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Basic Information Regarding Duchenne's Muscular Dystrophy (DMD) 

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Basic Information Regarding Duchenne's Muscular Dystrophy (DMD) 

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Duchenne Muscular Dystrophy primarily affects males more than females.

In 2007 the number of males affected by DMD/BMD aged 5-24 years was 349 out of 2.37 million in the US

In 2009, 233 out of 1.49 million males in Northern England reported having DMD/BMD

These statistics equal 16 out of every 100,000 males being affected

Onset of muscle weakness for DMD:

Before 5 years old

Muscles that show weakness first:

Upper arms and legs

What other parts of the body that can be affected?

Brain, throat, heart, diaphragm/chest muscles, stomach, intestines, spine

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- Developmental Disability:
A developmental disability, usually beginning during the developmental period, is a group of conditions that is caused by physical, learning,language, or behavioral impairments.

- Intellectual Disability:
An intellectual disability is the most common type of developmental disability. The term Intellectual Disability (ID) means that an individual has certain limitations with their cognitive functioning and skills, and deficits in adaptive behavior (prior to 18 years of age).

- Autism Spectrum Disorder:
Autism Spectrum Disorder (ASD),  the fastest growing developmental disability in the USA, is a neurodevelopmental disorder with diagnostic criteria based on behavioral and developmental characteristics. These include deficits in social and emotional reciprocity and impaired communication skills.

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While the exact cause of ASD is unknown, over the past 10 years many studies, and research have been conducted in attempt to better understand it. Three areas of research that have explained the disorder are:
1. Genetic abnormalities/genetics:

A 1977 study done by Folstein and Rutter found that identical twins were more likely to share autism than fraternal twins.

2. Neurological structure and development:

Researchers believe this is a factor of the development of ASD, because children with ASD are more likely (than children without ASD) to develop epilepsy.

-1/2 of the children studied with ASD had abnormal EEGs
-Individuals with ASD have fewer and smaller Purkinje cells
-The frontal cortex of individuals with ASD tends to be smaller, with isolated cells compared to individuals without ASD

3. Environmental factors:
Theories involving the correlation of pesticides, immunizations and ASD have been made.

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Social communication and interactions are significantly impaired for individuals with ASD. In addition, an individual with ASD has a difficult time adapting to and accepting changes in their environments.

Individuals with ASD also lack skills in social emotional reciprocity, interpersonal relationships, and understanding nonverbal communication. This may result in shorter attention spans, and inability to regulate or express their emotions.

Criteria for Diagnosis:
1. Deficits in social communication and interaction
2. Restricted, repetitive patterns of behavior, interests, and activities
3. Symptoms must be present during childhood or adolescence
4. Symptoms must cause significant functional impairment
5. All other possible causes for symptoms must be ruled out

Three Severity Levels
1) Requires support;
Notable deficits in social communication and interactions

2) Requires substantial support;
Deficits in social communication skills are apparent with supports, distress with change, and repetitive behaviors

3) Requires very substantial support;
Social communication deficits are severe and result in minimal social interactions and response to others. Restricted, repetitive behaviors cause daily schedules to be extremely inflexible

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Common secondary conditions associated with ASD include epilepsy, sleep disorders, hyperactivity, anxiety, and depression.

The most problematic secondary conditions are sensory processing dysfunctions, cognitive impairments, and self-injurious behaviors.

3 Primary Sensory Processing Difficulties:

1. Sensory over-responsivity: the brain is unable to inhibit sensations effectively. This results in "meltdowns" due to their brain's inability to properly respond to stimuli

2.  Sensory under-responsivity: individuals with ASD have an unusually less intense reactions to sensory information. This is due to the brain needing much more neural activity to receive a response. An example of this would be a child with ASD getting a severe injury and not feeling pain.

3. Sensory seeking individual: an individual that requires more intense sensory input than an individual without ASD. This often is in association with exhibiting high levels of self-stimulation

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1. Schedules- Using lists to complete tasks/activities in various forms  to meet the individual's needs.
2. Modeling- This treatment involves an adult or peer that demonstrates the desired behavior or task live or on videotape.
3. Self-management- This treatment intervention promotes independence for the individual by training them to regulate and maintain their behaviors. This is done through recording the occurrence/nonoccurrence of the desired/target behavior by using motivational strategies the individual has selected for achievement.

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1. Genetic causes:

- chromosome abnormalities, errors in genes, damage to genetic material
2. Problems during pregnancy:
- drugs, alcohol, malnutrition, illnesses
3. Problems at birth:
- delivery complications, lack of oxygen, birth injuries, low birth weight, prematurity
4. Problems after birth:
- lead/mercury poisoning, near drowning experience causing oxygen deprivation, head injuries, cerebrovascular accidents, shaken baby syndrome, diseases
5. Poverty and cultural deprivation:
- areas of poverty, environmental hazards, disease, lack of healthy stimulating environments

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Effective RT Interventions for Intellectual Disabilities 

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Effective RT Interventions for Intellectual Disabilities 

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Functional Skills-
- activities focused on: coordination, social skills, cognitive skills
Education, Training and Counseling-
- developing leisure skills, skills to initiate leisure activities with others, training for daily activities of life to promote independence
Community Integration-
- pedestrian training, public transportation training, recreation resources in the community, how to access facilities
Health Promotion-
- physical exercise and recreation to improve health, mood, strength, and enhanced quality of life

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Basic Information Regarding Cerebral Palsy (CP)

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Basic Information Regarding Cerebral Palsy (CP)

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Cerebral Palsy (CP)- describes a group of symptoms and neurological disorders appearing in infancy and early childhood.

CP

Cerebral- brain

Palsy- muscle problems or weakness

Result of non-progressive damage of areas of the brain that control movement and coordination

The areas of the brain affected are the cerebellum and basal ganglia- effects muscle tone, endurance, strength, and speech

Effects of CP

Varies among individuals depending on severity of damage to the brain

Spastic CP: 70-80% of individuals with CP. Includes muscle stiffness which can be permanently contracted. Tight muscles and tone is increased; further classified by limbs affected

Athetoid or dyskinetic CP (choreoathetoid or dystonic CP): 10-20% of individuals with CP; slow, uncontrolled movements usually in extremities and face, low muscle tone; frequently dysarthria- difficulty coordinating muscles required for speech; intelligence is rarely affected

Ataxic CP: 5-10% of individuals with CP; balance and depth perception are most commonly affected; poor coordination, unsteady and wide-based gaits

Mixed: A combination of the above types of CP. Combinations may be of high or low tone, stiffness and involuntary movements

Types of CP are classified further based on physical area that is affected:
-Diplegia: legs are impacted
-Hemiplegia: half of the body is impacted
-Quadriplegia: both upper and lower extremities are impacted- can also impact facial and trunk muscles

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General Symptoms of CP include:

Ataxia (poor muscle coordination)

Poor muscle control

Spasticity or tight muscles

Atypical gait (scissoring particularly with spastic CP)

Drooling

Swallowing and/or eating difficulties

Speech impairments in clarity and articulation

Difficulty with fine motor tasks

Toe walking

Atypical muscle tone (too high or low)

Involuntary movements or tremors

Causes of CP

Approximately 70% of individuals with CP occur prenatally- caused by genetic conditions, infection, maternal bleeding or seizures, abnormal brain development, lack of oxygen, stroke, and intrauterine growth restriction

New research has found a correlation between CP and abnormalities of the placenta

Less than 10% of cases of CP are due to labor or delivery occurrences

Breech position, infections, lack of oxygen, stroke, multiple births, and jaundice

The remaining percentage of CP cases occur during infancy (first years of life) and include head injuries, viral or bacterial infections affecting the CNS (such as meningitis), seizures, motor vehicle accidents, and child abuse

Children born prematurely (earlier than 37 weeks) or with low birth weights (less than 3.5 pounds) are at the greatest risk of developing CP

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The Metropolitan Atlanta Developmental Disabilities Surveillance Program reported 59% of 8 year olds with CP having another developmental disability. The disabilities included:

Intellectual disability: The most common secondary disability of CP. 40-67% of children with CP will have an intellectual disability

Epilepsy or seizures: ~ 35-50% of individuals with CP have seizures or epilepsy

Both intellectual disability and seizure disorder: Occurs in ~25% of individuals with CP. 20-40% of individuals with CP and intellectual disabilities have epilepsy

Behavioral problems: ~ 25% of children with CP have behavioral problems including attention-deficit/hyperactivity disorder, dependency, oppositional defiance disorder, and general hyperactivity

Learning disabilities: ~ 40% of children with CP have learning disabilities

Sensory impairments: 15-62% of adolescents with CP have vision impairments; 6% have hearing impairments. In adults with CP, 25-39% have vision impairments; 8-18% have hearing difficulties; ~75% of children with CP develop strabismus (lazy eye)

Feeding difficulties and/or malnutrition: Includes choking, long feeding times, requiring a gastric tube, underweight, sucking problems, swallowing, and silent aspiration. ~ 57% of children with CP have sucking problems during the first year of life; 80% have required feeding tubes, 50% are either overweight or underweight

Lung problems: About 33% of individuals with CP experience pulmonary infection in a 6 month period

Chronic pain: Pain in the back, foot, ankles, knees, shoulder pain, and headaches occur in ~ 28% of adults with CP

Autism: Approximately 9% of individuals with CP have autism

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Diplegia- only legs are impacted

Hemiplegia- only half of the body is impacted; usually one side of the body in both extremities

Quadriplegia- both upper and lower extremities are impacted; may also include facial and trunk muscles

Ataxia- poor balance and depth perception; poor coordination, unsteady wide-based gait

Dysarthria- difficult or unclear articulation of speech that is otherwise linguistically normal

Spasticity- muscle stiffness and can be permanently contracted; muscles are tight and tone is increased (classified by which limbs are affected)

Contractures- shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints

shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints

Osteopenia- weaker than normal bones (but not to the point of breaking)

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Basic information regarding Spinal Cord Injuries (SCI)

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Basic information regarding Spinal Cord Injuries (SCI)

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SCIs occur when the spinal cord is damaged due to trauma, disease or disorder. When damage occurs communication is interrupted, and may result in temporary or permanent loss of movement and/or sensations.

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SCI is classified by level of injury and type. Paralysis and function are related to the level of injury.

Level of Injury
Several tests are performed to determine LOI, and assess the vertebral column and spinal cord. These tests allow medical professionals to determine impairments.
Type of Injury

Exhibiting no motor or sensory function below the level of injury= complete SCI

Exhibiting some motor or sensory function below the level of injury= incomplete SCI

Can result from contusions to the spinal cord, displaced bone, or edema

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Divided into 2 groups: tetraplegia (which results from injury C1-C8), and paraplegia (which results from injury to T1-S5

Can be further broken down into complete tetraplegia, incomplete tetraplegia, complete paraplegia, and incomplete paraplegia

Most common- incomplete tetraplegia, followed by complete paraplegia, incomplete paraplegia, and complete tetraplegia

C1-C3: Limited neck flexion, extension, and rotation

C4: Increased control of neck flexion, extension, and rotation; scapula elevation (shoulder shrug); inspiration

C5: Elbow flexion and supination (can bend arms at elbow and turn palms up); increased shoulder control, including shoulder flexion, abduction, and extension; and scapular abduction and adduction (can raise arm)

C6: Increased strength and control of upper extremities, including scapular protraction and elevation, forearm supination, radial wrist extension; tenodesis resulting in thumb and index finger natural opposition with flexion

C6-7: Radial and ulnar wrist extension, elbow extension, partial finger extension and thumb abduction, partial finger flexors with C8 SCI

T1-T7: Upper extremity muscle function intact; some trunk control and stability

T8-L1: Improved trunk flexion, extension, and rotation

L2-S5: Partial to full control extremities as hip flexors, knee extensors, ankle dorsiflexors, and plantar flexors return with each level of SCI

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Recreational therapy interventions for CP 

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Recreational therapy interventions for CP 

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Functional Skills

Exercise/stretching fitness: Promoting activity and fitness to individuals with CP is extremely important to maintain and strengthen muscles, as well as cardiovascular and respiratory function, mobility, joint range of motion and motor skills

Aquatic therapy:  Improves respiratory and physical functioning, range of motion, increased bilateral upper and lower extremity movements, gross motor movements, balance, coordination, hand-eye coordination, endurance, strengthening, and development of new leisure skills. In addition, warm water reduces muscle tone, relieves pain, and facilitates movement. Improved moods, increased self-esteem and body image and reduced anxiety and depression are also factors.

Hippotherapy: Using horses as part of an integrated treatment. Benefits include improved head, neck, and trunk control; posture, gross motor skills, muscle symmetry, self-esteem, endurance and mobility. In addition, it promotes relaxation and reduction of hypertonia, improves speech and motor function, and increases motivation

Therapeutic horseback riding: improves the rider's ability to receive and process body-wide sensory information from the movements made by the horse.  Improvements include: balance, coordination, upper and lower extremity strength, sitting posture, gross motor skills, gait, riding skills, self-confidence, self-concept, sense of mastery and success, grasp, circulation, relaxation, and emotional and psychological status. Benefits of THBR also include reduction in abnormal muscle tone.

Massage therapy: manipulates the muscles and soft tissues in the body which can improve health, enhance well-being, and reduces pain and anxiety.

Education, Training, and Counseling

Accessibility: Education about accessing and finding accessible public areas, programs, and transportation

Advocacy: Advocate for inclusive environments, accessible facilities, and increased opportunities for participation

Barrier removal: Assist individuals with CP to overcome barriers they may face so they may fully participate in activities/society.

Mobile devices as adaptive equipment

Leisure and health education

Relaxation and coping skills: leisure activity promotes relaxation and effective coping skills to deal with stressors

Community Integration and Inclusion

Social skills and inclusion: ensure accessibility for full participation

Participation and inclusion: benefits of community integration and inclusion include: improved social skills, friendships, community skills, creative expression, sense of meaning, mobility management, assistive technology, self-esteem, and accessibility.

Advocacy skills: RT's can help individuals with CP learn these skills

Health Promotion

Adaptive sports: numerous benefits for individuals with CP. Improved well-being, overall health, quality of family and social life, feelings of self-efficacy, and self-confidence, enjoyment of life, and sense of well-being.

Animal-assisted therapy: improves communication, increases strength, endurance, psychological/emotional health, social interaction, and energy levels. It also decreases heart rate and blood pressure, and reduces anxiety and stress.

Volunteerism: enhances psychological well-being. Increases in self-esteem, greater sense of purpose and social connectedness, improved quality of life, community involvement, functional abilities, and improve empathy and understanding skills

TR camping program: Positive impacts including feeling a sense of community and respect.

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Autonomic dysreflexia or hyperreflexia

rise in blood pressure; most commonly caused by bladder issues

Pressure ulcers

blood flow to an area stops causing the skin to die

Respiratory complications

Spasticity or spastic hypertonia

increase in muscle tension; continuous contraction of muscles

Temperature regulation

Heterotopic ossification (HO)

abnormal growth of bone in muscles, tendons, or soft tissue

Deep vein thrombosis (DVT)

occurs when blood clots form in the leg's deep veins

Orthostatic (postural) hypotension

low blood pressure that occurs when standing up from sitting/lying down

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Tetraplegia-  refers to a spinal cord injury above the first thoracic vertebrae, or within the sections of C1-C8; commonly known as quadriplegia
Paraplegia- paralysis of the legs and lower body
Complete vs incomplete injury-

Exhibiting no motor or sensory function below the level of injury= complete SCI

Exhibiting some motor or sensory function below the level of injury= incomplete SCI

Autonomic dysreflexia- life threatening rise in blood pressure that can occur in individuals with LOI at or above T6 when a negative stimulus is present within or outside the body below the level of injury
Pressure ulcer- too much pressure that builds up on the skin in a particular area. The blood flow in this area is halted and the skin begins to die as a result. This dead skin then results in pressure ulcers

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Pressure Ulcer: (Bed Sores; Decubitus Ulcers): Too much (unrelieved) pressure that builds up on the skin in a particular area. The blood flow in the area is halted and the skin dies as a result. This dead skin results in a pressure ulcer.

- Stage 1: persistent skin redness that does not disappear with relieved pressure
-Stage 2: partial thickness is lost and appears as an abrasion, blister, or crater
-Stage 3: full thickness of skin is lost; subcutaneous tissues are exposed
-Stage 4: full thickness of skin and subcutaneous tissues are lost; muscle or bone are exposed

Incontinence: Lack of voluntary control over urination or defecation

-Measured using 5 categories:
Continent
Usually Continent: Incontinent episodes less than weekly
Occasionally continent: Incontinent episodes once a week
Frequently incontinent: Incontinent 2-3 times a week
Total Dependence: Incontinent all or almost all the time

Delirium: Deficit in attention and an additional deficit in cognition such as learning and memory, complex attention, executive function, language, perceptual-motor abilities, and social cognition.

Possibility of improved function

Dementia: (The DSM 5 allows this term to be used in settings where patients and medical personnel are familiar with the term; strongly suggests the term of neurocognitive disorder to be used); decline in mental ability that is severe enough to interfere with daily life

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Alzheimer's Disease: A type of dementia that causes issues with memory, thinking and behavior.

Predominant age: Early onset vs. Late onset

Early onset: before 65 years old- uncommon

Late onset: after 65 years old (incidence doubles every 5 years after 65)

Causes: Alzheimer's disease is caused by plaques that form in the brain. The plaque destroys brain cells, which creates progressive deterioration of higher functioning in the areas of memory, problem solving, and thinking.

Characterized by an inability to carry out everyday tasks or perform instrumental activities of daily living

Systems affected: The systems that are affected include the following:

complex attention: mild- Taking longer than they used to for tasks, need to double check more often, find thinking easier with fewer other things.

major- easily distracted by events in the environment which inhibits functioning; input needs to be simplified; mental calculations are not possible, and thinking takes longer than usual

executive function:

mild- requiring increased effort to complete multistage projects; trouble resuming a task after an interruption; requires extra effort to organize, plan, or make decisions; finds large social gatherings more taxing because of increased social effort following shifting conversations

major- abandons complex projects, needs to focus on one task at a time, and rely on others to plan instrumental activities of daily living or make decisions

learning and memory: mild- trouble recalling recent events, reliance on making lists, trouble keeping track of characters in movies/novels, repetition of stories within a couple weeks

major- repeating within the same conversation, cannot keep track of short lists of items when shopping, requires frequent reminders to stay with the current task

severe- early memories and implicit memory are preserved even when current memories are lost

language: mild- noticeable word finding difficulties and general terms are substituted for specific terms, subtle grammatical errors

major- significant difficulties with both expressive and receptive language ("that thing"), general pronouns, may stop speaking

perceptual-motor abilities: mild- reliance on maps and directions to get places, getting lost easily, problems with spatial tasks (sewing, carpentry, and knitting)

major- previously familiar activities become a problem; confusion at dusk when light levels change perceptions

social cognition: mild- subtle changes in personality, behaviors, or attitudes. Less ability to read facial expressions or recognize social cues

major- behavior outside of acceptable range; inability to react appropriately to cues from others during discussion or when doing things with them, safety is not a consideration in decisions, little insight to changes

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This term is an umbrella term for two related diagnoses:

It refers to Parkinson's disease NCD and NCD with Lewy bodies.

Affects 1.3 million individuals in the US.

Parkinson's disease affects ~ 2% of individuals over 65

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TR programs must be carefully designed, keeping in mind the individual's age, personality, stage of disease, cognitive and physical functioning, behavioral problems, and leisure interests/skill level.

Meaningful activities for individuals with NCD promote well-being, and prevent excess disability

Self-selected activities that promote a sense of personal expression are often most beneficial

To increase participation:

Farrington Leisure Interest Inventory- assesses past and current leisure interests

Neurodevelopmental Sequencing Program (NDSP)- conceptual framework to design and implement programs

Purpose: improve the quality of life for individuals with NCD through the enhancement of physical and psychosocial abilities related to recreation participation

TR Interventions

Functional Skills

Education, Training, and Counseling

Community Integration

Health Promotion

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The families of individuals with NCD are drastically impacted. The family often is responsible for the individual. The duties that the family must perform include medication management, scheduling and transportation to doctor's visits, personal care assistance, and other various activities.
In addition to the added responsibilities placed upon the family, emotional tolls are taken as the family must watch their loved one lose their cognitive abilities and capacities. All members of the family (not just the person diagnosed) are affected since roles often change in the family (Iacobacci, 2017).

Iacobacci, C. (2017, July 27). Neurocognitive Disorder as a Family Illness. Retrieved from https://www.omicsonline.org/open-access/neurocognitive-disorder-as-a-family-illness-2471-2701-1000158.php?aid=93513

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A disorder that affects people after traumatic events outside of combat situations (including events that were witnesses). The key feature of PTSD is the development of characteristic symptoms following exposure to one or more events.
PTSD can be caused by:

Rape

Surviving a traumatic event/injury

Witnessing others being injured or killed

Sudden, unexpected death of a loved one

Loss of job/home

Abuse

Natural Disaster

Being in a war zone

Exposure to a terrorist attack

Threatened or actual physical assault

Threatened or actual sexual violence

Catastrophic events (waking during surgery, anaphylactic shock, etc.)

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Mood and ability to cope effectively with stressful events:

diminished interest in significant activities, recurring distressing recollections and/or dreams of the event, feeling separate from others, negative beliefs concerning the future

Social functioning:

feelings of detachment due to avoidance of others, places, and activities that remind them of the trauma

Cognitive functioning:

poor concentration and focus

affect brain structure such as the limbic system- difficulties concerning emotional learning, emotional dysregulation

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Cognitive functioning:

Delusion and disordered thinking and speech

Perceptual functioning:

Positive symptoms- sensory hallucinations

Receiving, processing and initiating conversation may be impaired

Structural composition of the brain:

Decreased activity in frontal lobe

Emotional functioning:

Negative symptoms- blunted or flattened affect

Anhedonia- inability to experience pleasure

Social functioning:

Asociality, and inability to empathize with others

Amotivation and ability to initiate behaviors

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Increased risks of agoraphobia, OCD, social phobia, major depressive disorder, somatization disorder, and substance-related
disorders

Individuals with PTSD are 80% more likely than those without it to meet diagnostic criteria for at least one other mental disorder

Other issues that may arise include:

Panic disorder, suicidal thoughts/feelings

Fibromyalgia

Ability to continue education/employment

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No known cause, however there genetics seems to play a role in its development

Structure and chemical composition of the brain

enlarged ventricles; possibly related to tissue deterioration, and less activity in the frontal cortex

chemical imbalances in dopamine

Environmental factors

environmentally stressful settings such as urban or impoverished settings

lower socioeconomic groups

immigrants

Psychosocial factors:

biological condition that prevents one from developing an integrated sense of self

deviant family styles (especially in those with predispositions to SSD)

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Hallucination, delusion, psychosis, & anhedonia 

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Hallucination, delusion, psychosis, & anhedonia 

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Hallucination:

Vivid perceptions of something that is occuring in the real world even though nothing in the real world is causing the perception

Delusion:

Beliefs that the client will not change even though they are contradicted by evidence in the current situation.

Persecution delusions: belief that someone or some organization intends to harm them

Referential delusions: belief that certain gestures/environmental cues are directed towards self; (i.e. secret messages from a character on TV)

Grandiose delusions: inaccurate belief of exceptional abilities

Eromantic delusions: incorrect belief that someone is in love with them

Nihilistic delusion: belief in impending destruction

Somatic delusions: inaccurate beliefs about health

Psychosis: impaired thoughts and emotions that causes a reality loss
Anhedonia: inability to experience pleasure

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Axis I disorder manifested with diverse symptomatology that may occur as a single episode or recurrent condition that ranges in intensity from mild to severe
Symptoms may include:

Depressed mood most of the day, nearly every day

Diminished interest or pleasure in most or all activities, nearly every day

Significant unintentional increase/decrease in weight or appetite

Lack of sleep or sleeping excessively, nearly every day

Psychomotor changes noticed by others ( agitation or sluggishness), nearly every day

Fatigue and/or loss of energy, nearly every day

Feelings of guilt and/or worthlessness, nearly every day

Diminished cognitive abilities, nearly every day

Recurrent thoughts of death

Psychotic features:

accompanied by hallucinations or delusions

Catatonic features:

immobility, extreme irritation, extreme negativism, peculiarities of voluntary movement, echolalia or echopraxia

Melancholic features:

somatic symptoms of depression- early morning waking and intensified morning symptoms; anorexia or weight loss

Atypical features:

mood reactivity and at least two of the following: leaden paralysis, long-standing pattern of interpersonal rejection sensitivity, increase in appetite or weight, hypersomnia

Seasonal patterns:

relationship between depressive symptoms and time of year; hypersomnia

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Diminished quality of life

Lost work productivity

Cognitive and emotional impairment

Alters one's appraisals of existing social supports

Potentially cause negative impacts on short and long-term relationships

Disruption of daily activities through amotivation and lethargy

Low self-efficacy

Neglect of basic self-care

Weight gain/loss

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Chronic pain

Illness

Disability

Cardiovascular disorders

Anxiety

Substance abuse

Eating disorders

Dementia

Personality disorders

Social phobia

PTSD

Slightly less rates of OCD, panic disorder, and specific phobia

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One of ten anxiety disorders classified by the DSM 5

Characterized by:

Excessive and uncontrollable worry about everything more days than not for at least six months

Manifests physical symptoms: muscle tension, sweating, nausea, GI problems, jumpiness, fidgeting, trembling, inability to relax, being easily startled, trouble sleeping, feeling on edge

Feel like they are losing control of self and/or the situation during periods of extreme anxiety

Severity:

Mild: sharpens sense and expands the perceptual field, preparing us for action. Learning abe problem skills are enhanced
Moderate: decreases perceptual field. Sight, hearing, touch, taste and smell are limited and the ability to think is impaired. Problem solving and ability to mobilize resources can be hindered
Severe: constricts the perceptual field so that focus is limited to one specific detail. Completing tasks or processing information is compromised, and behavior and attention are directed towards to anxiety

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5 Categories of Symptoms for Schizophrenia 

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5 Categories of Symptoms for Schizophrenia 

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Delusions :

Beliefs that the client will not change even though they are contradicted by evidence in the current situation.

Persecution delusions: belief that someone or some organization intends to harm them

Referential delusions: belief that certain gestures/environmental cues are directed towards self; (i.e. secret messages from a character on TV)

Grandiose delusions: inaccurate belief of exceptional abilities

Eromantic delusions: incorrect belief that someone is in love with them

Nihilistic delusion: belief in impending destruction

Somatic delusions: inaccurate beliefs about health

Hallucinations

Vivid perceptions of something that is occuring in the real world even though nothing in the real world is causing the perception

Auditory hallucinations are the most common

Disordered Thinking and Speech:

Impairs communication

Switching topics in ways that the listener cannot follow, giving answers that are not related

Memory deficits

Delayed recall

Difficulty accessing vocabulary

Difficulty/inability to plan

Impairments in organizing information

Problems attending to single/multiple tasks

Motor behavior:

Behaviors interfere with activities of daily living or other goal-directed behaviors

Catatonia- resistance to instructions, rigid or bizarre postures, lack of response

purposeless, stereotyped movements, grimacing, staring, echoing of speech

Negative symptoms:

Diminished emotional expression- flattened affect

fewer/less emphatic facial expressions, lack of intonation in speech, less eye contact, fewer physical movements while communicating

avolition- decrease in or lack of motivation (with initiating behavior)

alogia- poverty of speech

asociality- decreased desire to interact with others

anhedonia- inability to experience pleasure

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Affects mental functions such as:

Mood

Cognition (trouble concentrating, difficulty learning new information and behaviors, misinterpretation of events and situations, poor short term memory, difficulty with abstract thinking), social functioning

Motor functioning:

Shakiness

Restlessness

Headaches

GI problems

Cardiovascular issues such as racing heart

Respiratory issues such as shortness of breath

Autonomic nervous system function

Excessive sweating

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Why Gambling Disorder is an addictive disorder

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Why Gambling Disorder is an addictive disorder

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Gambling affects the brain's reward system in a way that is similar to substance abuse.
If gambling becomes an addiction, the effects they get from gambling are similar to effects someone with alcoholism gets from alcohol.
They may begin to crave gambling like others with substance disorders experience.

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Behaviorally conditioned problem gamblers:

Access to gambling- believe they are able to win money back which begins the cycle. Cognitive distortions such as believing they have control over the outcome

often experience anxiety, depression, and substance use/abuse

lower levels of gambling problems and more likely to comply to treatment

Emotionally vulnerable problem gamblers:

develops similarly to the behaviorally conditioned group; similar conditioning, environmental, and psychological factors

characterized by pre-existing vulnerabilities such as anxiety and or depression, poor coping, and problem-solving skills, as well as negative family experiences and life events

attracted to gambling to meet psychological needs and reduce emotional states

Less likely to respond to treatment and are unlikely to gamble in non-problematic ways

Antisocial, impulsive problem gamblers:

More likely to have a predisposing psychological and biological factors that contribute to the gambling problem

believed to have neurological and neurochemical dysfunctions in addition to impulsivity, attention deficit disorder, and antisocial personality

Tend to have more psychopathy- more likely to report parents with substance abuse and antisocial problems, early exposure to substance/gambling disorders

unlikely to seek treatment and not comply

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Systems affected by Gambling Disorder and Secondary Problems 

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Systems affected by Gambling Disorder and Secondary Problems 

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Interference with occupational/social functioning

Cognitive processes become irrational- thought preoccupied with various elements of gambling including memories of past experiences, and anticipation of future gambling

Relationship strains

Antisocial behavior- stealing, fraud, embezzling, forgery, etc. in order to obtain more money to support the gambling behaviors

Emotional difficulties- depression, inability to cope, feelings of losing control

Substance misuse

Divorce/Separation

Occupational difficulties

Criminal behaviors

Antisocial behavior

Financial trouble

Affective/ substance-related disorders

Suicide

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Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Pica 

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Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Pica 

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Anorexia nervosa: refusal to maintain body weight at or above minimally normal weight for height, body type, age, activity level; intense fear of weight gain or being fat; feeling fat/overweight despite dramatic weight loss, extreme concern with body weight and shape; loss of menstrual periods

sudden weight loss, extreme dieting, food rituals, hair loss, dry skin/hair, brittle nails, fine downy hair are all warning signs

Bulimia Nervosa: recurrent episodes of eating large quantities of food in short periods of time, often secretly without regard to feelings of hunger or fullness, to the point of feeling out of control; following the binges with some form of purging or compensating behaviors to make up for the excessive calories- vomiting, laxative/diuretic use, fasting, obsessive/compulsive exercise, extreme concern with body weight and shape

disappearance of large amounts of food, frequent trips to the bathroom after meals, calluses on knuckles from vomiting, swelling of the face are all warning signs

Binge-eating disorder: frequent episodes of eating large quantities of food in short periods of time often secretly without regard to feelings of hunger or fullness; frequently feeling out of control during binges; not tasting the food during binges; eating alone; feelings of shame, disgust, and guilt; no compensatory behaviors

sudden weight gain and disappearance of large amounts of food are warning signs

Pica: persistent eating of nonfood/ nonnutritive substances that is developmentally inappropriate and not supported by cultural or social practices

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Influenced a variety of factors which can include genetics or the environment

Genetics:  Eating disorders tend to run in families. 50-80% of eating disorders are caused by genetics

Biological issues: Serotonin may influence eating behaviors. Disordered eating behaviors alter brain structure, metabolism, and neurochemistry which makes it difficult to discontinue the behaviors

Psychological or interpersonal issues: Eating disorders may develop or be triggered as a result for searching for control, coping with stress or trauma, personality factors, family issues, low self-esteem, feelings of inadequacy or lack of control in life, depression, anxiety, anger, stress, loneliness, troubled personal relationships, difficulty expressing emotions and feelings, history of being teased or ridiculed based on shape or weight, history of physical or sexual abuse

pre-existing psychological and emotional problems that contribute to the disorder such as- low self-esteem, perfectionism, impulsive behavior, troubled relationships

inability to mourn/cope with death, loss or abandonment

numbing feelings

Social/societal issues: Society's desire for thinness, peer pressure of media to be thin, unrealistic body images portrayed, constant influx  images or perfectionism, narrow definitions of beauty

body types portrayed by the perfect body ideal is possessed naturally by only 5% of American females

Cultural issues: Cultures that glorify "thinness" or muscularity place a high value on obtaining the "perfect body," which causes narrow definitions of beauty such as body shapes, weights, and sizes- emphasis on physical appearance rather than inner qualities and strengths

Obesity prevention programs: 30% of parents  of children aged six to 14 who participated in school-based childhood obesity prevention programs observed behaviors in their children that are commonly seen in eating disorders

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Social- impact family units; often withdrawn and socially isolated

Nutritional issues- problems including nutritional and caloric intake, eating patterns, eliminated or taboo foods, food rituals, using food inappropriately to deal with crisis

Cognitive- denial of the illness, severe body image issues, perfectionism, challenges with escape or avoidance thoughts or behaviors

Emotional- may include anxiety, depression, decreased self-esteem and self-worth, inability to express or cope with anger

Physical- dehydration, low blood pressure, osteoporosis, stomach and digestive complications, arrhythmias (irregular heartbeat), tearing of the esophagus

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Can cause severe medical issues: cardiac arrhythmia, cardiac arrest, brain damage, osteoporosis, infertility and death

~50% of people with eating disorders meet the criteria for depression

Eating disorders during pregnancy increase the risk for premature labor, low birth weight, cardiac irregularities, stillbirth or fetal death, gestational diabetes, miscarriage, preeclampsia, complications during labor, respiratory difficulties, abnormal fetal growth, increased risk of cesarean birth, difficulties breastfeeding, postpartum depression, anxiety or panic attacks, low self-esteem, poor body image, suicidal ideation, withdrawal or social isolation, lack of enjoyment in hobbies/activities, marital and family issues

Anorexia nervosa: Bone loss, difficulties with temperature regulation, loss of menstrual periods, low heart rate, low blood pressure, anxiety, depression, social isolation, perfectionism

Bulimia nervosa: Electrolyte imbalance, esophageal ulcers, tooth decay, anxiety, depression, substance use, difficulties with impulse control

Binge-eating disorder: gastric problems, obesity, obesity-related conditions, anxiety, depression, and substance use

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Familial, social or cultural factors: more likely to have issues with substance abuse if there are issues with the primary family, social and/or cultural network tolerates, approves, and/or models substance abuse and related behaviors

Personality factors: experiencing depression, high levels of stress, challenges in self-regulating behavior, and/or having poor coping skills increases the probability of substance related disorders

Cognitive factors:  substance use produces positive effects that reinforce the continued/increased use of substances; specific expectations that the substance will reduce negative emotional states

Genetic factors: individuals with parents with substance use problems increases the risk for them to develop a problem even when social factors are controlled

genetic vulnerability- greater sensitivity to positive psychopharmacological effects of substances

Biological factors: neurotransmitters including dopamine and serotonin affect the reward pathways of the brain. Research shows substance use artificially influences the function of the neurotransmitters to the extent that it becomes difficult for the reward system to be stimulated naturally

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Systems affected by substance related disorders 

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Systems affected by substance related disorders 

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Smoking marijuana/tobacco: lung damage

Alcohol: liver damage/functioning

Employment

Relationships

Personal health practices

Physical health- illness, injury, hyperactivity of autonomic NS , physical damage to the body

Mental health- anxiety, depression, loss of motivation, anger, agitation, and irritability

Social health concerns- strained or unhappy relationships

Cognitive health concerns- short term confusion, learning problems, and memory loss

hallucinations and delusions are possible

Poor impulse control, poor judgement, poor sleep quality with frequent disruptions in the sleep/wake cycle and insomnia

Lifestyle- financial instability, unemployment, homelessness, traffic accidents, conflict with the law, food insecurity, poor nutritional intake, and poor dental hygiene

may also include the influence of violence

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Secondary problems of substance related disorders 

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Secondary problems of substance related disorders 

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Others affected: may impact family, friends, co-workers, and classmates. May experience isolation, social life restrictions, dissatisfying relationships, public embarrassment, a disruption of  routines or family celebrations, feelings of shame, anger and resentment, the burden of multiple roles/changing roles, depression, guilt or responsibility, changes in physical health, financial instability and violence.

Concurrent disorders or dual diagnosis: it is not uncommon to also experience other mental health concerns. More than 50% of those seeking help for their substance use also have a mental illness

treatment can be complex and complicated; frequent relapse and recurrent crises tend to be a norm

increased challenges of coping with their circumstances and the stigma of problematic substance use and mental illness, clients with concurrent disorders more often experience higher rates of unemployment, relationship difficulties, social anxiety, poverty, homelessness, social marginalization, and/or conflict with the law

Other disorders associated with substance use:

anxiety disorders. 2-5x greater risk of having substance use problems

increased risk for individuals with attention-deficit/hyperactivity disorder

mood disorders- major depressive disorder, bipolar disorder, dysthymia, and cyclothymia

psychosis- delusions/hallucinations

schizophrenia

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A disease that affects the arteries in and around the brain. CVA's occur when blood vessels that carry oxygen and nutrients to the brain ruptures or is blocked by a clot.

This results in parts of the brain not receiving the required oxygen that it needs- the lack of oxygen causes brain cells in that part of the brain to die

Results in neurological impairments

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Face Drooping- if one side of an individual's face numbs or droops, the person may be having a stroke. (Ask the person to smile and make observations).
Arm Weakness- if one arm is numb or weak a stroke may be occuring. If both arms cannot be raised without having one drift down, a stroke may be occuring.
Speech Difficulty- if the person is having slurred speech or in unable to speak, they may be having a stroke. As the person to repeat "the grass is green.'"
Time to call 911- if any of these signs are exhibited, call 911 and get the person to the hospital immediately.

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Left CVA- right hemiplegia, language deficits, slow and cautious behavior style

Right CVA- left hemiplegia, visual deficits, quick and impulsive behavior style

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Blood clot that develops in the brain and blocks blood flow

thrombosis- main cause of ischemic strokes

Blood clot may originate elsewhere in the vascular system and travel to the brain, where it becomes lodged and blocks blood flow

Embolism- another main cause of ischemic strokes

Blood vessel breaks or ruptures, which causes bleeding in the brain

hemorrhage- often caused by weakened blood vessels and increased blood pressure.

causes of intracerebral hemorrhagic strokes and subarachnoid hemorrhage strokes

Risk factors:

hypertension

high cholesterol

heart disease

sleep apnea

smoking

alcohol use

heart rhythm disorders

drug use

BMI above recommended range

pregnancy

post-menopause

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Motor (most common- especially in face, arms, and/or legs), sensory, cognitive, language, and visual functions are impacted

Motor:

hemiplegia

motor planning

muscle power

muscle tone

reflexes

balance

gait

apraxia

coordination

Sensory:

decreased sensory awareness

numbness

tingling

astereognosis

agraphia

processing problems

Cognitive:

decreases in consciousness functions

calculation abilities

attention

concentration

problem solving

organizing

perception

orientation

time management

planning

judgement

safety

Language:

dysphasia in comprehension, reading, writing

decrease in expression and reception of language

Visual:

double vision

depth perception problems

field cuts

Emotions, personality, sexual functioning bowel and bladder functioning are also impacted

depression, reflex crying, emotional challenges, and one-side neglect

Effects depend on age and gender, type and location of stroke, speed and effectiveness of the medical care

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Secondary problems associated with stroke 

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Secondary problems associated with stroke 

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Inactivity- may affect work performance, academic performance, community involvement, and social relationships

lack of mobility

poor coping mechanisms

loss of function

barriers to recreation and leisure choices

Decreased in independence and participation

loss of mobility

loss of ability to perform both activities of daily living (ADLs)

personal hygiene

bowel and bladder management, ambulation, etc

instrumental activities of daily living (IADLs)

taking proper medications, managing money, shopping for groceries, etc

increase in the number and severity of falls

Increased burdens of caregivers

Post-stroke depression

1/3 of individuals that experienced a stroke

irritability, trouble sleeping,  low self-esteem, fatigue, withdrawal

Emotional lability

rapid transition from emotional highs to emotional lows with no apparent provocation

20% of individuals that have experienced a stroke

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A form of an acquired brain injury that occurs from a direct trauma to the brain.

Can be caused by a blow or jolt to the head or penetrating injury

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Mild TBI: concussion or minor brain injury

occurs when an impact or forceful motion of the head results in brief alteration of mental status, such as confusion or disorientation, loss of memory for events immediately before/after injury, brief loss of consciousness

Glasgow Coma Scale (GCS) score of 13-15 with symptoms of: headaches, fatigue, sleep disturbance, irritability, sensitivity to light/noise, balance problems, decreased concentration/ attention, decreased speed of thinking, memory problems, nausea, blurry vision, dizziness, depression, anxiety, emotional mood swings, seizures

Moderate TBI: loss of consciousness, along with persistent confusion and functional impairments in one or more of the cognitive, physical, emotional, or behavioral domains

GCS score of 8-12

Severe TBI: prolonged unconscious state or prolonged coma

GCS score less than 8

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Brain- wide spectrum of dysfunction

Physical changes: impairments such as weakness, muscle tone and coordination problems, full or partial paralysis, balance difficulties, fatigue

Cognitive changes: impairments such as arousal, attention, initiation, and memory. Problem solving and the whole set of functions may be affected including: judgement, organization and planning, time management, abstract reasoning, insight. Others can include changes in reading, language and communication

Emotional and behavioral changes: may include difficulty with social skills, such as empathy inabilities with others or poor pragmatics, inappropriate or self-centered behavior, disinhibited behavior, other emotional-behavioral issues such as irritability, agitation, frustration, flat affect, depression, and/or anxiety

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Further damage to the structure of the brain:

Anoxic injury: injury that results from an absence of oxygen to the brain

Hypoxic injury: injury that results from a decrease of oxygen to the brain

Cranial nerve dysfunction: 12 pairs of cranial nerves- injury to one or more may occur resulting in impairments in taste, smell, visual, auditory, or vestibular function

Edema: swelling and excess fluid in the brain

Hematomas: collection of blood that increases intracranial pressure (ICP)

subdural hematoma: blood vessels rupture between the brain and the dura

epidural or extradural hematoma: where blood vessels rupture between dura and the skull

intracerebral or intraparenchymal hematoma: bleeding within the brain itself

Hydrocephalus: (ventricular enlargement) occurs when cerebrospinal fluid (CSF) accumulates in the brain resulting in dilation of the cerebral ventricles and an increase in intracranial pressure

symptoms: incontinence, gait disorder, dementia

Heterotopic ossification (HO): formation of bone where bone does not usually form in soft tissues

10-20% of individual with severe TBI in proximal joints of the upper and lower extremities

symptoms: pain, warmth, swelling, contracture formation

Seizures: post-traumatic seizures and epilepsy. May develop immediately or more than one week after the injury

25% of patients with brain contusions or hematomas and about 50% of patients with penetrating head injuries develop seizures that occur within 24 hours of the injury

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Diabetes mellitus (MS) is a complex disease that occurs when insulin production is too low or when the body is unable to effectively use the insulin it produces because of defects in insulin receptors
Type 1 diabetes (T1D):
Insulin dependent diabetes mellitus (IDDM) and juvenile-onset diabetes are T1D.
This develops when the body's immune system destroys the pancreatic beta cells that make insulin. Primarily occurs in children and young adults.
Autoimmune, genetic and environmental factors are all risk factors
Type 2 diabetes (T2D):
Non-insulin dependent diabetes mellitus (NIDDM) and adult-onset diabetes are T2D.
Most common form of diabetes accounting for 90-95% of diabetes cases. The body does not produce enough insulin or the cells cannot use the insulin properly so there is a build-up of glucose in the bloodstream. This may causes damage to the eyes, kidneys, nerves, and heart, and is often associated with older age, obesity, family history of diabetes, impaired glucose tolerance, physical inactivity,

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T1D: caused by autoimmune disease, predominantly hereditary, that attacks and destroys beta cells in the pancreas. Environmental factors such as viruses, infection, and foods  are thought to trigger the autoimmune reaction

T2D: triggered by a combination of genetic, personal, and environmental factors. Hereditary seems to play a role- African Americans, Alaska Natives, American Indians, Pacific Islanders of American descent, and Hispanics/Latinos have a higher risk.
Having a parent/sibling with T2D also increases the risk.
Personal factors that increase risk are: obesity, middle-aged, physical inactivity, metabolic syndrome, high blood pressure, bad cholesterol levels, polycystic ovary syndrome, prediabetes, acanthosis nigricans (dark rash around neck/armpits), history of cardiovascular disease.

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1) Hypertension:
~ 2/3 of adults with diabetes have high blood pressure
2) Heart Disease and Stroke:
Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes are twice as likely to have heart disease or stroke
3) Blindness:
~ 1/3 of individuals 40 years of age or older with diabetes have diabetic retinopathy
4) Amputations:
More than 60% of non-traumatic lower extremity amputations are due to diabetes
5) Dental disease:
~ 1/3 of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more

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Multiple Sclerosis (MS) is an autoimmune disease that causes chronic inflammation of the CNS. The body's own defense system attacks the fatty substance (myelin) that surrounds and protects the nerve fibers of the brain, optic nerves, and spinal cord. AS the damage occurs, the myelin covering of the nerves becomes inflamed, swollen and detached from the fibers eventually becoming completely destroyed . Scars tissue (sclerosis) form over the nerve fibers in place of the myelin

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Immunologic: MS is an autoimmune process where the body's immune system attacks its own CNS destroying the myelin sheath
Environmental: Epidemiologic studies suggest that early exposure to an environmental agent might be a triggering factor in people who are predisposed by genetic factors in people who are predisposed by genetic factors to develop MS. The frequency of MS increases for people who live further from the equator. High risks in North America, New Zealand, Australia, and Europe
Viral: A virus triggering agent that causes demyelination and inflammation. Some suggest mycobacteria may be a cause
Genetic: Genetic markers have been shown to increase the chances of developing MS although it is not hereditary. Genetic predispositions to MS and exposure to environmental agents causing autoimmune responses are more likely to develop MS

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Since MS is a disorder affecting the CNS any system associated with the brain or spinal cord may be affected.
Primary symptoms due to demyelination are: weakness, numbness, tingling, tremor, visual problems, pain, paralysis, poor balance, bowel and bladder dysfunction, slurred speech, decline in cognitive functioning including reasoning, memory and processing, and dysphagia.
Symptoms are aggravated by heat, fatigue, and stress.

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Heart Disease and Associated Conditions 

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Heart Disease and Associated Conditions 

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Heart Disease: Umbrella term of medical terms that involve the heart in one way or another

Blood vessel disease (cardiovascular disease): narrowed, blocked, or stiffened blood vessels that impair circulation. Symptoms include angina (chest pain), shortness of breath, pain, numbness, weakness, or feelings of coldness in extremities
Heart arrhythmia: an abnormal heartbeat, which can be quick, slow or irregular. Symptoms include fluttering in the chest, tachycardia (racing heartbeat), bradycardia (slow heart beat), angina, shortness of breath, vertigo, feeling lightheaded, and syncope (fainting)
Congenital heart defect: Structural problems of the heart or major blood vessels- over 18 types of congenital heart defects are recognized. These defects are usually seen in babies. Symptoms vary depending on abnormality/defect and may include: cyanosis, swelling in hands, feet, ankles, abdomen, or areas around the eyes, shortness of breath during feedings leading to poor weight gain, tiring easily, and excess fluid on heart/lungs
Cardiomyopathy: thickening and stiffening of the heart muscle. Symptoms include shortness of breath; swelling in the legs, ankles, or feet, bloating in the abdomen, fatigue, irregular heartbeats that feel rapid or pounding, vertigo, feelings of lightheadedness and syncope
Heart infections: 3 types
a) pericarditis (infection of the tissues surrounding the heart)
b) myocarditis (infection of the muscular middle layer of the heart walls)
c) endocarditis (infection of the inner membrane that separates the chambers and heart valves
Symptoms include fever, shortness of breath, fatigue, weakness, swelling in the legs or abdomen, heart rhythm changes, dry or persistent cough, skin rashes pr unusual spots
Valvular heart disease: Functions of 1+ heart valves are damaged leading to stenosis (narrowing), regurgitation (leaking) or prolapse (improper closing). Symptoms include fatigue, shortness of breath, irregular heartbeat or heart murmur, swollen feet or ankles, angina, and syncope

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Secondary Problems related to Heart Disease 

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Secondary Problems related to Heart Disease 

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20-30% of individuals with congenital heart defects have other physical, developmental, or cognitive disorders

5-10% of people with cardiac problems have anxiety disorders, particularly panic attacks and phobias, and 10-15% have mood disorders, predominantly depressive episodes, minor depression, or dysthymia

Risk of depression is up to 25% for individuals with cardiovascular disease and diabetes, resulting in poorer medical outcomes, poorer glycemic control, increased diabetic symptoms, and greater all-cause mortality due to biological and psychological processes

Sexual activity may be affected due to increased stress on cardiovascular system

Back problems due to being overweight ot deconditioning from lack of physical activity

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Cancer is the generic name given to more than 100 diseases where abnormal cells divide and grow out of control. As the cancer advances it invades other parts of the body spreading to nearby tissues or moving through the blood or lymphatic system.
How cancer is named: The location where the cancer originates dictates the name of the cancer

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Secondary Problems related to Cancer Treatment 

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Secondary Problems related to Cancer Treatment 

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Surgery complications include pain, collapsed lungs, blood clots, fatigue, muscle atrophy, anesthesia effects, confusion or delirium and infection.
Chemotherapy effects include nausea, vomiting, loss of appetite, hair loss, mouth sores, low blood cell counts that increase risks for infections, bleeding, bruising or anemia.
Radiation effects include skin irritation and fatigue.

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In situ: early cancer that is present only in the layer of cells in which it began

Localized: cancer that is limited to the organ in which it began, without evidence of spreading

Regional: cancer that has spread beyond the original (primary) site to nearby lymph nodes or organs and tissues

Distant: cancer that has spread from the primary site to distant organs or distant lymph nodes

Unknown: describes cases for which there is not enough information to indicate a stage

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Chronic Obstructive Pulmonary DIsease (COPD) is a condition that makes it difficult to breathe.

Two Types:
Chronic Bronchitis: Chronic inflammation of the bronchial tubes with an increase in mucus secreting cells. This mucus obstructs the bronchioles, which makes it difficult to breathe in and out. The person coughs or trys to clear the mucus and becomes short of breath with exertion. Smoking is the most common cause
Emphysema: The walls of the alveoli begin to  break down and the lung loses its elasticity. Instead of having many small alveoli, only a few large air sacs remain.
Chronic bronchitis is often the cause of this

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The primary cause of COPD is smoking- approximately 85-90% of all COPD cases

Only a small proportion develop COPD from air allergens such as prolonged exposure to fumes, chemicals, or secondhand smoke

In rare cases it can be caused by alpha 1 antitrypsin deficiency, which is a gene-related disorder in which low levels of alpha 1 antitrypsin lead to deterioration of the lung

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Limited work and  physical  availability, household chores, social activities, sleeping and family activities

More prone to respiratory infections, pulmonary hypertension, heart problems, lung cancer, and depression

Poor nutrition, poor muscle strength and endurance, skeletal disease such as decreased bone density, psychosocial issues including anxiety, learned helplessness, loss of internal locus of control, and sensory problems

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RA is a chronic disease that involves inflammation of the lining (synovium) of the joints, causing joint damage, chronic pain, loss of function, and possibly permanent disability.
Is considered an autoimmune disorder, since the body attacks its own tissues.

3 Stages of RA:
1) Swelling of the synovial lining, causing pain, warmth, stiffness, redness, and swelling around the joint
2) Rapid division and growth of cells, which causes the synovium to thicken
3) The inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment leading to increased pain and loss of movement

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Possible Causes of Rheumatoid Arthritis 

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Possible Causes of Rheumatoid Arthritis 

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The exact cause of RA is still unknown, however, through research three factors have been found.

Genetic factors: Specific genes may play a role in whether a person develops RA and how severe the disease will become. HOwever, some clients possess these genes and don't develop RA.

Environmental factors: It is believed that an environmental factor such as a virus, bacterium, or mycobacterium may trigger the disease process. However, the exact agent is unknown.

Hormones: Deficiencies or changes in certain hormones may promote the development of RA in genetically susceptible clients who have been exposed to an environmental triggering agent.

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Systems Affected by Rheumatoid Arthritis 

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Systems Affected by Rheumatoid Arthritis 

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Musculoskeletal system is primarily affected, though sensory changes, involvement of other other organs, lower energy levels, and psychological issues may also be present

The wrist and finger joints closest to the hand, as well as neck, shoulders, elows, hips, knees, ankles, and feet

symmetrical pattern (both sides are affected)

Anemia: decrease in normal numbers of red blood cells. May impact the ability to use iron and produce RBC.

Depression: Most people with RA experience depression, anxiety, and/or feelings of hopelessness

Fatigue: May be the first sign of inflammation in the joints and of the most common symptoms of RA

Functional limitations: 40% report very difficult or cannot do at least one of nine important daily functional activities. Severe limitations in abilities to stoop, bend, or kneel, and walk.

Impaired range of motion:  The joints that are most affected are in the hands, wrists, feet, ankles, shoulders and elbows.

Inflammation: Joint inflammation which can done and ends of the bones

Joint deformity: Commonly seen in the fingers, which impacts grip, strength and hand function

Malaise: Feeling of illness associated with nearly all infections, metabolic or systemic diseases

Neck pain: RA may cause neck pain and stiffness which may radiate into the arms, causing numbness and weakness in the arms and hands

Rheumatoid nodules: bumps under the skin that often form close to the joints affect 1/4 of people with RA. These may be painful and interfere with daily life, put pressure on nerves, limit movement, or affect organ function

Fever: occasionally

Dry eyes and mouth: a less common symptom

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Secondary Problems of Rheumatoid Arthritis 

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Secondary Problems of Rheumatoid Arthritis 

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Bone loss: women are at an increased risk of bone loss with RA. Medications for RA can cause bone loss

Cardiopulmonary endurance: decreased involvement in cardiopulmonary conditioning due to the primary symptoms (pain, stiffness, limited ROM), and secondary symptoms (fatigue, depression) often results in this

Muscle atrophy: loss of muscle strength due to decreased activity

Life tasks: joints become tender and painful after excessive use, impacting one's ability to perform these

Psychological changes: depresion, anxiety, and feelings of helplessness

Sexual dysfunction: pain, limited ROM, resultant inflammation from activity, limited endurance, and psychological changes can affect desire to perform in sexual activity

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Epilepsy is a medical condition that affects brain neurons and causes abnormal signals which may be caused by an imbalance of neurotransmitters or defects in the connections between neurons in the brain. These abnormal signals cause brief, strong surges of electrical activity that affect the brain which is called a seizure.
Seizures can last from a few seconds- a few minutes. Having a seizure does not mean one has epilepsy. Two or more unprovoked seizures is the criteria for epilepsy

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Focal Seizures vs. Generalized Seizures 

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Focal Seizures vs. Generalized Seizures 

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Focal: partial seizures beginning in localized areas of the brain

Simple focal- remain conscious but experience unusual feelings or sensations.

Complex focal- experience altered consciousness, in which they may experience a dreamlike experience that lasts only a few seconds

Generalized: result of abnormal neuronal activity that occurs in more than one area of the brain

absence- momentary loss of consciousness of just a few seconds usually with no other symptoms. Muscles seem to jerk and twitch and may stare into space

Tonic- cause stiffening of the back, leg, and arm muscles

Clonic- repetitive, rhythmic jerks that involve both sides of the body at the same time

Myoclonic- jerks or twitches of the upper body, arms or legs

Atonic- loss or normal muscle tone- falling

Tonic-clonic-

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Potentially life threatening condition in which a person either has an abnormally prolonged seizure or does not fully regain consciousness between seizures. Prolonged seizures are 5+ minutes

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https://www.ted.com/talks/sitawa_wafula_why_i_speak_up_about_living_with_epilepsy/details?language=en#t-497347

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Fibromyalgia and Juvenile Fibromyalgia definitions 

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Fibromyalgia and Juvenile Fibromyalgia definitions 

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According to U.S. Department of Health & Human Services (2017), fibromyalgia (FM), or abnormal abnormal pain processing, "is a condition that causes pain that is felt all over the body- widespread pain, sleep disturbances, fatigue, and occasionally mental and emotional distress. This condition also causes individuals with FM to be more sensitive to pain."

According to Porter (2015), juvenile fibromyalgia (JFM), or "diffuse idiopathic pain syndrome (DIPS), or amplified musculoskeletal pain syndrome (AMPS) is fibromyalgia (FM) in children. The symptoms of JFM are different from FM since they present differently and can't be measured using adult FM assessment tools. Pain may start in localized areas of the body, then intensify and radiate to other areas. Children with JFM often are reluctant to move due to constant pain and discomfort. This may result in muscle spasms, abnormal posture and gait, and reduced fitness.

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Causes, Signs, Symptoms, and General Information 

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Causes, Signs, Symptoms, and General Information 

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Causes:
According to  U.S. Department of Health & Human Services (2017), "the cause of fibromyalgia is unknown- however, it can be treated and managed".
According to Porter (2015), "the cause of juvenile fibromyalgia is also unknown- however, pediatric chronic pain is commonly thought to be related to illness, injury, psychological distress, genetics, developmental influences, and environmental factors."
Signs/Symptoms:
According to Porter (2015), FM has symptoms of:

widespread pain for at least 3 months

pain and tenderness in at least 7 of 19 body areas

tender points the size of a quarter when pressure is applied

sleep disturbances

anxiety and depression

cognitive problems

irritable bowel syndrome

other muscle and nerve dysfunctions

According to Porter (2015), JFM has symptoms of:

localized pain that radiates to other areas

reluctance/avoidance to move

discomfort and pain that increases and may become constant

muscle spasms

abnormal posture and gait

reduced fitness

General Information:
According to Porter (2015), "FM affects approximately 80% of adults, with women being 7x more likely to develop FM than males. The prevalence of JFM has not been determined, however, research has shown approximately 30% of children experience pain that lasts more than 6 months.

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Treatment
According to Porter (2015), it is recommended that when treating FM, " multidisciplinary treatment approaches are recommended to help relieve pain and symptoms, including how to cope. Treatments may include:

pharmacotherapy: antidepressants, muscle relaxants, pain relievers, sleeping aids

aerobic exercise

muscle strengthening exercises

education and relaxation therapy

support groups and cognitive behavioral therapy

massage

movement therapies

chiropractic treatment

water therapy

deep breathing

aromatherapy

biofeedback

acupressure or acupuncture

Treatment interventions for JFM focus on management of symptoms and psychosocial rehabilitation through:

education about anatomy and physiology of JFM to reduce fear

pharmacotherapy

psychological therapy

habit reversal

attention-based therapies

engagement of life activities

exercise

coping strategies."

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According to Porter (2015), secondary problems of FM "vary greatly depending on the severity of the symptoms, but may include:

profound fatigue

sleep disturbances

unrelated pain

anxiety and depression

"fibro-fog"- cognitive problems such as confusion, lapses in memory, word-finding problems, word/name mix-ups, and difficulty concentrating

irritable bowel syndrome

morning stiffness

tingling/numbness in hands and feet

migraine and tension headaches

restless leg syndrome

temperature, light, and sound sensitivity

painful menstruation

In addition, secondary problems of JFM may include:

hypervigilance and hypersensitivity:  heightened awareness of pain and fear of touch

perceived thermodysregulation: limbs may be cool and mottled, or red and hot to touch

autonomic dysfunction: continuous pain signals,  compromised mobility, fatigue, emotional anxiety, cold sweats, hyperventilation, blurred vision, abdominal pain, nausea, dizziness or vertigo and feeling faint

musculoskeletal disequilibrium: holding certain positions that are more comfortable due to pain

fatigue

poor sleep patterns

low moods

may impact social life, education, sleep, fitness, independence, moods, appetite, eating, and family."

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According to U.S. Department of Health & Human Services (2017), "FM and JFM fall under the arthritis diagnostic family, but is not truly a form of arthritis.
In order to improve your quality of life with these conditions, they recommend to get physically active, go to recommended physical activity programs, and joining self-management education classes."

TR approaches for treating FM and JFM were discussed in the textbook. Porter (2015), suggests the following TR approaches:

"making lifestyle changes that affect the severity of the symptoms

working on finding activities that the client enjoys to promote healthy exercise and active participation in social and community life

providing techniques to help the client cope with and manage pain

alleviating relationship and support issues."

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Textbook:

Porter, H. R. (2015). Chapter 14: Fibromyalgia and Juvenile Fibromyalgia Recreational therapy for specific diagnoses and conditions (153-159). Enumclaw, WA: Idyll Arbor, Inc.

Online resources:
U.S. Department of Health & Human Services. (2017, October 11). Fibromyalgia | Arthritis | CDC. Retrieved December 14, 2018, from https://www.cdc.gov/arthritis/basics/fibromyalgia.htm