Presented an in-service on the evidence behind and the application of thoracic spine manipulation to the Martinsburg VA Medical Center's rehabilitation staff including: 7 PTs, 8 PTAs, 3 OTs, and 4 students.
This document discusses muscle energy technique (MET), a manual therapy procedure that involves voluntary muscle contraction against resistance applied by a therapist. It describes the types of muscle contractions involved - isotonic, eccentric, concentric, and isometric. MET uses post-isometric relaxation and reciprocal inhibition to facilitate muscle lengthening. Indications for MET include acute muscle spasm and restricted joints, while contraindications are acute injuries and unstable joints. Benefits of MET include restoring normal muscle tone, strengthening weak muscles, and improved joint mobility. Guidelines are provided for safely applying light contractions over multiple repetitions.
Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.
What is ESWT:
Shockwave Therapy is a noninvasive method that uses acoustive waves to treat varies musculoskeletal conditions.
Extracorporeal = outside body.
Shockwave = intense, short energy wave travelling faster than speed of sound.
Well-controlled mechanical insult to tissue.
Fast pain reliever and restore mobility.
The document discusses neurodynamics and summarizes key points in 3 sentences:
Neurodynamics examines the nervous system as a continuum that can withstand tension or sliding longitudinally and transversely. Proper sequencing and structural differentiation of movements is important for neurodynamic testing to isolate neural responses from musculoskeletal influences. Abnormal neurogenic responses on testing can be overt, reproducing symptoms, or covert, evoking different symptoms, and determining the relevance of the response guides clinical decisions.
This document discusses neurodynamic treatment techniques for the mechanical interface and neural components of the nervous system. It describes openers and closers to produce opening and closing actions around neural tissue. Slider and tensioner techniques are also explained to induce sliding and tension within neural tissue. Guidelines are provided for applying each technique, including when to use them, appropriate dosages, and progressing treatments away from or toward the source of pain. The goal is to address neuropathodynamic dysfunctions through specific movements and positions of the limbs and spine.
Evidence based practice in physiotherapy.pptxDrNamrataMane
The document discusses evidence-based practice (EBP) in physical therapy. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and describes the 5 steps of EBP as formulating a question, finding evidence, appraising evidence, implementing evidence, and evaluating outcomes. The document also explores barriers to EBP, such as lack of time and understanding of statistics, and facilitators, like access to online research summaries.
The document defines proprioceptive neuromuscular facilitation (PNF) as an exercise approach based on functional anatomy and neurophysiology. It was developed in the 1940s to mobilize patients' reserves and help them achieve their highest function. PNF uses techniques like resistance, stretch, traction and timing of contractions/relaxations to facilitate muscle strength, endurance and range of motion. Common PNF techniques include rhythmic initiation, repeated contraction, slow reversal and contract-relax stretching. PNF patterns target specific muscle groups through combinations of flexion/extension, abduction/adduction and rotation.
History of Manual Therapy and ArthrologyChrisBacchus
The document provides a history of manual therapy, outlining important figures and developments from Hippocrates in 460 BC to current practice. It discusses the evolution of osteopathy, chiropractic, and physical therapy. Key developments include Andrew Still establishing osteopathy in the US in 1874, Daniel Palmer founding chiropractic in 1895, and the establishment of physical therapy programs and professional organizations in the early 20th century. Current manual therapy practice draws from various techniques and philosophies.
Kinetics and Kinematics of Gait summarizes gait terminology, phases, joint motion, determinants, and the kinetics and kinematics of the trunk and upper extremities during gait. It describes the six determinants of gait including pelvic rotation and tilting, knee flexion in stance, and foot and knee mechanisms which function to minimize center of gravity displacement. The document also outlines the muscle activity, internal joint moments, and energy requirements including potential and kinetic energy exchange during the gait cycle.
This document outlines five principles of treatment for orthopedic problems: techniques, passive movements, active movements, injection and infiltration, and deep transverse friction massage. It describes the indications, contraindications, and techniques for deep transverse friction massage. This type of connective tissue massage was developed by Cyriax to treat soft tissue injuries from trauma or overuse. While the exact mechanism is unknown, it is believed to provide pain relief and better alignment of connective tissue fibers. When applied correctly, deep transverse friction massage is usually not painful and can help resolve soft tissue issues without steroid injections.
Kinesio tape was developed in the 1970s by a Japanese chiropractor and aims to enhance sports performance and treat orthopedic and neurological conditions. It is applied to the skin over muscles and joints to provide support without restricting range of motion while stimulating the sensory motor system to increase blood flow and facilitate or inhibit muscle contraction depending on the taping technique used. Studies have shown Kinesio taping can provide pain relief and faster recovery for various injuries like groin pain, back pain, and ankle sprains when applied by a certified physiotherapist.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Muscle energy techniques (MET) involve voluntary muscle contractions by the patient against a counterforce applied by the practitioner. The goal is to move restrictive barriers and normalize muscle and fascial restrictions. Key elements include controlled joint positioning, patient-applied muscle contractions in a specific direction, and operator counterforce. MET can be used to lengthen shortened muscles, strengthen weakened muscles, reduce pain and edema, and increase joint mobility. It relies on principles like post-isometric relaxation and reciprocal inhibition. Careful technique and patient/practitioner coordination are important for success. MET can help many somatic dysfunctions but requires an understanding of indications and contraindications.
Trigger points are hyperirritable spots within taut bands of muscle that are painful on compression and can cause referred pain patterns. They are commonly caused by overload, injury, lack of exercise, or poor posture in sedentary individuals between 27-55 years old. Trigger points have two types - active points that cause pain at rest and latent points that cause pain with direct pressure or muscle contraction. Electrotherapy can stimulate the body's endogenous opiate system to relieve pain by using low frequency stimulation below 10 Hz with long pulse durations to activate areas of the brain and spinal cord that inhibit nociception.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
PNF is a treatment approach based on the principle that all patients have untapped potential. It integrates principles of motor control and motor learning. The basic procedures of PNF include applying resistance, using irradiation and reinforcement, providing manual contact and verbal cues, and incorporating body positioning, vision, traction, approximation, stretching, timing, and movement patterns. The goal is to facilitate muscle contractions and motor control through optimal resistance applied in different ways like resisting specific motions or muscle groups.
This document summarizes evidence on the use of manual therapy and manipulation in the treatment of shoulder impingement syndrome (SIS). Several randomized controlled trials have found that combining manual therapy/manipulation with exercise therapy leads to better outcomes in pain, strength, and function compared to exercise therapy alone. While more research is still needed, the existing evidence supports the use of manipulation as a component of comprehensive treatment for SIS. Manipulation appears to be a safe intervention when applied properly to appropriate patients by a skilled provider.
This document discusses spine mobilization and manipulation techniques. It defines mobilization and manipulation as skilled passive movements applied to joints and soft tissues. Manipulation involves high velocity, low amplitude movements to restore mobility, while mobilization uses varying speeds and amplitudes. The effects include mechanical restoration of tissue extensibility, range of motion improvements, and neurophysiological impacts like reduced pain and altered muscle tone/motor control. Proper technique depends on factors like the joint involved and goal of the treatment.
- Ant Capital Partners is a small, private equity firm in Japan that focuses on operational improvements for small-to-medium enterprises (SMEs) through buyout deals typically between $50-150 million.
- While growth is limited in Japan's stagnant economy, SMEs remain an opportunity as over half of publicly listed companies have less than $100 million in market cap.
- In response to SMEs needing to expand overseas, Ant has taken on more cross-border deals, establishing a Hong Kong office and completing exits in China. This cross-border strategy will be integral to their future work.
The document lists 30 items to be judged at the 2014 Meats Judging Contest, including 10 processed meats and 20 retail cuts of meat. The processed meats section includes items like bologna, pepper bacon, frankfurters, and bratwurst. The retail cuts section covers a variety of beef, pork, and lamb cuts, such as chuck flat iron steak, brisket, top loin steak, oxtail, pork belly, lamb shank, and more. Contestants will evaluate and rank the quality of these various meats.
The Alternative Investment Fund Managers Directive (AIFMD) introduced by the European Commission aims to protect investors, but it poses challenges for Asian private equity firms seeking capital from European investors. To comply, firms must safeguard assets, keep transparent records and reports. However, few Asian firms are following their European peers in embracing the directive's requirements. Non-compliance could be considered a criminal offense and allow investors to revoke investments. As a result, some Asian managers avoid marketing directly to European investors or rely on reverse solicitation to circumvent restrictions, though this may limit their access to capital. The complex regulations have led to confusion and could negatively impact both Asian firms and European limited partners.
Emerging markets have experienced increased volatility recently, slowing GDP growth and disappointing returns from major countries like China, India, and Brazil. This has caused some investors to pause or reallocate funds to developed markets like the US. However, total fundraising for emerging markets private equity is up this year compared to last despite the macro challenges. While selectivity has increased, the fundamental promise of long-term growth in emerging economies remains intact, and volatility may create opportunities for strong managers.
El documento define límite y función, y explica que una función tiene límite en un punto si puede aproximarse a un valor L cuando se acerca indefinidamente a ese punto. También establece que para dos funciones con límite en un punto, el límite de la suma es la suma de los límites individuales, el límite de la diferencia es la diferencia de los límites, el límite del producto es el producto de los límites, y el límite del cociente es el cociente de los límites siempre que el límite del denominador sea distinto de cero.
This document summarizes evidence-based treatment approaches for shoulder pain, specifically shoulder impingement syndrome (SIS) and adhesive capsulitis. For SIS, manual therapy combined with exercise is more effective than exercise or usual care alone in reducing pain and improving function and strength. For adhesive capsulitis, corticosteroid injections and capsular distension provide short-term benefits but effects are not long-lasting. Manipulation is commonly used but risks injury, especially in osteoporotic patients. Physical therapy focused on stretching and strengthening is usually recommended first before more invasive treatments.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
The document discusses shoulder pain, specifically subacromial pain/non-specific shoulder pain. It notes that shoulder pain is prevalent, can impact daily activities, and for 40% of patients the pain is ongoing or recurrent after 12 months. Imaging and physical exams are not always reliable in diagnosing the source of pain. Exercise appears to be the most promising intervention for shoulder pain, though what type or amount of exercise is unclear. A proposed intervention focuses on teaching patients self-management skills and a home exercise program with 1-5 sessions from a physiotherapist and proactive follow-up.
manipulations for the cervical and lumbar spineamj20008
The document summarizes research on spinal manipulation for low back pain. It finds that manipulation is more effective than sham therapy or therapies deemed ineffective/harmful for acute low back pain. However, manipulation provides no significant advantage over other treatments like general practitioner care, analgesics, physical therapy, exercises, or back school. The document also outlines potential side effects of manipulation and clinical prediction rules to determine which patients are most likely to benefit from manipulation.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
The document summarizes a study that evaluated the efficacy of a joint mobilization apparatus in treating frozen shoulder. The study involved 48 patients with frozen shoulder who were randomly assigned to either a control group receiving regular physical therapy or an experimental group receiving physical therapy plus treatment with the joint mobilization apparatus. Outcome measures including range of motion and pain were assessed at baseline and after 4 and 8 weeks of treatment. The results showed that the experimental group had significantly greater improvements in range of motion and reductions in pain levels compared to the control group receiving only physical therapy. The study concluded that the joint mobilization apparatus combined with physical therapy can further improve shoulder function and relieve pain in patients with frozen shoulder compared to physical therapy alone.
The document summarizes key studies on the effectiveness of conservative treatment for multidirectional instability (MDI). Three studies found that conservative treatment including strengthening exercises improved some outcomes like muscle activation patterns and kinematics, but did not fully restore shoulders to normal. One study found that after 8 years, only 30% of patients had good results with conservative treatment alone. Overall, the studies suggest that while conservative treatment can provide some benefits for MDI, surgery may be needed for full resolution of symptoms for many patients.
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
This study examined the effects of using the upper limb tension test (ULTT) as a neural mobilization technique in addition to conservative treatment for patients with cervical radiculopathy. 40 patients were divided into a control group receiving conservative treatment only and an experimental group receiving conservative treatment plus ULTT. Outcome measures of cervical range of motion and pain were assessed before and after treatment. The results showed significantly greater improvements in cervical flexion, extension, and side flexion ranges of motion as well as pain levels for the experimental group compared to the control group, indicating that ULTT provides additional benefits for managing symptoms of cervical radiculopathy.
Basic concepts of Manual Muscle Testing (MMT)JebarajFletcher
Manual muscle testing is a procedure used to evaluate muscle strength. It involves manually applying resistance against a patient's movement through their available range of motion. There are several types of manual muscle tests including tests of individual muscles, muscle groups, and functional tests. The results are often graded on a scale like the Oxford scale. Manual muscle testing provides important information for diagnoses, evaluating treatment effectiveness, and tracking patient progress. It requires skill and standardization to obtain reliable results.
The document summarizes a study that compared the effectiveness of different combinations of manual therapy and exercise for treating mechanical neck pain. All patients received neck exercises and cervical spine mobilization. Additionally, some patients received thoracic spine manipulation. Those who received all three treatments experienced greater reductions in neck pain and improvements in daily functioning after one week compared to those who only received exercises and cervical mobilization. The combination of neck exercises, cervical mobilization, and thoracic manipulation led to quicker relief of neck pain symptoms.
The document summarizes recent advances in the management of hemiplegic shoulder pain in stroke patients. It discusses key factors that contribute to shoulder pain post-stroke like muscle weakness, tone alterations, and subluxation. Interventions studied till 2019 included cryotherapy, mobilization, ultrasound, TENS, PNF and exercise. Recent studies from 2020-2023 investigated extracorporeal shock wave therapy, kinesiotaping, sling exercise therapy, and trigger point dry needling. Meta-analyses found these newer interventions improved pain, function and quality of life compared to conventional treatment alone. Mechanisms of benefit included proprioceptive stimulation, muscle activation, joint support and increased blood flow.
Intermittent cervical traction for treatment of neck pain a meta-analysis of ...Yang Jheng-Dao
Intermittent cervical traction (ICT) involves alternating periods of traction and rest to treat neck pain. A meta-analysis of 7 randomized controlled trials assessed the effectiveness of ICT for neck pain. ICT provided short-term pain relief immediately after treatment but did not show clear benefits for functional improvement. ICT was generally well-tolerated, with some studies reporting mild muscle pain in 8-31% of patients but no severe adverse effects. The analysis was limited by heterogeneous ICT protocols between studies and unclear risk of bias in some studies. Further high-quality research is still needed to determine the long-term effects and optimal protocol for ICT.
Low frequency anteroposterior mobilization of the talus was found to be more effective at increasing ankle dorsiflexion range of motion than high frequency mobilization in healthy subjects. The low frequency technique allowed more time for plastic deformation of the connective tissues to occur, in line with their viscoelastic properties. Future studies should investigate these mobilization techniques in patients with acute, subacute, or chronic ankle conditions.
This study examined whether early improvement in neck function predicted overall response to a cervical strengthening program for chronic neck pain. 214 patients completed a 3-week strengthening program and were assessed for changes in neck disability index (NDI) scores. Patients with a positive change in NDI scores after 3 weeks had a 25 times greater odds of overall improvement. Early improvement likely reflects motor skill acquisition rather than muscle hypertrophy. While early responders saw small additional gains, continued strengthening may provide further benefits like reduced muscle co-activation.
A 50-year-old female presented with right forearm pain and limited shoulder range of motion. Her pain was reproduced with wrist flexion and extension tests. Her grip strength was decreased. Based on her history and examination findings, she was diagnosed with chronic medial epicondylalgia. She was treated with joint and soft tissue mobilization, eccentric exercises, and functional strengthening over 4 weeks. Her pain, range of motion, grip strength, and function all improved, meeting her goals of care.
Case presentation of a 14-year-old female presenting as unilateral breast enlargement and found to have a giant breast lipoma. The tumour was successfully excised with the result that the presumed unilateral breast enlargement reverting back to normal. A review of management including a photo of the removed Giant Lipoma is presented.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Why Does Seminal Vesiculitis Causes Jelly-like Sperm.pptxAmandaChou9
Seminal vesiculitis can cause jelly-like sperm. Fortunately, herbal medicine Diuretic and Anti-inflammatory Pill can eliminate symptoms and cure the disease.
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EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxsouravpaul769171
Theoretically, gene therapy is the permanent solution for genetic diseases. But it has several complexities. At its current stage, it is not accessible to most people due to its huge cost. A breakthrough may come anytime and a day may come when almost every disease will have a gene therapy Gene therapy have the potential to revolutionize the practice of medicine.
Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 3 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/pCU7Plqbo-E
- Video recording of this lecture in Arabic language: https://youtu.be/kbDs1uaeyyo
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, discuss NSCLC in this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Coronary Circulation and Ischemic Heart Disease_AntiCopy.pdfMedicoseAcademics
In this lecture, we delve into the intricate anatomy and physiology of the coronary blood supply, a crucial aspect of cardiac function. We begin by examining the physiological anatomy of the coronary arteries, which lie on the heart's surface and penetrate the cardiac muscle mass to supply essential nutrients. Notably, only the innermost layer of the endocardial surface receives direct nourishment from the blood within the cardiac chambers.
We then explore the specifics of coronary circulation, including the dynamics of blood flow at rest and during strenuous activity. The impact of cardiac muscle compression on coronary blood flow, particularly during systole and diastole, is discussed, highlighting why this phenomenon is more pronounced in the left ventricle than the right.
Regulation of coronary circulation is a complex process influenced by autonomic and local metabolic factors. We discuss the roles of sympathetic and parasympathetic nerves, emphasizing the dominance of local metabolic factors such as hypoxia and adenosine in coronary vasodilation. Concepts like autoregulation, active hyperemia, and reactive hyperemia are explained to illustrate how the heart adjusts blood flow to meet varying oxygen demands.
Ischemic heart disease is a major focus, with an exploration of acute coronary artery occlusion, myocardial infarction, and subsequent physiological changes. The lecture covers the progression from acute occlusion to infarction, the body's compensatory mechanisms, and the potential complications leading to death, such as cardiac failure, pulmonary edema, fibrillation, and cardiac rupture.
We also examine coronary steal syndrome, a condition where increased cardiac activity diverts blood flow away from ischemic areas, exacerbating the condition. The long-term impact of myocardial infarction on cardiac reserve is discussed, showing how the heart's capacity to handle increased workloads is significantly reduced.
Angina pectoris, a common manifestation of ischemic heart disease, is analyzed in terms of its causes, presentation, and referred pain patterns. We identify factors that exacerbate anginal pain and discuss both medical and surgical treatment options.
Finally, the lecture includes a case study to apply theoretical knowledge to a practical scenario, helping students understand the real-world implications of coronary circulation and ischemic heart disease. The role of biochemical factors in cardiac pain and the interpretation of ECG changes in myocardial infarction are also covered.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
2. What is a Spinal Manipulation?
Definition (IFOMPT):
“A passive, high velocity, low amplitude
thrust applied to a joint complex within
its anatomical limit with the intent to
restore optimal motion, function,
and/or to reduce pain.”
Names Used:
• Thrust Joint Manipulation (TJM)
• HVLA Thrust
• Grade V Mobilization
Who can Perform?
• PT’s, OT’s, DC’s, MD’s & DO’s
3. Reasons to Mobilize the T-Spine!
Easy to learn, use, and apply.
• Manipulation + exercise = Better than exercise alone for pain/disability
• Manipulation + mobilizations = Better than mobilizations alone for pain/disability
Overview of Benefits:
• Temporary relief of musculoskeletal pain
• Temporary increase of spinal mobility
• Increases benefits from HEP
• Can help improve compliance to HEP
4. Contraindications
• Any pathology that leads to significant bone weakening
• Osteoporosis, fractures, etc.
• Spinal Surgery*:
• Fusions, laminectomies, etc.
• Pathology:
• Active infection, active cancer, etc.
• Vascular:
• aortic aneurism, bleeding into joints
• Neurological:
• Nerve root compression with increasing neurological deficit
• Lack of diagnosis
• Patient positioning can not be achieved because of pain or resistance.
5. Who Benefits from T-spine Manipulation?
Mechanical Neck Pain
• Moderate evidence for immediate improvements in pain and disability
• Majority of studies done on 2-day or 1-week outcomes
• 75% of patients improve >2 points on the Numeric Pain Rating Scale (NPRS)
• 70% of patients improve >15% on the Neck Disability Score (NDI)
• Growing evidence for long term improvements in pain and disability
• Improvements in pain and disability can last up to 6 months following treatment
• 80% of patients had a GROC of 5+ by 6 months following treatment
• Global Rating of Change (GROC) of >5+ is indicative of moderate changes in status
Subacromial Impingement Syndrome (SAIS or SIS)
• Growing evidence for short-term and long-term improvements in pain/disability
• Mostly case studies, and added to programs in RCT’s for other interventions
6. Mechanical Neck Pain
• 70% of the population will have
an episode at some point
• Most prevalent in the 4th and 5th
decade of life
• Majority of neck pain is
mechanical in nature
• Can interfere w/ ADLs and
become a source of chronic pain
7. Subacromial Impingement Syndrome (SAIS)
• Shoulder pain affects 16-21% of
the population
• Second only to low back pain in
prevalence
• SAIS accounts for 44-60% of all
conditions of the shoulder
• Patients not treated may
develop functional impairments
with chronic symptoms.
8. Cross et al. (2011) Thoracic Spine Thrust Manipulation
Improves Pain, Range of Motion, and Self-Reported Function in
Patients With Mechanical Neck Pain: SR
Objective:
• Determine effects of T-spine thrust manipulation on pain, ROM, and self
reported function in patients with mechanical neck pain.
Methods:
• 6 high quality RCT’s examined
Conclusion:
• Thoracic spine thrust manipulation may provide short-term improvement in
patients with acute or subacute mechanical neck pain.
• May provide short-term and long-term improvement in neck disability.
• Manipulation + exercise = Better than exercise alone for pain/disability
• Manipulation + mobilizations = Better than mobilizations alone for pain/disability
• Limited number of RCT’s and limited generalizability.
11. Gonzales-Iglesias et al. (2009) Thoracic Spine Manipulation for
the Management of Patients with Neck Pain: RCT
Objective:
• Would patients with mechanical neck pain experience superior outcomes with
thoracic manipulation compared to not receiving it?
Methods:
• 45 participants, ages 18-45, and no contraindications
• Control Group:
• Electro/thermal therapy (6 visits over 3 weeks)
• Experimental Group:
• Control protocol + T-spine manipulation (6 visits, and 1x manipulation/wk over 3 weeks)
Outcomes:
• T-spine manipulation group experienced greater improvements in pain, cervical
ROM, and disability than electro/thermal therapy alone.
• Outcomes were maintained at the 2 week and 4 week follow ups.
• Average improvement of pain by 2.83 points and disability by 13.2%
13. Cleland et al. (2010) Examination of a CPR to Identify Patients
With Neck Pain Likely to Benefit From Thoracic Spine Thrust
Manipulation and a General Cervical ROM Exercise: RCT.
Objective:
• Examine the validity of the recently proposed CPR for use of thoracic spine thrust
manipulation in patients with mechanical neck pain.
Methods:
• 140 participants, ages 18-45, mean age of 40, and no contraindications
• Pain and disability collected at baseline, 1 week, 4 weeks, and 6 months.
• Control Group:
• 5 sessions of strengthening and stretching exercise
• Experimental Group:
• 2 sessions of thoracic thrust manipulation & cervical AROM exercise
• 3 sessions of control protocol
Outcomes:
• T-spine manipulation & exercise had greater improvements in disability at both the
short & long-term follow-ups and in pain at the 1 week follow-up than just exercise.
14. Clinical Prediction Rule
• Met 3 or more = “responders”
• Met 2 or less = “non-responders”
• Current study did not support the
validity of the previously proposed
CPR
What this means:
• They ALL benefited from
thoracic spine manipulation
17. Masaracchio et al. (2013) Short-Term Combined Effects of T-
Spine Thrust Manipulation and C-Spine Non-thrust
Manipulation in Individuals with Mechanical Neck Pain: RCT
Objective:
• Does T-spine manipulations + C-spine non-thrust manipulations work better than C-
spine non-thrust manipulations alone in the short-term?
Methods:
• 64 participants, ages 18-60, >20% NDI, and no contraindications
• Control group:
• C-spine non-thrust manipulations + neck AROM exercises (2 treatments, 2-3 days apart)
• Experimental group:
• Control protocol + T-spine manipulations (2 treatments, 2-3 days apart)
Outcomes:
• T-spine manipulation group demonstrated greater short-term outcomes in pain and
disability when compared to C-spine non-thrust and exercise.
• 75% had pain improvements that met or exceeded the MDC & MCID
• 70% had disability improvements that met or exceeded the MDC & MCID
18. Short-Term Combined Effects of Thoracic Spine Thrust
Manipulation and Cervical Spine Non-thrust Manipulation in
Individuals with Mechanical Neck Pain: RCT. 2013
19. Short-Term Combined Effects of Thoracic Spine Thrust
Manipulation and Cervical Spine Non-thrust Manipulation in
Individuals with Mechanical Neck Pain: RCT. 2013
20. How to Implement
1. Find a patient that you think would benefit
• Neck pain with no contraindications
• Shoulder pain with no contraindications
2. Explain the procedure to the patient. Get verbal consent
• “There is a hands-on technique that we can try that has good evidence for improving pain and
mobility in people with your condition.”
• “This technique may produce a “pop” sound and sudden relief, but some don’t feel the relief
until the next day. The “pop” sound is just a side effect of the maneuver, and some people
never get one.”
• “I think you would benefit from this technique, what do you think?”
3. Give patient the options for positioning
• “There are multiple positions that we can perform the technique: seated, one your stomach,
or on your back. There is no difference in regards to benefits.”
21. How to Implement
4. Position the patient
• Supine, prone, or seated
• Choose based off patient comfort and/or therapist confidence.
5. Re-explain procedure if needed
6. Perform technique!
8
2 2 2
26. References
1. Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moore JH, Koppenhaver SL, and Wainner RS. The short-term effects of thoracic
spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. 2009; 14(4):375-80.
2. Cleland JA, Childs JD, Fritz JM, Whitman JM, and Eberhart SL. Development of a CPR for Guiding Treatment of a Subgroup of Patients
with Neck Pain: Use of Throacic Spine Manipulation, Exercise, and Patient Education. Physical Therapy. 2007; 87:9-23.
3. Cleland JA, Mintken PE, Carpenter K, Fritz JM, Glynn P, Whitman J, Childs JD. Examination of a clinical prediction rule to identify patients
with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center
randomized clinical trial. Phys Ther. 2010; 90(9):1239-50.
4. Cross KM, Kuenze C, Grindstaff T, Hertel J. Thoracic Spine Manipulation Improves Range of Motion, and Self-Reported Function in
Patients with Mechanical Neck Pain: A Systematic Review. J Orthop Sports Phys Ther. 2011; 41(9):633-642.
5. Gonzalez-Iglesias J, Fernandez-De-Las-Penas C, Cleland JA, and Glutierrez-Vega MR. Thoracic Spine Manipulation for the Management of
Patients with Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2009; 39(1):20-27.
6. Masaracchio M, Cleland JA, Hellman M, and Hagins M. Short-Term Combined Effects of Thoracic Spine Thrust and Cervical Spine
Nontrhust Manipulation in Individuals with Mechanical Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2013;
43(3):118-127.
7. Puentedura EJ, Landers MR, Cleland JA, Mintken P, Huijbregts P, and Fernandez-De-Las-Penas C. Thoracic Spine Thrust Manipulation
Versus Cervical Spine Thrust Manipulation in Patients With Acute Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther.
2011; 41(4):208-220.
8. Salvatori R, Rowe RH, Osbourne R, and Beneciuk JM. Use of Thoracic Spine Thrust Manipulation for Neck Pain and Headache in a Patient
Following Multiple-Level Anterior Discectomy and Fusion: A Case Report. J Orthop Sports Phys Ther. 2014; 44(6)440-449.
9. Tate AR, McClure PW, Young IA, Salvatori R, and Michener LA. Comprehensive Impairment-Based Exercise and Manual Therapy
Intervention for Patients With Subacromial Impingement Syndrome: A Case Series. J Orthop Sports Phys Ther. 2010; 40(8):474-493.