The document discusses a client named Glenn who underwent pre-screening that revealed high risk during exercise due to medical conditions. An exercise program was implemented based on GP recommendations to help manage his conditions and reduce disease risks. Pre-screening methods are discussed as an effective way to reduce adverse events during exercise.
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Physical therapy exercises for low back painHealthQuest
Physical therapy exercises are highly acclaimed solutions for low back pain. Under proper guidance, you can undertake various physical therapy exercises to reduce pain and bring back muscle strength.
Case study on Holistic Diabetic Care using Diet, Yoga, Resisted Exercises usi...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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.
Physical Fitness for Elderly of a University Project Participants, Practition...CrimsonPublishersGGS
Physical Fitness for Elderly of a University Project Participants, Practitioners of Weight and Welcoming House Residents by Lidiane Requia Alli Feldmann in Geriatrics Studies Journal
Physical therapy exercises for low back painHealthQuest
Physical therapy exercises are highly acclaimed solutions for low back pain. Under proper guidance, you can undertake various physical therapy exercises to reduce pain and bring back muscle strength.
Case study on Holistic Diabetic Care using Diet, Yoga, Resisted Exercises usi...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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.
Physical Fitness for Elderly of a University Project Participants, Practition...CrimsonPublishersGGS
Physical Fitness for Elderly of a University Project Participants, Practitioners of Weight and Welcoming House Residents by Lidiane Requia Alli Feldmann in Geriatrics Studies Journal
Misty Trails at Hadapsar offers 1 & 2 BHK Budget homes. The project is nestled in the greens, adjacent to PMC reserved garden, away from the bustle and provides a great living environment. The project includes 200 units with Shops and Offices.
Valay is a well planned planned project or 2 BHK Apartments in Hadapsar. Highly contemporary design, proper space managment, right lifestyle amenities and good location, everything combines to create a perfectly planned, picturesque project.
Deep thought is given to the wants of the entire family and the result is a beautful abode, stylish, soothing and superb.
As follow-up to the workshop session on "Real-time Retail: It's What Customers Demand” moderated by Ken Morris, principal at Boston Retail Partners, we summized topics discussed during this session.
Whether you had the opportunity to attend this session, or not, I think will find the recap document to be insightful with interesting opportunities and perspectives of real-time retail.
This workshop recap encapsulating the ideas and comments that retail industry leaders debated and discussed in this session, including:
- Real-time Retail
- Personalized Selling
- Interactive CRM
- Monitor & React
- Task Management
- Nimble Execution
The Role of Heritage in Revitalizing Landscapes - Heritage Canada 2014Brenda Barrett
The Pennsylvania Wilds demonstrates the value of the state's conservation landscape program and on working on a regional scale as a tool for rural revitalization. Such work can build a more resilient community when faced with global energy issues such as drilling for natural gas.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
Investigation of the changes on muscular endurance in response to aerobic and...Sports Journal
The rationale of the study is to investigate the changes on muscular endurance in response to aerobic and
anaerobic training among type 2 diabetic patients. To achieve the purpose of the study 45 male type 2
diabetic patients from Ongole, in the southern state of Andhra Pradesh, India, were selected as subjects.
The subjects were selected in the age group of 45 to 50 years and they were randomly assigned into three
equal groups of 15 each. Experimental group-I performed aerobic training, experimental group-II
performed anaerobic training and group III acted as control. The muscular endurance was selected as
dependent variable. The data collected from the three groups prior to and post experimentation on
selected dependent variable was statistically analyzed to find out the significant difference if any, by
applying the analysis of covariance (ANCOVA). Whenever the obtained ‘F’ ratio value was found to be
significant for adjusted post-test means, the Scheffe’s test was applied as post hoc test. In all the cases the
level of confidence was fixed at 0.05 level for significance. The result of the study produced 20.48%
percentage of improvement due to aerobic training and 15.32% of improvement due to anaerobic training
in muscular endurance of the diabetic patients
To Assess the Effect of Body Mass Index on Cardiac Efficiency in Adolescent B...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Diabetic Peripheral Neuropathy- 6 Months Follow up Using Resisted Exercises a...inventionjournals
Introduction: An alarming global increase in type 2 diabetes, with second maximum known diabetic subjects in India, peripheral neuropathy which remain unfocussed with complications such as falls, ulcers, amputation, decreased mobility, dependence for ADL and disability associated along with. Aims and Objectives of This Research: To analyse obesity, glycemic control and neuropathy on a diabetic subject. Materials and Methodology: This original study was on a subject for 30 years with known type 2 diabetes and for 10 years with peripheral neuropathy, where the impact of resisted exercises and Proprioceptive training were analysed for 6 months period from October 2016 to March 2017. Results: A marginal reduction in obesity and improved glycemic control by 0.5% and slight lowering of Toronto clinical scoring system for diabetic neuropathy were recorded. Conclusion: The findings of this study could implicate benefits of larger population in the society as nearly 50% of diabetic develop neuropathy. Also this was an innovative and first research study among diabetic neuropathy subjects using RET and proprioceptive exercises. Key Words: HbA1C – Glycosylated Hemoglobin, IDF - International Diabetes Federation, TCSS - Toronto clinical scoring system, BMI – Body Mass Index, WC – Waist Circumference, UKPDS – United Kingdom Prospective Diabetes Study, NCV – Nerve Conduction Velocity, ACSM – American College of Sports Medicine, TENS – Transcutaneous Electrical Nerve Stimulation, VAS – Visual Analogue Scale, ADL – Activities of Daily Life
2. Each client undergoing exercise must have a
completed pre-exercise questionnaire and a report
from a GP if required.
These forms are completed on the first visit to the
clinic or if we are meeting at an alternate location,
the first meeting will involve completion of these
forms.
We use the Adult Pre-Exercise Screening Tool
supplied by ESSA for this purpose.
3. Patient: Glenn
Pre-screen and risk stratification revealed that he
was at high risk during exercise.
Exercise program implemented based on GP
recommendations for weight loss to manage
symptoms of Myasthaenia Gravis and cellulitis, as
well as reduce risk of diabetes due to impaired
GTT and hypertension.
Pre-screening has been shown to be an effective
method of reducing the incidence of exercise-related
adverse events (Resnick, Ory, Coday &
Riebe, 2008).
4.
5. American College of Sports Medicine [ACSM].
(2010). ACSM’s guidelines for exercise testing
and prescription (8th ed.). Philadelphia:
Lippincott, Williams & Wilkins.
National Health & Medical Research Council
[NH&MRC]. (2003). Clinical practice guidelines for
the management of overweight and obesity in
adults. Canberra: Commonwealth of Australia.
Resnick, B., Ory, M., Coday, M., & Riebe, D.
(2008). Professional perspectives on physical
activity screening practices: Shifting the
paradigm. Critical Public Health, 18(1), 21-32.
6. Movement capacity is assessed in patients who
present with musculoskeletal injuries or
disorders, as well as patients who will be
performing exercises that are dependent on
mobility or flexibility.
This can include healthy/athletic population
undergoing movement screening for sport e.g
overhead squat.
In clinical populations such as those recovering
from surgery, ROM assessment is vital to
determine the ongoing improvement expected
as a result of rehabilitative exercises.
9. Functional movement screening can be viewed as an analysis
of the degrees of freedom present in each joint. When
assessing a patient’s ROM we must first look at each segment
of their body to gain an understanding of ROM (Cook, 2010).
The assessment items used for this patient included
measures of both static and dynamic tasks (Gabbe, Bennell,
Wajswelner & Finch, 2004).
The assessment of active ROM in the hip is included in the
assessment items for this patient as ROM at the hip has also
been shown to be associated with low back pain (Ellison, Rose
& Sahrmann, 1990).
The lifting tasks were performed as this patient was on
workcover. It is expected that he will return to his previous
duties as a waste disposal worker at the conclusion of his
treatment.
10. Cook, G. (2010). Movement: Functional
movement systems: Screening, assessment,
corrective strategies. On Target Publications
Gabbe, B. J., Bennell, K. L., Wajswelner, H., &
Finch, C. F. (2004). Reliability of common lower
extremity musculoskeletal screening
tests. Physical Therapy in Sport, 5(2), 90-97.
Ellison, J. B., Rose, S. J., & Sahrmann, S. A. (1990).
Patterns of hip rotation range of motion: a
comparison between healthy subjects and
patients with low back pain. Physical
Therapy, 70(9), 537-541.
11. One of the primary roles of an AEP is to
develop safe, effective exercise programs and
ensure that the patient is both capable of
performing the required task and motivated
to continue to do so.
Programs should be based on screening and
assessment results.
This program was completed as part of an
assessment task.
12.
13. The program was developed based on current
evidence relating to interventions for low back
pain.
The frequency of RT sessions was kept to 2-3
times per week
Core exercises included everyday
Generalised aerobic conditioning is beneficial in
those with cLBP
(McGill, 2004; McGill, 2007; Smeets et al, 2006)
14. Smeets, R. J., Vlaeyen, J. W., Hidding, A.,
Kester, A. D., van der Heijden, G. J., van Geel,
A. C., & Knottnerus, J. A. (2006). Active
rehabilitation for chronic low back pain:
cognitive-behavioral, physical, or both? First
direct post-treatment results from a
randomized controlled trial. BMC
Musculoskeletal disorders, 7(1), 5.
McGill, S. (2007). Low back disorders:
evidence-based prevention and rehabilitation.
Human Kinetics.
McGill, S. (2004). Ultimate back fitness and
performance. Wabuno Publishers.
15. During my placement with ActivTherapy, I was
involved in giving numerous presentations on the
role of exercise in preventing and managing
chronic conditions.
I participated in a two week “My Wellbeing”
program run by the NRMA for it’s roadside assist
staff
During these presentations I discussed the nature
of chronic disease as well as the various risk
factors associated with them as well as the
relevant tests and assessments used in detecting
them.
16. I also gave a presentation at the wellness
centre in Liverpool hospital for cancer
patients
This outlined the benefits of exercise for their
condition.
17.
18. The presentations were designed to educate the audience as
to how to reduce risk factors for developing lifestyle related
diseases with emphasis on increasing activity an improving
dietary choices (Williams, 2001).
Physical activity as a means of managing symptoms of cancer
treatment was discussed during the presentation at the
hospital (Courneya & Friedenreich, 1997).
During both presentations I demonstrated a simple
assessment that people could use to determine their risk of
developing CVD or Diabetes (Savva et al, 2000).
19. Williams, P. T. (2001). Physical fitness and activity as
separate heart disease risk factors: a meta-analysis.
Medicine and science in sports and
exercise,33(5), 754.
Courneya, K. S., & Friedenreich, C. M. (1997). Relationship
between exercise pattern across the cancer experience and
current quality of life in colorectal cancer survivors. The
Journal of Alternative and Complementary Medicine, 3(3),
215-226.
Savva, S. C., Tornaritis, M., Savva, M. E., Kourides, Y.,
Panagi, A., Silikiotou, N & Kafatos, A. (2000). Waist
circumference and waist-to-height ratio are better
predictors of cardiovascular disease risk factors in children
than body mass index. International journal of obesity and
related metabolic disorders: journal of the International
Association for the Study of Obesity, 24(11), 1453-1458.
20. During placement I worked with clients who had
impaired glucose tolerance and hypertension.
These clients are at risk of developing diabetes
and cardiovascular disease.
The provision of lifestyle advice and exercise
programs is important to ensure that these
people do not continue to progress into a
diseased state.
I conducted group classes for those with, or at
risk of chronic disease. This included persons
with obesity, hypertension, pre/diabetes. The
classes were part of the EPC program and
participants were able to attend up to 10 classes
as part of this coverage .
21. First session of weight loss clinic program with 3 levels for
beginners – advanced. The inclusion of core exercises every
session is due to the high number of low back pain patients
who attend.
22. The provision of nutritional advice and support was
given through these classes.
At the conclusion of each class, I assessed food
diaries of participants and critiqued their food
choices if necessary.
Every 4 weeks I conducted a “shopping tour” which
involved a visit to the nearby Woolworths store
where I educated the participants on healthy food
choices and how to understand the nutritional
information displayed on each food item.
23. Below are some examples of the information provided to participants on
the shopping tour and throughout the classes. These brochures were
developed by the Australian Government National Health and Medical
Research Council and are available at www.eatforhealth.gov.au
24.
25. Winett, R. A., & Carpinelli, R. N. (2001). Potential
health-related benefits of resistance
training. Preventive medicine, 33(5), 503-513.
Van Tulder, M., Malmivaara, A., Esmail, R., & Koes, B.
(2000). Exercise therapy for low back pain: a
systematic review within the framework of the
cochrane collaboration back review
group. Spine, 25(21), 2784-2796.
National Health and Medical Research Council,
Australian Government Department of Health and
Ageing, New Zealand Ministry of Health. Nutrient
reference values for Australia and New Zealand
including recommended dietary intakes. Canberra:
Commonwealth of Australia; 2006.
26. Patients with complex or chronic medical
conditions often present a challenge to the
AEP who must ensure that exercises are safe
and effective. A delicate line has to be walked
between conservative approaches and
proactively pushing your client to ensure
sufficient stimulus for adaptations to occur.
27. This patient had Myaesthenia Gravis,
epilepsy, hypertension, Cellulitis, Impaired
GTT.
28. Lohi, E. L., Lindberg, C., & Andersen, O. (1993).
Physical training effects in myasthenia
gravis. Archives of physical medicine and
rehabilitation, 74(11), 1178-1180.
Paul, R. H., Nash, J. M., Cohen, R. A., Gilchrist, J.
M., & Goldstein, J. M. (2001). Quality of life and
well‐being of patients with myasthenia
gravis. Muscle & nerve, 24(4), 512-516.
Pan, X. R., Li, G. W., Hu, Y. H., Wang, J. X., Yang,
W. Y., An, Z. X., & Howard, B. V. (1997). Effects of
diet and exercise in preventing NIDDM in people
with impaired glucose tolerance: the Da Qing IGT
and Diabetes Study.Diabetes care, 20(4), 537-
544.
29. During placement I was responsible for
conducting hydrotherapy sessions with
numerous patients who had undergone
surgical procedures or had sustained acute
injuries.
Hydrotherapy has been used extensively in
rehabilitation of acute injuries.
(Giaquinto, Ciotola, Dall’Armi & Margutti, 2010; Foley, Halbert,
Hewitt & Crotty, 2003)
30. Provided hydrotherapy to a patient who had
recently undergone a ORIF procedure to
repair fractured tibia and fibula.
31.
32. Giaquinto, S., Ciotola, E., Dall’Armi, V., &
Margutti, F. (2010). Hydrotherapy after total knee
arthroplasty. A follow-up study. Archives of
gerontology and geriatrics, 51(1), 59-63.
Foley, A., Halbert, J., Hewitt, T., & Crotty, M.
(2003). Does hydrotherapy improve strength and
physical function in patients with osteoarthritis—
a randomised controlled trial comparing a gym
based and a hydrotherapy based strengthening
programme. Annals of the rheumatic
diseases, 62(12), 1162-1167.
Geytenbeek, J. (2002). Evidence for effective
hydrotherapy. Physiotherapy,88(9), 514-529.
33. Throughout my placement I was primarily
involved in providing secondary care to
patients.
Most patients were referred from a GP under
the EPC program or through work cover
insurance providers.
In many cases patients continued their
training after their EPC sessions had run out
however this is still classed as secondary
care.
Editor's Notes
Clinical portfolio by ben gonano. All placement hours completed with activtherapy in Moorebank under the supervision of Andrew Rivet.
and decision was made to refer to GP prior to commencing training.
Here is a completed Pre exercise screening tool that was filled out by a patient. His last name has been covered for confidentiality.
Presented on the next two slides are the results of movement and ROM screenings performed on a patient who presented with low back pain. Here we assessed the lumbar spinne for and lower limb for movemet and stability with emphasis on lumbopelvic complex.
Presented here are more exerts from the report of the previous patient. I performed the functional capacity assessment based on his work demands. He is required to be able to lift up to 20kg. This sllide also outlines the areas of pain and injury the patient is currently experiencing.
Functional movement screening can be viewed as an analysis of the degrees of freedom present in each joint. When assessing a patient’s ROM we must first look at each segment of their body to gain an understanding of ROM limitations and then assess their patterns of motion which may be grossly flawed but nonetheless pain free and unrestricted (Cook, 2010). The inclusion of the squat, lunge, single leg stand allow the therapist to examine these issues.
The assessment items used for this patient included measures of both static and dynamic tasks. For example the examination of lumbar flexion and extension coupled with hamstring extensibility have been shown to be valid predictors of future back pain (Gabbe, Bennell, Wajswelner & Finch, 2004).
The assessment of active ROM in the hip is included in the assessment items for this patient as ROM at the hip has also been shown to be associated with low back pain (Ellison, Rose & Sahrmann, 1990).
The lifting tasks were performed as this patient was on workcover. It is expected that he will return to his previous duties as a waste disposal worker at the conclusion of his treatment. He is required to lift objects up to 20kg above shoulder height. Therefore we will assess his ability to do so in our movement screen.
The exercise programs given to patients are designed based on initial screening and assessment results to ensure that all exercises are both safe and effective for that person’s current condition and goals.
Throughout my studies I have created numerous individualised exercise programs for the purpose of assessment and examination. One such program was completed for a client with chronic low back pain
This is an example of an exercise prograam developed for a ficticious client with low back pain. This is a copy of the first weeks training so intensty is failry low.
as that was shown to be effective at minimising fatigue and deteriorating movement patterns (McGill, 2004).
The inclusion of “core” exercises everyday has been shown to reinforce corrective movement patterns in those with back pain (McGill, 2007), and thus reduce the incidence of aberrant motion that often produces compensatory involvement of low back muscles.
The inclusion of generalised aerobic conditioning in the form of cycling has been shown to improve pain scores in subjects as well as serving to reduce body weight which is often a cause of back pain (Smeets et al, 2006).
During my placement with ActivTherapy, I was involved in giving numerous presentations on the role of exercise in preventing and managing chronic conditions.
I participated in a two week “My Wellbeing” program run by the NRMA for it’s roadside assist staff where we detailed how to incorporate exercise into their daily routine as a means of preventing the ever increasing incidence of diabetes and heart conditions among their employees (predominantly males, over 35 years of age with minimal formal education)
During this presentation I discussed the nature of chronic disease as well as the various risk factors associated with them as well as the relevant tests and assessments used in detecting them.
I also gave a presentation at the wellness centre in Liverpool hospital for cancer patients and outlined ways that exercise could help them manage symptoms of treatment as well as reducing the likelihood of developing co-conditions. This presentation also involved providing functional assessments of the audience which was used to assist in developing an individualised exercise program that they could perform unsupervised in their homes.
These slides formed a small part of the presentations
The presentations were designed to educate the audience as to how to reduce risk factors for developing lifestyle related diseases. As such the emphasis was on increasing physical activity and limiting poor dietary choices which can affect markers of health such as cholesterol, glucose and BP. A push for greater physical fitness as opposed to simply an accumulation of physical activity was also provided due to evidence that fitness may have a greater protective effect on cardiovascular health than simply low-moderate physical activity (Williams, 2001).
Physical activity as a means of managing symptoms of cancer treatment was discussed during the presentation at the hospital. The likelihood of developing co-morbid conditions is greater among post treatment cancer patients due to an increase in sedentary behaviour often attributed to fatigue. Therefore an increase in exercise and physical activities may assist this population to maintain a greater degree of health and independence (Courneya & Friedenreich, 1997).
During both presentations I demonstrated a simple assessment that people could use to determine their risk of developing CVD or Diabetes. The waist circumference measure was used and a tape with risk indications printed on it was supplied to the audience. The waist circumference measure has been shown to be an effective tool for predicting cardiovascular disease (Savva et al, 2000).
Each Class had people of varying levels of physical ability. Therefore the class required varying levels of intensity to ensure each participant could train to a level that was both safe and effective for them. We performed core exercises due to the high number of participants complaining of back pain and this has been shown in multiple studies to be an effective means of reducing symptomatic back pain.
The exercises are gradually progressed in difficulty each week to ensure sufficient stimulus for adaptation throughout the classes.
At the beginning all participants undergo a functional assessment where we record vital data which is used to determine the outcome of the sessions at the end. Throughut the duration of the classes every participant must report on their food intake for the week and their unsupervised exercises. We also provide each person with a measuring tape with risk indicators for both men and women.
All participants are given a rage of information brochures and resources to enable them to manage a healthy lifestyle. All resources are provided free from various government run programs such as eat for health .
A copy of the food diary filled out for 2 days by a participant of the classes. It also includes exercise and medications.
This is a copy of one weeks training performed with Glenn. He has a rare condition known as myaesthenia gravis which results in weakness of respiratory muscles during exertion as well as constant fatigue. On top of this condition he is obese, has hypertension, cellulitis in his legs and ankles which is painful during exercise and he currently has impaired glucose tolerance. His program was designed with the goal of weight loss as his doctor is contemplating starting him on diabetic medication however wants to see if he can lose weight on his own and possibly manage through lifestyle modification rather than medication. Due to his current functional stautus exercise needed to be low impact and low intensity. Aerobic exercise has been shown to improve symptoms of fatigue in persons with MG and as such this is included in his program. RT is also an important feature in a physical training program to ensure that strength is maintained or improved to enable easier performance of ADL. Most importantly the exercise has to be of sufficient intensity and volume to ensure changes in his blood profile pertaining to blood glucose. This has been studied extensively and researchers have found that 3 days per week at moderatete instensity for approximately 45-60 mins is sufficient to improve insulin sensittivity and glucose tolerance.
...and in the post-operative treatment of patients. It is known to decrease pain scores and improve functional ROM in individuals who have undergone knee arthroplasty and is also effective at improving strength and physical function in arthritic populations.
Some examples of conditions I managed were medial tibial stress syndrome, mastectomy, tibia and fibula spiral fracture who is the example provided, Rotator cuff repairs and ACL repairs.
During the sessions in the pool, I focused on restoring ROM, improving muscular endurance, strength and co-ordination. We performed exercises that were extrememly low impact such as wading through the water, pendulum swings with legs, squats against the wall, bicycle with legs and progressed to walking lunges, squats using foam resistance board, resisted flexion and extension and adduction and abduction, swimming (freestyle at first and eventually incorporated breast stroke due to it’s greater utilisation of leg muscles.
Open reduction and internal fixation procedure.
A report on functional capacity done after the hydrotherapy.