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.
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
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
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
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.
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
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
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
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.
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.
این ارائه توسط دکتر خیاط زاده در کارگاه رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه گردیده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه نمایید.
https://www.farvardin-group.com
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
Neurodevelopmental Therapy
Neurodevelopmental treatment (NDT) is a hands-on treatment approach used by physical therapists, occupational therapists, and speech-language pathologists
Without NDT interventions, the patient likely will develop a limited set of movement patterns that he or she will apply to nearly all tasks.
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
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.
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.
این ارائه توسط دکتر خیاط زاده در کارگاه رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه گردیده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه نمایید.
https://www.farvardin-group.com
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
Neurodevelopmental Therapy
Neurodevelopmental treatment (NDT) is a hands-on treatment approach used by physical therapists, occupational therapists, and speech-language pathologists
Without NDT interventions, the patient likely will develop a limited set of movement patterns that he or she will apply to nearly all tasks.
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
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
You will know what a motor control is
What are the theories and clinical implications of motor control
Physiology of motor control
Latest evidence on motor control in a musculoskeletal condition
Understanding the various theories of motor control- reflex-hierarchal theory, ecological theory, dynamic systems theory and it's clinical application; also forming the basis of neurological rehabilitation techniques like Task-orient approach, Constraint induced movement therapy (CIMT), NDT (Neurodevelopmental Facilitation).
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Theoretical Basis-Occupational therapy and strokeYousefBabish2
Includes the basic knowledge for the occupational therapist to implement a very structured intervention, and also includes a brief description of the most effective approaches, interventions, and frame of references. Furthermore, the document shows many aspects of the intervention and the stroke effects has on functionality and the human being itself.
Theoretical framework of infant physiotherapyAnwesh Pradhan
MPT class- Theoretical framework of infant physiotherapy. Require 3 class. Help us to decide the paediatric physiotherapy approach for paediatric patient.
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.
www.farvardin-group.com
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 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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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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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 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
این پاورپوینت در کارگاه مداخلات ادراکی حرکتی در کودکان با فلج مغزی توسط دکتر جانمحمدی ارائه شده است.
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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.
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این فایل متنی توسط دکتر میثم محمدی در کارگاه تخصصی آگاهی، توجه، عصب شناسی و توانبخشی ارائه شده است.
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این پاورپوینت در کارگاه تخصصی توانبخشی شناختی در اختلالات یادگیری توسط دکتر هاشم فرهنگ دوست ارائه شده است.
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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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More from Farvardin Neuro-Cognitive Training Group (20)
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
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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
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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
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
2. NDT Definition
• NDT is a holistic and interdisciplinary clinical practice model informed by current
and evolving research that emphasizes individualized therapeutic handling based
on movement analysis for habilitation and rehabilitation of individuals with
neurological pathophysiology.
• The therapist uses the ICF model in a problem-solving approach to assess activity
and participation, thereby to identify and prioritize relevant integrities and
impairments as a basis for establishing achievable outcomes with clients and
caregivers.
Tehran CP Workshop, May 2017 2
3. NDT Subsystems
• An in-depth knowledge of the human movement
system, including the understanding of typical and atypical development,
and expertise in analyzing postural control, movement, activity, and
participation (ICF) throughout the life span, form the basis for examination,
evaluation, and intervention.
• Therapeutic handling, used during evaluation and
intervention, consists of a dynamic reciprocal interaction between the client
and therapist for activating optimal sensorimotor processing, task
performance, and skill acquisition to enable participation in meaningful
activities
Tehran CP Workshop, May 2017 3
7. Motor Control Approach
• Neuromaturational Theories
1. Reflex/Hierarchical Theory
2. Generalized Motor Program Theory
• Dynamic System Theory
• Neuronal Group Selection Theory
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8. Reflex/Hierarchical Theory
• This theory assumed that the structures of the brain were organized
and developed in a hierarchy and that there was a fixed relationship
between function and structure.
• Each successively higher level of brain structures provided more
precise movement integration. Therefore, as these structures
developed, function changed accordingly.
Tehran CP Workshop, May 2017 8
9. Reflex/Hierarchical Theory
• The lowest level of fundamental movement
patterns were sensory-elicited reflexes,
which were then integrated into the
automatic postural reflex mechanism as the
higher brain levels developed.
• These automatic movements, including
righting and equilibrium reactions, were
considered to be the basis for skilled
voluntary movements.
Tehran CP Workshop, May 2017
9
10. Reflex/Hierarchical Theory
• The R/HTs helped to explain the stereotypic movements and postures
seen in persons with neuropathology.
• These were acceptable neural control models until the late 1960s and,
although they did offer explanations for predictable movement seen in
cerebral palsy (CP), their limitation was that they did not account for
context-based movement, variability, individuality, novelty, and context-
based behaviors.
Tehran CP Workshop, May 2017 10
11. Generalized Motor Programs (GMPs)
• Instruction are specified by the CNS
• Control process is managed by a motor program
• Motor program organizes, initiates, and carries out intended actions
• Linear changes in movement behavior
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12. Generalized Motor Programs (GMPs)
• Keele proposed the existence of a set of commands in the CNS named
Generalized Motor Programs (GMPs) , which were assembled and initiated
without sensory input and performed in the absence of peripheral
feedback.
• GMPs contain the abstract representation of movement, including the
commands for movement, codes of action, and general features of
movement sequences as well as the recruitment of appropriate agonists
and synergists with adjustment of antagonists of peripheral feedback.
Tehran CP Workshop, May 2017 12
13. Generalized Motor Programs (GMPs)
• There could be basic motor plans for reaching and grasping and
rhythmic movements for walking or speaking that are assembled
prior to the need to move.
• Simple sequences could then be linked together to produce complex
actions, such as walking down a slope or singing.
• The richness of the GMPs developed from both experience and
learning.
Tehran CP Workshop, May 2017 13
14. GMPs and CPGs
• GMPs renewed the interest in the
concept of Central Pattern
Generators (CPGs)
• Neural networks in the spinal cord
capable of producing rhythmic
movement even when isolated from
the brain and sensory systems.
• There was increasing evidence that
specialized neural circuits do exist in
the brain stem of vertebrates for
breathing, chewing, and swallowing,
and in the spinal cord for locomotive
functions.
Tehran CP Workshop, May 2017 14
15. Body Weight Support Treadmill Training
• Partial body-weight-bearing (PBWB)
gait training is one intervention that
gains support from CPGs.
Tehran CP Workshop, May 2017 15
16. Dynamic System Theory
• Movement is produced from the interaction of multiple sub systems
within the person, Task, and environment.
• No sub system is most important
• Dynamic system(DS) is complex
• Development is in a non-linear rate, not steady
• A movement pattern emerges (self-organizes) as a function of the ever-
changing constraints placed upon it.
Tehran CP Workshop, May 2017 16
17. Self organization
• This theory deemphasizes instructions or neural selectivity to achieve
coordinated actions and instead looks for explanations based on physical
parameters.
• Change occurs because one control parameter(Speed, Direction, force),
or variable, reaches a critical value, which causes a change in the entire
system.
• For example, change in velocity regulates a change from walking to
running. Change in the slope alters step frequency and step length in
young children.
Tehran CP Workshop, May 2017 17
18. What is a constraint?
• They limit the Movement
possibilities (degrees of
freedom) of the individual
1. Biomechanical and
anthropometric properties of
the body system : body shape,
weight, height, emotional, cognitive, etc.
2. Environmental: gravity, temperature,
light, wind, etc
3. Task constraints: rules of the game, goal
of the task, and the object or tools (i.e.
size, shape, weight) manipulated.
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19. Attractor States
• We prefer states to be stable. This state or stability is known as attractor
state or what we presently prefer.
• When a change in constraints occur, the stability of the system is
endanger!
• In time, the movement pattern will reorganize and the new one will begin
to take over and stability is regained.
Tehran CP Workshop, May 2017 19
20. Application in NDT
• The clinicians can identify constraints that limit functional change
and develop intervention strategies which directly target these
constraints.
• For example, in early infancy, the mass of the child’s head relative
to the size of the rest of the body places constraints on, or limits,
the rate at which head lifting and visual following can occur.
• Delays in independent sitting constrain the foundations for manual
development, mother–infant face to face interactions, and
reaching behavior by 6-month-old infants.
• In adults with CP, moderate weakness, increased muscle tone,
bone and joint deformities, and progressive asymmetry in posture
are independently responsible for limitations in independent ADL.
Tehran CP Workshop, May 2017 20
21. Gravity as a major constraints in
Motor Function
• Introduction of BWST and Anti Gravity
Treadmill
• Reduce gravity’s impact by selecting any
weight between 20% and 100% of your
body weight
Tehran CP Workshop, May 2017 21
22. Transitions or phase shift
• Specific motor skills emerge from a series of states of stability, instability,
and phase shifts in which new states become stable aspects of behavior.
• During development, as the subsystems of developing systems change,
motor behaviors can either become more stable or destabilize. These
periods of destabilization are referred to as transition states.
• During these times, new forms of movement are most likely to occur.
These transitions are characterized either by an increased latency in
time to return to a stable state after perturbation, or by increased
variability in behavior.
Tehran CP Workshop, May 2017 22
23. Problems of phase shift in CP
• People with neuropathology with limited repertoires of movements
may lack variability, and destabilizing these limited patterns is
difficult.
• The person continually tries to use the limited repertoires in all
situations, and transitions from one state to another are increasingly
difficult. The result is movement that is stereotyped and rigid
Tehran CP Workshop, May 2017 23
24. Application in NDT
• The intervention is most effective during periods characterized by
high degrees of variability. These are often the periods during new
experiences (and new environments)
• NDT recognizes that these periods of transition are the times that
intervention can promote and direct efficient motor patterns as the
client is working out new functional movements in increasingly
complex contexts.
Tehran CP Workshop, May 2017 24
25. Application in NDT
• As a child with hemiplegia experiences a normal growth spurt at age
2, he may appear clumsy, fall more frequently, stand with more of his
weight on the less involved side, or even walk without placing the
heel (on the more involved side) on the ground during the stance
phase.
• This is a time to increase the intensity of intervention to take
advantage of the variability in gait and balance
Tehran CP Workshop, May 2017 25
26. Neuronal Group Selection Theory
• When hundreds of thousands of strongly interconnected neuronal circuits
act as structural/ functional units, called neuronal groups, they increase their
effectiveness.
• Neural structures are determined by the competition among neural
elements to assure variation(Diversity) in neuroanatomical structures.
• Primary motor repertoires are movements characterized by variability and
are not connected to either sensory inputs(feedback) or function.
• These connected neuronal groups initially develop by genetic encoding
(Evolution).
Tehran CP Workshop, May 2017 26
27. Primary Neuronal Repertoires
• Orienting the head and eyes to light and sound.
• Orienting the head to clear the airway when prone.
• Coordinating suck and swallow.
• Bringing the mouth to the hand.
• Following moving objects with the eyes.
• Projecting the arm toward objects.
• Reciprocal kicking.
• Sensory elicited reactions and responses (sometimes referred to as
primitive reflexes, such as head and body righting, palmar grasp, rooting
reaction, Moro reflex).
• General motility.
• Attachment to the human face
Tehran CP Workshop, May 2017 27
28. PNR and NDT
• NDT therapists use a problem-solving approach to plan intervention
strategies that are flexible enough to accommodate the differences of each
individual client.
• Selective competition supports the hypothesis that variability of
movement.
• Primary Variability is part of a primary repertoire, and it is important to
allow clients to select their own way to organize motor responses.
• Intervention includes assisting the client to organize movement repertoires
in relevant contextes
Tehran CP Workshop, May 2017 28
29. Secondary Neuronal Repertoires
• If PNR are reinforced by a supportive environment, people in it, and the
infant’s success in fulfilling his or her needs, they lead to an even richer,
purposeful secondary repertoire of responses.
• The brain instantaneously “selects” the response that adapts to external
conditions and that is the most fit for each individual person.
• SNR is developed based on experience-dependent selection of the most
effective neuronal networks.
• The infant organizes postural control as an essential element of all
movement repertoires.
• Secondary repertoires link sensory features to specific motor behaviors.
• Children with mild to moderate forms of CP develop SNR, but at a slower
pace and in a reduced form
Tehran CP Workshop, May 2017 29
30. Change the PNR to SNR
• Transition occurs at function-specific ages
• All changes are not just changes in synaptic formation and neural circuitry.
• The development of secondary repertoires also depends on changes in the
musculoskeletal system, perception, experience, and a gradual change in
agility, adaptability, and the ability to make complex movement sequences.
• The development of successful reaching and grasping emerges during the
first 4 months, changing from movements that are variable in path, speed,
and accuracy, to reaching movements with mature kinematics involving
fewer movement units
Tehran CP Workshop, May 2017 30
32. NDT and SNR
• NDT intervention strategies provide very specific sensory input that grades
the intensity, rhythm, and duration of somatosensory, visual, and auditory
inputs while allowing the client to attend to specific aspects of the task.
• NDT intervention recognizes that repetition is an important component in
motor learning. Motor activities that are task specific and repeated
throughout a session with variability and are included in a home program
have a better chance of becoming part of the client’s favored functional
repertoire.
Tehran CP Workshop, May 2017 32
33. Forming and Connecting Global Maps
•The continual selection of neuronal groups during
development and through repeated selection binds
neuronal groups together to form neuronal maps.
• When maps are repeatedly selected to produce meaningful
behavior, they form global maps.
•Essential to the development of global maps is sufficient
experience with slightly different tasks to permit the
neuronal maps to respond differently to various objects and
events in the environment.( secondary variability)
Tehran CP Workshop, May 2017 33
34. DS versus NGS
• Like the theory of NGS, the theory of DS maintains that interactions
among the elements of a system give rise to patterns without
instructions or without a controller.
• Both theories propose that individuals who explore a variety of
possible solutions to motor problems will increase their movement
repertoires, have greater success, and have an easier time meeting
the demands of tasks in their daily lives.
Tehran CP Workshop, May 2017 34
35. DS versus NGS
• In DS the neural substrate plays a subordinate role than
environment whereas in NGS, development is the
result of a complex intertwining of information from
genes and environment.
•A central issue for DS is that, although movement
possibilities (or degrees of freedom) may be constrained
by any of the body systems, they are primarily
constrained by the biomechanical and anthropometric
properties of the musculoskeletal system.
• The variation in NGS is not random, but determined by
criteria set by genetic information
Tehran CP Workshop, May 2017 35
36. NDT effectiveness
Evans-Rogers et al reported on outcomes of short-term
intensive NDT intervention based on parental perspectives
and functional outcomes
Girolami and Campbell reported on the efficacy of NDT
treatment for infants born prematurely and found
improved motor control
Arndt et al report on the effectiveness in an NDT based
trunk protocol in infants.
Tsorlakis et al showed the effectiveness of NDT and
underline the need for intensive application of the
treatment.
Tehran CP Workshop, May 2017 36
37. COPCA (Coping with and Caring for infants with
special needs - a family centered program)
• COPCA has educational and motor goals.
• Learn 2 move 0-2 and learn 2 move 2-3
• Components:
1. A family involvement and educational component as coaching
2. A NDT based on the principles of the Neuronal Group Selection
Theory
• Its effectiveness has been showed (Hielkema et al 2010, Ketelaar
et al 2010)
Tehran CP Workshop, May 2017 37
38. NDT Critics
• Butler et al(2001)
More intensive therapy did not seem to confer a greater benefit
There was also no clear evidence that NDT produced other
potential benefits such as enhancement of social–emotional,
language, or cognitive domains of development, better home
environments, improved parent–child interactions, or greater
parent satisfaction
There was not consistent evidence that NDT changed abnormal
motoric responses, slowed or prevented contractures, or that it
facilitated more normal motor development or functional motor
activities
Tehran CP Workshop, May 2017 38
39. NDT Critics
• Diane L. Damiano(2009)
1. Therapies that involve multiple types of exercises, such as NDT are an
issue from a scientific standpoint because they each have multiple
components that are likely to have varying degrees of evidence. These
programs should be dissected so that the active ingredients can be
identified and retained if
superior to other alternatives and ineffective ones discarded.
2. The fact that NDT has failed to demonstrate superiority over any
alternative treatments to which they have been compared is also a
concern
Tehran CP Workshop, May 2017 39
40. NDT Critics
• Novak et al(2013)
1. regarding contracture, high-quality RCTs showed
that casting was a superior treatment to NDT
2. regarding tone reduction, the highest quality
evidence suggested that NDT was ineffective for this
indication and other evidence shows BTX exists as a
highly effective alternative
3. NDT is time-consuming and expensive for families,
and, what is more, a high-quality RCT shows that
substantially better functional motor gains are
achieved from motor learning than from NDT at
equal doses
Tehran CP Workshop, May 2017 40