IPHREHAB: NUTRITION IN MERATHON

IPHREHAB
NUTRITION IN MERATHON


1. Keep hydrated.
Drink eight glasses of water per day, and make sure to keep drinking while exercising.


2. Decrease or eliminate junk food.
It supplies empty calories, excess fat and sodium, sugar and food additives.


3. Feed your muscles.
They need energy to work, and their main energy source is glycogen. Carbohydrates are your best source of glycogen.


4. Eat 5 to 6 grams of carbohydrates per kilogram of body weight
To supply adequate glycogen to muscles.


5. Choose healthy sources of carbohydrates.
Eat fruits, salads, pasta, cereals and whole-grain breads. They not only provide carbohydrates, but are packed with fibres, vitamins and minerals.


6. Check with a professional trainer or nutritionist to assess whether you need extra protein.
If you are training vigorously, extra protein may be worth considering. The added amount is usually small, even for professional athletes.


7. Eat a healthy, well-balanced diet
The USDA's (United States Department of Agriculture) Food Guide Pyramid suggests three to five servings of vegetables and two to four servings of fruit every day.


8. Make sure to get fat in your diet.
Even if you are on a weight loss program, polyunsaturated and monounsaturated fats are better for you than saturated. The recommended amount is no more than 30 percent of your total intake of calories.

IPHREHAB : HYPOTONIA AND ETIOLOGY

IPHREHAB

HYPOTONIA


Disorders of muscle tone Hypotonia

• Hypotonia is a condition of abnormally low muscle tone, often involving reduced muscle strength.
• Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. 
• Recognizing hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying cause can be difficult and often unsuccessful.

§

• The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause.  
• Some disorders have a specific treatment but the principal treatment for most hypotonia of idiopathic or neurological cause is physical therapy to help the person compensate for the neuromuscular disability .

Etiology of Hypotonia

§

• Congenital - i.e. present from birth (presenting within 6 months) 

§

• Genetic disorders are the most common cause

Down's syndrome - most common

3-Methylcrotonyl-CoA carboxylase deficiency

Achondroplasia

Aicardi syndrome

Canavan disease

Centronuclear myopathy

Familial dysautonomia

Infantile spinal muscular atrophy

Krabbe disease

Leigh's disease

Marfan's syndrome

Menkes syndrome

Methylmalonic acidemia

Nonketotic Hyperglycinemia (NKH) or Glycine Encephalopathy (GCE)

Prader-Willi syndrome

Tay-Sachs disease

Trisomy 13

22q13 deletion syndrome

FG Syndrome

Developmental Disability

Cerebellar ataxia (congenital) 

Dysfunction in Sensory Integration (DSI) 

Developmental Dyspraxia 

Hypothyroidism (congenital) 

Hypotonic Cerebral palsy 

Teratogenesis from in utero exposure to Benzodiazepines 

Acquired

Genetic 

1. Muscular dystrophy (including Myotonic dystrophy) - most common 
2. Metachromatic leukodystrophy 

• Infections 

Encephalitis

Guillian-Barre syndrome

Infant botulism

Meningitis

Poliomyelitis

Sepsis

§

• Autoimmunity disorders  

Myasthenia gravis- most common

Abnormal vaccine reaction

§

• Metabolic disorder

Hypervitaminosis

Kernicterus

Rickets

§

• Neurological

Traumatic brain injury, such as the damage that is caused by Shaken Baby Syndrome

Lower Motor Neuron Lesions

Upper Motor Neuron Lesions

§

• Miscellaneous  

Central nervous system dysfunction, including Cerebellar lesions

Hypothyroidism

Other names for hypotonia

• Low Muscle Tone 
• Benign Congenital Hypotonia 
• Congenital Hypotonia 
• Congenital Muscle Hypotonia 
• Congenital Muscle Weakness 
• Amyotonia Congenita 
• Floppy Baby Syndrome 
• Infantile Hypotonia 

IPHREHAB : MUSCLE SPINDLE

IPHREHAB

MUSCLE SPINDLE

§Muscle structure is innervated by both sensory and motor neuron axons. When a skeletal muscle with intact nerve supply is stretched, this reflex is called as stretch reflex.

§Stimulus is stretch and response is contraction and the sense organ is muscle spindle. Example is knee jerk

§ The muscle spindle's functions are to send proprioceptive information about the muscle to the central nervous system, and to respond to muscle stretching.

§Muscle spindles are encapsulated by connective tissue capsule, and are aligned parallel to extrafusal muscle fibers, unlike Golgi tendon organs, which are oriented in series. 

§Muscle spindles are found within the fleshy portions of muscles, embedded in so-called extrafusal muscle fibres. They are composed of 3-10 intrafusal muscle fibres, of which there are three types:

§Dynamic nuclear bag fibres (bag1 fibres)

§Static nuclear bag fibers (bag2 fibres)

§Nuclear chain fibers and the axons of sensory neurons.

§There are two nuclear bag fibers per spindle whereas there are four or more nuclear chain fibers per spindle.

 Sensory Endings

Two kinds in each spindle

Primary or annulospiral endings are the terminations of rapidlly conducting Ia afferent fibers (innervates all three types of intrafusal fibers)

Secondary or flower spray endings are terminations of group II sensory fibers, located nearer the ends of intrafusal fibers but only on nuclear chain fibers.

Motor nerve supply

Motor nerve supply of their own

They make synapses at either or both of the ends of the intrafusal muscle fibers and regulate spindle sensitivity.

3-6μm in dia.

Constitute 30% fibers of ventral root.

Aγ group, also called as gamma efferent of Leksell, and go exclusively to spindles.

In addition, β motor neurons, innervates both intrafusal and extrafusal fibers. 

IPHREHAB : MUSCLE TONE

IPHREHAB

Muscle Tone

Muscle tone refers to the amount of tension or resistance to movement in a muscle.  

Muscle tone (a different phenomenon than muscle tension) is the continuous and passive partial contraction of the muscles. It helps maintain posture and declines during REM sleep.

Muscle tone is what enables us to keep our bodies in certain position or posture. 

Changes in muscle tone is what enables us to move.  For example, to bend your arm to brush your teeth, you must shorten (increase the tone of) the biceps muscles on the front of your arm at the same time you are lengthening (reducing the tone of) the triceps muscles on the back of your arm. 

To complete a movement smoothly, the tone in all muscle groups involved must be balanced.  The brain must send messages to each muscle group to actively change its resistance.

Purpose

Unconscious nerve impulses maintain the muscles in a partially contracted state. 

If a sudden pull or stretch occurs, the body responds by automatically increasing the muscle's tension, a reflex which helps guard against danger as well as helping to maintain balance.

The presence of near-continuous innervation makes it clear that tonus describes a "default" or "steady state" condition. There is, for the most part, no actual "rest state" insofar as activation is concerned.

§In terms of skeletal muscle, both the ex tensor muscle and flexor muscle use the term tones to refer to the "at rest" or normal enervation that maintains current positions of bones.

§Cardiac muscle and smooth muscle, although not directly connected to the skeleton also have tonus in the sense that although their contractions are not matched with those of antagonist muscles, their non-contractive state is characterized by (sometimes random) enervation.

§Many people don't understand the difference between muscle tone and muscle strength.

§True muscle tone is the inherent ability of the muscle to respond to a stretch. For example, if you quickly straighten the flexed elbow of an unsuspecting child with normal tone, the biceps will quickly contract in response (automatic protection against possible injury). When the perceived danger has passed, which the brain figures out really quickly once the stimulus is removed, the muscle then relaxes, and returns to its normal resting state.

§The child with high tone or "spasticity" has over-reactive response to the same stimulus. When his arm is stretched, the biceps tightens at an even more rapid rate, and the rate of recovery is much slower, even after the stimulus is removed. Full relaxation is difficult to achieve, so the muscle stays taut for an extended period of time.

§If another stimulus is added before the muscle has a chance to recover (which happens often during normal movement in the everyday world), the muscle contracts again, becoming tighter. Because this child's muscles never truly rest unless he is asleep, the long term result is tighter, shorter muscles with reduced joint range. This is typically seen in the child with spastic CP.

§The child with low tone has muscles that are slow to initiate a muscle contraction, contract very slowly in response to a stimulus, and can not maintain a contraction for as long as his "normal "peers.

§Because these low-toned muscles do not fully contract before they again relax, they remain loose and very stretchy, never realizing their full potential of maintaining a muscle contraction over time.

§These are the "floppy" children who have difficulty maintaining any posture without external support .

§Somewhere deep in the muscle are receptors responsible for detecting changes in muscle length.

§ These receptors then tell the brain there is a stimulus, and the brain tells the muscle to contract in response.

§There are numerous feedback loops to tell the brain whether the muscle has responded appropriately, needs to contract again, relax or whatever...

§In addition, there are receptors that tell where each joint is located in relation to all the other body parts that help to determine position in space, etc.

§ A delay in perception, decoding, or transmission anywhere along the neural pathways will result in a change from an optimal response, or "normal" tone. 

§Muscle tone occurs at an involuntary level. We can effect changes in muscle responses with sensory integration treatment techniques that increase the "alert state of the muscle" by bombarding it with sensory stimuli and improve the brains ability to perceive changes in muscle length, preventing it from accommodating to stimuli.

IPHREHAB: OBESITY & LIFESTYLE HAZARDS AND CONTROL

IPHREHAB

OBESITY

VERY COMMON NOW-A-DAYS

USA IS OBESE COUNTRY OF WORLD

CHILDHOOD OBESITY HAS BECOME NATIONAL PROBLEM

18 YEARS OLD GIRL WEIGHING 320 POUNDS DIED IN CLEVELAND

OBESITY REDUCES LIFE SPAN

NOT A SINGLE CENTURION IS OBESE

JAPAN  &  FRANCE ARE CALLED SLIM COUNTRIES

RESPONSIBLE FOR MANY DISEASES- Osteoarthritis, Hypertension, Heart Attack

FAST  FOODS  ARE   RESPONSIBLE  FOR THIS

FIBRE IN DIET REDUCES WEIGHT

ISAPHGOL (Grandmother’s Remedy) COMMONLY USED IN INDIA

WINE

WINE IF TAKEN PROPERLY GIVES PLEASANT INTOXICATION AND PRODUCES EXHILARATION, ENERGY, CONTENTMENT, COPULENCE, FREEDOM FROM DISORDERS, SEXUAL POTENCY AND STRENGTH

Charak Samhita 800 BC

ALCOHOL

In small amounts it is GOOD

In large amounts it is Dangerous

It increases HDL level

It reduces Cholesterol. & LDL

Two small  Pegs twice a week better with water than Soda.

STRESS

MAJOR CAUSE OF HIGH BLOOD PRESSURE

DIFFICULT TO DEFINE

IMPOSSIBLE TO MEASURE

ACUTE STRESS CAN BE FATAL

BUT IS ESSENTIAL FOR LIFE

 IT IS DRIVE FOR COMPETITION

PERFECTIONIST

HE  IS  NEVER  HEALTHY

HE HAS  PHYSICAL & MENTAL PROBLEMS

HE HAS EATING DISORDERS, DIFFICULT  RELATIONSHIPS & SUICIDAL  TENDENCIES

HE  IS  ANTISOCIAL

HE  SUFFERS FROM  HIGH BLOOD PRESSURE

WAYS TO RELAX

YOGA

   THEY ARE HINDU MEDITATIVE PRACTICES MAINLY CONTROL BREATHING & POSTURE

TRANSCENDENTAL MEDITATION (TM)

   USUALLY THINKING OF A WORD OR  SOUND

PROGRESSIVE MUSCLE RELAXATION (PMR)

   ACHIEVE CONSCIOUS CONTROL OVER MUSCLES GROUP AND INDUCE DECREASE IN TONE

 BIO FEED MECHANISM
    REDUCES BLOOD PRESSURE DRAMATICALLY IN HYPERTENSIVE .