All exercise programs for high-risk populations should be individually established based on diagnosis, limitations, physical therapy examination and evaluation, and consultation with the physician. Activities must address patient needs but should not further complicate the condition.
Develop good rapport with the patient and instill trust. Closely monitor the patient during all activities; re-evaluate her after each […]

Potential Impairments and Functional Limitations:
Risk of pulmonary or vascular complications
Postsurgical pain and discomfort
Development of adhesions at incisional site
Faulty posture
Pelvic floor dysfunction
  • urinary or fecal incontinence
  • organ prolapse
  • hypertonus
  • poor proprioceptive awareness and disuse atrophy
Abdominal weakness, diastasis recti
Coughing or Huffing
Coughing is difficult because of incisional pain. An alternative is huffing. A huff […]

Management
Early Intervention
It is a progressive disorder unless vigorous intervention is used during the acute stage. The best intervention is prevention when it is recognized that development of CRPS type I (RSD) is a possibility, such as when there has been trauma to the extremity or when the extremity is immobilized. It requires that the therapist […]

Protect the nerve
• Splint wrist in neutral
• Protect areas in decreased sensitivity
Modify activity and educate the patient
• Teach patient about provoking activities and how to modify them
• Teach safe exercises for home exercise program
• Teach patient how to protect areas of decreased sensitivity in the hand
Mobilize restricted joints, connective tissue, and muscle/tendon
• Mobilize carpals if […]

Suggest that your patients discuss with their physicians any guidelines or restrictions to exercise before engaging in an exercise program, either in a class or on a one-to-one basis. As always, follow your state practice act for physical therapy regarding referral, evaluation, and treatment.
Examination. Individually examine each woman before participation to screen for pre-existing musculoskeletal […]

Educate the patient
• Teach posture correction
• Teach how to modify provoking stresses
• Teach safe exercises for home exercise program
Correct impaired posture
Mobilize restricted neurological tissue
• Nerve mobilization techniques if testing is positive for restricted mobility
Mobilize restricted joints, connective tissue, and muscle
• Tissue-specific manual techniques to restricted structures if testing is positive for restricted mobility
• Self-stretching exercises […]

Potential Impairments and Functional Limitations
Stress, pain, and muscle imbalances from faulty postures
Poor body mechanics; related to lack of knowledge, changing body size and caring for growing child
Lower extremity edema and discomfort from altered circulation, varicose veins
Pelvic floor dysfunction
• urinary or fecal incontinence
• organ prolapse
• hypertonus
• poor episiotomy healing
• poor proprioceptive awareness and disuse atrophy
Abdominal muscle […]

Butler proposed that symptoms are the result of tension being placed on some component of the nervous system. If compression is preventing normal mobility, tension signs occur when the nerve is stressed either proximal or distal to the site of compression. Restriction of movement can be from inflammation and scarring between the nerve and the […]

In general, recovery from nerve injury can be viewed as occurring in three phases.
• Acute phase: This is early after injury or after surgery, when the emphasis is on healing and prevention of complications.
• Recovery phase: This is when reinnervation occurs. Emphasis is on retraining and re-education.
• Chronic phase: This occurs when the potential for […]

Postoperative rehabilitation is often a lengthy process. Given the limited number of justifiable therapy sessions available for postoperative management, it is highly unlikely for a therapist to have direct, ongoing contact with a patient through all phases of a rehabilitation program. Consequently, the key to successful postoperative outcomes is effective self-management that includes therapist-directed perioperative […]

Postoperative pain because of disruption of soft tissue
Postoperative swelling
Potential circulatory and pulmonary complications
Joint stiffness or limitation of motion because of injury to soft tissue and necessary postoperative immobilization
Muscle atrophy because of immobilization
Loss of strength for functional activities
Limitation of weight bearing
Potential loss of strength and mobility in unoperated joints
Time-Based and Criterion-Based Progression
Time frames for each phase […]

Every individually designed postoperative rehabilitation program must be based on initial and ongoing examinations of a patient. In addition to the components of a preoperative examination noted previously in this section, an assessment of integumentary integrity is important after surgery. The incision should be inspected before and after each exercise session to identify any evidence […]

Although surgical intervention can correct or reduce adverse effects and impairments (e.g., pain, deformity, instability) associated with musculoskeletal pathology, a carefully planned and progressed rehabilitation program is essential for a patient to achieve optimal functional outcomes after surgery. In an ideal situation, rehabilitation begins with patient education before surgery and continues after surgery with direct […]

An array of injuries, diseases, and disorders of the musculoskeletal system that affect muscles, tendons, ligaments, cartilage, fascia, joint capsules, or bones can cause impairment of the upper or lower extremities or the spine, resulting in functional limitation and disability to such an extent that surgical intervention is required. Ideally, surgery is preceded by a […]

The guidelines identify therapeutic interventions for common impairments during the early postoperative period and those that could develop at a later time.
Special Considerations
Patient education. The length of stay for patients after surgery for breast cancer is short. Therefore, direct intervention by a therapist starts on the first postoperative day with an emphasis on patient education […]

If a patient is at risk of developing lymphedema secondary to infection, inflammation, obstruction, surgical removal of lymphatic structures, or chronic venous insufficiency, prevention of lymphedema should be the priority of patient management. In some situations, such as after removal of lymph nodes or vessels, preventive measures may be needed for a lifetime. Even when […]

Patient education is fundamental in the management of chronic venous insufficiency and varicose veins. A patient must be advised on how to prevent dependent edema, skin ulceration, and infections. The therapist may be involved in (1) measuring and fitting a patient for a pressure-gradient support garment; (2) teaching the patient how to put on the […]

Impairments
Dull ache or pain usually in the calf
Tenderness, warmth, and swelling with palpation
Prevention of Deep Vein Thrombosis and Thrombophlebitis
Every effort should be made to prevent the occurrence of a DVT and subsequent thrombophlebitis, particularly in patients at risk. The following interventions are implemented to reduce the risk of a DVT.
· Prophylactic use of anticoagulant therapy […]

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 […]

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 […]

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 […]

Good clinical decision making is key to effective patient management. Physical therapists play a critical role in assessing neuromusculoskeletal problems. As more patients enter the medical system through the general practitioner, the patient is often referred to physical therapy without a clear diagnosis, especially those patients with musculoskeletal complaints. Physical […]

An understanding of the disablement process as well as knowledge of the process of making informed clinical decisions based on evidence from the scientific literature are necessary foundations of comprehensive management of patients seeking and receiving physical therapy services. Provision of quality patient care involves the ability to make sound clinical judgments, solve problems that […]