Summer Webinar Series Week 7: Customers with Chronic Medical Conditions

1. Summer Webinar Series Week 7: Customers with Chronic Medical Conditions

2. Welcome & Introductions • Henry Villarreal, RN, MSNMobility Assessment EvaluatorMTM, Inc. TriMetMobility Center • Christopher Hunter, BS, CTRSProgram DirectorMTM, Inc. TriMetMobility Center

3. Chronic Conditions Can Cause Disability • Chronic conditions can affect & limit a person’s functioning • Disabilities can be congenital or acquired • Affected by mental, vision & hearing impairments • Can be a result of lack of sleep, fatigue, pain, or trauma • Disabilities may reflect as impairments in gait, balance, ambulation & stamina

4. Neuro-Muscular Conditions • Spinal cord injury • Brain injury (acquired or traumatic) • Multiple sclerosis • Parkinson’s disease • Cerebral palsy • Spinal bifida • Muscular dystrophy • ALS Per the National Institutes of Health, Medline Plus

5. Mental/Cognitive Conditions • Severe anxiety • Unstable manic depression • Unstable schizophrenia • PTSD • Agoraphobia • Panic disorder • Separation anxiety • Evaluate severity of disabling effects Per the National Institutes of Health, Medline Plus

6. Prevalence of Mental Illness/Physical Disability • 43.8 million adults in US, or 18.5% of the population, experience Any Mental Illness (AMI) • 10 million adults in US, or 4.2% of the population, experience Serious Mental Illnesses (SMI) • Physical disabilities affect approximately 35.2 million adults, or 15% or the population Based on 2013 data

7. Chronic Conditions • Diabetes • Complications • Amputations & phantom pain • Low vision • Neuropathic pain • Numbness • Lack of sensation • Low vision • Late diabetic retinopathy • Late macular degeneration • Retinal detachment • Trauma • Legally blind

8. Prevalence of Diabetes • 2010: 25.8 million Americans, or 9.3% of population • 1.9 million new diagnoses • Seventh leading cause of death • 2012: 29.1 million Americans, or 9.3 % of population • 1.7 million new diagnoses • 1.25 million cases are Type I Per the American Diabetes Association

9. Pain Syndromes • Arthritis • Rheumatoid arthritis • Sports injuries • Osteoarthritis • Joint pain • DJD • “Bone on bone” • Rigorous PT post joint replacement • Chronic pain • Back pain • Spinal stenosis • Compression fractures • Trauma: vertebral or nerve injuries, falls, MVA, MCA, PHBC • Structural deformities: CP/MD Per WebMD

10. Neuropathic Pain • Nerves that carry pain signals to & from the brain can be triggered by trauma, compression, or swelling • Healing nerves may over-fire, causing increased sensation, tingling & pain • Examples: • Sciatica • Bulging or slipped discs • Diabetic neuropathy • Carpal tunnel syndrome National Institutes of Neurological Disorders & Stroke

11. Respiratory Conditions • Lack of O2 leading to SOB • Asthma • COPD: Inflammation & thickening of airway • Emphysema: Alveoli • Chronic bronchitis: Bronchial • Third leading cause of death • 11 million Americans have COPD, but 24 million don’t know they have it • Chronic wet cough • SOB w/ ADLs • Frequent respiratory infections • Cyanosis of lips & fingernail beds • Fatigue • Wheezing American Lung Association & Canadian Lung Association

12. COPD Prevalence, Adults 45-65

13. COPD Prevalence, Adults 65+

14. Cardiac/Cardiovascular Conditions Heart • Congestive Heart Failure: Back-up of blood flow • Coronary Artery Disease: Decreased blood flow • Valvular Diseases: Decreased or back-up of flow • Myocardial Infarction: Sudden blockage of flow Brain • Cardiovascular Accident: Blockage of flow to brain • Hemorrhagic: Vessel bleed, compression of brain • Ischemic: Blockage of blood flow to brain World Heart Federation

15. Prevalence of Cardiovascular Disease Men • Number one cause of death • Approximately one in four male deaths • 50% of men who die have no previous symptoms • 70-89 % of sudden cardiac events occur in men Women • Biggest killer, number three cause of death globally • 8.6 million annual deaths World Heart Federation & the CDC

16. Fibromyalgia • Widespread musculoskeletal pain accompanied by fatigue • Muscle & connective tissue • Hypersensitive pressure points • May affect energy, wellbeing, sleep & joint stiffness • Neurochemical brain imbalances leads to inflammation, which leads to abnormal brain processing • Associated with depression, anxiety, PTSD & chronic fatigue; can be associated with genetics, childhood & environmental factors • Treatment: Co-morbidities, antidepressants, anxiolytics, analgesics & psychotherapy National Institutes of Neurological Disorders & Stroke

17. Question 1 When working with an individual who has a chronic medical condition or disability, what is the proper terminology to remain respectful?

18. Question 2 How do you individualize an assessment for individuals with chronic medical conditions & disabilities?

19. Question 3 An applicant reports history of COPD & severe SOP. They report they don’t walk at all secondary to symptoms & fear. How would you assess this applicant?

20. Question 4 A client comes in with low vision. What questions can you ask? What would you observe?

21. Question 5 A client presents a history of Multiple Sclerosis. How would you begin the assessment?

22. Resources • National Institutes of Mental Health • American College of Rheumatology • National Institutes of Health • National Institutes of Arthritis • www.MedicineNet.com • American Diabetes Association • American & Canadian Lung Associations • National Institutes of Neurological Disorders & Stroke • Centers for Disease Control • www.macular.org • www.diabetes.org • World Heart Federation • American Heart Association

23. Contact Information • Henry Villarreal, RN, MSNMobility Assessment EvaluatorMTM, Inc. TriMet Mobility Centervillarrh@trimet.orghvillarreal@mtm-inc.net • Christopher Hunter, BS, CTRSProgram DirectorMTM, Inc. TriMet Mobility Centerhunterc@Trimet.orgchunter@mtm-inc.net

24. Questions?