Official Google Blog: Say hello to Google Allo: a smarter messaging app

Official Google Blog: Say hello to Google Allo: a smarter messaging app

New concepts in Knee reconstruction--physio role.

Owing to advancements in technology, the Orthopedics Department of Post-Graduate Institute of Medical Education and Research (PGIMER) and Government Medical College and Hospital (GMCH), Sector 32, are successfully treating nearly 500 patients every year by performing reconstruction surgeries of the anterior cruciate ligament (ACL) of the knee.

Professor M S Dhillon and Dr Sameer Aggarwal perform the surgery in PGIMER, while Professor Ravi Gupta performs the surgery in GMCH-32.

Talking to Newsline, Professor Ravi Gupta, said, "In the last few years the technique for performing this surgery has improved. Before that, injury to ACL was treated only with physiotherapy. But now, a simple surgical procedure of about one hour followed by extensive physiotherapy for six months can help the patient return to normal lifestyle".

The surgery, for which a patient's knee was earlier plastered for about three months, has now advanced enough for the patient to start physiotherapy just an hour after surgery and start walking the next day.

"If the patient starts with physiotherapy on the first day, there is a better chance that the movement of the operated knee will be as good as normal", said Professor Gupta.

When asked about the importance of physiotherapy in this surgery, Professor Raj Bahadur, head of department of Orthopedics said, "Following injuries to the knee joint, particularly to football and kabaddi players, there is an ACL injury. Earlier, orthopedic doctors stressed on physiotherapy which included muscle build-up. But ever since the arthroscopic surgeries of ACL started, the quality of life for patients with these injuries has improved. It is desired that the patient continues with physiotherapy".Gurjeet Singh, an international kabaddi player who underwent surgery in March 2013 from GMCH-32, said, "I am back to playing my game. My coaches have started training me with muscle building exercises. My knee has recovered and I am hoping to play an international game soon. Many of my colleagues have also undergone the same surgery and are doing fine".

Manpreet Singh, a national-level wrestling player said, "Though I am still under the desired recovery period after the surgery, I have started with my training with doctor's permission. Muscle recovery is a must after this surgery."

Both GMCH and PGI handle about 350 cases of ACL surgeries, of which 30 patients are international-level kabaddi players. According to Dr Sameer Aggarwal on an average five ACL surgeries are performed in a week at PGI.

Talking about the recovery of patients, Dr Sameer Aggarwal said, "One should opt for an ACL surgery only if they are ready to devote at least six months to recovery. There are people who come for consultation with sedentary jobs and can depend on physiotherapy for recovery. But for athletes who have an active lifestyle, the surgery becomes necessary".

Dr Praveen Taneja, a private orthopedic doctor in the city said, "Many patients who had undergone ACL surgeries from GMCH and PGIMER come to me for consultation. ACL injury is always accompanied with some damage to nearby tissues. ACL surgeries are successful, but orthopedics is yet to advance for other surgeries".

Bells/Facial Palsy Explained For Physios.

BELLS/ FACIAL PALSY
Facial palsy is condition in which there is lesion of the facial nerve and the resultant paralysis in the muscles that it supplies. So there will be following features on the side of lesion:

Loss of facial expression.
Drooping of the face- Low eyelid, eyebrow and corner of mouth sag.
Closing the eye is difficult.
Eating is difficult because food collects in the side of the cheek and fluid seeps out of the corner of mouth.
Speaking, whistling and drinking are impaired.
Non-verbal communication is lost as the patient cannot register the pleasure, laughter, surprise, interest and worry.
The patient tends to sit with the hand over the side of face.

There is difference between an upper motor neuron lesion and lower motor neuron lesion of the facial palsy.

A unilateral UMN lesion usually spares the forehead as it is also innervated from the other side of the brain; however an LMN lesion affects all of one side of the face.

An upper motor neuron lesion causes weakness of lower part of face on the side opposite the lesion. The frontalis muscle is spared; the normal furrowing of the brow is preserved, and the eye closure and blinking are not affected.
Moreover, in upper motor neuron lesion there relative preservation of spontaneous 'emotional' movement (e.g. smiling) compared with voluntary movement.

Causes of facial weakness:

These are as under:

The common cause of facial weakness is a supranuclear lesion e.g. cerebral infarction leading to upper motor neuron facial weakness and hemiparesis.
Lesions at four other levels may be recognized by the associated signs.

PONS. The sixth nerve nucleus is encircled by the seventh nerve fibers and is therefore involved in the pontine lesions of the nerve, causing lateral rectus palsy.
If there is accompanying damage to the neighboring centre for the lateral gaze and the cortispinal tract, there is the combination of:
LMN facial weakness
Failure of congugate lateral gaze (toward the lesion)
Contra lateral hemiparesis
Causes include pontine tumours (e.g. glioma), demyelination and vascular lesions.
The facial nucleus is affected in poliomyelitis and motor neuron disease; the lateral usually causes the bilateral weakness.

CEREBELLOPONTINE ANGLE. The fifth, sixth and eight nerves are affected with the seventh nerve in lesions in the cerebellopontine angle. Causes are acoustic neuroma and miningoma.

WITHIN THE PETROUS TEMPORAL BONE. The geniculate ganglion (a sensory ganglion for taste) lies at the genu of the facial nerve. Fibers join the facial nerve in the chorda tympani and carry taste from the anterior two third of the tongue. The (motor) nerve to the stapedius muscle leaves the facial nerve distal to the genu.

Lesions within the petrous temporal bone cause:

Loss of taste on the anterior two third of the tongue
Hyperacusis ( an unpleasant loud distortion of noise) due to the paralysis of the stapedius muscle

Causes include:

Bell's palsy
Trauma
Infectin of middle ear
Herpes zoster (Ramsay hunt syndrome)
Tumours (e.g. glomus tumour)

WITHIN THE FACE. Branches of the facial nerve pierce the parotid gland and supply the muscle of the facial expression. The nerve can be damaged here by parotid gland tumours, mumps (epidemic parotitis), sarcoidosis and trauma. The nerve is also affected in the polyneuritis (e.g. G.B. Syndrome) usually bilaterally.

Weakness of face also occurs in primary muscle disease and disease of neuromuscular junction. Weakness is usually bilateral. Causes include:

Dystrophia myotonica
Facio-scapulo humeral dystrophy
Myasthenia gravis
Bell's palsy
this is a common acute, isolated facial nerve palsy believed to be due to viral infection (most probably herpes simplex) that causes swelling of the nerve within the petrous temporal bone.

MANAGEMENT:

Spontaneous recovery occurs toward the end of second week. Thereafter, continuing recovery occur. Fifty percent recover within three months. Continuing recovery may take 12 months to become complete. About 15 percent of patients are left with a severe unsightly residual weakness.

Medical:

Steroids (prednisolone 60mg daily reducing to nil over 10 days.)
Acyclovir for viral infection

Physiotherapy:

During the paralysis:

Ultrasound given over the nerve trunk in front of the tragus of ear and in area between mastoid process and mandible. There is no fear of applying ultrasound while doing the treatment of patient with Bell's palsy. The ultrasound is always applied on the side of lesion in front of the tragus of ear & in area between the mastoid process and mandible where the maximum tenderness of the facial nerve is determined by palpation. It is applied in slow circular motion with a starting dosage of 1 watt per square centimeter. The dosage may be increased on the subsequent sessions if no remarkable improvement is noted. Let me explain that ultrasound waves cannot traverse the bone. That means ultrasound has zero penetration in the bone. Infact, ultrasound waves are reflected away from the bone. So there is no fear in applying the ultrasound on face. (This is only for LMN lesion type)

low level laser therapy (infrared 808 nanometer wavelength 400 mill watt power for 5 minutes continuous)

Infra-red: Infra red may be applied to warm the muscles and improve the function, but you must ensure that eyes are protected with linens when you are applying infra-red to face. Timing should be for 15 to 20 minutes.

Ultraviolet Therapy: Formerly ultraviolet was frequently used to give third degree erythema doses over the facial nerve trunk and in area between mastoid process and mandible to combat the infection and inflammation.

Microwave diathermy: As far as micro wave diathermy application is concerned, there is strict contra indication for the use of micro wave diathermy for the treatment of face as micro waves can spread randomly and can damage the lense of eye causing the opacity of the lense. So there is no room for the application of micro wave to face.

Short Wave Diathermy: SWD can be safely applied for the treatment of facial palsy. The technique used may be monopolar or bi polar. In bipolar technique using the capacitor field method, the one facial mask electrode is used as an active electrode for applying the rays to face while the second or indifferent electrode used on some distant part of the body to complete the circuit. In monopolar electrode method only one electrode is used to direct the rays to the target treatment area site and no second electrode is used at all.

Electrical Stimulation: The only form of electrical current used on face is interrupted direct current (I.D.C.). This is requested only to preserve the bulk of facial muscle and to prevent their atrophy while waiting them to be in faction whenever their re innervations arrives in case of axotomesis or reconditioning after neuropraxia if the nerve is not damaged completely. There is no room for the use of faradic current use on the face as it could lead to cause secondary contractures of the face.

Massage: Massage may be taught to the patient
stroking in the upward, outward direction.
Slow finger kneading applied over the paralyzed muscles maintains skin suppleness and muscle elasticity.
These techniques applied daily for 5 minutes or so help to maintain lymphatic and blood flow and prevent contractures.

During Recovery:

PNF techniques are used for re-education:

Quick stretch can be applied to regain rising of eye brow and the movement of the corner of mouth.

The physiotherapist can produce the movement passively and then ask the patient to hold, and then try to produce the movement.

Icing, brushing, tapping or brisk stroking may be applied along the length of the muscles. e.g. Zygomaticus

Exercises:

Look surprised then frown
Squeeze eyes closed then open wide
Smile, grin, say 'o'.
Say a, e, i, o, u.
Hold straw in mouth-suck and blow
Whistle

Heliotherapy:I have found traditional old lay men to use the convex lense to focus the sun rays to produce the third or four degree erythematic dosage to facial nerve trunk and in area between mandible and mastoid process behind the ear and it frequently gives dramatic result with excellent recovery of facial palsy. The treatment was needed to repeat after one week to repeat the same session of the dosage. Only three or four sessions of this kind were needed to do the excellent management of the patient. Infact, it is one kind of heliotherapy treatment which is available from the natural source of power i.e. the sun. This is most common form of physiotherapy medicine that is used by conventional lay men here in Pakistan with excellent results of the treatment.

FARADIC Vs GALVANIC CURRENT

The faradic current has a frequency of 50 Hz and hence so produces the tetanic muscle contraction. It is ,therefore, surged to produce the alternate contraction and relaxation of the muscles. Moreover, faradic current having short pulse duration can not be used to stimulate dennervated muscles as dennervated muscles requre pulses of longer duration for having its effects. So galvanic current has fair long duration impulses selections that can be used to stimulate dennervated muscles. Although in early days of nerve injury a response of muscle can be obtained witth faradic or faradic type of current depending upon the reaction of degeneration but when walerian degenration takes place, it is not possible to get the response from faradic type of current. Furthermore, facial muscles are very delicate and soft as they can tolerate the tetanic type of contraction produced by faradic current and this could lead to the secondary contractures of the facial muscle. Hence the most suitable current in that case will be interrupted galvanic current, that produces a brisk twitches of the facial muscles. And there will no danger secondary contractures.

Osteoporosis and Role of Physiotherapy.


http://www.youtube.com/watch?feature=player_embedded&v=ArWfAirQigY

Importance of physiotherapy after Mastectomy.

http://www.startribune.com/local/234016931.html?page=2&c=y

Top 10 Reasons to Exercise Regularly (Besides Losing Weight)

You've been told a hundred times that exercise is good for you, and it's true—but it's good for a lot more than just losing weight or building muscle. Here are 10 other benefits you'll see from just a little daily exercise,read them from 10 to 1.

10. You'll Improve Your Memory
Ever feel like you think a bit more clearly after a good workout? Not only is your brain getting more energy and oxygen, but many studies have shown that exercise can boost your memory and help you learn better. Of course, an intense workout right before a big exam could leave you more tired than smart—but the two are still undoubtedly linked.

9. You'll Have Better Posture
Good posture is important, and one of the best ways to fix your posture is to exercise the muscles holding you back. Check out some of the most common posture problems people have, and which muscles you should work out to help fix them. Regularly exercising your abs, back, and other muscles can go a long way into fixing your posture, both sitting and standing.

8. You'll Boost Your Confidence
Obviously, exercise can improve your appearance which can improve confidence, but there's more to it than that. Exercise can also help you feel more accomplished and social (if you work out at a gym). Even if you don't see immediate results in your body, that effort will make you feel better—and a bit of confidence can go a long way.

7. You'll De-Stress
We all have stress in our lives, whether it's the occasional rough day or a more serious, chronic problem. Stress can really wreak havoc with your mind, but studies have shown that exercise is a great way to combat it. Not only are those endorphins natural stress-fighters, but getting yourself into that exercise groove helps get your mind off the things stressing you out.

6. You'll Sleep Better
If you ever have trouble falling asleep at night, the National Sleep Foundation says at regular exercise can help you sleep better. The best time to work out is in the morning or the afternoon, rather than before bed—if you exercise too closely to bedtime, it can actually have the opposite effect! Luckily, there are other good ways to fill up that pre-bed relaxation time.

5. You'll Have More Energy
It may seem counter-intuitive—after all, working out can drain your energy quite a bit—but regular exercise can actually make you feel more energized throughout the day. In fact, one study found that exercising in the middle of the day can leave you feeling more energetic and productive for the rest of the afternoon. You should still try to get in some walking throughout the day, but a midday workout could be a great pick-me-up.

4. You'll Have Better Sex
Do we have your attention yet? Yes, studies have indeed shown that regular exercise can increase arousal and decrease men's risk for erectile dysfunciton, likely because exercise improves circulation (which is pretty important when it comes to sex).

3. You'll Get Sick Less Often
Nobody likes getting sick, and exercise can help. A recent study found that people who exercised regularly were half as likely to get a cold than people who didn't—which is odds I'd gladly take. Taking a good steam afterward can help, too.

2. You'll Live Longer
It's no secret that healthy living will keep you alive longer, but you might be surprised at how much. One study found that exercise improves life expectancy as much as quitting smoking. It really is true that sitting all day is killing you—and just a bit of regular exercise can stave off the reaper for awhile.

1. You'll Just Be Happier
All this put together equals a much happier you. It's not just those "runner's high" endorphins—regular exercise can actually improve your life in oh-so-many ways. All you need to do is make it a habit—the University of Bristol found that people's mood significantly improved on days they exercised, so find a way to fit a quick workout into your daily routine and you'll be well on your way.

Novel program to prevent hospital falls.

http://www.kentonline.co.uk/dartford_messenger/news/award-winning-project-helping-patients-back-8672