8) issues surrounding acute illness

possible outcomes of acute disease

recovery

chronic illness

Disability

death

disease

a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.

illness

an individuals perception of their symptoms and how they and their families respond to symptoms they are experiencing

disability

any impairment, activity limitations, or participation restrictions that result from the health condition or from personal, societal, or environmental factors in the individuals life

illness external factors

impairment

demographic - age, sex

built environment - accessibility, exposure

social environment - support

political environment - policies

illness personal factors

values, culture, beliefs

prior level of function, comorbidities, roles

Personality

education, health literacy, financial resources

coping can be

emotion, appraisal, or problem focused

resilience

internal and external factors

perceived control and roles

appraisal focused adaptive coping

reframing

Spiritually

meditating

painting, dancing, long walks

appraisal focused maladaptive coping

blaming others

harmful beliefs

fanaticism

excessive behavior

problem focused adaptive coping

information gathering

questioning

problem solviing

adherence

problem focused maladaptive coping

Intellectualization

avoidance

excessive behavior

Non-adherence

emotion focused adaptive coping

early denial

emoting

social support

Counseling

companionship

emotion focused maladaptive coping

continuous denial

drinking, drugs, self injury

Promiscuity

isolation

illness affects

the individual and the family

the illness-constellation model incorporates

physical symptoms

human response to those symptoms

illness experience

illness-constellation model stages

Uncertainty

Disruption

regain self

wellness

stage of uncertainty

- The individual detects or suspects signs of illness

- The individual attempts to make sense of the symptoms

- Family members may or may not be aware

stage of disruption

- acknowledgment of need for medical intervention

- relinquished control to others

- family begins to accept responsibility

striving to regain self

- examines the past for why the illness occurred

- attempts to make sense

- individual strives to preserve a sense of self

- focus on future - goal setting

- family may become protective

- role renegotiation

regaining wellness

- The individual takes charge

- attains mastery

- seeks closure

- revalues experience

- accepts consequences

- views life beyond one's self

- family monitors

5 stages of grief

denial, anger, bargaining, depression, acceptance

denial

protective response

believe the diagnosis is a mistake

avoidance

refusal of the truth

anger

victim "why me"

attempts to place blame

frustration

lack of trust with physician

barganing

postpone or distance from the reality of the situation

exhibits good behavior, makes up for perceived wrong doings, engages in behaviors to please

depression

feeling of loss of control or helplessness

withdrawn, no energy

makes few demands

when the situation can no longer be ignored

person grieves for themselves

Accpetance

a feeling of ability or resignation

makes realistic expectations

Individual becomes an active participant in their lives

"yes, i am ready"

post-stroke depression (PSD)

occurs in 25-50% of stroke survivors

peaks in the first 3 months post-stroke

PSD risk factors

psychological factors - pre-stroke history of depression, personality and coping, inadequate social support

level of disability

age <68 years

PSD symptoms

- persistent sad/empty mood

- hopelessness

- guilt, worthlessness, helplessness

- loss of interest/pleasure of doing things

- decreased energy

- thoughts of death/suicide

- weight changes

why PSD matters in PT practice

reduced adherence to exercise/therapy plans

lower functional recovery

increased caregiver burden and stress

poorer QOL and community reintegration

higher risk of mortality

elements of motivation

Attitude towards attending therapy

level of understanding

Acknowledgment of the need for treatment

increased engagement is correlated with

greater functional gain

decreased LOS

improved outcomes at 3 months

when screening for PSD, the PT role is

recognize red flags and refer

acute myocardial infarction (acute heart attack), depression preveleance

about 15-30%

impacts adherence to exercise and cardiac rehab

key partners we can work with

psychology/psychiatrist

nursing

medicine

OT/SLP

pharmacologic treatment

mirtazapine (remeron)

Sertraline (zoloft)

Non-pharmacological interventions

counseling and psychotherapy

group therapy

shorter and more intensive rehab for stroke survivors can lead to

improved long-term recovery

if we give intense rehab too soon it could lead to

higher medical instability

when thinking about when to start therapy for a stroke patient we need to consider

balance timing and safety

strategies to increase engagement

goal setting

problem-solving

behavioral contracts

diaries, logs, journals

promoting adjustment

social support from family and friends in early stages

education in problem-solving or practical caregiving skills