Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
Adhesive capsulitis case presentation physiotherapymanisha thakur
Satisfactory presentation on adhesive capsulitis because of satisfactory results in 2 weeks.
Can do these exercises to increase range
Muscle strength and overall well being.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
Adhesive capsulitis case presentation physiotherapymanisha thakur
Satisfactory presentation on adhesive capsulitis because of satisfactory results in 2 weeks.
Can do these exercises to increase range
Muscle strength and overall well being.
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.
Tilt table is a padded table that can be elevated from horizontal position to vertical position. It is used in a therapeutic setting for physiological accommodation to upright position, facilitate early weight bearing, cardiovascular conditioning etc.
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.
Tilt table is a padded table that can be elevated from horizontal position to vertical position. It is used in a therapeutic setting for physiological accommodation to upright position, facilitate early weight bearing, cardiovascular conditioning etc.
Abstract
A total of 50 procedures were performed, 25 patients were treated using SpineView decompressor and 25 patients by Nucleoplasty using the Arthrocare Coblation technology. The total population had leg pain (sciatica), 30 of which had low back pain (discogenic pain) . Mean age of patients was 30 – 60 years. The mean follow-up period was 1 year. Follow up was done weekly for the first 2 months then monthly for the first year post-procedure according to Visual Analogue Scale , Urs Muller et.al.(2008) as well as featured neurological examination.
Analgesic consumption was stopped or reduced in 9 of the 15 patients with sciatica and low back pain treated with SpineView decompressor (60%) at 2 months (66%) 4months after the procedure, and in 9 of the 15 patients with sciatica and low back pain treated by Nucleoplasty using the Arthrocare Coblation technology (60%) at 2 months (66%) 4months after the procedure.
The patients who had sciatica only has shown reduction in analgesic consumption in 9 of the 10 patients who were treated with SpineView decompressor (90%) at 2 months, and in 2 of the 10 patients who were treated by Nucleoplasty using the Arthrocare Coblation technology (20%) at 2 months.
Our results encourage us to use SpineView decompressor in carefully selected patients with sciatica and small contained disc protrusion . Also we find that applying Nucleoplasty using the Arthrocare Coblation technology in those patients with low back pain and small contained disc protrusion can give satisfactory results. These results need further efforts and researches in order to be general recommendations.
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
Case of Prolapse intervertebral Disc, lumbar disc prolapse, case, physiotherapy management, Assessment, recent Advance, orthopaedic case presentation, musculoskeletal physiotherapy case presentation, orthopaedic physiotherapy, case of a low back pain patient, lumbar radiculopathy, final year,
Meniscal injuries and physiotherapy managementSyed Adil
meniscal tear
Anatomy
Types of meniscal tear
Etiology
Clinical features including (special tests)
Differential diagnosis
Management for partial meniscal tear and full meniscal tear, meniscectomy
Recent advance
for meniscal tears
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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.
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
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.
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!
1. THE EFFECTIVENESS OF ROUTINE PHYSIOTHERAPY WITH
AND WITHOUT NEUROMOBILIZATION ON PAIN AND
FUNCTIONAL DISABILITY IN PATIENTS WITH SHOULDER
IMPINGEMENT SYNDROME: A RANDOMIZED CONTROL TRIAL
JOURNAL :- BMC Musculoskeletal disorders
AUTHORS : - Muhammad Akhtar, et. Al
Registered : 2019 Published : 2020
2. CRITICAL REVIEW-
TITLE AND ABSTRACT – 1a, 1b
TITLE
• Is the title of the article appropriate and clear? Yes
• Is the type of study mentioned? Yes
ABSTRACT
Structured summary of trial design
Overview about the methods, results and conclusions
3. PICOT format
• Population - Mentioned
• Intervention - Mentioned
• Comparison - Mentioned
• Outcome - Mentioned
• Time – Not Mentioned
4. INTRODUCTION-2a, 2b
• The shoulder impingement syndrome (SIS) consists of the rotator cuff
tendonitis and bursitis of the shoulder It shows the inflammation of the
supraspinatus tendon inside the anteroinferior junction of the acromion
and the greater tuberosity of the humerus.
• Patients with SIS report severe acute pain which increases during
overhead activities as well as sleeping on affected side
5. • The execution of specific components of body movements to generate
particular mechanical incident in the neural system is called NM.
• Mechanical management may therefore be used to augment
physiology in the nervous system
• The use of NM has the potential to lessen the perception of pain.
• The movement of the nervous system during NM may restore
axoplasm flow, restoring nutrients to the nerves.
6. • Matocha MA et al. highlighted neural involvement in patients with tendon
pain and discussed the role of NM for tendon pain [9]. The utilization of
neurodynamics may be important for the treatment purposes in patients
who suffer with tendonopathies which has neural component
7. AIM
• The objective of the study was to compare the effects of NM techniques
and routine physiotherapy on pain and functional disability in patients
having SIS.
9. BLINDING : - Single blinded
• An independent assessor, who specialized in musculoskeletal injuries
with more than 5 year experience of dealing patients with shoulder
injury, had performed allocation of patients.
RANDOMIZATION
• Computer generator method
10. INTERVENTIONS- 5
• Routine physiotherapy was performed on both groups while NM was
done on experimental group.
• Patients were treated thrice a week on alternative days.
11. ROUTINE PHYSIOTHERAPY
• Pulsed Short Wave Diathermy (SWD) with frequency 27.12 MHZ,
• Ultrasonic Therapy (US) with frequency 1.0 MHZ and intensity
1.45w/cm2
• Transcutaneous Electrical Nerve Stimulator (TENS) 2–200 HZ with
output current < 20 Ma width 200 μ seconds along with continuous mode.
• Exercises were comprised of shoulder strengthing and stretching exercises
that were performed for 5s with 10 repetitions for both groups.
12.
13. NEUROMOBILIZATION
• NM was applied by using Butler’s recommendations Initially, the patient
performed neural sliders and gradually progressed to neural tensioners.
• Neural sliders consisted of cervical lateral flexion movement, toward the involved
side, simultaneously with elbow flexion and extension movements. While moving
the head in to cervical lateral flexion the elbow was extended. When the elbow
began to flex, the cervical spine was returned to neutral position as shown in Figs.
1 and 2.
14.
15. • Neural tensioners were performed to create tension in the nerve to get the
desired results.
• The tension position was not held for a length of time, but is released by
extending the elbow and returning the cervical spine to neutral. Once the
patient had pushed slight pain or discomfort at any point as shown in Figs.
3 and 4 [20].
• NM technique was performed for 5 s with 10 repetitions to control the
pain and improve the functional disability score to relive the pain shown
in Table
16.
17. OUTCOME MEASURES- 6a
• VAS ( r = 0.94)
• UCLA Shoulder scale – (University of California and Los Angeles
shoulder score)
( r = 0.78 )
18.
19. INCLUSION CRITERIA
• Positive upper limb tension test
• Neer test
• Hawkins Kennedy
• Empty Can
• Painful arc
• Cross body adduction test
21. STATISTICALANALYSIS- 12a, 12b
• Data were analyzed by using (SPSS Version 22.0) software.
• Repeated measure ANOVA was applied to compare average pain score
as primary outcome while average UCLA score as a secondary
outcome at different time points (baseline, 5th week, 11th week).
• The confidence level of 95% was used as well as p value ≤0.05 was
considered as significant.
27. DISCUSSION
• Different neuromuscular responses (like hypoalgesia,, afferent
discharge and changes in the mobility of muscle) associated with
neuromobilization indirectly indicates the spinal cord mediated effect of
the NM.
• Neuromobilization had an quick hypoalgesic effect on C-fibre mediated
pain perception, as not on A-delta fibre mediated pain perception
28. • Another reason of more improvement of function in the experimental
group may be shown the restoration of mobility due to the
biomechanical effects which are inter-linked with NM
• Physiologically we may explain that a nerve which closely passes to a
joint is mostly kept in a tunnel or it is attached with collagen fibres or
fascia to the nearby musculoskeletal components.
29. • Nerves move side by side within the upper limb hence the
neuromobilization given during management cause break of the cross
linkages.
• The possible effect of stretch on axons is the improved ion flux in
stretch sensitive ion channels.
30. CONCLUSION
• On the basis of results it is concluded that addition of NM with routine
physiotherapy has greater improvement to reduce pain severity and
disability in SIS patients than without NM.
31. IMPACT FACTOR
• The impact score 2021 of BMC Musculoskeletal Disorders is 2.53
• h-index of 104.
35. REFERENCES
• Gebremariam L, Hay EM, van der Sande R, Rinkel WD, Koes BW, Huisstede BM.
Subacromial impingement syndrome—effectiveness of physiotherapy and manual
therapy. Br J Sports Med. 2014;48(16):1202–8.
• Koh E-K, Jung D-Y. Effects of modified cross-body stretching on range of motion in
Glenohumeral joint. J Korean Soc Phys Med. 2015;10(4):1–7.
• Neer CN. Impingement lesions. Clin Orthop. 1983;173(70):7.
• Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific
tendinitis of the shoulder. Arthroscopy. 1992;8(2):183–8.
• Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific
tendinitis of the shoulder. Arthroscopy. 1992;8(2):183–8.
36. • Shacklock M. Clinical neurodynamics: a new system of musculoskeletal
treatment: Elsevier Health Sciences; London. 2005.
• Kaux J-F, Forthomme B, Le Goff C, Crielaard J-M, Croisier J-L. Current opinions
on tendinopathy. J Sports Sci Med. 2011;10(2):238.
• Rees J, Wilson A, Wolman R. Current concepts in the management of tendon
disorders. Rheumatology. 2006;45(5):508–21.
• Siechen S, Yang S, Chiba A, Saif T. Mechanical tension contributes to clustering
of neurotransmitter vesicles at presynaptic terminals. Proc Natl Acad Sci.
2009;106(31):12611–6.
• Matocha MA, Baker RT, Nasypany AM, Seegmiller JG. Effects of
neuromobilization on tendinopathy: Part I. Int J Athletic Ther Train. 2015;
20(2):36–40.
• Cook J, Purdam CR. Is tendon pathology a continuum? A pathology model to
explain the clinical presentation of load-induced tendinopathy. Br J Sports Med.
2009;43(6):409–16.
37. CROSS REFERENCES
• Akalin E, El O, Peker O, et al. Treatment of carpal tunnel syndrome with nerve
and tendon gliding exercises. Am J Phys Med Rehabil. 2002;81:108- 113.
• Butler DS, Jones MA. Mobilisation of the Nervous System. London, UK:
Churchill Livingstone; 1991.