A presentation given at the South West UK radiographers study day in 2014. The overview was in vivo measurement of spinal biomechanics using quantitative fluoroscopy. The take home message is that flexion extension radiographs of the lumbar spine are unreliable due to measurement error and intra subject variability.
The United Kingdom Radiological Conference William Stripp Memorial Lecture 2014.
The webcast can be viewed here: http://www.ukrc.org.uk/presentation-webcasts
This work by respiratory physiotherapist Angelo Longoni aims to demonstrate how the use of diaphragmatic ultrasound can be helpful in the evaluation of results of rehabilitative respiratory programs.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
Introduction: Although it is thought that abdominal adiposity is one of the risk factor for postural deviation, such as increased lumbar lordosis, the studies in the literature only explored the effects of body mass index on spinal alignment and postural changes. The aim of this study was to investigate the correlation with detailed body composition and spine alignment in healthy young adults.
Anesthesia Management to Facilitate Same-Day Ambulatory Total Joint ReplacementRajnish Gupta
Some of the strategies for successful anesthesia management of patients with goal for same day or 23 hour observation total knee and total hip replacement surgery
The United Kingdom Radiological Conference William Stripp Memorial Lecture 2014.
The webcast can be viewed here: http://www.ukrc.org.uk/presentation-webcasts
This work by respiratory physiotherapist Angelo Longoni aims to demonstrate how the use of diaphragmatic ultrasound can be helpful in the evaluation of results of rehabilitative respiratory programs.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
Introduction: Although it is thought that abdominal adiposity is one of the risk factor for postural deviation, such as increased lumbar lordosis, the studies in the literature only explored the effects of body mass index on spinal alignment and postural changes. The aim of this study was to investigate the correlation with detailed body composition and spine alignment in healthy young adults.
Anesthesia Management to Facilitate Same-Day Ambulatory Total Joint ReplacementRajnish Gupta
Some of the strategies for successful anesthesia management of patients with goal for same day or 23 hour observation total knee and total hip replacement surgery
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
This study demonstrates that 3D-MRI is able to evaluate the anterolateral ligament fully in all normal knees. The classification system for injury to the ALL described shows high inter- and intra-observer reliability
Bryan Heiderscheit
Professor, Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, Director, UW Runners' Clinic, Director, Badger Athletic Performance Research, Co-director, UW Neuromuscular Biomechanics Lab, University of Wisconsin-Madison, Madison, WI, USA.
-
MRI findings regarding hamstring strain injury and recovery
(6th MuscleTech Network Workshop)
14th October, Barcelona
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
This study demonstrates that 3D-MRI is able to evaluate the anterolateral ligament fully in all normal knees. The classification system for injury to the ALL described shows high inter- and intra-observer reliability
Bryan Heiderscheit
Professor, Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, Director, UW Runners' Clinic, Director, Badger Athletic Performance Research, Co-director, UW Neuromuscular Biomechanics Lab, University of Wisconsin-Madison, Madison, WI, USA.
-
MRI findings regarding hamstring strain injury and recovery
(6th MuscleTech Network Workshop)
14th October, Barcelona
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Lecture References and online resources: Tendons: Mechanisms of pathogenicity...Mark Sexton
This lecture reviews and connects developments different areas of the published research: in the areas of Anatomy, Cellular Mechanotransduction, Connective Tissue (Histology, Innervation, differentiation, plasticity), Tendinopathy, Tendon Repair, Neural plasticity and Bioplasticity.
These developments have implications for clinical practice, research, education and health promotion.
This research was discussed as it informs common Treatment and Rehabilitation techniques (Exercise Therapy, Acupuncture, Manual Therapy, Low Level Laser, Biomechanics). Future directions in research were discussed.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
1. Quantitative Fluoroscopy
Vs
Functional Radiography
of the lumbar spine
Fiona Mellor
Research Radiographer
T: 01202 436280
E; imrci.fmellor@aecc.ac.uk
2. Learning outcomes
Why measure intervertebral motion?
Sources of errors and variation in
flex/ext (functional) radiographs
A new adaptation of fluoroscopy
(quantitative fluoroscopy - QF)
Comparison of radiation dose
Novel uses for QF/other studies
16. PhD
Hypothesis: There is a higher
prevalence of abnormal mid lumbar
inter-vertebral motion patterns in patients
with mechanical LBP compared to
controls
QF passive motion
40 Patients (mechanical CNSLBP) & 40 healthy
volunteers
Coronal and sagittal
Global range 40o Each direction (Lt Rt, flx, ext)
Funded by the NIHR Clinical Academic Training Fellowship
19. Reference intervals
A definition of ‘abnormal ‘
is those whose rotation
falls beyond that
achieved by 95% of the
healthy population
Hyper-mobility: p<0.05 Right L3/4 and Flexion L4/5
Hypo-mobility; p<0.05 Left and Right
20. Continuous motion patterns:
Reference intervals
Hyper mobility: Left L3/4 and Flexion L3/4
Hypo-mobility; Left L3/4 and L4/5. Right L4/5 and Flexion
21. Variation is still a problem!
- How to account for the variation
- How to measure the co-dependency of segments
27. Conclusions
QF is more responsive than
functional radiography with a
similar radiation dose
The coronal plane should be
considered
‘Non Specific’ back pain =
further subgrouping
29. QF research at AECC
i. Characteristics of kinematics in healthy
adults and their reproducibility over time
ii. Effect of muscle interaction in healthy
adults (surface electromyography)
iii. Effects of manipulation of the cervical
spine and patient reported outcomes
iv. Relationship between prosthetic fit and
intervertebral motion
38. Summary
Functional views of
cervical and lumbar
spine could be replaced
with QF
Further sub-grouping of
non specific neck and
back pain
Further analysis of
existing data and
economic analysis
39. Fiona Mellor
E: imrci.fmellor@aecc.ac.uk
Acknowledgements:
National Institute of Health. Clinical Academic Training Fellowship.
Bournemouth University Santander travel award.
Anglo-European College of Chiropractic. Bournemouth . UK
Orthokinematics. Texas USA
Professor Alan Breen and the team at IMRCI. Bournemouth. UK
Professor Nat Ordway and the team at SUNY. Syracuse. USA
40. Bibliography
Breen, A., Muggleton, J. and Mellor, F., 2006. An objective spinal motion imaging assessment (OSMIA): reliability,
accuracy and exposure data. BMC Musculoskeletal Disorders, 7 (1), 1-10.
Breen, A. C., Teyhen, D. S., Mellor, F. E., Breen, A. C., Wong, K. and Deitz, A., 2012. Measurement of inter-vertebral
motion using quantitative fluoroscopy: Report of an international forum and proposal for use in the
assessment of degenerative disc disease in the lumbar spine. Advances in Orthopaedics, 1-10.
Deitz, A. K., Mellor, F.E., Teyhan, D.S., Panjabi, M.M., Wong, K.W.M., 2010. Kinematics of the Aging Spine: A
Review of Past Knowledge and Survey of Recent Developments, with a Focus on Patient-Management
Implications for the Clinical Practitioner. Yue, Guyer, Johnson, Khoo & Hochschuler (eds) In: Yue, J. L., Guyer, R.
D., Johnson, P. J., Khoo, L. T., and Hochschuler, S. H., eds. The Comprehensive Treatment of the Aging Spine:
Minimally Invasive and Advanced Techniques. Elsevier.
Mellor, F., Breen, A., 2009. Objective assessment of spinal motion: the future? Imaging and Oncology, 3, 34-41.
Mellor, F. E. and Breen, A. C., 2014. Discrimination of biomechanical back pain patient subgroups from continous
inter-vertebral motion data: a protocol. Bone & Joint Journal Orthopaedic Proceedings Supplement, 96-B (SUPP
4), 5.
Mellor, F. E., Muggleton, J. M., Bagust, J., Mason, W. M. A., Thomas, P. W. and Breen, A. C., 2009. Midlumbar
lateral flexion stability measured in healthy volunteers by in-vivo fluoroscopy. Spine, 34 (22), E811-E817.
Mellor, F. E., Thomas, P. and Breen, A., . 2014a. Moving Back: the radiation dose received from lumbar spine
quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for further dose reduction.
Radiography, In print.
Mellor, F. E., Thomas, P., Thompson, P. and Breen, A., 2014b. Proportional lumbar spine inter-vertebral motion
patterns: a comparison of patients with chronic, non-specific low back pain and healthy controls European Spine
Journal, epub ahead of print (March).
Panjabi, M., Abumi, K., Duranceau, J. and Oxland, T., 1989. Spinal Stability and Intersegmental Muscle Forces: A
Biomechanical Model. Spine, 14 (2), 194-200.
Panjabi, M. M., 1992. The stabilising system of the spine - Part 2: Neutral zone and instability hypothesis. Journal
of Spinal Disorders, 5 (4), 390-397.
41. The Neutral Zone Theory
Neutral
zone
Flexion
Extension
Range of motion
Force
2Kg