The document discusses various facilitation and inhibition techniques used in physical therapy, outlining the theoretical basis, principles, receptors involved, differences between the techniques, guidelines for application, and clinical implications. It provides detailed descriptions of numerous proprioceptive and cutaneous facilitation techniques including quick stretch, tapping, joint compression, as well as inhibitory techniques like maintained stretch and cooling. The techniques aim to normalize muscle tone and facilitate or inhibit motor responses depending on a patient's needs.
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.
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.
Role of various systems to maintain balance.
Role of sensory systems-vision,proprioceptors,vestibular
Role of Musculoskeletal system
Biomechanics in balance
Contextual factors in balance
Role of nervous system
Strategies-ankle, hip,stepping
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
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.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
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
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
The TUG test (Timed Up and Go) to predict falls riskJames Brinton
Timed Up and Go (TUG) Test is a timed test of standing and walking that is a predictor of falls risk.
It is s gait-speed test used to assess a person's mobility and requires both static and dynamic balance.
It is very simple to perform, involves very little equipment and takes very little time. The results is a predictor of falls risk.
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
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
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.
Important structures associated with neural control of locomotion- CPGs, Peripheral receptors and afferents, Basal ganglia, Cerebellum, Brainstem, Cerebellar Cortex.
Introduced by Geoffrey Douglas Maitland - in 1950’s
He was born in Australia in 1924, trained as a physiotherapist from 1946 to 1949
Pioneer of musculoskeletal physiotherapy
Emphasized on:
Specific way of thinking
A total commitment to the patient
Continuous evaluation and assessment
Art of manipulative physiotherapy
The discipline of Motor Control is the study of human movement and the systems that control it under normal and pathological conditions.
Depends upon -
Environmental result of the movement (Outcome)
Movement pattern
Neuromotor processes underlying movement
Physiotherapy management of spasticity using diffrent modalities as well as manual techniques is described along with possible dosage ijn clinical use is also menstined.
Role of various systems to maintain balance.
Role of sensory systems-vision,proprioceptors,vestibular
Role of Musculoskeletal system
Biomechanics in balance
Contextual factors in balance
Role of nervous system
Strategies-ankle, hip,stepping
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
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.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
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
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
The TUG test (Timed Up and Go) to predict falls riskJames Brinton
Timed Up and Go (TUG) Test is a timed test of standing and walking that is a predictor of falls risk.
It is s gait-speed test used to assess a person's mobility and requires both static and dynamic balance.
It is very simple to perform, involves very little equipment and takes very little time. The results is a predictor of falls risk.
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
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
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.
Important structures associated with neural control of locomotion- CPGs, Peripheral receptors and afferents, Basal ganglia, Cerebellum, Brainstem, Cerebellar Cortex.
Introduced by Geoffrey Douglas Maitland - in 1950’s
He was born in Australia in 1924, trained as a physiotherapist from 1946 to 1949
Pioneer of musculoskeletal physiotherapy
Emphasized on:
Specific way of thinking
A total commitment to the patient
Continuous evaluation and assessment
Art of manipulative physiotherapy
The discipline of Motor Control is the study of human movement and the systems that control it under normal and pathological conditions.
Depends upon -
Environmental result of the movement (Outcome)
Movement pattern
Neuromotor processes underlying movement
Physiotherapy management of spasticity using diffrent modalities as well as manual techniques is described along with possible dosage ijn clinical use is also menstined.
This is a technical book and directory of clinical massage techniques applicable for debilities and neuro muscular conditions. It covers conventional therapies, and new techniques in sensory therapy, embryology, special sense therapies and therapeutic exercise.
Physical medicine and rehabilitation (PM&R) is a relatively young specialty that developed during the 20th century, with signifi cant growth and development stimulated by
two World Wars and by increasingly severe epidemics of
paralytic poliomyelitis during the fi rst half of the 20th century
(1–4). During and after each of the World Wars, many soldiers returned with serious injuries and severe disabilities, and physicians and therapists were needed to treat and manage their chronic disabling conditions. This was particularly true after World War II, when the availability of antibiotics and improved surgical techniques allowed more injured soldiers to survive, albeit with significant
disabilities. Similarly, over the same time period, increasingly
severe epidemics of polio, frequent industrial accidents,
and escalating motor vehicle accidents as a result of
the increased availability of automobiles and higher-speed
roadways added greatly to the burden of impairment and
disability among the civilian population. Thus, events in the
fi rst half of the 20th century necessitated the development
of new restorative treatment programs incorporating new
physical and rehabilitative techniques, and the establishment
of training programs for physicians and therapists to
administer the treatments.
Nevertheless, with the exception of a relatively few scattered physical medicine physicians, it was not until the second half of the 20th century that specialists in rehabilitation medicine could profi tably direct their energies exclusively, or even preferentially, to rehabilitation outside of the unprecedented and unsustainable circumstances of wartime
military programs. Also largely missing until the second half
of the 20th century were separate departments in academic and nonacademic medical centers devoted to the specialty, established training programs in PM&R, a sufficient number of PM&R practitioners, separate dedicated facilities for
provision of rehabilitation services (e.g., dedicated wards in hospitals or separate rehabilitation centers), forums for the interchange of ideas (e.g., texts, journals, and professional societies), recognition by professional colleagues and the
public that rehabilitation medicine specialists provided a
needed service, and supportive legislation that would provide
fi nancial mechanisms to develop and provide such
resources
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
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
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
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
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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. INTRODUCTION
It is of great challenge for physical therapist to select methods
most efficient for each patient's needs.
Following aspects needs considerations:
• The neuro-physiological basis of each method.
• The biomechanical influencing.
• The nature of pathology and symptoms affecting the patient's
activity.
• The individual characters of each patient.
2
3. DEFINITION
O’Sullivan S & Schmitz T (2007). Physical rehabilitation (5th ed). Philadelphia,
F. A. Davis Company.
The term neuromuscular facilitation refers to the facilitation, activation and
inhibition of muscle contraction and motor responses.
FACILITATION TECHNIQUES:
• It refers to the enhanced capacity to initiate a movement response through
increased neuronal activity and altered synaptic potential.
• The stimulus applied may lower the synaptic threshold of the alpha motor
neuron but may not be sufficient to produce an observable movement
response.
• It helps to normalize the muscle tone from flaccid state.
(On the other hand activation refers to the actual production of a movement
response and implies reaching a critical threshold level for neuronal firing.)
3
4. DEFINITION
INHIBITION TECHNIQUES:
• It refers to the decreased capacity to initiate a movement response
through altered synaptic potential.
• The synaptic potential is raised, making it more difficult for the neuron
to fire and produce movement.
• To normalize the muscle tone from hypertonic or spastic state.
( The combination of spinal and supraspinal inputs acting on the alpha
motor neuron (final common pathway) will determine whether a muscle
response is facilitated, activated or inhibited.)
4
5. THEORETICAL BASIS
Roods approach-As a therapeutic technique presented originally by Margaret
Rood to facilitate and inhibit movement responses.
Reflex Theory
• The basic unit of motor control are reflexes
• Reflexes purposeful movement.
• Damage to the CNS results to re-emergence of and inability to control the
reflexes.
5
6. THEORETICAL BASIS
Hierarchical Theory
• Motor control is hierarchically arranged
• CNS structures involved with movement can be grouped into HIGHER,
MIDDLE, and LOWER levels.
• Higher centers regulate and control the middle and lower centers.
• Damage to the CNS results to disruption of the normal coordinated function of
these levels.
6
7. PRINCIPLE OF TECHNIQUES
RECIPROCAL INHIBITION
• Aka innervation, mobility
• Phasic or quick type of movement
• Contraction of the agonist while antagonist relaxes
• Serves a protective function
CO-CONTRACTION
• Aka co-innervation, stability
• Tonic or static type of movement
• Simultaneous contraction of the agonist and antagonist
• Foundation for postural control
7
8. PRINCIPLE OF TECHNIQUES
HEAVY WORK
• Aka mobility superimposed on stability
• Proximal muscles contract and move while distal segments are
fixed
SKILL
• Aka mobility and stability
• Proximal segments are stabilized while distal segments move
8
9. PRINCIPLE OF TECHNIQUES
• A fast, brief stimulus produces a large synchronous movement. F
• A fast, repetitive stimulus produces a maintained response. A
• Slow, rhythmical, repetitive sensory input deactivates the body. I
9
10. DIFFERENCE
FACILITATION
• Provide sensation of normal
movement
• Provide system for relearning
normal movement
• Stimulates muscles to
contract(flaccid or weak muscles)
• Allow for practice of movements
• Teach ways to incorporate involved
side into functional tasks
INHIBITION
• Decrease abnormal muscle
tone(spasticity)
• Restore normal alignment
• Do not allow abnormal
movements(associated reactions)
• Teach methods to decrease
abnormal postures during
functional tasks.
10
11. GENERAL GUIDELINES TO BE
CONSIDERED
• Facilitative techniques (additive). Example, several inputs applied
simultaneously, such as a quick stretch, resistance and verbal cues, are
commonly combined during practice of a PNF.(SPATIAL
SUMMATION)
• Repeated stimuli (e.g. tapping) may also produce the desired motor
response owing to TEMPORAL SUMMATION.
11
12. GENERAL GUIDELINES TO BE
CONSIDERED
• Sensory receptors based on adaptation: Slow- and Fast- adapting.
• Fast- adapting, phasic receptors such as touch receptors and phasic 1a
muscle spindle endings are effective initiating and shaping dynamic
movements.
• Slow- adapting, tonic receptors such as joint receptors, GTOs, and
static 2 muscle spindle endings are effective in monitoring and
regulating postural responses.
12
13. GENERAL GUIDELINES TO BE
CONSIDERED
• The intensity, duration and frequency of stimulation need to be
adjusted to meet individual patients needs.
• Unpredicted responses = Inappropriate application of techniques. For
example, stretch applied to a spastic muscle may increase spasticity
and negatively affect voluntary movement.
• Facilitation techniques are not appropriate for patients who
demonstrate adequate voluntary control.
13
29. CUTANEOUS FACILITATION
LIGHT MOVING TOUCH
• Receptor: Rapidly adapting tactile receptors, autonomic nervous system (sympathetic division).
• Stimulus: Brief, light contact to skin.
• Response: Increased arousal, withdrawal response
• Effective in initiating a generalized movement response, to elicit arousal, contraindicated to
agitated patients or when ANS is unstable.
• Low threshold response, accommodates rapidly.
• Can be used to initially mobilize patients with low response levels(eg., the patients with TBI who
is minimally responsive).
R-TS, Jung JH, Jang SH, Kim KH, Jung KS, Cho HY. Effects of Light Touch on Balance in Patients
with Stroke. Open Med (Wars). 2019;14:259-263. Published 2019 Apr 9. doi:10.1515/med-2019-
0021
Findings indicate that light touch could be beneficial in postural control for individuals with hemi-
paretic stroke.
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31. CUTANEOUS FACILITATION
FAST BRUSHING (receptors: tactile receptors, ANS sympathetic division)
• Application can be manually or by using battery-operated brush.
• Skin overlying muscle can facilitate it and enhances static holding postural
extensors and will have immediate and long latency responses.
• Used to facilitate inhibited muscles below the skin.
• Anterior primary rami: excitatory effect is local and mainly to superficial
muscles.
• Posterior primary rami: effect is excitatory for deep back muscles.
• The area to be brushed is very specific to dermatomes and myotomes.
• Brush for at least 3 seconds , and wait for response until 20-30 minutes, where
nerve pathways are not active due to disuse or inhibition.
• Positive effect on H-reflex.
31
33. THERMAL FACILITATION- BRIEF
ICING
• A ICING (FAST ICING): stimulates A fibers causing reflex withdrawal response in superficial
muscles. Patients with hypotonia, muscles are in state of relaxation causes alertness in them.
• C ICING: stimulates non-specific C fibers that maintain postural response.
• Applied according to dermatomes.
• Contraindications: avoid to patients with h/o cardiovascular problems.
• Do not apply over the neck, it will cause low BP.
• Ice applied over lips and tongue facilitates sucking, swallowing and speech.
R-Abd El-Maksoud GM, Sharaf MA, Rezk-Allah SS. Efficacy of cold therapy on spasticity and hand
function in children with cerebral palsy. Journal of Advanced Research. 2011 Oct 1;2(4):319-25.
It can be concluded that cold therapy in conjunction with conventional physical and occupational
therapy significantly reduced spasticity, increased ROM and improved hand function in children with
spastic CP.
33
35. PROPRIOCEPTIVE FACILITATION
HEAVY JOINT COMPRESSION
• Joint awareness will improve by joint compression which will enhance motor control.
• Receptors in joints and muscles are involved in awareness of joint position and movement
which are stimulated by joint compression.
• Compression of the joint surfaces facilitates posture extensors which are needed to
stabilize the body. Compression greater than that applied by body weight is thought to
facilitate co-contraction at the joint.
• The application may be manually and/or by using weight bearing postures.
R-Poole JL, Whitney SL. Inflatable pressure splints (airsplints) as adjunct treatment for
individuals with strokes. Physical & Occupational Therapy In Geriatrics. 1993 Jan
1;11(1):17-27.
Paper concludes that splints have been effectively used to reduce tone, facilitate muscle
activity around a joint, increase sensory input, control edema, and reduce pain.
35
37. PROPRIOCEPTIVE FACILITATION
QUICK STRETCH
• Receptor: muscle spindle endings, detecting length and velocity changes.
• Stimulus: quick stretch or tapping over muscle belly or tendon.
• Response: activates agonist(intrafusal & extrafusal) to contract-stretch reflex,
reciprocal innervation effect will inhibit the antagonist; activates synergists.
• Optimally applied in the lengthened range. A low-threshold response, relatively
short-lived, can add resistance to maintain contraction.
R-Bovend'Eerdt TJ, Newman M, Barker K, Dawes H, Minelli C, Wade DT. The
effects of stretching in spasticity: a systematic review. Arch Phys Med Rehabil. 2008
Jul;89(7):1395-406. doi: 10.1016/j.apmr.2008.02.015. Epub 2008 Jun 13. PMID:
18534551.
There is a wide diversity in studies investigating the effects of stretching on
spasticity, and the available evidence on its clinical benefit is overall inconclusive.
37
39. PROPRIOCEPTIVE FACILITATION
INTRINSIC STRETCH
• Activates the proprioceptors in selected muscles and imply the
principle of reciprocal innervation.
• It promotes stability of the scapulohumeral region, bearing more
weight on the ulnar side of the hands and promoting resistive grasp.
• Joint compression to elbow with stretch to wrist extensors in
quadruped position.
39
41. PROPRIOCEPTIVE FACILITATION
SECONDARY ENDING STRETCH
• Combination of resistance and stretch to facilitate developmental
patterns. Once a muscle is put on a full stretch, secondary nerve
endings which is facilitatory to the flexors and inhibitory to the
extensors.
41
42. PROPRIOCEPTIVE FACILITATION
STRETCH PRESSURE
• Mechanical stresses in contracting muscles in terms of stretch and
pressure led to activation of glucose metabolism and protein synthesis.
Hence causes muscular hypertrophy.
• Here comes the combine role of GTO(muscle tension and contraction)
and muscle spindles.(change in length of muscle fibers)
42
44. PROPRIOCEPTIVE FACILITATION
RESISTANCE
• Receptors: muscle spindles
• Stimulus: resistance given manually or with body weight or gravity or
mechanical weights
• Response: enhances muscle contraction through recruitment;
facilitates synergists, enhances kinesthetic awareness
• Resistance needs to be graded dependent on the patient response and
goal; additional recruitment and overflow may be counterproductive to
movement goal.
44
46. PROPRIOCEPTIVE FACILITATION
TAPPING
• Stimulus: repeated quick stretch over tendon or muscle belly
• Response: activates agonist(intrafusal & extrafusal) to contract-stretch
reflex
• Tapping over muscle belly produces a weaker response than over the
tendon.
• Tapping over a muscle is used to enhance holding in a weight bearing
position.
46
48. PROPRIOCEPTIVE FACILITATION
VESTIBULAR STIMULATION(FAST)
• Receptor: semicircular canals in ears
• Stimulus: fast or irregular movement with acceleration and deceleration
component, such as spinning, use of a scooter board, fast rolling
• Response: facilitates general muscle tone and promotes postural responses to
movement
• Useful for patients with hypotonia (CP, downs syndrome); used to promote
sensory integration. Also in patients with sensory integrative
dysfunction(hyperactive child ADHD); patients with bradykinesia (PD).
R-Lena Schmidt et al (2013). Galvanic Vestibular Stimulation Improves Arm
Position Sense in Spatial Neglect : A Sham-Stimulation-Controlled Study.
Neurorehabil Neural Repair published online 11 February 2013 DOI:
10.1177/1545968312474117
48
50. PROPRIOCEPTIVE FACILITATION
THERAPEUTIC VIBRATION
• High frequency: 100 to 300 cycles/second
• Low frequency: 50 to 60 cycles/second
• Uses:
HF is used to elicit tonic vibration reflex which stimulates contraction of agonist muscle if applied
directly over the muscle belly. Inhibits the contraction of antagonist muscle and suppress stretch
reflex.
LF is inhibitory and suppress pain perception, desensitize hypersensitive skin.
R-Murillo N, Valls-Sole J, Vidal J, Opisso E, Medina J, Kumru H. Focal vibration in
neurorehabilitation. Eur J Phys Rehabil Med. 2014 Apr;50(2):231-42. PMID: 24842220.
This review aimed to describe the effects of focal vibratory stimuli in neurorehabilitation including
the neurological diseases or disorders like stroke, spinal cord injury, multiple sclerosis, Parkinson's'
disease and dystonia.In conclusion, focal vibration stimulation is well tolerated, effective and easy to
use, and it could be used to reduce spasticity, to promote motor activity and motor learning within a
functional activity, even in gait training, independent from etiology of neurological pathology.
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53. PROPRIOCEPTIVE FACILITATION
JOINT APPROXIMATION
• Receptors: Joint receptors
• Stimulus: compression of joint surfaces, using manual pressure or
position/gravity; weighted vest or belt.
• Response: facilitates postural extensors and stabilizing responses (co-
contraction); enhances joint awareness (joint receptors)
• Approximation applied to top of shoulders or pelvis in upright weight-
bearing positions facilitates postural extensors and stability (eg.,
sitting, kneeling, or standing).
• Used in PNF extensor extremity patterns, pushing actions.
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58. NEURAL WARMTH
• Receptors: thermo receptors, ANS(parasympathetic division)
• Stimulus: retention of body heat through body wraps (towel, snug-
fitting clothing gloves, socks, tights); air splints(warm)
• Response: Provides general relaxation and inhibition; decreased
muscle tone; decreased agitation or pain.
• Use for 10-15 mins; avoid overheating; appropriate for highly agitated
patients or individuals with increased sympathetic response.
58
60. GENTLE SHAKING OR ROCKING
• Rhythmical circumduction of the head and slight approximation is
given can also be used in the UE & LE.
• Provides inhibition/relaxation of muscles and painful muscle spasm.
• Decreases metabolic rate of the tissues.
60
61. SLOW STROKING
• Stimulus: applied to midline back
• Response: calming effect, generalized inhibition, decreased fight or
flight responses
• Performed with patients in prone or in supported sitting (head and
arms resting on table top).
• Can use massage, lubricant; stroke on either side of the spine; applied
for 3-5 minutes.
• May be contraindicated with very hairy surface.
61
63. SLOW ROLLING
• Patient is rolled slowly from a side lying position to prone and back in
a rhythmical pattern; use on both sides of the body.
• Causes calming effect and generalized inhibition/relaxation.
63
64. MAINTAINED TENDINOUS PRESSURE
• Receptors: slowly adapting tactile receptors, ANS (parasympathetic division)
• Stimulus: manual pressure applied to the tendon insertion of a muscles; can be used in spastic or
tight muscles.
• Response: calming effect, generalized inhibition, decreased fight or flight responses, desensitize
skin.
• Useful with patients with agitation and high arousal (eg., patients with TBI).
• Can be combined with other relaxation techniques (deep breathing imagery, quiet environment).
• Also useful for patients with hypersensitivity (eg., patients with tactile defensiveness).
R-Kukulka CG, Beckman SM, Holte JB, Hoppenworth PK. Effects of intermittent tendon pressure
on alpha motoneuron excitability. Physical therapy. 1986 Jul 1;66(7):1091-4.
Results suggest that a maintained reduction in muscle tone might be induced through intermittent
tendon pressure.
64
66. LIGHT JOINT COMPRESSION
• Light joint compression inhibits muscle control or relax muscle
spasticity.
66
67. MAINTAINED STRETCH
• Receptor: muscle spindle endings and GTO
• Stimulus: maintained stretch in a lengthened range
• Response: dampens muscle contraction
• Rationale for serial casting and splinting to increase the effect,
activates the antagonist.
67
69. ROCKING IN DEVELOPMENTAL
POSITION
• Stimulus: Shifting the weight forward and backward, progressing to
side to side then diagonal patterns.
• Response: calming effect and generalized relaxation.
69
70. PROLONGED ICING/COOLING
• Stimulus: immersion in cold water, ice wraps, ice massage, cooling
suit
• Response: decrease neural and muscle spindle firing. Provides
inhibition of muscles and painful muscle spasm. Decreases metabolic
rate of tissues.
• Monitor effects carefully: can produce sympathetic arousal,
withdrawal or fight-or-flight responses.
• Contraindicated in patients with sensory deficits, generalized arousal,
autonomic instability and vascular problems.
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72. POSITIONING
• Patients should be given individualized positioning and early
mobilization management plans as soon as possible after a
neurological impairment to prevent complications and to regain
function.
• It is based on reducing the effects of gravity on alpha motor neuron
and consequently inhibiting muscle tone.
R-Keating M et al (2012) Positioning and early mobilisation in stroke.
Nursing Times; 108: 47, 16-18.
Positioning and early mobilization strategies 24 hours a day, reducing
the risk of complications and improving functional recovery.
72
74. TECHNIQUES OF PNF
• Resistance
• Irradiation and reinforcement
• Manual contact
• Body position and body mechanics
• Verbal (commands)
• Vision
• Traction or approximation
• Stretch
• Timing
• Patterns
74
78. REFERENCES
1. O’Sullivan S & Schmitz T (2007). Physical rehabilitation (5th ed). Philadelphia, F. A. Davis Company.
2. Levitt S (2004). Treatment of cerebral palsy and motor delay (4th ed). Singapore, McGraw-Hill Inc.
3. Pedretti LW & Early MB (Eds) (2006). Occupational therapy: Practice skills for physical dysfunction (6th ed). St. Louis, Mosby-
Year Book, Inc.
4. Tecklin JS (1999). Pediatric physical therapy (3rd ed). Philadelphia, J.B. Lippincott Company.
5. M, Stokes & E, Stack. Physical Management for Neurological Conditions. Edinburgh: Churchill Livingstone, 2011.
6. Alison Baily Metcalfe, Nigel Lawes. A modern interpretation of the Rood Approach. Physical Therapy Reviews; Vol. 3, Iss. 4,
1998
7. Eisenberg MG. 1995. Dictionary of Rehabilitation. New York: Springer Publishing Company. p. 375
8. Tapping Available from :https://www.youtube.com/watch?time_continue=4&v=4b2UiVTlNLw accessed on 31/05/19.
9. Fast Brushing Heather Watson-Fournier Available from https://www.youtube.com/watch?v=0B23ngwLcGc accessed on
31/05/19.
10. A" Icing Available from https://www.youtube.com/watch?v=nE7HcZqMEgs. Accessed on 31/02/19.
11. Quick Stretch Available from https://www.youtube.com/watch?v=tRlpD_cQtzQ accessed on 31/05/19
12. Heavy Joint Compression Available from https://www.youtube.com/watch?v=2acoY3HAskc. Accessed on 2/6/19
https://www.physio-pedia.com/Neurology_Treatment_Techniques
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