Talipes equinovarus (clubfoot).

Torticollis

FIGURE 5.18 Hip spica devices for developmental dysplasia of the hip. (A) Pavlik harness. (B) Hip spica cast.

Achondroplasia

Osteogenesis Imperfecta

Osteopetrosis

Marfan’s Syndrome

5.1 CASE STUDY

STUDY QUESTIONS

USEFUL WEB SITES

REFERENCES

CHAPTER 6 Rheumatoid Arthritis and Related Conditions

LEARNING OBJECTIVES

KEY TERMS

Introduction

Why Does the Physical Therapist Assistant Need to Know About Rheumatoid Arthritis?

Rheumatoid Arthritis

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Articular (Joint) Pathological Changes

Table 6.1 Comparison of Osteoarthritis and Rheumatoid arthritis

FIGURE 6.1 A rheumatoid arthritis joint showing progressively worsening joint changes.

FIGURE 6.2 One of the signs of rheumatoid arthritis is “spindle finger,” also known as a fusiform-shaped finger, in the proximal interphalangeal joints.

FIGURE 6.3 Boutonnière’s deformity in a hand with rheumatoid arthritis.

FIGURE 6.4 Swan-neck deformity in a hand with rheumatoid arthritis.

FIGURE 6.5 Ulnar drift in a hand with rheumatoid arthritis (Z deformity).

FIGURE 6.6 A foot in a patient with rheumatoid arthritis.

FIGURE 6.7 Toe deformities in RA: claw toe, mallet toe, hammer toe.

FIGURE 6.8 Rheumatoid knees.

Nonarticular (Nonjoint) Pathological Changes

FIGURE 6.9 Rheumatoid nodule in the forearm.

“It Happened in the Clinic”

FIGURE 6.10 X-ray showing severe RA of hand.

FIGURE 6.11 Knee immobilizing splint.

FIGURE 6.12 “Ring” splint for swan-neck and Boutonnière’s deformity.

FIGURE 6.13 Modified “cock-up” splint for rheumatoid arthritis.

Table 6.2 Some Medications Used to Treat Rheumatoid Arthritis With Effects and Side Effects

GERIATRIC CONSIDERATIONS

FIGURE 6.14 Special molded handle cane for use with persons with reduced grip.

PRECAUTIONS, CONTRAINDICATIONS, AND SPECIAL CONSIDERATIONS FOR PT INTERVENTION FOR PATIENTS WITH RA

Why Does the Physical Therapist Assistant Need to Know About Juvenile Rheumatoid Arthritis and Still’s Disease?

Juvenile Rheumatoid Arthritis and Still’s Disease

Table 6.3 Characteristics of Still’s Disease

Why Does the Physical Therapist Assistant Need to Know About The Rheumatoid-Related Inflammatory Joint Pathologies?

Rheumatoid-Related Inflammatory Joint Pathologies

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Ankylosing Spondylitis

FIGURE 6.15 Bamboo spine appearance in ankylosing spondylitis.

FIGURE 6.16 Patient with ankylosing spondylitis showing typical posture.

“It Happened in the Clinic”

FIGURE 6.17 Patient measured with a spondylometer.

“It Happened in the Clinic”

Psoriatic Arthritis

Table 6.4 Types of Psoriatic Arthritis

FIGURE 6.18 Foot in a patient with psoriatic arthritis.

FIGURE 6.19 “Pencil-in-cup” deformity of the distal phalanx.

FIGURE 6.20 Pitting of the finger nail in a patient with psoriatic arthritis.

Reactive Arthritis (Reiter’s Syndrome)

Table 6.5 Comparison of Several Seronegative Polyarticular Arthropathies

GERIATRIC CONSIDERATIONS

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Why Does the Physical Therapist Assistant Need to Know About Connective Tissue Diseases?

Connective Tissue Diseases

Scleroderma

FIGURE 6.21 Hands of a patient with scleroderma.

FIGURE 6.22 The typical facial appearance of a woman with scleroderma.

Table 6.6 Signs and Symptoms of Scleroderma and Systemic Lupus Erythematosus

“It Happened in the Clinic”

Systemic Lupus Erythematosus

FIGURE 6.23 Butterfly rash of systemic lupus erythematosus.

Fibromyalgia

FIGURE 6.24 Location of tender points in fibromyalgia.

Giant Cell Arteritis

Polymyalgia Rheumatica

Myofascial Pain Syndrome

FIGURE 6.25 Infraspinatus trigger point location showing area of referred pain down the arm.

Polyarteritis Nodosa

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Why Does the Physical Therapist Assistant Need to Know About Other Rheumatoid and Connective Tissue—Associated Diseases?

Other Rheumatoid- and Connective Tissue—Associated Diseases

Complex Regional Pain Syndrome

Rheumatic Fever

Sarcoidosis

Sjögren’s Syndrome

Why Does the Physical Therapist Assistant Need to Know About Muscle Diseases?

Muscle Diseases

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Muscular Dystrophy

Myasthenia Gravis

Inflammatory Myopathies

6.1 CASE STUDY

6.2 CASE STUDY

6.3 CASE STUDY

STUDY QUESTIONS

USEFUL WEB SITES

REFERENCES

CHAPTER 7 Neurological Disorders

LEARNING OBJECTIVES

KEY TERMS

Introduction

Why Does the Physical Therapist Assistant Need to Know About the Anatomy and Physiology of the Neurological System?

The Anatomy and Physiology of the Neurological System

FIGURE 7.1 The brain. (A) Showing lateral view (external surface). B. Showing medial view of one side of the brain.

Development of the Nervous System in the Fetus

PRIMITIVE REFLEXES

Table 7.1 Primitive Reflexes and Reactions

Table 7.2 Normal Postural Reactions and Other Associated Responses

MOTOR DEVELOPMENT

Table 7.3 Some Major Milestones of Motor Development

The Neuron

FIGURE 7.2 A neuron.

NERVE TRANSMISSION

FIGURE 7.3 A synapse.

Table 7.4 Some of the Neurotransmitters Produced at Synapses

Table 7.5 More Commonly Known Substances That Either Enhance or Depress Synaptic Transmission

MOTOR NEURONS

FIGURE 7.4 Location of motor areas in the cortex of the brain.

Central Nervous System

BLOOD SUPPLY TO THE BRAIN

FIGURE 7.5 Circle of Willis.

CEREBROSPINAL FLUID

BRAINSTEM

Table 7.6 Cranial Nerves

BASAL GANGLIA

DIENCEPHALON

CEREBELLUM

CEREBRUM

Table 7.7 Some Deficits Resulting From Damage to Areas of the Brain

SPINAL CORD

FIGURE 7.6 Cross section of the spinal cord. (A) Main areas of gray and white matter. (B) Ascending (sensory) tracts and descending (motor) tracts. (The descending and ascending tracts travel on both sides of the spinal cord. The figure shows them separately for clarity.)

Table 7.8 Some of the Main Spinal Tracts of the White Matter of the Spinal Cord With Their Functions

FIGURE 7.7 Spinal reflex arc showing the stretch reflex.

VESTIBULAR SYSTEM

LIMBIC SYSTEM

AUTONOMIC NERVOUS SYSTEM

Peripheral Nervous System

Table 7.9 Cutaneous Sensory Receptors

FIGURE 7.8 Cervical plexus.

PERIPHERAL NERVE LESIONS

FIGURE 7.9 Brachial plexus.

FIGURE 7.10 Lumbar plexus.

FIGURE 7.11 Sacral plexus.

Table 7.10 Cervical and Thoracic Peripheral Nerves, Nerve Root Derivation, and Muscle and Other Innervations

FIGURE 7.12 (A) Anterior view and (B) posterior view of dermatomes.

Table 7.11 Lumbar and Sacral Peripheral Nerves, Nerve Root Derivation, and Muscle and Other Innervations

Testing for the Neurological System

CT SCAN

DERMATOMES

DEEP TENDON REFLEXES

ELECTRODIAGNOSTIC TESTING: ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES

GLASGOW COMA SCALE

MAGNETIC RESONANCE IMAGING (MRI)

MUSCLE STRENGTH TESTING

MYOTOMES

NEURAL TENSION TESTING/NERVE STRETCHING

Table 7.12 Manual Muscle Testing Grades

Table 7.13 The Spinal Nerve Root Supply to Groups of Muscles

PALPATION

POSTTRAUMATIC AMNESIA SCALES

RANCHO LOS AMIGOS LEVELS OF COGNITIVE FUNCTIONING

FIGURE 7.13 A selection of goniometers.

RANGE OF MOTION

FIGURE 7.14 An inclinometer.

SOME SPECIFIC PERIPHERAL NERVE TESTS

TWO-POINT DISCRIMINATION

VERTEBRAL ARTERY TEST FOR CERVICAL SPINE

Physical Therapy Treatment for People With Neurological Conditions

Adverse Mechanical/Neural Tension

Alexander Technique

Brunnstrom Approach

Constraint-Induced Movement Therapy

Craniosacral Therapy

Feldenkrais Method

Myofascial Release

Neurodevelopmental Therapy/Bobath Techniques

Proprioceptive Neuromuscular Facilitation

Sensory Integration

Tai Chi Chuan in Rehabilitation

Why Does the Physical Therapist Assistant Need to Know About the Anatomy and Physiology of the Neurological System?

Neurological Disorders

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Neurological Conditions Resulting From Deficits in the Development of the Nervous System or Birth Injury

Anencephaly

Arnold-Chiari Malformation/ Chiari Malformation

Autism Spectrum Disorder

Cerebral Palsy

Fetal Alcohol Spectrum Disorders

“It Happened in the Clinic”

Holoprosencephaly

Common Neurological Disorders

Alzheimer’s Disease (Also See Dementia—Non-Alzheimer’s)

Table 7.14 The Stages of Alzheimer’s Disease

“It Happened in the Clinic”

Amyotrophic Lateral Sclerosis

Cerebrovascular Accident and Transient Ischemic Attack

PRECAUTIONS AND CONSIDERATIONS FOR PHYSICAL THERAPY INTERVENTION

GERIATRIC CONSIDERATIONS

Creutzfeldt-Jacob Disease

Dementia—Non-Alzheimer’s (Lewy Body, Senile Dementia, Vascular Dementia)

Epilepsy, Seizure Disorder, and Epileptic Syndromes

Guillain Barré Syndrome and Acute Inflammatory Demyelinating Neuropathy

Huntington’s Disease

Multiple Sclerosis

“It Happened in the Clinic”

Near-Drowning/Drowning With Partial or Full Recovery

Neuropathy, Peripheral Neuropathy and Polyneuropathy

Parkinson’s Disease

Table 7.15 The Staging of Parkinson’s Disease Using the Hoehn and Yahr Scale

“It Happened in the Clinic”

Post-Polio Syndrome

Spinal Cord Injury

Traumatic Brain Injury and Head Injury

FIGURE 7.15 Coup and countercoup head injury

CASE STUDY 7.1

CASE STUDY 7.2

STUDY QUESTIONS

USEFUL WEB SITES

REFERENCES

CHAPTER 8 Burns and Skin Conditions

LEARNING OBJECTIVES

KEY TERMS

Introduction

Why Does the Physical Therapist Assistant Need to Know About the Anatomy and Physiology of Skin?

Anatomy And Physiology of the Skin

Table 8.1 Protective Functions of the Skin

FIGURE 8.1 Cross-section of the skin.

Table 8.2 Layers of the Epidermis of the Skin and Skin Appendages of the Epidermis With Their Characteristics

FIGURE 8.2 Various nerve endings in the skin.

Table 8.3 Types of Sensory Nerve Endings in Dermis and Epidermis of the Skin and Their Function

Why Does the Physical Therapist Assistant Need to Know About Skin Conditions and Diseases?

Skin Conditions and Diseases

HINTS ON USE OF THE GUIDE TO PHYSICAL THERAPIST PRACTICE

Table 8.4 Types of Skin Lesions

FIGURE 8.3 Appearance of various skin lesions. (1) macule: flat with a clear outline; (2) papule: small lump with a solid feel; (3) nodule: firm and elevated above the surface of the skin, extends deeply into the layers of the skin; (4) vesicle or blister: usually fluid filled with a thin covering of skin; (5) pustule: area filled with pus or exudates raised above the level of the surrounding skin; (6) plaque: scaly skin lesion; (7) fissure: a crack in tissue which may extend deeply into the dermal layer of the skin; (8). ulcer: an open cavity in tissue of varying depth.

Thermal Injuries

Burns

FIGURE 8.4 Depths of skin involved in various types of burn shown by shaded areas. (1) Depth of skin involved