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EL Physiotherapy – A new approach to physiotherapy (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

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EL Physiotherapy – A new approach to physiotherapy (practical solutions)

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  1. EL Physiotherapy – A new approach to physiotherapy (practical solutions) Presenter Margarita Gurevich

  2. 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

  3. Practice principles Use of the established in accordance with the Clinical Practice Guidelines computerised patient data management system which permits: • 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

  4. 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

  5. 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

  6. Example of clinical examination of neck pathology as part of the FBA Neck - ROM LEFT RIGHT 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

  7. Treatment techniques Electrotherapy: • Electrostimulation • Interferential • Ultrasound • Magnetotherapy • Pharmacological phoresis • SCENAR • Combination therapy Clinical Pilates General physiotherapy: • Mobilisation • Traction • Exercise programs etc.

  8. Electrotherapy Performed using the Chattanooga Intellect Advanced Therapy System and other modern devices

  9. 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

  10. Pharmacological phoresis Types of pharmacological phoresis: • 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: • NSAID • Corticosteroids • Local analgesics • Vasodilators

  11. 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

  12. Combination therapy Usually two treatment modalities on the same/different area Iontophoresis and ultrasound Interferential and phonophoresis Iontophoresis and magnetotherapy SCENAR and magnetotherapy

  13. 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

  14. 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

  15. 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

  16. 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

  17. General physiotherapy Mobilisations Traction Therapeutic weights Exercise programs Thermal therapy Prenatal, antenatal and postnatal therapy Incontinence therapy

  18. 19 year old male • Intersection syndrome of the right wrist (1 week history) • Main issues: • 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: • pain reduced by 70% • Increased wrist ROM and strength

  19. 71 year old female • Irritation of cervical (C5-7) and lumbar (L3-5) facet joints • Main issues: • 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: • Both cervical and lumbar pain reduced to 3/10 on VAS • Increased cervical and lumbar ROM

  20. 68 year old female • R knee fat pad impingement and patello-femoral joint pain • Main issues: • 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: • Pain completely disappeared

  21. 21 year old male • C5/6 disc bulge with extension instability • Main issues: • Acute cervical pain (1 week history) reaching 9/10 on VAS • Treatment method: SCENAR therapy • Number of sessions: 5 • Reassessment results: • Cervical pain settled almost completely

  22. 61 year old female • C5/6 disc bulge • Grade 2 right subacromial joint impingement • Main issues: • 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: • Right shoulder pain and neck pain settled almost completely • Increased cervical and right shoulder ROM

  23. 47 year old female • Left heel spur • Main issues: • 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: • L heel improved by at least 50%, getting out of bed and walking became easier

  24. 62 year old male • Left L2/3 posterolateral disc prolapse • Main issues: • 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

  25. 50 year old male • R tennis elbow • Main issues: • 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: • After 3 sessions pain ceased; able to work for 1-2 hours without pain • Trial tennis session after 7 sessions, no pain

  26. 72 year old female • Tx osteochondrosis, R shoulder grade 2 supraspinatus impingement • Main issues: • 6 month history of thoracic and R shoulder pain aggravated by ADL’s • Treatment method: combination SCENAR therapy • Number of sessions: 6 • Reassessment results: • After 1 session pain reduced; able to do shopping without pain after 3 sessions; ceased completely after 6 sessions

  27. 50 year old female • Plantar fasciatis • Main issues: • 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: • Getting out of bed got easier after the first session; significantly better 4 sessions; overall improvement at least 60%

  28. 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: • 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

  29. 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: • Pain started to decrease after the first session

  30. 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

  31. 54 year old male • Grade 2 subacromial impingement of the supraspinatus tendon • Main issues: • 1 month history of L shoulder pain aggravated by heavy lifting and lying on his left side • Treatment: • 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

  32. 53 year old female • Functional dyspepsia • Main issues: • 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: • Improved appetite and increased energy after 4 sessions • Nausea started to decrease after 7 sessions, disappeared completely after 12 sessions

  33. 49 year old female • Paradontosis • Main issues: • 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: • After 5 sessions redness and swelling decreased, lower gum lifting up • Patient able to eat coarse food (apples) after 9 sessions

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