Lupus and Physical Therapy:

There is more to do then you think!

http://www.youtube.com/watch?v=edhqiXciLIQ&feature=player_embedded

Characteristics/Clinical Presentation

Pathology

Histological changes within the body occur as a result of immunological changes or immunolgical attack associated with deposits of immune complexes within various tissues of the body.

SLE can affect many organs of the body, but it rarely affects them all. The following list includes common signs and symptoms of SLE in order of the most ...to least prevalent. All of the below symptoms might not be present at the initial diagnosis of SLE, but as the disease progresses more of a person’s organ systems become involved.
•“Constitutional symptoms (fever, malaise, fatigue, weight loss): most commonly fatigue and a low-grade fever
•Achy joints (arthralgia)
•Arthritis (inflamed joints)
This image illustrates the typical distribution pattern of the butterfly (malar) rash that can be a characteristic of SLE. This picture was included courtesy of: http://images.google.com/.

•Skin rashes
•Pulmonary involvement (symptoms include: chest pain, difficulty breathing, and cough)
•Anemia
•Kidney involvement (lupus nephritis)
•Sensitivity to the sun or light (photosensitivity)
•Hair loss
•Raynaud’s phenomenon
•CNS involvement (seizures, headaches, peripheral neuropathy, cranial neuropathy, cerebrovascular accidents, organic brain syndrome, psychosis)
•Mouth, nose, or vaginal ulcers”[1]

•The most common signs and symptoms of SLE in children and adolescents are: "fever, fatigue, weight loss, arthritis, rash, and renal disease."[5]

Associated Co-morbidities
•About 30% of people diagnosed with SLE are also diagnosed with fibromyalgia.[2]
•Atherosclerosis[6] [7]
•Lupus Nephritis- leads to End Stage Renal Disease (ESRD)
•Anemia[8]
•Some types of cancers (especially non-Hodgkin's lymphoma and lung cancer) [7][9] [10]
•Infections
•Hypertension
•Dyslipidemia
•Diabetes Mellitus
•Osteoporosis
•Avascular Necrosis [7]

Causes

There is no known cause of SLE, but research states that the interaction between a person's genetic make-up, immune system, hormonal balance, and environment could potentially cause SLE. At this time, autoimmunity is thought to be the primary causative factor of SLE.

There are certain factors that can predispose a patient to SLE including:
•Heredity- There is a high prevalence of SLE in first-degree relatives. The immune abnormalities associated with SLE can be triggered by both internal and external factors.
•Stress- It has been determined that stress can provoke changes in the neuroendocrine system causing changes in the function of immune system cells.
•Bacterial or viral infection- The Epstein-Barr virus has been found to be a risk factor for the development of SLE.
•Sunlight or UV exposure
•Immunizations
•Pregnancy- The evidence about whether or not pregnancy can cause exacerbations of SLE is very inconclusive because some studies state that pregnancy does affect the course of SLE, while others state that it has no affect on the course of the disease.
•Abnormal levels of estrogen
•Certain drugs- Drugs such as hydralazin, anticonvulsants, penicillin, sulfa drugs, and oral contraceptives can change the cellular responsiveness and immunogenicity of self-antigens and therefore make a person more susceptible to SLE.[1]

Systemic Involvement

There are many visceral systems can be affected from SLE, but the extent of the body's involvement differs from person to person. Some people diagnosed with SLE have only few visceral systems involved, while others have numerous systems that have been affected by the disease.

Musculoskeletal System:
This image was included courtesy of www.google.images.com
•Arthritis- typically affects hand, wrists, and knees
•Arthralgia
•Tenosynovitis
•Tendon ruptures
•Swan-neck deformity
•Ulnar drift

Cardiopulmonary/Cardiovascular System:
•Pleuritis
•Pericarditis
•Dyspnea
•Hypertension
•Myocarditis
•Endocarditis
•Tachycarditis
•Pneumonitis
•Vasculitis
1.Small Vessels Purpura
2.Large Vessels Papular Lesions
3.Arterial Thrombosis

Central Nervous System:
•Emotional instability
•Psychosis
•Seizures
•Cerebrovascular accidents
This illustration was included courtesy of http://www.medicinenet.com/.

•Cranial neuropathy
•Peripheral neuropathy
•Organic brain syndrome

Renal System:
•Glomerulonephritis
-inflammatory disease of the kidneys
•Hematuria
•Proteinuria
•Kidney failure[1]

Cutaneous System:
•Calcinosis
•Cutaneous vasculitis
•Hair loss
•Raynaud's phenomenon
•Mucosal ulcers
•Petechiae

Blood Disorders:
•Anemia
•Thrombocytopenia
•Leukopenia
•Neutropenia
•Thrombosis
Gastrointestinal System:
This picture was included courtesy of http://www.health.com/
•Ulcers--Throat & Mouth
•Ulcerative colitis/Crohn's disease
•Peritonitis
•Ascites
•Pancreatitis
•Peptic ulcers
•Autoimmune Hepatitis [11]

Medical Management (current best evidence)

The medical management for SLE is primarily drug therapy and is based upon the patients symptoms and systemic involvement. In addition to drug therapy, prevention is also very important when dealing with SLE. For patients with photosensitivities, flare-ups can be reduced if patients are cautious about the amount of sunlight or UV light that they are exposed to. Patients with SLE are also encouraged to lead a healthy lifestyle that includes: smoking cessation, controlling alcohol consumption, weight management, and regular exercise.[1][7] Exercise is beneficial for patients with SLE because it decreases their muscle weakness while simultaneously increases their muscle endurance. Patients with SLE are also encouraged to participate in support groups, ensure they are taking the correct dosages and amounts of medications, and ensure they visit medical professionals regularly.[1]

New Therapies

Topical Therapy/Medication

NSAIDS

Hormonal Intervention

Immunosupressant Therapy

IV Gamma Globulin

Apheresis

Stem-Cell Transplantation

Biological Therapy[12]

Physical Therapy Management (current best evidence)

Physical therapists can play an important role for patients with SLE during and between exacerbations. The patient's need for physical therapy will vary greatly depending on the systems involved.
•Education: It is essential for patients with skin lesions to have appropriate education on the best way to care for their skin and to ensure they do not experience additional skin breakdown.
•Aerobic Exercise: One of the most common impairments that patients with SLE experience is generalized fatigue that can limit their activities throughout the day.[1] In a study by Tench et al., it was determined that graded aerobic exercise programs are more successful than relaxation techniques in decreasing the fatigue levels of patients with SLE. Aerobic activity caused many of the participants with SLE to feel "much better" or "very much better" at the conclusion of the study. The aerobic exercise program consisted of 30-50 minutes of aerobic activity (walking/swimming/cycling) with a heart rate corresponding to 60% of the patient's peak oxygen consumption.[13] Another study, completed by Ramsey- Goldman et al., concluded that both aerobic exercise and range of motion/muscle strengthening exercises can increase the energy level, cardiovascular fitness, functional status, and muscle strength in patients with SLE. In this study, the patients completed aerobic exercise for 20-30 minutes at 70-80% of their maximum heart rate. The patients who completed range of motion and muscle strengthening activities met 3 times a week for 50 minutes sessions.[14]
•Energy Conservation: Physical therapists can educate patients on appropriate energy conservation techniques and the best ways to protect joints that are susceptible to damage.
•Additionally, physical therapists and patients with SLE should be aware of signs and symptoms that suggest a progression of SLE including those associated with avascular necrosis, kidney involvement, and neurological involvement.[1]

Alternative/Holistic Management (current best evidence)

Sometimes used in addition to medical treatment, alternative treatments are used to treat symptoms caused by SLE. These alternative treatments include:
•Homeopathy
This picture depicts acupuncture therapy that can be used to decrease pain. It was included courtesy of www.googleimages.com.

•Chiropractic
•Traditional Chinese medicines (acupuncture and Tai Chi)
•Ayurveda
•Naturopathy
•Massage therapy
•Meditation
•Biofeedback- In conjunction with medication, biofeedback has been shown to decrease a patient's pain and stress levels
•Herbs and Supplements
•Acupuncture- Some research reveals that acupuncture can decrease a patient's arthritis pain[11]

The Impact of Heel Pain

Have you ever experienced a sharp pain in your heel for no apparent reason? One of the causes of heel pain is a condition called plantar fasciitis. It is caused by inflammation of the plantar fascia, the tissue connecting the heel bone to the toes. The plantar fascia serves as a 'shock absorber' for the arch of the foot.

The patient typically experiences a stabbing sensation in the foot, especially when getting out of bed in the morning. It is not unusual for the pain to subside with movement or stretching. The pain tends to reoccur after prolonged sitting, standing, or walking.

Causes include weight, age, activity, and even gender. Certain activities that place stress on the heel (running, dancing) also play a role. Women are also more prone then men, especially when pregnant.

Too much tension in the plantar fascia can cause small tears in the tissue. When left untreated, the damage worsens and surgery may be warranted. Physical therapy plays an important role to reduce pain and help avoid surgery.

Importance of Exercise

Often, people who suffer from plantar fasciitis have tighter and weaker foot muscles. The physical therapist will conduct a detailed evaluation of the strength, flexibility and stability of the muscles and ligaments around your foot and ankle to determine the best course of action.

The right exercise program can strengthen the ankle and foot muscles, which reduces the strain on the plantar fascia. This helps break the cycle of pain and discomfort.

The physical therapist may also decide to combine exercises for plantar fasciitis with orthopedic shoe inserts. These are specially made inserts that are built to conform to the unique shape and arches of your feet. Pain medication (as prescribed by your physician), ice and rest are also helpful.

A Step in the Right Direction...

Surgery is an option but should be considered as the last resort.

Plantar fasciitis is best treated with a combination of exercise and lifestyle modification. As a weight bearing structure, your feet are under constant stress and strain every day. Healing can take several weeks (or months) and a physical therapist will work with the patient every step of the way. The best course of action is to work closely with a physical therapist and continue with the prescribed home treatment program.

As your physical therapists, we are committed to your health and wellness goals. If you know someone who is experiencing heel or foot pain, ask him or her to call us today. We look forward to hearing from you. Physical therapy is a step in the right direction.

Watch This Informative Video:
http://www.therapynewsletter.com/myarchive.php?userid=385&id=34470&secret=65838571ad4fb53e

 

Step Outside to Walk or Run

People enjoy walking or running for a number of reasons. For many, it's a simple form of exercise. For some, it's about 'the freedom of the road' and 'being one with nature', while others find it an effective way to decrease stress.

Walking or running helps condition the body and improve blood circulation. Regular walking is associated with a healthier heart and a greater sense of well being. For those who like to run, the right running technique combined with appropriate footwear helps minimize injuries.

When you work with a physical therapist, you can expect to learn the right movement techniques to minimize strain on your muscles and joints. Physical therapists can also help runners increase muscle strength and improve joint range of motion. This helps decrease stress on the runner's body and improves overall performance.

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Thought for The Day

The Mechanics of Motion

If you plan on stepping outside to walk or run, expect your physical therapist to teach you the right 'mechanics of motion'. With the proper walking and running technique, you can avoid injury and improve muscular endurance. Here are a few things to consider:

1. The right degree of flexion in your knees and elbows is important to reduce strain on your joints.
2. Posture is important. In fact, your entire technique is dependent upon your posture for efficiency and safety.
3. An appropriate range of motion helps minimize injuries and improve running technique.
4. Proper stride length is an important aspect of efficiency and injury prevention.
5. Proper rhythm, or cadence, will help you to minimize injury by eliminating unnecessary overuse of your muscles.
6. Coordination between your upper and lower body is an important aspect of running technique.

Each of these components plays a vital role in running technique. As you progress with each component, expect an improvement in your strength, efficiency, distance and possibly speed.

tips_body

Message From Your Physical Therapist

Injury Prevention with Physical Therapy

A physical therapist can identify muscle imbalances and improper joint alignments. The physical therapist will conduct a detailed evaluation, which includes an analysis of gait, foot alignment, upper body strength, hip alignment and spine alignment.

With an adjustment of running technique and correction of muscle imbalances, the therapist will get you on your feet so that you can walk (and possibly run) if your body allows it.

The best thing for you to do right now is to contact us and ask for an evaluation of your movement patterns before you start a walking or running program. We can help you plan ahead. We can also create a rehabilitation program if you are currently experiencing any discomfort while walking or running. Your body deserves the right kind of care, and we can help you. Let us help you prepare for your journey.

 

www.flagler-rehab.com                                       561-833-1747

What Is Charcot-Marie-Tooth Disorder (CMT)?
Charcot-Marie-Tooth, or CMT, is the most commonly inherited peripheral neuropathy and is found worldwide among all races and ethnic groups. Discovered in 1886 by three physicians, Jean-Martin Charcot, Pierre Marie, and Howard Henry Tooth, CMT affects an estimated 2.6 million people.

Non-Contagious, Non-Fatal, Inherited Disease
CMT usually isn’t life-threatening and almost never affects brain function. It is not contagious, but it ...is hereditary and can be passed down from one generation to the next.

Connection to the Muscular Dystrophy Association (MDA)
CMT is one of 40 diseases covered by the MDA, but unlike muscular dystrophy, in which the defect is in the muscles, CMT is a disorder in which the defect is in the nerves that control the muscles.

Symptoms
CMT patients slowly lose normal use of their extremities as nerves degenerate and muscles weaken because the affected nerves no longer stimulate the muscles. Many patients also have some loss of sensory nerve functions.

Treatments
CMT doesn’t have a cure, although physical therapy, occupational therapy, and moderate physical activity are beneficial. Sometimes CMT is surgically treated.

We want to help you better understand CMT by offering advice from professionals. Click here to find answers to the most frequently asked questions and post questions and concerns that have not yet been addressed—we’ll get you in touch with the right professional

http://www.cmtausa.org/index.php?option=com_content&view=article&id=74&Itemid=162See More

CMTA Charcot-Marie-Tooth Association - Treatment and Management of CMT

www.cmtausa.org

The Charcot-Marie-Tooth Association (CMTA) provides information and support to people with CMT, their families, and their caregivers. CMT is the most commonly inherited peripheral neuropathy, affecting an estimated 2.6 million people. Our vision is a world without CMT!

"Aiden, look!" piped NAO, a two-foot tall humanoid robot, as it pointed to a flat-panel display on a far wall. As the cartoon dog Scooby Doo flashed on the screen, Aiden, a young boy with an unruly thatch of straw-colored hair, looked in the direction the robot was pointing.

Aiden, who is three and a half years old, has been diagnosed with autism spectrum disorder (ASD). NAO (pronounced "now") is the diminutive "front man" for an elaborate system of cameras, sensors and com...puters designed specifically to help children like Aiden learn how to coordinate their attention with other people and objects in their environment. This basic social skill is called joint attention. Typically developing children learn it naturally. Children with autism, however, have difficulty mastering it and that inability can compound into a variety of learning difficulties as they age.

An interdisciplinary team of mechanical engineers and autism experts at Vanderbilt University have developed the system and used it to demonstrate that robotic systems may be powerful tools for enhancing the basic social learning skills of children with ASD. Writing in the March issue of the IEEE Transactions on Neural Systems and Rehabilitation Engineering, the researchers report that children with ASD paid more attention to the robot and followed its instructions almost as well as they did those of a human therapist in standard exercises used to develop joint attention skill.

The finding indicates that robots could play a crucial role in responding to the "public health emergency" that has been created by the rapid growth in the number of children being diagnosed with ASD. Today, one in 88 children (one in 54 boys) are being diagnosed with ASD. That is a 78 percent increase in just four years. The trend has major implications for the nation's healthcare budget because estimates of the lifetime cost of treating ASD patients ranges from four to six times greater than for patients without autism.

"This is the first real world test of whether intelligent adaptive systems can make an impact on autism," said team member Zachary Warren, who directs the Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) at Vanderbilt's Kennedy Center.

The initial impetus for the project came from Vanderbilt Professor of Mechanical Engineering and Computer Engineering Nilanjan Sarkar. His original research involved the development of systems to improve the man-machine interface. He did so by outfitting computer/robot users with biosensors and analyzing variations in various readings like blood pressure and skin response to evaluate their emotional state. The information was used to program computers and robots to respond accordingly.

Six years ago, when visiting his cousin in India, Sarkar learned that his cousin's son had been diagnosed with ASD. "After I learned something about autism, it occurred to me that my research could be valuable for treating ASD," he said.

"You can't just drop a robot down in front of a child and expect it to work," added Warren. "You must develop a sophisticated adaptive structure around the robot before it will work."

To develop this structure, which they named ARIA (Adaptive Robot-Mediated Intervention Architecture), Sarkar and Warren assembled a team that consists of Esubalew Bekele, a graduate student in electrical engineering and computer engineering, Uttama Lahiri, a graduate student in mechanical engineering who is currently an assistant professor of electrical engineering at the Indian Institute of Technology in Gandhinagar, Amy Swanson, a project manager at TRIAD, and Julie Crittendon, assistant professor of pediatrics at the Vanderbilt University Medical Center.

The team decided that a robotic system had the greatest potential working with young children. "Research has shown that early intervention, individualized to the learner's needs, is currently the most effective approach for helping children with autism develop the foundational social communication skills they need to become productive adults," Crittendon said.

So the researchers built an "intelligent environment" around NAO, a commercial humanoid robot made in France, whose control architecture was augmented for the purpose. The small robot stands on a table at the front of the room. Flat panel displays are attached to the side walls. The chair where the child sits faces the front of the room and is high enough to put the robot at eye level. The room is equipped with a number of inexpensive web cameras that are aimed at the chair. Their purpose is to track the child's head movements, so the system can determine where he or she is looking. To aid in this effort, children in the study wore a baseball cap decorated with a strip of LED lights that allowed the computer to infer where they are looking.

NAO has been programmed with a series of verbal prompts, such as "look over here" and "let's do some more," and gestures such as looking and pointing at one of the displays, that imitate the prompts and gestures that human therapists use in joint attention training. The protocol begins with a verbal prompt that asks the child to look at an image or video displayed on one of the screens. If the child doesn't respond, then the therapist provides increasing support by combining a verbal prompt with physical gestures such as turning her head or pointing. When the child looks at the target then the therapist responds with praise, such as telling the child, "good job."

The setup allowed the researchers to test the relative effectiveness of the robot-based system and human therapists in joint attention training with a dozen 2- to 5-year-old children, six with ASD and a control group of six typically developing children. They alternated short human-led and robot-led training sessions and compared how the children performed.

The test found that the children in both groups spent more time looking at the robot than they spent looking at the human therapist. During the human-led sessions, the children in the control group spent significantly more time watching the therapist than the children with ASD did. In the robot-led sessions, however, both groups spent about the same amount of time looking at the robot.

"The children's engagement with the robot was excellent," Crittendon said, "and we saw improvements across the board in both groups."

One of the key elements of ARIA is its closed loop design. The robot adapts its behavior to each child automatically depending on how he or she is responding. "There is a saying in the field, 'If you've seen one child with ASD, you've seen one child with ASD.' So one size does not fit all. To be useful, the system must be adaptive," Warren said.

In addition, ARIA is not designed to replace human therapists, who are in short supply, but to leverage their efforts. "A therapist does many things that robots can't do," said Sarkar. "But a robot-centered system could provide much of the repeated practice that is essential to learning. The cost of robotic systems like this will continue to come down in the future so it should easily pay for itself by supplementing human intervention."

Warren hopes that robotic systems can act as an "accelerant technology" that actually increases the rate at which children with ASD learn the social skills that they need. Encouraged by the success of this current study, Sarkar and Warren have started developing robot-mediated autism intervention systems that will address other deficits of children with autism such as imitation learning, role playing and sharing.

http://www.youtube.com/watch?v=7T7cIY-MIxc&feature=player_embedded

Our heart and prayers go out to all those affected by the Boston Marathon bombing. May we one day be able to live in peace..

A very special thank you to the hero's who rushed from the Medical tents and the volunteers who risked their lives to help others.

What if you could do something today to fight against cancer, change lives, and impact people for generations to come?

The American Cancer Society is working on one of its biggest research projects ever – a ground-breaking study that will have an enormous impact on our ability to prevent cancer and create more birthdays – and we need your help.

We are inviting men and women between the ages of 30 and 65 years who have never had cancer to join the 3rd generation American Cancer Society's Cancer Prevention Study (or CPS-3). This study will help us better understand what causes cancer and how to prevent it, so we can saves lives and create a world with less cancer.

Want to participate in the ground-breaking CPS-3 study to help prevent cancer? Schedule an enrollment appointment in your area today!

For each generation, the American Cancer Society conducts what we call a Cancer Prevention Study (CPS). Researchers follow that generation, so researchers can use the information and apply what they learn to the next generation to save more lives. The ultimate goal of this historic research study is to enroll at least 300,000 adults from various racial/ethnic backgrounds from across the United States.

This is a once-in-a-lifetime opportunity to be a part of the research that may change the course of cancer forever. Enrollment will take place May 9 – 11, 2013 at Jupiter Medical Center. To see the schedule of dates, times and locations please click here.


Participation is easy! Just follow these simple steps:

1. Click here to schedule your appointment
2. Follow the link in your confirmation email to complete your first survey online, from wherever you are. This survey will take approximately 45-60 minutes to complete.
3. Go to your appointment where you will complete a brief survey, sign an informed consent, provide a waist circumference measurement and a small blood sample (similar to a doctor's visit). Your in-person enrollment should last no longer than 30 minutes.

And that's all for now! After you've enrolled in the study, you will receive shorter surveys mailed to your home every few years to update your information. You will also receive annual study newsletters to update you on research results.

For more information about CPS-3, please visit cancer.org/cps3florida email cps3@cancer.org or call toll-free 1.888.604.5888.

Click Here to Schedule Your Appointment


Thank you,

Alpa Patel, PhD Principal Investigator, CPS-3

Angela McAuley Interim VP, Mass Market Strategies

Nancy Madsen Patient Services Manager

P.S. Not eligible to enroll? Please forward this email to friends, coworkers, and family members in the Palm Beach area and encourage them to fight back against cancer by enrolling in CPS-3. Together, we have the power to save countless lives and create a world with less cancer and more birthdays!