Cystic Fibrosis, Asthma, and Spinal Cord Injury Overview

Cystic Fibrosis

Congenital exocrine gland disease affecting lungs and pancreas.

- affects GI and respiratory systems

- HEREDITARY

Median Age of Survival (Cystic fibrosis)

Average lifespan for cystic fibrosis patients is 37 years.

Diagnosis for Cystic Fibrosis

10% diagnosed in late teens or later.

Symptoms of Cystic Fibrosis

• Progressive lung damage

• Delayed growth

- Failure to gain weight normally during childhood

- Excessive appetite but poor weight gain

• Salty-tasting skin

- High concentration of sodium & chloride in sweat

• Persistent coughing, wheezing, pneumonia

• Production of abnormally thick mucus

Cystic Fibrosis Vest

Device that vibrates chest to aid mucus clearance.

- can also use cup shaped hand percussion

Oxygen Therapy (Cystic Fibrosis)

Supplemental oxygen to assist breathing in patients.

- help open airways

Enriched Diet (Cystic Fibrosis)

High caloric intake with fats and proteins.

Life Span Cystic Fibrosis

average lifespan 37 years due to lung complications

Complications with Cystic Fibrosis

• Chronic respiratory infection

• Bowel problems (i.e. gallstones, intestinal obstruction, etc.)

• Coughing up blood

• Diabetes

• Infertility

- 95% - sperm transport

- 50% -cervical mucus

• Liver disease or liver failure, pancreatitis, biliary cirrhosis

• Malnutrition

• Pneumonia

Managing cystic fibrosis

- Encourage coughing to clear out mucus

• Cystic fibrosis is not a communicable disease

- Dietary issues

- Precautions to minimize respiratory infections

- Fluid intake before, during, & after exercise.

- Obtain physician's approval before participating in any activity

Asthma

Chronic lung disease causing airway inflammation.

- creates difficulty breathing

- recurrent periods of wheezing, chest tightness, shortness of breath, and coughing

Airway Function Asthma

- inflamed airways

- react strongly to certain inhaled substances

- muscles around airways tighten

- make more mucus

Asthma Triggers

Include dust, pets, weather changes, and exercise.

Symptoms of Asthma

- cough (w/ or w/o phlegm

- shortness of breath (worsens with exercise)

- wheezing

Exams and testing asthma

- stethoscope

- chest x- ray

- lung function test

- peak flow measurement

Treatment goals for asthma

- control swelling

- stay away from triggers

- prevent attacks (medications)

- quick relief (medications)

Long-term Asthma Medications

- prevent symptoms

- people w/ moderate- severe asthma

- taken daily

Inhaled Steroids

Prevent airway swelling to control asthma.

Quick-relief Drugs

prevent symptoms by preventing airway swelling

- rescue inhalers

- can be used before exercising

Chronic Respiratory Infections

Common complication of cystic fibrosis.

Coughing Up Blood

Serious symptom indicating potential lung complications.

Diabetes in Cystic Fibrosis

Occurs due to pancreatic dysfunction affecting insulin.

Infertility in Cystic Fibrosis

95% of males and 50% of females affected.

C5 spinal injury

Most common site for spinal cord injuries.

Hyperflexion injury

Forward bending injury to the cervical spine.

Hyperextension injury

Backward bending injury to the cervical spine.

Axial loading

Vertical compression of the spinal cord.

Rotation injury

Excessive head rotation beyond normal range.

Penetration injury

Injury from objects like guns or knives.

Spinal injury classification

- level

- complete or incomplete

- tetraplegia or paraplegia

Level

• Most distal uninvolved nerve root segment w/normal function

- Normal function = muscles innervated by the most distal nerve root

• At least a 3+/5 MMT grade indicating sufficient strength for functional use

Complete lesion

- no sensory or motor function below the lesion

- caused by a complete transection ( or severing), severe compression

Incomplete lesion

•Preservation of some sensory or motor function

•Often from contusions, pressure on the cord or swelling w/in spinal canal

•Clinical picture is unpredictable

Tetraplegia

Paralysis of all four limbs and trunk.

- includes respiratory muscles

- cervical lesions

Paraplegia

•All or part of the trunk & both lower extremities

- Thoracic, lumbar or sacral lesions

Spinal Shock

•Immediately following SCI a period of areflexia

- Not clearly understood

- Characterized by absence of all reflex activity, flaccidity, & loss of sensation below the level of the lesion

- Can last hours to weeks, but typically subsides w/in 24 hours

Nerve Tracts spinal cord

• Many spinal cord injuries have ascending & descending nerve tracts stunned

• w/o activity, these fibers atrophy

• When muscles are stimulated w/electrodes &/or exercise, nerve tracts sometimes partly revive

Anterior Cord Syndrome

Usually caused by cervical flexion

- Motor function is lost bilaterally

- Pain & temperature sensation are lost bilaterally

Brown-Sequard Syndrome

• Result of hemisection of spinal cord (gunshot or stab wound)

- Ipsilateral paralysis, loss of proprioception & vibration

- Contralateral loss of pain & temperature sense

Cauda Equina Injuries

Injuries below L1 vertebra causing lower motor neuron lesions.

- usually incomplete

• Results in flaccidity, areflexia, and impairment of bowel & bladder function

• Regeneration of peripheral nerves is possible

Central Cord Syndrome

• Hyperextension injuries

- Impairment of function in the upper extremity > lower extremity

- High % of patients will attain ambulatory function

Posterior Cord Syndrome

• Very rare

- Compression by tumor or infarction of the posterior spinal artery

- Motor function is preserved

Clinical Manifestations Spinal Cord

- motor paralysis

- sensory loss

- respiratory dysfunction

- impaired temperature control

- spasticity

Bowel and bladder dysfunction

- Sexual Dysfunction

Motor Paralysis (Spinal cord)

Following SCI there will be either complete or partial loss of muscle function below the level of the lesion

Sensory Loss (spinal cord)

Disruption of ascending sensory fibers results in or absent sensation below the level of the lesion

Respiratory Dysfunction Inhalation

- Diaphragm & external intercostals

• Impairments = decreased chest expansion & lowered inspiratory volume

Respiratory Dysfunction Expiration

- Abdominals and internal intercostals

• Impairments = decrease expiratory efficiency

Impaired Temperature Control Spinal Cord

• Hypothalamus can no longer control cutaneous blood flow or sweating below the lesion

• Lose the ability to shiver, absence of thermoregulatory sweating below the level of the lesion

Spasticity Spinal Cord

• Characterized by hypertonicity, hyperactive stretch reflexes, & clonus

- Below lesion level after spinal shock subsides

- Gradually increases during first 6 mo & plateaus by 1 year

Bowel Dysfunction Upper motor lesion

Spastic bowel

Bowel Dysfunction Lower motor lesion

Flaccid Bowel

Sexual Dysfunction Male Spinal cord

erection and ejaculation are possible depending on the level of the lesion and complete/ incomplete

Sexual Dysfunction Female Spinal Cord

mended and fertility remain unchanged

Post Injury Spinal Cord

Prevention of secondary complications

- Diaphragmatic breathing

- Strengthening

- Assisted coughing

- Abdominal support

Post Spinal cord injury Maintaining ROM

Facilitating movement in available musculature

- Pull ROM daily except when contraindicated

ROM Spinal Cord Contraindications

- paraplegia : hip flex> 90 (w/ combined hip and knee flexion)

- Tetraplegia: motion of head and neck

- Stretching of the shoulders

Peyton Manning's Injury

Cervical disc herniation affecting spinal function.

• The discs of the spine are the cushions between the vertebrae. These discs can become damaged and put pressure on the nerves surrounding the spinal cord.

• When pressure is put on these nerves, typical symptoms include arm pain, numbness, and weakness. In addition, a damaged disc can cause neck pain.

Obesity

Obesus- to eat away

Obesity causes, incidence, and risk factors

- Caloric balance/diet

- Biology

- Socialization/society

- Medical problems/medicines

Signs and tests for obesity

- Physical exam

Physical Exam

- Anthropometric measures

• Body mass index (BMI)

• Waist circumference

gynoid(pear) android (apple)

• Skin fold measurements

- Clinical measures

• Bod Pod

• DEXA

BMI Classification underweight

<18.5 kg/m2

BMI Classification Normal

18.5-24.9 kg/m2

BMI Classification Overweight

25-29.9

BMI Classification Obese- Class 1

30.0-34.9

BMI Classification Obese- Class 2

35-39.9

BMI Classification- Class 3

>_ 40

Skin fold measurements minimal

Men: 5%

women: 8%

Skinfold measurements below average

Men: 5-15%

Women :14-23%

skinfold measurements above average

men: 16-25%

women: 24-32%

skinfold measurements at risk

men: >25%

women: >32%

Waist circumference

Measurement around the abdomen indicating fat distribution.

Gynoid obesity

Fat distribution resembling a pear shape.

Android obesity

Fat distribution resembling an apple shape.

Bod Pod

Device measuring body composition via air displacement.

DEXA

Dual-energy X-ray absorptiometry for body composition.

treatment for obesity

Lifestyle

- diet

- physical activity

- life management

Medications

Surgery

Obesity Complications

- Cardiovascular disease

- Bone & joint problems (i.e. osteoarthritis)

- High blood cholesterol & triglycerides

- High blood pressure (hypertension)

- Fatigue

- Diabetes (High blood sugar (glucose)

Obesity and diabetes

90% of diabetes cases are Type II

- Almost 90% of those with Type II Diabetes are overweight or obese

- Abdominal adiposity

diabetes

high levels of blood sugar

Related to the body turning food into energy (diabetes)

- Sugar (glucose) enters the bloodstream

- Pancreas makes insulin

People w/ diabetes have high blood sugar

- Body cannot utilize sugar

- Pancreas does not make enough insulin

- Cells do not respond to insulin normally

• Affects more than ~29 million Americans

Type 1 diabetes

• Can occur at any age

• Most often diagnosed in children, teens, or young adults.

• Body makes little or no insulin.

• Insulin injection

• Exact cause unknown

Type 2 diabetes

• Most of diabetes cases

- Doesn't produce enough insulin

- Cells are resistant to insulin, or both

• Often occurs in adulthood

• Related to obesity

Gestational diabetes

• High blood sugar

• Develops at any time during pregnancy

- In a woman who does not have diabetes.

• Develops in 2-5% of pregnant women

Prevention > treatment (Diabetes)

• Taking preventative measures will result in the largest decrease in obesity rates

• ~ 20% maintain weight loss after 1 year

• Treatment methods are expensive - insulin can be up to $80 every 7-10 days

Screening for Diabetes

• Screening for type 2 diabetes in people who have no symptoms is recommended for:

- Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years

- Overweight adults (BMI=25+) & have other risk factors

- Adults over age 45, repeated every 3 years

Treatment for diabetes

No cure for diabetes

Medicines, diet, and exercise to control blood sugar

Prevent symptoms and problems

diabetes complications

Diabetic neuropathy

Diabetic ketoacidosis

High blood sugar can lead to kidney damage

Diabetic neuropathy

• Nerve injuries caused by high blood sugar levels & decreased blood flow

- More common when blood sugar levels not well controlled

• ~50% of people w/diabetes will develop nerve damage

- Most of the time symptoms do not begin until 10 to 20 years after diabetes has been diagnosed

Diabetic ketoacidosis

• Body cannot use sugar

- Because there is no insulin or not enough insulin

• Fat is used for fuel instead

- Fats are broken down, acids (ketones)build up in the blood & urine

• High ketone levels are poisonous.

diabetic ketoacidosis prevention

- Keeping an ideal body weight

• Exercise

• Diet

- Active lifestyle may prevent type 2 diabetes.

- No way to prevent type 1 diabetes

Exercise and Diabetes

• Improves blood glucose control

- While exercising glucose is pushed out of the bloodstream and into the muscles for energy

• Improved insulin sensitivity

Strength training for diabetes

•More muscle = more blood sugar stored

•30-50% of 1-repetition max

Aerobic training for Diabetes

•150+ min/week resulted in reduction in HbA1c levels

- 40-60% of VO2 max is considered moderate exercise

Overweight and Diabetes

• Overweight person needs 2-3x more insulin

- Pancreas is pushed past its limit & insulin producing cells begin to die off

• Abdominal fat cells can be harmful to the pancreas

- More damage to the pancreas & less efficient at

producing insulin

Weight loss and diabetes

• Lower body - pancreas is able to produce insulin more efficiently for the body

- Losing weight has the potential to restore blood sugar levels back to normal

• Can eliminate diabetes & lower risk of developing complications of diabetes

• Can reduce dependence on insulin therapy

ozempic Is a glucagon-like peptide 1 (GLP-1) receptor agonist. It works by:

stimulating insulin secretion

ozempic lowers

digestion

• Ozempic slows down gastric emptying

- Increases feelings of fullness during meals.

- It also increases the time it takes for food to leave the body.

- Suppressing liver glucose production:

• Ozempic suppresses the amount of glucose produced by the liver.

Insulin

Hormone regulating blood sugar levels.

Overweight Insulin Needs

Overweight individuals require 2-3 times more insulin.