Are You Using the Right Electrical Stimulation and Ultrasound Treatment?

The technology behind electrical stimulation and ultrasound treatments continues to change. Unfortunately, the administration of electrical stimulation and ultrasound treatments hasn’t always kept pace with the changing technology. Physical therapists recently had the opportunity to learn the correct way to complete electrical stimulation and ultrasound treatments at a seminar sponsored by Advantage Medical Rehab Equipment and Supplies.
The one-day seminar provided physical therapists with a comprehensive overview of the history, theories and proper administration of ultrasound and electrical stimulation treatments. Participants learned the correct frequency and time required to correctly achieve a 1 to 4 degree rise in tissue temperature when using an ultrasound. The guidelines for achieving a rise in tissue temperature are outlined below:

Tissue Temperature Rise (Degrees Centigrade)	1.0 MHz Frequency (1.0 w/cm2) Time Required	3.0 MHz Frequency (1.0 w/cm2) Time Required
1	2 minutes 32 seconds	51 seconds
2	5 minutes 4 seconds	1 minute 42 seconds
3	7 minutes 35 seconds	2 minutes 32 seconds
4	10 minutes 6 seconds	3 minutes 22 seconds

Seminar participants also learned proper techniques for completing nerve blocks, pain modulation, muscle re-education, tissue healing, edema management and other electrical simulation and ultrasound treatments. A few simple things physical therapists can do to immediately improve electrical stimulation and ultrasound treatment administration include:
1. Avoid using ultrasound gel warmers.  When heated, the viscosity of the ultrasound gel decreases and reduces the efficiency of sound wave transmittal.
2. Take it easy. During an ultrasound treatment, gently glide the ultrasound head on top of the gel along the patient’s body. Do not press so hard on the device that the gel pushes out from the sound head. The added pressure can make the treatment less effective and more painful for the patient.
3. Use quality electrodes. The type of electrodes you use impacts outcomes. Mesh electrodes may cost less but do not conduct electricity as well as carbon based electrodes. To provide patients with the best possible outcomes invest in carbon-based electrodes.
4. Take time to consider the patient before doing a treatment.  Take your patient’s age, health and purpose of treatment into consideration.  Use this information to determine the right frequency to use for the treatment you’re planning to give.
5. Talk with patients prior to giving a treatment. Help patients understand how the treatment works, how they can expect the treatment to feel and any risks and benefits associated with the procedure.

Plantar Fascitis

Background

Plantar fascitis is , a repetitive strain injury of the medial arch and heel, is one of the most common causes of foot pain. It is an inflammation of the dense, fibrous connective tissue structure originating from the medial tuberosity of the calcaneus. It has 3 portions :- medial, lateral and calcaneal and the largest is calcaneal.

The function of the plantar fascia is twofold: statically, it stabilizes the medial longitudinal arch; dynamically, it restores the arch and aids in reconfiguring the foot for efficient toe-off. When this tissue
becomes damaged, pain and/or weakness may develop in the area.

Risk factors

• overweight
• training errors
• lack of stretching before sports
• repetitive strain injuries of foot
• occupations
• foot wear
• flat foot deformity
• prolonged standing, walking

Biomechanics of the foot and ankle during walking and running
A runner’s gait can be separated into two phases: the stance phase and the swing phase. During the stance phase, the foot contacts and adapts to the ground surface; during the swing phase, the leg accelerates forward and prepares for ground contact. The stance phase consists of the following four sub-phases: initial contact, loading response, midstance, and terminal stance. During initial contact, the heel contacts the ground surface. The loading response occurs immediately after initial contact, ending
when the contralateral foot lifts off of the ground surface. The midstance phase starts when the contralateral foot lifts off of the ground surface; the contralateral leg is now the swing leg. The midstance phase ends as the tension on the gastrocnemius, soleus, and achilles tendon of the stance leg causes the heel to lift off of the ground surface. The terminal stance phase begins when
the heel lifts off of the ground and ends when the swing leg contacts the ground

The subtalar joint consists of the articulation of the undersurface of the talus with the calcaneus.Movement of the subtalar joint is pivotal in transforming the foot from a rigid lever during initial ground contact to a mobile shock absorber during loading response and early midstance, and back into a rigid lever as the foot prepares for toe-off. The two primary movements that occur at the subtalar
joint (STJ) are pronation and supination.

Symptoms

• pain occurs when placing foot on the ground at very first in the morning
• swelling occurs
• limmited range of motion in severe cases
• inferior heel pain

Treatment
Literature indicates that plantar fasciitis may be successfully treated using a conservative approach.An understanding of the anatomy and kinematics of the foot and ankle, the static and dynamic function of the
plantar fascia during ambulation, and knowledge of the contributing risk factors associated with plantar fasciitis aid in developing a proper treatment and preventative protocol for this condition.

General principles of treatment

• examine lower extremity for possible factors :- pes cavus or pes planus, LLD, fat pad atrophy,signs of arthritis
• review questions for possible traning errors or overuse findibgd in runners and atheletes
• identify poor shoe wear, hard walking, or running surface,supinator or pronators like wear of running shoes
• assessment of tight calfs and hamstring that may contribute to this condition
• treatment are more aggressive or more invasive if first phase is unsuccessful
• patient education- to ensure patient does exs at home, time table

phase 1
SRICE
electrotherapy- ultrasound, TENS, cold pack, cryo
Plantar fascia stretching
1.Cross your affected leg over your other leg.


2.Using the hand on your affected side, take hold of your affected foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia.

3.Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.

4.Hold the stretch for a count of 10. A set is 10 repetitions.

5.Perform at least 3 sets of stretches per day. You cannot perform the stretch too often.

Calf stretch

Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times.

                                                                                    



Deep friction massage of the plantar fascia- Apply gentle pressure across the entire foot as you smoothly glide down the foot. This will help loosen the tendon and direct tissue towards the heel to either help prevent or heel a bone spur, a condition which often goes hand in hand with plantar fasciitits.

Exercises

• Marble lift- Put marbles on the floor next to a cup. Using your toes, try to lift the marbles up from the floor and put them in the cup.Repeat exercise 15 times.
• Toe curls on towel- curl up your toes on towel. Try to grab the towel with your toes. Hold for 10 seconds and do 20 reps
• Balance exercises on wobble board
• ROM exercises for ankle and toes

Shoe wear modifications ( Running shoes )

• Flared stable heel to help control heel stability
• Firm heel counter to control hindfoot
• Soft cushioning of the heel, raising the heel 12-15mm higher than the sole
• Well molded achilles pad
• Avoid rigid leather dress shoes that increase torque on the achilles tendon

Anti-inflammatories

Oran anti-inflammatories have variable results. Ex : cyclooxygenase



Myofascial techniques have been shown to stimulate fibroblast proliferation, leading to collagen synthesis that may promote healing of plantar fasciitis by replacing degenerative tissue with a
stronger and more functional tissue. There is considerable clinical evidenceto support the effectiveness

of deep tissue procedures in treatment of strain/sprain injuries.

Referrence

Department of Foot and Ankle surgery- Kaiser permanente

Kinesiology of the Musculoskeletal system- Donald A.Neumann

Plantar fascitis video

A short video of Plantar fascitis :) there will be an article coming soon

Antenatal exercise and Back care

Antenatal exercises are aimed to :-

• improve rom of joints especially at your pelvic floor
• abdomen strengthening and especially pelvic floor to prevent urine leaking
• maintaining a good upright posture through your pregnancy
• teaching relaxation techniques through your pregnancy
• teaching breathing control to assist you during labour

In the UK, you're recommended to attend antenatal classes and breastfeeding workshops (NCCWCH 2008). Traditional teacher-led classes are now making way for classes where mums-to-be and their partners set the agenda. This is because interactive classes help women have a better birth experience and make the early weeks with their babies easier to cope with (NCCWCH 2008).

 
 
 
 
 
 
 
 
Below are some good video on antenatal exerices together with some notes on the exercises in pdf format.



Back_care

Spinal Cord Injury Assessment form

This is an assessment form produced by the American Spinal Injury Association. It is intended for use in patients who have suffered a spinal cord injury. It includes motor, sensory and functional assessment

Spinal Cord Injury[1]

Physical examination for patella instability

Yoga Found To Be Beneficial For Childhood Cancer Patients And Their Parents

A new study reports that yoga can reduce the stress of cancer diagnosis and treatment experienced by childhood cancer patients and their parents. The findings were published in the September/October 2010 edition of Journal of Pediatric Oncology Nursing, published by the Association of Pediatric Hematology/Oncology Nurses (APHON).

"Parents and adolescents showed a decrease in anxiety and increase in sense of well-being" following yoga sessions conducted for the study, the authors wrote. Megan V. Thygeson, BA, Mary C. Hooke, PhD, RN, CNS, CPON, Jeanine Clapsaddle, MA, LAMFT, CCLS, Angela Robbins, MS, RN, CNP, and Kristin Moquist, MA, RN, CNP, CPON wrote the study, which they conducted at the Children's Hospitals and Clinics of Minnesota.

"Yoga is emerging as an effective complementary therapy in adult oncology," the authors wrote, "promising benefits for decreasing symptom distress including fatigue, insomnia, mood, and stress resulting in improved quality of life." The authors explored a new area, focusing on childhood cancer patients and their families, noting that parents experience stress and anxiety because of the uncertainty of the disease and the suffering of their children.

Children in the study between the ages of 7-12 did not show any change in their anxiety or sense of well-being. However, adolescents between the ages of 13-18 years and the parents of hospitalized patients showed significant improvement.

"Teens reported that that they felt relaxed and calmer, and that it (yoga) was fun," the authors wrote. Parents detailed even greater benefits. Parents found the yoga sessions were relaxing, allowed them to stretch their muscles and strengthen their bodies, and relieved stress. They felt better about themselves, and those who participated in the sessions with their children felt it helped them bond with their children.

Yoga lowers heart rate and blood pressure and improves circulation and oxygenation. It also improves muscle tone, circulation, pulmonary function, coordination and flexibility. "Larger studies are needed to evaluate the influence of yoga on other distressing patient symptoms such as fatigue, sleep disturbance, pain and nauseam" the authors wrote.

Source:
Association of Pediatric Hematology/Oncology Nurses (APHON)

Cyriax technique- Chiropractic adjustment

Trigger points chart

How to apply Shortwave diathermy

Many of us not really knows much about short wave diathermy. Here's a brief note on it and a video on how to apply shortwave diathermy for patients
Short waved diathermy is the therapeutic elevation of temperature in the tissue by means of an oscillating electric current.
The tissue and body organs are overheated, which increases local metabolism, supports absorption of chronic inflammatory, post-injury and post-operation infiltrates, improves tissue elasticity and has analgetic effects.

Indication: chronic diseases of joints, tissue and sinews, chronic inflammations, both gyneacological and urological, post-operation states, urge incontinence
Contraindication: cardiostimulator, direct application to metal implants, malignant tumors, acute inflammations, bleeding states, tromboflebitis etc. During the menstrual period the procedure cannot be applied to patient´s stomach, as well as to growth zones.

The procedures must always be prescribed by the doctor.

Duration: 10 - 15 minutes.




Shortwave Diathermy

Book Review : Essentials of Cardiopulmonary Physical Therapy 2nd edition

This comprehensive textbook of cardiopulmonary physical therapy presents balanced and integrated coverage of the cardiac and pulmonary systems, covering anatomy and physiology, pathophysiology, assessment and treatment.

Case studies at the end of every chapter provide students with a realistic understanding of actual clinical practice.

 

• Presents balanced and integrated coverage of the cardiac and pulmonary systems.
• Provides a logical structure closely related to most courses: anatomy and physiology, pathophysiology, assessment and treatment, which enables the book to be used in pathophysiology courses, assessment courses, etc.

 

Authors: Ellen Hillegass EdD, PT, CCS, Adjunct Faculty, Department of Physical Therapy, Emory University, Atlanta, GA; Cardiovascular and Pulmonary Consultant

 

H. Steven Sadowsky MS, RRT, PT, CCS, Associate Clinical Professor, School of Physical Therapy, Texas Women's University, Denton, TX; Physical Therapist, Department of Rehabilitation Services, Presbyterian Hospital of Dallas, Dallas, TX

Glenohumeral Joint Mobilization tecnhiques

JOINT MOBILZATION

Joint Mobilization is a technique used to increase the range of motion of an injured limb. It is also used to align the articulating surfaces of a joint and to reduce joint play.

To understand the concept of joint mobilization, it is important to understand the types of movements a joint can perform. The first types are called physiological movements such as flexion, extension, abduction and adduction. The second type of movements, which is the principle on which joint mobilization is based, are accessory movements such as spins, rolls, and glides. Here are their definitions:


Spins- rotation of a segment around a stationary axis. An example of this is the radioulnar joint
Glides- specific point on one articulating surface comes in contact with many points on another
Roll - Many points on one articulating surface comes in contact with many points on another

The key principle of joint mobilization is known as the concave-convex rule. The rule states: If a concave surface is moving on a convex surface, then the glide will occur in the same direction as the roll. If a convex surface is moving on a concave, then the glide is in the opposite direction of the roll.
Below are some examples on how glenohumeral joint mobilization techniques.

Muscle contraction - animation

Principles of Examination

Here's a brief notes on the aspects to look on when you are doing an assessment or examination on a patient

• tell patient what you are doing
• test normal ( uninvolved ) side first
• do active movements first then passive movements, then resisted isometric movements
• painful movements are done last
• apply overpressure with care to test and feel
• repeat movements or sustain certain postures or positions if history indicates
• do resisted movements in resting position
• with passive movements and ligamentous testing, both the degree and quality ( end feel ) of opening are important
• with ligamentous testing, contractions must be held for 5 seconds
• with myotome testing, contractions must be held for 5 seconds
• warn patient of possible exacerbations
• maintain the dignity of the patient
• refer if necessary

below is an example on physiotherapy assessment done for patients
Physiotherapy Assess Men 1

referrence
david j.magee orthopaedic physical assessment 4th edition

Chest Physiotherapy Notes

Chest Physiotherapy

Maitland's Grading

Referring to the previous article that Ive taken from WEB PT : here's a brief summarization on what is GPR

Global Postural Re-education (GPR) The technique is known as Souchard's Global Postural Re-education and it employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that have become tight and weak from underuse.
It was developed in France 25 years ago, GPR is only now being introduced in the United States.


This treatment, which has been successfully used in Europe for many years, follows the same principal as other muscle-release, posture retraining techniques.
GPR because is becoming accepted by mainstream doctors. Internet searches for the term “GPR,” brings up mainly Orthodox medical sites. You might note these sites make no mention of any other similar treatments that have been around in North America for years.
Most importantly, anything that helps to recognize "muscle release therapy" is a very good thing, and we never look a gift horse in the mouth. No matter how this highly successful treatment method is brought out of the dusty closets of practicing physicians it will prove of immense benefit to the hundreds of millions of people who make up that 95% of back and neck pain for which there is no apparent diagnosis.

In addition to that, Ive added a video on GPR technique which is useful for you all

PT Today : Souchard's global postural re-education relieves back pain

April 18, 2008 - Fox News( WEB PT )

PT News: Innovative Physical Therapy Relieves Back Pain

An innovative physical therapy technique may relieve back pain even when all other treatments fail.

The technique, called Souchard's global postural re-education -- or GPR for short -- employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that have become tight and weak from underuse.

"GPR corrects the patient's posture and decompresses the spinal canal," says Conrado Estol, MD, PhD, of the Neurologic Center for Treatment and Rehabilitation in Buenos Aires, Argentina. He presented his study at the American Academy of Neurology 57th Annual Meeting.

Return to Daily Activities

"In our study, nine in 10 people with chronic back pain due to disc disease significantly improved and were able to return to their usual daily activities -- usually within five months."

GPR can also help the 95 percent of adults who will suffer acute back pain injury at some point in their lives, he tells WebMD.

Developed in France, GPR is only now being introduced in the United States.

Patient, Therapist Work Together

A person with chronic back pain is in too much discomfort to perform the exercise on his own. A physical therapist guides the process, stretching the muscles along the spinal column while the patient is in the specified positions.
There are two basic positions: standing up and lying down with the knees bent. While in each of these positions, the patient places his arms at his side and tries to open them wider and wider.
"The therapist helps you to find the level you're comfortable with, as you keep increasing the range of motion," Estol says.
When Back Pain Treatments Fail
Estol says medications and surgery for severe and chronic back pain typically have limited or no benefit.
That's why he decided to try the new method on 102 patients with chronic back pain associated with severe degenerative disc disease of the spine. Patients with degenerative disc disease can experience back pain so debilitating that they can't bend, stretch or, sometimes, even get out of a chair without help.


Five Months of Treatment

The participants had severe pain for an average of seven months; 82 had lower back pain and 20 had neck pain. About half were women.
"The patients had tried almost all combinations of treatments you could think of, including regular physical therapy, bed rest, anti-inflammatory medications, acupuncture, and epidural injections," Estol says. "Quite a few had already had surgery and others were scheduled for surgery when we treated them."
Importantly, three-fourths couldn't walk more than 10 blocks without stopping, he says. Thirty-five percent had pain so severe they couldn't walk more than five blocks and had to stop working or playing sports.
The treatment included two GPR sessions during the first week, then one session a week for an average of five months. Participants also practiced breathing techniques and were given a home exercise program.



Back Pain Relieved in Nearly All
The findings showed that 92 of the 102 people reported pain relief and were able to return fully to their daily activities.
For 85 percent of the patients, the improvement was noted after just three weeks of treatment. And after an average of almost two years, the pain has not recurred, Estol says.



Cautious Optimism
Other researchers at the meeting were cautiously optimistic.
Albert Lo, MD, PhD, assistant professor of neurology at Yale University in New Haven, Conn., and a moderator of the session at which the findings were presented, says a success rate of 90 percent in patients with chronic back pain "is very unusual and begs for further investigation."
"If the findings are reproducible in [future studies], GPR could be a very exciting adjunctive therapy for patients with chronic neck and back pain," he tells WebMD.


By Charlene Laino, reviewed by Michael W. Smith, MD
SOURCES: American Academy of Neurology 57th Annual Meeting, April 9-16, 2005, Miami Beach, Fla. Conrado Estol, MD, PhD, Neurologic Center for Treatment and Rehabilitation, Buenos Aires, Argentina. Albert Lo, MD, PhD, assistant professor of neurology, Yale University, New Haven, Conn

Subscapularis / Frozen Shoulder - Advanced Myofascial Techniques

Scoliosis Massage Therapy for Non-curved Side

Mulligan Taping Techniques- Tennis Elbow

A good video on Mulligan taping technique for tennis elbow.

Treat and Rehabilitate - by Anusha Sehgal and Mark Reyeneker

My first time ever being interviewed by the vice editor of Kunang-kunang magazine :)

Sacroiliac joint stretch

Here's a vidoe on sacroiliac joint stretch for back and leg pain

http://www.youtube.com/watch?v=uuozn0i-De8&feature=fvsr

Tennis Elbow and Exercise Protocol

Tennis Elbow

Background
It is also called as lateral epicondylitis. It is defined as a pathlogic condition of wrist extensor muscles at their origin on lateral humeral epicondyle.
The tendinous region of extensor carpi radialis (ERCB) is the area of most pathologic changes

Risk factors

• Most patients are 30 to 50 years
• 95% occurs in tennis players
• Active in sports activities
• Poorly conditioned muscles

Symptoms

• pain or tenderness on the outer side of the elbow bony prominence
• pain when you straighten or raise your wrist and hand
• pain made worse by lifting a heavy object
• pain when you make a fist, grip an object, shake hands, or turn door handles
• pain that shoots from the elbow down into the forearm or up into the upper arm

Physical Examination

• Point of tenderness is examined
• Muscle strength
• Range of motion- Active and passive
• Resisted isometric movements
• Special test : Cozen's test, Mill's test - will be discussed below
• Neck- pain of elbow may be referred to the neck as well

Special test for Tennis elbow

Cozen's test

The examiner stabilizes the elbow with a thumb over the lateral epicondyle. Pain in the lateral epicondyle is seen with patient making a fist, pronating the forearm, radially deviating and extending the wrist against resistance by the examiner. Passive extension of the elbow with forced flexion of the wrist may precipitate pain at the lateral epicondyle

You can view the video on how the test is done

http://www.youtube.com/watch?v=4LK4PTGGg4s&feature=related

Mills test

With this test, pain occurs over the lateral epicondyle when the wrist and fingers are completely flexed.There's a video on how the test is done

http://www.youtube.com/watch?v=sL-W5aeDsHI&feature=player_embedded

Positive signs of Examination

• point of tenderness typically occuring at ERCB origin at lateral epicondyle
• the tenderness will be generalized over the common extensor wad insertion at the lateral epicondyle
• pain often gets worst by wrist extension against resistance with forearm pronated (palm down)
• elbow extension is limited
• neck pain and stiffness
• bursitis
• cozen's test,mills test : positive

Physiotherapy Treatment

Phase 1

Tennis elbow is a soft tissue injury of the muscles and tendons around the elbow joint, and thereforer should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain,the R.I.C.E regime should be employed. This involves

Rest

Ice

Compression

Elevation

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy

techniques. The application of heat and massage is one of the most effective treatments for removing
scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your

treatment. The aim of this phase it to regain the strength, power, endurance and flexibility of the muscle
and tendons that have been injured.

Phase 2 : Rehabilitation

Gentle stretching exercise

Gentle stretching exercises including wrist

flexion (bending the wrist down), extension
(bending the wrist up). The elbow should
be fully straightened. These stretches
should be held for 20-30 seconds and
repeated 5-10 times, at least twice a day.
Vigorous stretching should be avoided - do
not stretch to the point of pain that
reproduces your symptoms

Strengthening exercise

With the elbow bent and the wrist supported perform the following exercises:


Wrist Extension. Place 1 lb. weight in hand with palm facing downward; support
forearm at the edge of a table or on your knee so that only your hand can move.
Raise wrist/hand up slowly, and lower slowly.

Wrist Flexion. Place 1 lb. weight in hand with palm facing upward; support
forearm at the edge of a table or on your knee so that only your hand can move.
Bend wrist up slowly, and then lower slowly

Forearm Rotation. Grasp dumbell (wrench, or some similar device) in hand with

forearm supported. Rotate hand to palm down position, return to start position (dumbell

perpendicular to floor), rotate to palm up position, repeat. To increase or decrease

resistance, by move hand farther away or closer towards the head of the dumbell

Theraband exercise for tennis elbow

Begin this elbow strengthening exercise with a resistance band around your hand as demonstrated at the figure above. Your elbow should be at your side and bent to 90 degrees. Slowly rotate your forearm against the resistance band so your palm faces up. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain.

Begin this elbow strengthening exercise with a resistance band around your hand as demonstrated at the figure above. Your elbow should be at your side and bent to 90 degrees. Slowly rotate your forearm against the resistance band so your palm faces down. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain

Biceps Curl 

Begin this elbow strengthening exercise with a resistance band under your feet and around your hands as demonstrated as the figure above. Your back and elbows should be straight. Slowly bend your elbows against the resistance band tightening your biceps. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain.

Advanced exercises

Biceps Preacher Curl


Begin this elbow strengthening exercise kneeling over a Swiss ball and holding a light weight as demonstrated as above. Your back and elbows should be straight. Slowly bend your elbow tightening your biceps. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain.


I hope all this information had helped you all. :)

Below is the link to the video on the exercises for tennis elbow.Feel free to watch it
http://www.youtube.com/watch?v=ayTzSzYFUxM&feature=fvst

By, Anusha Sehgal

Referrence

• S brent brotzman, Kevin E.Wilk : Clinical Orthopaedic Rehabiltation 2nd edition 1996
• http://www.sportsinjuryclinic.net/
• http://www.medicine.net.com/



Book Review : Pocketbook of Neurological Physiotherapy

Publisher : Elsevier Health Sciences
Pages : 317
Published : 07 October 2008

I am sure many have heard about Pocketbook of Physiotherapy and had been using it in practice. Now they have a new pocketbook that specifies Neurological Physiotherapy. Pocketbook of Neurological Physiotherapy" is designed for working with people with neurological problems in any clinical setting. It is written by a team of expert contributors offering an international perspective on core concepts, irrespective of philosophical frameworks or health care systems. Rapid access to essential information is contained in one concise volume, providing expert knowledge and advice at your fingertips. This pocketbook should be a valuable guide to evidence-based practice for student physiotherapists and their teachers, as well as qualified clinicians.It is essential and benefit to use this pocketbook since we have a lot of assessments and test for neurological patients.

Lumbar spine mobilization techniques

A very good video on lumbar mobilization techniques. Enjoy
http://www.youtube.com/watch?v=YXQr2f5aiug

New Vestibular Rehabilitation Techniques can help patients with dizziness

A good rehabilitation approach is essential for patients who are suffering from vertigo, dizziness, unsteadiness and loss of balance caused by disorder of vestibular system. A special issue of The Journal of Neurologic Physical Therapy (JNPT) presents an update on new and emerging vestibular rehabilitation techniques, highlighting the physical therapist's role on the multidisciplinary teams providing patient care and research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.
The special issue provides physical therapists and other professionals with an update on new developments in vestibular rehabilitation. "We hope that this Special Issue will help clinicians explore some new innovations and discoveries in physical therapist examination and treatment of persons with vestibular disorders," according to guest editors Michael C., Schubert, P.T., Ph.D., and Susan L. Whitney, P.T., Ph.D. "This issue of JNPT is unique," commented Special Issue Editor Kathleen M. Gill-Body, DPT, PT, NCS who also serves as an Associate Editor of JNPT. "Emerging data is reported for specific components of vestibular rehabilitation, and for some specialized patient populations, reflecting the more sophisticated research questions that are being asked now that the overall efficacy of vestibular rehabilitation has been established by prior studies. What was particularly exciting to me was to see preliminary data reported by several authors, and to review the authors' interpretation of the meaning and clinical relevance of their findings."

New Technologies and Emerging Techniques for Vestibular Rehabilitation

The supplement includes nine research papers and reviews, authored by an invited panel of international experts at the forefront of research and practice in vestibular rehabilitation. "The topics covered are diverse and so is the authors' expertise," Drs. Schubert and Whitney write. "The authors include physical therapists, engineers, and physicians who work to enhance the care of persons with vestibular disorders."

The original mainstay of treatment for people with vestibular disorders was developed in the 1950s and included a set of simple, progressive exercises called Cawthorne-Cooksey exercises designed to manage dizziness and improve balance following damage to the inner ear. More recently, techniques have been developed to address specific problems with gaze and postural instability, motion sensitivity, and vertigo in patients with a variety of different vestibular disorders such as benign paroxysmal positional vertigo, Meniere's disease, brain injury, and others.

Several papers report on the use of advanced technologies, such as a "balance vest" that provides patients with vibrotactile feedback to help them relearn balance function. Other topics include computerized techniques to help restore steady vision during head movements (gaze stability) and to document improvements in the ability to focus on tasks in the presence of distractions (perceptual and motor inhibition).

One study uses a device similar to a mirrored "disco ball" to provide optokinetic stimulation for patients with vestibular disorders. All of these techniques "involve some degree of innovative technology to assess treatment effectiveness, measurement of vestibular function, or reveal behavior in people with vestibular dysfunction," Drs. Schubert and Ryan write.

Physical Therapists Play Key Roles in Research and Treatment

Other articles in the special issue document the benefits of vestibular rehabilitation for specific groups of patients. One study shows that gaze stability exercises can reduce the risk of falling in older adults with vestibular disorders. Another paper is one of the first reports on the effectiveness of vestibular rehabilitation on vestibular-visual-cognitive function following blast-induced head trauma sustained by soldiers in Iraq or Afghanistan.

Similarly, a third study reports improvements in dizziness, walking and balance after participation in a customized vestibular physical therapy program in children and adults with concussion. Other articles included in the special issue evaluate the comparative benefits of different types of vestibular rehabilitation exercises (habituation exercises versus gaze stability exercises) to reduce dizziness and improve gaze stability, as well as the influence of damage to the otolith organs of the inner ear on outcomes following vestibular rehabilitation. Such studies are essential to document the effectiveness of specific rehabilitation techniques for specific groups of patients with different types of vestibular disorders.

Physical therapists play a central role in vestibular rehabilitation not only as care providers, but also in helping to advance new research in the field. The next wave of vestibular rehabilitation approaches could include virtual reality feedback and training, vestibular prostheses (implants), and even stem cell techniques, according to Drs. Schubert and Whitney. They encourage physical therapists to collaborate with researchers in evaluating these new techniques as well as in pointing out patient problems in need of new rehabilitation approaches and helping to maximize the value of new technologies.

Source: Wolters Kluwer Health

Core stablizers

What is a core stability? Core stability” describes the ability to control the position and movement of

the central portion of the body. These muscles are known as the 'core' or powerhouse muscles and provide a solid base upon which all other muscles can work upon to initiate movement.

Core stability targets the muscles deep within the abdomen which connect to the spine, pelvis and shoulders,that controls good posture and provides movements to arms and legs.

Anatomy of core muscles

Transversus Abdominus (TA)
- known as the deepest muscle of abdominal muscles
-connects to the individual vertebrae of the lower (lumbar) spine and wraps right around each side to meet in the midline of the front of the abdomen.
- it mainly provides stability to the trunk during trunk flexion


Multifidis
- this deep back mucles lies either on the side of the spine and connects each individual lumbar vertebrae
- functions in extending the back

Diapraghm
- primary muscle for breathing
- when the Transversus Abdominus contracts, the diaphragm tightens to maintain pressure in the abdomen and so provides stability to the spine.

Pelvic Floor
-The pelvic floor muscles are the foundation for the core of the body.
-Stabilize the pelvis, and they support the organs of the lower abdominal cavity, like the bladder and uterus.

Ed Note

" What does it mean when every part of our back hurts? " We often asked to ourselves what is causing it and what should we do to prevent it? I had been taking so many analgesics and pain relief medications, it seems not to help at all. What should I do now?" says Maria, 48 who had been suffering with chronic back pain for nearly 7 years. One of her friend told her to visit a physiotherapist to get her back fixed and soon after few sessions of treatment she felt a relief from the pain she had been suffering from.
Like we all know, there had been always news about health, illness and various type of medications for conditions. Here are some findings that you can act on and benefit from this blog, which is why i combined physiotherapy and health together. This blog is mainly created for everyone, for physiotherapist to discuss and leave comments about the new types of treatment for certain conditions,for patients to learn about their own conditions and home exercise programe,and  physiotherapy students to look forward for various topics.
Enjoy the articles, research findings, assessment tools and notes you can look on :)