This is a presentation of the results of the Care of Ataxia Patients (COAP) study, given by Dr Gavin Daker-White at the COAP study day in Manchester on 18 November 2011. It gives the views of neurophysiotherapists and patients with ataxia about the care of people with ataxia in the Greater Manchester region.
This presentation from Wendy Hendrie looks at how health professionals can help people with MS cope with ataxia. It was presented at the MS Trust Annual Conference in November 2013.
Ataxia Physiotherapy Presentation - COAP study dayAtaxia UK
This is a presentation given by Anita Watson, Lecturer in Physiotherapy, at the Care of Ataxia Patients (COAP) study day on 18 November 2011 in Manchester. It is an overview of physiotherapy treatment options for people with ataxia.
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This presentation by Dr Lisa Bunn looks at the practical management of ataxia and balance impairment among people with MS. It includes information on assessing ataxia, the rehabilitation of balance, and relevant research studies.
It was presented at the MS Trust Annual Conference in November 2013.
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An alternative description of my Critically Appraised Topic on Neurodevelopmental treatment when used on children with cerebral palsy. This presentation focuses more on the process of the research.
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
This presentation from Wendy Hendrie looks at how health professionals can help people with MS cope with ataxia. It was presented at the MS Trust Annual Conference in November 2013.
Ataxia Physiotherapy Presentation - COAP study dayAtaxia UK
This is a presentation given by Anita Watson, Lecturer in Physiotherapy, at the Care of Ataxia Patients (COAP) study day on 18 November 2011 in Manchester. It is an overview of physiotherapy treatment options for people with ataxia.
Practical management of ataxia and balance impairment: Part 2MS Trust
This presentation by Dr Lisa Bunn looks at the practical management of ataxia and balance impairment among people with MS. It includes information on assessing ataxia, the rehabilitation of balance, and relevant research studies.
It was presented at the MS Trust Annual Conference in November 2013.
Neurodevelopmental Treatment and Cerebral Palsy- Researchda5884
An alternative description of my Critically Appraised Topic on Neurodevelopmental treatment when used on children with cerebral palsy. This presentation focuses more on the process of the research.
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
Children with cerebral palsy can be given good functional improvement with the combination of advance therapeutic modality & measure to control spasticity . Earlier, we use to focus on child deformity & functional deficit but now literature are coming in the favor of change in environment and task oriented therapy .For getting best outcome we should not hesitate in using best combination of therapeutic modality. Treatment protocol should be based on detail assessment. Results are always good if we use combination of child focus therapy as well context therapy program .
The ICU team created a standard “Progressive Early Mobility Program” for their patients. The expectation was set - this would be the norm for all appropriate patients.
Any kind of physical activity is great and helps keep your body functioning well, but a recent study showed that there’s even a specific kind of exercise to aid with balance: Tai Chi.
Children with cerebral palsy can be given good functional improvement with the combination of advance therapeutic modality & measure to control spasticity . Earlier, we use to focus on child deformity & functional deficit but now literature are coming in the favor of change in environment and task oriented therapy .For getting best outcome we should not hesitate in using best combination of therapeutic modality. Treatment protocol should be based on detail assessment. Results are always good if we use combination of child focus therapy as well context therapy program .
The ICU team created a standard “Progressive Early Mobility Program” for their patients. The expectation was set - this would be the norm for all appropriate patients.
Any kind of physical activity is great and helps keep your body functioning well, but a recent study showed that there’s even a specific kind of exercise to aid with balance: Tai Chi.
Management of Progressive Ataxia - Dr John EalingAtaxia UK
This presentation was given by Dr John Ealing, Consultant neurologist at Salford Royal NHS Foundation Trust, at the Care of Ataxia Patients (COAP) Study Day in Manchester on 18 November 2011. It summarises the symptoms and management of the progressive ataxias and briefly outlines specific therapies.
For what basis is neuropsychiatry a developing field?SanityPharma
Furthermore, it is also applied to clinical cases with no known biological reason by the current neurological indications. We are at a time in science where the association between the body and psychological well-being is owned and progressively proof-based.
April 11, 2018
With growing neuroscientific research on sports concussions, states have revised their policies and statutes. Yet at present we have limited research on how these state sports concussion laws are working. This panel explored the intersection of neuroscience and law in the context of preventing, detecting, and treating youth sports concussions.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/how-to-fix-youth-sports-concussion-laws
The presentation was directed towards Saskatchewan family physicians on exercise prescription for mental health and osteoarthritis in the primary care setting.
Dr Catherine Hayle - Regional ELC - Complex decision making Innovation Agency
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Recent studies demonstrate the effectiveness of understanding how and why pain is generated, and why it sometimes persists long after it protective effect has passed. We have combined an educational program with mindfulness exercises and skills training to help individuals develop their own recovery plan
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This presentation by Professor Adrian Edwards and Dr Freya Davies from the Institute of Primary Care and Public Health at Cardiff University looks at the experiences of patients, carers and clinicians at the stage of transition to SPMS.
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http://www.polioconference.com/Power%20points.php
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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.
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
- 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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
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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
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.
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Presentation of COAP study results
1. Views of neuro physios and
people with ataxia about
Physiotherapy in progressive
ataxia
Gavin Daker-White1, Caroline Sanders1, Katherine
Payne1, Julie Greenfield2, Helen Kingston3, Krystle
Kontoh4, and John Ealing5
1 University of Manchester; 2 Ataxia UK; 3 Clinical
Genetics, CMFT; 4 Genetic Alliance; 5 Neurology, SRFT
2. Summary
• Aims of this presentation
• Background – The Care of Ataxia Patients Study
• Overview of preliminary results from COAP
• The views of neuro physios derived from
qualitative interviews
Methods / Sample
The main problems faced by people with ataxia
What can or can‟t be done?
Expectations and outcomes
Other issues
• The views of patients
3. caveat emptor
The focus of this presentation is on the views and
experiences of individual neurological physiotherapists
who have worked with people with ataxia
The purpose of this presentation is not to recommend
particular treatments. The findings of this study cannot
be used to suggest „what works.‟ That would require
properly validated studies of patient outcomes
There is a lack of evidence in this field (more about that
in Anita Watson‟s session this afternoon)
4. Components of the COAP study
• Qualitative interviews with 38 people with ataxia in
Northwest England
• Qualitative interviews with 25 health professionals,
including 8 neurological physiotherapists and 10
consultant neurologists
• A national survey of health professionals (in
progress)
• A health economics study of NHS resource use by
people with ataxia
• An examination of care pathways in ataxia as
compared with Ataxia UK‟s „best practice‟ guidelines
5. Patient Interviews: main themes
• The problems with an ataxia diagnosis (rare,
untreatable) especially when „idiopathic‟ =
Prognostic uncertainties
• The stigma of appearing or sounding drunk
• Although physiotherapy / physiotherapists were
mentioned in some of these interviews, this was
not a focus of the discussions
• There was a wide variability in terms of who had
seen a physiotherapist and whether
physiotherapy was viewed as helpful or not
6. Neurologist interviews: main themes
• The diagnostic pathway
• Involvement usually ends following the
diagnosis process (but not in ataxia specialists)
• The costs and yield of different diagnostic tests
• Different levels of diagnosis – definitive versus
„black box‟ diagnosis of ataxia
• Physiotherapy was commonly viewed as one of
the few management options available for
patients, although a minority of neurologists
were sceptical that anything could be done
7. The views of Neuro Physios
“I‟m a physiotherapist. I don‟t cure people. I help
them deal with the situation they‟re in”
(P3: 12: 233-234)
8. Methods - Recruitment
• Initially unsolicited recruitment emails were
sent to physiotherapy departments, neuro-rehab
units & community neuro-rehab teams
• Only 2 interviewees were recruited by this route
• Further invitations were sent out via Ataxia UK
to NW-based professional members. Others
were recruited by word of mouth.
9. The sample
• 2 x academic physiotherapists, research active in
neuro-physio
• 1 x specialist neuro physio based in an NHS
outpatient physiotherapy department
• 1 x specialist neuro physio, private practice
• 2 x physiotherapists working in community
neuro-rehab teams
• 1 x physiotherapist working in an in-patient
neuro-rehab unit (non-stroke)
• 1 x physiotherapist working in a private inpatient
unit (brain injury)
10. The interview schedule
• Can you tell me about your role and what
experience you have had in looking after people
with ataxia?
• What are the main problems faced by people
with ataxia?
• What treatments and/or management options
are you able to offer people with ataxia?
• Can you give examples (without personal
identifiers) of what you do for patients with
ataxia
11. Results – Experience of working
with people with a progressive
ataxia
• Those in in-patient settings had little experience:
one had seen one person with a progressive
ataxia (FA) in 11 years; one had not seen any
progressive ataxia cases, but had seen a patient
with a cerebellar tumour
• Others most commonly reported seeing “one or
two” people with progressive ataxia per year
12. “Quite a lot of people are sort of, a bit scared of
seeing ataxic patients, they‟re not quite sure
what to do with them”. . . “I think, oh God, I
can‟t make a difference here.”
(P2: 10: 169-181 & 13: 205-206)
13. The main problems faced by
people with progressive ataxia
• Safety / Falls
• “Postural control and coordination problems”
(P2: 27: 406-427)
• Weakness in core muscles (P5: 22: 362-364)
• Problems with core stability and locus of control
(P3:20: 458-459)
• Compensatory strategies: “They‟ll really overuse
a lot of their peripheral superficial muscles to
stop themselves shaking” (P2: 16: 246-253)
14. • “Their reference points are lost. So . . . their feed-
forward and feed-backwards mechanisms coming from
[the] cerebellum have been interrupted.” (P3: 7: 121-
132)
• “When you get a diagnosis like that and you‟re told
there‟s no cure, what are you going to do? Sit in a chair?
And then what about all the other parts of your nervous
system that then just get disused?” (P3: 31: 842-845)
• Many physiotherapists talked about needing to know
what the underlying problems are for each individual
patient. For example, if fatigue is a central part of their
pathology, vigorous exercise is going to make it worse
(in P1: 23: 200-213)
15. What can’t be done?
• People with „pure‟ cerebellar syndromes were
characterised as a hard to treat group. They were often
contrasted with those with ataxia as a result of stroke or
MS, who were seen as easier to treat
• “I've got a hand full of patients where no matter what
we do . . . the ataxia doesn't change. And it's often . . .
something that gets worse the more they think about it,
and the more they're being watched and the more
they're being analysed as well. So we do have to take
that into account when we're treating and assessing
patients. If they're put under pressure to perform, the
ataxia sometimes [gets worse].” (P2: 14: 205-212)
16. • “As a physio [you] need to see results. If they are
not improving then there‟s nothing you can do
for them . . . I‟ve seen him three or four times
and I‟m thinking, well, you‟re not reporting any
improvements or any changes in the treatment,
so I have to, I have to question what I am
achieving here” (P4: 9: 242-256 & 19: 633-636).
• “It‟s really hard to measure improvement” (P5:
10: 162)
17. What can be done?
• “My job is to improve their quality of life” (P3: 27: 725-
728; P4: 5: 125-134)
• Preventing deterioration (P7: 9: 563-584)
• “It‟s about stopping them sliding down the hill . . . and
putting the brakes on as much as we possibly can, but
unfortunately that‟s not sexy at the moment” (P3: 35:
948-951)
• “If they really limit their activities because they‟re really
worried about falling over, then they‟re going to get the
associated muscle weakness that you‟d get with inactivity
so in that sense to me there might be some potential for
people to improve.” (P5: 12: 170-174)
18. Goal setting with the patient
• “It‟s about getting the patients to take ownership
for their problems” rather than about “what you
do to the patient” (P4: 13: 292-316, extracts)
• “So if I see a patient I‟ll say, „Right what are your
goals; what are your expectations for physio?‟ If
they say to me, „I want to walk normally,‟ I say,
„Well that‟s not a very realistic goal. So what are
your main problems?‟ „I want to be able to walk to
the car.‟ Okay. So looking at the patient and . . .
decide well is that a reasonable goal or not? (P4:
18: 617-628)
19. “I may be the only sort of, health professional
they have any contact with, so for that reason I try
not to lose them . . . To be honest, with some
patients it does turn into more of a counselling
session, it's not always hands on, I'm just
somebody sat here that can listen to them. I may
not have any answers, but we can talk through,
and then I can give some advice, make
recommendations, and make referrals onto other
[services]. Sometimes that can be just as much
benefit as me actually doing hands on treatment.”
(P2: 27: 406-427)
20. Patient Expectations
“ „Oh I don‟t really know why I‟ve been referred to you
because there‟s nothing that anyone can do‟ . . . And I
said, „Well hang on a minute, why don‟t we have a go?‟
. . . And then in the end she agreed to do some physio
and started to improve and got some benefits and
absolutely loved it . . . So she was really enthusiastic
despite having been told no there is nothing that can be
done about it. But on the other hand if patients are told,
„Yes you‟ve got this condition. I can‟t help you, but the
physio might be able to improve things,‟ and they may
well come to us with completely unrealistic
expectations.” (P5: 19: 312-324)
21. Specific therapies mentioned
• Resistance work to address core stability
• Weight bearing exercises to increase stability
• „Real world‟ exercises (e.g. in shops, supermarkets)
• Counting strategies: cognitive override to make the
movement smoother
• “Explore the wobble” – learn to “unfix”
• Pilates exercises – core stability
• “Getting them in the water” (but safety concerns)
• Bilateral walking poles (note not available on NHS)
22. Outcomes
• “This particular problem may not get better and it‟s
working with them to try and help them deal with it
better.” (P2: 24: 345-350)
• Linked to whether patients follow advice or not
• “I suppose the ideal outcome is that they have a period
of stability after they‟ve been seen by [the] service . . .
So, I‟d want to know that they felt reasonably safe when
we discharge them . . . I‟d want to know that they were
coping and that they weren‟t having to kind of work to
their maximum just to get through the day to do all the
tedious menial things that everybody has to do.” (P5: 31:
774-804)
23. Measuring Outcomes
• “The lady that I had some improvement with I
measured her, how long she could stand without
holding on for, so I timed it . . . And that told me
that she‟d improved.”
• Validated measures?
24. Patient views of physiotherapy
• Physiotherapy was only mentioned in 21 / 38
(55%) interviews with people with ataxia
• Of the 15/21 (71%) who expressed an opinion
about physiotherapy in relation to their ataxia,
9/15 (60%) were positive or felt it had helped,
whereas 6/15 (40%) were critical or expressed
negative opinions
26. ‘Neutral’ views?
• “The physiotherapist . . . a long time ago, said there
was nothing they could do” (Pa10: 10: 140-145)
• “I‟m trying to get help with physiotherapy for years
and years” (Pa11: 15: 300-319)
• “Nobody has ever told me” physiotherapy might
help – only just found out (Pa2: 54: 973-981)
• No time to do physio exercises, but still in
demanding work and walks “miles” every day
(Pa14: 23 & 30)
• 2 patients were waiting to see a physio at the time
of interview
27. Negative views
• Physiotherapy did not help / make a difference
(3 patients)
• Critical of short course of treatment / exercise
sheet model (3 patients):
“Basically I‟ve just got to carry on doing what I
do. The more I can do for myself the more I can
keep mobile” (Pa36: 24: 538-650)
28. Positive views
• “The physio has been absolutely wonderful”
(Pa5: 26: 319-332)
• “The most positive thing for me is the
physiotherapy” (Pa12: 62: 1022-1029)
• “The improvement with the physio is untold”
(Pa13: 8: 258-279)
• “The occupational and physiotherapist and the
speech therapist . . . Is the most help I‟ve had”
(Pa18: 11: 77-79) (Similar in Pa19: 593-634)
• “I have an absolutely fantastic physio” [only
patient to be seen continually for years] (Pa22:
33: 222-270)
29. Conclusions for practice
• The difficulties in recruiting professionals might
suggest that some people with progressive ataxia
face difficulties accessing services. This was also
reflected in the small number of patients who
were not aware physiotherapy may have role
• Managing patient expectations and goals seems
to be of fundamental importance
• Giving information, advice and support may be
as important as „hands on‟ physiotherapy
30. Conclusions for research
• This study tells us very little about what happens
to patients when they progress to the extent that
they need full-time care
• Given that ataxia is an „umbrella‟ term,
measuring and developing appropriate validated
outcome measures appears challenging,
especially given the small numbers of patients
• We will have a fuller picture of what
physiotherapists do in progressive ataxia when
we analyze the results of our national survey (c.
200 respondents)
31. This presentation presents independent research
commissioned by the National Institute for
Health Research (NIHR) under its Research for
Patient Benefit (RfPB) Programme (Grant
Reference Number PB-PG-0807-13181).
The views expressed are those of the author(s)
and not necessarily those of the NHS, the NIHR
or the Department of Health.