All the Systems

K-0

No ability to ambulate or transfer safely with or without assistance. Wheelchair bound individual.

K-0 Prosthetic consideration

Not eligible for prosthetic.

K-1

Can perform transfers or ambulation on level surfaces at a fixed cadence. Household mobility.

Prosthetic Consideration K-1

Single-axis ankle and knee joints

K-2

Can traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. Limited community mobility.

Prosthetic Consideration K-2

Constant friction mechanism at knee and multiaxial foot. Adapts uneven surface. Allows PF, DF etc…

K-3

Can use variable cadence and traverse most environmental barriers. Unlimited community mobility.

K-4

High-level ambulation skills, including running, and participation in sports.

Prosthetic Consideration K-3

Variable friction mechanism at knee and multiaxial foot.

Prosthetic Consideration K-4

Advanced microprocessor-controlled knees, dynamic response feet designed for high performance activities.

Service-based codes

Billed per service, regardless of the time spent (e.g., Hot packs, unattended electrical stimulation)

Time-based codes

Billed based on the actual time spent providing a service (e.g., Therapeutic exercises, therapeutic activities, and manual therapy)

To calculate billable units:

PT provided:

12 minutes of therapeutic exercise

12 minutes of manual therapy

10 minutes of neuromuscular re-education

Total timed therapy = 34 minutes.

To calculate billable units: 34/15= 2 whole units and remainder of 4 Hence, billable units= 2

Cancer: Early warning signs

Unexplained weight loss more than 10lbs

Fatigue that is persistent

Lumps or swelling Breasts, kidney, lungs, thyroid, prostate

Changes in skin ABCDE

Persistent cough or hoarseness

Changes in bowel or bladder habits

Unusual bleeding or discharge

Difficulty swallowing

Persistent pain

Sores that don’t heal

What treatment has systemic side effects

Chemotherapy

What treatment has local side effects

Radiation therapy

Chemotherapy

Drugs can be given orally, subcutaneously, intramuscularly, or intrathecally

Chemotherapy symptoms

Fatigue, GI tract symptoms, bone marrow suppression leading to leukopenia, anemia, thrombocytopenia, skin rashes, phlebitis, neuropathies, and hair loss.

Immunotherapy

To strengthen the ability to fight cancer cells using interferons, interleukins-2, and cytokines. Also includes bone marrow transplant and hormonal therapy.

Immunotherapy side effects

Fatigue, weight loss or gain, fever, chills, nausea, anorexia, fluid retention. GI tract symptoms, hot flashes, steroid induced diabetes, muscle atrophy

Radiation Therapy

To destroy cancer cells, inhibit their growth and division. Can be given pre- or post-operatively.

Radiotherapy Symptoms

Pain, fatigue, radiation sickness, burns, delayed wound healing, immunosuppression, ROM deficit around the joints and neuropathy.

Cancer Exercise Contraindications

Day of intravenous chemotherapy or within 24 hours of treatment

Severe reaction to radiation therapy

Platelet count <10,000/mm³ → no therapeutic exercise; hold therapy

White blood cell count <5,000/mm³ with fever → no exercise permitted

Hemoglobin <8 g/dL and/or hematocrit <25% → essential ADLs only; assist needed for safety

Acute infection or fever with temperature >100.5°F

Severe nausea, vomiting, or diarrhea within the past 24–36 hours

Unusual or extreme fatigue with recent joint pain

Chest pain, rapid or significantly slow heart rate, elevated blood pressure, or ankle swelling

Dizziness, disorientation, confusion, blurred vision, or ataxia

Significant bony metastasis or severe osteoporosis → AROM and ADLs only; weight bearing may be restricted due to fracture risk

Avoid thermal agents directly over tumors, over tissue exposed to radiation therapy, or over desensitized areas

Platelets 12,000 →

YES CAN EXERCISE (NO RESISTANCE)

Hot flashes + steroid-induced diabetes →

IMMUNOTHERAPY

Hair loss + neuropathy + thrombocytopenia

CHEMOTHERAPY

Burns + fibrosis + ROM loss →

RADIATION THERAPY

Hemoglobin 7.8 g/dL →

NO EXERCISE LESS THAN 8

WBC 4,500 + fever →

NO EXERCISE

Bony metastases →

INCREASE FRACTURE

is an autoimmune disease and is an example of a type III hypersensitivity resulting in a chronic condition.

SLE

is the most common form of lupus

SLE

Hallmark presentation is a malar rash that looks like a red butterfly across the cheeks and nose

SLE

Skin rash can also appear over the extensor surfaces of the arms, forearms, and hands/fingers. Arthralgia and arthritis are common presenting manifestations

SLE

SLE Epidemiology

More common in African-American, African-Caribbean, Hispanic American, American-Indian, and Asian persons > Caucasians

• Women > Men (9:1 ratio) • 15 – 40 years old

Autoimmune connective tissue disorder characterized by excessive collagen production, leading to fibrosis and hardening of the skin and internal organs. The disease can affect multiple body systems, including the skin, blood vessels, gastrointestinal tract, lungs, heart, and kidneys.

Scleroderma

Rare autoimmune disorder that can affect both adults and children, with a higher incidence in women and Caucasians.

Scleroderma

3–30 days after tick bite

Early localized Lyme disease

Erythema migrans (bull'seye rash), fever, fatigue, headache, malaise

Early localized Lyme disease

Days to weeks

Early disseminated Lyme disease

Facial nerve palsy (Bell's palsy), meningitis, radiculopathy, cardiac involvement, multiple erythema migrans lesions. Nervous System / Heart

Early disseminated Lyme disease

Weeks to months (or longer)

Late Disseminated Lyme disease

Arthritis, intermittent joint swelling, large-joint involvement (especially knee), cognitive changes ("brain fog"), chronic neurologic symptoms. Joints / Cognition

Late Disseminated Lyme disease

is an infectious disease caused by the bacterium Borrelia burgdorferi. Which transmitted to humans through the bite of infected black-legged ticks. Commonly affecting children.

Lyme disease

is a civil rights law that prohibits discrimination against individuals with disabilities.

ADA: Americans with Disabilities Act (ADA)

The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else.

ADA: Americans with Disabilities Act (ADA)

DOORWAY WIDTH

32 INCH

HALLWAY WIDTH

36 INCH

TURNING RADIUS

60 INCH DIAMETER

RAMP SLOPE

1:12 (1 RISE TO 12 INCH RUN

is a federal law in the United States that ensures children with disabilities are provided with Free Appropriate Public Education (FAPE) tailored to their individual needs.

IDEA The Individuals with Disabilities Education Act

General provisions and administrative provisions

Part A

Aid for education of children with disabilities ages 3-21

Part B

Early intervention services for infants and toddlers with disabilities from birth to age 2

Part C

National activities to improve education for children with disabilities

Part D

Seizures Recognition

Aura (warning sensation)

Sudden unresponsiveness/loss of consciousness

Muscle jerking/twitching

Stiffening of muscles/loss of muscle tone • Incontinence

Seizure Response

Clear nearby objects that could cause injury, such as furniture, sharp items, or hard surfaces

Gently turn the person onto their L side to clear airway

Time the seizure (start and end)

Call emergency services if seizure lasts >5 minutes

What do you not do with seizures

Do not restrain or hold the person down

Do not place any objects or fingers in the person’s mouth

Concussion recognition

Headache

Nausea

Balance problems

Fatigue

Blurred vision

Sensitivity to light or noise

Numbness or tingling

Cognitive, emotional, and sleep-related deficits

Response to Concussion

Stop activity immediately

Monitor for any worsening symptoms.

Consult a healthcare professional promptly for a thorough evaluation

When to seek emergency medical help

Loss of consciousness

Repeated vomiting

Severe headache

Seizures

Unequal pupil size

Prolonged confusion

Slurred speech

Weakness or numbness

Unusual behavior

Profuse Diaphoresis

Heat exhaustion

Dry no diaphoresis

Heat stroke

Pupils normal

Heat exhaustion

Pupils contract, then dilate

Heat stroke

Pale

Heat exhaustion

Flushed or changes gray

Heat stroke

Weak, rapid HR

Heat exhaustion

Strong, rapid HR

Heat stroke

Dehydration

Mild dehydration: Thirst, dry mouth and lips

Moderate dehydration: Very dry mouth, cracked lips, headache, sunken eyes, poor skin turgor, and postural hypotension

Severe dehydration: Rapid and weak pulse, confusion, lethargy, rapid breathing, seizures and

Dehydration Response

Identify symptoms early to prevent worsening

Start by drinking water or oral rehydration solutions

If the person is nauseous, have them take small, frequent sips rather than large amounts at once

Severe cases →IV fluids required →call EMS

Treat Heat exhaustion

Hydrate with water or sports drinks. No alcohol. • Move to a cooler, air-conditioned place • If fully conscious, sip water • Take a cool shower or use cold compresses • Remove tight-fitting clothing or extra layers • If vomiting continues, seek medical attention • Act quickly. Untreated heat exhaustion can progress to heat stroke.

Treat Heat Stroke

Call 911. This is a medical emergency. • Move the person to a cooler place • Do not give fluids