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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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