Chapter 16 Ms and Jra
Transcript of Chapter 16 Ms and Jra
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CHAPTER 16
MUSCULAR DYSTROPHYAND
JUVENILERHEUMATOID
ARTHRITIS (JRA)
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MUSCULAR DYSTROPHY
(ADD THE CASE STUDY FROMPAGE 237 HERE.)
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I. Definition – Skeletal neuromuscular disease
is characterized by persistent deteriorationof striated muscle tissue. Muscular
Dystrophy is distinguished from other
Neuromuscular diseases by four criteria:
• 1. Primary myopathy
• 2. Genetic base
• 3. Progressive nature
• 4. Degeneration of muscle fibers
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• The disease is a degeneration of muscle tissue in
which muscle cells degenerate and the emergence
of fat and fibrous tissue replaces muscle tissue.
(Insert Figures 16.1 and 16.2 on page 239 here.)
II. Physical Characteristics as the disease
progresses include:
• Muscle weakness
• Fatigue
• Respiratory/heart complications
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III. Types and Characteristics of Muscular
Dystrophy
(Insert Table 16.1 on page 238 here.)
Progression through stages of functional ability
include:
1. Low strength/endurance; normal ambulation
with possible overwork weakness; slight
deficiency in function.
2. Reduction in activity; tendency to fatigueeasily; reduced strength/endurance; habitual
activity, mild contractures and possible
overwork weakness; ambulation with assistance.
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3. Poor strength/endurance; overwork weakness;
contractures; limited ambulation and decrease in
physical activity and standing.
4. Ambulation significantly decreased;
functional use of wheelchair; severe contractures
and muscular weakness; pulmonary difficulties
and cardiomyopathy.
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IV. Planning the Physical Activity Program:
Individuals with muscular dystrophy
commonly demonstrate low muscle enduranceand fatigue quickly while walking and
climbing stairs.
Guidelines for Intervention:• Medical Approval - determine type and state;
recommendations for intervention.
•
Assessment - Determine residual strengthflexibility and functional capabilities.
• Intensity - Avoid all out bouts of exercise. Use
alternative resistance and water exercise to
maintain functional ability.
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• Warm-up Cool-down: Critical component to
prepare weakened muscle for work out. Facilitate
strength, flexibility and maintaining function.
V. Implementing the Physical Activity Program -
A. Concerns: Early recognition is essential for early intervention physical activity will help
maintain muscular strength and functional ability.
Recommendation for intervention should promote
range of motion, maintain positive and alleviatecontractures. Several concerns are evident in
developing an excise program. They include:
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• Extent of muscle weakness
• Progression of disease
• Degree and intensity of the exercise
• Individual needs
B. Individualized Program Approach:
The components of an exercise program should include
strength, endurance and aerobic power that is essentialfor standing, walking and functional daily tasks. Goals
of the program should include:• Provide short-term realistic goals
•
Focus on maintaining or reducing the rate of deterioration• Focus on submaximal exercises and reduce intensity to
avoid fatigue
• Prevent contractures and provide nutritional counseling
• Provide activities in an enjoyable setting to facilitate
compliance
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C. Community Home Based Interventions
(Insert Table 16.2 on page 244 here.)
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JUVENILERHEUMATOID
ARTHRITIS (JRA)
(Insert Case Study on page 245 here)
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I. Definition - JRA
• JRA is a general term for all types of arthritis
and related conditions occurring (Arthritis
Foundation 2009). The primary pathology of the chronic disease is inflammation of the
connective tissues and is characterized by
swelling and pain.
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II. Symptoms and Types
• Juvenile arthritis is characterized by majorchanges in the joints including inflammation,contractures and joint damage which affectmobility, strength, and endurance.
• Nearly all children experience periods whensymptoms reduce in severity or disappear butmay go from symptom free to extreme pain andswelling
• When children are symptom free they should beencouraged to participate in developmentalactivities
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• Psychological and social impacts aremultidimensional as joint pain and stiffness
becomes a distraction that effect concentration;medication schedules are also disruptive andhave side effects – subtypes are distinguished bythe number of joints involved within the first 6
months of onset:• Systemic arthritis – entire body is affected from
high spiking fever to concomitant jointdiscomfort
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•Polyarticular arthritis – arthritis in five or more
joints with major symptoms of pain in the knees,
ankles, wrist, fingers, elbows and shoulders.
Constant pain is prevalent
•Pauciarticular arthritis - arthritis in four or fewer
joints within the first 6 mo of onset; large joints of
knee, ankle, elbow, and wrist are affected.
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III. Planning the Physical Activity
ProgramMedication
• Nonsteroidal anti-inflammatory medication
approved in children 12 and under although sideeffects are apparent
• Glucocorticoid Drugs including cortisone and
prednisone are used for pain and swelling. Side
effects include high blood pressure, osteoporosis, weight gain and slower growth rate.
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Exercise Considerations!
Physical activity and exercise are mainstays in
treatment. The Arthritis Foundation recommends participation in physical activity which leads to the
following benefits:
•Maintains joint flexibility
•Maintains muscle strength
•Regains range of motion or strength in joint or
muscle
•Makes functional activities such as walking easier
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Exercise Considerations! (contd.)
•Improves general fitness and endurance
•Improves self-esteem
•Prevents deconditioning
•Maintains bone density
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IV. IMPLEMENTING THE PHYSICALACTIVITY PROGRAM
Input is needed from the collaborative team andalleviating stress on their joints on jointprotection. The Arthritis Foundationrecommends 3 types of exercises:
Flexibility exercises for joint movement
Strengthening exercise including isometric and
isotonic exercise to support and protect joints
Cardiovascular exercise to control weight and
maintain functional ability
Add Table 16.3 from page 249 here.
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Learning Activity
• Have your class identify several exercise
programs developed by the Arthritis
Foundation including the aquaticsexercise program and walking with ease.
Also contact the Center for Disease
Control concerning the National ArthritisAction Plan.