Individuals with chronic diseases have..

 Decreased MSK strength.

 Compromised cardiovascular endurance.
 Altered psychological status.
 Changes in social interaction.
 Altered sleep habits.
 Unhealthy nutritional habits.
 Changes in digestion.
 Reduced balance and coordination.
 Extended pain and suffering.
 Increased depression, anger & frustration.
 Decreased quality of life.
 The priority of health care is to optimize each
individual’s quality of life.
 Life style changes.
 Stress management.
 Nutrition.
 Dental health.
 Proper sleep.
 Relaxation( relaxation techniques).
 Time management.
 Coping.
 Locus of control.
 Emotional health.
 Balance between work and play.
 Spirituality and Religion.
 USPSTF(United States Preventive and Services Task
Force) recommend following steps to help individual
change poor health habits
1. Identify individual believe about specific behavior.
2. Provide rationale for recommendation and develop
a realistic time frame for results.
3. Add new behaviors. Adapting good habits is easier
than discarding bad ones.
4. Link positive behavior with daily routine.
5. Subspecialists in many field can educate patients.
Another form of referral is sending novice patients
to talk with successful patient.
6. Call from a health professional to inquire about
progress is effective in changing behavior.
 Stress is How an individual reacts(physically
and emotionally )to change.
 Stress can be positive (Eustress) e.g stress of
job promotion.
 Negative stress (Distress) e.g loss of a loved
one.
 Individuals need resources to manage their
stress to avoid negative stress related
behavior.
Some physical distress symptoms includes.
 Jiggling or foot tapping reflect impatience or
irritability
 Tight or round shoulder signals anxiety.

 Tightly folded arms suggest disapproval.

 Sagging or slopping shoulder suggest
fatigue.
 Nail biting conveying worry or tension.

 Jutting the jaw shows tension.

 Behavior changes includes overeating or loss
of appetite, alcohol abuse ,smoking ,sleeping
disorders, emotional disturbance, violence
and aggression.
Steps for managing stress include...
 Identify stressors
 Using relaxation or coping strategy to relieve
stress
 Seek solution for avoiding or controlling
stress
 Being as fit and healthy as possible
 Changing way of thinking
Good nutrition
Receiving and using the optimal nutrients.
Signs of good nutrition
Toned and well developed body, ideal body
weight for body composition, smooth skin,
clear and bright eyes, glossy hair and an alert
facial expression.
Over nutrition
Overabundance of nutrients exceeding health
guidelines.
Under nutrition
 Diet that lacks a full complement of healthy
nutrients.
 Cause limitations in physical work capacity,
mental activity and ability to recover from
illness and injury.
Malnutrition
 Nutritional stores are depleted and the body
lacks sufficient nutrients for the demand of
daily living….commonly in distressed and
impoverished conditions plus individuals with
chronic disease.
❑ Lacto-ovo vegetarians….exclude red meat,
allowing dairy products, eggs and may include
fish and poultry.
❑ Lacto-vegetarians….do not allow fish, meat
and poultry, accept dairy products and plant
sources
❑ Vegan diet…strictly limited to plant sources of
protein
❑ All these vegetarians need well-planned diet to
ensure adequate amino acid balance.
 Lactose intolerance….intolerance to milk and
some dairy products.
 Need supplements for calcium and vitamin D.
 PT= screen for possible nutritional
deficiencies or conditions that pose
nutritional risks and refer to dietician.
 Dehydration is one of the most preventable
and common dietary problem.
 Tips to prevent dehydration…

1. Eight 8-ounce glasses of fluid daily

2. Avoid fluids with added sodium.

3. Avoid caffeinated drinks.

 A balanced diet is essential for growth,

development and healing.
 Physical therapists can encourage their clients
to take good care of their teeth to avoid
difficulty while eating.
 While public health policies encourage the
fluoridation of water to prevent cavities.
 Regular brushing and flossing must be
encouraged to prevent caries.
 Physical therapist need to remind individuals
to wear protective mouth gear when engaging
in sports.
 Adequate sleep is required to function
normally.
 Sleep allows the body to repair and restore
itself.
 70% of the body’s daily dose growth hormone
is circulated during sleep.
 Important time for regeneration of immune
system.
 Essential for mental ability and concentration.
Missing sleep
 Reduces the body’s ability to resist and fight
infections.
 Decreases ability to undertake useful mental
work.
 Increases possibility of accidents.

❖ Physical therapists should ask their clients

about sleep difficulties and locate resources
for sleep management.
 To reduce stress and induce relaxation.
Relaxations response
 Reflecting the role of parasympathetic
nervous system in restoring homeostasis,
calms the overactive sympathetic nervous
system and restores the body to a healthier
state of natural equilibrium.
 Relaxation techniques include following…
1.Progressive muscle relaxation
 Stress, anxiety, insomnia and certain types of
chronic pain.
 Simple isometric contractions of one muscle
group at a time followed by a release of tension.
 Starting from lower extremities and progressing
towards head , ending with contractions of facial
muscles.
 Contraction for 5-8 sec and then relax. After
relaxing 30 seconds , the next set of muscles
may be contracted
 Relaxation facilitated by verbal direction
 Like tighten the muscles in your feet and hold it
for 5 seconds….1…2..3…4…5 now relax
2.Visual imagery
 Using imagination to create mental pictures
to promote relaxation and relieve pain.
 Good for sleep problems

 not recommended for mentally ill people.

3.Meditation
 Conscious mental process that induces a set of
physiological changes termed the
relaxation response.
Transcendental meditation
 repeating a mantra ( a single word or phrase)
Mindfulness Meditation
 focusing attention on moment by moment
thoughts and sensations.
 Increase in left sided anterior brain activity
positive emotional states, localized brain
responses and improved immune function.
4.Autogenic training
 Uses visual imagery and body awareness to elicit
relaxation response.
 The individual self-regulates the body focusing
on areas needing relaxation including limbs,
lungs, heart etc.
 Induce physiological responses through
concentration like….
▪ Increased muscle relaxation
▪ Increased peripheral blood flow
▪ Lowered heart rate
▪ Lowered blood pressure
▪ Slower and deeper breathing
5.Biofeedback
 Feedback from body functions to
increase the person’s awareness
of internal body workings.
 Body function is measured with
electrodes and displayed on
monitor.
 Treat tension, headaches and
chronic pain.
6.Massage
 Manipulation of soft tissues for the purpose
of reducing muscle tension or normalizing
other soft tissue structures.
 Various types of massage...

(i) Relaxation massage

 promote relaxation, improve circulation, full
range of movement, relieve muscular tension
(ii) Therapeutic massage
 to restore function of injured soft tissues or
move abnormal fluids from one body
compartment to other.
(iii) Sports massage
 to enhance sport performance and
recuperation post injury.
(iv) Acu-pressure massage
pressure at particular acu-pressure points
associated with visceral structures.
(v) Oriental massage therapies
 acupressure and shiatsu(finger and palm
pressure techniques)…ease discomfort.
 All massage give benefits like….increased
blood flow, reduced muscle tension,
neurological excitability and increased
wellbeing.
1.Petrissage
kneading and
rubbing with force to
manipulate tissues
and muscles.
2.Effleurage
light or heavy
stroking of skin
3.Friction massage/ deep transverse friction
massage.
 using firm finger pressure in soft tissues to
treat muscles, tendons, ligaments and joint
capsules.
 Difficulties in time management contribute to
stress.
 Factors increasing stress
 Increase working times.
 Decreased leisure time.
 Work for more than 40 hours per week.
 Difficult to delegate.
 More information to be managed.
=>To manage time individual must
establish priorities and devise a plan.
1. Establish priorities:
 What the individual enjoy doing should be the highest
priority and centers on person’s unique strengths and
attributes.
 SWOT analysis
✓ Strength
 What advantages do you have?
 What do you do well?
✓ Weaknesses
 What could you improve?
 What do you do badly?
✓ Opportunities
 What are the good opportunities facing you?
 What are the interesting trends you are aware of?
✓ Threats
 What obstacles are you facing?
 What is threatening to you?
2. Monitor and analyze current time
usage
 Check the schedule of past seven days.
 Priorities vs non-prioritized activities?
 Electronic calendars.
 Eating well, adequate sleep and regular
exercise, matching personal priorities,
socializing with family and friends?
3. Setting goals
 Develop a plan, listing activities based on
priorities.
 Based on long term goals…to be accomplished in
next 10 years.
 Emphasize strength while reducing time utilized
with weaknesses.
 Long term goals focusing multi-faceted aspects
of life.
 Goals prioritized are broken into short term
achievable goals.
4. Delegate tasks
 Final step is to determine what can be
delegated to others and what can be more
easily managed by the individual.
 Delegate those tasks that are areas of
weakness or responsibilities that do not
directly contribute to the long term plans.
 Art of constantly changing cognitive and behavioral
effort to manage internal and external demands
 Resources includes exercise, self talk skills, problem
solving skills, communication skills Social support,
material resources and community services.
Coping model offers three options
 Altering the stressors
 Avoid the stressors
 Adapting the stressors
 Coping resources include social support, money etc.
 Being assertive using effective communication
(especially listening) and sharing concerns with others
can decrease stress.
 Way in which one attributes success or
difficulty to either internal factors (personal
effort)or external factors (fate or other
behaviors
 Internal locus of control(under one’s own
personal control) can help in preventing
health problems.
 Psychological hardiness ( a personality style
consisting of commitment, control and
challenge) can help buffer the negative
impact of stressors.
Emotional Health
• Positive traits promise to improve the
quality of life and mitigate distress.
• These traits include optimism, hope,
wisdom, creativity, future-mindedness,
courage etc.

 Stress mounts when life is out of balance.

 Mostly more work demands than leisure
activities.
 Engage in activities voluntarily with the reward
being intrinsic.
 Laughter can play a key role in releasing stress.
Spirituality
 Spirituality can be defined as search of meaning and
connectedness with others, nature, the self and greater
power.
 Physical therapist should “recognize, respect and
respond to individual and cultural differences with
compassion and sensitivity including each individual’s
spirituality.”
 Spiritual values provide a sense of hope and life and
health problems seem manageable.
 Religious involvement is health promoting, lower
morbidity and mortality, shorter hospital stays, less
depression, lower substance abuse etc.
 Religious organizations and churches often provide
emotional or material support to their members.
 PT= promote spiritual resources(sense of peace,
meaningful life and supportive and caring
relationships) and facilitate access to new resources.
Prayer
• Many silent or vocal forms, includes meditation,
thankfulness for things received, requesting needs be
met, reading written prayers ,conversing with GOD
and expressing anger or emotions.
• Most individuals 72% pray daily.
• Promote relaxation, hope and comfort.
• PT= seek an appropriate spiritual leader to assist a
client desires prayer.
Music
 Express deep spiritual feelings.
 Calming, relaxation, improve mood, relief of boredom,
soothing effect etc.
Devotional supports
 Health promoting devotion “an act of prayer or private
workshop” facilitated by silence, prayer, music,
readings etc.
 Devotional readings may enhance hope, peace and
relaxation.
 Plan model
 If a client has difficulty with a particular spiritual need such as
forgiveness, hope, supportive relationships the Physical
therapist may find...
PLAN MODEL
 Giving Permission to individual to express concerns.
 Providing Limited information.
 Activating past-coping resources.
 Refer to Non-Physical therapy discipline.
Forgiveness
“Letting go of negative feeling towards other in a way that
restores and repair relationship”
PT= listening empathically to the client through four
forgiveness stages of anger..
1. Inability to forgive
2. Wondering if they should forgive
3. Letting go of negative feelings
4. Not forgetting
Hope
 Person’s ability to imagine and participate in
the enhancement of a positive future.
 Lower anxiety, higher functional status and
better physical health.
 PT promoting client confidence that he or
she is not alone, share a vision for the client
of a mutually established, achievable positive
future and giving energy to achieve goals.