Dr. Anton de Wijer is a specialist in special dental care, TMD and orofacial pain at the UMC St Radboud in the Netherlands. His practice focuses on treating temporomandibular disorders (TMD) using a multidisciplinary approach involving psychologists, manual therapists, dentists and other specialists. The document provides statistics on patients seen in his practice, describes the multidisciplinary treatment approach used at his clinic, and discusses the links between TMD and neck pain based on current research findings.
Cervicogenic Dizziness - identification and treatmentNVMT-symposium
Cervicogenic dizziness is a controversial diagnosis caused by dysfunction in the upper cervical spine that results in imbalance or disequilibrium. It is identified through a 5-step process including characteristics of imbalance-type dizziness, neck pain or stiffness exacerbating dizziness, and physical exam findings. Sustained natural apophyseal glides are an effective manual therapy treatment, shown to decrease dizziness and pain more than mobilizations or placebo. Multi-modal treatment including balance exercises is also recommended. Long-term follow up shows treatment effects are maintained for up to 12 months.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
The document discusses a maladaptive perception model of chronic low back pain (CLBP). It summarizes evidence that CLBP is associated with changes in brain structure and function, sensory processing, motor control, and body perception. A plausible model is that maladaptive cognitive and sensory processes could influence tissue loading, sensitivity, fear and worry in a way that perpetuates pain. Experimental research supports the idea that correcting maladaptive body perception through sensory discrimination training and graded cortical retraining can reduce pain. Functional rehabilitation targeting both cognitive perception and self-perception may help normalize movement behaviors and integrate activities to mutually normalize perception and pain.
This document discusses interventional pain procedures for chronic pain, including epidural injections, facet joint injections, medial branch blocks, and radiofrequency nerve ablation. It provides details on how each procedure is performed, when they are appropriate, and their potential benefits which include temporary pain relief and allowing patients to progress in rehabilitation. It also covers guidelines for opioid prescribing for chronic pain, including maximum recommended doses, conversion between opioid medications, requirements for authorities to prescribe, and factors to consider in opioid trials and maintenance therapy.
This document discusses chronic subjective dizziness (CSD), a condition characterized by non-vertiginous dizziness or imbalance that is exacerbated by motion and visual stimuli. CSD is thought to develop through classical and operant conditioning following acute vestibular disorders. Treatment involves diagnosis, education, pharmacology like SSRIs, psychotherapy, and vestibular rehabilitation therapy including habituation exercises and graded exposure. CSD is differentiated from other conditions through characteristic symptoms and normal exam findings despite a history of vestibular dysfunction.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
This document discusses various interventional pain procedures for chronic pain management, including their indications and how they are performed. It describes epidural injections, facet joint injections, sacroiliac joint injections, medial branch blocks, and radiofrequency nerve ablation. Epidural injections are most effective for nerve root compression and spinal stenosis. Facet joint injections target back pain from facet joints, while sacroiliac joint injections are for referred pain in the low back or lower extremities. Medial branch blocks and radiofrequency ablation can provide diagnostic information and long-term pain relief by denervating facet joints. Proper patient selection, aseptic technique, imaging guidance, and monitored sedation are important for safety. The document also reviews
Cervicogenic Dizziness - identification and treatmentNVMT-symposium
Cervicogenic dizziness is a controversial diagnosis caused by dysfunction in the upper cervical spine that results in imbalance or disequilibrium. It is identified through a 5-step process including characteristics of imbalance-type dizziness, neck pain or stiffness exacerbating dizziness, and physical exam findings. Sustained natural apophyseal glides are an effective manual therapy treatment, shown to decrease dizziness and pain more than mobilizations or placebo. Multi-modal treatment including balance exercises is also recommended. Long-term follow up shows treatment effects are maintained for up to 12 months.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
The document discusses a maladaptive perception model of chronic low back pain (CLBP). It summarizes evidence that CLBP is associated with changes in brain structure and function, sensory processing, motor control, and body perception. A plausible model is that maladaptive cognitive and sensory processes could influence tissue loading, sensitivity, fear and worry in a way that perpetuates pain. Experimental research supports the idea that correcting maladaptive body perception through sensory discrimination training and graded cortical retraining can reduce pain. Functional rehabilitation targeting both cognitive perception and self-perception may help normalize movement behaviors and integrate activities to mutually normalize perception and pain.
This document discusses interventional pain procedures for chronic pain, including epidural injections, facet joint injections, medial branch blocks, and radiofrequency nerve ablation. It provides details on how each procedure is performed, when they are appropriate, and their potential benefits which include temporary pain relief and allowing patients to progress in rehabilitation. It also covers guidelines for opioid prescribing for chronic pain, including maximum recommended doses, conversion between opioid medications, requirements for authorities to prescribe, and factors to consider in opioid trials and maintenance therapy.
This document discusses chronic subjective dizziness (CSD), a condition characterized by non-vertiginous dizziness or imbalance that is exacerbated by motion and visual stimuli. CSD is thought to develop through classical and operant conditioning following acute vestibular disorders. Treatment involves diagnosis, education, pharmacology like SSRIs, psychotherapy, and vestibular rehabilitation therapy including habituation exercises and graded exposure. CSD is differentiated from other conditions through characteristic symptoms and normal exam findings despite a history of vestibular dysfunction.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
This document discusses various interventional pain procedures for chronic pain management, including their indications and how they are performed. It describes epidural injections, facet joint injections, sacroiliac joint injections, medial branch blocks, and radiofrequency nerve ablation. Epidural injections are most effective for nerve root compression and spinal stenosis. Facet joint injections target back pain from facet joints, while sacroiliac joint injections are for referred pain in the low back or lower extremities. Medial branch blocks and radiofrequency ablation can provide diagnostic information and long-term pain relief by denervating facet joints. Proper patient selection, aseptic technique, imaging guidance, and monitored sedation are important for safety. The document also reviews
The document discusses the classification and management of chronic low back pain. It notes that 95% of back pain cases do not require surgery or radiology, and most patients need multidisciplinary care. While patients experience back pain, investigations and treatments directed at the back are often ineffective, suggesting the cause may involve neurological reorganization in the brain. The document provides tools to assess patients and strategies for clinicians, including explaining to patients that the cause is often not well understood, recommending evidence-based treatments like exercise over passive therapies, and avoiding factors that could worsen the condition like prolonged opioid use.
This document summarizes interventional pain procedures for chronic pain. It describes common origins of lumbar back pain such as degenerative discs and discusses invasive treatment options like surgery, injections, and radiofrequency ablation. Facet joint injections are described as effective for pain originating from facet joints. Epidural injections can provide temporary relief for nerve root compression or spinal stenosis. Medial branch blocks are used diagnostically prior to potential radiofrequency ablation to denervate medial branch nerves controlling facet joint sensation. Psychological assessment and management strategies are also outlined to optimize pain treatment.
This document discusses medication options for low back pain. It begins by outlining first-line treatments including non-opioid analgesics like paracetamol and NSAIDs. Combination therapy using both is recommended if pain persists. The document then discusses second-line options if pain involves neuropathic components, such as tricyclic antidepressants, tramadol, or tapentadol. Strong opioids are a fourth-line treatment option if other medications are ineffective.
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Spinal manipulation therapy (SMT) was more effective than medication for relieving acute or subacute neck pain in both the short and long term. Home exercise with advice (HEA) resulted in similar pain outcomes to SMT at most time points. For 272 participants with neck pain lasting 2-12 weeks, SMT had statistically significantly less pain than medication after 8 weeks and up to 1 year later. HEA was superior to medication for pain relief at 26 weeks. No important differences in pain were found between SMT and HEA. The trial demonstrated that SMT and HEA were both more effective than medication for acute or subacute neck pain.
Pain is common in elderly patients due to age-related changes in peripheral nerves and the central nervous system. Chronic pain is prevalent, with about 1 in 5 elderly patients experiencing pain for over 24 hours in the past month. Common causes of pain include arthritis, fractures, and neuropathies. Untreated pain can lead to depression, sleep disturbances, functional impairment, and reduced quality of life. Treatment involves both pharmacological and non-pharmacological approaches, with special considerations for age-related changes impacting drug metabolism and side effects.
Awareness and assessment of the pain in
postoperative children is important
Remember the different pharmacology in
neonates, infants and children
Multi-modal approach to preventing and treating
pain to minimize adverse effects
Regional analgesia must be considered unless
contraindicated
Ponencia en @LaSalleSaludUAM sobre como Identificar de manera sistemática y adecuada los factores psicosociales que intevienen en los procesos de salud de nuestros pacientes, y abordarlos mediante estrategias de EPS.
Exercise Therapy in the Management of Low Back PainOlubusola Johnson
This document discusses exercise therapy for the management of low back pain. It provides background on low back pain, noting that most episodes are non-specific and occur with normal activities. It reviews the epidemiology of low back pain and classifications by duration and etiology. The document then discusses the anatomy of core muscles like the transversus abdominis and multifidus. It reviews evidence on exercises for flexibility, strengthening, core stabilization and their effectiveness in treating low back pain according to studies. Core stabilization exercises targeting the transversus abdominis and multifidus are emphasized as important for both treatment and prevention of recurrent low back pain.
ISMST - 2014 Presentation Final PresentationKenneth Craig
This document summarizes a case series study on the use of extracorporeal shockwave therapy (ESWT) to treat complex/neuropathic pain syndromes. It describes 12 patients who underwent 4 treatments of ESWT at weekly intervals and experienced significant reductions in pain, physical impairment, and emotional distress that were maintained at 24-week follow up based on standardized questionnaires. The proposed mechanisms of action of ESWT for neuropathic pain and rationale for its application are discussed. The study concludes that ESWT shows promise for treating neuropathic pain and warrants further research.
Management of tmd symptoms with photobiomodulation therapyNishu Priya
Conservative approaches, such as soft diets, anti-inflammatory drugs and photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT), have been used to manage TMD.
Lasers have proven to be successful in clinical settings and treatments of soft tissues, musculoskeletal pain, bone regeneration, dentinal hypersensitivity, and provide reduction in symptoms and improved function.
The mechanism of action in PBMT is via absorption of light, with deeply penetrating wavelengths ranging from 630 nm to 1300 nm, to stimulate tissues with direct irradiation to achieve analgesic and anti-inflammatory effects.
The output energy in PBMT does not affect skin temperature and is classified as a soft laser, which increases lymphatic flow, reduces edema and prostaglandin E2 (PGE2) and cyclooxygenase (COX) levels.
A systematic review for pain management reported placebo vs LLLT for practical and clinically relevant parameters using 700nm to 1200nm.
An interappointment flare-up is an unplanned return of a patient to the dentist due to pain and/or swelling after a root canal treatment. The document discusses the definition, incidence, criteria, risk factors, etiology, prevention, and management of flare-ups. The incidence of flare-ups is reported to be between 1.5-5.5%. Risk factors include pulpal necrosis, acute apical abscess, larger periapical lesions, and female gender. The etiology involves introducing new irritants during treatment that disrupt the local adaptation to the original irritant and cause an inflammatory reaction. Prevention focuses on managing risk factors and patients' pain and anxiety before and after treatment.
The document discusses the classification and management of chronic low back pain. It notes that 95% of back pain cases do not require surgery or radiology, and most patients need multidisciplinary care. While patients experience back pain, investigations and treatments directed at the back are often ineffective, suggesting the cause may involve neurological reorganization in the brain. The document provides tools to assess patients and strategies for clinicians, including explaining to patients that the cause is often not well understood, recommending evidence-based treatments like exercise over passive therapies, and avoiding factors that could worsen the condition like prolonged opioid use.
This document summarizes interventional pain procedures for chronic pain. It describes common origins of lumbar back pain such as degenerative discs and discusses invasive treatment options like surgery, injections, and radiofrequency ablation. Facet joint injections are described as effective for pain originating from facet joints. Epidural injections can provide temporary relief for nerve root compression or spinal stenosis. Medial branch blocks are used diagnostically prior to potential radiofrequency ablation to denervate medial branch nerves controlling facet joint sensation. Psychological assessment and management strategies are also outlined to optimize pain treatment.
This document discusses medication options for low back pain. It begins by outlining first-line treatments including non-opioid analgesics like paracetamol and NSAIDs. Combination therapy using both is recommended if pain persists. The document then discusses second-line options if pain involves neuropathic components, such as tricyclic antidepressants, tramadol, or tapentadol. Strong opioids are a fourth-line treatment option if other medications are ineffective.
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Spinal manipulation therapy (SMT) was more effective than medication for relieving acute or subacute neck pain in both the short and long term. Home exercise with advice (HEA) resulted in similar pain outcomes to SMT at most time points. For 272 participants with neck pain lasting 2-12 weeks, SMT had statistically significantly less pain than medication after 8 weeks and up to 1 year later. HEA was superior to medication for pain relief at 26 weeks. No important differences in pain were found between SMT and HEA. The trial demonstrated that SMT and HEA were both more effective than medication for acute or subacute neck pain.
Pain is common in elderly patients due to age-related changes in peripheral nerves and the central nervous system. Chronic pain is prevalent, with about 1 in 5 elderly patients experiencing pain for over 24 hours in the past month. Common causes of pain include arthritis, fractures, and neuropathies. Untreated pain can lead to depression, sleep disturbances, functional impairment, and reduced quality of life. Treatment involves both pharmacological and non-pharmacological approaches, with special considerations for age-related changes impacting drug metabolism and side effects.
Awareness and assessment of the pain in
postoperative children is important
Remember the different pharmacology in
neonates, infants and children
Multi-modal approach to preventing and treating
pain to minimize adverse effects
Regional analgesia must be considered unless
contraindicated
Ponencia en @LaSalleSaludUAM sobre como Identificar de manera sistemática y adecuada los factores psicosociales que intevienen en los procesos de salud de nuestros pacientes, y abordarlos mediante estrategias de EPS.
Exercise Therapy in the Management of Low Back PainOlubusola Johnson
This document discusses exercise therapy for the management of low back pain. It provides background on low back pain, noting that most episodes are non-specific and occur with normal activities. It reviews the epidemiology of low back pain and classifications by duration and etiology. The document then discusses the anatomy of core muscles like the transversus abdominis and multifidus. It reviews evidence on exercises for flexibility, strengthening, core stabilization and their effectiveness in treating low back pain according to studies. Core stabilization exercises targeting the transversus abdominis and multifidus are emphasized as important for both treatment and prevention of recurrent low back pain.
ISMST - 2014 Presentation Final PresentationKenneth Craig
This document summarizes a case series study on the use of extracorporeal shockwave therapy (ESWT) to treat complex/neuropathic pain syndromes. It describes 12 patients who underwent 4 treatments of ESWT at weekly intervals and experienced significant reductions in pain, physical impairment, and emotional distress that were maintained at 24-week follow up based on standardized questionnaires. The proposed mechanisms of action of ESWT for neuropathic pain and rationale for its application are discussed. The study concludes that ESWT shows promise for treating neuropathic pain and warrants further research.
Management of tmd symptoms with photobiomodulation therapyNishu Priya
Conservative approaches, such as soft diets, anti-inflammatory drugs and photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT), have been used to manage TMD.
Lasers have proven to be successful in clinical settings and treatments of soft tissues, musculoskeletal pain, bone regeneration, dentinal hypersensitivity, and provide reduction in symptoms and improved function.
The mechanism of action in PBMT is via absorption of light, with deeply penetrating wavelengths ranging from 630 nm to 1300 nm, to stimulate tissues with direct irradiation to achieve analgesic and anti-inflammatory effects.
The output energy in PBMT does not affect skin temperature and is classified as a soft laser, which increases lymphatic flow, reduces edema and prostaglandin E2 (PGE2) and cyclooxygenase (COX) levels.
A systematic review for pain management reported placebo vs LLLT for practical and clinically relevant parameters using 700nm to 1200nm.
An interappointment flare-up is an unplanned return of a patient to the dentist due to pain and/or swelling after a root canal treatment. The document discusses the definition, incidence, criteria, risk factors, etiology, prevention, and management of flare-ups. The incidence of flare-ups is reported to be between 1.5-5.5%. Risk factors include pulpal necrosis, acute apical abscess, larger periapical lesions, and female gender. The etiology involves introducing new irritants during treatment that disrupt the local adaptation to the original irritant and cause an inflammatory reaction. Prevention focuses on managing risk factors and patients' pain and anxiety before and after treatment.
2013 Toronto Academy of Dentistry, 76th Annual Winter Clinic
New Approaches in Management of Endodontic Pain by
Dr. Pavel S. Cherkas, Endodontist-Neuroscientist and
Dr. Ruslan Dorfman, Molecular Geneticist
Trigeminal neuralgia is a painful facial nerve condition that sometimes occurs in multiple sclerosis patients. The document discusses the epidemiology, diagnosis, and management of trigeminal neuralgia. It provides details on the characteristics of trigeminal neuralgia pain, the various drug and surgical treatment options, and outlines remaining research questions regarding how trigeminal neuralgia presents and is treated in multiple sclerosis patients specifically. The goal is to determine if current trigeminal neuralgia treatment guidelines apply to those with multiple sclerosis and how best to manage their pain.
This document discusses interappointment flare-ups following root canal treatment. It begins with definitions of flare-ups and discusses the typical incidence rate, which ranges from 1.5-5.5%. Patient risk factors like pulpal necrosis, acute apical abscesses, and larger periapical lesions are associated with higher flare-up rates. Treatment factors like retreatment versus initial treatment and single versus multiple visits have been studied but no strong conclusions exist on their impact on flare-up risk. Managing flare-ups involves understanding their causes and addressing patient pain and swelling when they occur.
Prof Joanna Zakrzewska - Trigeminal neuralgia in MS patientsMS Trust
This document summarizes a presentation on trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). Some key points:
- TN occurs in 2-4% of MS patients, who may experience more constant, bilateral pain compared to other TN patients.
- Diagnosis involves investigating potential causes like neurovascular compression through MRI and ruling out other conditions.
- Treatment includes carbamazepine, oxcarbazepine and other medications, as well as ablative surgical procedures for refractory cases.
- More research is needed on the prevalence and management of TN specifically in MS patients compared to other populations.
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION THERAPY IN TEMPOROMANDIBULAR DISO...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document summarizes a presentation on physiotherapy interventions for lifelong vaginismus. It finds that physiotherapy is effective in helping women achieve intercourse, gynecological exams, and reduced anxiety, but formal measures show many still experience sexual distress and low sexual function after treatment. While physiotherapy helps with symptoms, integration with interventions targeting sexual rehabilitation may be needed for full recovery.
The document discusses various types of orofacial pain including trigeminal neuralgia, post-herpetic neuralgia, atypical facial pain, and burning mouth syndrome. It covers the etiology, pathophysiology, clinical manifestations, diagnosis and management of each condition. Chronic pain is defined as pain persisting beyond tissue healing. Neuroplastic changes in the central nervous system are believed to underlie chronic pain. Treatment involves cognitive therapy, medications like anticonvulsants, antidepressants and opioids, as well as surgical options in some cases.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Lecture 12 general considerations in treatment of tmdLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name 12 general considerations in the treatment of TMJ
Al Azhar University Gaza Palestine
Dr. Lama El Banna
examination of temporomandibular joint disorders in orthodontic patientsMaher Fouda
This document discusses the examination of temporomandibular disorders in orthodontic patients. It begins by reviewing past assumptions that orthodontic treatment could cause TMD issues but notes that most scientific studies do not confirm these assumptions. The document then outlines the process for examining TMD in orthodontic patients, including taking a thorough patient history and conducting a physical examination of the temporomandibular joints and muscles. The goal of the examination is to identify any TMD issues before beginning orthodontic treatment and make appropriate referrals if needed.
2011-10-21 ASIP Santé Conférence Télémédecine "Présentation de COPD Briefcase"ASIP Santé
Présentation d'un outil de télésurveillance médicale à domicile de patients atteints de broncho-pneumopathie chronique obstructive (COPD Briefcase)
Anne DICHMANN-SORKNAES, Universitaire d’Odense au Danemark - COPD Briefcase
The document discusses various treatment controversies for Meniere's disease. It describes the definition of Meniere's disease and outlines different medical and surgical treatment options including diuretics, intratympanic gentamicin injections, and vestibular nerve section surgery. While some treatments like intratympanic gentamicin show promise, the document indicates that more research is still needed to determine the most effective therapies for controlling symptoms of Meniere's disease.
The document discusses various treatment controversies for Meniere's disease. It outlines the history and definition of the disease, as well as current understandings of physiology and pathophysiology. It then summarizes different medical, mechanical, intratympanic, surgical, and ablative treatment options and discusses evidence from studies evaluating their efficacy and side effects, finding that many options remain unproven or controversial while intratympanic gentamicin titration and vestibular nerve section/labyrinthectomy can reliably reduce vertigo.
‘Neurodynamics as a therapeutic intervention; the effectiveness and scientifi...NVMT-symposium
This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
‘Clinical Neurodynamics: clinical application from an anatomical perspective’ NVMT-symposium
This document provides an overview of neurodynamics, including:
1. The history and key figures in the development of neurodynamics from the 1920s to present.
2. Anatomy of the peripheral nervous system, including gross anatomy of major nerves in the upper and lower limbs, microanatomy of nerves, and biomechanics of nerve movement.
3. Applications to clinical examination including common nerve pathoanatomies and how joint movement affects nerves.
4. Research on neurodynamic techniques and their effects on nerve displacement and strain.
Cervical Arterial Dysfunction – implications for clinical practice" NVMT-symposium
Cervical arterial dysfunction (CAD) is an area that requires a broader conceptual framework and updated clinical guidelines. CAD can initially manifest as neck and head pain and assessing blood pressure and performing cranial nerve and eye exams may help direct patient management. A new classification system categorizes CAD into 5 classes based on symptoms and risk level to better frame the condition. Evidence around CAD continues to emerge so re-evaluation of current practices is needed.
This document discusses contemporary theories of motor adaptation related to neck pain. It proposes that motor adaptation: (1) involves diverse changes from subtle muscle activity changes to movement avoidance; (2) is specific to individuals; (3) aims to protect painful areas from further injury; (4) can precede or follow pain; and (5) has potential long-term consequences if maintained improperly. Studies show examples of adaptive changes in people with neck pain, such as altered muscle recruitment patterns and delayed responses to perturbations. Long-term motor adaptations can potentially cause further injury issues if excessive or inappropriate.
Presentatie Dr. Sue Shea - Providing Compassionate Healthcare NVMT-symposium
Getting to the ‘Heart’ of the Therapeutic Relationship – A Compassionate Approach discusses the importance of compassion in healthcare. It defines compassion as desiring to help relieve another's suffering through understanding, empathy, and action. The document explores how compassion benefits both patients and providers physically and mentally. It emphasizes the need for communication, individualized care, and seeing patients as more than their conditions to establish compassionate therapeutic relationships.
Joker Wigs has been a one-stop-shop for hair products for over 26 years. We provide high-quality hair wigs, hair extensions, hair toppers, hair patch, and more for both men and women.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
If you are interested in experiencing transformative massage treatment at Malayali Kerala Spa Ajman, you can use our Ajman Massage Center WhatsApp Number to schedule your next massage session.
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Fit to Fly PCR Covid Testing at our Clinic Near YouNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
4. instroom
• 90% ♀, µ 43 jaar
• hoger opgeleid
• Tx: 0-9 sessies 92%
• geen tx na 1e consult 17%
Praktijk:
• 66% ♀, µ 47 year
• 68% lager en middelbaar opgeleid
• 40% sociaal en emotioneel disfunctioneren
Frequent comorbiditeit
CBT Radboud:
5. selfcare
Complex
cases
High risk
cases
80% of
people
High % of
professional care
Equally shared
care
High %
of self
care
Patient education
Psychosocial support
Assessment self
management
Collaborative decision
making
Guidelines available
instroom
7. Temporomandibular disorders is a collective term that embraces a number of clinical
problems [musculoskeletal conditions] that involve the masticatory muscles, the TMJ,and
the associated stuctures .
8. Von Sölder 1890
Kunc 1970
V1
V2
V3
lesser
occip. n.
(C2)
greater
auric. n.
(C2,3)
greater
occip. n.
(C2)
third
occip. n.
(C3)
transv. cut. n.
of neck (C2,3)
V o
V i
V c
PeripheralBranchesvsDermatomes
C2
C3
Vc
Vi Vo
Neuropathic
pain projection areas
Nociceptive
referral pain areas
13. How to explain?
Neck/ shoulder
Phrenicus nerve
BRAIN
Perception
Emotional brain
nV
neck
Co-activation
Birgitta Haggman Henrikson
PhD 2004
Functional jaw movements with
simultaneous movements in tmj,
atlantooccipital and cervical joints!
14. How to explain?
Neck/ shoulder
Phrenicus nerve
BRAIN
Perception
Emotional brain
nV
neck
Co-activation
Birgitta Haggman Henrikson
PhD 2004
• Preparatory head extension
before the start of chewing
• Association between size
and texture of bolus with
head extension and
mandibular movements
• Neck muscle activity is
present in rhytmic jaw
activities
• In wAD patients smaller
amplitudes and disturbed
coordination of head and
mandibular movements
Functional jaw movements with
simultaneous movements in tmj,
atlantooccipital and cervical joints!
15. Reciprocal nature of cervical-trigeminal interaction
Cervical nociception facilitate trigeminal sensation
Trigeminal nociception facilitates cervical perception
Association between neck and jaw disability is strong and
clinically relevant
Serious TMD increased 19.32 / 50 points on NDI
Differences in craniocervical posture & max strength cervical flexor
muscles not clinically relevant for patients with TMD
How to explain?
Susan Olivio
17. Unicausal explanatory models
Presumed causation
Misalignment
Occlusal interferences
Stress-induced
parafunction
Targeted action
Repositioning
Adjustment
Habit control
Treatment goal
Condylar concentricity
Proper disk-condyle
relationship
Proper occlusal
relations
Normal function
18. Unicausal explanatory models
TMD unicausaal ???
Occlusale therapie als behandeloptie en zelfs houdingsproblemen
worden beïnvloed door occlusie tx
Causale relatie malocclusie en houdingsproblemen en vice versa
Er is geen biologische plausabiliteit voor een pathologische relatie
tussen occlusie en houding.
Er is geen evidentie dat stabilometrische
(zwaartepuntverplaatsingen) en posturografische testen
diagnostisch valide zijn.
19. Unicausal explanatory models
TMD monocausaal ???
Occlusale therapie als behandeloptie en zelfs houdingsproblemen
worden beïnvloed door occlusie tx
Causale relatie malocclusie en houdingsproblemen en vice versa
Er is geen biologische plausabiliteit voor een pathologische
relatie tussen occlusie en houding.
Er is geen evidentie dat stabilometrische
(zwaartepuntverplaatsingen) en posturografische testen
diagnostisch valide zijn.
xNEEN
20. casus
Secundaire hoofdpijn
Dr. Paul Schokker J Craniomandib Disord. 1990 Spring;4(2):126-30.
The result of treatment of the masticatory system of chronic
headache patients.
27. Casus
Sluderse neuralgie = Vidian neuralgia ( Vail 1932)
SN CH
Pain type boring, burning stabbing
or nagging boring
Severity (moderately) severe severe / very
Site Unilateral/ bi unilat orbital
peri, intra orbital supraorbital
root or lat side nose temporal
Radiation maxilla, mastoid, head
occiput, neck shoulder
Attack freq attacks or continuous 1 every other day
to 8 per day, in
cluster periods
Duration hour(s) to days 15-180 minutes
Autonomic yes yes
features
K. Oomen Cephalalgia 2010
N III, vll , lx en x// ggl pterygopalatinum
28. Key Questions
Timing: onset, duration, periodicity
Location and radiation
Quality and severity
Relieving and aggravating [screen]
Associated factors [clenching, locking, clicking, nasal, eye, taste,
salivary flow, ear eg.]
Other pain condition [headache, chronic widespread pain]
Impact of pain [sleep, mood, concentration, fatigue, beliefs, quality of life]
SCEGS!!
WAT DOET DE MANUEEL THERAPEUT
30. Diagnostic value of Orthopedic tests in patients with TMD
J Dental Research, 1993, 1443-1453
Conclusion:
in routine clinical practice, besides history taking and conventional radiography, a functional
examination consisting of active movements, passive opening, and palpation provides valuable
diagnostic information. % class. 89.3 sens. 95, spec. 67, OR 36
in patients with specific diagnostic problems additional tests might be indicated.
FUNCTIE
31. Diagnostic value of Orthopedic tests in patients with TMD
J Dental Research, 1993, 1443-1453 , Lobbezoo-Scholte et al
Conclusion:
active movement was the most powerful test for distinguishing the different
subgroups.
Palpation and passive opening were additional useful for distinguishing between patients and
controls and between the subgroups myogenous and arthrogenous.
N= 621 patients, 144 matched controls
DC TMD update van RDC TMD Schiffman et al 2014
Expanding DC TMD Peck et al 2014
Topical review JOP; Steenks, Türp, de Wijer; submitted
32. DC TMD update van RDC TMDSchiffman et al 2014
Conclusion:
The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener
for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-
related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and
specificity of 0.97).
The 12 common TMD include arthralgia, myalgia, local myalgia, myofascial pain, myofascial pain with referral,
four disc displacement disorders, degenerative joint disease, subluxation, and headache attributed to TMD.
33. DC TMD update van RDC TMDSchiffman et al 2014
Conclusion:
34. DC TMD update van RDC TMDSchiffman et al 2014
• Part two: the secondary
headaches
• 11. Headache or facial pain
attributed to disorder of the
cranium, neck, eyes, ears, nose,
sinuses, teeth, mouth or other
facial or cervical structure
• 11.7 Headache attributed to
temporomandibular disorder
10-15%/ 5% / 1.5%
35. Pain is dental until proved negative!
Panoramic photo
Teeth
Mucosa
Bone
Nerve
Muscle
Joint
36. Treat all circles
• Biopsychosocial model
pain
Cognitions
Physiology Behaviour
37. Treat all circles
Nociception
Prevention/ medication
Pain awareness
Local anaesthethic/ anti- depressant/ -
epileptics/ morfine/ TENS
Gate Control th
Explanation/ counseling/
re-assure/ relaxation/ self
confidence /
CBT,Anxiolytica
Sleepmedication
Graded activity
Keep on moving
Positive
38. Treat all circles
Nociception tx
Prevention/ medication
Pain awareness
Local anaesthethic/ anti- depressant/ -
epileptics/ morfine/ TENS
Gate Control th
Explanation/ counseling/
re-assure/ relaxation/ self
confidence /
CBT,Anxiolytica
Sleepmedication
Graded activity
Keep on moving
Positive
39. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular
Disorders: Systematic Review and Meta-Analysis 2016
• The overall evidence for this systematic review was considered low. The
trials included in this review had unclear or high risk of bias. Thus, the
evidence was generally downgraded based on assessments of risk of
bias. Most of the effect sizes were low to moderate, with no clear
indication of superiority of exercises versus other conservative
treatments for TMD. However, MT alone or in combination with
exercises at the jaw or cervical level showed promising effects
• No high-quality
evidence was found,
indicating that there
is great uncertainty
about the
effectiveness of
exercise and MT for
treatment of TMD
Susan Armijo-Olivo, Laurent Pitance, Vandana Singh, Francisco
Neto, Norman Thie, Ambra Michelotti
41. Tx
Randomized or quasi randomized clinical trials have
reported that all treatment methods are equally
effective and that treatment success rate is not therapy
specific but due to an interaction of confounding factors
such as spontaneous remission, counseling and
information, context effect, patient expectation and
cognitive tx
42. An average painintensity reduction of 27% was found after the first consultation, which
provided only a diagnosis and no specific treatment.
Extensive research by Benedetti and colleagues provide detailed information about several
aspects of the neurobiological mechanisms of the placebo (and nocebo) effect. The key
aspect of the placebo effect is expectation.
Frisaldi E, Piedimonte A, Benedetti F. Placebo and nocebo
effects: a complex interplay between psychological factors
and neurochemical networks. Am J Clin Hypn.
2015;57(3):267-284.
Benedetti F. Placebo effects: from the neurobiological
paradigm to translational implications. Neuron.
2014;84(3):623-637.