Insulin deficiency

5% to 10% of all diabetes

insulin dependent or juvinile onset

autoimmune response that destroy insulin producing cells (beta cells) 

genetic predisposition w/environment; diet, infection, toxins 

adult onset 

non-insulin dependent

genetic predisposition

obesity in 80% to 20% high abdominal fat 

Incidence and prevalence 

(diabetes) 

under 18  (15,000 in 2002 type I; 3,700 Type II)

Adult (1.6 million in 2006; 8% of the US population) 

Polydipsia 

Polyuria

Polyphagia

Blurred vision

weakness

fatigue

dizziness

Muscle cramps

irritability

emotional liability 

headaches 

anxiety attack

abdominal pain and GI upset

Ketonuria

Skin, gum and bladder infections

slow healing 

numbness or tingling in hands or feet 

hypertebsion

cardiovascular disease

cerebrovascular disease

peripheral artery disease

micro vascular complications

diabetic retinopathy 

diabetic nephropathy 

weight bearing

sensory polyneuropathy - diminished pain and teperature

poor healing 

dry, cracked skin (autonomic neuropathy) 

50-75% LE amputation in the US 

common in diabetes

-gingivitis

-periodontitis  

neuromuscular disorder 

progressive muscular weakness, defects in muscle protein and wasting of muscles

-lack or absence of dystrophin 

X-linked

most common

delayed motor development

proximal weakness

increased fatigue

development of contractures  

characteristic of Duchenne MD 

indentation behind the shoulder;dorsal surface

X-linked

similar to Duchennes but slower progression

Gower's Maneuver 

indicates weakness in LE. 

characterized by using hands and arms to walk up your body from squatting position 

Autosomal dominant inherited disorder 

male/female

muscle wasting

delayed relaxation

locking up of muscle

GI, vision, heart and respiratory system

cognative impairments 

3rd most common 

autosomal dominant 

winged scapula 

less common

muscle contractures before weakness

heel cord tightness

muscular rigidity 

Blood work

electromyographyt

muscle biopsy 

respiratory maintenance 

skin integrity 

pain

nutrition 

drugs - corticosteroids 

1.5 million have ABI

80,000 have disabilities due to ABI

50,000 die because of ABI 

Insult to the brain from an external source

does not include degenerative or congenital factors

blunt objects, bullets, falling, MVA 

nontraumatic - drug overdose, carbon manoxide poisoning, anoxia, meningitis 

Primary - at time of injury

secondary - occuring days to weeks after injury

Focal brain injury - coup/countre coup

Epidural Hematomas (EDH) disruption of meningeal arteries

subdural hematomas (SDH) between dura and brain tissue - spread across entire hemisphere of brain

coup: under the site of impact with an object 

countre coup: on the opposite side of the area that was impacted 

adequate airways and stabilize blood pressure

CT and look for hematomas

Optimize brain tissue oxygenation, minimize brain swelling and maintain basic life fuctions 

Severe- loss of consciousness longer than 6 hours; Glasgow Coma Scale of 8 or less 

moderate - initial Glasgow of 9 -12

Mild - Trauma-induced disruption of brain function (loss of consciousness, pre post amnesia, alteration in mental state, Glasgow of 13-15 

Eyes opening

spontaneous 4

to speech 3

to pain 2

nil 1

Best Motor response

Obeys 6

Localizes 5 

Withdraws 4

Motor 

Abnormal Flexion 3

Extensor response 2

nil 1

Verbal response 

oriented 5

confused conversation 4

inappropriate words 3

incomprehensible sounds 2

nil 1

Capacity for environmental interaction 

responses are inconsistent 

Very Mild  (less than 5 minutes) 

Mild  (5-60 minutes)

Moderate (1-24 hours) 

 severe (1-7 days) 

very severe (1-4 weeks) 

extremely severe (>4)

I (no response)

II (generalized response)

III (localized response)

IV (confused, agitated)

V (confused-inappropriate, some response to simple commands)

VI (confused-appropriate, response more goal directed but cues necessary)

VII (automatic-appropriate, judgement and problem solving skills lacking)

VIII ( purposeful appropriate response, needs assistance to acknowledge other people's needs)

IX (purposeful-appropriate but needs cues to anticipate problems and adjust performance 

X (modified independent) responds to multipule tasks but may need more time or breaks 

no awareness of self or the environment

-no sustained reproducible, or voluntary behavioral responses

diagnosed within 1 month

can improve w/some individuals regaining some consciousness

-recovery of consciousness is rare for individuals in a persistive vegetative state 12 months after insult (permanent) 

Clearly discernible, reproducible behavior in

-ability to follow commands

-gestural or verbal yes/no responses

-intelligible verbalization

-purposeful movemenbt or affective responses. 

UE spastic flextion, LE in spastic extended position 

- damage to the cerebral hemispheres, internal capsule, thalamus 

UE and LE in spastic extension, adduction and internal rotation

-damage to the brain stem, midbrain, red nucleus 

Loewenstein OT cognitive assessment (LOTCA)

Cognative Assesment of Minnesota Level IV and above 

COGNISTAT 

galveston orientation and amnesia test

letter cancellation tests - attention

rivermead behavioral memory test

contextual memory test

Toglia category test 

Thermal

Chemical

Electric 

Previously 1st degree, 2nd degree, 3rd degree

now called 

superficial

superficial partial thickness

deep partial thickness

full thickness 

epidermis only

painful and red

spontaneous recovery within 7 days 

epidermis and upper level of dermis

characterized by blisters

painful

spontaneous healing in 7-12 days

epidermis and deep dermal layer 

blotchy in color with white 

painful with diminished light touch 

slow healing 3 to 5 weeks 

chance of converting to a full thickness burn 

epidermis and dermis destroyed 

appear white and waxy 

no pain 

must be skin grafted

percentage of total body burns 

(rule of nines) 

leg  18% 

arm 9%

torso 36% 

head 9%

genitalia 1% 

emergent phase of burn management

-initial 72 hours 

GOALS

stabilize patient 

fluids

manage breathing 

escharotomy and fasciotomy 

infection control 

(burned tissue) 

and foscia do not expand to compensate for severe swelling of limb or torso

-may reduce blood flow 

- constrict movement 

ointments to protect wound from infection

(burns) 

sulfamylon

silvadene

0.5% silver nitrate solution 

Autographs 

(burn) 

xenographs (bovine skin)

allografts (cadaver skin)  or manufactured 

Role of OT during acute phase 

(burns) 

ADL - adaptations 

splinting and positioning 

exercise - A/PROM 

perioperative care (5-10 days post graft) 

-immobilization of surgical area

-ROM contraindicated 

tubigrip, elastic bandages, coban 

-jobst garment (25mm pressure for scar organization, used when wounds are dime sized or less)

inserts (facial splints, elastomere)

burn of underlying tissue 

may result in amputation

may destroy nerves or muscles 

Arm - 9%

head and neck - 18% 

anterior trunk - 18%

posterior trunk - 18% 

leg - 14% 

Immunologic and neurodegenerative disease 

-chronic inflammation and diffuse demyelination 

-reduced axonal conductivity 

-genetic, viral, environmental causes suspected 

1% of the population

Location and sex - northern temperate zones and female.

caucasian most affected 

Visual deficits 

paresthesia 

muscle weakness

gross and fine motor incoordination

LE ataxia 

dysphagia, dysarthria

vestibular dysfunction

cognitive and emotional problems 

beginning - 1 or 2 episodes with no continuation

-relapsing ---remitting--- nonprogressive 

-relapsing---remitting---progressive 

progressive 

-modified fatigue impact scale

-cognative screening

-vision evaluation

-Beck Depression scale

-dysphagia assessment 

-manual dexterity 

-spasticity 

-vestibular evaluation 

decrease prolonged standing 

-energy conservation

-body temperature and increased fatiue 

shift important activities to morning

adaptive equipment

seating systems 

depigmentation of the substantia nigra and the presence of Lewy bodies 

-decrease in dopamine leads to deficits in the speed and quality of motor movement, postural stability and cognative skills. 

55-60 years of age 

-1% of the population

Tremors, rigidity, bradykinesia

swallowing problems 

-festinating gait

-pill rolling tremors and at rest tremors

micrographia

cognative impairments

poor balance

psychosocial issues

dexterity and corrdination difficulties 

Genetic, environmental

-no known cause 

Destruction of dopaminergic neuronal cells in the substantia nigra

depletion of dopamine stores

imbalance of excitatory and inhibitory neurotransmitters

extra pyramidla tracts (tremors, rigidity, bradykinesia, postural changes)

Lou Gehrig's disease 

-scars on neuron of corticospinal pathways, motor nuclei of brainstem, anterior horn cells

progressive manual muscle weakness 

spasticity, speaking and swallowing 

2-5 year survival rate 

bulbar nerve involvement 

hyperreflexia, muscle atrophy 

not degenerative 

demyelination of peripheral nerves

90% have few residual symptoms 

muscle weakness and mild sensory loss 

Viral infections resulting in flaccid paralysis of the spinal muscles or muscle enervated by the cranial nerves

-post polio is thorugh to result from failure of oversized motor units created during the recovery process  

interference of neuromuscular junction

-skeletal, primarily cranial nerves, muscles are affected

begins with ptosis or diplopia

difficulty with chewing, swallowing and speaking 

Autoimmune disorder that primarily affects the joints but may affect major organs 

-characterized by (morning stiffness, symmetrical polyarticular joint pain and inflammation of synovial membrane) 

Stage 1 (early, no distructive changes)

Stage 2 (moderate, osteoporosis, no joint deformity, mm atrophy)

Stage 3 (severe, bone joint and mm changes)

Stage 4 ( terminal, fibrous or bony ankylosis) 

MCP and PIP 

metatarsalphalangeal joints

wrists and elbows

knees and hip

shoulders

DIP

thumb 

Onset prior to 16 

persistent arthritis for 6 weeks 

Ulnar drift splint 

RHS

Figure 8 splints

Thumb spica splint 

Affects articular cartilage and bone

due to repetitive impact to joints

-knees, hips, thump, spine, DIP 

systemic inflammation disease characterized by small vessel vasculitis 

(fever, rash, alopecia, pericarditis, Raynaud's phenomenon, pleurisy, nephritis) 

1 in 6 (17%) of adults age 45 and older (13.5 mil.) 

15% 45-64

17% 65-74

26% 75 and older 

WHO definition: best corrected visual acuity les than 6/120 (20/600) in the better seeing eye

US definition: best corrected vision 6/60 or worse (20/200) in the better seeing eye 

or 

peripheral vision field restricted to 20 degrees or less 

in 2000 ( 937,000 blind Americans older than 40, 0.78%)

2,400,000 with low vision (1.98%) 

3.3 million Americans age 40 or more with a visual impairment 

opacity or clouding of the lens 

-trauma, hereditary factors, birth defects or diabetes 

due to normal agind (50% of americans between 65 and 74, 70% over the age of 75 

smokers - 60% increase

cornea is prone to dystrophies, deposition, non inflammatory progressive thinning, infection, viral diseases and trauma. 

(severe glare, cloudy vision, reduced acuity) 

degenerative changes in the macular area of the retina (atrophy, hemorrage, exudates, fibrovascular scare, cysts) 

-visual distortions, decrease in color recognition, loss of contrast 

5,000 new cases of blindness each year 

-those with diabetes have 25x greater risk of blindness 

-40% of ppl with diabetes have diabetic retinopathy

distruction of the peripheral retina 

a progressive eye disease that affects the pigmentary layer of the retina 

-affects periphery or midperiphery 

-most common cause of inherited blindness

-30% of people with RP also have some hearing loss 

caused by walled bacterium

-spread through sputum or coughing

3.8 per 100,000 ppl

fever, weight loss, night sweats

coughing, chest pain 

TB tests (skin test, Xray, quantiFERON-TB Gold blood test) 

Rx - long term antibiotics 

1 million in US, 38 Million world wide

1 in 5 unaware of status 

Cat. 1 (CD4 + 500 or more)

Cat. 2 (CD4 + 200 to 499)

Cat. 3 (CD4 + less than 200) 

A (lympadenopathy)

B (fever, diarrhea, herpes zoster, peripheral neuropathy)

C (AIDS defining illness) 

NNRTI (blocks transcriptase which makes compies of itself)

Fusion inhibitors (blocks HIV from entering cells

Protease inhibitors Pls (block protease which is needed by the virus to make copies 

HAART 

Primary (reduces risks of getting the disease) 

Secondary (prevents complications)

tertiary (deal with problems that occur secondary to the disease) 

UE heal in 4-6 weeks

LE heal in 8-12 weeks 

Stage 1 - burning pain

Stage 2 - pain increases if left untreated

stage 3 - pain may subside *glossy and pale hand, severe osteoporosis 

10,000 spinal cord injuries a year

200,000 living with SCI 

22% falls or hit by object

19% violence 

11% sports 

43% MVA

5% other 

A (Complete)

B( sensation inact, motor loss)

C (some motor function, 1/2 the mm are grade 3 or less) 

D (motor function is spared, 1/2 mm greater than grade 3)

E (motor and sensation is intact)

T6 and above 

-sudden dangerous increase in blood pressure 

-headache and sweating main symptoms) 

-UTI, distended bladder, pressure sores 

usually occurs at 6 mo after injury