PREFERRED PRACTICE PATTERN3
As of July, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.
Patient is a 28-year-old male who presents to the outpatient physical therapy department by referral from his primary physician for general strengthening and endurance training. The patient appears very cachectic and muscle wasted. He reports malaise and fatigue with minimal activity. He reports frequent achy joint pain throughout his body. The patient states his symptoms increase with the types of food he eats, and that his physician has stressed he needs to eat a “gluten-free” diet. In addition, the patient reports occasional abdominal bloating and loose bowel movements.
Upon physical therapy examination, the patient’s mobility status is modified independent because of decreased speed and general joint discomfort. Bilateral upper extremity and lower extremity strength is 4/5 but with decreased muscle endurance. Joint range of motion is full with inconsistent discomfort. Sensory is fully intact. Performance on the functional strength and endurance tests (30-second chair stand and the 6-minute walk) results are in below-average scores for his age. Heart rate at rest was 72 bpm but was elevated to 140 during the 6-minute walk. During pulmonary testing the patient demonstrated poor maximal inspiratory and expiratory pressures revealing weakness of his diaphragmatic and respiratory musculature.
The human colon. (From Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong’s Review of Medical Physiology. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Regulation of intestinal ion transport. The balance between fluid and electrolyte absorption and secretion across the intestinal epithelium is regulated by an interplay between endocrine, neurocrine, and immune cell factors. (From Barrett K. Gastrointestinal Physiology. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Intolerance of the protein gluten, found in wheat, rye, and barley products
Clients may have GI pathology and be receiving physical therapy for secondary problems, such as weakness, gait abnormalities, limited aerobic endurance
Changes in bowel habits: Constipation, diarrhea, bowel urgency, incontinence, abdominal cramping
Pain frequently referred ...