Deep Vein Thrombosis and Thrombophlebitis: Signs and Symptoms
During the early stages of a DVT, only 25% to 50% of cases can be identified by clinical manifestations, such as dull aching or severe pain, swelling, or changes in skin temperature and color, specifically heat and redness.
Although edema in the vicinity of the clot may be present, […]

Just as arterial disorders of the extremities can be acute or chronic, so can venous disorders. Therapeutic exercise is one aspect of management of patients with an acute disease, such as thrombophlebitis, or a chronic disorder, such as varicose veins or chronic venous insufficiency.
Types of Venous Disorders
Thrombophlebitis and Deep Vein Thrombosis
Thrombophlebitis is a disorder typically […]

Rationale for Graded Exercise
The following factors related to the body’s normal response to exercise are the basis for using a graded exercise program to improve the functional status of patients with chronic arterial insufficiency.
· Blood flow temporarily decreases during active contraction of a muscle, but the blood flow rapidly increases immediately after the contraction.
· After […]

Except with advanced disease, chronic arterial insufficiency caused, for example, by ASO or Raynaud’s disease is managed conservatively by medical and physical means and does not constitute a medical or surgical emergency.
Medical/Surgical Management
Medical management of chronic arterial insufficiency must be ongoing. Related medical disorders must be identified and treated. Diabetes and hypertension are commonly associated […]

Acute arterial occlusion often is a medical or surgical emergency. The resulting ischemia causes severe pain, the risk of tissue necrosis and local or systemic infection, and the possible need for amputation. The viability of the limb depends on the location and extent of the occlusion and the availability of collateral circulation.
Medical or surgical measures […]

· Palpation and comparison of pulses in the involved and uninvolved upper or lower extremities
· Skin temperature
· Skin integrity and pigmentation
· Tests for reactive hyperemia (rubor of dependence)
· Claudication time
· Ultrasonography, Doppler measurement of blood flow, transcutaneous oximetry
· Magnetic resonance angiography
· Arteriography
Skin Integrity and Pigmentation
Diminished or absent arterial blood flow to an extremity causes trophic […]

A comprehensive examination of a patient with known or suspected peripheral arterial disease is necessary to determine or verify the etiology of a patient’s impairments and functional limitations. For example, the origin of a patient’s buttock and leg pain or lower extremity weakness could be caused by vascular or neuromuscular pathologies.The initial and subsequent examinations […]

The following signs and symptoms are associated with peripheral arterial disorders.
Diminished or Absent Peripheral Pulses
The more occluded or restricted the arterial blood flow and the more diminished the peripheral pulses, the more severe or advanced is the arterial disease. If the collateral circulation is extensive, the patient may not experience pain despite diminished pulses.
Integumentary Changes
A […]

Types of Arterial Disorders
Acute Arterial Occlusion
A thrombus (blood clot), embolism, or trauma can cause acute loss of blood flow to peripheral arteries. The most common location of an arterial embolus is at the femoral popliteal bifurcation, although an embolus can occur at other arterial bifurcations in the extremities. Crush injuries to the vessels of the […]

Vascular disorders causing insufficient circulation to the extremities, can result in significant physical impairments and subsequent loss of function of either the upper or lower extremities. Disturbances of structure or function of the circulatory systems are broadly classified as acute or chronic peripheral vascular disease (PVD) and can be caused by a number of underlying […]

Nerve injuries are classified using either the Seddon or Sunderland classification systems; both are based on structural and functional changes that occur in the nerve with various degrees of damage. These systems describe the degree of injury to nerve substructures and the effect on prognosis. Seddon’s system describes three levels of pathology: neuropraxia, axonotmesis, and […]

Nerve Injury and Recovery
Peripheral nerve injury may result in motor, sensory, and/or sympathetic impairments. In addition, pain may be a symptom of nerve tension or compression because the connective tissue and vascular structures surrounding and in the peripheral nerves are innervated and the peripheral nerve function is sensitive to hypoxic states. Knowing the mechanism of […]

The plantar and calcaneal nerves may become entrapped as they turn under the medial aspect of the foot and pass through openings in the abductor hallucis muscle, especially with overpronation of the foot, which stresses the nerves against the fibrous-edged openings in the muscle. Symptoms elicited are similar to acute foot strain (tenderness at the […]

The lumbosacral plexus terminates in three primary peripheral nerves, which are responsible for innervating the tissues of the lower extremity. They are the femoral and obturator nerves from the lumbar plexus and the sciatic nerve from the sacral plexus.
Femoral Nerve: L2-4
The femoral nerve arises from the three posterior divisions of the lumbar plexus. It emerges […]

The brachial plexus terminates in five primary peripheral nerves that are responsible for innervating the tissues of the upper extremity: musculocutaneous, axillary, median, ulnar, and radial nerves. Common sites for compression or tension injuries for each of the nerves are described in this section.
Axillary Nerve: C5,6
The axillary nerve emerges from the posterior cord of the […]

Injury to the nerves of the peripheral nervous system can occur anywhere along the pathway from the nerve roots to their termination in the tissues of the trunk and extremities. As each nerve courses from the intervertebral foramina to its peripheral destination, there are sites that increase its susceptibility to either tension or compression. Symptoms […]

Therapeutic exercise and related manual therapy techniques would not be possible without the nervous system and all its components activating, controlling, and modifying the motor system responses as well as receiving and interpreting feedback from the variety of sensory receptors throughout the body. Because of their intimate proximity to all the structures in the trunk […]

Many factors contribute to a patient’s postoperative impairments, any one of which influences postoperative management. A patient who has undergone thoracotomy for a pulmonary or cardiac condition typically is hospitalized for a week or less.  Therapeutic interventions begin on the first postoperative day and include breathing and coughing exercises, shoulder ROM, posture awareness training, and […]

Restrictive pulmonary disorders are characterized by the inability of the lungs to expand fully as a result of extrapulmonary and/or pulmonary disease or restriction. In other words, the patient has difficulty taking in a deep breath.
Acute and Chronic Causes of Restrictive Pulmonary Disorders
There are a variety of acute or chronic disorders directly involving structures of […]

Chronic obstructive pulmonary disease is a broad term encompassing a number of chronic pulmonary conditions, all of which obstruct the flow of air in the conducting airways of the lower respiratory tract and alter ventilation and gas exchange. Although a variety of pulmonary diseases are classified as obstructive in nature, each disease has its unique […]

Some patients who require postural drainage cannot assume or cannot tolerate the positions optimal for postural drainage. For example, a patient with congestive heart failure may exhibit indications of orthopnea (shortness of breath while lying flat). After neurosurgery a patient may not be allowed to assume a head-down (Trendelenburg) position because this position causes increased […]

Positions for postural drainage are based on the anatomy of the lungs and the tracheobronchial tree.
RIGHT AND LEFT LOWER LOBES
The patient may be positioned on a postural drainage table that can be elevated at one end, a tilt table, a reinforced padded table with a lift, or a hospital bed. A small child can be […]

Postural drainage (bronchial drainage), another intervention for airway clearance, is a means of mobilizing secretions in one or more lung segments to the central airways by placing the patient in various positions so gravity assists in the drainage process. When secretions are moved from the smaller to the larger airways, they are then cleared by […]

An effective cough is necessary to eliminate respiratory obstructions and keep the lungs clear. Airway clearance is an important part of management of patients with acute or chronic respiratory conditions.
The Normal Cough Pump
A cough may be reflexive or voluntary. When a person coughs, a series of actions occurs Under normal conditions, the cough pump is […]

Chest mobilization exercises are any exercises that combine active movements of the trunk or extremities with deep breathing.21,60 They are designed to maintain or improve mobility of the chest wall, trunk, and shoulder girdles when it affects ventilation or postural alignment. For example, a patient with hypomobility of the trunk muscles on one side of […]

Inspiratory resistance training, using pressure- or flow-based devices to provide resistance to airflow, is designed to improve the strength and endurance of the muscles of inspiration and decrease the occurrence of inspiratory muscle fatigue. This technique has been studied in patients with acute and chronic, primary and secondary pulmonary disorders, including COPD, cystic fibrosis, respiratory […]

Positive expiratory pressure breathing is a technique in which resistance to airflow is applied during exhalation, similar to what occurs during pursed-lip breathing, except that the patient breathes through a specially designed mouthpiece or mask that controls resistance to airflow. This breathing technique is used to hold airways open during exhalation to mobilize accumulated secretions […]

Many patients with COPD (e.g., emphysema and asthma) may suffer from periodic episodes of dyspnea (shortness of breath), particularly with physical exertion or when in contact with allergens. Whenever a patient’s normal breathing pattern is interrupted, shortness of breath can occur. It is helpful to teach a patient how to monitor his or her level […]

Breathing exercises and ventilatory training are fundamental interventions for the prevention or comprehensive management of impairments related to acute or chronic pulmonary disorders. For example, these interventions are frequently advocated in the literature for patients with COPD (chronic bronchitis, emphysema, asthma) or cystic fibrosis, for patients with a high spinal cord lesion, for patients who […]

Breath sounds are classified by location, pitch, and intensity as well as the ratio of sounds heard on inspiration versus those heard on expiration. Breath sounds also are identified as normal or adventitious (extra).
Normal breath sounds occur in the absence of pathology and are heard predominantly during inspiration. Normal breath sounds are categorized as vesicular, […]