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Archive for the ‘Physical Therapy’ Category

Restless legs syndrome (RLS) is a disorder when the legs feel exceedingly uncomfortable while sitting or lying down, irresistibly urging the legs to move to stop these odd sensations. It pushes one to keep getting up and move around. This can also affect the arms or torso, but mostly affects the legs. While doing so, the unpleasant and irritating feeling of restless legs syndrome temporarily disappears, providing temporary relief.

RLS causes a sensation that can be explained by drawing a parallel to an itching, burning, or tickling feeling in the muscles. It can happen to anyone, from either sex, and can begin at any age, only increasing as one gets older. It can disrupt sleep, lead to daytime sleepiness, and make travelling complicated.

Causes

Most of the times, there are no concrete reasons for the occurrence of restless legs syndrome. It is suspected that this might be due to an imbalance in the chemical, dopamine, in the brain. Dopamine is responsible for the sending of messages to control the movement of muscles. The causes of RLS could also be one or more of the following:

It could be heredity. Some genes for RLS have been identified as responsible for it to be a genetic phenomenon. If so, most people of the family are afflicted by RLS.

Stress also exacerbates symptoms of RLS. Hormonal changes may also increase RLS. Some women also get affected by RLS during pregnancy, which normally only lasts during the course of the pregnancy.

Mostly RLS isn’t connected with any serious medical issues. However, at times, it comes along with other conditions, such as; peripheral neuropathy, which damages the nerves in the limbs probably due to chronic illnesses such as diabetes, alcoholism etc.; iron deficiency; or kidney failure, which is normally accompanied by iron deficiency as well.

Symptoms

RLS has signs of having indescribable uncomfortable sensations in the feet, calves, thighs, or arms as creeping and crawling, aching and burning, jittery and tingling, deep-seated feelings. You might get such feelings, if you are inactive for long periods of time, or in the nighttime, when the legs twitch and kick involuntarily. This can lead to restless sleep, and thus insomnia. Relief can be achieved only through movement, and the symptoms usually worsen by evening.

Treatments

Treating an underlying condition, such as peripheral neuropathy or iron deficiency, can sometimes cure the restless legs syndrome, for e.g., taking iron supplements to correct the iron deficiency, only under medical supervision of course. Making some serious lifestyle changes, could also go a long way in lessening the symptoms, like taking pain killers, taking baths and massages to relax your muscles, doing meditation or yoga to reduce stress, to unwind and calm the body and mind, application of warm and cool packs whose use in alternation, cuts down the sensations in the limbs, trying to sleep well in a soothing setting, exercising, avoiding energy drinks, coffee, or other caffeine containing products as well as alcohol and cigarettes.

Although controversial, medications can also be prescribed if the RLS condition is very severe and should be administered only under medical supervision.

Modern medicine, with its drugs and advanced surgical methods, has not found the answer to all the disabilities that afflict man. Medical professionals often have to resort to massage, exercise, and other methods of physical manipulation to treat certain diseases and conditions. Also known as physiotherapy, physical therapy can trace its origins to England in the late nineteenth century, when The Society of Trained Masseuses was formed by nurses and midwives hoping to give official recognition to their massage practices.

Physical therapists deal with musculoskeletal, cardiopulmonary, and neurological conditions. Patients who require physical therapy include those with permanent disabilities, those who have lost the function of their limbs due to an accident, or those with disabling conditions such as arthritis, heart disease, head injuries, cerebral palsy, and low back pain.

Apart from restoring function, relieving pain, and improving mobility, physical therapists also help to maintain overall fitness and health. Through a range of exercises, and with the help of other stimulants such as hot and cold compresses, they help patients improve flexibility, strength, endurance, balance, and coordination. Physical therapists also help patients get used to assistive walking devices such as crutches and wheelchairs. The aim is to encourage such patients on the road to recovery and to help them function effectively at work or at home.

Physical therapists practice either privately or in a hospital, or in a fitness center or clinic, with almost 25% working only part-time. Physical therapy is a demanding job, requiring strength and high fitness levels. A physical therapist has to be able to lift a patient and will often spend most of his time crouched or bent over a patient. Physical therapists often have to work over weekends to fit in with a patient’s schedule.

Considered a part of conventional medicine, physical therapy requires considerable training. Many universities in the U.S. offer graduate programs in physical therapy. On graduation, physical therapists also have to pass a licensure exam before they can practice in any state in the U.S.

Physical therapy often achieves what medicine cannot, making it a deeply satisfying and challenge field of work.

The classic findings on physical examination for carpal tunnel syndrome are a Tinel’s and Phalen’s test. A Tinel’s sign is performed by tapping the median nerve, where you’ll feel electricity shoot down the thumb, index finger, middle finger, and a portion of your ring finger. A Phalen’s sign is similar, with the wrist held in a flexed position and electricity shooting down the thumb, index finger, middle finger, and a portion of the ring finger.

More severe cases have persistent pain that doesn’t go away, even with splinting or therapy. You may also have muscle wasting, which is where the muscles at the base of thumb start to atrophy, or become thinner.

An electromyogram (EMG)/ Nerve Conduction Velocity/ (NCV) test is the gold standard for CTS, simply because it links what you’re feeling to what the doctor sees on the physical exam, as well as what the insurance company wants.

As a patient or doctor, you can always fudge a little with feelings in your hand. Also, as an individual, you may feel pain, tingling, or numbness quite differently than other people. The EMG/ NCV is an objective test that is machine based, so it can generate numbers that allow the doctor to compare your CTS/ carpal tunnel syndrome to other patients. That way, the severity is known and can be treated accordingly.

Classic/ old school EMG/ electromyogram and NCV/ nerve conduction velocity testing uses needles to transmit electricity down the nerves to generate a response. Granted, the needles are quite small and thin, but it’s still a needle. Also, the electricity generated is usually stronger and more painful.

Personally, I like using the “Neurometrix” system (shown above), which is a device that uses sticky pads on the hands, with the option of using needles. The electricity that you feel is substantially less than with traditional EMG/ NCV, so it’s more comfortable. The results are sent over the internet to the server, so you typically get a result in 10 minutes or less. This kind of test usually takes only about 10-15 minutes to give.

Before you have surgery, you should go over the test with your surgeon. You can always get a 2nd opinion about the results as well. As a surgeon, I’m not always eager to do surgery- sometimes the findings point to maximizing NON-surgical treatment before carpal tunnel surgery. Every patient is different, so finding should be interpreted and compared to findings on physical examination.

Physical therapy is noted in history since ancient times. But, irrespective of the period, the main goals of physiotherapy have always remained the same- to restore the rehabilitation and mobility of the patient.

Physical therapy’s first documented account is from the old master of medicines- Hippocrates. In the year 460 BC, Hippocrates introduced the idea of manual manipulation like hydrotherapy and massage for pain relief. From early time the advantages of such activities was understood and this understanding continues till date. But it wasn’t until the nineteenth century that a cohesive group of physical therapy practitioners was formed. In England, the Chartered Society of Physiotherapy established itself followed by other similar organizations dedicated to providing the best care to people who required it. Physical therapy in the United States is the same as physiotherapy in other countries. Irrespective of what term is used, the idea, procedure and practice are all the same.

While World War-I was going on, people trained in providing physical therapy (also called reconstruction aid), helped wounded and injured soldiers relieve their pain. but it wasn’t till the year 1921 that first physical therapist organized group came into being. It was formed by the famous Mary Mcmillan, and was called the American Women’s Physical Therapeutic Association. Soon, the group turned into he American Physical Therapy Association which included even men. The name change brought about a curriculum change and physical therapists had to meet a different set of requirements. This occupation gained more professionalism and formality and the medical community began to recognize it as a viable treatment for pain and injury.

Another landmark in the history of physiotherapy was during the breakout of the polio epidemic. These physiotherapists did groundbreaking work in the rehabilitation and treatment of the polio patients. Although the primary procedures include massage and exercise during the time, physical therapy benefited the polio patients to a large extent. The focus on joints and use of manipulation started gaining popularity in the 1950′s.

The first example of specialized practice by a group of physiotherapists happened in the 70′s with the orthopedic practice being formed by the Association of American Physical Therapy. The history of physiotherapy has grown and changed a lot over time. By now therapists had begun practicing in different places including nursing homes, outpatient clinics and hospitals, where most modern day specialists practice today.

After the 80′s, with the invention of the computer and different technologies, many advances were made in the field of physical therapy. Electric stimulators and ultra sounds became common technologies used in the medical field. New technologies dramatically changed the face of physical therapy and now therapists were able to use far more advanced machines and tools to help their patients.

The history behind physical therapy has grown and evolved a lot over the years and its evolution is an ongoing process. With each new innovation, technique and procedure, the capability of the craft that therapists use to treat t heir patients keeps getting better. Physical therapy has come a long way since its beginning and with a lot of success.

Fetal Alcohol Syndrome affects approximately 1-2 out of every 1,000 births. Prenatal exposure to alcohol can have many subtle side effects such as: trouble learning, impaired development, mental retardation, facial deformities and an inherited propensity to drink.

When you are drinking alcohol, it enters your bloodstream and travels to the placenta, where it interacts with the baby. Since babies metabolize alcohol content much slower than adults, the baby’s blood alcohol content will naturally be much higher than his or her parent’s. The presence of alcohol can deprive the baby of nutrients and impair regular development.

Fetal Alcohol Syndrome is one of the few known preventable causes of mental retardation. Physical features of someone with FAS may include any or all of the following: small eyes, a short upturned nose, small head circumference, a thin upper lip, a cleft palate, light sensitivity, hypoplastic kidneys, a short neck, and deformed joints or limbs. It’s likely that prenatal exposure to alcohol will have side effects, like slow physical growth/development before and after birth, vision or hearing difficulties, hyperactivity, poor impulse control, extreme nervousness, learning disabilities and a short attention span.

Drinking during the first trimester, when the most basic developments are taking place, is what causes the facial distortions of babies with Fetal Alcohol Syndrome. In the early weeks of pregnancy, women may not even know they are pregnant. In France, more than half of pregnant women reported having an occasional glass of wine.

In fact, they see nothing wrong with drinking while pregnant. In America, this is highly discouraged, although doctors find it hard to pinpoint how much alcohol consumption is too much and some say that one glass of wine may actually help development. Of course, binge drinking at any stage of pregnancy can certainly kill a baby and most health professionals discourage even trace amounts of alcoholic drink.

To diagnose Fetal Alcohol Syndrome, doctors look at a few basic characteristics, such as unusually low birth weight and size, evidence of physical retardation, such as a small head, small eyes, short eye opening, underdevelopment of the upper lip, a groove between the lip and nose, an upturned nose and flattened cheekbones, as well as intellectual impairment. FAS can be difficult to diagnose before and after birth, may be confused with many other disorders and doesn’t have the scientific backing that many other disorders have, thus making it hard to deal with.

Acquiring a license to practice physical therapy is not easy. You need to commit a few years to this endeavor and only after mastering important physical therapy concepts, participating actively in practicums, and passing a standardized national examination will you be finally rewarded with your official license to practice in any state that you choose, promising to provide the best care possible for your patients.

As with most other professions, regulations exist to provide some measure of protection and assurance for the public-at-large with respect to the qualifications and capabilities of physical therapy practitioners. Licensed therapists are bound by state laws and their profession’s standards to offer patients carefully thought out treatment plans, and to provide the best and safest care to their patients.

This official license, therefore, weeds out the competent from the incompetent practitioners and assures the public of the availability of safe physical therapy services as regulated by applicable laws. The public is also assured of quality therapy services from therapists who have passed the NPTE or the National Physical Therapy Examination.

A licensed practitioner, however, must still be cautious when dealing with and treating patients. Any carelessness resulting in mistakes leads to patients who will lose confidence in you and your practice. This means no return visits and no referrals. In addition, any negligence that has been proven could mean loss of your hard-earned license leading to the demise of your career as a physical therapist. So a license to practice means an obligation to practice with the best ethics, safety, and competence standards.

Physical therapists must also constantly be updated in their information and education because the profession continually evolves with new treatment protocols and new advances in technology. Previous advanced learning and training does not mean you already know all there is to know. There will always be something new for you to learn so keep on with the reading, research, and seminars to stay abreast of new techniques.

After a few years of clinical experience and continuing education, therapists evolve to become experts in their field and also in the area of the human body’s physical functions and conditions. As such, therapists not only provide treatments to patients who are suffering from injuries and other impairments, but they can also help provide total care and well-being to their patients by restoring any loss of motor functions in their bodies. This restoration does wonders for a patient’s overall well-being.

Ultimately, the license you acquire in your quest for a career in physical therapy is a stepping-stone to so much more. You may start off thinking that you will be contented practicing entry-level physical therapy, but over the years, you may find yourself recording your real achievements as getting this patient to walk again, or getting that patient to write again, and just overall, providing the patients who come to you with a better quality of life that they were meant to live.

Remember that your license to practice means patients’ license to live better lives so care for this responsibility as you would care for your life and the lives of your loved ones.