Physical Limitations Progressive Disorders

1. Physical Limitations & Progressive Disorders KNR 270

2. Factors that Impact Individual’s Response to Disability (Vash, 1981) Factors in the individual Factors in the environment Factors in disability itself

3. Factors in Individual Previous experience with PWDs Premorbid coping skills Problem-solving & decision-making abilities Level of emotional control Cognitive appraisal skills Levels of self-esteem Religious/spiritual/philosophical belief system

4. Other Factors Marital status Married or partner respond better Level of education Highly educated respond better Work history Long & varied work history respond better

5. Factors in Environment Degree of family support & acceptance Availability of self-help & mutual support groups Assistive technology available Quality of professional services rendered Individual’s income level

6. Factors in Disability Time of onset Type of onset Functions impaired Severity of disability Visibility of disability Degree, if any, of disfigurement Degree of stigma

7. Factors in Disability (cont.) Course of disability (stable, progressive, episodic) Prognosis of disability Treatment required

8. Time of Onset Congenital Exist at or before birth Generally less prejudice & stigma Acquired Often requires a change of identity Generally the earlier the age of onset, the better the response When a baby is born with a disability, it is the parents who respond to the disability

9. Type of Onset Acute Has a sharp, definite beginning point Example: spinal cord injury Insidious Begins in subtle, stealthy manner Often the date of diagnosis is used because hard to pinpoint actual time of onset Example: diabetes, multiple sclerosis

10. AS YOU READ, THINK Impact on life & leisure Impact on consumers Impact on employees Impact on family or friends Modifications, adaptations, accommodations Consideration/accommodations

11. Categories Identified byCarter, Van Andel & Robb, 2003 Musculoskeletal impairments Neurological impairments Neuromuscular impairments Affect musculoskeletal & nervous systems Circulatory impairments Respiratory impairments Metabolic impairments Cancer

12. Musculoskeletal Impairments Spina bifida Arthritis Amputations & congenital absences Muscular dystrophy Poliomyelitis / Postpolio syndrome Thermal injuries

13. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS SPINA BIFIDA Congenital disability of spinal column Usually in lumbar area Covering of spinal cord is displaced Sac-like protrusion Protrusion cause improper formation of vertebrae Ranges from no effect to paraplegia Most severe = mylomeningocele (spinal cord protrudes through back) Occurs 1st 4 weeks of pregnancy No known cause or cure

15. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSSpina Bifida Hydrocephalus Spinal fluid builds up on head Shunting procedure Drain fluids to portions of body that can dispose of the fluid Scoliosis Curvature of the spine Both hydrocephalus & scoliosis can be connected with other disabilities

18. Considerations/AccommodationsSpina Bifida High incidence of latex allergy 18-40% If shunt, protect against direct insult to head, neck, chest, & abdomen Wheelchair accessibility Others???

19. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS ARTHRITIS Most crippling disease in US 2nd leading cause for receiving disability benefits 1/7 people 3 times more women than men Progressive Unknown cause

20. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSArthritis 100 different forms Inflammation of joint tissues Breakdown of joint cartilage Results in pain, swelling & stiffness in or around joint Osteroarthritis: Degenerative, younger people, caused by erosion of cartilage Rheumatoid: Primarily attacks joints but can also affect, skin, muscles, heart, etc. Juvenile: Could be children as young as 6 weeks

23. Considerations/AccommodationsArthritis May experience pain Walking, swimming, stretching, aerobics might be helpful (aquatic programs) Goal is mobility vs. strength

24. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS AMPUTATIONS & CONGENTIAL ABSENCES Born with limb missing Remove of limb Prosthesis Artificial limb or body part Remaining ability affect by use or inability to use joint Phantom pain

30. Considerations/AccommodationsAmputations & Congenital Absences Prostheses might be removed during activities Others???

31. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS MUSCULAR DYSTROPHY (MD) Chronic Not fatal itself, but affects respiratory & cardiac systems that cause death Hereditary Progressive degeneration & weakness of voluntary muscles Duchene (most common & severe type) Rapid progression, poor prognosis Primarily in males, before age 6 Pelvic muscles affected first

32. Considerations/AccommodationsMuscular Dystrophy Become less active as age Provide rest periods Progressive adaptations Others???

33. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Poliomyelitis (Polio) Caused by virus Attacks nerves that controls muscles Vaccination eliminated most cases in US Still problem in other countries Postpolio syndrome Chronic over use of undamaged muscles that compensated for weaker ones when younger

34. Considerations/AccommodationsPoliomyelitis (Polio)/Postpolio Syndrome Depression with postpolio Encourage involvement Others???

35. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Thermal injuries Caused by flames, chemicals, electricity, sunburn, prolonged contact with extreme heat and cold Damage is determine by duration of time exposed to source Burns are identified by depth of tissue injury & percent of body surface involved

36. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSThermal Injuries 1st degree burn Superficial, affect epidermis; characterized by pain, edema, & redness 2nd degree burn Affect epidermis & dermis to varying depths; characterized by blisters, infection, loss of body fluids, & pain 3rd degree burn Affect all skin; charred, painless surface All electrical burns are 3rd degree

37. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSThermal Injuries Rule of Nines Head & upper extremities = 9% each Front & back of trunk = 18% Lower extremities = 18% each

38. Considerations/AccommodationsThermal Injuries Might be sensitive to sunlight & pool chemicals Arrange protective clothing or shade Others???

39. Neurological Impairment Cerebrovascular Accident (CVA)/ Stroke Multiple sclerosis

40. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS CEREBROVASCULAR ACCIDENT (STROKE) 3rd leading cause of death in elderly Form of brain injury that originates in brain itself Occurs when portion of brain deprived of oxygen-rich blood Higher incidence in African-Americans Few people under 40 have stroke

41. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCerebrovascular Accident (CVA)/Stroke Major cause = hypertension Most common form = cerebral thrombosis Blood clot in artery that supplies blood to brain Cerebral embolism Blood clot travels to brain from another part of body Cerebral hemorrhage Blood vessel bursts in brain Most serious form of stroke

42. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCerebrovascular Accident (CVA)/Stroke Often no warning that stroke will occur If warning: Sudden, temporary weakness or numbness of face, arm or leg Temporary difficulty or loss of speech or trouble understanding speech Sudden dimness or loss of vision, especially in 1 eye An episode of double vision Unexplained headaches or a change in headache patterns Temporary dizziness or unsteadiness Recent change in personality or mental ability

43. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCerebrovascular Accident (CVA)/Stroke Some may have a series of small strokes before Transient ischemic attacks Degree of injury depends on type & location of damage Hemiplegia

44. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCerebrovascular Accident (CVA)/Stroke Right-brain stroke Left side of body Memory loss, impulsive behavior Inappropriate reflex crying or laughter or anger Left-brain stroke Right side of body Memory loss, speech & language problems

45. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCerebrovascular Accident (CVA)/Stroke Visual neglect Half of visual field disappears Eat from only 1 side of plate Talk to people standing on 1 side Aphasia Receptive: No longer understand spoken or written language Expressive: Can understand what is said or written but can not respond

46. Considerations/AccommodationsCerebrovascular Accident (CVA)/Stroke Recognize a stroke S: Ask person to smile T: Ask person to talk R: Ask person to raise both arms Call 911 Give time to respond Adaptations Others????

47. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS MULTIPLE SCLEROSIS (MS) Leading cause of chronic neurological disability in young adults (20-50 y/o) Every week 200 new cases diagnosed in US Progressive No known cause or cure Near normal life expectancy

48. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSMultiple Sclerosis Multiple scaring of central nervous system (CNS) Lesions at nerve endings & disappearance of protective nerve coverings Prevents impulses from traveling to & from brain Numbness, tingling in hands or feet, weakness of lower extremities, loss of voluntary movements of muscles, loss of vision, facial numbness, abnormal fatigue, vertigo, swallowing difficulty, loss of balance

49. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSMultiple Sclerosis Exacerbations Increasing severity of symptoms Remissions When lesions heal, some relief of symptoms Who? More women than men More Caucasians

50. Considerations/AccommodationsMultiple Sclerosis Be prepared for fluctuations in behavior/skills Heat usually makes symptoms worse Exercise in cold water Watch intensity & duration of physical activity Avoid heat & humidity Stress aggravates symptoms Stress management programs Relaxation programs

51. Neuromuscular Impairments Parkinson’s disease

52. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS PARKINSON’S DISEASE Slow deterioration of section of brain that supplies dopamine to area of brain which controls movement By time symptoms noticed, have lost 80% of dopamine producing cells As dopamine decreases, movements become erratic or slow Slurred speech Problems initiating movement, odd gait, poor balance Mostly people over 60

53. Considerations/AccommodationsParkinson’s Disease Problems with swallowing Problems with gait Others????

54. Circulatory Impairments Cardiovascular disease

55. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Cardiovascular disease Number 1 killer of men & women in US Coronary heart disease Narrowing of coronary arteries, causes decreased blood supply to heart Myocardial infarction (MI) Oxygen demand in heart is greater than supply Congestive heart failure Progressive weakness of heart Causes fluid to build up in body’s tissues (edema)

56. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCardiovascular Disease Angina pectoris Severe chest pain that may signal onset of heart attack Pain radiates to jaw, neck, shoulders, or arms Sweating, shortness of breath, nausea, vomiting, & generalized weakness Symptoms may differ in women

57. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCardiovascular Disease American Heart Association Functional activity levels No restrictions: Heart disease present yet no limitation & no symptoms present with activity II: Slight limitations. Comfortable at rest, yet with more than ordinary physical activity may result in shortness of breath, or angina pain.

58. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCardiovascular Disease American Heart Association Functional activity levels III: Marked limitation. Comfortable at rest, less than ordinary activity leads to fatigue, palpitation, shortness of breath, angina IV: Discomfort is experienced with any physical activity

59. Considerations/AccommodationsCardiovascular Disease Person at level IV: Painting, playing cards Person at level II: Golf, bicycling Stress management Monitor wind chill & temperature-humidity Colder than 30 or hotter than 80, outdoor exercise is discouraged

60. Considerations/AccommodationsCardiovascular Disease Automatic external defibrillator (AED) Cardiac arrest Heart stops suddenly Caused by arrhythmias in heart Pre-existing heart disease common cause Others do not have heart problems Chances of survival decrease by 7-10% for each minute without defibrillation If required to do CPR, should be trained on AED AED should be available within 1-2 minutes Dworkin, 2005

61. Respiratory Impairments Chronic obstructive pulmonary disease (COPD) 4th leading cause of death in US Emphysema Asthma Allergies Multiple chemical sensitivity (MCS)

62. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Respiratory impairments prevent body from adequately ventilating the lungs Leads to insufficient body supply Leads to retaining carbon dioxide COPD most common lung disorder

63. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Emphysema Develops from exposure to cigarette smoke Over inflation of air sacs in lungs Lungs loose elasticity Difficult to expel air Heart pumps harder to compensate for lack of oxygen Heart failure becomes possible complication Barrel-shared chest

64. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Asthma Reactive airway disease Inflammation & increased sensitivity of the airways Obstructed airflow caused by narrowed airways Coughing, wheezing, tightness in chest Many also have allergies to pollens, mold, animal dander Could be exercise or cold induced

65. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Allergies 50-60 million in US 6th leading cause of chronic disease in US May be sensitive to more than I irritant Dust, mold, mildew, pollen, foods, insects

66. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Multiple chemical sensitivity (MCS) Symptoms when exposed to irritants like fragrances, cleaning agents, smoke, pesticides, car exhaust, paint, new carpeting, etc Causes headaches, dizziness, nausea, breathing difficulties, tightening of throat, chronic laryngitis, problems concentrating, memory loss, etc.

67. Considerations/AccommodationsRespiratory Impairments How handle medications/inhalers at programs Take medication before physical activity Precede with warm-up activity Identify program elements that might trigger attacks/ allergies If asthma, shouldn’t scuba dive Oxygen tanks at programs

68. Considerations/AccommodationsRespiratory Impairments Avoid use of chemicals or toxins Good ventilation or air purification Follow and enforce no-smoking regulations Discourage smokers from congregating at the entrance to building

69. Metabolic Impairments Diabetes mellitus

70. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERS Diabetes mellitus (diabetes) 6th leading cause of death in US CDC, 2005 Chronic Most food turned into glucose or sugar for body energy Insufficient supply of insulin available to act on carbohydrates Large amounts of sugar in blood & urine

71. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSDiabetes Type 1: (previously insulin-dependent) Affects children & youth Pancreas don’t manufacture enough insulin Lifelong condition Type 2: (previously non-insulin dependent) Affects adults who are overweight Increasing number of youth Pancreas produces insulin but it doesn’t function properly Diet & exercise recommended

72. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSDiabetes Secondary complications of diabetes Heart & kidney diseases Blindness Amputations

73. Considerations/AccommodationsDiabetes Must monitor blood sugar levels before, during, & after activity Low blood sugar (too much insulin) Insulin shock or hypoglycemia Caused by insufficient amount of carbohydrates, delayed meals, prolonged strenuous activity Intense hunger, sweating, nervousness, nausea, headache, fatigue, raised pulse, confusion, muscle weakness Sugar is needed (sports drinks, fresh & dried fruits, or other foods with rapidly absorbed carbohydrates)

74. Considerations/AccommodationsDiabetes Diabetic coma (hyperglycemia) More severe Body breaks down fats to use as fuel because insulin is not available Increased urination, dehydration, loss of electrolytes Becomes unconscious Insulin is needed

75. Considerations/AccommodationsDiabetes May need smaller daily meals to maintain constant blood sugar levels Exercise is important Watch for mood swings Storage of medications/food Refrigerator Containers for needles/syringe disposal

76. Considerations/AccommodationsDiabetes Watch alcohol intake

77. Cancer 2nd leading cause of death in US More than 100 diseases Uncontrolled growth and spread of abnormal cells that affect any body system Highest rates Lung cancer Breast cancer Prostate cancer

78. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCancer Metastases Cancer at new site Benign Will remain at its site of origin Malignant Has potential to spread

79. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCancer Stage of cancer determined by 3 variables TNM system T = size & extent of primary tumor T0, T1, T2, T3, T4 N = extent of regional spread in lymph nodes N0, N1, N2, N3 M = evidence of distant metastasis spread M0, M1

80. PHYSICAL LIMITATIONS, PROGRESSIVE DISORDERSCancer Stage 1 usually means a cancer is relatively small and contained within the organ it started in  Stage 2 usually means the cancer is localized, but the tumor is larger than in stage 1. Sometimes stage 2 means there are nearby lymph nodes that have cancer cells in.  Stage 3 usually means the cancer is larger and there are cancer cells in the lymph nodes in the area  Stage 4 means the cancer has spread from where it started to another body organ, such as the liver, bones or lungs

81. Considerations/AccommodationsCancer Wellness & exercise programs Nature & outdoor programs Watch sun exposure Others???