Transcript EL Physiotherapy – A new approach to practical solutions

EL Physiotherapy – A new
approach to physiotherapy
(practical solutions)
Presenter
Margarita Gurevich
EL Physiotherapy – a new approach to physiotherapy in
Australia
Implemented modern physiotherapy techniques
new to Australian practice
Extensive use of electrotherapy techniques with
proven capabilities for efficient disease
prophylaxis and treatment as demonstrated
in Europe and the USA
Combination of electrotherapy and Clinical
Pilates
Practice principles
Use of the established in accordance with the Clinical Practice Guidelines computerised
patient data management system which permits:
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Accurate and detailed patient record including a wide range of diagnostic and treatment
parameters
Effective monitoring of the treatment progress based on regular clinical reassessments
Traceability at all stages (patient history, diagnostic results, treatment plan and protocols,
clinical notes, records of adjustments to the treatment procedures, and treatment effect)
Regular data back up
Privacy Policy assuring the confidentiality of health records
Documented diagnostic and treatment procedures
Regular staff training and maintaining appropriate training records
Continuous search and implementation of new proven diagnostic and treatment
approaches
Main diagnostic techniques
General clinical examination
Imaging techniques e.g. ultrasound, MRI, CT,
etc.
Special physiotherapy techniques:
 FBA
 MMT using the designed at the Centre
adjustable fixation device
 Real Time ultrasound
FBA (full body assessment)
Special physiotherapy diagnostic approach
allowing detailed clinical examination of the
musculoskeletal system of a patient to
identify potential pathological conditions
Performed for 1 hour during the initial session
Comprises over 200 different diagnostic
parameters
Example of clinical examination of neck
pathology as part of the FBA
Neck - ROM
Flexion (90 degrees) and repeat flexion
Flexion after repeat retraction
Extension (110) and repeat extension
Extension after repeat retraction
Rotation (190)
LF (190)
Retraction (110)
Protraction (110)
Passive physiological movement
Neurological
ULTT - 1 (elbow extension <10)
ULTT - ulnar nerve (shoulder abduction)
ULTT - radial nerve (shoulder extension)
Palpation - neck
Significant findings
Cx disc bulge
Disfunction
Facet pain
Cx instability - flexion
Cx instability - extension
Other
LEFT
RIGHT
Treatment techniques
Electrotherapy:
 Electrostimulation
 Interferential
 Ultrasound
 Magnetotherapy
 Pharmacological phoresis
 SCENAR
 Combination therapy
Clinical Pilates
General physiotherapy:
 Mobilisation
 Traction
 Exercise programs etc.
Electrotherapy
Performed using the Chattanooga Intellect
Advanced Therapy System and other modern
devices
Parameters of the Chattanooga
electrotherapy system
The features of the electrotherapy system include:
 More than 25 clinical waveforms
 2 independent electrotherapy channels
 Various ultrasound frequencies
 Pulsed and continuous mode
 Variable duty cycles
 Over 200 clinical protocols available
 Over 100 user-defined protocol capacity
 Graphic anatomical and pathological clinical library
 Documentation of treatment outcomes with patient
data cards system
Pharmacological phoresis
Types of pharmacological phoresis:
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Iontophoresis
Drug delivery system using galvanic current
Phonophoresis
Drug delivery system using ultrasound
Magnetophoresis
Drug delivery system using magnetic flux
Drugs administered as single preparations or in combinations from the
following groups:
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NSAID
Corticosteroids
Local analgesics
Vasodilators
SCENAR therapy
Standard use for treatment of musculoskeletal,
cardiovascular, gynecological, neurological,
dermatological, gastroenterological, respiratory and
other diseases
Special dental probe for treatment of oral pathology
such as gingivitis, parodontosis etc.
SCENAR blanket for enhancing the therapeutic effect
of the treatment
Combination therapy
Usually two treatment modalities on the same/different
area
Iontophoresis and ultrasound
Interferential and phonophoresis
Iontophoresis and magnetotherapy
SCENAR and magnetotherapy
Clinical Pilates – diagnostic assessment
Detailed diagnostic assessment
FBA using special modern diagnostic
techniques:
 MMT with the adjustable fixation device
 ROM
Aquilla real-time ultrasound
Haematological and biochemical analyses if
required
Clinical Pilates - treatment
Use of modern treatment equipment:
 Allegro reformers
 DMA trapeze tables
Individual and group treatment sessions
conducted by physiotherapists
Sessions also include hands-on work if
required
Principles of treatment sessions
Individual exercise treatment programs for specific pathologies based
on outcome of FBA
Performance control
Regular reassessments after 7 weeks and comparison with the
previous results
Program adjustments following reassessments
Detailed record of results at each session
Individual sessions initially, then potential for group sessions
Group treatment sessions
Groups composed of patients with similar level
of physical strength and Pilates skills
Group structures
2:1 (2 patients, 1 physiotherapist)
3:1 (3 patients, 1 physiotherapist)
Progressive transfer of patients to the next level
based on the reassessment results
General physiotherapy
Mobilisations
Traction
Therapeutic weights
Exercise programs
Thermal therapy
Prenatal, antenatal and postnatal therapy
Incontinence therapy
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19 year old male
Intersection syndrome of the right wrist (1 week
history)
Main issues:
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Pain (6/10 on VAS) aggravated by lifting and carrying
objects heavier than 500g
Treatment method: combination of 2-pole
interferential therapy and phonophoresis with
diclofenac 1% (w/w)
Number of sessions: 8
Reassessment results:
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pain reduced by 70%
Increased wrist ROM and strength
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71 year old female
Irritation of cervical (C5-7) and lumbar (L3-5) facet
joints
Main issues:
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Cervical pain (7/10 on VAS) aggaravated by lying down
Lumbar pain (7/10 on VAS) aggravated by prolonged
standing
Treatment method: combination of SCENAR and
magnetotherapy
Number of sessions: 9
Reassessment results:
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Both cervical and lumbar pain reduced to 3/10 on VAS
Increased cervical and lumbar ROM
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68 year old female
R knee fat pad impingement and patello-femoral
joint pain
Main issues:
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Unable to walk more than 5 mins without knee pain
Treatment method: combination of 2-pole
interferential and phonophoresis with diclofenac 1%
(w/w)
Number of sessions: 3
Reassessment results:
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Pain completely disappeared
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21 year old male
C5/6 disc bulge with extension instability
Main issues:
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Acute cervical pain (1 week history) reaching 9/10
on VAS
Treatment method: SCENAR therapy
Number of sessions: 5
Reassessment results:
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Cervical pain settled almost completely
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61 year old female
C5/6 disc bulge
Grade 2 right subacromial joint impingement
Main issues:
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Longstanding history of right shoulder and neck pain
Had 2 cortisone injections into right shoulder
Treatment method: SCENAR therapy
Number of sessions: 8
Reassessment results:
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Right shoulder pain and neck pain settled almost
completely
Increased cervical and right shoulder ROM
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47 year old female
Left heel spur
Main issues:
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6 month history of L heel pain (5/10 on VAS)
Difficulty getting out of bed, walking
Treatment method: phonophoresis with
diclofenac 1% (w/w)
Number of sessions: 8
Reassessment results:
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L heel improved by at least 50%, getting out of
bed and walking became easier
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62 year old male
Left L2/3 posterolateral disc prolapse
Main issues:
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Longstanding history, 1 month flare-up
Taking oxycontin, voltaren (25mg),
panadol/panadeine (2 tablets, 3-4 times/day)
Treatment method: Clinical Pilates
Results: stopped taking analgesics after 5
sessions; able to increase exercise intensity
after 7th session
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50 year old male
R tennis elbow
Main issues:
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Longstanding history aggravated by playing tennis, work
Treatment method: combination of SCENAR and
Clinical Pilates
Number of sessions: 3 sessions of SCENAR only,
then combination for further 5 sessions
Reassessment results:
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After 3 sessions pain ceased; able to work for 1-2 hours
without pain
Trial tennis session after 7 sessions, no pain
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72 year old female
Tx osteochondrosis, R shoulder grade 2
supraspinatus impingement
Main issues:
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6 month history of thoracic and R shoulder pain aggravated
by ADL’s
Treatment method: combination SCENAR therapy
Number of sessions: 6
Reassessment results:
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After 1 session pain reduced; able to do shopping without
pain after 3 sessions; ceased completely after 6 sessions
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50 year old female
Plantar fasciatis
Main issues:
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4 year history aggravated by getting out of bed in
the morning and walking
Treatment method: combination of SCENAR
and phonophoresis with diclofenac1% (w/w)
Number of sessions: 10
Reassessment results:
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Getting out of bed got easier after the first
session; significantly better 4 sessions; overall
improvement at least 60%
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53 year old female
Longstanding history of LBP: Lx facet joints
irritation, L3/4, L4/5 ext instability, bilateral
anterior SIJ instability
Treatment method: Clinical Pilates
Reassessment results:
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Started feeling significantly better after 7 sessions
Still gets occasional flare-ups, but significantly
reduced in frequency and intensity; much better
body awareness, posture and core stability
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41 year old female
4 week history of cervical pain with
numbness in the R middle finger
Main issues: C5/6 disc bulge
Treatment method: Clinical Pilates
Reassessment results:
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Pain started to decrease after the first session
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34 year old female
Longstanding history of LBP aggravated
during pregnancy (had a baby 6 months ago)
Main issues: L4/5 disc bulge with extension
instability
Treatment method: Clinical Pilates
Reassessment results: noticed an
improvement after the first session, pain
disappeared completely after 5 sessions
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54 year old male
Grade 2 subacromial impingement of the
supraspinatus tendon
Main issues:
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1 month history of L shoulder pain aggravated by heavy
lifting and lying on his left side
Treatment:
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2 sessions of SCENAR therapy – moderate reduction in
pain which returned after patient went back
3 sessions of iontophoresis with dexamethosone sodium
phosphate (8mg/2mL) – good results, pain disappearing
almost completely for 1-2 days after each treatment,
returning with reduced intensity
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53 year old female
Functional dyspepsia
Main issues:
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7 month history of almost constant nausea, reduced
appetite, decreased energy
Has been taking motilium, lexapro, stemitil/maxalon
Treatment method: SCENAR therapy in combination
with SCENAR blanket
Reassessment results:
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Improved appetite and increased energy after 4 sessions
Nausea started to decrease after 7 sessions, disappeared
completely after 12 sessions
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49 year old female
Paradontosis
Main issues:
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Pain and swelling of the lower gum (L side>R)
Visual swelling, redness and dropping of the lower gum;
difficulty eating coarse food
Treatment method: SCENAR
Number of sessions: 10
Reassessment results:
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After 5 sessions redness and swelling decreased, lower
gum lifting up
Patient able to eat coarse food (apples) after 9 sessions