1/17. Caring for survivors of torture in an urban, municipal hospital.survivors of torture can present with multiple health consequences, both physical and psychological, which can persist even years after the abuse. The authors developed a multidisciplinary program in the primary care medical clinic of an urban municipal hospital in new york city serving an ethnically diverse population to provide multidisciplinary care to survivors of torture and their families.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/17. role of neurophysiologic evaluation in diagnosis.The electrodiagnostic evaluation assesses the integrity of the lower-motor-neuron unit (i.e., peripheral nerves, neuromuscular junction, and muscle). Sensory- and motor-nerve conduction studies measure compound action potentials from nerve or muscle and are useful for assessing possible axon loss and/or demyelination. Needle electromyography measures electrical activity directly from muscle and provides information about the integrity of the motor unit; it can be used to detect loss of axons (denervation) as well as reinnervation. The electrodiagnostic examination is a useful tool for first detecting abnormalities and then distinguishing problems that affect the peripheral nervous system. In evaluating the patient with extremity trauma, it can differentiate neurapraxia from axonal transection and can be helpful in following the clinical course. In patients with complex physical findings, it is a useful adjunct that can help discriminate motor neuron disease from polyneuropathy or myeloradiculopathy due to spondylosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/17. Cervical headache.headache presents a diagnostic challenge for the physical therapist due to similarities of signs and symptoms among the many types of headache. Effective treatment depends upon accurate diagnosis and identifying the factors that may precipitate or perpetuate the symptoms. This commentary overviews some common forms of headache and specifically addresses cervical headache as a possible beneficiary of physical therapy intervention. Details of the history and physical examination, which is designed to diagnose cervical headache and rule out potential serious pathologies, are presented. Guidelines for treatment of articular and myofascial dysfunction are presented. A case report illustrating principles of examination, inherent ambiguities in diagnosis, and successful treatment is also presented.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
4/17. Towards successful physical stress reducing products: an evaluation of seven cases.lifting, carrying, pushing and pulling at work are assumed to be related to increased risks of musculoskeletal injury, mainly in the low back and shoulder region. The implementation of products to reduce the physical load in heavy work is a well-known strategy to attack this problem. The success of these products depends not only on the product itself, but also on the process of product development and implementation. In this paper, seven cases are described where products have been developed to reduce the physical load on scaffolders, bricklayers, bricklayer's assistants, roofworkers, aircraft loaders, glaziers and assembly line workers. These products are described with special reference to the physical load problem in the occupational task, the process of product development, the nature of the product, the potential effects on physical load and the opinion of workers. From these cases, a list of key factors in product development contributing to the success of a product is composed. These concern among others a direct participation of workers, a wide analysis of risks, an analysis of potential negative side effects, and a systematic stepwise approach.- - - - - - - - - - ranking = 8keywords = physical (Clic here for more details about this article) |
5/17. Musculoskeletal causes of chest pain.BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/17. Determining foot and ankle impairments by the AMA fifth edition guides.The fifth edition of the Guides has been criticized for its failure to provide a comprehensive, valid, reliable, unbiased, and evidenced-based system for rating impairments and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation [8]. The lower extremity chapter utilizes numerous functional and anatomic methods of assessment, as well as diagnosis-based estimates. Though this process of using multiple approaches to measure impairment increases the chances that an underlying physical impairment may be detected, it is time-consuming and may increase rating variability [9]. McCarthy et al studied the correlation between measures of impairment for patients with fractures of the lower extremity. They found that the anatomic approach of evaluation was better correlated than functional and diagnostic methods with measures of task performance based on direct observations as well as the patient's own assessment of activity limitation and disability. Also, muscle strength assessment as described in the Guides was a more sensitive measure of impairment than range of motion [9]. The most elusive part of the foot and ankle evaluation is the inability to capture the added impairment burden caused by pain. The assessment of pain is the most problematic part of any evaluation. Pain is considered and incorporated into the impairment ratings found in the foot and ankle section, as well as the other individual chapters. chronic pain is often not adequately accounted for, however, and the examiner must evaluate permanent impairment from chronic pain separately. The examiner has the ability to increase the percentage of organ system impairment from 1% to 3% if there is pain-related impairment that increases the burden of illness slightly. If there is significant pain-related impairment, a formal pain assessment is performed. Chapter 18 provides guidance in making these determinations. Impairments for Complex Regional Pain syndrome (CRPS), type 1 (reflex sympathetic dystrophy), and CRPS, type 2 (causalgia) should incorporate the use of a formal pain assessment in addition to the standard methods of assessment. The formal pain evaluation relies mostly on self-reports from the individual and is most heavily weighted for ADL deficits. The physician must make assessments of the individual's pain behavior and credibility for this evaluation. The formal pain assessment classifies the pain-related impairment into categories of mild, moderate, moderately severe, or severe and determines whether this impairment is ratable or not. These categories do not have impairment percentages associated with them. The individual's symptoms or presentation should match known conditions or syndromes in order to be ratable. If not ratable, the examiner should report that the individual has apparent impairment that is not ratable on the basis of current medical knowledge. In the end, pain evaluations are used administratively and, depending on the situation, may be given equal weight with the standard evaluation or may be totally disregarded.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/17. Musculoskeletal deterioration and hemicorporectomy after spinal cord injury.BACKGROUND AND PURPOSE: The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. CASE DESCRIPTION: The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. OUTCOMES: The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. DISCUSSION: The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/17. A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/17. dermatomyositis: evolution of a diagnosis.BACKGROUND AND PURPOSE: As direct access evolves, physical therapists will increasingly encounter patients with pathology that might have an underlying systemic origin. The purpose of this case report is to describe the diagnostic process that led a patient's physical therapist to recognize signs and symptoms of dermatomyositis. CASE DESCRIPTION: The patient was an 18-year-old woman who was referred for physical therapy by her primary care physician on 3 occasions with 3 separate musculoskeletal diagnoses. During the third episode, the physical therapist recognized signs and symptoms that could be indicative of dermatologic disease and referred the patient to a dermatologist. OUTCOMES: A rheumatologist diagnosed the patient's condition as dermatomyositis and referred her for physical therapy. The physical therapy plan of care focused on strengthening and stretching, with an emphasis on a home exercise program. The Medical Outcomes Study 36-Item Short-Form health Survey (SF-36) indicated that the patient continually made functional improvements over an 18-month period. DISCUSSION: Although diagnosis of diseases such as inflammatory myopathies is not within a physical therapist's scope of practice, this case demonstrates the role a physical therapist can play in recognition of underlying systemic pathology by using the diagnostic process.- - - - - - - - - - ranking = 8keywords = physical (Clic here for more details about this article) |
10/17. palliative care: a challenge for orthopaedic nursing care.patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National association of Orthopaedic nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of palliative care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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