IPHREHAB : NPTE FOR PTs IN USA

IPHREHAB

If you are a Foreign PT (physiotherapist) seeking career in USA
Here is the process of starting your career as a physical therapist in USA:


1. Just sit quietly and give yourself sometime and think which STATE you are planning to work in as a PT.


2. Decided? Now let's move ahead.


3. Apply to one of the Credential evaluation agencies to find out if your education is equivalent to USA entry level education.


You can apply to one of these agencies depending upon the state you are interested in:-
a) www.fccpt.org
b) www.cgfns.org
c) www.ierf.org


FCCPT COVERS THE MAXIMUM NUMBER OF JURISDICTIONS.SO FOR LONG TERM APPLYING WITH THIS AGENCY IS BENEFICIAL.LIKE IF IN FUTURE YOU WANT TO APPLY FOR SOME OTHER STATE'S EVALUATION,THERE IS NO NEED OF REQUESTING YOUR DOCUMENTS AGAIN FROM YOUR ACADEMIC INSTITUTION, AS FCCPT KEEPS YOUR PAPERS WITH THEM FOR A LONG TIME.
IERF DOES NOT HAVE VISA SCREENING SERVICE SO THOSE WHO NEED WORK PERMIT OR H1, ITS BETTER TO GO FOR CGNFS OR FCCPT.


4) Credential evaluation can take a long time upto 6-7 months .All depends on the agency you choose and the time your academic institutions take to send over your documents to USA.(better use fedex account ) 


5)while you have applied for educational evaluation,don't waste time:- you have three choices:-


i) If u need H1,better start preparing for "TOEFL".And get done with it.The score requirements differ with states so better check with agencies not with state boards because TOEFL is required only for Visa Screening not for PT license.


ii) Few country PT always get some deficiency in general credits like INDIA.(i know this because I am an Indian).So giving few Clep exams won't hurt.i did the same.this will save time in future.Don't go for lab courses as you don't know which compulsory lab course will u get.So better opt for English.Science etc.


iii) Read the reference books for NPTE as u won't get time for them later.I mentioned in my earlier post regarding the reference books.


6) If u do not have a social security number u have to apply for a alternate identification number(AIN) which will b required when u register for the NPTE.This can be applied here:-
http://www.fsbpt.org/download/AINApp_20090105.pdf

7) Apply to required state board of education.And fill their application for PT License.
u can send them application even now as u apply to one of the agencies (fccpt,ierf,cgfns).they will again open a file for u and keep and as soon as they receive doc or report from the agency ,they will give you a green signal to appear for NPTE.this 7th step can differ a bit depending upon the state.


8) After TOEFL, start preparing for NPTE so that as soon as evaluation is complete and state board sends u approval letter ,u can apply to fsbpt for a ATT(approval to test).This will give a 2 months eligibility period starting frm around the date u apply,so apply for att only once sure of giving the exam within coming 2 months.
Also after this 2 months eligibility period u have to agian apply for another Att n pay the fees again.The site is www.fsbpt.org


5) Once Att letter is in ur hand register for a date with prometric.they have centres all around.u can choose which suits u according to the available day and date.And all the best for the exam.


So thats all ...the process looks very lengthy n confusing but dont worry...just apply for credential evaluation for now..the rest will take no time. In fact a few will be done while waiting for evaluation to be complete.
Have patience !


Hope this helps......

IPHREHAB : Vertebrae and Spinal Cord Segmental Levels

IPHREHAB

Vertebral vs. Cord Segmental Levels

The spinal cord is situated within the spine. The spine consists of a series of vertebral segments. The spinal cord itself has "neurological" segmental levels which are defined by the spinal roots that enter and exist the spinal column between each of the vertebral segments. As shown in the figure the spinal cord segmental levels do not necessarily correspond to the bony segments. The vertebral levels are indicated on the left side while the cord segmental levels are listed for the cervical (red), thoracic (green), lumbar (blue), and sacral (yellow) cord.

Vertebral segments. 

There are 7 cervical (neck), 12 thoracic (chest), 5 lumbar (back), and 5 sacral (tail) vertebrae. The thoracic vertebrae are defined by The spinal cord segments are not necessarily situated at the same vertebral levels. For example, while the C1 cord is located at the C1 vertebra, the C8 cord is situated at the C7 vertebra. While the T1 cord is situated at the T1 vertebra, the T12 cord is situated at the T8 vertebra. The lumbar cord is situated between T9 and T11 vertebrae. The sacral cord is situated between the T12 to L2 vertebrae.

Spinal Roots. 

The spinal roots for C1 exit the spinal column at the atlanto-occiput junction. The spinal roots for C2 exit the spinal column at the atlanto-axis. The C3 roots exit between C2 and C3. The C8 root exits between C7 and C8. The first thoracic root or T1 exits the spinal cord between T1 and T2 vertebral bodies. The T12 root exits the spinal cord between T1 and L1. The L1 root exits the spinal cord between L1 and L2 bodies. The L5 root exits the cord between L1 and S1 bodies.

The Cervical Cord. 

The first and second cervical segments are special because this is what holds the head. The lower back of the head is called the Occiput. The first cervical vertebra, upon which the head is perched is sometimes called Atlas, after the Greek mythological figure who held up earth. The second cervical vertebra is sometimes called the Axis, upon which Atlas pivots. The interface between the occiput and the atlas is therefore called the atlanto-occiput junction. The interface between the first and second vertebra is called the atlanto-axis junction. The C3 cord contains the phrenic nucleus. The cervical cord innervates the deltoids (C4), biceps (C4-5), wrist extensors (C6), triceps (C7), wrist extensors (C8), and hand muscles (C8-T1).

The Thoracic Cord. 

The thoracic vertebral segments are defined by those that have a rib. These vertebral segments are also very special because they form the back wall of the pulmonary cavity and the ribs. The spinal roots form the intercostal (between the ribs) nerves that run on the bottom side of the ribs and these nerves control the intercostal muscles and associated dermatomes.

The Lumbosacral Cord. 

The lumbosacral vertebra form the remainder of the segments below the vertebrae of the thorax. The lumbosacral spinal cord, however, starts at about T9 and continues only to L2. It contains most of the segments that innervate the hip and legs, as well as the buttocks and anal regions.

The Cauda Equina.

 In human, the spinal cord ends at L2 vertebral level. The tip of the spinal cord is called the conus. Below the conus, there is a spray of spinal roots that is frequently called the cauda equina or horse's tail. Injuries to T12 and L1 vertebra damage the lumbar cord. Injuries to L2 frequently damage the conus. Injuries below L2 usually involve the cauda equina and represent injuries to spinal roots rather than the spinal cord proper.

In summary, spinal vertebral and spinal cord segmental levels are not necessarily the same. In the upper spinal cord, the first two cervical cord segments roughly match the first two cervical vertebral levels. However, the C3 through C8 segments of the spinal cords are situated between C3 through C7 bony vertebral levels. Likewise, in the thoracic spinal cord, the first two thoracic cord segments roughly match first two thoracic vertebral levels. However, T3 through T12 cord segments are situated between T3 to T8. The lumbar cord segments are situated at the T9 through T11 levels while the sacral segments are situated from T12 to L1. The tip of the spinal cord or conus is situated at L2 vertebral level. Below L2, there is only spinal roots, called the cauda equina.

IPHREHAB : What are Stretch Marks? Symptoms,Cause,Remedies and Diet

IPHREHAB

What are Stretch Marks? 

Stretch marks are skin lesions that occur when skin is pulled rapidly and the problem is caused by rapid weight gain. Although most of us tend to associate the problem of stretch marks with women, post-pregnancy, the problem is not restricted to women alone. The problem of stretch marks has become increasingly common with many being afflicted with the condition, particularly after resorting to fad diets and medications for rapid weight loss.

Symptoms of Stretch Marks

When skin is excessively pulled it hampers the production of collagen and elastin in the skin, causing them to thin out and weaken. This causes the skin to stretch and discolor. When stretch marks first appear, they take on an angry red color. The skin is stretched so much that it appears transparent and the blood vessels show through; this is what gives the marks the red color. Over time the blood vessels contract and leave the skin looking pale. This whitish color that replaces the red comes from the body fat that is visible through the stretched skin. 

Causes of Stretch Marks

This may be a result of pregnancy, when the skin gets pulled as the belly size increases, as a result of puberty in teens experiencing a growth spurt, a side effect of obesity or of illnesses like diabetes. Stretch marks usually appear on the abdomen and thighs.

Remedies for Stretch Marks

While stretch marks don’t vanish, they do fade with time. The use of over the counter creams and ointments helps the scars fade. One such effective ointment is cocoa butter cream. It is widely available and will help moisturize skin and is effective in smoothing out scars. In extreme cases patients seek laser therapy and surgery to correct the scars left on the body. These are painful and invasive treatments that serves no great cause. So instead of taking such a drastic step, it would be better to opt for simple and effective home remedies for stretch marks. Though the marks won’t vanish over night, they will fade away with proper treatment and dieting.

 Try some the following home remedies and observe the progress:

• Lavender Oil – Lavender oil is a highly recommended home remedy for stretch marks. Rubbing a few drops of lavender oil on the affected area twice a day ensures the scars fade quickly. Applying olive oil is also very effective.

• Sandalwood – A great preventive measure for stretch marks is applying sandalwood on the skin daily. It keeps the skin moisturized and prevents it from stretching.

Diet for Stretch Marks

An important aspect in the treatment of stretch marks is eating right. Eat foods that are good for your skin. These include fresh fruits and vegetables, especially those rich in Vitamin A, C and D. These foods improve skin tone and minimize blemishes. Zinc rich foods like nuts and fish also help diminish scars on skin. It is also of great importance that you drink lots of water through the day.

Suggestions for Stretch Marks

For anyone fighting off stretch marks, it is important to incorporate at least 30 minutes of exercise into your daily schedule. Exercising helps tone and firm up muscles, which in turn firms the skin. Yoga is a good option as it allows you to stretch and tone every muscle in the body.

IPHREHAB : STRETCH MARK ON BREAST AND TREATMENT

IPHREHAB

Stretch Marks on Breast

Why do you get stretch marks on breasts? 

Stretch marks can appear on any part of the body and can be quite emotionally disturbing for almost any individual. The fact that today’s world seems to place such a high significance in the way a person looks makes things even more emotionally traumatic. Stretch marks, while being of no real medical seriousness, can greatly affect an individual’s quality of life because of the amount of confidence it can dent.

It can completely dictate the kind of clothes that one wears, thereby greatly influencing ones aesthetic appeal. Stretch marks on the breasts, just like the stretch marks on any part of the body, are a result of the constant expansion and contraction of the skin to adjust to the fluctuations in a person’s weight, as a result of weight gain or dieting. While it is possible to reduce the prominence of the stretch marks, complete removal can prove completely impossible.

While a number of big cosmetic brands may market some of their lotions and creams as the perfect solution, even the cosmetic industry have not yet found a way to completely remove the stretch marks and the lotions will simply reduce the prominence of these marks. Another very common reason for the occurrence of stretch marks is going through a pregnancy, as this is also characterized by rapid weight gain and loss.

While there isn’t really much one can do about stretch marks that have already developed, following a healthy and balanced diet will help moisturize the skin, causing the stretch marks to fade away to some degree.

 The logic behind this is to make sure that your skin remains firm and as elastic as possible. One of the most effective home remedies to achieve this is to mix the ingredients of ¼ cup of Aloe Vera gel, ½ cup of olive oil, the liquid content of 6 vitamin E capsules and the liquid content of 4 vitamin A capsules. Once blended together, store the mixture in a fridge and topically apply the mixture over all the locations of your body where the stretch marks normally occur. The application of Aloe Vera gel over the affected areas also helps significantly lighten the prominence of stretch marks. Increase your intake of seeds and nuts that contain zinc as it is a vital ingredient in the removal of stretch marks.  The application of cocoa butter twice a day over the affected area will also help considerably as will the application of pure lavender oil.

IPHREHAB: UPPER LIMB ORTHOTICS AND NERVE INJURY

IPHREHAB


UPPER LIMB ORTHOTICS and NERVE INJURIES


PERIPHERAL NERVE INJURIES


AIM OF ORTHOTICS
—  To keep denervated muscle from remaining in an overstretched position
—  To prevent joint contracture
—  To improve functional use of the hand
—  Imp. issue to consider before prescribing an orthoses- etiology & prognosis for neuropathy
—  If injury- Neuropraxic - prefabricated orthotics & cheap


RADIAL NERVE INJURY: 


Ideal splints allows
—  Tenodesis action
—  Finger extension with wrist flexion
—  Wrist extension with finger flexion
—  Protects against over-lengthening of paralyzed wrist extensors & shortening of flexors.


PROXIMAL RADIAL NERVE INJURY


DEFORMITIES                                                        ORTHOTIC OBJECTIVES


1. WRIST DROP                                                         PREVENT WRIST DROP
                                                                                  ASSIST WRIST EXTENSION


2. MCP AND IP CONTRACTURE                             PREVENT DERFORMITY  


3. THUMB WEB SPACE CONTRACTURE                ASSIST THUMB 
                                                                                      EXTENTION/ABDUCTION
                                                                                 MAINTAIN THUMB WEB SPACE


4. FLATENING OF PALMER ARCH                    MAINTAIN TRANSVERSE ARCH


   —  Forearm-based dorsal or volar static wrist extension splint with dynamic out triggering for the fingers (Directly over the proximal   phalanges)


PROXIMAL MEDIAN NERVE INJURY
—  As the recovery is poor, splinting of this level of deformity to maintain passive ROM is appropriate for tendon transfers


SPLINTS:
—   Thumb spica splint
            Resting hand splint
           Tendon transfers


DEFORMITY                                                ORTHOTIC OBJECTIVES


1.Forarm and Thenar Atrophy                       Prevention   


2. Thumb on Finger plane                               Maintain Thumb in Adduction/Abduction


3.Thumb web space contracture                    Maintain Thumb Web Space


4.Flattening of transverse palmer arch          Maintain transverse Palmer arch


5.Others                                                            Assist MIP / IP  Flexion
                                                                           Reduce pain by limited wrist thumb


 As the recovery is poor, splinting of this level of deformity to maintain passive ROM is appropriate for tendon transfers.


DISTAL MEDIAN NERVE INJURY


DEFORMITY                                          ORTHOTIC OBJECTIVES


1.Thenar Atrophy                                     Prevention   


2. Thumb on Finger plane                       Maintain Thumb in Adduction/Abduction


3.Thumb web space contracture             Maintain Thumb Web Space


4.Others                                                    Assist MIP / IP  Flexion
                                                                   Reduce pain by limiting wrist and thumb.


—  SOFT DYNAMIC THUMB ABDUCTION SPLINT
—  THUMB SPICA SPLINT
—  C-BAR/OPPONENS BAR TO STABILIZE THE THUMB IN OPPOSITION


CARPAL TUNNEL SYNDROME :


—  VOLAR WRIST ORTHOSIS
—  Wrist-between 10º of extension & neutral position


PROXIMAL & DISTAL ULNAR NERVE INJURY


DEFORMITY                                                            ORTHOTIC OBJECTIVES


1.Flattening of Transverse Palmer Arch            Maintain Transverse Palmer arch.


2.During Pinch, 1st IP hyperflex &/ 1st              Stabilize 1st MCP
   MCP hyperextends.


3. Partial Claw hand                                              Improve Grasp
                                                                               Limits 4th and  5th MCP extention
4.Interosseous atrophy
   Hypothenar atrophy
   5th MCP jt. contracture


ULNAR NERVE INJURY


—  LMB Ulnar Nerve Splint. For ulnar nerve injury and boxer’s fracture of 4th and 5th metacarpal.
—  Used to prevent shoulder subluxation in patient with
—  Brachial plexus injury
—  Hemiplegia
—  Central cord syndrome


SHOULDER SLINGS
 This restrict movement of the shoulder by keeping the shoulder by keeping the humerus in abduction & internal rotation & placing the elbow in flexion.


SPASTICITY
PRINCIPLES
—  Prolonged muscle stretch to reduce spasticity
—  Positioning opposite to patterns of spasticity to inhibit or prevent development of increased tone
—  Tactile stimulation to facilitate hypotonic muscles
—  Splint must incorporate both the wrist & fingers in order to stretch the long finger flexor muscles
—  Splints are moulded to provide 30º of wrist extension , 45º of MCP flexion & full IP extension, finger abduction & thumb extension & abduction