Physiotherapy in systemic conditions

A. Thangamani ramalingam

PT, MSc(psy),PGDRM, ACspss MIAP

Diabetes Mellitus Diabetes mellitus is defined as a metabolic disorder

of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action, or both. The clinical diagnosis of diabetes is often indicated by the presence of symptoms such as polyuria, polydipsia, and unexplained weight loss, and is confirmed by measurement of abnormal hyperglycaemia

Classification

  Type I Type II

Epidemiology Younger/lean/< 30 yrs Older> 30 yrs, obesityFamily heredity,Sedentary lifestyle

Heredity Genetic susceptibility,Hla-dr3 or dr4> 90%

Identical twins >50% chances,Polygenic

Pathogenesis Auto immune disease(islet cell abnormality),Insulitis,

No immune involvement,Insulin resistance/Secretory failure of beta cell,Beta cell exhaustion.

Clinical features Weight loss,No response to diet and tablet treatment,Persistent ketonuria

Biochemical C-pepide disaapearsTNF- ALPHA, CRP is increased.

C-peptide persistsTNF- ALPHA, CRP is increased

Aims of management

Hypertension It is a medical condition in which blood pressure is

chronically elevated. (Systemic arterial hypertension). Hypertension is a disease of blood vessels in which the vascular biology is altered structurally and functionally due to traditional and non- traditional risk factors.

Primary HTN (Essential) (No medical cause) Secondary HTN (With medical cause)

An elevated blood pressure (BP) is defined as a systolic blood pressure (SBP) > 140 mm Hg or diastolic blood pressure (DBP) > 90 mm Hg or both.

Classification   Systolic pressure(mm Hg) Diastolic pressure(mm Hg)

Normal 90-119 60-79

Pre-hypertension 120-139 80-89

Stage I HTN 140-159 90-99

Stage II HTN >=160 >=100

Isolated Systolic HTN >=140 < 90

Hypertension Syndrome

Recommended Methods for Measuring Blood Pressure

Drugs

Anti-hypertensive drugs: ACE inhibitors Angiotensin II receptor antagonists Calcium channel blockers Diuretics Alpha/ Beta blockers

Diagnosis and Management of Hypertension Algorithm

Impact of health behaviours on blood pressure

Obesity Obesity is a medical

condition which is characterized by excess amount of fat deposition subcutaneously which might lead to adverse effect on health of an individual and also life expectancy. There are two type of obesity: Android and Gynoid.

World Health Organization guidelines(based on BMI) 27 underweight (<18.5kg/m2) normal weight (18.5-24.9kg/m2) preobese (overweight)

(25–29.9kg/m2), obesity class I/moderate obesity (30–

34.9 kg/m2), obesity class II/severe obesity

(≥35kg/m2).

Causes and risk factors/ associated conditions

Early Child Disorder Lack Of Physical Activity Post Drug Overdose Psychiatric Illness Hormonal Imbalance Genetic Susceptibility Obesity Associated Mood Swings

(Depression, Inferiority Complex, Social Introvert behaviour)

The risk of being obese increases with age, reaching a peak between the age of 45-54 for men and between the age of 55-64 for women

Measurement methods Girth measurement, Skin fold measurement, Waist-hip ratio, Body fat percentage

assessment, bioelectrical impedence

analysis, biopsy Body mass index.

QUALITY OF LIFE

The World Health Organization (WHO) defines quality of life as “an individuals’ perception of their position in life in the context of the culture in which they live and in relation to their goals, expectations, standards and concerns” .

The sense of total well- being that encompasses both the physical and psychological aspect of patient’s life.