5 TIPS TO AVOID CHRONIC PAIN

1. Know Pain, Know Gain. There is a growing body of evidence suggesting that understanding how our pain systems work is an excellent strategy in managing it. The great news is that you don’t need to know a lot! Simply knowing the basics of how our brain and nerves work, and their role in pain, can help reduce your chance for developing chronic symptoms. Learn more.

2. Keep moving. Gradually and steadily. Living an active, healthy lifestyle not only improves our general well-being and health, but can also reduce our chances of developing chronic pain. Our body was built to move, and we need to understand that not all aches or soreness is cause for concern. Learn more.

3. Spend time with a good PT. If you experience an injury, or develop the onset of pain, seeing a physical therapist (PT) early on can help address and manage your symptoms. PTs are movement experts who can diagnose and treat injuries and help you identify strategies to better manage your pain. The earlier you seek care, the better the chances you have for not developing chronic symptoms. And there’s no reason to wait: you can see a physical therapist without a physician’s referral in all 50 states and the District of Columbia. Learn more.

4. Don't focus on an image. While most of us want a diagnostic image (ie, x-ray, MRI) to tell us “why we hurt,” images actually give us little information about what’s causing pain. A study performed on individuals 60 years or older, who had no symptoms of low back pain, found that more than 90% had a degenerated or bulging disc, 36% had a herniated disc, and 21% had spinal stenosis. What shows up on an image may or may not be related to your symptoms. Once imaging has cleared you of a serious condition, your physical therapist will help guide you back to the life you want to live!

5. Addressing depression and anxiety helps. Your chances of developing chronic pain may be higher if you also are experiencing depression and anxiety. A recent study in the Journal of Pain showed that depression, as well as some of our thoughts about pain prior to total knee replacement, was related to long-term pain following the procedure. Make sure that you talk to your medical provider about your mental health throughout your treatment; it can help make your journey go much more smoothly following an injury or surgery.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.

Authored by Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC @ www.APTA.org

IRON DEFICIENCY IN ATHLETES

What is it?
Iron deficiency and iron deficiency anemia are important, and occasionally, controversial topics in Sports Medicine.  Iron is used by red blood cells to help deliver oxygen all throughout the body.  When iron levels are too low, bodily functions are negatively affected.  Iron levels in the body can be low for reasons such as a diet deficient in iron, inadequate iron absorption in the stomach and intestines, or by loss of iron, which is a common cause in menstruating women.  Iron deficiency (ID) is the result of low iron stores. Occasionally, iron levels may be low enough to cause anemia, which is known as iron deficiency anemia (IDA).  True anemia may have negative effects on immune function, cognitive abilities, and even athletic performance.  This is particularly concerning to endurance athletes.

Symptoms

• Fatigue
• Weakness
• Shortness of breath
• Palpitations (a feeling of having an irregular heartbeat)
• Diminished athletic performance

Sports Medicine Evaluation and Treatment
When an athlete suspects that he or she may have low iron levels, he/she should visit a physician.  A sports medicine physician will be aware of the association between low iron levels and decreased athletic performance, and will perform a thorough history and physical exam. Lab tests may be ordered, and are particularly important in assessing iron stores in the body. These include tests getting the level of hemoglobin, hematocrit, ferritin, and iron, among others.  Routine screening for ID and IDA in female athletes and male endurance athletes is often recommended.

An athlete with low ferritin and iron levels, and normal hemoglobin and hematocrit, is considered to have ID, but not IDA.  If the athlete also has low hemoglobin and hematocrit levels, then he or she has IDA.  For athletes with IDA, the evidence is clear that a daily oral iron supplement is beneficial in improving athletic performance.  However, there is controversy about whether iron supplementation in athletes with ID alone is helpful.  The decision to start iron supplementation in ID should be shared between the athlete, physician, and potentially, a dietician.  Iron supplementation without knowing iron levels is not recommended. 

Iron is best absorbed in the form of food, as opposed to iron supplements, so increasing the intake of iron-rich foods is important to treating both ID and IDA.  Iron-rich foods include animal protein such as red meat, chicken, and fish, as well as non-animal sources, including iron-enriched cereals and pastas, beans, and dark-green leafy vegetables.  Iron supplement absorption is improved with vitamin C supplementation. Orange juice (without calcium) is a great option to take with the supplement.  Iron supplements should not be taken with milk, coffee or calcium tablets, as these can reduce the absorption of iron.  Finally, iron supplements can cause constipation, so increasing dietary fiber intake and considering a fiber supplement is important.

Prevention
Eating a healthy diet with foods rich in iron is a good way to help maintain normal iron stores in the body.  As meat is a good source of iron, athletes who adhere to a vegetarian or vegan diet should be particularly careful to ensure adequate dietary iron consumption.

Return to Play
Athletes with symptoms like weakness, shortness of breath, or heart palpitations will likely have difficulty in competition, and exercise restriction may be considered until the athlete feels better.  As iron levels increase, the athlete will likely experience improved symptoms and expect to return to a normal level of athletic performance.

Authors: AMSSM Members Kyle V. Goerl, MD; Cindy J. Chang, MD

10 WAYS EXERCISES HELPS DURING CANCER TREATMENTS

Exercise supervised by a physical therapist can help anyone undergoing cancer treatment exercise safely and comfortably during treatment, and remain physically active. It also may relieve many of the side effects of cancer treatment.

With a physical therapist’s help, exercise during cancer treatment can:

1. Reduce fatigue 
Exercise helps boost energy and endurance during cancer treatment.

2. Maintain muscle strength 
Safe exercise can help keep your muscles strong.

3. Reduce stress 
Exercising during cancer treatment can help ward off anxiety, fear, and depression.

4. Prevent or reduce lymphedema and swelling 
Special physical therapy treatments address lymphedema and swelling.

5. Reduce pain 
Safe and comfortable exercise is proven to be effective in reducing pain.

6. Prevent and reduce weight gain
Staying physically active can help you maintain a healthy weight.

7. Reduce brain fog
Exercise has an immediate and long-lasting effect in reducing brain fog.

8. Reduce bone density lossCertain exercises done while standing and moving can stimulate your bones to stay healthy and strong, helping to avoid fractures.

9. Improve the survival rate
Research studies have suggested that consistent exercise during cancer treatment may have beneficial effects that improve the outcome of that treatment.

10. Assist athletes to continue sports training
Athletes undergoing cancer treatment may not have to give up their sport. A physical therapist can help design a special exercise plan that includes an athlete’s chosen sport, a modified version, or aspects of it.

OSTEOPENIA (LOW BONE MASS)

Osteopenia, now called low bone mass, is a term used to describe lower-than-normal bone density or thickness. Approximately 44 million adults in the United States have osteopenia.The condition is different than osteoporosis, which is a disease where normal bone structure becomes thinned out and porous.

Low bone mass can occur at any age, but noticeable and significant bone loss is most likely to occur in women during the 5 to 7 years following menopause. This group is also more likely to experience a bone fracture than someone with normal bone mass.

What is Osteopenia?

Low bone mass is a condition that develops when a person:

• May naturally have less-dense bones due to factors such as body size, genetics, or gender.
• Has gradually lost bone mass over time due to lack of exercise and poor diet.
• Has begun to experience perimenopause, symptoms that signal the onset of menopause or who is in menopause.
• Has rapidly lost bone mass due to an illness or use of medication.

How Is It Diagnosed?

Low bone mass is diagnosed through a quick and painless specialized scan ordered by aphysician. If you are seeing a physical therapist for rehabilitation, the therapist may confer with your physician when detecting a possible need for bone testing.

The results of the scan are reported using T- and Z-scores.

The T-score compares your score to that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass. Those who have a T-score of -2.5 and lower have osteoporosis.

If you have a T score of -1 or less, you have a greater risk of experiencing a fracture. A person with a T-score of -2 has lower bone density than a person with -1.

The Z-score compares your bone mineral density to the average of peoplewho are of the same age, sex,weight,and race as you. A Z-score of -2 or lower might mean that something other than normal bone loss due to age is occurring. Your doctor will likely explore other health issues that might be causing the bone loss.

Other methods of screening bone density include x-ray, ultrasound, and CT scan.If you have risk factors that includecertain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan may be prescribed.

How Can a Physical Therapist Help?

A physical therapist can help you prevent and treat low bone massat any age by prescribing the specific amount and type of exercise that best builds and maintains strong bones.

When you see your physical therapist, the therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. Your physical therapistwill also conduct a complete physical therapy examination and identify your risk factors for low bone density.

It is important to exercise throughout life, and especially when you have been diagnosed with low bone mass in order to build and maintain healthy bones. Exercise can help to build bone or slow the loss of bone.

Your physical therapist is likely to prescribe 2types of exercise that are best to build strong bones:

Weight-bearing Exercises

• Dancing
• Walking at a quick pace (122-160 steps per minute or 2.6 steps per second)
• Jumping, stomping, heel drops
• Running at least a 10-minute mile
• Racket sports

Resistance Exercises

• Weightlifting
• Use of resistance bands
• Gravity-resistance exercises (pushups, yoga, stair climbing, etc.)

Your physical therapist will design an individual exercise program for you based on your particular needs. Your physical therapist will test you to see how much resistance is needed and is safe for your specific bone density as well asother physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add more strenuous activity with physical effort to encourage your bones to grow stronger.

Your exercise prescription will include guidelines for weightbearing and resistance training for the hips, spine, shoulders, and wrists. The therapist will prescribe guidelines for the intensity, frequency, and progression of your exercises.

Exercise is only 1component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet, including foods rich in calcium, to reach the amount recommended according to your age and health status. Your physical therapist may recommend that you meet with a dietitian to learn about the many foods that contribute to bone health. Sometimes, medication or hormone replacement therapy may be recommended. Your physician will help guide you to find the best combination of exercise, diet, and medication to treat your condition.

Can this Injury or Condition be Prevented?

Risk factors that you can avoid in order to lower your chances of developing low bone mass include:

• Cigarette smoking
• Excessive alcohol intake (greater than 1 drink per day for women, 2 per day for men)
• Poor diet
• Low calcium and Vitamin D levels        
• Sedentary or low level activity—less than 5,000 steps per day

PHYSICAL THERAPY AND ALZHEIMER'S DISEASE

US population estimates indicate that 5 percent of people over age 65—about 5.2 million—and more than 40 percent of people over the age of 85 have Alzheimer's disease. Along with memory loss and other cognitive problems, people with Alzheimer's disease may have difficulty performing simple tasks of daily living. Physical therapists partner with families and caregivers to help people with Alzheimer's disease keep moving safely and delay worsening of the condition.

What Is Alzheimer's Disease?

Alzheimer's disease is a progressive condition that damages brain cells and affects how we speak, think, and interact with other people. It's the most common cause of dementia, a group of brain disorders that cause a decline in memory and the ability to perform daily activities. And it's the fifth leading cause of death among adults over age 65 in the United States, after heart disease, cancer, stroke, accidents, and respiratory disease.

The risk of getting Alzheimer's disease increases with age; it's rare to get it before age 60. Having a relative with Alzheimer's disease raises your risk of getting it, but most people with the disease do not have a family history of it.

One of the major symptoms of Alzheimer's disease is confusion. There are several other potential causes of confusion, some of which may be reversible if discovered early:

• If confusion comes on suddenly, schedule a visit with a physician or a neurologist immediately.
• If confusion occurs or gets worse after a fall or a head injury, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent.

Signs and Symptoms

There are 10 important warning signs of possible Alzheimer's disease:

• Memory changes that disrupt daily life
• Difficulty making decisions, especially in planning or solving problems
• Difficulty completing familiar tasks
• Confusion about time and or place
• Trouble understanding visual images or the way things physically fit together (spatial relationships)
• Finding the right words to say when speaking or writing
• Misplacing items and losing the ability to retrace your steps
• Poor or decreased judgment about safety
• Withdrawal from work or social activities
• Changes in mood or personality

People with Alzheimer's disease also may get lost in once-familiar places. In the later stages of the disease, they might get restless and wander, especially in the late afternoon and evening (this is called "sundowning"). They may withdraw from their family and friends or see or hear things that are not really there. They may falsely believe that others are lying, cheating, or trying to harm them.

Along with these "cognitive" symptoms, people with Alzheimer's disease may develop difficulty performing simple tasks of daily living in the later stages of the disease. Eventually, they may need assistance with feeding, bathing, toileting, and dressing. The physical ability to walk is usually retained until the very last stage of the disease; however, due to confusion and safety concerns, people with Alzheimer's disease may need supervision or an assistive device to help them get around safely.

How Is It Diagnosed?

The exact cause of Alzheimer's disease remains unknown and is most probably due to many factors, which makes diagnosis difficult. Researchers are getting closer to making a diagnosis by using brain imaging studies such as computed tomography scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or ultrasound. These tests can show abnormalities in brain structure or function. Mental function tests, cerebral spinal fluid tap, biomarkers, and genetic testing also can be used to help make a diagnosis. But a definitive diagnosis can be made only on autopsy.

Your physical therapists may play an integral role in recognizing early signs or symptoms of this disease. If they recognize you or your loved one is exhibiting signs or symptoms consistent with Alzheimer’s, they will make an appropriate referral to the necessary specialist.

How Can a Physical Therapist Help?

For people with Alzheimer's disease, research shows that:

• Physical activity can improve memory.
• Regular exercise may delay the onset of dementia and Alzheimer's disease.
• Regular exercise may delay the decline in ability to perform activities of daily living in people who have Alzheimer's disease.

As the movement experts, physical therapists can design exercise programs for people with a variety of health conditions, including Alzheimer's disease.

In the early and middle stages of Alzheimer's disease, physical therapists focus on keeping people mobile and help them continue to perform their roles in the home and in the community. In the later stages of the disease, physical therapists can help people keep doing their daily activities for as long as possible, which reduces the burden on family members and caregivers. Physical therapists also can instruct caregivers and family in how to improve safety and manage the needs of a loved one with Alzheimer's disease. Physical therapy can help improve quality of life and possibly delay the need for institutionalization.

People with Alzheimer's disease develop other conditions related to aging, such as arthritis, falls, or broken bones. Physical therapists are trained to treat these conditions in people who have underlying Alzheimer's disease. Therapists take into account the impact of the disease on other health conditions, on general health, and on the individual's ability to understand important instructions.

The therapist may use various teaching methods, techniques to simplify instructions, and unique approaches, including:

• Visual, verbal, and tactile cueing - The physical therapist provides "cues such as pointing to objects or gesturing. For instance, lifting up both arms can signal the person to stand up. Cues can also be given verbally with short, simple, or one-step instruction. Tactile clues holding someone's hand to have them walk with you. Sometimes, 2 or 3 cueing techniques are used simultaneously.
• Mirroring - With this technique, the physical therapist serves as a "mirror," standing directly in front of the person to show them how to move. To help the person raise his or her right arm, the therapist's left arm would be raised.
• Task breakdown - Physical therapists are trained in how to give step-by-step instruction by breaking down the task into short, simple "pieces" to be completed separately. For instance, if the therapist wants to teach a person how to safely move from lying in bed to sitting in a chair, the therapist might have the person practice rolling to the side, then pushing up to sitting, then moving to a chair in separate steps.
• Chaining- The physical therapist can provide step-by-step instructions by linking one step to the next step in a more complicated movement pattern. This technique usually is used once task breakdown has been successful and unites the separate steps of moving from lying in bed to sitting in a chair, to make it one fluid movement.
• Hand over hand facilitation - The physical therapist takes the hand or other body part of the person who needs to move or complete a task and moves that body part through the motion.

Although people with Alzheimer's disease usually maintain the ability to walk well into the late stages of the disease, balance and coordination problems often lead to walking difficulties. The physical therapist will train the muscles to "learn" to respond to changes in the environment, such as uneven or unstable surfaces.

Train Family Members and Caregivers

The family and caregiver may need instruction in how to safely move, lift, or transfer the person with Alzheimer's disease to prevent injury to the caregiver as well as the person with Alzheimer's disease. In addition to hands-on care, physical therapists provide caregiver training to improve safety and to decrease the risk of injury. For instance, the therapist can show caregivers how to use adaptive equipment and assistive devices, such as special seating systems, canes, or long-handled reachers, and how to use good "body mechanics" (the way you physically move to do a task).

Can this Injury or Condition be Prevented?

Although the answer to this question is still unknown, many research studies have found that people who are physically active are less likely than sedentary people—even in later life—to have cognitive decline or dementia as they age. Some research suggests that increased cardiorespiratory fitness might even prevent brain atrophy. Your physical therapist can design an exercise program to help you improve your odds for healthy aging.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with conditions related to aging. Some physical therapists have a practice with a geriatric focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatrics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have underlying Alzheimer's disease.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Authored by William Staples, PT, DPT, GCS. Reviewed by the MoveForwardPT.com editorial board.

FAMILIES MAKING SMART "MOVES"

Making a commitment to be physically active is one of the best ways families can prevent or combat obesity and its consequences. Physical therapists support the Department of Health and Human Services' Physical Activity Guidelines, which states:

• Children should get 1 hour or more of physical activity a day.
• Adults should do 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes a week of vigorous-intensity aerobic physical activity.

Physical therapists' extensive knowledge of pre-existing conditions (such as type 2 diabetes and obesity) allows them to help people of all ages and abilities establish life-long patterns of physical activity. For those who already are obese, physical therapists can devise safe exercise programs that reduce pain, restore flexibility, and increase strength and cardiovascular endurance. For people with type 2 diabetes, they can design and supervise exercise programs that reduce the need for medications, lower the risk of heart disease and stroke, and help manage glucose levels, among other benefits.

The following tips were designed by physical therapists to help families stay active and incorporate physical activities into their daily lives:

"Smart Moves" for Families

• Plan weekend family activities involving physical activity, such as hiking, swimming, bicycling, mini-golf, tennis, or bowling.
• Help your child plan physical activities with friends and neighbors, such as skating or softball.
• Have your kids brainstorm a "rainy day" game plan of indoor activities involving fitness games such as Wii Fit or Dance Dance Revolution.
• Remember that your family does not need to join a health club or buy fancy equipment to be active. Walking isn't costly and it's easy. So is designing a backyard obstacle course. Weights can be made from soda or detergent bottles filled with sand or water!
• Provide positive rewards for your child when he or she engages in physical activities, such as workout clothes, a new basketball, or an evening of roller-skating.
• Provide positive feedback about your child's lifestyle changes. Remember not to focus on the scale (for you or your child).
• Be your child's "exercise buddy." Plan daily walks or bike rides and set goals together for increasing physical activity rather than for losing weight. It's also great "bonding" time!
• As you schedule your child's extracurricular activities, remember to plan time for exercise and activity as a priority for the entire family. Don't just "squeeze it in."
• Encourage children to try individualized sports such as tennis and swimming. Studies show such activities are the basis of lifelong fitness habits.
• Parents and children can do exercises while watching television (or at least during commercials), such as sit-ups, push-ups, or running in place. Discourage snacking or eating meals while watching.

9 THINGS YOU SHOULD KNOW ABOUT PAIN

1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care. A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).

8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

PROPER SQUAT TECHNIQUE

Provided by a video blog endorsed by the American Physical Therapy Association. Copy and past the link below into your URL search bar above to view! 

http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/exercise-proper-squat-technique

DOWN SYNDROME: LEARN MORE ABOUT THE ROLE OF PHYSICAL THERAPY

Down syndrome (DS) affects approximately 6,000 (1 in 700) babies born in the United States (US) each year. Most children with Down syndrome experience physical and developmental delays, and may have physical conditions requiring treatment. Individuals with Down syndrome experience cognitive (intellectual) delays, but the effect is usually mild to moderate and is not indicative of the many strengths that each individual possesses. Approximately 400,000 people living in the US and more than 6 million people worldwide have Down syndrome. Physical therapists work with individuals with Down syndrome from infancy through adulthood to help them function at their maximum potential and lead healthy, productive lives.

What is Down Syndrome?

Down syndrome, also called Trisomy 21, is a genetic disorder causing babies to be born with an extra copy of chromosome 21. Chromosomes determine how a baby grows in the mother's womb before birth and how the baby's body functions after birth; normally, a baby is born with 46 chromosomes. The extra copy of chromosome 21 in babies born with Down syndrome changes the typical development of the brain and the body, causing intellectual and physical challenges.

The current average life span of a person with Down syndrome living in the US and in other developed countries is approximately 60 years. Although DS continues throughout a person's life span, children and adults can improve their ability to perform movement activities and everyday tasks with the help of physical therapists and other health care professionals. Physical therapists working side-by-side with individuals with Down syndrome and their families can help prevent some of the complications of DS, such as developmental delay and obesity, and help boost and maintain their levels of heart and cardiovascular fitness.

Signs and Symptoms

Down syndrome may be detected during pregnancy by screening or diagnostic tests. If not detected before birth, Down syndrome usually is detectable at birth by the baby's physical characteristics. These physical characteristics include:

• Low muscle tone
• A single deep crease across the palm of the hand
• A slightly flattened facial profile, and an upward slant to the eyes

A chromosomal analysis of a newborn baby can be performed to confirm a diagnosis of DS.

Approximately 40% to 60% of babies born with DS will have some type of congenital heart disease, which may be noted at the time of birth or soon following birth. Motor development (movement) is often delayed because the baby may have low muscle tone, decreased strength, increased movement at the joints, postural and balance difficulties, feeding problems, or challenges with hand use. Children with Down syndrome also may experience some vision and hearing challenges, and develop and use language at a slower rate. They also often require increased time to learn complex movements, such as riding a tricycle.

Other challenges may include:

• Poor language development and use
• Vision and hearing problems
• Cognitive (ie, thinking, decision making) difficulties
• Obesity

In later childhood and adulthood, people with DS may develop other challenges, such as:

• Difficulty learning complex movement tasks
• Degenerative joint disease
• Poor cardiovascular health (ie, hypertension)
• Thyroid dysfunction
• Diabetes
• Skin disorders
• Lower bone density
• Digestive problems
• Leukemia
• Sleep apnea
• Depression (approximately 30% of cases)
• Early onset of dementia

Physical therapists will work with the individual, the family, and other health care providers to reduce the effect of these conditions, or even prevent them from developing.

Good medical care, strong educational environments that include physical therapy from preschool through high school and into adulthood, and support from families can help keep adults with DS living at their maximum potential. Many adolescents and adults with DS participate in family and community activities and lead happy, productive lives.

How Is It Diagnosed?

Three types of DS have been identified, and all types are diagnosed by a chromosomal analysis—frequently a blood test—ordered by a physician.

Type 1. The most common type of DS is called "Nondisjunction Trisomy 21." This type of DS occurs when 3 copies of chromosome 21 are present in the fertilized egg. Typically, 1 copy of chromosome 21 comes from the father and 1 copy comes from the mother. When 3 copies are present, the extra chromosome may come from either the mother or the father. As the baby develops, the extra chromosome is copied into every cell in the body.

Type 2. Translocation Trisomy 21 is seen in about 4% of all people with Down syndrome. In this type of DS, part of chromosome 21 breaks off during cell division of the fertilized egg and attaches to another chromosome. The total number of chromosomes in the cells is the usual 46, but the extra part of chromosome 21 causes the baby to have the characteristics of Down syndrome.

Type 3. Mosaic Trisomy 21 occurs in approximately 1% of persons with Down syndrome. This type of DS develops when a "nondisjunction" or error occurs in 1 of the cell divisions of the fertilized egg, but not all cell divisions are affected. Some of the baby's cells contain 46 chromosomes, which is typical, but other cells contain the extra chromosome 21 for a total of 47. People with Mosiac DS may have fewer characteristics of the syndrome.

How Can a Physical Therapist Help?

The physical therapist is an important partner in health care and fitness for anyone diagnosed with DS. Physical therapists help people with DS gain strength and movement skills in order to function at their best throughout all the stages of life.

Specifically, physical therapists work with children with DS to improve muscle strength, balance, coordination, and movement skills to improve independence with daily activities and quality of life. Early intervention by a physical therapist helps a child with DS develop to their maximum potential.

Your child's physical therapist will perform an evaluation that includes:

• Birth and developmental history. Your physical therapist will ask questions about your child's birth and developmental stages (the age he or she performed activities such as holding the head upright, rolling over, sitting up, crawling, walking, and running).
• General health questions. Your physical therapist may ask some of the following questions: Has your child been sick or hospitalized? When did your child last visit a physician or health care provider? Were any health concerns shared with you during that visit? Has your child had any surgeries?
• Parental concerns. Your physical therapist will ask about your chief concerns. What are your goals? What do you hope to accomplish first in physical therapy?
• Physical examination. The physical exam may include measuring your child's height and weight, observing movement patterns, and making a hands-on assessment of his or her muscle strength and tone, movement, flexibility, posture, balance, and coordination. Your child’s heart health and fitness may also be assessed, as well as his or her foot posture and potential need for orthotics.
• Motor skill acquisition. Your physical therapist will perform specific tests to determine your child's motor development such as sitting, crawling, kneeling, pulling up from sitting to standing, walking, and more advanced skills like running, jumping, or kicking and throwing a ball. Your therapist also may screen the child's hand use, vision, learning strategies, and other areas of development.
• Referrals. Your physical therapist may refer you to other health care professionals who can participate in a team effort to address your child's needs. The therapist may coordinate regularly with other consultants, such as a developmental pediatrician, a cardiologist, or a speech and language therapist, to schedule regular checkups.

The physical therapist will design an individualized treatment program that may include:

• Improving strength. Your physical therapist may teach you and your child exercises to increase muscle strength. The therapist will identify games and fun tasks that improve strength, and adjust them as the child grows, identifying new fitness activities to reduce the risk of obesity and increase and maintain heart health.
• Improving developmental skills. Your physical therapist will help your child learn to master motor skills such as crawling, pulling up from sitting to standing, and walking. Research has shown that infants with DS can benefit from activities like walking on a treadmill. Physical therapists can help caregivers support their child's movement development by providing hands-on training for positioning, movement, feeding, and play. Your physical therapist also may suggest changes at home to encourage movement development, communication, hearing, vision, and play skills.
• Improving balance, coordination, and postural control. Your physical therapist may use equipment such as a firm, round pillow or an exercise ball to improve your child's ability to hold the head erect or to maintain a sitting position. Other skills such as jumping, skipping, and dribbling a ball may be incorporated into a fun physical therapy regimen.
• Improving physical fitness. Your physical therapist will help determine the specific exercises, diet, and community involvement that can promote healthy living choices for your child, and prevent complications of DS, such as activity limitations and decreased participation with siblings or peers.

Physical therapy may be provided in the home or at another location like a community center, school, or a physical therapy outpatient clinic. Physical therapists work with other health care professionals to address the needs of individuals with DS, as treatment priorities shift throughout their lifespans.

How Often Does This Occur?

The exact cause of the chromosomal changes that result in DS is not known, but the disorder is associated with increasing age in mothers. Women older than 35 years at the time of childbirth have an increased incidence of having a baby with Down syndrome. Mothers at age 20 have an incidence of having a baby with DS at 1 in 2,000 births; at age 40, incidence increases to 1 in every 100 births. However, due to the fact that younger women have a much greater childbirth rate, the overall majority of babies with DS are born to women younger than 35 years of age.

Excellent prenatal care is important for all pregnant women. Once a child is diagnosed with DS, the physical therapist and other health care professionals can prevent or reduce additional complications that might occur following birth.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

• A physical therapist who is experienced in pediatrics and developmental disorders. Some physical therapists have a pediatric practice and will work with you and your child in the clinic, home, school, and community environment.
• A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to developmental conditions such as DS.
• Experienced pediatric physical therapists who also understand the importance of working with other health care professionals as needed to maximize outcomes for people with DS.
• A physical therapist who specializes in neurological conditions, musculoskeletal impairments, or pain management for an adult with DS, depending on that individual’s needs. Your physician or physical therapist can direct you to the appropriate specialist.
• Early-intervention physical therapy from birth to 3. Each State in the US is responsible for providing early intervention programs for infants and toddlers. Services for children are provided at the local level, under state supervision. Find out the agency for your state at the ECTA Center, or contact your pediatrician or family physician.

 You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic or home health agency for an appointment, ask about the physical therapists' experience in helping children with Down syndrome or other developmental disorders.
• During your first visit with the physical therapist, be prepared to describe your child's symptoms and motor skills in as much detail as possible.
  
  For more information, visit www.apta.org

CDC DRAWS ATTENTION TO YOUTH CONCUSSION RISKS

This post was contributed to AJN‘s blog by the Traumatic Brain Injury Team at the CDC Injury Center.

As an A-student and star soccer player, Sarah was used to hard work. However, after she sustained a concussion while playing a varsity soccer game during her freshman year in high school, she found herself challenged in ways she had never expected.

“Recovering from the concussion was harder than recovering from other injuries I’ve had,” Sarah recalls. “When I got a concussion, I expected to sit out some games, but I never realized that it would actually hurt to think. For nearly two months I needed frequent breaks to make it through the school day. I would have to go to the school clinic and rest when I was overcome by headaches from the lights and noise of the classroom.”

Sarah’s story is not unusual. In fact, children and teens have the highest rate of emergency department visits for traumatic brain injury (TBI), including concussion, of all age groups. Fortunately, Sarah made a full recovery after four months and continues to be successful both in school and on the sports field, she uses the best sport equipment found at dugla.co.il.

Supporting a student recovering from a concussion requires a team-based approach by the student’s health care provider, school nurse, teachers, and parents. Providing students with written instructions on how to safely return to school and play is critical. During recovery, both physical and mental activities can cause concussion symptoms—such as an inability to pay attention or learn new information, fatigue, or headaches—to reappear or get worse.

The Centers for Disease Control and Prevention’s (CDC) Injury Center encourages you to spread the word about ways to prevent concussions and other TBIs, and help people recognize, respond, and recover if this injury occurs.

Free online trainings. Through its HEADS UP campaign, CDC has created free online trainings for nurses and other health care providers that include a continuing education opportunity. Take the training today.

CDC also developed materials for school nurses to help with the healthcare-to-school transition. To get these free resources, as well as handouts for teachers and parents with steps to help kids and teens return to school and play, please go to: https://www.cdc.gov/headsup/schools/index.html.