By N. Campa. The Richard Stockton College of New Jersey.
Observers and practitioners o f medi cal care have failed to grasp the implications o f the evidence buy aurogra 100mg line. As a result buy aurogra 100mg online, the burning issue of the day is national health insurance 100mg aurogra amex, not the end o f medicine. We have tolerated tiers of medical practice paralleling class structure and even have created classes o f medical untouchables. T heir logical exten sion has always been some form o f comprehensive national health insurance that would greatly expand public support of medical care while leaving the delivery system intact. The Obstacles 229 National health insurance was a m ajor issue in the 1972 presidential election, and the debate has continued in Con gress since then. Thus, the assault proposed against inequi table access to care in this country will be m ade with dollars rather than with structural reform. T he solution being ad vanced, despite differences in details, is to increase purchas ing power to a level that presumably would be relatively uniform throughout the population. But when m easured against the argum ents made here, the plans are all o f a piece. A nd failure to engage these issues will have two profound and irreversible conse quences. T he first is that m ajor expansion in the financing system will lock in the current system for delivery of care for the indefinite future. This is the pitfall o f the otherwise salutary means being taken to assault inequities in medical care through an expansion of purchasing power. T he issue m ust be so stated as to make it possible for those who wish to limit the scope o f the existing system to fix on that goal and not be deflected by the benefits that comprehensive health in surance will ostensibly provide. T he second is that underw riting the costs of medical care through a com prehensive health insurance plan will inevita bly result in even steeper escalations in the cost of care and a m ore disproportionate consum ption of the gross national product by medical care. Enoch Powell, based on his years of experience in adm inistering England’s health service (and leaving aside his animadversions on other subjects), has m arveled at the capacity o f patients to consume large doses 230 The Transformations of Medicine of care. T he passage of a national health insurance plan will dissolve the last consum ption constraint—the lack of uni form purchasing power. As a nation we will have then de cided to further feed an already bloated system and in so doing divert monies that could otherwise be spent to ameliorate social and environm ental conditions that have a dem onstrably greater impact on health, such as poor hous ing and m alnutrition. And, most tragically, we will deepen the dependency of consumers on services and providers. Because we are on the verge of putting public monies to the task that private money and health care professionals have not accomplished, the prospects for a new medicine are dim. Thus, passage o f a national health insurance plan poses a real and poignant conflict to those who wish to devise and im plem ent a system of medical care that will deal with causes, not cures, and with health rather than disease. T he failure to prom ote a new medicine means that “the future belongs to illness,” to use Peter Sedgewick’s phrase: we ju st a re going to get m ore an d m ore diseases, since o u r expectations o f health are going to becom e m ore expansive a n d sophisticated. M aybe one day th e re will be a backlash, p erh ap s at th e point w here everybody has becom e so lux uriantly ill. O f course, the oppor tunity to seek well-being is not widespread, but the resources are available and could be tapped if they were not harnessed to the causes o f war, competition, and exploitation. And those uses and misuses o f our resources m ust come to an end as well, if not through revolution then at least through natural attrition and decay. We have failed to do so because we have not understood what health is—we have been confused by an assumption that it was an alloy o f good luck and medical care. T he pursuit of health and o f well-being will then be possible, but only if our environm ent is made safe for us to live in and our social order is transform ed to foster health, rather than suppress joy. In this sense, Virchow was profoundly right: Medicine is simply a form of politics. E pilogue A D esign fo r th e F u tu re This epilogue contains some of my personal views about the medicine of the future. We do know, in broad terms, what is likely to be m ore effective, but we do not know enough. People must be given the opportunity to gain a greater understanding of their bodies, of the signals they receive. As simple and even conventional as this sounds, it is unquestionably the most im portant step. But it should also be understood that I am not proposing third-grade classes in personal hygiene. Health education should be far m ore sophisticated than that; there is m ore to health than brushing one’s teeth every day. Health education should be a major com ponent in any curriculum , particularly during the adolescent years when health habits are developed. The task is a large one; the knowledge deficit is great and will take time to over come. Almost every hospital has some space that could be made available for community health education programs. Both written and graphic materials could be 232 A Design for the Future 233 made available. And some o f the tools o f care, such as bandages, splints, and some medications, could be explained and distributed. T o fund these program s initially, all hospi tals in receipt o f federal assistance could be required to make space and resources available. O u r science focuses on what agents cause disease, not on what interactions introduce and maintain health. We recognize the influence o f diet and nutrition and the benefits of exercise, even if we do not know exactly how they benefit us. But we have not learned how to motivate people to take m ore responsibility for themselves and to adopt healthy be haviors. T he only evidence we have now is the occasional anecdote about the 136-year-old Bolivian peasant who attributes his longevity to liquor and loose women. T he system would require that the healer give full notification to prospective patients o f his or her training, if any, and treatm ent modalities utilized, costs, and so on. This certification system should be coupled with pub lication of the outcomes of therapy by individual healers and health care institutions. Nonetheless, the current system must be dim inished to about half its current size. In countries that have medical care systems much smaller than ours, health is not m easura bly worse than in the United States. One elem ent that should be preserved, because it works, is the care and treatm ent of the acutely ill. Physicians should practice directly with and in acute care facilities, which in most cases will be existing hospitals, when the hospital has the capacity to provide such care. Acute care facilities should also develop greatly im proved emergency 234 Epilogue: A Design for the Future care facilities. Physicians, other than those involved in acute and emergency care, should be redeployed and retrained, if necessary, to design and staff the prevention program s out lined below. They should be allowed to treat patients with conditions not requiring hospitalization in acute care facilities only through or in connection with prevention program s, or in residential complexes for the aged. For those practitioners who cannot be retrained, or who cannot find positions, jobs should be offered in any areas that con tinue to be underserved. For example, persons might be trained to provide initial detec tion and diagnostic services and some limited treatm ent for am bulatory patients. Also, persons should be trained to pro vide initial screening and nonacute remedial services to per sons residing in areas currently without such services. Such new personnel should be trained in medical schools until such time as the faculty and administrative staff of such schools can be pared to the size appropriate to train the lesser num ber of fully-trained physicians required, or rede ployed to train an array o f healers. Over the next 10 years or so, health sciences program s should be totally redesigned to train health personnel along a continuum of need, with the acute care physician at one pole. Drugs, once checked for efficacy, should be made available for purchase by patients without a prescription, along with a complete and intelligible description of the drug, its appropriate use, and potential side effects. Simi larly, many of the simple tools of medical care—bandages, splints, clamps, and some simple surgical tools—should be made available for general use. A special need will exist for the training of persons in A Design for the Future 235 health ecology with an understanding o f system interactions. Such persons must develop the skills to design, implement, and adm inister health care prevention and environm ental protection program s, a few of which are described below. Residential complexes should be established for those aged who cannot m aintain a residence, although every attem pt should be made to allow the elderly to care for themselves. For those who require institutionalization, a range o f facilities should be made available to fit the needs of individuals along a housing-health continuum. Medical care should be integrated into such complexes (or through hom e care if the aged prefer to live at home). Public and private health care financing program s should perm it paym ent to the healer of the patient’s choice, in a setting o f m utual choice by the healer and the patient, irrespective of the treatm ent modality o f benefit sought and offered. Accordingly, such plans, whether public or private, should eliminate restrictive definitions of “provider,” and of a “health benefit” and should further provide ready access without or with minimal deterrents such as “deductibles” and “co-insurance. However, if there are fewer healers and hospital beds, dem and can be controlled to some degree. Moreover, if health education works at all, dem and should be far m ore closely calibrated with need then is now the case. An intensive effort m ust be m ade to further concep tualize our understanding o f what health is, what new ap proaches should be tried, and what new concepts will under lie a new paradigm for the medicine o f the future. Investm ent in biomedical research oriented to tech niques o f prevention in individual cases should be expanded to ensure early detection o f cancer, for example.
Quest Books aurogra 100mg visa, At the core of the Hakomi method can be found the Wheaton buy 100mg aurogra visa, Illinois guiding principles of mindfulness generic aurogra 100 mg line, non-violence, 2. LifeRhythm, Mendocino, ness – a relaxed and alert, self-observing state of con- California sciousness – is employed by the therapist and the 3. Levine P, Frederick A 1997 Waking the tiger: client in order to study present experience as it unfolds healing trauma: the innate capacity to in the therapeutic session. North client to stay with experience as it deepens into core Atlantic Books, Berkeley, California organizing material and ultimately bring this material into consciousness. Spondylotherapy (percussion techniques) The principle of non-violence promotes working cooperatively with the system that is being studied. Working Percussion methods have obvious diagnostic/assess- in alignment with this principle, the Hakomi therapist ment value, where they can help to provide informa- views the client’s resistance as important and works tion in regard, for example, to localization of diseased to support it, rather than break through it or overcome lung tissue, such as pleural effusion = stony dull; it. Not only are defenses valued as an important pro- atelectasis or consolidation = dull; pneumothorax = tective function, they are viewed as a signiﬁcant and hyper-resonant; collapsed lung = dull, etc. Evi- percussion, particularly when applied spinally (spon- dence of core beliefs (how one views oneself and the dylotherapy), is to stimulate visceral organs via the world) exists both in the mind and the body; these spinal pathways, or to inﬂuence the nervous system beliefs not only determine thinking and behavior pat- locally or more generally. In Hakomi, the therapist and client are continually Naturopathy, states: ‘Spondylotherapy is a method of working the mind–body interface. This principle assumes that the client’s process will In addition, experts in the ﬁeld of myofascial trigger unfold precisely according to the needs of the system, points, Travell & Simons (1992a), suggest that these and the therapist’s role is to facilitate and support that can be treated effectively using a series of percussive process. Health of the human system depends upon the health Methodology of the communication between the parts of that To treat a trigger point using percussion: system. The unity principle also recognizes the inter- dependence of human beings and, as such, assumes 1. The muscle is lengthened to the point of onset mutuality in the therapeutic relationship. The clinician uses a hard rubber mallet, or Janse et al (1947) provide a variation on this approach, reﬂex hammer, to hit the trigger point at as follows: exactly the same place, approximately 10 times. As to location of application, this team of authors – The trigger points in muscles that they list as bene- who comprised two chiropractors and an osteo- ﬁting most from percussion techniques include path (Wells) – note that percussion is most effective quadratus lumborum (Travell & Simons 1992b), when applied ‘to the area marking the junction of brachioradialis, long ﬁnger extensors and peroneus the transverse processes and the body of the longus and brevis. One or two percussive repetitions braced by the thumb and index ﬁnger are applied per second. Treatment The degree of force applied during percussion is also would be applied only if the area is painful to palpat- of three types: ing pressure. A mild ‘ﬂare up’ of symptoms and increased sensitiv- ity in the area treated would normally indicate that Treatment may be offered daily, on alternate days or the desired degree of stimulation had been achieved. B Percussion technique (spondylotherapy) for reﬂexive effects or treatment of trigger points (slow percussion). Reproduced with permission from Chaitow (2001) Research was carried out on the cerebral This approach is, therefore, not one that produces haemodynamics of patients with cerebral birth injury instant results, but that inﬂuences and gradually har- before and after acupressure (percussion as well as nesses the potential for recovery and improvement compression techniques) therapy. Chapter 7 • Modalities, Methods and Techniques 269 • Tuberculosis • Malignant tumors • Hemorrhagic disease • Skin disease in area to be treated • Poor constitutional states such as malnutrition or asthenia Naturopathic perspectives The use of percussion to stimulate or decrease visceral activity as part of a therapeutic intervention, where such outcomes seem to offer beneﬁt to self-regulation, ﬁts with naturopathic principles. He gives the example motion was performed 10 to 15 times during each of a muscle spasm that can be released by placing the session to each of the following muscles in order: muscle in a position of functional rest followed by coccygeus, iliococcygeus, pubococcygeus, and application of sustained pressure. At the practitioner’s discretion, 10 On the other hand, neurostimulation is most easily to 15 seconds of ischemic compression was applied to achieved by deep and rapid short-duration percus- trigger points. A typical treatment lasted fewer than 5 sion at a rate of approximately 2 per second – inter- minutes. Each massage was scheduled at least 2 days spersed with brief rest periods as suggested by Janse apart to allow for any inﬂammation or discomfort from et al (above). Cautions The researchers in this study noted that: • Acute disease The technique is easy to learn and carries minimal • Severe heart disease risk. Nurses, or even the patient’s partner, can learn 270 Naturopathic Physical Medicine and apply the technique, making this therapy Safety accessible to patients unable to see a physical There are clear issues relating to the potential for inap- therapist. Licensing pelvic ﬂoor muscle compression, stretching, and right and scope of practice issues are also of paramount angle ‘strumming’, with the simultaneous use of importance. The treatment itself, if protocols are fol- external muscle stretching or heat application to facili- lowed, is relatively painless, commonly successful in tate greater muscle relaxation. This was followed by mitigating distressing symptoms, and carries little or transvaginal or transrectal posterior traction with an no risk. Cognitive behavioral therapy, used as part of manual therapy, is advocated by some researchers (McCracken & Turk 2002): Our premise is that, in addition to releasing painful myofascial TrPs, the patient must supply the central nervous system with new information or awareness to progressively quiet the pelvic ﬂoor. Surgery and a variety of electrical approaches (Caraballoa et al 2001) are used in treating such conditions. Regrettably, since most such problems appear to A involve excessive tone of the pelvic ﬂoor muscles, many such patients are referred for Kegel-type toning exercise, with predictably negative results. A question also needs to be asked regarding inap- propriate use of core-stability (Pilates) type exercises for such patients, who above all need to reduce tone rather than increase it. B Physiological effects Removal of sensitized, local, pain-generating areas (trigger points) and normalization of high-tone muscles appears to allow normal function to be restored in many patients with apparently intractable Figure 7. A coccyx with two segments is shown here but coccyges can be in one, two, three or Cautions four segments. Redrawn from Maigne & • Active inﬂammatory conditions or actual Chatellier (2001) pathology involving the tissues of the region. Chapter 7 • Modalities, Methods and Techniques 271 1 2 A 3 B 6 4 C E D 5 Figure 7. Muscles: A, coccygeus; B, iliococcygeus; C, pubococcygeus; D, puborectalis; E, obturatorius internus. Redrawn from Pool-Goudzwaard et al (2004) • Clearly since this approach is aimed at therefore orients the anterior lesser curve of the reducing tone it will be of little value in stomach to the right and the greater posterior curva- conditions associated with low-tone pelvic ture to the left. The pylorus is therefore rotated supe- ﬂoor musculature – where toning exercises are riorly and the cardia inferiorly. Indirect approaches The motility cycle is divided by Barral & Mercier Researchers such as the French osteopaths Barral & into two phases which are termed inspir and expir, that Mercier (1988) and the British osteopath Caroline are unrelated to the breathing cycle. Stone (1999) have documented the existence – in Inspir describes the inherent motion and expir the health – of symmetry in inherent axes of rotation return to neutral afterwards (7–8 cycles per minute). With An example of this is that the liver’s inherent inspir disease, these motions are claimed to be at variance phase involves rotation posterosuperiorly (its mobil- with one another. Additionally, there exists an inher- feel the expir phase (although inspir is more ‘active’, ent organ motility, possibly relating to embryological as there is less resistance to it), being a return to development phases. As an example, Barral & Mercier describe how, Just as joints have articulations, so do viscera. The transverse rotation cavity and pericardium in the heart) as well as a system 272 Naturopathic Physical Medicine of attachments (including ligaments, intercavity pres- place the thumb of the left hand alongside the nails of sure, various folds of peritoneal structures forming the right ﬁngers. Unlike most simultaneously, the left hand thumb being twisted joints, few muscular forces directly move organs. This achieves an appreciable breaking-up, Visceral biomechanics relate to the movements that the without trauma or hurt to the patient, of tensions, organs make against each other, and against the walls adhesions, congestions, etc. Obviously ‘articulate’ by utilizing sliding surfaces formed by the these ﬂicks with the hands need to be repeated a peritoneal (and pleural or pericardial) membranes that number of times to feel a discernible difference in the surround the organs and line the body cavities. Stanley Lief achieved dramatic changes to normal body movement including bending and in tissue structure and functional improvements in locomotion, as well as body processes such as micturiti many types of abdominal stresses including digestive on]. The methodology of positional release is commonly Naturopath and chiropractor Stanley Lief, developer utilized in visceral manipulation, i. All these would normally be outside the scope of the conventional Safety manual therapist. But, with [this] technique, a The methods of indirect visceral manipulation are practitioner can achieve almost dramatic beneﬁts. Boris Chaitow described this method as follows: Validation of efﬁcacy = 3 (see Table 7. Chapter 7 • Modalities, Methods and Techniques 273 In physical therapy (physiotherapy) settings more Physiological effects direct methods are employed. For example, Pierce & Enhanced mobility and motility would be anticipated Webber (1996) report that: to produce functional improvement, as well as Visceral manipulation is a treatment involving speciﬁc enhanced circulation to, and drainage from, organs. Using these techniques, a trained Cautions therapist is able to break down the adhesions formed • Malignant or other serious diseases of the between the connective tissue layers over individual lungs, liver, spleen or associated organs organs. Studies have shown that adhesions are formed • Recent abdominal or thoracic surgery when the serous ﬂuid between connective tissues thickens and becomes more viscous in nature during • Hepatitis the inﬂammatory process. This phenomenon can occur • Infectious mononucleosis after trauma such as motor vehicle accidents, direct • Osteoporosis blows to the rib cage, surgery, and some illnesses. In • Fracture, dislocation or other painful some ﬁbromyalgia patients, visceral manipulation dysfunction involving the joints of the thoracic therapy may offer an important adjunctive therapy cage or spine towards the restoration of efﬁcient lateral-costal breathing. Barral J-P, Mercier P 1988 Visceral ments would seem to be safely achieved by use of the manipulation. You should be seated or standing on the right, hand towards the umbilicus (see Fig. Place your right hand over the lower ribs, molding to should rotate anteroinferiorly around a transverse their curve, covering the outer aspect of the liver. Ideally with eyes closed you are trying to assess the as the ﬁngers seem to press more closely. Each of these planes of movement can be assessed motion would be the opposite to that palpated during separately before they are assessed simultaneously, this phase. Periodically the patient should be asked to hold the Kuchera suggests that tenderness and tension in the breath for a 20-second period, to see whether this mesentery (see Fig. Reproduced with permission from Chaitow (2003) Chapter 7 • Modalities, Methods and Techniques 275 Box 7.
Results: There was no statistically signifcant cor- J Rehabil Med Suppl 55 Poster Abstracts 75 relation between age and the risk of fall buy aurogra 100 mg otc. Also buy aurogra 100mg low price, it was not determined infammatory arthritis and as an evaluation of the temperomandibu- the signifcant correlation between the values of latency and ampli- lary joint discount aurogra 100mg without a prescription, it is however a new method for objective pain evaluation. Material and Methods: In inten- may be not alone signifcant factor for the risk of fall. Thir- measurements may not be provide a signifcant contribution to evalu- teen (n=9. Our participants can be considered as pain of the retinaculum patellae and were included in this study. It is thought to work by underlining that there may be a 90 degrees and 45 degrees. Results: The temperature differences risk of falling more than expected in the community. To our knowledge, this is the frst 1 2 3 report of an objective assessment of pain of the retinaculum patel- M. Our fndings could help making it Shiraz University of Medical Sciences, Physical Medicine and Re- possible to localize and assess pain more precisely. We suppose distal crease of the ance obtained from the electrode applied to the hand was measured, wrist as a point of no. The patients with omalgia and the low back pain in para- tween each two points, and each segments between each 2points lyzed side were done the hyperthermia of hot pack and the xylocaine are called 1to7 from proximal to distal. Results: Mean age of par- intramuscular injection, and visual analogue scale was compared ticipants was 45. Results: For of distal sensory latency (both antidromic and orthodromic) with the patients with omalgia and the low back pain, the difference was inching method are greater in patients than control group (p-value admitted in the individual value that was able to be put in the resting <0. Conclusion: We reveal signifcant difference of antidro- the improvement of the pain sensation was, the smaller increases of mic sensory latency between two adjacent points belonged to ffth impedance when the low back pain was improved by the effect of and sixth segments. Conclusion: The pain is a subjective phenomenon, latency between points was greater in patients than control group and it is changeable. The objective evaluation is diffcult because but only sixth segment had statistically signifcant difference. Kimura, and electromyography was bell’s type facial nerve palsies were compared in 5 years interval performed with monopolar needle electrode 1 inch and a half in The presence or absences of spontaneous activities in orbicularis the muscle bellies. In each patient the perception of pain was as- oculi or frontals muscles were considered. Results: The results showed the following: volved sites and normal sites in each patient calculated. Finally the The perception of pain was much higher during the nerve conduc- data of two groups were compared statistically. Results: Only in 25% of patients Conclusion: Nevertheless, the pain perceived in both tests was with Bell’s palsy the spontaneous activities were recorded while high, considering this kind of tests as painful and invasive tests it was recordable in all trauma patients at p=0. Material and Methods: 3 month retrospective study of inpatients 1Ahvaz Jundishapur Univeristy of Medical Scineces - Ahvaz - Iran, from Apr–Jun 2015 (n=25). The study end point was either pa- Physical Medicine and Rehabilitation, Ahvaz, Iran, 2Ahvaz Jundis- tient discharge or optimised analgesia. We captured demographic hapur Univeristy of Medical Scineces - Ahvaz - Iran, Neurology, data, injuries/treatments nature, and pain scores at admission and Ahvaz, Iran, 3Ahvaz Jundishapur Univeristy of Medical Sciences discharge/end points. Data displayed as median (range) unless - Ahvaz - Iran, Health Research Center- Diabetes Research Center- otherwise stated. Pain scores tend to improve and Introduction/Background: Most of the post stroke patients suffer analgesia use tended to decrease over time. Discussion: We described the with the method of including stretching exercises in addition to dis- profle, pain prevalence, and use of analgesia in rehabilitation pa- port injection in the affected muscles. Majority of patients come from surgical specialties, and ex- number of eight hemiplegic patients following their middle cerebral perience a combination of pain caused by their initial insult and/ artery embolism divided in two identical groups. Patients tended to be pain-free at study disport injected in their involve muscles and for the second group endpoint. Their analgesics rationalised and optimised, leading to the stretching exercises was added to their shoulders, elbows, wrist reduce usage by endpoint. This reduced analgesia supports im- and fnger fexors in addition to the treatment plan for the frst group. Conclusion: Rehabilitation pa- ity were compared using Mann-Withney test after 8 weeks. We have shown that our patients There was a signifcant improvement in upper limb spasticity in the have demonstrably reduced pain scores, optimised and typically second group in compare with the frst group at p<0. This may refect a com- The present study reveals the disport injection did not exclude the bination of a rationalised approach to analgesia, and therapeutic need for upper limb stretching exercises in studied group. Limitations: This study was retrospective, and small sample size (subgroup analyses were 249 not possible). Uğurlu2 1Muğla Sıtkı Koçman University- Faculty of Medicine, Physical Introduction/Background: Hand grip disability is a common dis- 2 order among Patients suffering from spasticity and weakness af- Medicine & Rehabilitation, Muğla, Turkey, Yıldırım Beyazıt Uni- ter traumatic brain injuries. The aim of this study was to compare versity- Faculty of Medicine, Physical Medicine & Rehabilitation, the Effect of Three methods of treatments. They were divided to three groups consisted of fve resulting in the mosaic pattern to the lameller bone. Their Glasgow coma score at hospital admis- terised by focal abnormalities of increased bone turnover affecting sion time were 3–6. The their limbs spasticity and abilities to hold and carrying a ball dur- pain character was mechanical produced by walking and resolved ing the treatments method were compared using non parametric by rest. He had antalgic posture because of decreased spinal mo- and chi square statistical tests. He had also limitation and pain during lumbar spine motion ments leaded to decrease patients limbs spasticity (p<0. Besides straight leg-raising test was hand grip ability improved in the 2nd and 3rd groups. On the other hand, he had local tenderness there was not any advantage in using tizanidin or disport in this over the lumbar spine. Conclusion: In order to gain a normal hand grip function There was no abnormality on neurological and systemic examina- not only the spasticity should be treated but also the other deter- tion except above fndings. There was also moth-eaten radiolucent minants such as weakness and patients insights and co-operation appearance on vertebral corpus of bone. Tecnetium bone scan demonstrated an increased 250 radioactive isotope uptake activity in the lumbar (L2–5) vertebras. Repeat radionuclide bone scanning 1Bolton, United Kingdom was signifcantly showed the reduced distrubition of affected bones. Patients with mild to moder- bones mimicking lumbar discopaty with neuropatic pain. With suc- ate carpal tunnel syndrome have normal to mildly abnormal nerve cessful theraphy, the patient’s back pain resolved. Severe disease is suggested by worsening clinical symptoms and clearly abnor- mal electrodiagnostic studies. Alexandria University - Faculty of Medicine, Physical Medicine Six relevant articles were eventually identifed: (Brininger et al and Rehabilitation, Alexandria, Egypt 2007), (M. De Angelis et al 2008), (Shingo Nouta et al 2009), Introduction/Background: Aim of the work. This is arguably valid 60 asymptomatic hands of healthy volunteers as a control group. Conclusion: Good therapeutic were done: (1) Sensory nerve conduction studies: median and ul- response in an 84-year-old patient might not be the case, or might nar nerves; (2) Motor nerve conduction studies: median and ulnar even be a life-impacting outcome in a 30-year-old active patient. She had global muscle hypertonia in both her upper tra- pezius and scalene muscles. Conclusion: Post stroke visual 1 problems may result in compensatory head posture with chronic C. Rehabilitation is focused on correctable visual defcit, 1China Medical University, Department of Physical Therapy Grad- rebalancing neck muscles, optimisation of posture and ergonomics uate Institute of Rehabilitation Science, Taichung, Taiwan with visual biofeedback and pacing of daily activities. Material and Methods: Patients with colorectal 1The First Rahabilitation Hospital of Shanghai, Rahabilitation De- cancer received oxaliplatin administration were routinely referred partment, Shanghai, China, 2Huashan Hospital-Fudan University- from the Department of Oncology and Cancer Center. Both groups are stimulated for 20 times, 5 times a week for 254 a total of four weeks, 60min each time. Material and Methods: A 19-year-old lady Subsequent studies may further demonstrate whether there is a dif- had chronic axial neck pain after right thalamic bleed with intra- ference between these two. Infam- 1Cheras Rehabilitation Hospital, Rehabilitation Medicine, Kuala matory markers and articular symptoms improved after treatment. Lumpur, Malaysia Conclusion: In conclusion, post-chemotherapy rheumatism may be seen after completion of chemotherapy in patients with Hodgkin Introduction/Background: Rheumatoid arthritis is a chronic pro- lymphoma. Clinicians should kept in mind this diagnosis to speed gressive disease causing infammation in the joints and resulting in up the diagnosis process without unnecessary investigation and it painful deformity and immobility, especially in the fngers, wrists, will be better if the patients are informed about this complication feet, and ankles. She was diagnosed with Seropositive Rheumatoid Arthritis in Jul 2013 after a four years period of persistent and recurrent joint pain and swell- 258 ing involving both her ankles, knees and elbow joints. She was 1 Gulhane Military Medical Academy - Haydarpasa Research and also noted to have multiple bilateral joint contractures involving her Training Hospital, Physical Medicine and Rehabilitation, Istanbul, shoulders, wrists and knees. She Material and Methods: A-40-yr man who was diagnosed ankylos- could hardly stand because of the bilateral knee pain. Cryotherapy ing spondylitis presented to our outpatient clinic due to the increase was also provided however this only improved her pain slightly. Her standing balance improved and Sulfasalazine (2,000 mg daily) and dicıofenac (200 mg daily) treat- by the 5th cycle of hydrotherapy, she was able to walk 5 rounds in ments were discontiniued because of their side effects. She progressed very well in the ab treatment (40 mg) was started every other week. Two days after hydrotherapy pool, walking independently under supervision of our the frst adalimumab application, patient presented to our outpatient therapist. There is no fever and there is no to her late presentation to hospital and hence to rehabilitation, this increased expectoration.