این پاورپوینت در کارگاه ارزیابی و توانبخشی مشکلات راه رفتن در کودکان فلج مغزی توسط دکتر محمد خیاط زاده ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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Waddling gait- definition|role of muscle|gait analysis|kinematic and spatiote...jasna ok
This powerpoint is about WADDLING GAIT,muscle that cause waddling gait , its causes, reasons for why this gait is called duck gait and pregnancy gait, gait analysis , and its physical therapy treatment
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.
Waddling gait- definition|role of muscle|gait analysis|kinematic and spatiote...jasna ok
This powerpoint is about WADDLING GAIT,muscle that cause waddling gait , its causes, reasons for why this gait is called duck gait and pregnancy gait, gait analysis , and its physical therapy treatment
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.
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.
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
This presentation contains detailed knowledge about Down's Syndrome its types, clinical presentation, diagnosis, medical and physio therapeutic management of the condition.
Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Vojta technique is neuromuscular approach deals with all the conditions of CNS and Musculoskeletal system.
Contents :
Introduction
Definition
What is REFLEX LOCOMOTION
Indication
Stimulating Points
Reflex locomotion
Reflex Rolling phase 1
Reflex Rolling phase 2
Reflex creeping
Effects of Vojta technique
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
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
این پاورپوینت در کارگاه ارزیابی و توانبخشی مشکلات راه رفتن در کودکان مبتلا به فلج مغزی توسط دکتر محمد خیاط زاده ماهانی، عضو هیات علمی دانشگاه جندی شاپور اهواز در محل دانشگاه بهزیستی ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت در کارگاه عملی ارزیابی و توانبخشی مشکلات راه رفتن در کودکان فلج مغزی دکتر خیاط زاده ارائه شده است. برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
WWW.FARVARDIN-GROUP.COM
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.
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
This presentation contains detailed knowledge about Down's Syndrome its types, clinical presentation, diagnosis, medical and physio therapeutic management of the condition.
Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Vojta technique is neuromuscular approach deals with all the conditions of CNS and Musculoskeletal system.
Contents :
Introduction
Definition
What is REFLEX LOCOMOTION
Indication
Stimulating Points
Reflex locomotion
Reflex Rolling phase 1
Reflex Rolling phase 2
Reflex creeping
Effects of Vojta technique
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
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
این پاورپوینت در کارگاه ارزیابی و توانبخشی مشکلات راه رفتن در کودکان مبتلا به فلج مغزی توسط دکتر محمد خیاط زاده ماهانی، عضو هیات علمی دانشگاه جندی شاپور اهواز در محل دانشگاه بهزیستی ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت در کارگاه عملی ارزیابی و توانبخشی مشکلات راه رفتن در کودکان فلج مغزی دکتر خیاط زاده ارائه شده است. برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
این پاورپوینت در کارگاه ارزیابی و توانبخشی مشکلات راه رفتن در کودکان مبتلا به فلج مغزی توسط دکتر محمد خیاط زاده ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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Comparison of a strengthening programme to a proprioceptive training in impro...IOSR Journals
Abstract: Strength and proprioception are important to have a stable and functional ankle .Individuals with
ankle injuries are bound to develop a loss of either or both of these during and after the phase of
immobilization. Objectives: 1. To assess the effects of a 4 weeks strengthening programme on dynamic balance
in CAI. 2. To assess the effects of a 4 weeks proprioceptive training on dynamic balance in CAI.3. To compare
the effects of a 4 weeks strengthening programme to a proprioceptive training on dynamic balance in CAI.
Materials and methods: This was an interventional study done amongst athlete students at Deccan Education
Society college campus, Pune during November 2013 to April 2014. Total 27 college students who were known
athletes with chronic ankle instability were selected by convenient sampling. These 27 subjects were randomly
allotted, 13 to the strengthening group and 14 to the proprioceptive group. Dynamic balance was assessed
using the Functional reach test (FRT) prior to the intervention. Maximum three readings were collected and
then an average of the best two was taken while the first was considered as the trial. This was considered as the
pre intervention reading. These subjects then underwent a 4 week programme depending upon the group they
were allotted. Post intervention readings were taken of the FRT scores in the two groups and statistical analysis
was done. Results & Conclusion: Paired andUnpaired t tests were done to compare the Functional reach test
(FRT) scores pre and post in both the strengthening and proprioceptive groups and also the post training FRT
scores between the two groups. The differences in the pre and post FRT scores were found to be extremely
significant in both the groups (p value < 0.0001). However there was no significant difference between the FRT
scores post training between the two groups (p value > 0.0001). The study proves that both the strength training
as well as proprioceptive training are equally effective in improving the dynamic balance in athletes with ankle
instability. They should thus both be given to improve dynamic balance.
Keywords: Strength, Proprioceptive training, chronic ankle instability.
Nikos Malliaropoulos - Rehabilitation of hamstring injuries MuscleTech Network
Nikos Malliaropoulos
Director of the Athletics National Sports Medicine Centre Thessaloniki Greece. Consultant SEM Physician Barts and The London Clinical Senior Lecturer QMUL CSEM.
-
The rehabilitation of Hamstring injuries - Can we be more injury specific?
(6th MuscleTech Network Workshop)
14th October, Barcelona
The effect of instability training on knee joint proprioception and core stre...Fernando Farias
A general 10-week IT program utilizing Swiss balls and body mass as a resistance proved effective for improving knee proprioception as well as trunk flexion and extension strength in previously inactive individuals. The present study demonstrates that the use of body weight as a resis- tance under unstable conditions can provide significant improvements in knee proprioception (for as long as 9 months after training) and trunk strength for the untrained population that should contribute to general health and functionality.
a little dated, about 5 years, but still a great starting point for those interested in performance or rehab of the athlete's lumbar spine, more to come!
این پاورپوینت در اولین کارگاه از سیر تا پیاز اوتیسم توسط دکتر هاشم فرهنگ دوست ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه توانبخشی هوش دکتر میثم محمدی ارائه شده است. برای مشاهده فایلهای بیشتر در این زمینه، به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه توانبخشی هوش دکتر محمدی ارائه شده است.
برای مطالعه موارد بیشتر در این زمینه، لطفا به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت در کارگاه توانبخشی هوش توسط دکتر میثم محمدی ارائه شده است. برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه رویکرد ادراکی حرکتی در کودکان مبتلا به فلج مغزی توسط دکتر ابراهیم پیشیاره ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه رویکرد ادراکی حرکتی در کودکان مبتلا به فلج مغزی توسط دکتر پیشیاره ارائه شده است. برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت توسط دکتر محمد خیاط زاده در کارگاه ارزیابی و توانبخشی مشکلات راه رفتن در کودکان مبتلا به فلج مغزی ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه، لطفا به وب سایت فروردین مراجعه کنید:
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این پاورپوینت در کارگاه مداخلات ادراکی حرکتی در کودکان با فلج مغزی توسط دکتر جانمحمدی ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه معاینات عصبی در توانبخشی کودکان توسط دکتر محمدی ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه معاینات عصبی در توانبخشی کودکان توسط دکتر میثم محمدی ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه کنید.
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این ارائه در کارگاه تخصصی تقلید و آپراکسی سرنخ هایی برای مداخلات مبتنی بر شواهد توسط دکتر هاشم فرهنگ دوست تدریس شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه ارزیابی و توانبخشی کودکان مبتلا به فلج مغزی توسط کاردرمانگر مهدی بیغم ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این فایل متنی توسط دکتر میثم محمدی در کارگاه تخصصی آگاهی، توجه، عصب شناسی و توانبخشی ارائه شده است.
برای مطالعه موارد بیشتر در این زمینه، به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه تخصصی توانبخشی شناختی در اختلالات یادگیری توسط دکتر هاشم فرهنگ دوست ارائه شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه فرمایید.
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این پاورپوینت در کارگاه تخصصی رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه شده است.
برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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این پاورپوینت در کارگاه تخصصی آگاهی، توجه، عصب شناسی و توانبخشی توسط دکتر میثم محمدی، دکترای کاردرمانی تدریس شده است. برای مشاهده مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت توسط دکتر محمدی در کارگاه آگاهی، توجه، عصب شناسی و توانبخشی ارائه شده است.
برای دریافت مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت در کارگاه تخصصی آگاهی، توجه، عصب شناسی و توانبخشی توسط دکتر میثم محمدی ارائه شده است.
برای دریافت مطالب بیشتر، به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت در کارگاه توانبخشی توجه توسط دکتر علیزاده ارائه شده است.
برای دریافت مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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این پاورپوینت توسط دکتر هاشم فرهنگ دوست در کارگاه توانبخشی عملکردهای اجرایی ارائه شده است. برای مشاهده ویدئوهای بیشتر در این زمینه به وب سایت فروردین مراجعه نمایید.
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More from Farvardin Neuro-Cognitive Training Group (20)
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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!
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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1. presented by:
Mohammad Khayatzadeh Mahani
Assistant professor in OT
Ahvaz Jundishapur University of medical sciences
Feb 2018
Tehran
در شده ارائه
فلج بهمبتالکودکاندررفتناهر مشکالتتوانبخشیوارزیابی تخصصیکارگاهمغزی
3. Gait Abnormalities in CP
Focusing on Individual
Strength Training
Deformity Control
Spasticity Management
Balance and Postural Control
Training
Motor Learning
Sensory Regulation
Treadmill Training
Robot-Assisted Gait
Training/ Virtual gait training
Hippotherapy
Aquatic Therapy
Space Suit Therapy
3
4. Gait Abnormalities in CP
Strength Training Program
To participate in a strength training program, the
child must be able to comprehend and to consistently
produce a maximal or near-maximal effort.
Children as young as 3 years of age may be capable of
this, but waiting to augment the program until the
child is age 4 or 5 years is more realistic.
4
5. Gait Abnormalities in CP
Strength Training Program
Even highly functional children with spastic CP are likely to
have considerable weakness in their involved extremities .
If a child has at least some voluntary control in a muscle
group, the capacity for strengthening exists.
In the absence of voluntary control, strength training is more
problematic, but may be facilitated by the use of electrical
stimulation or by strengthening within synergistic movement
patterns.
Most ambulatory children with CP have the capacity to
strengthen their muscles.
Nonambulatory children may also experience improvements
in their ability to use their upper extremities, transfer more
effectively, or engage more actively in recreational and fitness
activities.
5
6. Gait Abnormalities in CP
Strength Training Program
Invasive procedures such as muscle–tendon
lengthening, selective dorsal rhizotomy, intrathecal
baclofen pump implantation, or botulinum toxin
injections may improve muscle length and/or control
so that muscles can then be strengthened more
effectively.
In turn, strength training may serve to augment or
prolong the outcomes of these procedures.
6
7. Gait Abnormalities in CP
Strength Training Effectiveness
Improve motor activity in people
with CP without adverse effects.
Spasticity remained unchanged
Improve LE muscle strength
To develop cardiovascular and
muscular endurance
7
8. Gait Abnormalities in CP
Strength Training Effectiveness
Task-specific strengthening exercise, run
as a group circuit class, resulted in
improved strength and functional
performance that was maintained over
time.
Exercise training improves physical
fitness, participation level, and quality of
life in children with CP
8
9. Gait Abnormalities in CP
Strength Training
Progressive resisted exercise improves
muscle performance & functional
outcomes in CP children.
Closed chain V open chain
use of theraband, theratube, Springs,
weight cuff, Bike, stationary bike,
treadmill
Aerobic
Plyometric
Core stability: Ball, TRX
Circuit Training: treadmill walking,
step-ups, sit-to-stands and leg presses.
9
10. Gait Abnormalities in CP
Strength and Endurance Training
In practical terms, a person should be able to lift a
specified load two to three times before experiencing
fatigue.
An optimal strength training program would be to use high
loads with a low number of repetitions (3 to 8) arranged in
multiple sets with a rest between each set.
To improve muscle endurance, the load does not need to
be high, but repetitions should be greater (8 to 20) before
resting.
As the patient improves, the load and/or the number of
repetitions can be increased depending again on the
therapist’s goal.
If the goal is to try to increase strength, the recommended
frequency of sessions is three times a week.
10
11. Gait Abnormalities in CP
Deformity Control
Manual Stretch
Casting
BTX-A
Orthosis
Surgery (SEMLS)
11
12. Gait Abnormalities in CP
Manual Stretching
No conclusive evidence to definitely state that passive
stretching can increase the range of movement in a joints
It was difficult to judge if the decrease in spasticity was
clinically significant after stretching.
Duration and period of stretching differs from:
40–60s, 3 times for each movement, 1 or 2 times per week
60s, 5 repetitions for each joint, 3 times a day and 5 days a
week
20–60s, 5 repetitions for each joint, 5 days a week
12
13. Gait Abnormalities in CP
Passive Stretching by Tilt-table
Standing in tilt-table for 30 min each time, 3 times per
week for 42 days reported a significant reduction in
resistance during passive plantar flexion of the ankles
after stretching and the effect lasted up to 35 minutes
poststretching.
They did not find any significant changes in gait
patterns as measured by video recording after 30
minutes of stretching on a tilt-table.
13
14. Gait Abnormalities in CP
Deformity Control
(Orthotic Management)
6 hours a day for muscle enlargement
As a general rule the use of KAFOs is not indicated for
children with CP and fixed knee are poorly tolerated.
Anterior Floor Reaction AFOs that prevent dorsiflexion
at the ankle can prevent knee flexion during stance by
realigning the GRF in front of the knee.
Twister orthoses incorporating a flexible torque cable
extending from a waistband to an AFO create active
rotational forces and can alter the foot-progression
angle.
Different kinds of AFO such as Solid, hinged, PLS ,
supramalleolar , and FR AFO are prescribed
14
15. Gait Abnormalities in CP
AFO Effectiveness
Wingstrand et al(2014): 2200 cases
The use of AFO is most frequent at 4–6 years of age in
children with lower levels of gross motor function.
Three quarters of the children treated with AFO attained
the treatment goals.
15
19. Gait Abnormalities in CP 19
Casting
Serial casting in the CP
population has been shown to
improve ROM.( Brouwer 2000)
Novak proposed that Casting is a
good method of contracture
management in UE and LE (2013)
22. Gait Abnormalities in CP
Knee Flex Contracture
Spasticity in hamestrings
Semitendinosus (shorter fiber lengths) the
most contracted muscle
Then semimembranosus and biceps
Relative decreased growth rate of the
length of the muscle fibers
Tend to be worse in children who do no
stand and spend all day sitting in a
wheelchair (GMFCS 4 & 5)
Fixed flexion contracture develop (
contracture of the posterior knee capsule)
Severe contractures , secondary changes
can develop in the knee joint with
flattening of the femoral condyles.
22
23. Gait Abnormalities in CP
Knee Flex Contracture
(Non surgical)
PT/OT: Manual stretching, prolonged stretching
using a tilt table, prolonged stretching using a
sandbag/weight over the distal femur, mechanical
traction, passive range of motion exercises and joint
mobilization
Casting
Spasticity management (Botulinum toxin, SDR)
23
28. Gait Abnormalities in CP
BTX-A
Target muscles in LE
In more severe cases: medial hamstrings and adductors
in less severe cases: hamstrings or calf, or occasionally adductors
and calf
In hemiplegia: 1. calf 2. hamstring
In diplegia: 1. hamstrings 2. calf
In quadriplegia: 1. adductors 2. calf and hamstrings
Repeated exposure to BTX-A can lead to immunoresistance
Novak proposed that BTX-A is a good method of spasticity
management in children with CP(2013)
BTX-A reduces spasticity and improves ambulatory status.(Flett
1999)
28
29. Gait Abnormalities in CP
Balance and Postural
Control Training
Normal balance development
involves three systems: the
vestibular, visual, and
somatosensory.
The apparent integration of the
visual, vestibular, and
somatosensory inputs appears to
occur by 4 to 6 years of age, with
the responses of the 7- to 10-year-
old group being similar to adults.
29
30. Gait Abnormalities in CP
Balance Training
Environments must be structured
and tasks created in both open and
closed situations to allow the
greatest carryover to functional life
skills.
Closed tasks are those whose
characteristics do not change from
one trial to the next; these require
less information processing with
practice.
Open environments require more
attention and information
processing.
30
31. Gait Abnormalities in CP
Balance Training
Lateral sway is helped by training standing on one foot
(counterpoising), and is also developed in cruising
sideways and other activities which promote lateral
weight shift from leg to leg.
Recent studies of treatment to improve balance in
children with spastic and ataxic CP are promising and
include the application of cerebellar transcranial direct
current stimulation (TDCS), in combination with
treadmill training.
32. Gait Abnormalities in CP
Role of AFO in Improvement of
Balance
Three side support AFO
Gait Plate
32
33. Gait Abnormalities in CP
Treatment Program
for all Hemiplegic Gait Patterns
Equal distribution of weight on each foot.
Teach weight shift on to the affected side.
Standing on two weighing scales and help him correct this
as you read the equal weight borne on each scale.
Use a mirror for both you and the child to see that he is in
correct alignment with his weight on both feet.
Use a wide base and then bring both feet together for
standing, then stand with one foot in front of the other.
Correct any deformities, especially of the feet, such as
equinus
Stand on different surfaces, e.g. carpet, sponge rubber,
rough ground
Using video games
33
GaitAbnormalitiesinCP
34. Gait Abnormalities in CP
Treadmill Based Gait Vs Ground
Gait
Spatiotemporal gait variables: increased cadence and
decreased stride length
Change in Joint kinematics
Change in kinetic gait parameters
Narrow treadmill belt
Consistent speed in treadmill
34
35. Gait Abnormalities in CP
Treadmill Gait Training Benefits
Controlling environmental constraints
Reducing physical demand of service providers
Providing a consistent training setup
It can be ideal for a task-oriented training and target-
specific training, such as improvement on cadence, ankle
dorsiflexion, or hip flexion.
The treadmill can be one of the best tools for gait
endurance training.
35
36. Gait Abnormalities in CP
The combination of a
Treadmill and technology
Partial Body Weight Support (
Less fear of falling, non
ambulatory chidren)
Underwater Treadmill
Antigravity Treadmill
Robotic Gait Training
36
37. Gait Abnormalities in CP
Robot-Assisted Gait Training
Intensive, repetitive and task-oriented therapies, such
as robotic-assisted gait training (RAGT), improve
walking function in children with CP.
This therapy is believed to promote motor learning
and influence neuroplasticity.
RAGT has the potential to improve walking speed,
walking endurance, balance and gross motor function
in children with CP.
With the addition of virtual reality (VR) scenarios,
especially game-based VR, this type of training further
offers the patients diversification, fun and challenge
37
38. Gait Abnormalities in CP
Robot-Assisted Gait Training
RAGT was performed using the commercially available
Lokomat.
The legs of the Lokomat are connected to the frame of a
bodyweight support system
38
39. Gait Abnormalities in CP
Hippotherapy
“The use of the movement of a horse as a tool by PT/OT /SLP
to address impairments, functional limitations and disabilities
in patients with neuromusculoskeletal dysfunction.
Hippotherapy is not to be confused with therapeutic riding.
Therapeutic riding is not a formal treatment and focuses on
recreation or riding skills for disabled riders.
39
41. Gait Abnormalities in CP
Hippotherapy
A typical hippotherapy session lasts from 45 minutes to
an hour, two times per week, for at least 10 weeks.
41
42. Gait Abnormalities in CP
Aquatic Therapy
The relief of hypertonus
in the spastic type of CP is
one of the major
advantages of aquatic
therapy.
Buoyancy, viscosity,
turbulence, and
hydrostatic pressure are
properties of water that
can provide assistance or
resistance to a body.
42
43. Gait Abnormalities in CP
Aquatic Therapy
For a gradual increase in
weightbearing activities, the
individual can be
progressively moved to
shallower water, starting in
deep water using flotation
devices.
In addition to providing
weight relief from
gravitational forces, buoyancy
can support movements
43
44. Gait Abnormalities in CP
Aquatic Therapy
Due to its hydrostatic pressure, water is a natural brace to
the trunk and a compression garment for lower extremities.
The viscosity of water acts as resistance to movement,
meaning the faster the motion, the greater the resistance.
Sensory and vestibular issues can also be addressed in an
aquatics environment. Underwater swimming, splashing,
water play, and pouring are examples of sensory exercises.
The vestibular system can be challenged through activities
such as spinning in an innertube, flips underwater, and
diving for rings
44