Physical Therapist,

SWINE FLU BASICS

2010-02-20T23:44:00.000-08:00

What is novel H1N1 (swine flu)?
Novel H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.
Is novel H1N1 virus contagious?
CDC (Centers for Disease Control and Prevention) has determined that novel H1N1 virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of this virus in people?
The symptoms of novel H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.
How does novel H1N1 virus spread?
Spread of novel H1N1 virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
How long can an infected person spread this virus to others?
At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods.
Prevention & Treatment

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against novel H1N1 virus. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:
· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
· Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
· Avoid touching your eyes, nose or mouth. Germs spread this way.
· Try to avoid close contact with sick people.
· Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

Other important actions that you can take are:
· Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs, tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious.
What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. If you are sick, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.
If I have a family member at home who is sick with novel H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with novel H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective. If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness.
What should I do if I get sick?
If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed
If you become ill and experience any of the following warning signs, seek emergency medical care.
In children, emergency warning signs that need urgent medical attention include:
· Fast breathing or trouble breathing
· Bluish or gray skin color
· Not drinking enough fluids
· Severe or persistent vomiting
· Not waking up or not interacting
· Being so irritable that the child does not want to be held
· Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
· Difficulty breathing or shortness of breath
· Pain or pressure in the chest or abdomen
· Sudden dizziness
· Confusion
· Severe or persistent vomiting
· Flu-like symptoms improve but then return with fever and worse cough
Are there medicines to treat novel H1N1 infection?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with novel H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current outbreak, the priority use for influenza antiviral drugs during is to treat severe influenza illness.
Recommendations for Travel to Areas Reporting Novel H1N1 Flu
CDC recommends that travelers at high risk for complications from any form of flu discuss their travel plans with their doctor. Together, they should look carefully at the H1N1 flu situation in their destination and the available health-care options in the area. They should discuss their specific health situations and possible increased risk of traveling to the area affected by novel H1N1 flu.
Travelers at high risk for complications include:
· Children less than 5 years of age
· Persons aged 65 years or older
· Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection
· Pregnant women
· Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders
· Adults and children who have immunosuppressant (including immunosuppressant caused by medications or by HIV)
Healthy people may make travel plans as they normally would and take common sense precautions to protect their health during travel.
Before Your Trip
If you are planning travel to an area where cases of novel H1N1 flu are being reported, the following recommendations will help you reduce your risk of infection and stay healthy.
Prepare for your trip
· Be sure you are up-to-date with all your routine vaccinations, including seasonal influenza vaccine, when available.
· Find out about the other health risks and travel recommendations for your destination.
· Pack a travel health kit along with facemask that contains basic first aid and medical supplies.
· Identify the health-care resources in the area(s) you will be visiting.

Please travel if necessary.

NECK PAIN

2007-09-09T10:14:00.000-07:00

NECK PAIN

The neck (cervical spine) is composed of vertebrae which begin in the upper torso and end at the base of the skull. The long vertebrae along with ligaments provide stability to the spine. The muscles allow for support and motion.

Neck pain or cervical spine pain is a common ailment occurring in all age groups affecting 50 – 70% of people. Prevalence of neck pain was diagnosed to be common in women 48% than in men 38%.

The neck can be vulnerable to injury and disorders that produce pain and restrict the motion. Since, it is less protected than the rest of the spine.

The most common cause of neck pain is soft tissue abnormalities due to injury or prolonged wear and tear. The factors which cause repetitive strain on soft tissues are prolonged sitting postures in computer professionals with out adequate support, forward head posture, faulty postures during sleep, and overhead tasks in electricians, painters and machine operators.

Proprioception is defined as the perception of positions and movements of the body segments in relation to each other. When there is damage to the mechanoreceptors in the joint, the persistent presence of pain inhibits the surrounding musculature to contract, which impairs the threshold of Proprioception leading to the recurrence of the symptoms.

Cervical spine pain is treated depends on what diagnosis it reveals and most patients are treated successfully. A better understanding of the variety of spine pain population is to cost-effective assessment and management necessary for primary spine care specialist.

To make the rehabilitation holistic, it is necessary to retrain Proprioception of the joint which helps in the reduction of neck symptoms and improvement in general health for self-experienced working ability.

OSTEOPOROSIS

2007-09-09T10:11:00.000-07:00

Five Fundamental steps to maintain bone health

A. Encage in regular PHYSICAL ACTIVITY 30 minutes per day for 3 to 5 days per week

B. Take medications if need and do check for Bone mineral density once a year.

C. Consult family doctor about bone health and maintenance.

D. Intake of recommended amount of Calcium and vitamin D.

E. Avoid smoking and Excessive alcohol.

Geriatrics

2007-09-09T10:06:00.000-07:00

Geriatrics is the branch of medicine dealing especially with the problems of ageing and diseases of the elderly. People are classed as elderly on reaching up to the age of 60 years, but in the 21^st century due to the high standards of living have increased the life expectancy up to 75 years.

The increasingly ageing population presents unique challenges for rehabilitation medicine. One third of the population over age 65 – 75 years experiences one fall per year. In the elderly population Falls are common in old age, Falls have been highly associated with the muscle strength, alternation, altered stride characteristics balance etc..

Frequent Falls and difficult in doing functional abilities are particularly likely to occur due to ageing process or weakness. These impairments may have an addition or interactive effect on an individual’s level of mobility mainly on doing functional tasks.

Fall is an event in which a person comes to rest inadvertently on the ground. A fall can result in disability by decrease in confidence, restricting mobility causing injury and debilitation and resulting in loss of independence. Old people need to strengthen their muscles in order to reduce their risk of falling and improve their functional ability. (Simpson 1993). Strict observation in home circumstances is necessary to achieve the sufficient intensity to the exercise program as in hospital setting.

Functional activities are highly skilled movement pattern which have been developed and refined with many years of practice. The leading factor to a decline in function in elderly people is lack of practice to these functional activities leading to a downward spiral in ability.

Exercise is a great way to keep older people active and function, but should be approached with caution. Exercises should not to be vigorous to be beneficial. Mild, regular and functional exercise is the key factor for staying healthy and happy.

EXERCISES BOOST IMMUNE SYSTEM

2007-08-31T10:00:00.000-07:00

EXERCISES BOOST IMMUNE SYSTEM

Increase oxygen
u Clearing the body toxins
u Deepening the breath & stimulate lymph system
u Delivering immune cells to their sites of activity
u Shifting out the adrenaline mode
u Stimulation of Neuro transmitters that provide a sense of well being.
u Boost production of macrophages

u During exercise the immune cells circulate throughout the body more quickly and are able to kill bacteria and viruses

u Regular exercises help to build up the Immune system and also it prevent diseases.

PROTOCOLS

u Duration : 20—30 minutes

u Frequency : 4 days per week

u Walking

u Bicycling

u Light Gym workouts

u Playing Golf, Shuttle..

Bony Configuration LUMBAR

2007-07-23T09:49:00.000-07:00

Lumbar spine is a single functional unit composed of 5 vertebras forming a motion segment connected in series each motion segment consist of 2 adjacent vertebral bodies and connected by Intervertebral disc, Ligaments and muscles^1,4,6.

Bony Configuration

Vertebra consists of anterior block of bone – The body.

Posterior bony ring consist of Neural arch – containing articular, transverse and spinous processes.

Neural arch consist of two pedicles and two lamina from which arises the seven processes – one spinous processes, Two Transverse processes and four articular facet^.

Adjacent Vertebra is connected together by Intervertebral disc, contributing 20 – 30 % of the spinal length^.

Ligaments

Six Ligaments

Anterior longitudinal Ligament, Posterior longitudinal Ligament, Capsular Ligament, Ligamentum Flavum, Interspinous Ligament, Supraspinous Ligament.

CAUSE OF LOW BACK PAIN

2007-07-23T09:43:00.000-07:00

Physical work factor

Heavy manual work

Lifting and twisting

Postural stress – sitting and driving

Whole body vibration

Psychosocial work factors

Societal influences

Monotonous work

Lack of personal control – Tension, Stress, Anxiety, fear and depression.

Low job satisfaction

Physiological factors

Low physical fitness

Inadequate trunk strength

Personal risk factors

Heredity, sex, age, body built, smoking, social class.

Patellofemoral pain syndrome (PFPS)

2007-07-19T18:33:00.000-07:00

Patellofemoral pain syndrome (PFPS) is one of the prevalent musculoskeletal injuries seen by physiotherapist and sports medicine practitioners. (Clement et al., 1981). The etiology of PFPS is not clearly understood. It may occur due to variety of factors including lower leg and foot mal alignment. Abnormal position of the Rear foot tends to cause abnormal movement in the associated joints like Knee, Hip, Pelvic & SI joint.

Patellofemoral pain may affect as many as 25 % of athletic population.( Mcconnell. 1986). Patellar problems are common in adolescents and distance athletes (runners, cyclists). (Christopher Hess,2003). Patient usually active and Young complain of retropatellar or peripatellar Pain. It results from physical and biochemical changes in the patellofemoral joint. (Rothbart BA, Estabrook 1998).

Excessive Pronation of the Subtalar Joint leads to Patellofemoral Pain. (Buchbinder 1979).The Excessive subtalar joint Pronation may delay External rotation of leg, and therefore inhibit supination of Foot. (Donatelli, 1987). Excessive Rear foot Pronation leads to Tibial Internal rotation which translates abnormal stress in Knee cause pain in anterior area of knee. (Buchbinder et al., 1979, Donatelli 1987, Kaufman et al., 1999).

Patients with patellofemoral pain syndrome have anterior knee pain that typically occurs with activity and often worsens when they are descending steps or hills. It can also be triggered by prolonged sitting.( Cutbill JW 1997.) It is precipitated by sitting for prolonged periods (Movie – goer sign).One or both knees can be affected. Consensus is lacking regarding the cause and treatment of the syndrome.

BYSSINOSIS

2007-05-21T08:15:00.000-07:00

BYSSINOSIS

Derived from Greek—Flax

Clinical Symptoms:

Tightness of the chest Cough
Asthmatic wheezing
Fever
Also called as Monday fever or Monday sickness Since after a day breaks the person’s feel reappearance of symptoms.

Pathology :
Mechanism of bronchial reaction is not uniformed in all patients
Initially it produces Broncho spasm,
Oedema of respiratory mucosa Lung muscles (i.e) Smooth muscles & Mucous glands of central airway are hypertrophied.
It has both features of Chronic bronchitis & Emphysema.

GRADES :

Grade 0 – Symptom less on Monday
Grade ½ – Occasional chest tightness on the 1st working day of the week or mild symptoms such as irritation of the respiratory tract.
Grade 1 – Chest tightness or Breathlessness on the 1st day of the working week only.
Grade 2 – Chest tightness or Breathlessness on the 1st day & other days.
Grade 3 – Chest tightness or Breathlessness accompanied by permanent respiratory incapacity from reduced ventillatory capacity

TREATMENT: Same as COPD No special tretment is for THIS

HAZARDS IN MEAT CUTTING INDUSTRY

2007-05-21T07:57:00.000-07:00

HAZARDS IN MEAT CUTTING INDUSTRY

The Hazards are grouped as follows
1) Back injuries
2) Cumulative trauma disorders
3) Falls
4) Infectious diseases.
5) Knife cuts
6) Toxic substances

Back Injuries

Repeated bending activities roots to back injuries
Heavy carrying luggage’s on the back
Lower cutting table causes more stress to low back
Prolonged standing also cause stress to back

Cumulative trauma disorders

Tendonitis – Inflammation of tendon sheath due to repeated activities
Carpal tunnel syndrome – Repeated Movement of wrist cause compression at the nerve and other structures around the wrist results in Pain , Numbness, Paresthesia.
Prolonged condition leads to motor loss and sensory loss.

Falls :

Represent greater source of serious illness Causes of Falls are
 Animal fat accumulate on the floor
 Blood
 Floor surface tend to wet
 Leaking Pipe
 Nature of work,
 Poor drainage &
 Slippers

Infectious disease:

Brucellosis, Erysipeloid, Leptospirosis, Dermatophytoses & Warts.

Brucellosis:
It is a Bacterial infection Transmitted by handling cattle
Signs
1. Head ache
2. Joint Pain
3. Loss of appetite
4. Night sweat
5. Running fever
6. Weakness

Erysipeloid :

It is a Bacterial Infection Spread through animals
Signs
1. Redness
2. Irritation

Leptospirosis :

It is a Bacterial Infection Spread through Direct contact with Infected Animal, water, Soil
Signs
1. Muscle ache
2. Chills
3. Eye irritation
4. Fever
5. Kidney/ Liver damage
6. Vomit

Dermatophytoses

Also known as Ring worm It is a Fungal Infection
Transmitted by contact with hair & skin of infected person
Sings
1. Hair fall
2. Small yellowish cup like crest to develop in scalp

Verruca Vulgaris:

It is a Viral Infection Transmitted by use of Towel, Meat, Fish Knife and Work tables

KNIFE CUTS

It is the major cause of Cuts and Abrasions to the Hands and Torso.
Workers have also been cut by other worker as they remove their knife from a slab of meat (Neighbor Cuts) Occur in over crowding working conditions.

TOXIC SUBSTANCES :

Workers exposed to Ammonia Ammonia used in refrigerators which leaks result in irritation in skin & Mucous membrane
Ammonia gas also irritate to Eyes, Head ache, Salivation, nausea, Perspiration, Vomiting, & even deaths.
It also aggravates Cardiac problems and Respiratory problems.

PREVENTIVE METHODS

Sharp knife prevent Musculo skeletal injuries, since sharp blades reduce grip force & cutting time
 Cut away from not towards—cutting stand to the side of the cut to keep blade away
 Replace or Tighten the Hand grips of Knives.
 Use correct Knife
 Use cutting board for chopping
 Use food pusher in advanced machines, not Fingers
 Use stabilizing tools don’t use finger since it may cause cut
 Wear appropriate gloves

FIBROMYALGIA

2007-05-21T07:45:00.000-07:00

FIBROMYALGIA

It is a disorder causes Muscle Pain & Fatigue
Fibromyalgia subjects have “Tender points” in their body

SYMPTOMS

Pain through out the body
Especially Shoulder, Buttock, Neck, Low back
Sleep Disorder
Morning Stiffness
Head ache
Painful Menstrual cycles
Tingling or Numbness in Hand & Feet
Problem in Thinking & Memory ( Fibro Fog)

CAUSES:

Stressful traumatic events
Repetitive injuries
Illness
Certain diseases

PREDISPOSING FACTORS:

Rheumatoid Arthritis
SLEAnkylosing spondylitis
Stress
Weather

TREATMENT

Medications ( Analgesics, NSAID, Antidepressant)
Sleep
Diet
Massage
Exercises
Work environment Modification

SELF CARE:

Reduce stress
Well Sleep
Exercise
DIET
Massage

REDUCE STRESS:

Avoid situation that cause Stress
Take time to relax
Breathing Exercise
Guided Imagery
Meditation
Yoga

SOUND SLEEP

Go to bed early
Avoid caffeine
Good mattress
Say no to alcoholic

EXERCISES:

Stretches
Low intensity Aerobics
Walking, Swimming
Bicycle
Calisthenics
Tai Chi

DIET

Avoid Caffeine
Avoid Alcohol
Proper Vitamin
Balanced Diet
Quit Smoking

Effect of OCCUPATIONAL INJURY

2007-05-15T07:07:00.000-07:00

Spinal problems: One of the commonest areas which get problem due to Lifting activities, prolonged standing, lengthened walking and frequent stair climbing. Common problem area is at the Neck and Back. Low back pain is more prevalence in physiotherapist. It is about 48 % in physiotherapy population. ( Mary .w. kelly. 2005).
Neck pain is also one of the common problems encountered to physiotherapist, It occurs due to prolong bending of neck during treatment or during computer operation for discharge summary or documentation. About 33% of individuals are suffering with Neck pain.
Hand & Fingers: Hand and fingers are the other common area which gets involved following physiotherapeutic treatment. Finger strain occurs as a result of massage application for a long duration or Quite a lot of patients. Thumb strain occurs as a result of application of manual therapy techniques for a long time. Approximately 23% affected following thumb injury. Wrist problems occur as a result of application of massage technique or by administration of Chest physical therapy techniques (Clapping).
Large Joints: Weight bearing or large joints go for degenerative changes following prolong occupational hazard. Standing for a long duration causes abnormal loading in joint tends to cause damage to the articular surface (Structure present in the bony ends) which results in degeneration.
PREVENTIVE MEASURES:
Variety of measure taken to prevent occupational Hazards in Physiotherapy practice. There are certain things therapist can do to combat their risk of injury. Simple steps done before and during tasks can help the body counter strains that come with the occupation.
Stretching : Warming up prior to the activity makes general body conditioning and prevent fatigue and muscle strains.
Correct Posture and Positions: Performing each Task in correct posture and position prevent excessive stress in the joints. Frequent break between the work.
Outsourcing : Obtain assistance from another individuals to reduce load during task like transferring patient or working with heavy patients.
Modify : Modifying techniques or environment to avoid stress put on the therapist body prevent injury. Make adjustment to posture by modifying Bed height, Pause to stretch and frequent change in positions. Avoid bending activities which cause Low back pain.
Reactive : Respond to discomfort or injury. If use of thumb mobilization cause pain then change to Knobbler (A hand held plastic equipment use to treat) which replace role of thumb, Choose an Electro modality to treatment for replacing manual therapy techniques. Reducing the working hours till the wound gets healed.
Use of Aids : Use belts for transfer as well as treatment. Use stool to obtain any equipment from the upper berth. Use Mask while treating patient in ICU. Earth circuit should connect to prevent shock. Proper aid should be used for prevention from exposure of radiations like wearing Goggles, aprons, Ect...

PIRIFORMIS SYNDROME

2007-05-06T08:47:00.000-07:00

Piriformis syndrome is an often misdiagnosed cause of sciatica, leg, or buttock pain, and disability. The sciatic nerve may be compressed within the buttock by the piriformis muscle, with pain increased by muscular contraction, palpation, or prolonged sitting.
The piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve,
This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back.
Patients generally complain of pain deep in the buttocks,
Worse by sitting,
Climbing stairs, or
Performing squats.
The piriformis muscle assists in abducting and laterally rotating the thigh.
This is the action of the right piriformis muscle
It balance the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling.

TREATMENT:
§ Stretching exercises and
§ Massage.
§ Anti-inflammatory drugs prescribed.
§ Cessation of running, bicycling, or similar activities may be advised
Stretching:Lie flat on the bed. Bend the legs to 90º the knee, lifting the feet in the air. Let the feet spread apart from each other, keeping the knees together

DIABETICS -- An Introduction

2007-04-14T08:18:00.000-07:00

IDDM

IDDM is associated with inflammation of the ilets of the pancreas and appears to be an autoimmune response.
Infection with Coxsackie’s viruses B has been shown to be the likely trigger of the autoimmune response
Other Etiological factor is inherited susceptibility after infection with virus, the beta cells inappropriately express an antigen.
The antigens on the beta cells are recognized and destroyed by circulating T cells.
The process of cellular destruction is marked by the appearance of Islet cell antibodies.
Some time the Pancreas will attempt to produce near – normal or normal levels of insulin during a “Honey Moon” Phase. Usually noticed after initial diagnosis. This phase may last upto 6 months or longer, but in true DM, the patient will develop signs of hyperglycemia again.

NIDDM

Refractoriness to insulin in the cell membrane receptors causes NIDDM
In Obesity, the pancreas cannot compensate for problems in the receptors by increasing insulin production. Some newer theories suggest that over time, the high levels of circulating insulin that occur with obesity “Insulinise” the cells, making them resistant to the action of insulin

DIAGNOSTIC ASSESSMENT:
1. Blood Glucose
2. Fasting Blood Sugar
3. Post Prandial Blood Sugar
4. Blood Glucose finger sticks
5. Glycosyloted haemoglobin
6. Glucose tolerance test. (GTT).

MEDICAL MANAGEMENT:

There is No cure for Diabetes.
Diabetes control depends on the proper interaction of 3 factors.
1) Diet.
2) Insulin or oral medication to lower blood glucose.
3) Exercise.

DIETARY:
The dietary management is the cornerstone for diabetes. The balanced nutritional plan for patients with diabetes has a two fold purpose
1) To discourage the ingestion of food with high sugar and fat content
2) To correct or avoid Obesity
The current recommendation for the distribution of calories are
-55 to 60 % of CHO
-30 % of FAT
-12 to 20 % of PROTEIN

PHARMOCOLOGICAL MANAGEMENT:
Oral hypoglycemic agents:
Oral hypoglycemic agents are not insulin. They lower the Blood glucose in part by stimulating the pancreatic beta cells to release insulin.

First generations:

1) Talbutamide (orinage)
2) Tolazamide ( tolinage)
3) Acetohexamide (dymelor)
4) Chlorpropamide ( diabinase)

Second generation:

1) Glyburide
2) Glipizide

Insulin therapy:

Patients with IDDM must inject insulin daily to survive. Some patients with NIDDM may require insulin if diet , exercise & oral hypoglycemic agents are ineffective.
Some medications such as Prednisone may elevate blood glucose levels & necessitate insulin injection for a time.
Insulin lower blood glucose by
1) Promoting the transport of glucose into cells
2) Inhibiting the conversion of glycogen & amino acids to glucose.

TYPES OF INSULIN:

1) Rapid Acting – eg Hunulin R ( 6- 8) hrs duration
2) Intermediate Acting -eg Lente insulin ( 6- 12) hrs
3) Long Acting -eg Protamine zincinsulin ( 18 – 24) hrs
If Blood glucose is difficult to control, two different insulin can be mixed & administerd as a single injection.

EXERCISE:

A program of planned exercise can greatly benefit the patient with diabetes.
1) Lower blood glucose by increasing CHO metabolism
2) Facilitates weight reduction & proper weight maintainence
3) decrease Blood Pressure
4) Decrease Stress & tension

SURGICAL MANAGEMENT:
Pancreas transplants

MOTIVATION

2007-04-14T08:15:00.000-07:00

Motivation is the process
a) of Arousing or initiating behavior
b) of sustaining an activity in progress
c) of Channeling of activity in the given course
Determinants of Motivation
Unending process.
A psychological concepts.
The whole individual is motivated.
Motivation may be financial or Non financial.
Frustrated cannot be motivated
Goals are motivators

Unifying force
Motivation can be positive or negative
Motivation & job satisfaction are different

Determinants of motivation

Ø Forces operating within the individuals
Ø Forces operating within the organizations Forces operating in the Environment

A STUDY TO DETERMINE THE EFFECTIVENESS OF VERTICAL OSCILLATORY PRESSURE ON PAIN AND CARDIOVASCULAR RESPONSE FOR NECK PAIN PATIENTS.

2007-04-07T06:46:00.000-07:00

A STUDY TO DETERMINE THE EFFECTIVENESS OF VERTICAL OSCILLATORY PRESSURE ON PAIN AND CARDIOVASCULAR RESPONSE FOR NECK PAIN PATIENTS.
AUTHOR : B.ARUN.MPT,CMPT*. B.GANESAN. MPT**.
*Physiotherapist, K.G.Hospital, 18, Arts College Road, Coimbatore-18.
** Principal, Infant Jesus College of Physiotherapy, Bangalore.
Purpose of the Study:
This study was aimed to ascertain the immediate response of Neck pain to Vertical Oscillatory pressure and to establish the effect of Cardio vascular responses.

Methods: An experimental Pre Test Post Test Same Subject design was selected for the study.20 subjects with Neck Pain were selected by Cervical Mobility Test. Pre treatment assessment of Pain, Blood Pressure and Heart Rate were Measured. Post Treatment assessment of Pain Heart rate Blood pressure were measured immediately and After 5 Mins following Vertical Oscillatory Pressure.
Parameters: Borg Scale, and Sphygmomanometer.

Result:
Neck pain Intensity decreased from very Uncomfortable to very mild after Treatment (t = 12.83, p > 0.05%)
There are no significant changes in Heart Rate Systolic Blood Pressure Diastolic Blood Pressure In Immediate and 5 Mins after Vertical Oscillatory pressure.

Conclusion:
Vertical Oscillatory pressure relieves Neck Pain with out inducing significant myocardial stress or alteration in cardiovascular function suggested by variables measured in the study

A CORRELAITON STUDY TO ANALYSE THE RELATIONSHIP BETWEN REAR FOOT VALGUS AND ANTERIOR KNEE PAIN.

2007-04-07T06:44:00.000-07:00

A CORRELAITON STUDY TO ANALYSE THE RELATIONSHIP BETWEN REAR FOOT VALGUS AND ANTERIOR KNEE PAIN.
AUTHOR : B.ARUN.MPT,CMPT*.
*Physiotherapist, K.G. Hospital, 18, Arts College Road, Coimbatore-18.

INTRODUCTION:
Abnormal position of the Rear foot tends to cause abnormal movement in the associated joints like Knee, Hip, Pelvic & SI joint. Excessive Rear foot Pronation leads to Tibial Internal rotation which translates abnormal stress in Knee cause pain in anterior area of knee.
Purpose of the Study:
Purpose of the study is to determine the relationship between the Rear foot abnormality (Valgus) and anterior knee pain.
Methodology:
A total of 50 subjects were selected by convenient sampling method with the age group range form 18—27 yrs. Subjects were chosen following an inclusive criteria and an informed consent was obtained. Study was conducted for duration of 6 months. And the parameters are Anterior knee pain and the Rear foot abnormality was assessed to the subjects. Anterior knee pain was assessed by using VAS pain scale, where as the Rear foot abnormality was measured using Goniometer, before measurement of rear foot abnormality Subtalar neutral was found.
Result:
The results were calculated using Kearl pearlson’s correlation coefficient.
It analyses the relationship between the Anterior knee pain and Rear foot Valgus. The result found that it has a strong negative correlation of 0.90. This shows that the anterior knee pain occurs following abnormal rear foot positions.

Conclusion:
The study concluded that abnormality in the Rear foot will cause a significant changes in Knee tends to cause knee pain.

FORWARD HEAD POSTURE

2007-04-07T06:40:00.000-07:00

FORWARD HEAD POSTURE

Forward head posture is a clinical entity that has been identified by multiple authors as a significant factor in a variety of musculoskeletal pain syndromes .
Donatelli R, Wooden M. 1989
Cailliet R , 1977
Haughie L J, Fiebert IM ,1995
Adaptive shortening of soft tissues and muscle weakness, caused by prolonged poor postural habits is considered to be a Postural dysfunction.
KISNER AND COLBY.
Therapeutic Exercise, 3rd edition,
Each inch the head is held forward of neutral, requires the exertion of 15 to 30 pounds of extra muscle tension to hold the head erect.
Increasing chronic loading on the vertebrae and intervertebral discs.
Rene Calliet, MD, 1985.
Dysfunction Mechanics
Mal-Posture is the common for causing Mechanical Dysfunction.
Cervical spine is stabilized by Soft tissues surrounding the joints.
In abnormal posture, Head & Neck is Counter balanced by passive tension in soft tissue structures.
The Most common dysfunction in Neck is Forward Head Posture.
FHP mechanics
A Neutral & Erect posture of Head & Neck provided by
Optimal balance,
Muscular coordination,
Minimal energy expenditure and
Minimal stress on supporting structures.
Any alteration in the Normal result in poor posture.

COMMON COMPLAINS
u Head ache
u Cervical Dysfunction
u Thoracic Outlet syndrome
u Cervical Spondylosis
u Breathing Difficulty
u TMJ Dysfunction
u Shoulder Impingement syndrome

Prevention & Treatment
u Strengthening of neck muscles by
Ø Stretching
Ø Breathing exercises
Ø Neck support by pillows
Ø Posture correction
Ø Ergonomic Advices

REDESIGN THE ROLE PHYSIOTHERAPIST IN COMMUNITY SETTINGS

2007-04-07T06:36:00.000-07:00

REDESIGN THE ROLE PHYSIOTHERAPIST IN COMMUNITY SETTINGS

“Limit the disability and Lead the Quality Life”

Author : B.Sharmila, K.Kadhambari.BPT,

K.G. College of Physiotherapy,

K.G. Hospital, Coimbatore.

Introduction :
Physiotherapists play a foremost role in all areas of Rehabilitation. Community rehabilitation is one of the central parts of Physiotherapists work.

Rehabilitation in Community is defined as training in the people with disabilities at their own area.
Recent survey shows there are about 3 lacks people with disabled live in INDIA. About 2 lacks are living in villages.
Appropriate rehabilitation at the community level is essential to prevail over the disabilities. Physiotherapist can play an immense role in rehabilitation undoubtedly in community setup.
Physiotherapist can be a Team leader in the community, Collaborative work is the nature in Community, and each and every member in the Team has a definite role to do. In community every one is accountable for the patient.

Vital role of Physiotherapist in Community

Physiotherapist care starts from the Root to the Fruit.
Physiotherapist not only Treat the patients in Community they also play a major role in Prevention of disease and Disability.
Physiotherapist should have abrupt knowledge in field so that he can do Diagnose, Prevent & Treat the diseases in community.

Levels of Prevention

Primoidal prevention
Ø By teaching Healthy habits we can prevent diseases &
Ø Routine exercises should be incorporated to prevent ailments.

Primary prevention
Ø Health promotion — Promotion of health helps in prevention of diseases
Ø Specific promotion — Promotion of particular habits to prevent rapid spreading of diseases

Secondary prevention
Ø Early diagnosis and treatment — Regular Screening at the school level or at the area helps in early diagnosing as well as preventing diseases and can given a proper treatment & advices.
Ø Limit the compilation — Early diagnosis helps in limiting complication of the diseases and check further dispersion of infections.

Tertiary prevention
Ø Restoration of Function
Ø Restoration of the capacity to earn a lively hood
Ø Restoration of family and social relationship
Ø Restoration of personal dignity and confidence.

There are lots of role Physiotherapist have to play in the community. If they develop their skills in earlier diagnosing and appropriate treatment they can excel in the community.
Conclusion
Physiotherapist aims to prevent the disease and there by promoting their abilities and they can limit the disabilities. As a Physiotherapist we can make the Disabled as Differently able.

“We care for your abilities and we cure your disabilities”

PHYSICAL THERAPY INTERVENTION FOR TREATMENT OF PREMENSTRUAL SYNDROME

2007-04-07T06:32:00.000-07:00

PHYSICAL THERAPY INTERVENTION FOR TREATMENT OF PREMENSTRUAL SYNDROME

Author: G.Thilagavathi, BPT, MIAP.

Premenstrual syndrome (PMS), also known as premenstrual tension (PMT) or premenstrual dysphoric disorder (PMDD). It is a term used to describe some of the physical & emotional changes which occurs before the period. These changes can occur a few days to more than a week before the beginning of the period & usually resolves when the period starts.

PMS is very common because of the diverse life style which paves the way for this syndrome. PMS causes physical & emotional changes, which can be changed by appropriate Physiotherapy.

Symptoms of this syndrome are-
ü Headache,
ü Migraine,
ü Sleeplessness,
ü Tiredness,
ü Difficulty in concentrating,
ü Decreased efficiency,
ü Tension anxiety,
ü Mood swing (depression, irritability,& anger),
ü Food carving,
ü A bloated feeling in the abdomen.

Some women suffer many of these symptoms some only a few. In some women the symptoms are mainly physical and in others emotional symptom are the most prominent.

These symptoms will reduce the working stamina in both working place & in the home & this will alter the working environment Thus it can be reduced by
ü Exercise therapy
ü Diet
ü Nutritional supplement

EXERCISE THERAPY;
Women who exercise regularly report fewer headaches, less period pain. Studies have shown that regular exercise that increases your heart rate is beneficial for premenstrual symptoms. Exercise should be enjoyable and helpful
Lot of exercises useful for the syndrome.
ü Aerobics exercise
ü Yoga
ü Swimming
ü Cycling
ü Walking
ü Dancing

DIET
A balanced diet supplies vitamins & minerals necessary for good health. Heavy periods can lead to iron deficiency and result in anemia or excessive tiredness, so diet should iron rich food (liver, meat, sea food, dried fruits, wholegrain cereals, egg yolk &dried peas, beans & lentils).
NUTRITIONAL SUPPLEMENTS
Calcium supplement have been shown to be effective in PMS

CONCLUSION
In addition to Aerobic exercises and Yoga which relaxes the body and mind, Exercise programme, Diet and Nutritional supplement should also be used to reduce the
Symptoms.
There are many more problems like this, we physiotherapist should be aware.

Shifting the Borders of PHYSIOTHERAPIST in ACCIDENT & EMERGENCY DEPARTMENTS

2007-03-27T05:41:00.000-07:00

INTRODUCTION:
As a Medical practioner, how many of us know the Emergency ambulance number to call ? Probably 95% would not know.
Accidents can occur at any times and any places usually at Odd times and at Places where a doctor would not be expected to be.
Injuries are a common cause of Death, Most of the Deaths due to injuries may be unavoidable, but prompt care saves life.1
Early skilled care can reduce the extend & duration of damage and return the patient into his community in earlier period.2
Emergency medical service is a life saving service, it is a chain of human & Physical resources, brought together to provide total patient care. 3, 4
Emergency triage is a process of sorting or classifying patients according to the need for Emergency treatment & potential for further injury. Triage comes from French. 5.
The health care industry is becoming more complex, there are considerable personal shortages in many of the professional disciplines.
Physiotherapists are responsible for providing quality services and care for patients. Still they can provide more services if they extend their area.
This article focuses role of physiotherapist in Accident & Emergency situations through Available literatures. The available literatures for the Role of Physiotherapist practioners in Emergency department are severely limited.
There are Major Benefits for employing Physiotherapist practioner in Emergency Department. 6, 7.
Ø Enhance the ability of department
Ø Reduce the Waiting time for patients.
Ø Reduce Hospital admissions
Ø Treatment applied on the site of injury
Ø Help to manage the increasing load
Ø Being a part of flexible & responsive work force
Ø Giving timely & Quality care
Ø Improving access to most appropriate emergency practioner.

The Major Disadvantage for not applying physiotherapist in Accident & Emergency situations are. 6
Ø Lack of Communication Skills
Ø Deficient in Hands on approach on First Aid.
Ø Insufficient knowledge in Emergency Code/ Colour.
Ø Not knowing to apply POP
Ø Poor Knowledge on Monitors.

Physiotherapist can reduce the number of admission in hospital. A study on COPD patients’ states that Exercises delivered in the Community will reduce the number of hospital admission and ease the burden on waiting list. 8
Physiotherapist work successful in all areas in U.K, Physiotherapy Triage was successfully trialed in the Emergency department of Royal Melbourne Hospital in 2004, where a Physiotherapist found vital in reducing waiting time and total treatment time for emergency patients with Musculoskeletal injuries.
Jibuike et al., conducted a study on “ Acute Knee screening service” shows that Physiotherapist can reduce number of patients in Trauma & Accident & Emergency clinics.
Jibuike et al., also found that Physiotherapy practioners could diagnose knee conditions better than Accident & Emergency Senior house officers. 9
The Role of the Accident and Emergency extend scope of Physiotherapy practioners with the ability to treat patients autonomously can be challenging for both the practioners & other health care providers whose professional boundaries have been crossed. 10
Conclusion:
There are clear advantages in having Accident & Emergency extend scope Physiotherapy practioner in emergency departments particularly for patients with Musculoskeletal injuries.
Physiotherapy practioner are already providing a valuable resources for the A& E team members and their role fits in with the ‘See and Treat’ and minor injury streaming systems that the department of Health. 12
Suitably trained and Qualified physiotherapy practioner can lead Accident & Emergency soft tissue injury review clinics, thereby freeing up senior doctors for other duties. 11

Bibliography:
1) John Norman (1978) “Management of injured patients” Mc Milan journal limited, USA.
2) Easton. K (1970) “The general practioner and the rescue services” community health. Bristol.
3) Herbert J. Proctor MD( 1979) “Management of Acute trauma” Year Book Medical publishers, USA.
4) Gene Weatherall. (1983) “Instructors guide for emergency care” Prentice—Hall Publishing, Mary land.
5) Jean H Roger.(1989) “Emergency Nursing—A Practical guide” William & Willikins, USA.
6) Bethel J (2005) “The role of the Physiotherapist practioner in Emergency departments: A critical appraisal, Emergency Nurse.
7) Department of Health (2003). “Work force matters: A guide to role redesign in emergency care. The stationary Offices, London.
8) Kathleen Philip (2006), “Physiotherapy can reduce Hospital admission” Australian journal of Physiotherapy.
9) Jibuike et al (2003). “Management of soft tissue knee injuries in an Accident & Emergency department.
10) Mike smith ( 2004). “Collaborative working” Emergency nurse.
11) Boyce S ( 2003) “ The Physiotherapist practioner: Extending the role of the physiotherapist. Emergency medicine journal.

Author: B. Arun., MPT, CMPT,

Efficacy of sensorimotor training in the rehabilitation of improving function and Proprioception of patient with Osteoarthrosis of Knee

2007-03-06T08:36:00.000-08:00

The knee joint is commonly involved area which gets degeneration. The treatmentrequires great skill and perfection to bring the patient into the track of work.

Osteoarthrosis causes much musculoskeletal pain and disability.Patients suffer prolongedpain and disability some of the patients suffer with deformity of joint.

Apart form this many patient suffer with Q’ceps weakness, Proprioception deficit and postural instability.

Strengthening of Q’ceps muscle and the training to the joint improves patients Proprioception and postural stability.

QPER and DAPRE techniques commonly prescribed to improve the function and Proprioception.

ERGONOMIC ANALYSIS FOR PADDY WORKERS

2007-03-06T08:33:00.000-08:00

Musculoskeletal disorder is very common in all occupations.
Surprisingly Agricultural workers are also having problems due to Poor positions & Awkward postures.

Agriculture is the very physical occupation where muscular aches & pain are often considered to be “Part of Job”

Susan.G.2003

Repetitive forces at the same muscle, tendon or region result in Trauma, injury & inflammation lead to Cumulative trauma disorders or Repetitive Stress Injury.

James 2006

Field crop production workers are at high risk for work related muscular disorders

Murphy 2003

Heavy physical work, repeated lifting & Twisting activity causes Low back Pain in workers. Marras et al., 1993

Repeated force to joints and soft tissues results in Pain. Musculoskeletal disorders affect the work force & Production.

Blondell et al.,1977.

“To forget how to dig the earth & to tend the soil is to forget ourselves.”

Mahatma Gandhi.

SUBCALCANEAL HEEL PAIN

2007-03-06T08:30:00.000-08:00

SUBCALCANEAL HEEL PAIN

Pain in the plantar pad of heel in a common condition and has been reported in patients aged from 18 to 80.

It is a summation of series of micro trauma to the plantar fascia caused by a strain of the attachment of plantar fascia to the calcaneum.

AETIOLOGY:

Excessive Pronation of subtalar joint

Repeated stress over the fascia.

Pes cavus highly arched foot.

Occupational stress like prolonged standing and walking.

High heel shoes.

Obesity

Length and stride during running

Wearing shoes without sufficient

CLINICAL FEATURE:

Sharp or acute pain over the heel.
Pain is most severe when the athlete first puts weight on the foot.
Pain occurs in the heel when no person getting out of the bed in the morning.
Pain diminishes during activity.
Pain increase when the activity stops.
Tenderness over the calcaneal end of the Aponeurosis seen over the anterior medial tuberosity of the calcaneum.

INVESTIGATION

X-Ray

May reveal the presence of calcaneal spur.

MANAGEMENT:

Medical Management

Cortisone injection

Aspirin pills

Soluble steroid injection

Physiotherapy Management

Acute phase

Pulsed ultrasound

Electrical stimulation

Faradic foot bath.

Rehabilitation phase

Continuous ultrasound
Ionoto / phonopheresis
Cryotherapy

Stretching

T.A. Stretching
Foot mobilization
plantar fascia stretch
intrinsic foot muscle strengthening

Foot Support

Custom foot Orthosis

Home program

Avoid prolonged standing
Advice about suitable standing foot wear.
Exercise for intrinsic foot muscle should be taught to the patient.
Contrast bath
Rest splits should be administered if necessary.

Exercise

Pricking a golf ball and up your toes.

Lay a towel on the floor and scrunch it up with your toes

RECTUS ABDOMINIS DIASTASIS

2007-03-06T08:27:00.000-08:00

RECTUS ABDOMINIS DIASTASIS

Rectus abdominis diastasis is a conventional term used to define the split between the two rectus abdominis muscles (Polden and Mantle 1990). However, as the two Recti muscles are attached in the middle by the linea Alba, the widening actually occurs as a result of stretching and thinning of the linea alba. It commonly occurs in childbearing women, third trimester. (Boissonnault and Blaschak 1988). It can persist in 30-60% of women during the post partum period at different sites along the linea alba. (Boissonnault and Blaschak 1988; Bursch 19987).

This can vary between a small vertical gap 2-3cm wide and 12-15cm long to a space measuring 12-20cm in width and extending nearly the whole length of the recti muscles.

Investigation

Checking for Diastasis recti should be done in the,

Beginning of second trimester and continue throughout the rest of pregnancy.

Post partum phase.

Patient Position

Supine Hook lying.

Procedure

Chin should be tucked

Arm extended to knees

Patient should raise her head, shoulders until the scapulae clear the Surface

Therapist check for Central budge in abdomen and with fingers placed Cephalo Caudally, measure the amount of seperation between the Rectus abdominis Muscles 2 inches above, below, al the level of umbilicus.

Common treatment given for diastasis recti includes Binder, Exercise and Rest. Binder helps to hold the abdomen tight and maintain the muscle length properly. Abdominal exercises helps to strengthen the abdominals and helps in maintain the posture

Patellar tendinitis

2007-03-06T08:24:00.000-08:00

Patellar tendinitis or Jumper’s knee is a over use or repetitive trauma to the extensor mechanism of the knee, which commonly results from jumping or running sports such as ‘Basket ball’ and ‘Volley ball’.
The prevalence of Jumpers knee is 40-50% among elite volleyball and basketball players. Ferrati A, Panpandrea P -1990 ,Lion O, Holen K J -1996.
They are present with anterior knee pain and intermittent swelling.
The tenderness is localizes to the patellar tendon, primarily at its origin on the ‘Inferior pole of patella’ and the tenderness is appreciated with the knee in extension.
This often recurrent condition can severely limit or even an athletic career and recovery from each episode can be prolonged. Cook J L, Khan K M-1997.
Recent investigations have shown that squat performed on a 25 degree decline board ‘target knee extensor mechanism more specifically than the ‘Standard squat ‘ and it has been suggested that this may be relevant in the management of patellar tendinopathy Purdam C R -2004 , Cook J -2003.
The progressive eccentric strengthening forming the corner stone of most rehabilitation programmes. The treatment includes Ultrasound and Transfriction Massage.
Therapeutic ultrasound is one of the most common treatments used in the management of soft tissue lesions like tendon, ligament, and bursa.
Ultrasound induces thermal and non thermal physical effects in tissues. The thermal effects are increased blood flow, reduction in muscle spasm, increased extensibility of collagen fibers and an inflammatory response at the temperature level of 40-45 degree for 5 minutes.

ROLE of Orthopaedic Physical therapist

2006-12-22T04:59:00.000-08:00

• Orthopeadics & physiotherapy are Two faces of same coin.A Good Orthopedic Surgeon is one who has a Good Physiotherapist (John Ebenezer. 2003).
• Physiotherapist blends with orthopedics and makes patient put back to normal
( Pre injury) state.
• The role of Physiotherapist doesn’t starts after the fracture is fixed or after the disease is healed but it starts from the day one of the onset of Disease or Fracture.
Causes for weakness following Immobilization
• Trauma to soft tissue
• Surgery (e.g., joint replacement)
• Joint disease (e.g., osteoarthritis)
• Prolonged immobilization
• Neuromuscular disease
Ultimate Purpose of exercise program is
· To restore function
· To restore Performance
· To restore Muscle strength
· To restore endurance – Pre trauma level
ISOMETRICS
n Maintain Muscle Strength
n Done at the early stage
n Done with POP or Plaster cast
n Done in Immobilization period
ISOTONICS
· Increase Muscle Strength
· Done at the Intermediate stage
· PRE are advised
· Dumbbells, Weight cuff, sand bags are used.
ISOKINETICS
Joint movement at a constant rate
Improves Muscle Strength
Done at the Late stage
Cyberx is used to train.
CONDITIONING EXERCISE:
Increase endurance
Cardiopulmonary fitness increases
Conditioning exercise enhance peripheral oxygen utilization & efficiency & result in Aerobic muscle metabolism.
E.g Stationary bicycle, Treadmill

Chikungunya Facts

2006-12-22T04:49:00.000-08:00

Chikungunya [chick’-en-GUN-yah],
Also called chikungunya virus disease or Chikungunya fever,
Caused by Musquito Bite Named as Aedes aegypti is the major vector of chikungunya virus.
It is a viral illness that is spread by the bite of infected mosquitoes. The disease is characterized by severe, sometimes persistent, joint pain (arthritis), as well as fever and rash. It is rarely life-threatening.
Chikungunya occurs in Africa, India, and Southeast Asia.
1. There is no specific treatment for chikungunya.
2. Prevention centers on avoiding mosquito bites in areas where chikungunya virus may be present, and by eliminating mosquito breeding sites.
How soon after exposure do symptoms appear?
The time between the bite of a mosquito carrying chikungunya virus and the start of symptoms ranges from 1 to 12 days.

Diagnosis:
Chikungunya is diagnosed by blood tests. Since the clinical appearance of both chikungunya and dengue are similar, laboratory confirmation is important.
TREATMENT: There is no specific treatment for chikungunya., Only supportive therapy is given nonsteroidal anti-inflammatory drugs, and getting plenty of Rest.
Infected persons should be isolated from mosquitoes in as much as possible in order to avoid transmission of infection to other people.

PREVENTION
Use mosquito repellents on skin and clothing.
Use insect repellents that have been approved by the Environmental Protection Agency (EPA). They are safe and effective.
When indoors, stay in air-conditioned or well screened areas. Use bed nets if sleeping in areas that are not screened or air-conditioned. · When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants. Lasts through 5-6 washes.

Footwear modifications reduce load on knee.

2006-12-22T04:44:00.000-08:00

Patients with Osteoarthritis Knee may benefit from footwear modifications that can effectively reduce knee joint moments. Foot wear design in which the Rear foot portion of the Mid sole moves independently of the rest of the shoe.
The design allows the foot to move mediolaterally as well as anteroposteriorly relative to the shoe outsole-which, the researchers found, can significantly reduce both abduction and external rotation moments at the knee.
Rigid midsoles were associated with significantly higher maximum knee abduction moments and external rotation moments than the softer midsoles.Footwear modifications that reduce knee joint moments may also be able to help patients with knee osteoarthritis
Clacaneus Valgus & Varus also contribute more stress on the knee will cause pain in Knee.
Alteration in Foot e.g. Altering foot by elevating foot wear medially at the sole cause marked reduction in stress implicated on the joint. Will make the patient feel better

Chondromalacia Patella

2006-12-22T04:36:00.000-08:00

The term chondromalacia patella has often been used interchangeably with patellofemoral syndrome and anterior knee pain,
The term chondromalacia patella describes the softening and progressive breakdown of the articular cartilage of the patella.
It occurs secondary to an underlying condition such as malalignment or trauma (Greenfield and Scott, 1994).
Grades of the extent of cartilage damage. Eisele (1991),

1. Grade 1 - Articular cartilage only shows softening or blistering
2. Grade 2 - Fissures appear in cartilage
3. Grade 3 - Fibrillation of cartilage occurs, causing 'crabmeat' appearance Grade 4 - Full cartilage defects are present and subchondral bone is exposed

DO BONE MINERAL DENSITY IMPROVES WITH EXERCISE

2006-12-22T04:20:00.000-08:00

Osteoporosis is a serious health problem that diminishes quality of life & Leads to decrease the person’s life.
The intense exercise training program presented here was effective in improving strength, endurance, quality of life parameters, and even BMD in women in their critical early postmenopausal years, Kemmler W, et al., 2002.
Physical activity as a way to prevent osteoporosis is based on evidence that it can regulate bone maintenance and stimulate bone formation including the accumulation of mineral,
Strengthening muscles, Improving balance, and thus reducing the overall risk of falls and fractures.
These exercise-stimulated increases in bone diameter diminish the risk of fractures by mechanically counteracting the thinning of bones and increases in bone porosity.
Seven principles of bone adaptation to mechanical stress
Principles are
(i) Be dynamic, not static;
(ii) Exceed a threshold intensity;
(iii) Exceed a threshold strain frequency;
(iv) Be relatively brief but intermittent;
(v) Impose an unusual loading pattern on the bones;
(vi) Be supported by unlimited nutrient energy; and Include adequate calcium and cholecalciferol (vitamin D3) availability. Borer KT, et al., 2005

Foot Types.

2006-11-22T04:54:00.000-08:00

Foot Types.

1. Fore foot varus – in this deformity the fore foot is inverted relative to the hind foot in subtalar neutral position (also known as metatarsal adductus or varus). Deviations of the fore foot greater than 5° will ultimately lead to foot pain and needs to be treated. The first metatarsal becomes hypermobile. To compensate and allow the fore foot to bear weight during walking, the subtalar and the midtarsal joints pronate. The hind foot is in valgus position.
2. Rear foot varus – in this deformity the posterior surface of the calcaneum is inverted in relation to the ground with the subtalar joint in neutral. As a result of this the plantar surface of the foot becomes inverted and the patient tends to walk on the lateral surface of the foot. During weight bearing, this is compensated by pronating the foot to bring the medial side to ground contact. The first ray is plantar flexed.
3. Fore foot valgus – this is where the fore foot is everted in relation to the calcaneum with the subtalar joint in neutral position. This causes the medial side of the foot to come in contact with ground very early in the gait cycle. The foot may compensate by dorsiflexing the first metatarsal joint (lower first metatarsal), to allow the lateral side to come in contact with the ground. If this movement is insufficient then the midtarsal and subtarsal joints may supinate
4. Rear foot valgus – this happens as compensation to fore foot varus. This may be defined as a deformity in which the heel is everted in relation to the midline of the leg with the subtalar joint in neutral. This causes pronation of the leg and internal rotation of the leg.

Osteoporosis

2006-11-22T04:51:00.000-08:00

Osteoporosis
It is a generalised diseases of bone in which there is a marked decrease in the amount of Bone.
· Acc. To WHO Less than 2.5 SD consider as Osteoporosis.
· Common in Post menopausal women, due to decrease of Oestrogen
Common Sites are : neck of femur, proximal Humerus, proximal Tibia, Pelvis, metatarsal bones
Risk Factors:
· Age = Over 50 Yrs
· Sex = women > men
· Race = whites > blacks
· Body type = Small frame > large frame.
· Family history
· Post menopausal.
· Nutritional Factors
· Life style factors
· Medical factors
· Mensural cycle disturbance
Treatment:
· Exercise
· Oestrogen replacement
· Increase calcium consumption
· Weight bearing exercises
· Strengthening exercises
· Walking best exercise increases strength of Lower extremities and Spine

Geriatric Rehabilitation

2006-11-22T04:47:00.000-08:00

Geriatric Rehabilitation
Ø Geriatric Rehabilitation is the branch of rehabilitation dealing with alleviative or remedial, preventive or social aspects of the elderly disabled and disadvantaged.Geriatrics is the Branch of medicine dealing especially with the Problems of ageing and disease of the elderly
PRINCIPLES
Ø Ascertain level of function.
Ø Ascertain available resources and options
Ø Avoid im-mobilization
Ø Beware of altered physiological reactions
Ø Determine patients Goals & Motivation.
Ø Determine family expectation.
Ø Differentiate between delirium, dementia, depression.
Ø Emphasis function, management.
Ø Emphasis task specific exercises, simplify program
Ø Encourage socialization and stimulation
Ø Minimize medications
Ø Realize the function may not be regained, recognize that patients have multiple interacting impairments.Understand that improvement occurs in slow increment

OVERUSE INJURY

2006-11-22T04:44:00.000-08:00

OVERUSE INJURY
n Anatomical factors
n Excessive body weight
n Imbalance in muscle strength
n Improper shoe wear (specific to activity)
n Improper technique
n Pushing too hard (not allowing for rest)
n Repetition of exercises – no variety
n Training errors (too much, too soon)
n Training surfaces
n Training Climate
n Improper Warm up or Cool down Phase

Individual Joints involvement:
n Back: (low back pain syndrome) caused by anatomical, lack of stretching, imbalance of muscle strength, impact exercise
n Feet/Ankle: (Plantar Fasciitis, stress fractures, bunions, achilles tendonitis) caused by anatomical, improper shoes, lack of stretching, impact exercises.
n Hips: (Psoas bursitis) caused primarily from lack of stretching, improper technique, anatomical, overuse.
n Knees: (Chondromalacia, Patellar tendonitis) usually caused by running everyday, downhill running/walking and muscle imbalance.
n Legs: (Shin splints, Anterior compartment syndrome, Stress fracture) caused by lack of stretching, improper shoe wear, uneven surfaces, repetitive running, muscle imbalance between calves and shins (anterior tibialis)
n Shoulder/Arms: (Subacromial bursitis, Rotator cuff tendonitis) caused by overuse, lack of stretching, muscle imbalance, lifting too much weight, improper technique using weights.
Treatment
Treatment usually given is RICE.
n REST: Essential for healing
n ICE: Reduce pain and swelling
n COMPRESSION: Help to reduce swelling and provide support to injured area
n ELEVATION: Reduces pain and swelling

LATE RESPONSE

2006-11-22T04:40:00.000-08:00

LATE RESPONSE IN EMG/ NCV
F- WAVE

l The F wave results from Antidromic activation of motor neurons involving conduction to and from spinal cord and occurs interface between the peripheral and central nervous system.
l Name attributed – Foot muscles. (Magladery & Mc Dougal 1950).
STIMULATION: Supramaximal from any distal muscles by stimulating appropriate nerve.
l 25 % above maximal.
l Not more than 0.5 Hz frequency.
l Electrode placed on a belly tendon montage similar to MNCV.
l Amplifier Gain 200- 500 μv.
l Sweep speed 5-10 ms / div.
l Slight voluntary contraction may enhance F waves.
l F- wave requires amplitude more than 20μv.
l Clinical purpose 10-20 F waves are adequate.
l For study persistent 20 responses desirable.
l Latency, chronodispersion, persistence and amplitude.
l F latency is related to Height, Limb length and Age.
l The correction for these improves sensitivity.
l F latency usually expressed as Minimal latency.
l F wave calculate NCV as well as Proximal conduction time.
l It refers to difference between minimal and maximal latency in a series of F wave.
l It measures range of conduction of F wave.
DURATION
l Tells the number of motor units used
AMPLITUDE
l Refers the Size of motor units
PERSISTENCE
l The Number of Occurrence of response divided by the number of stimuli.
l Refers to the Antidromic activity of a particular motor neuron POOL.
l F amplitude to the associate M is a measure of proportion of motor neuron pool activated by Antidromic stimulation.
l Mean is used to calculate FM ratio.
l Normal F latency in adult 31ms for Hand & 61 ms for Foot.
l Rt to Lt asymmetry 2ms in Hand & 4 ms in Foot.
l Chronodispersion of F wave for abductor pollicis brevis is 3.6+/- 1.2
l F wave amplitude is 5% of M wave.
l Persistence of F wave ab.dm is & adductor hallucis are 0.8 – 0.9
l F differ b/w neonates, child, and limb length.
l Elders have long latency than men.
l F latency in Men 31 ms and women is 34.4 ms
l The Latency can be sensitive measure in Polyneuropathy.
l Abnormal seen in distal motor conduction are unremarkable.
l GBS slowing of F wave.
l Abnormality seen in PNL, Radiculopathy, peripheral neuropathies.
l ALS reduced persistence
l Chondrodispersion increased in Polyneuropathies.Duration prolonged UMN lesions

ARE YOU FIT ?

2006-11-22T04:13:00.000-08:00

ARE YOU FIT ?

Fitness is not something that belongs to the young – it’s everybody’s right, no matter what the age…
& How many of you feel that “fitness” is an important part of your job?
& How many of you work out more than 6 days a week?
& How many of you feel that management supports your “wellness”?
Why Fitness?
n Fitness improves overall health.
n An established fitness regime improves personal attitude.
n Helps decrease absenteeism and increase productivity in the workplace.
n Maintaining good physical fitness can improve work and cope up with stress.
In order to have an effective fitness program – you MUST balance all of the fitness components. …… No Short Cuts!
Program starts with
n Warm-Up ( 10—15 Mins )
n Aerobics (Exercise with O2)
n Dumbbell Exercise
n Flexibility (stretching)
n REST…….and Relaxation….. simply named Cool down ( 5—10 Mins)

Swiss ball exercises

2006-11-22T04:08:00.000-08:00

Swiss ball exercises
The exercise ball (or Swiss ball or Physio ball) is a versatile piece of exercise equipment available to help people with pain. In particular, many Swiss ball exercises are designed to bring movement to the joint in a controlled manner to keep the joint nourished.
The exercise ball has additional applications in areas such as
 General fitness,
 Strength or weight training, and
 Exercise for pregnant women.
Role of Swiss Ball on Low back pain :
Reducing Back Pain,
Strengthening Core Body Muscles
“The exercise ball - also called a Swiss ball or Physio ball - is a conservative treatment option for back pain sufferers and is designed to help prevent further episodes of low back pain as part of a rehabilitation program. The exercise ball is effective in rehabilitation of the back because it helps strengthen and develop the core body muscles that help to stabilize the spine.
The muscles used to keep in balance on the Swiss [exercise] ball become stronger. Individuals build strength of back muscles and abdominal muscles.
The benefits of Swiss ball are.
Improved muscle strength
Greater flexibility and range of motion of the spine
Enhanced balance and coordination of core muscle groups used to stabilize the spine and control proper posture while using the exercise ball
Increased tendency to maintain a neutral spine position during exercise
Exercise are simple and easy to do
Easy Home programme
Wanna to Know more Contact…………

PHANTOM PAIN

2006-11-08T04:29:00.000-08:00

PHANTOM PAIN
Phantom pain is described as "cramping, shooting, aching, hand clenched in a tight fist, toes out of joint, frozen or rigid joints, or any combination of these" and usually subsides within a year after surgery
WHY IT OCCURS ???
• Prior experience with pain prior to amputation
• Incorrect surgical procedure
• Climatic conditions
• Stress
• Inactivity

HOW TO TREAT IT ??????
• Psychological Counseling
• P.T Modalities like TENS, US, Massage
• Bandaging, Acupuncture.
• Regular exercise,
• Stretching.

Wanna know more ………………

Effect of ligaments and Muscles in Osteoarthritis

2006-11-08T04:21:00.000-08:00

Effect of ligaments and Muscles in Osteoarthritis
Effect of OA Changes in Ligaments
Abnormal joint alignment stresses
Effect of OA Changes in Muscles
Immobility shortens pain, causes guarding and reflex inhibition, leading to weakness
Effect of OA Changes in Bones
Subchondral bone remodeling changes shock-absorbing properties, joint-margin spurring leads to bony blockade and pain
Effect of OA Changes in Extra articular system
Increased energy expenditure from abnormal movement patterns
Effect of OA Changes in Synovium
Abnormal joint alignment stresses
Effect of OA Changes in Articular cartilage.
Thickening to softening, to thinning to loss
Wanna know more ………………

CAN YOU STRETCH YOUR NERVES ?????

2006-11-08T04:15:00.000-08:00

CAN YOU STRETCH YOUR NERVES ?????
The muscles, ligaments, tendons even bone has elastic properties and has elastic limit. But we still don’t know the exact limit of elasticity of Nerve. I have certain queries to find out the behavior of nerve when application of tensile stretch.
1. How much load does the nerve requires to cause a conduction block?
2. At what percentage of stretching cause rupture of nerve?
3. When the nerves will behave a plastic property?
4. After releasing of stretch does the nerve regenerate?
Wanna to learn more contact ………………..

TRANING EFFECT ON LIGAMENTS

2006-11-08T04:13:00.000-08:00

Physical training has found to increase the tensile strength of ligaments,
Physical training produces considerable effect on ligaments.
Tipton et al., tries to find out the strength of MCL in dogs.
He concluded in his study that the strength of MCL develops in dogs as a result of training. The ligaments in the trained group are stronger and stiffer than the control group.
Immobilization found decrease strength in Ligaments--Aminel et al.,
Following immobilization when a load is applied to ligaments results in failure
Noyes et al., found there is about 39 % of decrease of stress tolerance in ligaments following immobilization
Immobilized ligaments displayed more elongation and significantly less stiff.
Following immobilization if ligaments are trained it need considerable time to develop its strength.
Aminel et al., found strength training to ligament injury has to be started as soon as possible to get back the ligament in normal

Wanna to learn more contact ………………..

COMPUTER VISION SYNDROME

2006-10-21T01:47:00.000-07:00

Professionals who work more than 6-8 hours in computer may show some of these symptoms.

Symptoms:

ï Eyestrain
ï Blurred vision
ï Dizziness or nausea
ï Headaches
ï Red, dry or burning eyes
ï Increase in near sightedness
ï Change in color perception
ï Slow refocusing
ï Difficulty seeing clearly at a distance after prolonged computer use
ï Excessive fatigue
ï Eye-teaming problems and/or occasional double vision.
ï Slow refocusing when looking from screen to distance objects
Apart from these the professionals may experience Neck pain, Shoulder pain, Wrist pain, and Low back pain.
When you find any of these symptoms, then you are at a great risk of Having Computer vision syndrome.
Computer vision syndrome (CVS) is not a complicating disease, it is easily preventable with the correct eye care program that includes eye exercises, and proper diet and supplementation, and you can significantly effect and even improve your vision.
exercise that help to reduce stress
it helps in improving work on other muscel than the particular muscle
For more Details or Doubts feel free to contact me
B.Arun.M.P.T. C.M.P.T.
Physical therapist
+ 91 94436 80473.
arunmpt@rediffmail.com

OCCUPATIONAL HEALTH IN PHYSICAL THERAPY POPULATION

2006-10-19T05:04:00.000-07:00

Occupational health in physiotherapists

Physiotherapy practice expose therapist to infection, harmful chemicals, radio frequency, electromagnetic radiation and work-related musculoskeletal disorders. workers in health care facilities are exposed to wide range of pathogens, including HIV, hepatitis B virus, mycobacterium tuberculosis and rubella. Besides these hydrotherapy, electro physical agent and lifting are most commonly reported work hazards for physiotherapist.

Hydrotherapy exposes the skin to water and its constituent chemicals and contaminants, which may produce Dermatitis, Fungal infection.

Electro Physical agents like Short wave and Micro wave risk female therapist to congenital abnormality in 1st trimester, Miscarriage. It produces Impotence, and Heart disease in male therapists.

Physical therapist populations are highly involved in repetitive activities, which lead to work related musculo skeletal disorders (WMSD), Like LBP and RSI. With regards to prevalence of injury to a particular body part, Highest occurrence of WMSD among therapist is Low back (45%), Wrist and Hand (29%) Upper Back (28%) Neck (24%) Shoulder, Elbow, Hip and Thigh, Knees, Ankle and Feet (each Less than 20%)

PREVENTION
Simple step done before and during tasks can prevent most of the occupational related hazards, this also help the body to counteract strains that come with the occupation.
a) Proper work practice
Ø Stretching –warming up prior to the activity
Ø Modify technique or Environment to avoid the stress on therapist body that causes injury.
Ø Make changes such as adjustment to postures during therapy, Adjustment to height of Bed, Pause to Stretch or Change posture.
Ø Make use of Height adjustable Beds, Lifting belts, Slide boards, Splints and
Stool on casters.
Ø Personal Hygiene in hydrotherapy
Ø Use of Apron, goggles ect.. while using electro physical agents

b) Job Rotation and Out sourcing.

v obtain assistance fro m another individual to reduce the load during tasks
such as transferring patients or working with Heavy patients.
v TEAM WORK

c) Reactive

Respond to discomfort or injury by
ü Use of technique to avoid aggravation of discomfort or injury.
ü Substitute electrotherapy for some manual therapy
ü Use a different part of the body to a administer a manual technique or stop
a technique that cause or aggravates discomfort or injury.

Health is around us, So we tend to ignore our health. If We the medical people take a little attention in this factor we can avoid most of the work related problems in our physiotherapy practice.

Courtesy : Mr.Sameer Babu, BPT, Mr.Arun.B, M.P.T
Physiotherapists, K.G Hospital, Coimbatore.
www.arunmpt.blogspot.com, sameerphysio310@yahoo.com, arunmpt100@yahoo.co.in

RESISTANCE TRAINING

2006-10-17T05:59:00.000-07:00

RESISTANCE TRAINING:

Principles of Conditioning and Training

• Warm-up/Cool-down
• Motivation
• Overload and SAID principle
• Consistency/routine
• Progression
• Intensity
• Specificity
• Individuality
• Relaxation/Minimize Stress
• Safety

TECHNIQUES IN RESISTANT TRAINING:
• Progressive resistance exercise
• Overload principle must be applied
• Must work muscle at increasingly higher intensities to enhance strength over time
• If intensity of training does not increase, but training continues, muscle strength will be sustained

PHYSIOLOGY OF STRENGTH TRAINING:

• Three theories of muscle hypertrophy:
– Increase in number of fibers
– Infusion of blood - transient hypertrophy
– Increase in protein myofilament number and size
• Other enhancements due to training
– Increased noncontractile tissue strength, bone mineral content, aerobic/anaerobic enzymes, enhanced oxygen uptake

WANNA TO READ MORE …… CONTACT ME……….

SPLINT AND ITS USES

2006-10-07T04:01:00.000-07:00

Conditions Used

•De Quervains Synd

rome
•Carpal Tunnel Syndrome
•Pregnancy-related Carpal Tunnel Syndrome
• Arthritis
• Tendonitis
• Repetitive Motion Injury
• Cramping and Fatigue

USES..

Help to prevent repetitive injuries
Help to restore from an injury
Help to relieve stress
Help to do activity
Lightweight and compact (4 oz. for 4.25” x 36” strip)Can be rolled or folded for easy storage in emergency kits/backpacksFastens in place with tape or wrap. No extra equipment needed.Not affected by extreme temperatures or altitudes. Even works underwater!

Contact Me for More on it.......

Effect of exercise on aging--effect of aging on exercise.

2006-10-07T03:17:00.000-07:00

Effect of exercise on aging--effect of aging on exercise.

1. Exercise Cause lot of changes in ageing.
2. The coincidence of age changes with alterations in body structure and function is striking.
3. Increasing evidence indicates that many of the changes commonly attributable to aging can be retarded by an active exercise program. Physical exercise, properly supervised, is a safe and widely applicable form of therapy.
4. Exercise help in activity of every individual
5. Isometric strength, endurance, and the blood pressure and heart rate responses during isometric exercise in healthy men and women,
6. Exercise help in reduction of Body Fat.

CASE STUDY

2006-10-07T00:20:00.000-07:00

“EFFECT OF TIBIAL and SUBTALAR MOBILIZATION IN THE MANAGEMENT OF PATELLA TRACKING SYNDROME – A CASE STUDY.”

ARUN.B.,MPT, CMPT.
ABSTRACT:
The Aim of this study is to reveal the effect of Manual therapy on Patella tracking problem. The Patients comes with complain of anterior knee pain, he diagnosed as Patellofemoral pain syndrome. The physical therapy assessment and somatic diagnosis were found that the Pain is in Knee but the cause is at the Ankle. Malalignment in the ankle is the common cause for knee problems. Patient under went a course of manual therapy along with exercises. Pain was reduced dramatically in the end of the course. This study helps to give a clear idea to Therapist that knee pain may occur as a result of Ankle problem or even as a result of Foot wear Problem.
KEY WORDS:Patella tracking, Pronated Foot, Calcaneal mobilisation. Tibial mobilisation.

EYE NUTRITIONS

2006-10-05T09:04:00.000-07:00

EYE NUTRITIONS

A healthy well-balanced diet is of great importance if you wish to maintain or improve your vision. Base your diet on wholefoods, eating plenty of fresh fruit, vegetables, nuts and dairy products and keep tea, coffee and refined sugars to an absolute minimum
Vitamin A is helpful for many types of eye problem including poor vision in dim light or at night. Good food sources are: fish liver oil, liver, carrots, egg, cheese, butter, margarine, milk, green vegetables, yellow and orange fruits and vegetables.
B complex is required by the eyes to keep them healthy. A deficiency of B2 can lead to bloodshot, burning or gritty feeling eyes, cataracts and sensitivity to bright lights. Good food sources are, brewer's yeast, yeast extract, wheatgerm, wholegrain cereals
Vitamin C has been found to be helpful in the prevention of cataracts and glaucoma
Vitamin E is needed to prevent cataracts. It helps to keep the blood vessels and retina

ARE YOUR FOOT IS NORMAL????

2006-10-01T01:38:00.000-07:00

ARE YOUR FOOT IS NORMAL????
$. there are various types of deformity seen in our foot
$. so check your foot wright now
$. check first your shoe
$. if you are using your shoe for a long time, check your shoe sole
$. find where it gets worn off more?
$. if it worn on left / Right then you have Deformity
$. go to an Podiatrist and check it up.contact a physical therapist
go on....

How important your SHOE is ?

2006-09-27T05:39:00.000-07:00

HOW IS YOU SHOE?
Did you watch your shoe’s
How long you take to change shoes
If you didn’t change your old shoe here it’s the time
Prolonged wear of shoe can cause lot of symptoms in leg and feet
Here is some tips need to follow
TIPS
Change your shoe at least 6 months once
Shoe used for a long time cause wear at the bottom ( SOLE)
Shoe used for long cause wear at the inner side
Long time use of shoe shows a less support to foot
If you look into your shoe at the right or at Left of sole there is slide seen it occurs because of excess usage
WHY TO CHANGE A SHOE
Worn shoe cause abnormal position of your lower leg
It may cause Leg Pain
It is the cause for Plantar rupture (Fascitiis)
It may cause knee pain and
so on…………

Arun MPT Blog

2006-09-23T07:52:00.000-07:00

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