IPHREHAB : LIFESTYLE QUESTIONNAIRE ANALYSIS FOR STRESS CONTROL AND WEIGHT MANAGEMENT

IPHREHAB

IPHREHAB : LIFESTYLE QUESTIONNAIRE ANALYSIS FOR STRESS CONTROL AND WEIGHT MANAGEMENT


Lifestyle Questionnaire Analysis
Please select which of the following relate to you and workout accordingly, consult to your physician and consult the experts. you can mail and comment also.

A. Stress control Profile

• 1. Have you experience lower energy levels, now compared to past.
• 2. Do you feel anxious and tensed , unhealthy mind is not good for health.
• 3. Are you clear about your goals , sole search is important as what you want.
• 4. Do you become angry easily , as Anger is one word short of Danger.
• 5. Do lots of things simultaneously , it will lead you nothing in end.
• 6. Have problems in sleeping, as it will leads to abnormal weight gain or loss. 

B. Weight Management

• 1. Water Retention , main problem in weight gain
• 2. Binge eating/drinking , habitual training needed with environmental change.
• 3. Cravings for certain foods , control and management in diet plan.
• 4. Lack of appetite , ultimately leads to under-nutrition.
• 5. Compulsive eating , main reason for weight gain and obesity.
• 6. Unexplained weight loss or weight gain, thyroid , genetics can be reason.

Stress control and weight management are both interdependent on each other as one control other, for further discussion you can comment or mail to ask specific questions. 

IPHREHAB : OSTEOMALACIA & RICKETS WITH TREATMENT

IPHREHAB


OSTEOMALACIA & RICKETS

DEFINITION
It is a condition characterised  by defective bone mineralisation.
There is increased bone turnover.
It is usually due to Calcium & Vitamin D deficiency.
Condition is rare in USA, UK..
More common in Arab countries

DEFINITION

Rickets is seen in children before Puberty..

Osteomalacia is adult counterpart of Rickets..

Both have same aetiology :

There is failure or defective mineralisation of newly formed matrix

AETIOLOGY

Diet poor in calcium & Vitamin D

Malabsorption Syndromes Chronic Diarrhoea, Sprue,    Steatorrohoea, 

Tuberculosis of Intestines

Chronic  Renal Failure  

AETIOLOGY

Lack of Sunlight Exposure- Reduced Vit. D Conversion 

Hypophophatemia

Vitamin D Resistance Rickets

There is increased thickness of Osteoid Seams, reduces calcification –mineralisation is defective

VITAMIN D METABOLISM

Ultraviolet Rays 

Skin 7-DHC (dehydrocholesterol)

Vitamin D3

Liver  - converts into 25-hydroxylase

Inactive 25(OH) D3

Kidney- 25(OH) Vitamin D 1-a hydroylase

Biological Active 1,25 (OH)2 D3  

Increases absorption of calcium from gut

CLINICAL PICTURE

Delayed DEVELOPMENT-Short Stature

Decreased Muscular Tone (Hypotonia)

Craniotabes  6-12 years 

Frontal Bossing

Delayed Frontallae Closing

Enlargement of Epiphysis (Rickets Rosary)

CLINICAL PICTURE

Teeth are pitted Caries common

Pot-belly Abdomen

Carpopedal Spasms

Laryngeal Stridor

Tetany may be seen

Bone Pains – Defective spine

Waddling Gait

INVESTIGATIONS

Complete Blood Anaemia Common

Serum Calcium Low

Phosphates usually low 

Alkaline Phosphatase raised

X-ray of bones characterstic changes in children Epiphysis thined & distal end of bone widened SAUCER deformity

INVESTIGATIONS

In Adults bone X-ray may be normal or shows osteoporosis

In Children Pseudofractures & Looser’s zones (Radiolucent bands)  may be seen It affects the ribs, Axilliary border of Scapula, Pubic rami

X-Ray of Rickets

BOWED  LEGS

MANAGEMENT

Calcium 1-2 gm daily

Diet- 1 litre of milk

Vitamin D 60,000 IU (1.5 mg of D3) Daily Orally

For tetany IV Calcium gluconate is given

Response to treatment is excellent

Conservative Management

1.Dietary supplement:

2.Physiotherapy treatment :

 .Gentle range of motion exercise.

 .Gradual weaght bearing training.

 .Prevention from fall and injury.

 .Coordination and reconditioning.

 .Light endurance training.

IPHREHAB : INFECTION, TYPHOID

IPHREHAB

TYPHOID

• Very common disease in our country
• Outbreaks are known to occur from time to time
• Pollution & Insanitary condition
• Present in animals except S.Typhi
• Transmitted by food, water, Milk
•  May be directly from one person to another

AETIOLOGY

• Caused by Salmonella Group of Organisms
• Reservoir are animals except for S.Typhi which is seen only in human beings
• There are 2000 Serotypes
• Faeco-oral route
• Tranmission through food, Flies & Fomites
• It involves Payer’s patches of small Intestines

CLINICAL PICTURE

• Fever is most common presenting symptom
• Fever is step ladder pattern
• Onset is insidious
• There is Malaise, Headache, Cough,  Drowsiness & Bodyaches
• Constipation common
• Relative Bradycardia
• Rash may appear on fifth day
• Toxaemia is Max. in 2nd Week
• Spleen is palpable
• Toxaemia increases in 3rd Week
• Coma may set in & may lead to death
• Antibiotics give the best results
• Carriers are well known

INVESTIGATIONS

• Complete Blood Leukopenia Increase in Lympho
• Blood Culture +ve  first week
• Widal’s  Test  2nd Week Rising titer is diagnostic
• Urine & Stool Culture

COMPLICATIONS

• Perforation
• Haemorrhage
• Osteomyelitis
• Meningitis
• Myocarditis
• Pneumonia
• Nephritis
• Hepatitis

MANAGEMENT

• General Management :- Analgesics for fever, Antiemetics (Perinorm) for vomiting
• Antibiotics Ciproflxacillin 500mg BD
• Cotrimoxazole 
• Amoxycillin
• Carrier Ciproflox for 4 weeks
• Prevention - Vaccination

IPHREHAB : INFECTIONS, MEASLES AND MUMPS

IPHREHAB

INFECTIONS

MEASLES

• It is caused by Virus ( Paramyxo)
• It is usually seen in children
• One attack give permanent immunity
• It is in in severe form in malnourished person ( in our country)
• Very high mortality
• Incubation period is 10 days

CLINICAL  PICTURE

• Catarrhal Stage    High Fevere    Severe Nasal Catarrh Sneezing, Redness of Eyes- Conjuctivitis Kapolick Spots in mouth
• Cough Hoareseness of Voice Photophobia
• Child is very irritable & in Miserable Stage
• Exanthematous stage  Koplik  spots disappear  Rash appear on 2-4 day  Rash is maculo papular initially on back of   ear
• It rapidly spread over the body – become blotchy
• Rash settle down in one week Fever subside

COMPLICATIONS

• Stomatitis Entertitis Pneumonia Keratitis
• Otitis Media, Conjunctivitis
• Brochopneumonia
• Encephalitis
• Malnutrition Vitamin A deficiecy
• Severe weight loss

MANAGEMENT

• Bed Rest No schooling for 10 days
• Symptomatic Treatment
• Antibiotics
• Prevetion – active immunisation
• Passive immunisation in serious cases  250 mg IM

MUMPS

• Common disorder in our country
• Caused by virus
• Incubation period 18 days
• Spread by droplet infection
• Not very virulent
• Infectivity ver low
• May remain subclinical

CLINICAL  PICTURE

• Fever
• Pain in the jaw
• Trismus
• Swelling of Parotid Gland subside in 2-3 days
• Meningitis Encephalitis
• Pancreatitis
• Orchitis

MANAGEMENT

• Treat the symptoms
• Antibiotics if bact. Infection is present
• In orchitis cases give predisolone 40 mg daily
• Vaccination for prevention- MMR

IPHREHAB : INFECTIONS, DIPHTHERIA

IPHREHAB

INFECTIONS

DIPHTHERIA

• It is disease caused by Gram + Bacteria
• Bacteria produces Exotoxin – which damages Heart & Nervous system
• It is common in India usually affecting children
• Sore Throat is presenting symptom
• Disease spread by droplet Infection

CLINICAL PICTURE

• Incubation period is 2-4 days
• Infection can occur over the Conjunctiva, Genital tract, Wounds & Abrasions
• Fever is high
• Grayish Green Membrane on Tonsils
• Membrane is firm & adherent
• Swelling of Neck (Bull’s Neck)
• Nasal Infection Common 
• Nasal Discharge ++ – May be Bloody in nature
• Husky voice due to Laryngitis
• Respiratory Infection can lead to death
• ECG may show tachycardia & T-wave changes
• Palatal Paralysis
• Accommodation may be paralysed
• Polyneuritis is seen in few cases

MANAGEMENT

• Inform the Public Health Department
• Give anti-toxin 4000-32000 IM
• Benzyl Penicillin -4 lacs Units 6 hourly for one week
• Treat Complications -  Resp. & Cadiac
• Protect Close relatives Erythromycin Immunization.

IPHREHAB : MENTAL RETARDATION AND MANAGEMENT TEAM

IPHREHAB



MENTAL RETARDATION AND MANAGEMENT TEAM


Management Team
• Management of a case of mental retardation is  undertaken by a team consisting of psychiatrist or physical medicine expert, psychologist and a special educationalist.
•  The other members of team included are speech therapist, physicooccupational therapist, social worker and a vocational counsellor.
After a thorough assessment, the case is referred to either special school whenever possible, home based training or vocational training.


•  In overall management, there is very significant role of counsellor to help the parents in understanding and accepting the child's problem.
•  This requires a life long adjustment. In order to assist the parents in dealing effectively with the situation, counselling for behaviour modification is essential, as a part of the whole rehabilitation management plan.
•  The focus of counselling depends upon the individual needs and requirement of the mentally retarded and his family.


•   The parent counselling is done as given below;
(1)    To provide information regarding the condition of the mentally retarded child. The counsellor should explain child's condition in simple words to the parents and give enough trial.
Further information regarding management of his associated medical problem and other disabilities must be made available to the parents. The false hopes should be avoided.


(2)    Development of correct attitudes towards their handicapped child. Usually parents have wrong beliefs, ideas and thoughts regarding causes and treatment of their disabled child. They blame each other for being responsible for the birth of such child due to lack of awareness. Parents tend to believe that the child would become normal in due course of time. Hence counsellor should give correct information on the nature, causes and treatment of mentally retarded child.


Educational and Treatment Settings
• Only about 8 percent of mentally retarded students attend regular schools. The majority of mentally retarded students attend schools for children with special needs; a minority are home schooled.
There are real advantages to be had by mainstreaming mentally retarded children into regular schools where they can interact with non-disabled peers
• Some mildly mentally retarded children can attend a regular school with learning support. While attending regular classes most of the day, they may also attend a learning support classroom.
• Special education and learning support classrooms are designed to help children learn both academic and independent living skills.
• Special education is closely tied to social training and vocational training in that special education classes are designed to encourage self-determination.
• Traditional learning environments are not always beneficial for students who have more severe forms of mental retardation.
•  In order to ensure that students who have more severe forms of mental retardation are properly accommodated, they may be placed in a special school.
•  Such alternative schools are staffed by special education and learning support professionals. 


Useful Methods for Teaching Mentally Retarded Students
•  Mentally retarded individuals do better in environments where visual aides such as charts, pictures, and graphs are used as much as possible. Such visual components are useful for helping students to understand what is expected of them.
• The typical academic curriculum also incorporates social skills training and practical learning. Social skills help students navigate through social situations, maintain meaningful relationships, and thrive in the work environment.
 • Individuals with mental retardation benefit from the same teaching strategies used to teach individuals with learning disabilities, attention deficit/hyperactivity disorder, and autism.
• It is helpful to break tasks down into small steps and introduce the task one step at a time to avoid overwhelming the individual.
•  Once the student has mastered one step, the next is introduced.
•  Mentally retarded individuals do better in environments where visual aides such as charts, pictures, and graphs are used as much as possible. Such visual components are useful for helping students to understand what is expected of them.
•  Individuals with mental retardation require immediate feedback in order to make a connection between their answers, behaviors, or questions and the teacher's responses.
•  A delay in providing feedback may interrupt the connection between cause and effect in the student's mind, and the point will be lost.
•   Most people are kinesthetic learners who learn by doing, by completing a hands-on tasks and appreciating the results.
•  This is especially true for mentally retarded students who cannot comprehend abstract lectures very easily at all.


For example, a teacher who wants to teach the concept of gravity has several options: She can tell students that things are pulled towards the earth by a force known as gravity; she can show students how gravity works by dropping something; or she can instruct the students to drop something while teaching the concept.

IPHREHAB : PULMONARY EMBOLISM

IPHREHAB


PULMONARY EMBOLISM:

• PAIN CHEST
• PAIN SEVERE RESEMBLE  LIKE THAT OF MYOCARDIAL INFARCTION 
• DYSPNOEA-SEVERE
• COUGH
• HAEMOPTYSIS
• PLEURAL RUB

PULMONARY EMBOLISM

Flight-related Deep Vein Thrombosis (DVT) 

• AN IMPORTANT ENTITY
• KNOWN AS “ECONOMY CLASS SUNDROME”
• SEEN IN PERSONS ON LONG DISTANCE TRAVEL
• OBESE,, OEDEMATOUS
• DEHYDRATED
• COAGULATION DISORDERS

INVESTIGATIONS

1. COMPLETE HAEMOGRAM
2. BT, CT, PROTHROMBIN TIME
3. VENOGRAPHY
4. CT SCAN
5. MRI SCAN
6. ULTRA SOUND- can localize the clot.

Prevention of Pulmonary Embolism

• RISK OF PULM.  EMBOLISM IN PROX DEEP VEIN THROMBOSIS IS  50%
• IN CALF VEIN THAROMBOSIS IS 5-20
• ANTOCOAGULANTS;-  Heparin 7500 Units IV initially, followed by 1000 Units hourly. Should be maintained for 5-7 day

PULMONARY EMBOLISM

• Heparin can be given SC and should be for 3-5 months
• THROMBOLYSIS:- Streptokinase, Urokinase can be used. They are less effective.
• Warfarin can be used also for long time

• LOW DOSE HEPARIN may be very helpful. 5000 Units twice daily SC. It is also helpful in preventing embolsm in Surgical cases.
• ASPIRIN in low doses is also very helpful

MANAGEMENT :

Preventive

• STAND UP & WALK
• CALF MUSCLE EXERCISES
• LOT OF FLUIDS
• NO ALCOHOL
• NO SMOKING
• AVOID CROSS LEGS IN POSTURE
• WEAR LOOSE CLOTHING

MANAGEMENT

• PHYSIOTHERAPY
• REDUCE WEIGHT
• ELEVATE YOUR LEGS
• STOCKINGS
• ROLE OF ASPIRIN
• LOW DOSE HEPARIN
• WARFARIN

CONCLUSIONS

• DVT is very common condition
• It is common in elderly diabetic especially travelling by air on long flights
• IN USA 600,000 cases are diagnosed  every year
• 1% can lead to Pulm.Embolism
•  Pulm. Embolism  may be fatal
• It is Preventable
• Exercise & anticoagulant play important part.