1. Summer Webinar Series Week 7: Customers with Chronic Medical Conditions

2. Welcome & Introductions  Henry Villarreal, RN, MSN Mobility Assessment Evaluator MTM, Inc. TriMet Mobility Center  Christopher Hunter, BS, CTRS Program Director MTM, Inc. TriMet Mobility Center

3. Chronic Conditions Can Cause Disability  Chronic conditions can affect & limit a person’s functioning  Disabilities can be congenital or acquired Affected by mental, vision & hearing impairments Can be a result of lack of sleep, fatigue, pain, or trauma  Disabilities may reflect as impairments in gait, balance, ambulation & stamina

4. Neuro-Muscular Conditions  Spinal cord injury  Brain injury (acquired or traumatic)  Multiple sclerosis  Parkinson’s disease  Cerebral palsy  Spinal bifida  Muscular dystrophy  ALS Per the National Institutes of Health, Medline Plus

5. Mental/Cognitive Conditions  Severe anxiety  Unstable manic depression  Unstable schizophrenia  PTSD  Agoraphobia  Panic disorder  Separation anxiety  Evaluate severity of disabling effects Per the National Institutes of Health, Medline Plus

6. Prevalence of Mental Illness/Physical Disability  43.8 million adults in US, or 18.5% of the population, experience Any Mental Illness (AMI)  10 million adults in US, or 4.2% of the population, experience Serious Mental Illnesses (SMI)  Physical disabilities affect approximately 35.2 million adults, or 15% or the population Based on 2013 data

7. Chronic Conditions  Diabetes Complications Amputations & phantom pain Low vision Neuropathic pain Numbness Lack of sensation  Low vision Late diabetic retinopathy Late macular degeneration Retinal detachment Trauma Legally blind

8. Prevalence of Diabetes  2010: 25.8 million Americans, or 9.3% of population 1.9 million new diagnoses Seventh leading cause of death  2012: 29.1 million Americans, or 9.3 % of population 1.7 million new diagnoses  1.25 million cases are Type I Per the American Diabetes Association

9. Pain Syndromes  Arthritis  Rheumatoid arthritis  Sports injuries  Osteoarthritis  Joint pain DJD “Bone on bone” Rigorous PT post joint replacement  Chronic pain  Back pain  Spinal stenosis  Compression fractures  Trauma: vertebral or nerve injuries, falls, MVA, MCA, PHBC  Structural deformities: CP/MD Per WebMD

10. Neuropathic Pain  Nerves that carry pain signals to & from the brain can be triggered by trauma, compression, or swelling  Healing nerves may over-fire, causing increased sensation, tingling & pain  Examples: Sciatica Bulging or slipped discs Diabetic neuropathy Carpal tunnel syndrome National Institutes of Neurological Disorders & Stroke

11. Respiratory Conditions  Lack of O2 leading to SOB  Asthma  COPD: Inflammation & thickening of airway Emphysema: Alveoli Chronic bronchitis: Bronchial Third leading cause of death 11 million Americans have COPD, but 24 million don’t know they have it  Chronic wet cough  SOB w/ ADLs  Frequent respiratory infections  Cyanosis of lips & fingernail beds  Fatigue  Wheezing American Lung Association & Canadian Lung Association

12. COPD Prevalence, Adults 45-65

13. COPD Prevalence, Adults 65+

14. Cardiac/Cardiovascular Conditions Heart  Congestive Heart Failure: Back-up of blood flow  Coronary Artery Disease: Decreased blood flow  Valvular Diseases: Decreased or back-up of flow  Myocardial Infarction: Sudden blockage of flow Brain  Cardiovascular Accident: Blockage of flow to brain  Hemorrhagic: Vessel bleed, compression of brain  Ischemic: Blockage of blood flow to brain World Heart Federation

15. Prevalence of Cardiovascular Disease Men  Number one cause of death  Approximately one in four male deaths  50% of men who die have no previous symptoms  70-89 % of sudden cardiac events occur in men Women  Biggest killer, number three cause of death globally  8.6 million annual deaths World Heart Federation & the CDC

16. Fibromyalgia  Widespread musculoskeletal pain accompanied by fatigue Muscle & connective tissue Hypersensitive pressure points May affect energy, wellbeing, sleep & joint stiffness  Neurochemical brain imbalances leads to inflammation, which leads to abnormal brain processing  Associated with depression, anxiety, PTSD & chronic fatigue; can be associated with genetics, childhood & environmental factors  Treatment: Co-morbidities, antidepressants, anxiolytics, analgesics & psychotherapy National Institutes of Neurological Disorders & Stroke

17. Question 1 When working with an individual who has a chronic medical condition or disability, what is the proper terminology to remain respectful?

18. Question 2 How do you individualize an assessment for individuals with chronic medical conditions & disabilities?

19. Question 3 An applicant reports history of COPD & severe SOP. They report they don’t walk at all secondary to symptoms & fear. How would you assess this applicant?

20. Question 4 A client comes in with low vision. What questions can you ask? What would you observe?

21. Question 5 A client presents a history of Multiple Sclerosis. How would you begin the assessment?

22. Resources  National Institutes of Mental Health  American College of Rheumatology  National Institutes of Health  National Institutes of Arthritis  www.MedicineNet.com www.MedicineNet.com  American Diabetes Association  American & Canadian Lung Associations  National Institutes of Neurological Disorders & Stroke  Centers for Disease Control  www.macular.org www.macular.org  www.diabetes.org www.diabetes.org  World Heart Federation  American Heart Association

23. Contact Information  Henry Villarreal, RN, MSN Mobility Assessment Evaluator MTM, Inc. TriMet Mobility Center villarrh@trimet.org hvillarreal@mtm-inc.net villarrh@trimet.org hvillarreal@mtm-inc.net  Christopher Hunter, BS, CTRS Program Director MTM, Inc. TriMet Mobility Center hunterc@Trimet.org chunter@mtm-inc.net hunterc@Trimet.org chunter@mtm-inc.net

24. Questions?