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AClITE CARE HANDBOOK FOR PHYSICAL ntERAPISTS
ron ate, or intravenous pamidronare). Other bisphosphonates
currently under investigation include zoiedronare and ibandronate.52
Other interventions can include the foliowing47•S2:
•
Administration of calcitonin
•
Calcium supplementation (if necessary)
•
Promotion of mobility
•
Adequate hydration
•
Sympromatic relief with nonsteroidal anti-inflammatory agents
or acetaminophen
Management
Clinical management of endocrine dysfunction is discussed earlier in
specific endocrine gland and metabolic disorders sections. This section focuses on goals and guidelines for physical therapy intervention.
The following arc general physical therapy goals and guidelines for
working with patients who have endocrine or metabolic dysfunction.
These guidelines should be adapted ro a patient's specific needs. Clinical tips are provided earlier ro address specific situations in which the tips may be most helpful.
Coals
The primary physical therapy goals in this patient population are the
following: (1) ro optimize functional mobility, (2) ro maximize activity tolerance and endurance, (3) to prevent skin breakdown in the patient with altered sensation (e.g., diabetic neuropathy), (4) to
decrease pain (e.g., in patients with osteoporosis or hyperparathyroidism), and (5) to maximize safety for prevention of falls, especially in patients with altered sensation or muscle function.
Cuide/i1les
Patients with diabetes or osteoporosis represent the primary patient
population with which the physical therapist intervenes. Physical
ENDOCRINE SYSTEM
693
therapy considerations for these patients are discussed in the form of
clinical tips in earlier sections (Diabetes and Osteoporosis, respectively).
For other patients with endocrine or metabolic dysfunction, the
primary physical therapy treatment guidelines are the following:
l .
To improve activity tolerance, it may be necessary to decrease
exercise inrensiry when the patient's medication regimen is being
adjusted. For example, a patient with insufficient thyroid hormone
replacement will fatigue more quickly than will a patient with adequate thyroid hormone replacement. In this example, knowing the normal values of thyroid hormone and reviewing the laboratory tests
helps the therapist gauge the appropriate treatment intensity.
2.
Consult with the clinical nutritionist to help determine the
appropriate activity level based on the patient's caloric intake,
because caloric intake and metabolic processes are affected by endo·
crine and metabolic disorders.
References
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