1/11. An integrated physiotherapy/cognitive-behavioural approach to the analysis and treatment of chronic whiplash associated disorders, WAD.PURPOSE: The aim of this paper was to describe a model for an integrated physiotherapy/cognitive-behavioural approach in the analysis and treatment of chronic WAD patients, as well as to evaluate the effectiveness of this approach in three experimental single case studies. METHOD: Three patients with a diagnosis of chronic WAD were included in the study. Psychological and physical functional analyses were used to describe the problem areas and as a basis for the management of WAD. A programme including learning of basic and applied skills, generalization, and maintenance was carried through. RESULTS AND CONCLUSION: The results showed that functional behavioural analyses can be useful in physiotherapy for structured patient assessment and in planning of treatment. It was also shown that physiotherapy integrated with cognitive behavioural components decreased the patients' pain intensity in problematic daily activities.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
2/11. Management of a proximal interphalangeal joint fracture dislocation with a compass proximal interphalangeal joint hinge and therapy: a case report.The purpose of this report is to describe the management of a chronic proximal interphalangeal (PIP) joint fracture dislocation in a 46-year-old computer programmer. Twenty days following injury, a right ring finger volar plate arthroplasty was performed, loose fracture fragments were excised, and a Compass PIP joint hinge was applied. The hinge was locked at 10 degrees to 15 degrees extension and held in this position for 8 days. On postoperative day 8, hand therapy was initiated. Many challenges were encountered. insurance constraints required the patient to change therapists. The device frame cracked. The patient developed a PIP joint contracture with extensor lag. Despite these obstacles, the patient achieved a successful outcome, returning to normal pain-free use with grip strength at 87% of that of the uninvolved hand. At discharge, active range of motion was 12 degrees/100 degrees at the PIP joint and 0 degrees/40 degrees at the DIP joint. Passive extension was 0 degrees. At 6 months postoperatively, active range of motion was 0 degrees/105 degrees at the PIP joint and 0 degrees/60 degrees at the DIP joint. This case demonstrates the need for closely supervised postoperative therapy that includes good communication between providers, ongoing patient education, and close monitoring of range of motion.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
3/11. chronic pain syndrome should be recognized as a separate clinical entity.chronic pain is a relatively new concept in our understanding of pain. It is rarely recognised or diagnosed as a separate clinical entity in sri lanka. Thus the extent of this problem is not known. The case histories of two patients with the chronic pain syndrome are presented, with a brief review of the theoretical aspects of chronic pain. Trends in the management of chronic pain are summarized. Unfortunately, organized treatment programmes for chronic pain are unavailable in sri lanka.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
4/11. otitis media in Dar es Salaam, tanzania.To assess the prevalence of otitis media in tanzania a study was made of 3772 patients attending for the first time the ENT out-patient department of Muhimbili Medical Centre, University Hospital of Dar es Salaam. otitis media in one form or another was present in 524 patients (14 per cent). The majority reported a long history of ear discharge. hearing loss was a major complaint and was often found to be between 40-60 dB. H.L. Most patients admitted previous treatment, but otoscopy had rarely been performed. The medical profession in tanzania cannot possibly deal with the large number of cases of chronic otitis media. With the recent introduction of otorhinolaryngology into the curriculum of the medical school of tanzania it seems advisable to include otology in the programme for primary health workers.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
5/11. Multiform ventricular tachycardia.Electrophysiological studies were performed in three patients with chronic recurrent ventricular tachycardia (VT) associated with coronary artery disease. In each case the ventricular origin of the tachycardia was confirmed and induction of tachycardia by programmed stimulation suggested a re-entry mechanism. Multiple types of ventricular tachycardia were observed which differed in cycle length, QRS morphology, timing of local epicardial and endocardial ventricular electrograms and the use of the specialized conduction system for propagation. There was evidence of one or more re-entry circuits arising in or near previously infarcted areas, with features of cycle length alternation, change in exit points and variations in subsequent conduction through the myocardium and specialized conduction tissues. These findings suggest multiform VT can be due to a number of factors. A modified surgical approach is recommended for management of medically refractory VT when there is evidence of multiple types.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
6/11. Interpretive psychotherapy with chronic pain patients.patients for whom medical and surgical management has failed to relieve chronic pain were treated in a multimodal programme which included interpretive psychotherapy. Dynamic conflicts were identified in all cases and utilized in the psychotherapy and programme design. Examined in the light of ego functioning, pain that was previously considered intractible, yielded to psychological treatment. Further research is planned to identify the parts played by the different modalities and to study outcome.- - - - - - - - - - ranking = 2keywords = programme (Clic here for more details about this article) |
7/11. Response-contingent taste-aversion in treating chronic ruminative vomiting of institutionalised profoundly retarded children.Two case studies are presented describing the use of response-contingent taste-aversion procedures to treat chronic ruminative vomiting of profoundly retarded children. Each treatment programme was designed to be carried out by para-professional staff in an institutional setting. Each programme eliminated rumination, with effects maintained one to nine months following treatment. For one subject who exhibited major weight-loss prior to intervention, substantial weight-gain was also demonstrated.- - - - - - - - - - ranking = 2keywords = programme (Clic here for more details about this article) |
8/11. Chronic intrahepatic cholestasis in sickle cell disease requiring exchange transfusion.A 15 year old boy with sickle cell disease developed intrahepatic cholestasis. A course of exchange transfusion successfully corrected the extreme hyperbilirubinaemia over one year. Upon stopping the exchange transfusion programme the hyperbilirubinaemia relapsed but transfusion was effective when reinstituted.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
9/11. Chronic mesenteric ischaemia: diagnostic challenges and treatment options.OBJECTIVES. A description of the clinical presentation, diagnostic procedure and mode of therapy in three patients suffering from chronic mesenteric ischaemia. DESIGN AND INTERVENTIONS. In all cases, the diagnosis was made on the basis of abdominal complaints in combination with angiographic findings. The primary treatment objective was restoration of blood flow via a revascularization procedure, for the patient in whom this could not be accomplished an enteral feeding programme was undertaken. RESULTS. One patient had a panmalabsorption syndrome which was treated with an aortomesenteric bypass operation, the second one presented with multiple gastric ulcerations which only improved after a percutaneous transluminal angioplasty. In the third patient, neither surgery or angioplasty were feasible and a tentative enteral feeding programme was given, after which the ability to consume a normal oral diet without abdominal distress was regained. CONCLUSIONS. These three cases illustrate the diverse clinical pictures by which chronic mesenteric ischaemia may present itself. This diagnosis should be kept in mind when other more common causes of a patient's abdominal complaints cannot be found, hence giving consideration to abdominal angiography as the next diagnostic procedure. With respect to therapy, restoring blood flow through surgery or angioplasty is the primary form of treatment. However, if neither of these therapeutic options is feasible, it is suggested that such patients may benefit from a nutritional training programme.- - - - - - - - - - ranking = 3keywords = programme (Clic here for more details about this article) |
10/11. A behavioural approach to retraining bowel function after long-standing constipation and faecal impaction in people with learning disabilities.The authors describe a behavioural programme--involving prompted toilet-sitting after meals, rewards for appropriate evacuation and increased fibre--for four people with severe learning disabilities. Although treatment times were long, such training resulted in near-normal bowel function. While this behavioural approach does not ignore the biological aspects of the problem, soiling in intellectually disabled people should not be attributed to the handicapping condition alone. Training at an earlier age should be considered.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
| | Next -> |