Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
A highly structured, goal-oriented, individualized intervention program designed to return the employee to work. Our Work Hardening programs are multidisciplinary in nature and utilize real or simulated work activities designed to restore physical, behavioral and vocational functions.
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
A highly structured, goal-oriented, individualized intervention program designed to return the employee to work. Our Work Hardening programs are multidisciplinary in nature and utilize real or simulated work activities designed to restore physical, behavioral and vocational functions.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
CBR vs IBR-CBR subject. Download [15.00 KB]. Author Amisha Angle Posted on December 2, 2016. Leave a Reply Cancel reply.Community Based Rehabilitation: With CBR, the locus of control should be with the community.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
CBR vs IBR-CBR subject. Download [15.00 KB]. Author Amisha Angle Posted on December 2, 2016. Leave a Reply Cancel reply.Community Based Rehabilitation: With CBR, the locus of control should be with the community.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different soft tissue injuries are the part of curriculum for the undergraduate students at KUSMS.
Common sports-relatedshoulder injuriesShoulder pain is.docxcargillfilberto
Common sports-related
shoulder injuries
S
houlder pain is commonly treated in general practice; its causes are often
multi-factorial. The focus of this article is on sports-related shoulder injuries
likely to be seen in the community. This article aims to overview the presen-
tation, assessment and management of these conditions in general practice.
The GP curriculum and common sports-related shoulder injuries
Clinical module 3.20: Care of people with musculoskeletal problems lists the learning objectives required
for a GP to manage common sports-related shoulder injuries in the community or refer for specialist management. In
particular, GPs are expected to be able to:
. Communicate health information effectively to promote better outcomes
. Explore the perceptions, ideas or beliefs the patient has about the condition and whether these may be acting as
barriers to recovery
. Use simple techniques and consistent advice to promote activity in the presence of pain and stiffness
. Agree treatment goals and facilitate supported self-management, particularly around pain, function and physical
activity
. Assess the importance and meaning of the following presenting features:
. pain: nature, location, severity, history of trauma
. variation of symptoms over time
. loss of function – weakness, restricted movement, deformity and disability, ability to perform usual work or
occupation
. Understand that reducing pain and disability rather than achieving a complete cure could be the goal of
treatment
. Understand indications and limitations of plain radiography, ultrasound, and magnetic resonance scans
. Diagnose common, regional soft-tissue problems that can be managed in primary care
. Understand the challenge that many musculoskeletal conditions might be better and more confidently managed
by other healthcare personnel rather than GPs, because most GPs do not gain the necessary treatment skills
during their training
. Refer those conditions which may benefit from early referral to an orthopaedic surgeon
The four most common categories of shoulder pain
seen in primary care are (Mitchell, Adebajo, Hay, &
Carr, 2005):
. Rotator cuff disorders (85% tendinopathy)
. Glenohumeral disorders
. Acromioclavicular joint disease, and
. Referred neck pain.
There are many different types of sports that can cause
acute or chronic shoulder injuries. In professional English
Rugby Union, for example, the most common match
injury is of the acromioclavicular joint (32% overall) and
the most severe injury requiring the longest time off
(mean of 81 days) is shoulder dislocation (Headey,
Brooks, & Kemp, 2007).
Shoulder injuries can also occur in non-contact sports,
such as golf, tennis, swimming and weightlifting.
Although shoulder injuries may be more common in con-
tact sports, the injury may have a larger impact on the
performance of individuals playing non-contact sports.
For example, golfers require very precise manoeuvres
of their dominant.
Common sports-relatedshoulder injuriesShoulder pain is.docxdrandy1
Common sports-related
shoulder injuries
S
houlder pain is commonly treated in general practice; its causes are often
multi-factorial. The focus of this article is on sports-related shoulder injuries
likely to be seen in the community. This article aims to overview the presen-
tation, assessment and management of these conditions in general practice.
The GP curriculum and common sports-related shoulder injuries
Clinical module 3.20: Care of people with musculoskeletal problems lists the learning objectives required
for a GP to manage common sports-related shoulder injuries in the community or refer for specialist management. In
particular, GPs are expected to be able to:
. Communicate health information effectively to promote better outcomes
. Explore the perceptions, ideas or beliefs the patient has about the condition and whether these may be acting as
barriers to recovery
. Use simple techniques and consistent advice to promote activity in the presence of pain and stiffness
. Agree treatment goals and facilitate supported self-management, particularly around pain, function and physical
activity
. Assess the importance and meaning of the following presenting features:
. pain: nature, location, severity, history of trauma
. variation of symptoms over time
. loss of function – weakness, restricted movement, deformity and disability, ability to perform usual work or
occupation
. Understand that reducing pain and disability rather than achieving a complete cure could be the goal of
treatment
. Understand indications and limitations of plain radiography, ultrasound, and magnetic resonance scans
. Diagnose common, regional soft-tissue problems that can be managed in primary care
. Understand the challenge that many musculoskeletal conditions might be better and more confidently managed
by other healthcare personnel rather than GPs, because most GPs do not gain the necessary treatment skills
during their training
. Refer those conditions which may benefit from early referral to an orthopaedic surgeon
The four most common categories of shoulder pain
seen in primary care are (Mitchell, Adebajo, Hay, &
Carr, 2005):
. Rotator cuff disorders (85% tendinopathy)
. Glenohumeral disorders
. Acromioclavicular joint disease, and
. Referred neck pain.
There are many different types of sports that can cause
acute or chronic shoulder injuries. In professional English
Rugby Union, for example, the most common match
injury is of the acromioclavicular joint (32% overall) and
the most severe injury requiring the longest time off
(mean of 81 days) is shoulder dislocation (Headey,
Brooks, & Kemp, 2007).
Shoulder injuries can also occur in non-contact sports,
such as golf, tennis, swimming and weightlifting.
Although shoulder injuries may be more common in con-
tact sports, the injury may have a larger impact on the
performance of individuals playing non-contact sports.
For example, golfers require very precise manoeuvres
of their dominant.
Phased approach of Connecting from posture and movement assessment (1).pdfTomohiro Sawatari
I am a physiotherapist in Japan. I used to work in a conditioning gym and since I got my physiotherapy licence I have been working in an orthopaedic clinic.
The postural and movement assessment as a concept for therapeutic intervention is summarised in this slide.
---------------------------------------------------------
姿勢・動作の評価の考え方について、このスライドにまとめています。
Arthritis is the swelling and tenderness of one or more joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.
A traditional manual therapy technique developed by John Upledger, involving bare hands and stretching the tension membrane so as to ease the tension within
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
Traction: a basic physiotherapy modality used for inducing space between the joints. this slideshow deals with various types of traction and its application to cervical, thoracic and lumbar spine.
the PPT Describes about various types of dysfunction in mechanical pattern as described by Janda's. it also describes about normal muscle slings prresent within the body and its compensation and decompensation patterns towards the adaptations of the body
this slideshow describes about the hip joint anatomy, biomechanics and its pathomechanics along with angles of hip joint. the slide show also briefs about the pelvic femoral rhythm in daily activities
Thoracic and rib cage anatomy, biomechanics, and pathomechanicsRadhika Chintamani
This slide show describes about thoracic and rib cage in detail with its anatomy, kinetics and kinematics along with force couple. the slideshow also describes about the pathology and pathomechanics related to the topic
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
A very old school of manual therapy which comprises of two main principle centralization and peripheralization thought given by Robin McKenzie. The slideshow explain theoretical and practical part of both entire spine and extremities as well
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Massage of therapeutic form is beneficial in many conditions like stroke, flaccidity, muscle tightness, spasm etc.
it has many physiological effects along with many types for different conditions as well as different body areas.
it is another taping technique which inhibits or control the movement. it is helpful in postural correction and movement pattern correction as well. usually used clinically
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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3. Definition
Impairment: An impairment is a
permanent or transitory
psychological, or anatomical loss
and /or abnormality. For example a
missing or defective part, tissue organ,
or “mechanism” of the body, such as
an amputated limb, paralysis after
polio, myocardial infarction,
cerebrovascular thrombosis, restricted
pulmonary capacity, diabetes, myopia,
disfigurement, mental retardation
4. Functional limitation: Impairment may cause functional
limitations which are the partial or total inability to
perform those activities necessary for motor, sensory, or
mental functions within the range and manner of which a
human being is normally capable such as walking, lifting
loads, seeing, speaking
5. The universal guidelines for the assessment and
certification of the following disabilities were
finalised by a group experts and were notified by
Ministry of Social Justice and Empowerment.
1. Visual impairment
2. Locomotor disability
3. Speech and hearing
4. Mental retardation
5. Multiple disabilities
6. Disability: Disability in which functional limitation and or
impairment is a causative factor, is defined as an existing difficulty
in performing one or more activities which, in accordance with the
subject’s age, sex and normative social role, are generally accepted
as essential, basic components of daily living
7. According to PWD Act (persons with disability) the empowered
persons to give disability certificate will be a Medical Board
consisting of at least 3 members out of which atleast 1 shall be a
specialist in a particular field for assessing
locomotor/visual/hearing and speech, MR , duly constituted by
central and state government.
8. The minimum degree of disability should be 40% in
order to be eligible.
`disability` means-
1. Blindness
2. Leprosy cured
3. Hearing impairment
4. Locomotor disability
5. Mental retardation
9. •“Expert Group Meeting on Disability Evaluation” was
held in September, 1981 in New Delhi with the
objective to develop simple norms for evaluation of
permanent physical impairment in Indian patients.
• Guidelines developed at the meeting were given due
trial at various centres in the country.
•It was then followed by “National Seminar on
Disability Evaluation & Dissemination” held in
December, 1981.
11. BROAD PRINCIPLES OF DISABILITY ASSESSMENT
Functional loss : it is the assessment of functional
loss on some uniform test resulting from permanent
physical impairment caused due to congenital or
acquired conditions
Individual function requirement :functions are
assessed in relation to standard desired functions of
anatomical part.
12. Where to decide percentage on extent of function/activity-
1. No loss – activity can be performed normally
without assistance
2. Partial loss – activity can be performed partly or
with assistance
3. Total loss – activity cannot be performed even with
assistance.
13. Guidelines for evaluation
In order to arrive at the total % of multiple disability,
the combining formula is:
a + b (90 – a)
90
where “a” will be the higher score
“b” will be the lower score
This formula is used to evaluate permanent physical
impairment.
14. Variables in assessing locomotor disability
The following variables need to be taken into
consideration while assessing disability:
1. Strength of muscle
2. Range of motion of joint
3. Coordination
4. Stability
5. Limb length discrepancy
6. Hand function ( prehension, sensation and
strength
17. ARM COMPONENT
Total value of arm component is 90%
It consists of measuring:
1. Loss of movement
2. Muscle strength
3. Coordination activities
18. Range of motion assessment
The value of maximum ROM in the arm component
is 90%
Each of the three joints of arm is weighted equally
(30%) each
Example: the intra articular fractures of bones of
right shoulder may affect ROM after healing. The
loss of ROM can be calculated as
19. Arc of ROM Normal value Active ROM Loss of ROM
Shoulder flexion 0-180 90 50%
Rotation 0-180 90 50%
Abduction-
Adduction
0-180 90 50%
• Hence the mean loss of ROM of shoulder will be
50+50+50 = 50 %
3
• Shoulder movements constitute 30% of motion
of the arm component, so the loss of motion of
arm will be 50*0.30= 15%.
20. Principles of evaluation of Strength of muscles
Manual muscle strength grading Loss of strength in percentage
0 100%
1 80%
2 60%
3 40%
4 20%
5 0
• MRC grading is done and tested for strength
from 0-5. Loss of muscle power can be given
percentages.
• The mean % of loss of muscle strength is
multiplied by 0.30
21. Principles of evaluation of coordinated activities
Total value is 90%
10 different activities are tested
Value of each activity is 9%
Total value for the arm component is obtained by
combining value of loss of ROM, muscle strength and
coordinated activities.
22. Principles of evaluation of Prehension
Total value is 30%
1. Opposition 8%
Index finger 2%
middle finger 2%
ring finger 2%
little finger 2%
2. Lateral pinch 5%
tested by asking patient to hold a key between
thumb and lateral side of index finger
23. 3. Cylindrical grasp: 6%
Large objects 4” diameter
Small object 1” diameter
4. Spherical grasp: 6%
Large objects 4” diameter
Small object 1” diameter
5. Hook grasp: 5%
Tested by asking patient to lift
a bag
24. Principles of evaluation of sensation
Total value of sensation is 30%
Complete loss of sensation-
1. Thumb 9%
2. Middle finger 5%
3. Index finger 6%
4. Ring finger 5%
5. Little finger 5%
25. Principles of evaluation of strength
Total value of strength is 30%
grip strength 20% pinch strength 10%
Strength can be assessed using hand dynamometer.
Additional weight age can be given to the following
accompanying factors if they are continuous:
1. Pain
2. Infection
3. Deformity
26. 4. Mal alignment
5. Contractures
6. Cosmetic disfiguration
7. Dominant extremity- 4%
8. Shortening of extremity- first 1” no weight age for each
1” beyond 1st
is 2% disability
Combining values for the extremity:
( a + b ) 90 – a
90
27. Guidelines for evaluation of disability in
lower limb
The measurement of loss of function in lower
extremity is divided into
mobility stability
Mobility component : total value is 90%
ROM Muscle strength
28. Evaluation of ROM
The value of maximum range of motion is 90%
Each of the three joints hip, knee and ankle are
measured equally at 30%.
If more than one joint of the limb is involved the mean
loss of ROM in percentage should be calculated in
relation to individual joint separately and then added
together to calculate the loss of mobility.
29. Evaluation of Strength of muscles
Maximum value is 90%
Can be tested using MRC
Mean % of strength loss is around a joint is
multiplied by 0.30
Combining values for the extremity:
( a + b ) 90 – a
90
30. Extra points
Deformity :
1. in functional position 3%
2. In non functional position 6%
Pain :
1. Severe 9%
2. Moderate 6%
3. Mild 3%
Loss of sensation:
1. Complete loss 9%
2. Partial loss 6%
31. Guidelines for evaluation of Permanent
Physical Impairment of Spine
PPI caused by the spine tends to change over years.
PPI should be awarded in relation to spine and not in
relation to the whole body.
PPI due to neurological deficit in addition to spinal
impairment should be added by combining formula.
traumatic
PPI of spine
non traumatic
32. Traumatic lesions
25% or more compression of one or two adjacent vertebral
bodies with no involvement of posterior elements and no
nerve root involvement, moderate neck rigidity and
persistent soreness – 20
Posterior element damage with radiological evidence of
moderate/ partial dislocation including whiplash injury:
1. With fusion healed, no permanent changes- 10
2. Persistent pain with radiological evidence – 25
Severe dislocation
1. Fair to good reduction with or without fusion- 10
2. Inadequate reduction - 15
33. Cervical and intervertebral disc lesions:
1. Treated case of disc lesions with persistent pain and no
neurological deficit: 10
2. Treated case with pain and instability: 15
Thoracic and thoraco-lumbar spine injuries:
3. Compression <50% with 1 vertebral body + no
neurological manifestation: 10
4. Compression >50% with 1 or more posterior element,
healed, no neurological manifestation, pain, fusion- 20
5. Same as 2 but pain only on heavy use- 15
6. Fracture + dislocation/ instability with persistant pain -
30
34. Lumbar and lumbo-sacral spine:
Compression of 25% or less of 1 or 2 adjacent vertebral
bodies , no neurological deficit-15
Compression of >25% + disruption of posterior elements+
persistent pain+healed with or no fusion+ inability to lift
>10kg- 30
Radiologically demonstrable instability + pain- 35
Disc lesion:
1. Treated case + pain: 15
2. Treated case + pain + instability: 20
3. Treated case of disc disease + pain + lifting affected- 25
4. Treated case of disc disease + pain + lifting affected +
modification of all activities required- 30
35. Non traumatic lesions
Scoliosis:
Cobb`s method for measurement of angle of curve in the
radiograph taken in standing position should be used.
GROUP COBB`S
ANGLE
PPI in
relation to
the spine
1 0-20 Nil
2 21-50 10
3 51-100 20
4 101 and
more
30
36. Torso Imbalance
Measured by dropping a plumb line from C7 spine
and measuring the distance of plumb line from
gluteal crease.
Deviation of plumb line PPI
Up to 1.5 cms 4%
1.5- 3 cms 8%
3.1-6.0 cms 16%
6.1 cms and more 32%
Head tilt over C7 spine PPI
Upto 15 4%
More than 15 10%
37. Cardiopulmonary test
Chest expansion PPI
4-5cm normal
less than 4 cms 5% for each cm
No expansion 25%
Associated problems
1. Pain
2. Cosmetic appearance
3. Leg length discrepancy
4. Neurological deficit
38. Kyphosis
Evaluation should be done on the similar
guidelines as used for scoliosis with the following
modifications.
Spinal deformity PPI
less than 20 Nil
21-40 10%
41-60 20%
Above 60 30%
39. 1. In case of multiple amputees, if the total sum of percentage
permanent physical impairment is above 100%, it should be
taken as 100%.
2. Amputation at any level with uncorrectable inability to wear
and use prosthesis, should be given 100% permanent physical
impairment.
3. In case of amputation in more than one limb percentage of
each limb is counted and another 10% will be added, but when
only toes or fingers are involved only another 5% will be added.
4. Any complication in form of stiffness, neuroma, infection
etc. has to be given a total of 10% additional weightage.
5. Dominant upper limb has been given 4% extra percentage.
Guidelines for Evaluation of Permanent
Physical Impairment in Amputees
40. Upper Limb Amputation Percent PPI and loss of physical function of each
limb
1. Fore-quarter amputation 100%
2. Shoulder Disarticulation 90%
3. Above Elbow upto upper 1/3 of arm 85%
4. Above Elbow upto lower 1/3 of arm 80%
5. Elbow disarticulation 75%
6. Below Elbow upto upper 1/3 of forearm 70%
7. Below Elbow upto lower 1/3 of forearm 65%
8. Wrist disarticulation 60%
9. Hand through carpal bones 55%
10.Thumb through C.M. or through 1st MC Joint 30%
11.Thumb disarticulation through metacarpophalangeal joint or through proximal
phalanx 25%
12.Thumb disarticulation through inter phalangeal joint or through distal phalanx
15%
42. Lower Limb Amputations
1. Hind quarter = 100%
2. Hip disarticulation= 90%
3. Above knee upto upper 1/3 of thigh=
85%
4. Above knee upto lower 1/3 of thigh =
80%
5. Through knee = 75%
6. B.K. upto 8 cm=70%
7. B.K. upto lower 1/3 of leg = 60%
8. Through Ankle= 55%
9. Syme’s= 50%
10. Upto mid-foot=40%
11. Upto fore-foot =30%
12. All toes=20%
13. Loss of first toe =10%
14. Loss of second toe= 5%
15. Loss of third toe= 4%
16. Loss of fourth toe=3%
17. Loss of fifth toe=2%
43. Miscellaneous conditions
Those conditions of the spine which cause stiffness and
pain etc and rates as follows.
Conditions Percentage PPI
a) Subjective symptoms of pain, no involuntary muscle spasm, not
substantiated by mild radiology change: 20%
b) Same as A with moderate radiological changes : -25%.
c) Same as B with moderate radiological changes involving Anyone
of the regions of spine : -30%.
d) Same as C involving whole spine :-40%.
44. Guidelines for evaluation of disability(PPI) in
Neurological conditions may/may not be
associated with Spine.
Basic Conditions:
1) Assessment of neurological conditions is not the
assessment of disease but the assessment of its
effects. i.e clinical manifestation.
2) These guidelines should only be used for central
and upper motor neuron(UMN) lesions.
3) Performa (form A & B) will be utilized for
assessment of lower motor neuron lesions,
muscular disorders and other loco motor
conditions.
45. Neurological Status: Physical Impairment
Altered sensorium 100%
Intellectual Impairment (to be assessed by
psychiatrist/clinical psychologist)
Degree of mental
retardation
IQ Range Intellectual
Impairment
Border line 70-79 25%
Mild 50-69 59%
Moderate 35-49 75%
Severe 20-34 90%
Profound Less than 20% 100%
46. Speech defect PPI
Mild dysarthria Nil
Moderate dysarthria 25%
Severe dysarthria 50%
Cranial nerve disability
Type of Cranial nerve Physical Impairment
Involvement
Motor cranial nerve 20% of each nerve
Sensory Cranial nerve 10% of each nerve
47. Motor system Disability – Hemi paresis
Neurological Involvement Mild Impairment
Mild 25%
Moderate 50%
Severe 75%
Sensory System Disability
Anesthesia Hypoaesthetia : Up to 10% for each limb depending
upon % of loss of sensation
Paraesthetia: Loss of sensation upto 30% depending
Hands/feet sensory loss : upon % loss sensation
48. Bladder disability due to neurogenic
involvement
Bladder involvement Physical
impairment
Mild (Hesitancy/Frequency) 25%
Moderate(precipitancy) 50%
Severe (occasional but recurrent incontinence)
75%
Very Severe(Retention/total incontinence) 100%
49. Post head injury Fits & Convulsions
Frequency/severity of convulsions Physical
impairment
Mild-occurrence of one convulsion only Nil
Moderate 1-5 convulsions/month on adequate medication.
25%
Severe 6-10 convulsions/month on adequate medication
50%.
Very severe more than 10fits/mth on adequate medication
75%.
50. Ataxia (Sensory or Cerebellar)
Severity of Ataxia Physical Impairment
Mild (detected on examination) 25%
Moderate 50%
Severe 75%
Very severe 100%
51. Guidelines for Evaluation of Physical Impairment in
(A) Burns of Head and Neck, Trunk and Genitalia (B)
Facial Injuries
(A) TEN-POINT FORMULA FOR EVALUATING POST-
BURN DISFIGUREMENTS AND DEFORMITIES OF HEAD
AND NECK
Head & Neck As a Unit 100 Points Distribution amongst
Equatable Components
52. SR. NO COMPONENT POINTS
1. Scalp & Vault Including Fore head 10
2. Eye Brows Rt. & Lt. (5 + 5) 10
3. Eye Lids – Rt. Upper 6 Lf.
Upper 6
Lower 4 Lower
4
20
4. Pinna Right
Left
10
10
5. Nose 10
6. Lips Upper 5
Lower 5
10
7. Cheek & Lateral Area of Face Right 5
Left 5
10
8. Neck 10
53. Trunk and Genitalia Total
Points 100
SR. NO REGION MALE FEMALE
1 Front of the trunk
& abdomen
excluding breasts
5 10
2 Breast 10 40
3 Total Back 10 5
4 Groins 10 10
5 Buttock 5 5
6 Genitalia 60 30
54. (B) FACIAL INJURIES
Head and Neck as a Unit 100 points
SR. NO COMPONENT POINTS
1 Scalp and Vault including
forehead
10
2 Eye Brows Rt. & Lt. (5 +5) 10
3 Eye Lids –Rt. Upper 6
Lower 4
Lt. Upper 6 Lower
4
20
4 Pinna Right 10
Left 10
20
5 Nose 10
6 Middle and lower third of
face
(excluding nose & pinna)
30
55. Guidelines for Evaluation of Physical Impairment due
to Cardio Pulmonary Diseases
• Modified New York Heart Association subjective
classification should be utilized to assess the functional
disability.
•The physician should be alert to the fact that patients who
come for disability claims are likely to exaggerate their
symptom. In case of any doubt patients should be referred
for detail physiological evaluation.
•Disability evaluation of cardiopulmonary patients should be
done after full medical, surgical and rehabilitative treatment
available, because most of these diseases are potentially
treat able.
•Assessment of cardiopulmonary impairment should also be
done in diseases which might have associated
cardiopulmonary problems, e.g. amputees, myopathies etc.
56. Group 0 : A patient with cardiopulmonary disease who is
asymptomatic (i.e. has no symptoms of breath-lessness,
palpitation, fatigue or chest pain).
Group 1 : A patient with cardio-pulmonary disease who
becomes symptomatic during his ordinary physical activity
but has mild restriction (25%) of his ordinary physical
activities.
Group 2 : A patient with cardiopulmonary disease who
becomes symptomatic during his ordinary physical activity
and has 25-50% restriction of his ordinary physical
activity.
Group 3 : A patient with cardiopulmonary disease who
becomes symptomatic during less than ordinary physical
activity so that his ordinary physical activities are 50-75%
restricted.
57. Group 4 : A patient with cardiopulmonary disease who is
symptomatic even at rest or on mildest exertion so that his
ordinary physical activities are severely or completely
restricted (75-100%).
Group 5 : A patient with cardiopulmonary disease who gets
intermittent symptoms at rest (i.e. patients with bronchial
asthma, paroxysmal nocturnal dyspnoea etc.).
58. References
Kumar R. Assessment and Certification. Guidelines and
Gazette Notification. National Institute for the
Orthopedically Handicapped.
Manual for Doctors to Evaluate Permanent Physical
Impairment. National Seminar on disability Evaluation and
Dissemination. A.I.I.M.S. New Delhi 1991.
The ACC User Handbook to the AMA “ Guides to the
Evaluation of Permanent Impairment”. 4th edition. 2010
Guidelines for Other Disabilities. Ministry of Social Justice
and Empowerment. New Delhi, 1st June 2001.
WHO Global Disability Action Plan. 2014-2021. Better
Health for All People With Disability.