tag:blogger.com,1999:blog-42266919127451361212024-03-15T03:29:56.591-07:00Physiotherapy RevisionWelcome! This blog is a collection of notes developed throughout a physiotherapy degree. As this was created for personal use, the information presented is to be used only as a guideline. All notes are collated from a variety of sources and all images are independently created. If you are interested in the sources, please visit physioref.blogspot.co.uk for the majority of references. Happy reading!rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.comBlogger68125tag:blogger.com,1999:blog-4226691912745136121.post-21840638581987526132014-05-20T05:25:00.005-07:002014-05-20T05:27:26.125-07:00Hypertonia & Ataxia in MS<div class="WordSection5" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px;">
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<b><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #cc0000;">Management of MS Hypertonia</span><span style="color: #222222;"><o:p></o:p></span></span></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Spasticity<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Reduction of tone must have a clear objective with an achievable functional benefit<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· High tone is often useful for standing and transferring<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Some hypertonia can be changeable in distribution, for example lower limb extensors in standing but flexors in lying<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Where there is a hypertonic muscle, the antagonists are often hypotonic.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Imbalances may need to be corrected to avoid contractures and deformity<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Most common muscle groups are:</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Trunk rotators<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Trunk lateral flexors<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Hip flexors and adductors<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Knee flexors<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Plantarflexors<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Inverters</span></div>
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<b style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18.479999542236328px;"><span style="line-height: 15.179999351501465px;"><span style="color: #e69138;">Types of Ataxia</span></span></b><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Sensory ataxia<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· High stepping gait pattern<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· More reliance on visual or auditory senses<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Information about leg or foot position<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Vestibular ataxia<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Disturbed equilibrium in standing and walking<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Loss of equilibrium reactions<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Wide-based, staggering gait pattern<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Cerebellar ataxia<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Disturbance in the rate, regularity and force of mvt<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Loss of mvt co-ordination<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Dysmetria (overshooting of target)<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Dyssynergia (decomposition of mvt)<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Dysdiadochokinesia<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Inco-ordination of agonist and antagonists<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Loss of continuity of muscle contraction (tremor)<o:p></o:p></span></div>
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<b><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: purple;">Management of MS Ataxia</span><span style="color: #222222;"><o:p></o:p></span></span></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Commonly seen w</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ith spasticity</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Alters the direction and extent of a voluntary mvt<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Impairs the sustained voluntary and reflex muscle contraction necessary for maintaining posture and equilibrium<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Inability to make mvts which require groups of muscles to act together at varying degrees of co-contraction, as required during gait as the single stance phase requires co-contraction in order to support body weight whilst shifting body weight forward<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Walking aids allow the pt to flex at the hips removing the need for co-ordinated change between hip flexion to extension whilst weight bearing on the stance leg<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Can lead to postural abnormality<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Exaggerated lumbar lordosis<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Anterior pelvic tilt<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Hip flexion<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Hyperextensive knees<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Weight shift towards heels<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Clawed toes<o:p></o:p></span></div>
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<b><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">Assessment & Treatment Approached for MS Ataxia</span><span style="color: #222222;"><o:p></o:p></span></span></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Maintaining equilibrium<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Weight bearing and transference<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Increase postural stability<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Control of CoG<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Differing base of support<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Co-ordination of dynamic mvt<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Patterns of mvt<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Enhance smoothness of control<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Progress from simple, fast mvts to complex, slow mvts<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Located in body axis and trunk<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Gross body mvts ie transfers<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Independent head mvt<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Increase control of mvt around the midline<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Mvt of limb girdles in relation to midline (especially rotation)<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Located in limbs<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Voluntary body mvts<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Enhance proximal limb stabilisation<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Co-ordinate activity of agonist and antagonists<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Progress from large to small range mvts<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Reduce requirement of visual guidance</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com43tag:blogger.com,1999:blog-4226691912745136121.post-41686398009387398152014-05-20T05:23:00.005-07:002014-05-20T05:24:13.876-07:00Multiple Sclerosis<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18.479999542236328px; text-indent: 0cm;">Multiple sclerosis (MS) can present from any age, however has peak influence at 25 – 35 years. The course of the illness is unpredictable, and is twice as common in women as in men. The course of the disease ranges from a single transient neurological deficit with full recovery to permanent disability within weeks or onset. Many people remain mobile and can live a near-normal life.</span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">MS is a demyelinating disease that has immune mediated destruction of myelin as the primary pathological finding, with relative sparing of the other elements of the CNS. It has episodes of acute neurological disturbance, affecting non-contiguous (unconnected) parts of the CNS, are separated by periods of remission. The disease can be progressive in nature and initially, recovery following a relapse is normally complete. However some attacks do not recover completely and leave remains of continuing disability.<o:p></o:p></span></div>
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<b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 15.179999351501465px;"><span style="color: #6aa84f;">Classification</span></span><span style="color: #222222;"><o:p></o:p></span></span></b><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Benign MS<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· One or two relapses, separated by some considerable time, allowing full recovery and not resulting in disability<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Relapsing Remitting MS<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Characterised by a course of recurrent discrete relapses, interspersed by periods of remission when recovery is either complete or partial<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Secondary Progressive MS<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Progressive deterioration after relapses and remissions, with or without identifiable relapses where disability increases even when no relapse is apparent<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Primary Progressive MS<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Typified by progressive and cumulative neurological deficit without remission or evident exacerbation<o:p></o:p></span></div>
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<b><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #e69138;">Early Signs & Symptoms</span><span style="color: #222222;"><o:p></o:p></span></span></span></b><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Visual loss<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Double vision<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Weakness<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Numbness<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Imbalance<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Slurred speech<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Nystagmus (rapid involuntary mvts of the eyes)<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Intention tremor<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Trigeminal neuralgia (intermittent stabbing pain in the face)<o:p></o:p></span></div>
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<b style="text-indent: 0cm;"><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #cc0000;">Signs & Symptoms During MS</span></span></span></b><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Fatigue<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Optic atrophy<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Opthalmoplegia, with facial sensory and motor symptoms<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Cerebellar disease causing nystagmus, ataxia and tremor<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Hypertonia<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Spasticity<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Pain<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Tremor<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Weakness<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Brisk reflexes<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Impaired walking ability<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Sphincter disturbances<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Psychiatric and psychological disturbances<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Possibly epilepsy (generally focal)<o:p></o:p></span></div>
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<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18.479999542236328px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px;"></span><span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18.479999542236328px;">Symptoms are exacerbated by heat and cold.</span><br />
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<b><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #3d85c6;">Physiotherapy Interventions</span><span style="color: #222222;"><o:p></o:p></span></span></span></b><br /><b style="color: #222222;"><span style="line-height: 15.179999351501465px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Stretching<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Reduce hypertonia<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Active exercise<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Retraining function<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Muscle strengthening<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Retraining of balance and co-ordination<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Maintaining ROM<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Therapeutic exercises causing fatigue were widely thought to be damaging and the consensus is that moderate exercise is appropriate but that too much, which precipitates fatigue, is too much. Exercises can lead to worsened motor impairments, however leads to significantly less deterioration.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Weight-resisted exercises are deemed inappropriate.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Aerobic exercises aim to increases overall physical activity and cardiovascular effort, prevent general muscular weakness and reduce health risks due to deconditioning and disuse.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Walking aids<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Aims to maintain ambulation<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Need to avoid postural instability and deformity with long term use<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Hydrotherapy<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Inconclusive. Similar argument to on land exercises.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Heat & cold<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Heat aids muscle stretching exercises<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· May exacerbate clinical and subclinical deficits<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 86.2pt; text-indent: -14.2pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Cold could further compromise circulation with vasoconstriction<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 50.2pt; text-indent: -14.2pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Electrotherapy<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 86.2pt; text-indent: -14.2pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· As an adjunct to active exercise and stretching<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 90pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">· Is not suitable for all MS patients</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com5tag:blogger.com,1999:blog-4226691912745136121.post-56492030232435846732014-05-20T05:22:00.001-07:002014-05-20T05:27:59.212-07:00Parkinson's Disease<span style="color: #e69138; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b style="background-color: white; line-height: 18.479999542236328px;">Diagnostic Signs</b><span style="background-color: white; line-height: 18.479999542236328px;">:</span></span><br />
<div style="background-color: white; color: #222222; line-height: 18.479999542236328px; margin: 0px 0px 0px 7.1px;">
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Resting tremors</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Rigidity – lead pipe and cog wheel (catches)</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Bradykinesia – slowness of movement</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Caused by a loss of dopamine in the basal ganglia.</span></li>
</ul>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Akinesia</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> – no movement </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hypokinesia</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> – reduced, small movements</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
</div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="font-weight: bold;"><span style="color: purple;">Clinical Features:</span></span></span></span><br />
<div style="background-color: white; line-height: 18.479999542236328px;">
<div>
<div style="color: #222222; margin: 0px 0px 0px 7.1px;">
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Festinating gait (increased speed shuffle)</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Postural problem</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Loss of facial expression</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Altered speech</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Depression</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Difficulty Swallowing</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Sleep disturbance</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pain</span></li>
</ul>
</div>
<span class="Apple-style-span" style="color: #222222;"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></b></span><span class="Apple-style-span"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">Secondary Impairments</span></span></b></span><br />
<div style="color: #222222; margin: 0px 0px 0px 7.1px;">
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Falls (inc. fear of)</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Weight loss</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Reduced ROM</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Muscle weakness</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Social exclusion</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Fatigue</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Infections (esp. chest)</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Balance issues</span></li>
</ul>
</div>
<span class="Apple-style-span" style="color: #222222;"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></b></span><span class="Apple-style-span"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #3d85c6;">Assessment</span></span></b></span><br />
<div style="color: #222222; margin: 0px;">
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Current medication</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Certainty and date of diagnosis</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hoehn and Yahr stages and UPDRS</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Symptoms</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Observation</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Walking</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dual task eg carrying & walking</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Fall History inc. fear of falling</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Two thirds of PD patients fall each year</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Location</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Activity and suspected cause</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Saving reactions/landing</span></li>
</ul>
</div>
<span class="Apple-style-span" style="color: #222222;"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></b></span><span class="Apple-style-span"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #cc0000;">Treatment</span></span></b></span></div>
<div style="color: #222222;">
<span class="Apple-style-span"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></b></span></div>
<div>
<span class="Apple-style-span" style="color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This is mainly L-dopa as it is small enough to cross the blood brain barrier. It works fantastically in new patients, but the effect fades. It creates on-off phases depending on the timing of the dosage.</span><br />
<ul style="color: #222222; line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;"></ul>
<span class="Apple-style-span" style="color: #222222;"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></b></span><span class="Apple-style-span"><b><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #bf9000;">Cueing</span></span></b></span></div>
<div style="color: #222222;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span class="Apple-style-span" style="color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This is what is used to bypass the dopamine system. It is the use of a response to a stimulus.</span><br />
<div style="color: #222222; margin: 0px 0px 0px 14.2px;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Visual – lines on the floor/signs</span></div>
<div style="color: #222222; margin: 0px 0px 0px 14.2px;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Auditory – metronome or instructions</span></div>
<div style="color: #222222; margin: 0px 0px 0px 14.2px;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Proprioceptive – conscious movement to break freeze</span></div>
<div style="color: #222222; margin: 0px 0px 0px 14.2px;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Cognitive – focus on movement, really think about it</span></div>
<span class="Apple-style-span" style="color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><br /></b></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="color: #351c75;">Physiotherapy</span></b></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #351c75;"> </span><span style="color: #222222;">for 2 -3 times a week for 4 – 12 weeks, including a follow up.</span></span></div>
</div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com10tag:blogger.com,1999:blog-4226691912745136121.post-17309413608775564302014-05-20T05:20:00.003-07:002014-05-20T05:28:13.855-07:00Stroke<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;">A </span><span style="background-color: white; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><span style="color: #3d85c6;">stroke </span></span><span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;">is a blood clot in the brain that deprives an area of blood carrying oxygen. WHO defines stroke as ‘an acute deficit resulting from vascular disease that lasts for more than 24 hours.’ If it less than 24 hours it is a </span><span style="background-color: white; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><span style="color: #cc0000;">Transient Ischaemic Attack </span></span><span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;">(TIA).</span><br />
<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; line-height: 18.479999542236328px;"></span><span class="Apple-style-span" style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;">The most improvement in strength within the first month is observed in the first 48 hours, hence Hyper Acute Stroke Unit (HASU) for the first 72 hours. There are 67,000 deaths in England and Wales with 300,000 people living with a stroke.</span><br />
<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; line-height: 18.479999542236328px;"></span><span class="Apple-style-span" style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><span style="text-decoration: underline;">Ischaemia</span></span><span class="Apple-style-span" style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"> – a deprivation of oxygen</span><br />
<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><b><br /></b><b>Risk Factors</b></span><br />
<div style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; margin: 0px 0px 0px 14.2px;">
<br />
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Age</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hypertension</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ischaemic Heart Disease</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">High blood cholesterol</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Genetic predisposition</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">High salt level</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Smoking</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Diabetes mellitus</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Atherosclerosis</span></li>
<li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Alcohol consumption</span></li>
</ul>
</div>
<span class="Apple-style-span" style="background-color: white; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><br /><span style="color: #222222;">It can accumulate over 2 years with small blood clots at the ends of vessels that give similar symptoms to going senile.</span><br /><br /><b><span style="color: #e69138;">Types of Stroke</span></b></span><br />
<span class="Apple-style-span" style="background-color: white; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.479999542236328px;"><br /><span style="color: #674ea7;">Ischaemic Stroke </span><span style="color: #222222;">– this is the slow onset of a thrombosis and accounts for 85% of strokes. It is embolic – there is a blockage of arterial access by an embolus which is a travelling particle.</span><br /><br /><span style="color: #6aa84f;">Haemorrhagic Stroke</span><span style="color: #222222;"> – this is rapid onset and accounts for 15% of strokes with 2 categories. The first being subarachnoid which is where blood flows into the subarachnoid space, usually resulting from a ruptured aneurysm. The second is intracerebral which is where the lumen narrows leading to microaneurysms (little bubbles).</span><br /><br /><span style="color: #a64d79;">Ischaemic Punumbra </span><span style="color: #222222;">– an area of vulnerable cells surrounding the core ischaemic area.</span><br /><br /><span style="color: #3d85c6;">Ischaemic Cascade </span><span style="color: #222222;">– a decrease in O</span><sub style="color: #222222;">2</sub><span style="color: #222222;"> levels an increase of lactate no Na</span><sup style="color: #222222;">+</sup><span style="color: #222222;"> + K</span><sup style="color: #222222;">+</sup><span style="color: #222222;"> pump. This means there is an influx of calcium that allows no synthesis and deactivation of enzymes.</span><br /><br /><span style="color: purple;">Hemispacial Neglect</span><span style="color: #222222;"> – inability to pay attention to stimuli on contraside of damaged hemisphere. This is generally in the parietal and temporal lobe and two thirds of this type are affected.</span></span>rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com8tag:blogger.com,1999:blog-4226691912745136121.post-14447743579237542122014-05-20T05:18:00.003-07:002014-05-20T05:18:41.198-07:00Guillain-Barre Syndrome<div class="MsoListBulletCxSpMiddle" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">Guillain-Barre Syndrome</span><span style="color: #222222;"> (GBS), also known as acute inflammatory demyelinating polyneuropathy, is an autoimmune disease whereby antibodies mistake the myelin sheath for pathogens. This results in demyelination of the peripheral nerves and nerve roots leading to muscle weakness. It commonly follows a respiratory tract or gastric infection, or perhaps from immunisation or surgery. In order to be classified as GBS, the time of onset to peak disability (nadir, meaning opposite or lowest point in fortunes) should be less than 4 weeks. </span><br /><br /><span style="color: #222222;"><o:p></o:p></span></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Muscle Weakness<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 54pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Leg weakness if often noted first, progresses proximally and includes all muscle groups<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 54pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Asbury & Corblath (1990) discovered that 50% of pts reach nadir in two weeks<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 54pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Nadir can include complete paralysis, and 50% of pts have facial weakness<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 54pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Frequently bulbar muscle groups are affected to require NG feeding to avoid aspiration<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 54pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span>Paralysis of respiratory muscles causes vital capacity to fall in 30% of pts, where elective ventilation is indicated<o:p></o:p></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px;">
<br /></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">GBS </span><span style="color: #222222;">is predominantly a motor neuropathy, but 42-75% of pts have some alteration in </span><u style="color: #222222;">sensation</u><span style="color: #222222;">. Joint positional sense in the toes is missing in over 50% of pts. It has been postulated that </span><u style="color: #222222;">pain</u><span style="color: #222222;"> could be due to inflamed and tightened neural structures in the acute stage, however could be due to abnormal forces on joints that are poorly protected by weakened muscles.<o:p></o:p></span></span></div>
<div class="MsoListBulletCxSpMiddle" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.479999542236328px; margin-left: 0cm; text-indent: 0cm;">
<br /></div>
<span style="background-color: white; color: #222222; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18.479999542236328px; text-indent: 0cm;">Recovery tends to occur within a month of nadir, and has the potential to be complete providing secondary implications such as contractures are avoided. </span>rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com5tag:blogger.com,1999:blog-4226691912745136121.post-64751437795432272752014-04-26T02:25:00.001-07:002014-05-20T05:28:43.196-07:00Sprains<u><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Early Management </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Aims during the first 72 hours</span></u><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Reduce tissue temperature, pain and swelling</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Reduce metabolic demands of the tissue</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Prevent further injury</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Promote collagen growth and realignment</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Maintain cardiorespiratory and musculoskeletal activity</span></li>
</ul>
<div>
<u><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></u>
<u><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute Inflammatory Stage - PRICE</span></u></div>
<div>
<u><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></u></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #990000; line-height: 18.399999618530273px;">Protection</span><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"> - Prevents worsening of injury</span><br style="background-color: white; color: #222222; line-height: 18.479999542236328px;" /><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><span style="color: #e69138;">Rest</span> - Avoids pain from movement. Complete immobilisation is not indicated to prevent significant loss of ROM. Even for grade III injuries a functional splintage is strongly suggested.</span><br style="background-color: white; color: #222222; line-height: 18.479999542236328px;" /><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><span style="color: #3d85c6;">Ice </span>- Reduces pain. Application of ice should be for 10-30 minutes wrapped in cloth to avoid cold injury. Repetition can be as frequent as required, providing the affected part is fully warmed back to body temperature.</span><br style="background-color: white; color: #222222; line-height: 18.479999542236328px;" /><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><span style="color: #6aa84f;">Compression</span> - Provides comfort by limiting movement and reducing swelling, although should be applied so as to not reduce blood flow. </span><br style="background-color: white; color: #222222; line-height: 18.479999542236328px;" /><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><span style="color: #741b47;">Elevation</span> - Helps to reduce swelling, especially with the affected part above heart level.</span></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><br /></span></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><u>Sub-Acute Proliferation & Remodelling Stage</u></span></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;"><u><br /></u></span></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222; line-height: 18.399999618530273px;">Active rehabilitation:</span></span></div>
<div>
<ul>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Electrotherapy (for example ultrasound for collagen synthesis)</span></span></li>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Manual therapy (for joint pain)</span></span></li>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Restore mobility and prevent joint deformity</span></span></li>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Progressive loading to begin to restore strength and improve joint stability</span></span></li>
</ul>
<div>
<span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><br /></span></span>
<span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">In the remodelling stage:</span></span></div>
</div>
<div>
<ul>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Deep tissue frictions</span></span></li>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Electrotherapy (for example ultrasound to enhance tensile strength and scare mobility)</span></span></li>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Manual therapy (for joint stiffness)</span></span></li>
<li><span style="color: #222222; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">Progressive mobilisation and strengthening exercises</span></span></li>
</ul>
</div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com1tag:blogger.com,1999:blog-4226691912745136121.post-2446324937805778502014-04-24T12:23:00.000-07:002014-04-24T12:23:59.776-07:00Soft Tissue Healing<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">A soft tissue injury is the damage of muscles, ligaments and
tendons throughout the body when their tensile strength is interrupted. They
normally result in pain, swelling and bruising as well as loss of function. <span style="font-size: small;"><o:p></o:p></span></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tissue healing compromises two essential components: regeneration and repair (dependant on the resultant tissue). In regeneration
specialised tissues is replaced by the proliferation of surrounding undamaged
specialised cells. In repair, lost tissue is replaced by granulated tissue
which matures to form scar tissue.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The healing process is divided into 4 phases: <b><span style="color: #cc0000;">bleeding</span></b>, <b><span style="color: #e69138;">inflammation</span></b>, <b><span style="color: #3d85c6;">proliferation</span></b>
and <b><span style="color: #6aa84f;">remodelling</span></b>. These 4 phases
hugely overlap and integrate during repair.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="line-height: 115%;"><span style="color: #cc0000;">Bleeding</span></span></b><span style="line-height: 115%;"><span style="color: #cc0000;"> </span>is a
relatively short phase that occurs following trauma or another similar insult.
The normal time for bleeding to stop varies depending on the injury and the
tissue type. Vascular tissue such as muscle will bleed for longer causing a
greater escape of blood into the surrounding tissues whereas other tissues such
as a ligament will bleed less and for a shorter amount of time. The average
bleeding time is 6-8 hours although is heavily dependent on the patient and the
nature of the injury, for example a crush injury to a vascular tissue could continue
bleeding, admittedly minimally, for 24 hours post trauma.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 115%;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="line-height: 115%;"><span style="color: #e69138;">Inflammation</span></span></b><span style="line-height: 115%;"><span style="color: #e69138;"> </span>is a
normal and necessary prerequisite to healing (Hardy 1989) and onsets after a
few hours. It rapidly increases in magnitude over the following 1-3 days before
gradually resolving over the following couple of weeks. Signs of inflammation
include: swelling, pain, redness, heat and loss of function.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 115%;"><br /></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The cascade that is responsible for the initiation and
control of inflammation can be due to trauma, mechanical irritation, thermal or
chemical insult as well as immune responses. Fibrin and fibronectin form a
substratum (underlying foundation layer) which is hospitable to the adhesion of
various cells. The two essential elements to inflammation are the <span style="color: #674ea7;">vascular </span>and <span style="color: #bf9000;">cellular </span>cascades. They occur in parallel and are somewhat
interlinked.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 115%;"><span style="color: #674ea7;">Vascular </span></span><span style="line-height: 115%;">events are
additional to the initial bleeding. Vasodilation follows an initial brief
vasoconstriction and there is an initial increase in the velocity of the blood
followed by a prolonged slowing. The white cells form a margin, platelets
adhere to the vessel walls and the endothelial cells (lining the blood vessels)
swell. The local vessels also become more permeable, which when combined with
vasodilation, increases the flow of blood through the more permeable vessels
and results in exudate (including protein rich plasma) passing into the tissue
spaces. This can be at both the arterial and venous ends of the capillary
network as the increase hydrostatic pressure overcomes the osmotic pressure of
the plasma proteins. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The effect of the exudate is to dilute any irritant
substances in the damaged area and form a fibrin clot with the high fibrinogen
content of the fluid. This union between the surrounding intact tissues forms a
mesh which can trap foreign particles and debris. Mast cells in the damaged
area release hyaluronic acid and other proteoglycans which bing with the
exudate and create a gel which limits local fluid flow and further traps
various particles and debris (Hardy 1989).<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 115%;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 115%;">The <span style="color: #bf9000;">cellular</span></span><span style="color: #bf9000;">
</span><span style="line-height: 115%;">events
of inflammation include the early emigration of the phagocytes within minutes.
They are followed out of the vessels by monocytes, lymphocytes, eosinophils and
basophils (Lorena et al 2002). Once in the tissue spaces monocytes become
macrophages (Forrest 1983). These cells exhibit a strong phagocytic activity
and are responsible for the removal of damaged tissue and foreign objects. And
to top it all off lactic acid, one of the end products of phagocytosis, is a
stimulant for proliferation. Pretty clever, ‘ey? </span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;">Increased hydrostatic pressure for the oedema can be
detrimental as it can restrict blood flow if the injured tissue space is
limited, increasing pain and limiting function.</span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="line-height: 115%;"><br /></span></b></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="line-height: 115%;"><span style="color: #3d85c6;">Proliferation
</span></span></b><span style="line-height: 115%;">is the generation and deposition of granulation (repair) tissue, which in
the majority of musculoskeletal injuries is collagen (scar) material. It has a
rapid onset of 24-48 hours but takes 2-3 weeks to reach its peak reactivity,
although the more vascular the tissue the shorter the time taken to reach this
peak phase. The bulk of the scar production is completed during this time, but
proliferation decreases thereafter through several months post injury. The key
events in proliferation are: fibroplasia (production of fibrous tissue),
angiogenesis (development of blood capillaries), increased extracellular
collagen production, wound contraction (from myofibroblasts) to minimise the
scar and a complex interactive response amongst cells and chemical mediators to
ensure effective completion of the scar tissue.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="line-height: 115%;"><br /></span></b></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="line-height: 115%;"><span style="color: #6aa84f;">Remodelling</span></span></b><span style="line-height: 115%;"><span style="color: #6aa84f;"> </span>is the
strengthening (type I collagen replaces type III) and alignment of collagen
that results in an organised, quality, functional scar that allows movement in
a similar way to the original tissue. This phase is widely reported to begin at
the same time as the peak of the proliferative phase (2-3 weeks) however
further research shows that it may begin at around 1-2 weeks post injury.
During this phase movement is essential to ensure that the collagen aligns in
the direction most suited to functional activities. Signs of the remodelling
phase include reduced redness, oedema and pain.<o:p></o:p></span></span></div>
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="font-size: small;"><br /></span></span></span>
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="font-size: small;">Factors
that are known to </span><span style="color: #a64d79;">delay healing </span>can
be general or local. General factors include age, protein deficiency, low
vitamin C levels, steroids and NSAIDs as well as cold temperatures. Local
factors include ischaemia, adhesion to bone of other underlying tissue,
continued inflammation, drying of the wound and excessive movement as it
restarts inflammation.</span></span>rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com1tag:blogger.com,1999:blog-4226691912745136121.post-61693412286272576682014-04-23T13:03:00.000-07:002014-05-20T05:12:42.948-07:00Leg Length Discrepancy<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Having worked in a ski resort for the last 5 months, I have been in the unique position of only being able to see clients for the duration of their holiday. This means I have encountered a number of people who have been seeing the same therapist, at home, for a period of months to years. This has led me to one shocking revelation: </span><br />
<div style="text-align: center;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #3d85c6;">so many people don't know their own diagnosis</span></span></div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">
</span>
<br />
<div style="text-align: left;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">...and yet they continue to see their therapist. Does it not seem crazy that most of these clients cannot state what their therapist has been treating?! From these clients, the best I hear is nearly always 'My hips are out of alignment' or '</span><span style="color: #e69138; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">I've got one leg slightly shorter than the other</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">.' Well... so what?</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Gurney (2002) reviewed leg length discrepancy and suggested it does not need treating in all cases, with </span><span style="color: #6aa84f; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">20mm often used as the 'breakpoint'</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">. Two centimetres! That's not a small amount. Furthermore, Gross (1978) conducted a survey in which all patients with a leg length discrepancy between 15 and 20mm 'did not consider their short leg to be a problem in any way.'</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Based on a review published in 2005, </span><span style="color: #c27ba0; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">90% of the population has some anatomic leg length discrepancy</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> (average 5.2mm), although this figure hugely varies between studies. Seven of the studies reviewed identified whether participants were symptomatic (LBP or knee/hip problems) or asymptomatic (varying from last 6 months to ever) ...and guess what? The mean leg length discrepancy between the two groups differed by 0.1mm (symptomatic mean 5.1mm, SD 3.9; asymptomatic mean 5.2mm, SD 4.2).</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This isn't new information. The studies used in the above review were conducted between 1970 and 2005. Soukka et al (1991) measured leg length using radiographs in 247 participants between the ages of 35-54 years. 78 of these participants had disabling low back pain during the previous twelve months and a mean leg length discrepancy of 5.3mm (maximum 17mm). However, a further 53 participants also had a discrepancy (mean 5.5mm, maximum 20mm) but... wait for it... absolutely no history of low back pain.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Then, in 2006, 126 of 1,100 military cadets were identified to have lower limb discrepancy over 0.5cm. Over the following year there was no difference in incidence of injury between those with discrepancies and those without (Goss et al, 2006). Furthermore, gait asymmetry and effects on kinetics and kinematics are only present in discrepancies over 2cm (Kaufman et al, 1996).</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Furthermore, accurate measurement of a leg length discrepancy requires the use of radiographic imaging.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">However, amongst these studies, there is evidence that</span><span style="color: #cc0000; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> leg length discrepancies are linked to increasing your chances of some injuries</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">. Lower limb stress fractures have been shown to be of higher incidence in those with discrepancies. This is also true of trochanteric bursitis, patellar apicitis, and patellofemoral syndrome amongst many others. However, there are also studies that state leg length discrepancies have little to no effect. And on an interesting side note, there are differing conclusions as to whether leg length discrepancies would predict or be the result of knee and hip OA (intriguingly this is predominantly in the longer leg, rather than the shorter).</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Basically, there remains huge debate as to the effects and clinical relevance of leg length discrepancy. It is logical for there to be pelvic torsion when one leg is longer than the other, however there is inconclusive evidence to use leg length discrepancy and hip misalignment as a diagnosis for pain - especially for an acute issue. If using leg length discrepancy as a diagnosis, why not investigate whether there is piriformis malfunction, OA, plantar fasciitis or one of the many other questioned associated pathologies? With treatment for leg length discrepancy (such as foot lifts or surgery) recommended only for those with >2cm difference, manual therapies and exercise prescription are commonly looked to for those with <2cm difference. Clients should be questioning exactly how manual therapies are going to benefit their leg length discrepancy, or whether therapy is instead for an effect of their leg length discrepancy (that is, if the issue is related at all).</span><br />
<u style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></u>
<u style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">References</u><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Goss, D. L., Moore, J.H., Slivka, E. M. and Hatler, B. S. (2006) 'Comparison of injury rates between cadets with limb length inequalities and matched control subjects over 1 year of military training and athletic participation' </span><i style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Military Me</i><i style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">dicine </i><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">171(6), pp. 522-525.</span></div>
<div style="text-align: left;">
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Gross, R. H. (1978) 'Leg length discrepancy: how much is too much?' <i>Orthopedics</i> 1(4) pp. 307-310.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Gurney, B. (2002) 'Leg length discrepancy' <i>Gait & Posture</i> 15 pp. 195-206.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Kaufman, K.R., Miller, L.S., Sutherland, D. H. (1996) 'Gait asymmetry in patients with limb-length inequality' <i>Journal of Paediatric Orthopaedics</i> 16 pp. 144-150.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Knutson, G. A. (2005) 'Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance' <i>Chiropractic & Osteopathy </i>13(11)</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Soukka, A, Alaranta, H, Tallroth, K and Heliovaara, M (1991) 'Leg-Length Inequality in People of Working Age: The Association Between Mild Inequality and Low-Back Pain Is Questionable' <i>Spine</i> 16(4). </span></div>
</div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">
</span>rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-31350405575787684312014-04-22T12:20:00.000-07:002014-04-24T01:15:29.156-07:00Wrist Fractures<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Colles fractures (fracture of the distal radius) are the most common fracture in adults and are typically caused by a <span style="color: #6fa8dc;">fall on an outstretched hand</span>. The two categories that are most predominant are osteopenic females aged between 60-80 and males between 20-40. The former is typically a low-energy injury at a ratio of male:female 1:4. The latter is typically a high-energy fall to impact on the denser bone.</span><br />
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The angle of the wrist on impact (primarily ulnar/radial deviation and dorsiflexion) and the weight of the patient ultimately determine the fracture pattern, whether of the radius, scaphoid and the ulna.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #e69138;">Signs & Symptoms</span>:</span><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">History of trauma or osteoporosis</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Wrist pain</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tenderness over the fracture sight (distal radius/ulna or carpals)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Swelling</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Deformity (for displaced fractures)</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tenderness in the anatomic snuff box (suggestive of a scaphoid fracture)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Finger numbness (high-energy injuries typically on the median nerve)</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;"><br />Other pathologies</span> with similar signs and symptoms include:</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Wrist strains (no deformity or signs on x-ray)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Ligamentous carpal injury (pain with palpation on dorsum of wrist at the scapholunate interval)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Triangular fibrocartliage complex tear (ulnar sided wrist pain increasing on ulnar deviation)</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br />The need for <span style="color: #cc0000;">surgical intervention</span> is determined from radiography. Surgery is indicated when there </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">is radial length loss of 15mm or more or when there is a d</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">orsal tilt of over 10 degrees.</span></div>
</div>
<div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #741b47;">Initial treatment </span>is typically immobilisation by cast or splint. For undisplaced fractures, cast are normally maintained for 4-6 weeks. Undisplaced fractures may also result in spontaneous rupture of the extensor pollicis longus tendon; typically in the first 12-16 weeks after injury. Precisely why I don't know, however spontaneous EPL rupture also occurs in synovitis, tenosynovitis and RA. There's even the occasional case where the patient doesn't have any predisposing factors, but has a spontaneous EPL rupture none the less.</span></div>
<div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Interestingly, a HEP and application of ultrasound and ice has is supported by limited evidence (</span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><a href="http://www.aaos.org/Research/guidelines/drfsummary.pdf">AAOS Treatment Guidelines</a>), however patients perform active finger motion exercises following diagnosis. Furthermore there is moderate evidence to support that patients do not begin early wrist motion following stable fracture fixation. The prescription of Vitamin C also has moderate evidence to prevent disproportionate pain.</span></div>
</div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com3tag:blogger.com,1999:blog-4226691912745136121.post-20082822563336521272014-04-04T00:01:00.000-07:002014-04-24T01:19:21.045-07:00Ankle Fractures<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Ankle fractures typically refer to a break in either malleolus, although there are multiple possible fracture sites in the bony structure of the foot. Over the age of 65 they are more common in white women and present as an isolated fibular fracture. Under the age of 65 they are more common in males and present as a lateral malleolus fracture. The most common mechanism is usually a low-energy fall, with the next most common causes being: an inversion injury to the ankle, sporting injury, fall down the stairs, fall from a height or road traffic accident. </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">There is increased risk of ankle fractures in those with a history of osteoporosis or frequent falls.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Diagnostic Factors</b></span><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Recent trauma, typically from a low-energy fall</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pain and swelling, especially over the medial or lateral malleolus and on palpation</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inability to weight bear</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">'Pop' or other sound heard on fall</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Giving way on fall</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Deformity - typically indicative of dislocation</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Crepitus on range of motion</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tenderness of the proximal fibula</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tenting of the skin over the medial malleolus - typically indicative of dislocation</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Ottawa Ankle Rules</b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">A diagnostic tool to help decide the need for x-rays. If there is:</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Posterior lateral or medial bony tenderness within 6cm of the distal aspect of the fibula or tibia</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inability to weight bear 4 steps at the scene or A&E</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">...then an x-ray should be ordered.</span></div>
</div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9_0GgwTzlgw83YstZGrdLx1pZiCbo86vfeIbUYjyQa7rcZqnowfavvSE77RxINsmt87LmN2oddunCGVCXG_T1RRtJF_0JHbhPKaKnKnvJcEWFym9pJEIJEyboQ-Vp8QcNd0UBCYZpORM/s1600/Foot.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9_0GgwTzlgw83YstZGrdLx1pZiCbo86vfeIbUYjyQa7rcZqnowfavvSE77RxINsmt87LmN2oddunCGVCXG_T1RRtJF_0JHbhPKaKnKnvJcEWFym9pJEIJEyboQ-Vp8QcNd0UBCYZpORM/s1600/Foot.jpg" height="400" width="270" /></a><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Imaging</b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Fracture --> X-ray</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Comminuted fractures --> CT</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Ligament or tendon damage --> MRI</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Differential Diagnosis</b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">ATFL</span> or <span style="color: #3d85c6;">CFL</span> ligament tear presents with minimal lateral malleolar posterior bony tenderness. There may be a positive anterior drawer test or increased talar tilt, but there is rarely significant deformity.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #cc0000;">Achilles</span> tendon rupture presents with no malleolar tenderness. There may be a gap in the Achilles tendon or a positive Thompson's test.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: purple;">Talar</span> fracture is unlikely to present with malleolar tenderness, but there may be a deformity to the ankle and hindfoot.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: orange;">Syndesmotic</span> disruption is unlikely to present with malleolar tenderness. Test with external rotation and calf squeeze test.</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com3tag:blogger.com,1999:blog-4226691912745136121.post-45174509744351073972014-03-19T05:02:00.000-07:002014-03-19T05:15:51.252-07:00Back Anatomy<b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">Superficial </span>Muscles</span></b><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Trapezius</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from C7-T12 spinous processes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts on the spine of scapula and the lateral third of the clavicle</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Rhomboid Minor</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Superior to rhomboid major</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from C7-T1 spinous processes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts on the medial border of the scapula</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Rhomboid Major</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from T2-5 spinous processes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts on the medial border of the scapula</span></li>
</ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Latissimus Dorsi</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from T7-L5 spinous processes, sacrum, iliac crest and ribs X-XII</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts on the humerus</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Levator Scapulae</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from C1-4 transverse processes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts on the medial superior portion of the scapula</span></li>
</ul>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEqg0WLtlVfnM2fSb5Bq1MXrUZN3-jf-RFi9hIs4dUN_FuYfeogVwmEEyRtpAcIYCdPNJBGXucNrCb2W3Qfkl0LAP5rEADsF7HAvAy5GZ4Symofiv1lUsMYXs6SDRx2uW81i0yTgxv-gA/s1600/P1130324.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEqg0WLtlVfnM2fSb5Bq1MXrUZN3-jf-RFi9hIs4dUN_FuYfeogVwmEEyRtpAcIYCdPNJBGXucNrCb2W3Qfkl0LAP5rEADsF7HAvAy5GZ4Symofiv1lUsMYXs6SDRx2uW81i0yTgxv-gA/s1600/P1130324.JPG" height="265" width="400" /></a></div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><span style="color: #e69138;"><br />Intermediate </span>Muscles</b></span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Serratus Posterior Superior</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from C7-T3 spinous processes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts to upper border of ribs II-V</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Serratus Posterior Inferior</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Attaches from T11-L3 spinous processes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inserts to lower border of ribs IX-XII</span></li>
</ul>
</ul>
<div>
<b style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: #3d85c6;"><br />Deep </span>Muscles</b></div>
</div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Suboccipital muscles</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Splenius</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Capitis and cervicis</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Erector Spinae</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Longissimus</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Capitis, cervicis and thoracis</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Iliocostalis</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Cervicis, thoracis and lumborum</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Spinalis</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Capitis, cervicis and thoracis</span></li>
</ul>
</ul>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;"><br />Superficial </span>and <span style="color: #e69138;">intermediate </span>muscles are innervated by anterior rami of spinal nerves (or cranial nerve XI for the trapezius). <span style="color: #3d85c6;">Deep </span>muscles are innervated by the posterior rami of spinal nerves.<br /></span><br />
<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<br />
<b style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="color: purple;">Transversospinales </span>Muscles</b></div>
</div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Three groups of muscles that connect the transverse processes to the spinous processes superiorly, sitting underneath the erector spinae. When they contract bilaterally they work similarly to the erector spinae, but when they contract unilaterally they rotate the spine.</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Semispinalis</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Most superficial. Cervical and thoracic spine. Attaches over 4-6 vertebrae.</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Multifidus</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Intermediate. Full length of spine. Attaches over 2-4 vertebrae.</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Rotatores</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Most deep. Full length of spine. Long rotators attach over 2 vertebrae. Short rotators attach over adjacent vertebrae.</span></li>
</ul>
</ul>
</div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-608391605096666892014-03-18T10:33:00.006-07:002014-05-20T05:14:50.531-07:00FAQ - What is a Muscle Knot?<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">This is undoubtedly one of the most commonly questions asked during a massage, alongside with 'What does a muscle knot feel like?' and 'What does massage actually do?' These questions are not always easy to answer, and with many possible answers being thrown around the internet finding an easy way to explain what a 'knot' is and how your massage techniques are beneficial is difficult.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Up until this point I have done my best to keep it simple, primarily to not feel like I'm throwing medical terms at holiday makers who were ultimately looking to relax. From my experience they are commonly used<span style="color: #6aa84f;"> areas that are used statically or in a small range</span>, resulting in the <span style="color: purple;">individual fibres becoming almost 'sticky' and struggling to glide over one another in full range</span>. This links in well with the term 'adhesion' that is frequently used interchangeably with 'knot', as the effect a small drop of adhesive would have provides good imagery. Using whichever term you prefer, they are typically common in the levator scapulae, trapezius, rhomboid and quadratus lumborum muscles from desk work (or other jobs that often use similar posture, including drivers, waitresses and massage therapists themselves). </span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Generally I find that it is not only one point in the muscle that is 'knotted', with<span style="color: #e69138;"> increased tension along the length of the muscle</span> presenting in almost all cases. Additionally <span style="color: #3d85c6;">where muscles overlap</span>, adhesions can start to form not only between the individual muscle fibres, but the fascia surrounding whole muscles. As a number of muscles work in different directions to perform a single movement, you can almost think of it as increased friction between the muscles leading to increased difficulty and discomfort.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Many sources refer to 'knots' as '<span style="color: #cc0000;">myofascial trigger points</span>' that occur in typical patterns in individual muscles. There is variable methodology and theories that practitioners use to diagnose, with a number of classifications (e.g. active, potential, latent or key). Trigger point maps indicate roughly 620 possible trigger points across the body, which on observation support areas that I work through on a daily basis. These areas are frequently described as predisposed to trigger points, which I think works well with the typical pattern most desk workers seem to follow. Other than postural or ergonomic <span style="color: #674ea7;">causes</span>; trauma, overuse, strain, imbalanced mechanics, poor nutrition, stress and cold temperatures can also exacerbate trigger points. </span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Knots, trigger points, adhesions or whatever else you may refer to them as are also commonly described as <span style="color: #e69138;">small areas of tension</span>, whereby the muscle has been used and <span style="color: #3d85c6;">ineffectively relaxed</span> afterwards. I see this commonly amongst skiiers, as it is one of the rare forms of exercise where few warm up or stretch and most cool downs are very much sedentary with an apres-ski pint. There are <span style="color: #6aa84f;">definite ways to avoid or lessen the effect of knots and prevent damage</span>:<br /><br />Number 1) Have a long '<span style="color: #f1c232;">warm up</span>' run as your first run of the day. A nice meandering blue at a relaxed pace is perfect. An actual warm up or stretch is often ineffective due to the time taken to then begin skiing and the limitations presented by your equipment.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Number 2) Use <span style="color: #cc0000;">heat </span>to help vasodilate your blood vessels; increasing blood flow to the area and promoting recovery. Hot tubs and baths work well for this, relaxing you both physically and mentally. However be cautious that with an injury you want to reduce blood flow to the area for the first 48 hours, meaning that the hot tub won't do you any good. If you are in doubt contact a healthcare professional.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Number 3) Take the time to <span style="color: purple;">stretch</span>. Yes, I know it's a faff, but the benefits are beautiful. The quadriceps, gluteals and calves commonly tighten up in skiiers and are possible to slip into your daily routine. For example, stretch your quadriceps whilst waiting for the kettle to boil, your gluteals just before you go to sleep or you calves when you're brushing your teeth. The longer you hold the stretch, the more time you are giving your muscles to stretch along all the areas of tension, rather than just the one it reaches first. So try to hold the stretch for a minimum of 15-30 seconds.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">If it's too late and the above aren't helping to lessen the effect; see a trained <span style="color: #674ea7;">therapist</span>. This can be a remedial or sports massage therapist, acupuncturist or whoever else works for you. Although they can be expensive, the benefits are often quick and effective. </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">However if you are commonly obtaining areas of tension or knots it's almost certainly worthwhile booking in with a physiotherapist (or osteopath or chiropractor if you prefer) to try and identify the cause and work on techniques you can use to prevent them, rather than managing the symptoms when they appear.</span>rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com4tag:blogger.com,1999:blog-4226691912745136121.post-43511280935925221832014-03-09T12:17:00.006-07:002014-03-09T12:32:39.104-07:00Fractures<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">A fracture presents as a loss of continuity in the substance of the bone. It can present as open, closed or complicated. Causes include direct violence (e.g. trauma), indirect violence (e.g. twisting), fatigue and stress (e.g. osteoporosis). </span><br />
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<li><span style="color: #cc0000; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Haematoma Formation</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Within 3 days</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Adjacent vessels are torn, limited blood supply to osteocytes</span></li>
</ul>
<li><span style="color: purple; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Sub-periosteal and endosteal cellular proliferation</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Haematoma reduces</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Cellular tissues push in</span></li>
</ul>
<li><span style="color: #3d85c6; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Callus Formation</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Proliferated cells lay down intercellular substance (chondrogenic and osteogenic)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Becomes calcified to form woven bone/callus</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Bone is united</span></li>
</ul>
<li><span style="color: #6aa84f; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Consolidation</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Woven bone transformed into lamellar bone</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Osteoclasts burrow through the debris</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Osteoblasts fills in gaps between fragments (takes months)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Should be weight bearing by this stage</span></li>
</ul>
<li><span style="color: #e69138; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Remodelling</span></li>
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<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Bone strengthened in lines of stress by continual formation</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Restored to original form</span></li>
</ul>
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<b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Fracture Healing Time</span></b></div>
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<br />rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com7tag:blogger.com,1999:blog-4226691912745136121.post-84858562804854257992014-03-08T02:53:00.001-08:002014-03-08T02:57:37.361-08:00Knee Differential Diagnosis<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The Mechanism of Injury (MOI) is useful subjective information that can be used to direct the objective assessment. This includes discussing the location of contact, location of pain, history of previous injury, areas of anaesthesia/dysaesthesia or weakness and swelling. </span><br />
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<span style="color: #cc0000; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Anterior Cruciate Ligament (ACL)</b></span><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Non-contact twisting injury in flexion</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Blow to the hyperextended knee</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In young patients, ACL tear is the most common cause of acute swelling</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tests include Lachman's, Anterior Drawer and</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Pivot Shift</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Imaging includes a standing AP x-ray</span></li>
</ul>
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<span style="color: purple; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Posterior Cruciate Ligament (PCL)</b></span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Blow to the flexed knee (e.g. dashboard injury)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Posterior knee pain</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tests include Posterior Drawer, Posterior Sag Sign and Quadriceps Active test</span></li>
</ul>
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<span style="color: #3d85c6; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Medial Collateral Ligament (MCL)</b></span></div>
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<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Blow to lateral aspect of the knee (valgus injury)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute medial pain</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tests include valgus laxity at 0 to 30 degrees of knee flexion</span></li>
</ul>
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<span style="color: #6aa84f; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Posterolateral Corner (PLC)</b></span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Blow to the hyperextended knee</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Blow to the medial aspect of the knee</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute lateral pain, including <b>Lateral Collateral Ligament (LCL)</b></span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tests include varus opening at 30 degrees of flexion, posterolateral drawer test, reverse pivot shift test and the figure-4 test.</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Varus thrust gait</span></li>
</ul>
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<span style="color: #bf9000; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Meniscus</b></span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Non-contact twisting injury in flexion</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute pain (med/lat)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chronic pain (med/lat) indicates a degenerative meniscal tear</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute swelling</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lack of full extension (bucket handle tear)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lack of full flexion may be indicative of an injuy to the posterior horn of the mensci</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Posterior knee pain on flexion</span></li>
</ul>
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<span style="color: #a64d79; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Patellofemoral</b></span></div>
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<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Anterior knee pain with flexion of the knee</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Patella translation</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Retropatellar Crepitation (indicative of chondromalacia)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Imaging includes a patellar sunrise x-ray</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Weakness in quadriceps strength</span></li>
</ul>
</div>
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<div>
<span style="color: #134f5c; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Patella Subluxation or Dislocation</b></span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Non-contact twisting in extension</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Increased risk with patella alta (when the patella is higher than normal, therefore disturbing the interactions with the trochlear groove)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute anterior pain</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acute swelling</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Deformities (typically lateral)</span></li>
</ul>
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<span style="color: #93c47d; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Infections and Tumours</b></span></div>
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<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chronic swelling (also indicative in osteoarthritis)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Joint warmth or redness may be indicative of infection (aspiration may be required to evaluate the synovial fluid)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Bloody effusions are more consistent with trauma or tumour</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Non-bloody effusions are more consistent with infection or inflammatory arthritis</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">A Baker's Cyst normally indicates that swelling elsewhere in the joint has leaked posteriorly between the semimembranous tendon and the medial head of the gastrocnemius tendon</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Knee effusion may limit full flexion</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Imaging includes CT and bone scans for tumours or another bony pathology</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Aspiration invasive testing may also be carried out with acute effusion</span></li>
</ul>
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<span style="color: #990000; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Chronic Pain</b></span></div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chronic medial pain indicates a degenerative meniscal tear, medial compartment arthritis or pes anserine bursistis</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chronic lateral pain indicates a degenerative meniscal tear, lateral compartment arthritis or biceps bursitis</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chronic anterior pain indicates patellofemoral joint chondromalacia and patellar tendonitisa</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chronic posteroir pain indicates posterior horn meniscal tears or a Baker's (popliteal) cyst</span></li>
</ul>
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<b style="color: #674ea7; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">History of Previous Injury</b></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Patients who have had previous ligament injuries are at an increased risk of secondary injuries. Additionally, patients who have had menisci resections are at a high risk of developing arthritis, which could present with pain and swelling upon activity.</span></div>
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<span style="color: #f6b26b; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Anaestheia or Dysaesthesia or Weakness</b></span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Direct blows to the anterior aspect of the knee can cause sensory changes in the infrapatellar branch of the sapenous nerve, resulting in altered sensation on the anterolateral aspect of the knee.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Blows to the anteromedial knee or a varus of hyperextension injury can stretch the common peroneal nerve, resulting in reduced sensation in the first dorsal web space and lateral foot. There may also be motor weakness in the extensor hallucis longus, extensor digitorum longus, peroneals and tibialis anterior.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Medial knee injuries may have decreases sensation along the medial aspect of the leg due to the saphenous nerve.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">It is important to assess the function of tibial nerve for severe injuries by assessing sensation on the sole of the foot as well as plantar flexion and inversion strength. </span></div>
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rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com12tag:blogger.com,1999:blog-4226691912745136121.post-57926741296815243092014-03-08T01:59:00.004-08:002014-03-08T02:02:01.028-08:00Posterolateral Corner<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The posterolateral corner (PLC) is a collective term for multiple structures within the knee joint. These include:</span><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Tibia</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Fibula</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lateral Femur</span></li>
<li><span style="color: purple; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">IT band</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Long and short heads of biceps femoris tendon</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #e69138;">LCL </span>(otherwise known as the fibular collateral ligament)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">Popliteus </span>tendon</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Popliteofibular ligament (<span style="color: #3d85c6;">PFL</span>)</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lateral gastrocnemius tendon</span></li>
</ul>
<div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />The three most important static stabilisers are the </span><span style="color: #e69138; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">LCL</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">, </span><span style="color: #6aa84f; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">popliteus </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">tendon and </span><span style="color: #3d85c6; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">PFL </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">as they restrict varus, external rotation and posterior translation.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">From 0 to 30 degrees of flexion, the <span style="color: #e69138;">LCL </span>is the main structure preventing varus opening of the knee (although the <span style="color: purple;">IT band</span> assists). The <span style="color: #3d85c6;">popliteofibular ligament</span> connects the <span style="color: #6aa84f;">popliteus</span><span style="color: #cc0000;"> </span>muscle at the musculotendious junction to the posterior, medial portion of the fibular styloid and stablises the knee during external rotation.The <span style="color: #6aa84f;">popliteus </span>tendon provides static and dynamic stabilisation to the knee during posterolateral rotation.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The two convex opposing surfaces (lateral femoral condyle and lateral tibial plateau) makes the posterolateral corner more unstable than the medial aspect, therefore increasing the risk of poor healing post-injury.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Specialised Tests</b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><u>Varus Stress Test at 0 and 30 degrees</u></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> Grade I - Pain but no gapping of the lateral joint space</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> Grade II - Some gapping of the lateral joint space, but with a definite end point</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> Grade III - Significant gapping with no definite end point.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Increased gapping at 0 degrees typically indicates a serious posterolateral injury with a high probability of cruciate ligament involvement. Lower grades at 30 degrees are more indicative of partial <span style="color: #e69138;">LCL </span>tears, with higher grades indicating complete tears of the <span style="color: #e69138;">LCL</span>.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<u style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Posterolateral Drawer Test</u><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> - Similar to the posterior drawer test, however the foot is externally rotated to 15 degrees. While stabilising the foot, appy a posterolateral rotation to the tibia. Increased mobility indicates injury to the <span style="color: #6aa84f;">popliteus </span>complex.</span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><u>Figure 4 Test</u> - Patient lies supine and flexes the knee to 90 degrees with the ankle resting on the other knee by placing the hip into external rotation. Application of a varus stress on the knee places tension particularly on the <span style="color: #6aa84f;">popliteus </span>complex. When injured, there is no tension to stabilise the lateral meniscus allowing it to medially displace into the joint, reproducing the patient's symptoms at the lateral joint line.</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-46016974401936021942014-02-24T23:53:00.003-08:002014-02-24T23:53:56.625-08:00Knee Anatomy<div class="MsoNormal" style="text-align: left;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The knee joint consists of the weight-bearing articulation
between the tibia and femur and the articulation between the patella and femur,
which allows the pull of the quads to be directed anteriorly over the knee to
the tibia without wearing the tendon.</span></div>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Menisci</b></span></div>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The articular surfaces include the two femoral condyles and
the superior aspect of the tibial condyles. Two fibrocartilaginous menisci sit
on the tibia and wrap around the outside to form C-shapes. They improve congruency between the femoral
and tibial condyles during jhoint movements where the femoral surface changes
from a small, curved surface in flexion to a large flat surface in extension.
The medial meniscus is attached to the margin of the capsule and the MCL
whereas the lateral meniscus is unattached to the capsule making it more
mobile. The menisci area interconnected anteriorly by the transverse ligament
and the lateral meniscus is also connected to the popliteus tendon.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Ligaments</b><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: purple;">Patellar Ligament</span>
– continuation of the quads. It is attached above to the margins and apex of
the patella and below the tibial tuberosity.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">Lateral Collateral
Ligament</span> – a cord-like ligament that is attached to the lateral femoral
epicondyle (just above the groove for the popliteus tendon) and the lateral
fibular head. It is separated from the fibrous membrane by a bursa.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #3d85c6;">Medial Collateral
Ligament </span>– a broad and flat ligament that is attached by much of its deep
surface to the underlying fibrous membrane. It is attached to the medial
femoral epicondyle just inferior to the adductor tubercle and the medial
surface of the tibia above and behind the attachments of Sartorius, gracilis
and semitendinosus. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #e69138;">Transverse Ligament</span>
– Connect the anterior external regions of the lateral and medial menisci
within the knee joint, sitting behind the infrapatellar fat pad.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #cc0000;">Anterior Cruciate
Ligament </span>– attaches to a facet on the anterior intercondylar area of the
tibia and a facet at the posterior lateral wall of the intercondylar femoral
fossa. It prevents anterior displacement of the tibia relative to the femur.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #741b47;">Posterior Cruciate
Ligament</span> – attaches to the posterior intercondylar area of the tibia and
medial wall of the intercondylar femoral fossa. It restricts posterior
displacement.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The ACL crosses the PCL laterally
as they pass through the intercondylar region.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;"><b>Tibiofibular
Joint</b></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">This is a synovial joint between the tibia and fibular that
allows very little movement. The capsule is supported by anterior and posterior
tibiofibular ligaments.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Locking
Mechanism</b><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b><br /></b></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In order to reduce the amount of work required to stand, the
knee joint is ‘locked’. The change in shape and size of the femoral surfaces
facilitates this. In flexion, the surfaces are curved on the posterior aspect
of the femoral condyles. In extension, the surfaces move anteriorly to the flat
areas on the inferior aspect of the femoral condyles. Therefore the joint
becomes more stable in extension due to an increase in the surface area.
Additionally the femur rotates medially on the tibia leading to the associated
ligaments tightening. Furthermore, in standing an individual’s centre of
gravity falls anteriorly to the knee joint further reducing the work required
to stand.</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-80508911030919054922014-02-24T02:31:00.000-08:002014-02-24T03:40:38.138-08:00Strains<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Sprains or strains often present with an<b> <span style="color: #3d85c6;">acute onset of symptoms</span></b>. Eccentric exercise is likely to cause
injury at the musculotendinous junction, making the <b><span style="color: #674ea7;">mechanism of injury</span></b> an important assessment point. <span style="color: #741b47;"><b>Pain</b> </span>is often present, although complete
ruptures present with no/minimal pain. The amount of <span style="color: #6aa84f;"><b>swelling</b> </span>depends partly on the severity and time since injury,
alongside with the area damaged. It can take up to 24 hours for the full extent
of the swelling to become apparent. In a muscle strain<b> <span style="color: #990000;">bleeding </span></b>is common. For an intramuscular haematoma, bleeding is
contained within the sheath resulting in pain and localised swelling. Whereas in
extramuscular haematoma, bleeding spreads throughout the intermuscular spaces
resulting is less pain but with more diffuse swelling.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">More severe strains can be indicated by the symptoms lasting
more than a few days. ROM is primarily limited during the acute phase;
therefore if limited range of motion remains after the pain and swelling
decreases a grade III strain is more likely. Additionally, weakness is also
more common during the acute phase due to painful inhibition of contraction. A ‘pop’
sound can also suggest a grade III strain.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<b><span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Grading
Strains<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></b></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><u><span style="line-height: 115%;">Grade 1</span></u><span style="line-height: 115%;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Less than 5% of the fibres are damaged and the fascia remains
intact. Therefore the bleeding is contained and minimal. Pain is localised with
minimal loss of function. Recovery takes 1-4 weeks.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Treatment includes PRICE, gentle stretching, active movement
and return to function.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><u><span style="line-height: 115%;">Grade 2</span></u><span style="line-height: 115%;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Many fibres are damaged although the fascia remains intact.
The bleeding is considerable but remains contained. Pain is significant enough
to reduce contraction. Recovery takes 3-6 weeks.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Treatment includes PRICE, stretches at 24 hours and active
movement.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<u><span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Grade 3<o:p></o:p></span></span></u></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Severe number of fibres are damaged and the fascia is
disrupted. There is considerable bleeding that may diffuse, resulting in a
significant loss of function. Recovery takes 4-8 weeks.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Treatment includes PRICE and stretching after 5-7 days.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><u><span style="line-height: 115%;">Grade 4</span></u><span style="line-height: 115%;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Complete rupture of the muscle with extensive bleeding and
swelling. Contracture of muscle ends begins with complete loss of active
contraction and function. Recovery takes 3 months.<o:p></o:p></span></span></div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;">Treatment includes PRICE and possible surgical management.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;"><b>Treatment</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;"><b><br /></b></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;">In the first 24-48 hours PRICE, gentle mobilisation and analgesics (inc. NSAIDs for rapid return to work or competitive sports) is indicated. </span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;">Physiotherapy and early mobilisation can be started after 2-3 days of rest. Patients should be reviewed after one week to assess for improvement, as those with worsening pain and no functional improvement may have a grade III rupture. Complete ruptures presenting in the first 24-48 hours should undergo surgical repair followed by physiotherapy.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><u>PRICE</u></span><br />
<span style="color: #990000; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;">Protection</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"> - Prevents worsening of injury</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><span style="color: #e69138;">Rest</span> - Avoids pain from movement. Complete immobilisation is not indicated to prevent significant loss of ROM. Even for grade III injuries a functional splintage is strongly suggested.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><span style="color: #3d85c6;">Ice </span>- Reduces pain. Application of ice should be for 10-30 minutes wrapped in cloth to avoid cold injury. Repetition can be as frequent as required, providing the affected part is fully warmed back to body temperature.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><span style="color: #6aa84f;">Compression</span> - Provides comfort by limiting movement and reducing swelling, although should be applied so as to not reduce blood flow. </span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><span style="color: #741b47;">Elevation</span> - Helps to reduce swelling, especially with the affected part above heart level.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><u>Medications</u></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;"><span style="color: #674ea7;">Paracetamol</span> is the first choice for minor injuries and when taken regularly (every 6 hours) is highly effective. <span style="color: #bf9000;">NSAIDs</span> are also effective, but the adverse effects are greater. They may reduce healing time and therefore are effective for people who need to return to work or sport. A topical NSAID is rarely indicated. Paracetamol and NSAIDs can be used, however a combination of 2 NSAIDs is contraindicated.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><br /></span></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><u>Early Mobilisation</u></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;">Prevents stiffness and maintains ROM.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><br /></span></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><u>Therapeutic Ultrasonography</u></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;">Little evidence to support that ultrasound has significant benefit and is no longer recommended.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><br /></span></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><u>Short Wave Diathermy</u></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;">Although commonly used, there is little evidence to support use for swelling, pain and ROM improvements.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><br /></span></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 18.399999618530273px;"><u>Surgery</u></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18.399999618530273px;">Is not indicated within the first 24 hours due to the implications of swelling on repair.</span>rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-27746385156612950672014-01-18T03:24:00.002-08:002014-01-18T03:28:20.198-08:00Low Back Red Flags<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_1" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; margin-bottom: 10px; padding: 10px 15px;">
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">What are Red Flags?<br /><br /><span style="background-color: white; line-height: 15.989583969116211px;"><span style="font-weight: normal !important;">Features, signs and symptoms in a patient with back pain which may indicate serious spinal pathology.</span><br /><br />Features</span></span></strong></h4>
<div>
<div>
<ul style="line-height: 20px;"><span style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1;">
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Previous malignancy</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Age <16 or >50 with new onset of pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Unexpained weight loss</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Longstanding steroid use</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Recent infection</span></li>
</span></ul>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 27.77777862548828px;"><b>Signs & Symptoms</b></span></span></div>
<div style="line-height: 20px;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1;">
</strong>
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<div style="line-height: 20px;">
<ul style="line-height: 20px;"><span style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1;">
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Saddle anaesthesia</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Reduced anal tone</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Generalised neurological deficit</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Progressive spinal deformity</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Urinary retention</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Non-mechanical pain that is worse at rest</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Thoracic pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Fevers/rigors</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">General malaise</span></li>
</span></ul>
</div>
<div style="line-height: 20px;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1;">
</strong></div>
</div>
<div style="line-height: 20px;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.1;">
</strong></div>
</div>
<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_2" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; line-height: 20px; margin-bottom: 10px; padding: 10px 15px;">
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; font-weight: normal !important; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Cancer</span></strong></h4>
<div class="page-block-body" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;">
<ul>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Low back pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">History of cancer</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Unexplained weight loss >10 kg within 6 months</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Age over 50 years or under 17 years old</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Failure to improve with therapy</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pain persists for more than 4 to 6 weeks</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Night pain or pain at rest</span></li>
</ul>
</div>
</div>
<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_3" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; line-height: 20px; margin-bottom: 10px; padding: 10px 15px;">
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; font-weight: normal !important; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Infection</span></strong></h4>
<div class="page-block-body" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;">
<ul>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Low back pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Persistent fever</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">History of intravenous Drug Abuse</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Severe Pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lumbar spine surgery within the last year</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Recent bacterial infection (e.g. UTI, cellulitis or pneumonia)</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Immunocompromised states (e.g. HIV, transplant or diabetes)</span></li>
</ul>
</div>
</div>
<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_4" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; margin-bottom: 10px; padding: 10px 15px;">
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; font-weight: normal !important; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Cauda Equina Syndrome</span></strong></h4>
<div class="page-block-body" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;">
<ul>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Back Pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Urinary incontinence or retention</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Saddle anesthesia</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Anal sphincter tone decreased or fecal incontinence</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Bilateral lower extremity weakness or numbness</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Progressive neurologic deficit</span></li>
<ul>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Major motor weakness</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Major sensory deficit</span></li>
</ul>
<li><span style="line-height: 24.44444465637207px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Erectile dysfunction</span></span></li>
</ul>
</div>
</div>
<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_5" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; line-height: 20px; margin-bottom: 10px; padding: 10px 15px;">
<h3 style="background-color: white; border: none; line-height: inherit; margin: 0px 0px 0.3em; padding: 0px; position: relative; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: small;">Cord Compression</span></h3>
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; font-weight: normal !important; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Low back pain</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Leg weakness</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Limb numbness</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Ataxia</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Urinary retention</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Hyper-reflexia</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Extensor plantars</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Clonus</span></li>
</ul>
</h4>
</div>
<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_6" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; line-height: 20px; margin-bottom: 10px; padding: 10px 15px;">
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; font-weight: normal !important; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Vertebral Fracture</span></strong></h4>
<div class="page-block-body" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;">
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Low back pain</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Prolonged use of c</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">orticosteroid</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">s</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Age greater than 70 years</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">History of o</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">steoporosis</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Mild trauma aged over 50 (or with osteoporosis)</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.6;">Recent significant trauma at any age</span></li>
</ul>
</div>
</div>
<div class="page-block fpnContent-page-block bg-light margin-bottom-10" id="fpnContent-panel-id_7" style="background-color: #fefefe; border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; border: 1px solid rgb(229, 229, 229); box-sizing: border-box; clear: both; line-height: 20px; margin-bottom: 10px; padding: 10px 15px;">
<h4 class="page-block-title" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; font-weight: normal !important; line-height: 1.1; margin-bottom: 10px; margin-top: 5px; text-shadow: none;">
<strong style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">AAA (Abdominal Aortic Aneurysm)</span></strong></h4>
<div class="page-block-body" style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box;">
<ul>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Low back pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Abdominal pulsating mass</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Atherosclerotic vascular disease</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pain at rest or nocturnal pain</span></li>
<li style="border-bottom-left-radius: 0px !important; border-bottom-right-radius: 0px !important; border-top-left-radius: 0px !important; border-top-right-radius: 0px !important; box-sizing: border-box; line-height: 1.6;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Age greater than 60 years</span></li>
</ul>
</div>
</div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com1tag:blogger.com,1999:blog-4226691912745136121.post-19032194610944792442014-01-18T02:53:00.000-08:002014-01-18T02:53:54.922-08:00Tilt Table<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKpOu17RMcJXDNEJWONoD-LHLWLgEuoQB69_01D_g1PC8UHh-x7UZBs2uFhCxvYFI73QpGf3DZcR3o9ZMaPJSsaG29tf9yoqPjLTMpMZIvQ5GkY-ApQ_LRCCXEvuD0355dB_2mmoPBfJM/s1600/Tilt+Table.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKpOu17RMcJXDNEJWONoD-LHLWLgEuoQB69_01D_g1PC8UHh-x7UZBs2uFhCxvYFI73QpGf3DZcR3o9ZMaPJSsaG29tf9yoqPjLTMpMZIvQ5GkY-ApQ_LRCCXEvuD0355dB_2mmoPBfJM/s640/Tilt+Table.png" height="484" width="640" /></a></div>
<br />rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-65058475707689114692013-10-26T10:14:00.002-07:002013-10-26T10:16:05.046-07:00Neurotransmission<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: purple;">Action potential</span> is the maximum positive charge
generated within the axon as a result of a nerve impulse. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Synapses are specialised junctions where
impulses pass from one neuron to the next.</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
</div>
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">A </span><span style="color: #6aa84f; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">sensory </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">neurone carries a nerve impulse from a
receptor into the central nervous system.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">A </span><span style="color: #e69138; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">relay </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">neurone carries a nerve impulse from the
central nervous system to a motor neurone. </span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;">A </span><span style="color: #cc0000; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;">motor </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 115%;">neurone carries a nerve impulse from the central nervous system
to a skeletal muscle. </span></li>
</ul>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">There are two </span><span style="color: #3d85c6; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">main types of cells</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> in the nervous
system:</span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">1. Neurones, that are adapted to carry nerve
impulses <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2. Neuroglia, that provides structural and
metabolic support to the neurones. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The <span style="color: #6aa84f;">basic structure</span> of the neurone is: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">1. A <span style="color: #6aa84f;">cell body </span>containing a nucleus surrounded
by a granular cytoplasm (perikaryon). The granules in the cytoplasm are
referred to as Nissl substance and consist of dense clusters of rough
endoplasmic reticulum. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2. An <span style="color: #6aa84f;">axon</span> which conducts impulses away from the
cell body to other neurones or to effectors. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">3. One or more <span style="color: #6aa84f;">dendrites</span> that are highly
branched processes which carry impulses from specialised receptors or from
adjacent neurones. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">There are <span style="color: purple;">three types of neurones</span>: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed;">
<tbody>
<tr style="height: 10.9pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Type <o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Structure <o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 205.55pt;" valign="top" width="274"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Function <o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr style="height: 36.95pt; mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 36.95pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Multipolar
neurones <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 36.95pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Most common type.
Have many dendrites. <o:p></o:p></span></div>
</td>
<td colspan="2" style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 36.95pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 219.75pt;" valign="top" width="293"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">They act as motor
neurones. <o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 34.65pt; mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 34.65pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Bipolar <br />
neurones <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.65pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Uncommon. Have one
dendrite. <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.65pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 205.55pt;" valign="top" width="274"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">They act as
receptors for sight, smell and balance <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.65pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</td>
</tr>
<tr style="height: 38.5pt; mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 38.5pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pseudo-unipolar
neurones <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 38.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Have one dendrite <o:p></o:p></span></div>
</td>
<td colspan="2" style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 38.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 219.75pt;" valign="top" width="293"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Act as sensory
neurones. <o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
</div>
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Axons are surrounded by Schwann cells, which is
called a myelin sheath.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Myelinated neurones are mostly found in sensory
and motor neurones.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Unmyelinated are found in relay neurons and the
autonomic nervous system.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Between the Schwann cells there are small gaps
where the axon is not covered by myelin, known as nodes of Ranvier.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The conduction velocity of the nerve impulses is
proportional to the diameter of the axon.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The conduction velocity of myelinated neurons is
faster than that of unmyelinated neurons of the same diameter.</span></li>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">When a neurone is not conducting an impulse it
is in </span><i style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">resting state</i><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">.</span></li>
</ul>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="color: #3d85c6; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">In resting state</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">:</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">1. Large negatively charged organic ions are
mainly on the inside the axon. This is because the membrane is impermeable to
them. They cause the overall negative charge inside the axon. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2. Potassium ions are in greater concentration
inside the axon. This is because there protein channels that allow K+ to pass
through. They do not diffuse out down their concentration gradient because they
are attracted by the overall negative charge inside. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">3. Sodium ions are in greater concentration
outside. This is because the permeability of the axon membrane to Na+ is low
and also because they are expelled by ion pumps. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">4. Chloride ion concentration is greater
outside. Their concentration gradient is inward but they are repelled by the
overall negative charge. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #6aa84f;">When an impulse is generated</span>: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">1. Sodium channels open and Na+ enter faster
than they are expelled. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2. The overall charge inside the axon becomes
positive. This is known as the <i>action potential</i>. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">3. The permeability of the membrane to Na+
decreases and the permeability to K+ increases. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">4. K+ flow out. Overall charge inside becomes
negative. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">5. Potassium ions continue to leave and the
overall charge inside becomes slightly more negative than the when in resting
potential. This is called <i>hyperpolarisation</i>. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">6. Resting potential is restored as K+ and Na+ return
to their resting concentration. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>Saltatory conduction
</i>is
when the action potential jumps from one node of Ranvier to the next and takes
place in myelinated axons, greatly increasing the conduction velocity. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">At a synapse an impulse travels from one neurone
to the next. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">There are two main types of synapse: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">1. Electrical. This occurs when the two neurons
are very close together. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2. Chemical. This is the most common. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="color: #cc0000;">In chemical synaptic transmission</span>: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">1. An action potential reaches the synaptic knob
of the presynaptic neurone and calcium channels open. Calcium ions diffuse into
the knob. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2. This increase in calcium ions stimulates the
movement of vesicles containing a transmitter substance towards the presynaptic
membrane. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">3. The vesicles fuse with the membrane and
release their substance by exocytosis into the synaptic cleft. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">4. The transmitter substance diffuses across the
synaptic cleft and binds to receptors on the postsynaptic membrane. This causes
ion channels to open. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">5. The movement of Cl, Na+, K+ in or out of the
postsynaptic neurone generates a postsynaptic potential. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">6. Depending on which ion moves in or out the
postsynaptic membrane is either depolarised or hyperpolarised. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">7. Depolarisation results in the development of
an excitatory postsynaptic potential and hyperpolarisation results in an
inhibitory postsynaptic potential. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">8. The transmitter substance is quickly removed
by enzyme action and diffusion.</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">There are four<span style="color: #e69138;"> main groups of transmitter
</span>substances:</span></div>
<br />
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed;">
<tbody>
<tr style="height: 10.9pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Transmitter
substance <o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Function
<o:p></o:p></span></b></div>
</td>
</tr>
<tr style="height: 24.7pt; mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 24.7pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acetylcholine <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 24.7pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Found at
neuromuscular junctions and many parts of the brain <o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 24.7pt; mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 24.7pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Amines e.g.
noradrenaline. <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 24.7pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In the sympathetic
nervous system and some parts of the central nervous system <o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 24.7pt; mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 24.7pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Amino acids e.g.
glycine <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 24.7pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inhibitory
substance in nerve pathways in the spinal cord. <o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 10.9pt; mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 10.9pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Neuropeptides e.g. endorphins <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 10.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 206.55pt;" valign="top" width="275"><div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Regions of the
brain. Block pain. <o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com1tag:blogger.com,1999:blog-4226691912745136121.post-70838835177508430562013-10-26T10:01:00.001-07:002013-10-26T10:01:25.492-07:00Legionella Pneumonia<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Caused by an aerobic bacteria belonging to the genus Legionella, which contains 20-30 species. Most commonly cause by Legionella pneumophilia, a gram negative bacteria. </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; vertical-align: baseline;">The
bacteria can be found in any freshwater environment but in low numbers due to
the low temperature. It is when the water is taken into artificial water
systems and the temperature arises to around 20-45 degrees with impurities such
as rust, </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; vertical-align: baseline;">limescale</span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; vertical-align: baseline;"> or algae that they start to
multiply. </span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; vertical-align: baseline;"><br /></span>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; vertical-align: baseline;"><span style="color: #3d85c6;">Vulnerable water systems include</span>:</span><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Cooling towers</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Air conditioning systems</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Water systems for large buildings, such as hospitals, hotels or sports complexes</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="color: #6aa84f; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Symptoms</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Flu like symptoms including mild headaches, fever, muscle pain and chills.</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">As the disease progresses to the lungs, a persistant cough appears with chest pains and shortness of breath.</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Cough progresses from dry to mucus filled, possibly with blood</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Approximately 30% of people also encounter D&V</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Around 50% show signs of mental confusion</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
</div>
<div>
<span style="color: #e69138; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Risk Factors</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Aged over 50 years</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Smoking</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Kidney Ulcer</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Diabetes</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">COPD</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
</div>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Patients commonly end up on ICU, sometimes with a tracheostomy and the use of the Bird (IPPB) with vibs.</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com2tag:blogger.com,1999:blog-4226691912745136121.post-36195178279367866452013-10-25T13:05:00.003-07:002013-10-25T13:06:33.697-07:00Frozen Shoulder<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Frozen Shoulder has no specific definition or cause. It can be primary (idiopathic) or secondary (T2DM, CV disease, hemiparesis, trauma or TB). It is also known as adhesive capsulitis, painful stiff shoulder, retractile capsulitis and monoarticular arthritis.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="color: #6aa84f; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Symptoms</span><br />
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pain felt near deltoid insertion</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inability to sleep on affected side</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Painful and incomplete elevation and ER</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">No primary diagnostic test; AROM=PROM</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Mistakable for bicipital tendonitis or impingement</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Standard tests (e.g. Neers) positive during the painful phase as they stretch the joint capsule</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">ER most restricted, abduction, less, IR less still (Cyriax, 1982) although arthritis and fractures could cause a similar capsular pattern</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Negative x-rays</span></li>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="color: #e69138; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Progression</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Stage One - 'Freezing Stage'</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Progressive stiffening</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Loss of ROM</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Increasing pain on mvt</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">2-9 months</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Stage Two - 'Frozen Stage'</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Gradual decrease in pain, stiffness remains</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Considerable loss of ROM</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">4-12 months</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Stage Three - 'Thawing Stage'</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Improvement in ROM</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">12-42 months</span></li>
</ul>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
</div>
<div>
<span style="color: #3d85c6; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Treatment</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Conservative Treatment</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Medication</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">NSAIDS, opiods</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Physio</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Advice and education</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Superficial heat or cold therapy</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Electrotherapy</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Exercise and mobilisation</span></li>
</ul>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Minimally Invasive Treatment</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Injections</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Hydrodilation</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Corticosteroids</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Sodium hyaluronate</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Acupuncture</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Invasive Treatment</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Arthroscopic capsular release</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Manipulation under anaesthetic</span></li>
</ul>
</ul>
<div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></div>
</div>
<div>
<span style="color: purple; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Physiotherapy Treatment - Stage III</span></div>
<div>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Home Exercise Programme</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">ROM and strengthening</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Progress from static to dynamic strengthening</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Shoulde retraction and rolls</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pendular mvts in forward leaning</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Mobilisation</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">End range and mobilisations with movement more effective than mid-range mobilisation (Yang et al, 2007)</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Shoulder classes</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Long-term</span></li>
</ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Education</span></li>
<ul>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Up to 17% of patients experience frozen shoulder in their other arm within 5 years</span></li>
</ul>
</ul>
</div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com9tag:blogger.com,1999:blog-4226691912745136121.post-50492322090330344892013-10-25T12:47:00.000-07:002013-10-25T13:11:00.741-07:00Duchenne Muscular Dystrophy<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• Most common muscular dystrophy</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• Progresses more rapidly than
other dystrophies</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• 20-30 of 100,000 males</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• X-linked recessive</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• Absence of large protein: dystrophin</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• Results in abnormal muscle
degeneration with fat and connective tissue regeneration in its place</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• Pseudohypertrophy</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">• Results in muscle
weakness associated with wasting</span></div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div style="direction: ltr; line-height: 80%; margin-bottom: 0pt; margin-left: 0.38in; margin-top: 5.76pt; text-indent: -0.38in; unicode-bidi: embed; vertical-align: baseline;">
<div class="separator" style="clear: both; text-align: center;">
</div>
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rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com5tag:blogger.com,1999:blog-4226691912745136121.post-70829938819284261792013-10-25T11:59:00.000-07:002013-10-25T11:59:46.464-07:00Cerebellum<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
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<li><span style="color: #333333; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">Primary function is to evaluate how well movements initiated by motor areas are actually being carried out eg coordination of movement</span></li>
<li><span style="color: #333333; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">Cognition (acquisition of knowledge) eg learning from mistakes and feedback loop through thalamus</span></li>
<li><span style="color: #333333; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">Regulates balance and posture</span></li>
<li><span style="color: #333333; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">Found in the posterior fossa, inferior to the occipital lobe. </span></li>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Three Areas:</b></span><br />
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<span style="color: #3d85c6; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-style: italic; line-height: 1.15; white-space: pre-wrap;">Vestibulocerebellum</span><br />
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Found on the inferior surface in the Flocculonodular (flok-u-lo-NOD-u-lar) lobe</span></span></div>
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Receives vestibular and visual input</span></span></div>
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Contributes to equilibrium and balance</span></span></div>
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - A lesion in this area results in disturbances in posture and gait</span></span></div>
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<span style="color: #e69138; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-style: italic; line-height: 1.15; white-space: pre-wrap;">Spinocerebellum</span><br />
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Found in the centre in the vermis</span></span></div>
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Receives proprioceptive input</span></span></div>
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<span style="color: #6aa84f; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-style: italic; line-height: 1.15; white-space: pre-wrap;">Cerebrocerebellum</span><br />
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Found in the lateral hemispheres (anterior and posterior lobes)</span></span></div>
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<span style="background-color: transparent; color: #333333; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"> - Governs subconscious aspects of skeletal muscle movements, ensuring a smooth orderly sequence of muscle contraction</span></span></div>
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<span style="color: #333333; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">Input and output is via the three pairs of large tracts known as the superior, middle and inferior peduncles.</span><span style="color: #333333; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">Dysfunction of the cerebellum will result in the inability to perform smooth directed movements, eg ataxia, kinetic tremor dysmetria (inaccuracy)</span></div>
rawr!http://www.blogger.com/profile/02543271236188530163noreply@blogger.com1tag:blogger.com,1999:blog-4226691912745136121.post-61166837927373354192013-10-24T07:00:00.004-07:002013-10-24T07:04:09.229-07:00Dual Tasks<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18px;"><span style="background-color: transparent; color: #e69138; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dual task</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> performance can be defined as an individual’s capability to complete two tasks concurrently (Pashler, 1994; O’Shea, Morris & Iansek, 2002; Yang, Wang, Chen & Kao, 2007; Kizony et al, 2010). The ability to </span><span style="background-color: transparent; color: #e69138; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> affects activities of daily living on a vast scale (O’Shea, Morris & Iansek, 2002; Sethi & Raja, 2012), with reduced </span><span style="background-color: transparent; color: #e69138; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task </span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">performance defined as a</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: #cc0000; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task cost</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> (McCulloch, 2007). </span><span style="background-color: transparent; color: #cc0000; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dual task costs (DTC)</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> have greater functional decrement in persons with neurological impairment (Kizony et al, 2010), which may result from pathology, such as Multiple Sclerosis (MS) (Sosnoff et al, 2013) and Parkinson’s Disease (PD) (O’Shea, Morris & Iansek, 2002; Mak, Yu & Hui-Chan, 2013), or natural aging processes (Beauchet et al, 2009; Yogev-Seligmann, Giladi, Brozgol & Hausdorff, 2010). However, the application of </span><span style="background-color: transparent; color: #6aa84f; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task theories</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> is relevant to the wider patient population, with few studies researching the effect of </span><span style="background-color: transparent; color: #cc0000; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task costs</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> on a young, healthy population. Therefore, further research in this area may facilitate development of </span><span class="Apple-style-span" style="color: #3d85c6;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> strategies</span></span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> applicable to a wider spectrum of clinical specialities. </span><span style="background-color: transparent; color: black; font-style: italic; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></span><br /><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="line-height: 18px; white-space: pre-wrap;"><i><br /></i></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 18px;"><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Previous research has looked at the benefits of using </span><span style="background-color: transparent; color: #3d85c6; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task strategies</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> as part of assessment, for example post-stroke (Yang, Wang, Chen & Kao, 2007) and to predict risk of falls (Beauchet et al, 2009). Additionally, </span><span style="background-color: transparent; color: #e69138; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual tasks</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> can be used as part of rehabilitation to improve safety in functional performance (Albinet, Bernard & Palut, 2006), for example by reducing </span><span style="background-color: transparent; color: #cc0000; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task costs</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> in persons with dementia (Schwenk, Zieschang, Oster & Hauer, 2010), improving balance in persons with a history of falls (Silsupadol, Siu, Shumway-Cook & Woollacott, 2006) and improving gait in older adults for safer road crossing (Silsupadol et al, 2009) and poststroke (Salbach et al, 2005; Yang, Wang, Chen & Kao, 2007). Furthermore, the use of traffic lights as an audio-visual cue can be utilised to enhance </span><span style="background-color: transparent; color: #e69138; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> walking performance in persons with PD (Mak, Yu & Hui-Chan, 2013). The frontal lobes are the areas of the brain most affected by the natural aging process, thereby implicating co-ordination and management functions (Kramer & Larish, 1995). This may partially explain why </span><span style="background-color: transparent; color: #e69138; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">dual task</span><span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> decrement is reduced in a younger population compared to in an older population.</span></span><br /><br /><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #6aa84f;">Dual task theories</span></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> can be used to understand how the interaction between cognitive, perceptual, mechanical, and neurological components of </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: #e69138;">dual task</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> performance results in a </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: #cc0000;">dual task cost </span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">(Huang & Mercer, 2001). The bottleneck theory suggests that when two tasks are performed simultaneously, they require the use of the same neural machinery at the same point in time. The critical operations are carried out sequentially (Pashler, 1994), with one task delayed until the other task has been processed. For example, the bottleneck theory can be used to explain why some older adults stop walking in order to talk (Beauchet et al, 2009). The capacity-sharing model suggests that two tasks can be processed in parallel by dividing capacity between two or more resource pools. For example, an individual can walk and talk simultaneously but the speed or accuracy of one or both tasks will decrease. According to Pashler (1994) the crosstalk model assumes that similar tasks are easier to perform concurrently as use of the same pathway utilises less attentional resources and therefore increases the efficiency of processing. Navon & Miller (1987) state that crosstalk refers to the features or stimuli of two tasks overlapping. All three theories suggest that when more than one task is performed at any given instant, there is reduced capacity for individual tasks, resulting in a decline in performance in one or both tasks.</span><br /><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #3d85c6;">Dual tasks strategies</span></span> are commonly used in falls assessment and rehabilitation as a progressive tool that facilitates functional training. It is additionally used in vestibular rehabilitation to train the components of balance to compensate for vestibular dysfunction. This can be transferred to neurological rehabilitation or musculoskeletal function to deal with reduced vision, central inputs or proprioception (for example with an ACL injury).</span></div>
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