Biofeedback machines commonly used in the physiotherapy practice are described along with available evidences for clinical use.
Most of the feedback modalities are described along with its use and the mechanism behind it.
22- Force platform- is the device used to measure the ground reaction forces in steady and/or in moving phase. Sensors in the force platform give visual feedback on the screen attached to therapist as well as patient about the weight distribution and other parameters of gait can also be measured.
33- Mirror -used as visual feedback to treat the pain as well as disability in different conditions. It healps to activate the mirror neuron in the brain. Mirrior therapy proposed by Ramchandran et al has been found most beneficial treatment in the phantom limb pain treatment
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
This document discusses electrogoniometers, which are devices that measure joint angles through electrical signals. It outlines the background, definition, types, uses, advantages, and reliability of electrogoniometers. The main types are optoelectronic systems, potentiometers, and strain gauges. Electrogoniometers are useful for rehabilitation by precisely measuring joint angles to identify impairments, but they can be bulky and interfere with natural movement. While easy to use, their accuracy is less than other movement measurement systems.
Electrical stimulation involves applying modified electric currents to excitable tissues like nerves and muscles to produce therapeutic benefits. Direct and alternating currents can be used to stimulate tissues. Faradic and interrupted galvanic currents of varying durations and frequencies are used for stimulation of normal and denervated muscles. Electrical stimulation modalities like TENS, NMES, FES and interferential therapy are used for pain management and rehabilitation by stimulating nerves and muscles. Precise electrode placement is important for effective stimulation.
Electromyography (EMG) measures the electrical activity produced by muscle contractions. Surface EMG (sEMG) uses electrodes on the skin to detect muscle activation, while fine wire EMG inserts electrodes directly into muscles. EMG can indicate which muscles are active during motions like gait, but does not determine strength, movement type, or whether activity is compensatory. Proper electrode positioning, skin preparation, and signal processing are needed to obtain accurate, repeatable EMG data for analysis of muscle function.
This document provides an overview of electromyography (EMG). It defines EMG as the study of motor unit activity through the recording and analysis of myoelectric signals. EMG allows direct examination of muscle performance and function. It describes the motor unit and how EMG detects the motor unit action potential. Different types of electrodes used for EMG are discussed, including surface, fine-wire, and needle electrodes. The document outlines how EMG signals are captured and factors that can influence the myoelectric signal recording.
Biofeedback machines commonly used in the physiotherapy practice are described along with available evidences for clinical use.
Most of the feedback modalities are described along with its use and the mechanism behind it.
22- Force platform- is the device used to measure the ground reaction forces in steady and/or in moving phase. Sensors in the force platform give visual feedback on the screen attached to therapist as well as patient about the weight distribution and other parameters of gait can also be measured.
33- Mirror -used as visual feedback to treat the pain as well as disability in different conditions. It healps to activate the mirror neuron in the brain. Mirrior therapy proposed by Ramchandran et al has been found most beneficial treatment in the phantom limb pain treatment
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
This document discusses electrogoniometers, which are devices that measure joint angles through electrical signals. It outlines the background, definition, types, uses, advantages, and reliability of electrogoniometers. The main types are optoelectronic systems, potentiometers, and strain gauges. Electrogoniometers are useful for rehabilitation by precisely measuring joint angles to identify impairments, but they can be bulky and interfere with natural movement. While easy to use, their accuracy is less than other movement measurement systems.
This document provides information about nerve conduction studies (NCS). It discusses the basic components of a NCS including compound muscle action potentials, sensory nerve action potentials, F-waves, and H-reflexes. It describes the procedure, techniques, and applications of NCS in evaluating conditions like neuropathies, radiculopathies, and neuromuscular junction disorders. Limitations include NCS only assessing the largest nerve fibers and conditions proximal to the dorsal root ganglia potentially showing normal results.
This document discusses muscle plasticity, which refers to the ability of skeletal muscle to adapt structurally and functionally in response to environmental changes such as increased or decreased activity levels. It provides definitions and history of the concept. It describes the effects of chronic low frequency electrical stimulation on muscles, including fiber type transformations, increased mitochondria and vascularization, and changes to contractile properties. Over time periods of hours to weeks, stimulated muscles demonstrate metabolic and structural adaptations that increase their fatigue resistance and transform them from fast-twitch to slow-twitch phenotypes. Several studies are summarized that investigate muscle adaptations to long-term stimulation in animals and humans.
Environmental influence on performance Sukanya1411
This document discusses how environmental factors like temperature, altitude and humidity can influence human performance. It covers the body's thermoregulation processes for maintaining core temperature during cold and heat exposure. During cold, the body increases heat production and conservation through vascular, muscular and hormonal adjustments. During heat, the main mechanisms of heat loss are radiation, conduction, convection and evaporation. Acclimatization to altitude involves both immediate and long-term adaptations to the reduced oxygen levels to improve tolerance. The key factors for exercising in heat and cold are maintaining hydration and avoiding large fluctuations in core temperature.
This document provides an overview of electromyography (EMG) including:
- EMG measures the electrical activity of active muscle fibers using electrodes placed close to muscles. Rectified EMG signals indicate muscle activity.
- Applications of EMG include assessing muscle function, neuromuscular diseases, and prosthetics.
- Factors that impact EMG signal quality include signal-to-noise ratio, filtering, and minimizing noise contamination and signal distortion.
- Different types of EMG electrodes exist including fine-wire, needle, and surface electrodes, each with their own advantages and disadvantages for measuring muscle activity.
This document discusses a student project assessing coordination. It begins with an introduction on balance and coordination, describing how they depend on multiple body systems interacting. It then discusses various causes of coordination impairments like flaccidity and spasticity. The purpose section notes that coordination examinations can determine muscle activity characteristics during movement and ability to work together. They also assess skill, movement initiation/control/termination, and timing/sequencing/accuracy. Examination data helps establish diagnoses and goals to remediate impairments.
This document discusses isokinetic testing in sports. It begins with an introduction to the concept of isokinetics, which refers to constant speed muscle contractions. It then covers open and closed kinetic chain exercises, the purposes of isokinetic testing like objectively assessing muscle performance, and the protocol for testing. Advantages include efficiency and safety, while limitations include the equipment being large and expensive. Contraindications for testing include pain and limited range of motion.
History of Manual Therapy and ArthrologyChrisBacchus
The document provides a history of manual therapy, outlining important figures and developments from Hippocrates in 460 BC to current practice. It discusses the evolution of osteopathy, chiropractic, and physical therapy. Key developments include Andrew Still establishing osteopathy in the US in 1874, Daniel Palmer founding chiropractic in 1895, and the establishment of physical therapy programs and professional organizations in the early 20th century. Current manual therapy practice draws from various techniques and philosophies.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
Ergonomics in Physiotherapy and WorkplaceSusan Jose
We discuss about various risk factors related to causing of cumulative trauma disorders and how to manage each risk factor using bio mechanical principles and physiotherapy knowledge.
This document discusses various photo optical techniques used to capture and analyze human movement, including cinematography, video, and optoelectric techniques. It describes cine cameras, their characteristics, types, lenses, and camera positioning. It also discusses other measurement devices like accelerometers, gyroscopes, force platforms, footswitches, and instrumented walkways that are used along with video recordings to measure temporal gait parameters and forces during walking. The analysis of gait cycle and advantages of using video recording for gait analysis are also summarized.
This document discusses high volt pulsed galvanic stimulation (HVPGS), a type of neuromuscular stimulator that uses high voltage, low amperage, short pulses to penetrate deep tissues. HVPGS can produce muscle contractions and chemical changes, and is used for analgesia, wound healing, and other clinical applications. It allows for deep penetration without risk of tissue damage. Physiological effects include increased range of motion, edema reduction, and accelerated wound healing. Common indications are adhesive capsulitis, bursitis, cervical sprain, and post-operative conditions. Treatment involves 30-40 minute sessions 3 times per day.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
The document discusses electrodiagnostic tests like electromyography (EMG), nerve conduction velocity (NCV) tests, and evoked potentials (EP) which are used to study the nervous system. EMG involves inserting needle electrodes into muscles to record electrical activity, NCV tests how quickly electrical signals move through nerves, and EP stimulates nerves or parts of the body to measure response in the brain. Together these tests can provide information about nerve and muscle injuries, diseases, and help guide treatment.
This document provides an overview of electromyography (EMG). It discusses that EMG records the electrical activity of muscles based on motor unit activity. It describes the components of a motor unit and how they produce electrical signals. The document outlines the EMG examination process, including the use of electrodes, signal processing, and analyzing insertional activity, spontaneous activity, motor unit potentials, and recruitment and interference patterns during voluntary contractions. It provides details on normal and abnormal EMG findings.
This document provides information about electromyography (EMG) and motor nerve conduction velocity testing. It discusses how EMG works by recording electrical muscle activity using needle or surface electrodes. Normal motor unit potentials are described. Motor nerve conduction velocity testing measures nerve conduction speed and can identify axonal or myelin abnormalities. The objectives are listed as learning how to perform the tests and analyze results in health and disease. The procedure for EMG and motor nerve conduction velocity testing is outlined, including instrument setup and electrode placement. Normal and abnormal EMG and nerve conduction findings are presented.
This paper will review the works on Surface Electromyography (SEMG) signal acquisition and controlling as well as the uses of SEMG signals analysis for Transfemoral amputee's people. In the beginning, this paper will briefly go through the basic theory of myoelectric signal generation. Next, the signal acquisition & filtering techniques applied for SEMG signal will be explained. Then after this EMG signal control or actuate the myoelectric leg who was suffering from Transfemoral amputee using microcontroller. This paper gives the better controlling SEMG signal and also very smooth and easy controlling of the Prosthetic leg motor using Myoelectric Controller.
Electromyography (EMG) is the study of muscle electrical activity. Key developments included:
- In the 1600s, Redi documented electric rays as a source of muscle electricity.
- In 1773, Walsh showed eels' muscle tissue could generate sparks.
- In the 1790s, Galvani provided direct evidence linking muscle contraction and electricity by stimulating muscles with static electricity.
- Volta later concluded Galvani's findings were due to dissimilar metals touching muscle, not muscle itself.
- In the 1800s, techniques like using galvanometers to study nerve and muscle electrical activity advanced the field.
- Modern SEMG allows noninvasive quantification of muscle electrical activity through sensors
Electromyography (EMG) involves inserting needle electrodes into muscles to record electrical activity and diagnose neuromuscular conditions. EMG results provide information on motor unit action potentials including amplitude, duration, and number of phases. Abnormal insertional activity and spontaneous activity such as fibrillations and positive sharp waves indicate denervation. Nerve conduction studies measure nerve impulse velocity and involve stimulating nerves and recording from muscles to identify neuropathies. Together, EMG and nerve conduction studies localize nerve and muscle disorders.
This document provides an overview of electromyography (EMG) techniques and normal EMG findings. It describes how EMG is used to study electrical activity in muscles to aid in neurological examination. It explains the motor unit, action potential generation, different electrode types, equipment, procedures, and normal EMG findings like insertional activity, end plate noise and spikes, fibrillation and fasciculation potentials, and motor unit action potentials. Precautions for the procedure and factors that can influence EMG readings are also summarized.
This document provides information about electromyography (EMG), including the components, techniques, and normal findings. It discusses:
- EMG uses needle electrodes to study electrical activity of muscles and aids neurological exams by identifying motor unit disorders.
- A motor unit consists of a motor neuron and innervated muscle fibers. There are slow-firing and fast-firing motor unit types.
- During EMG, electrical potentials are amplified, filtered, and displayed. Various electrodes like concentric bipolar and monopolar are used.
- Normal EMG findings include insertional activity, end plate noise, end plate spikes, and motor unit action potentials within expected amplitudes, durations, and frequencies.
EMG involves detecting and recording electrical signals from muscle contractions. A successful EMG requires knowledge of anatomy, physiology, and technique. The equipment includes an EMG machine, needle, cables, and electrodes. Either concentric or monopolar needles can be used. A typical EMG examines insertional activity, spontaneous activity at rest, and motor unit action potentials. Abnormal spontaneous activities include fibrillation potentials, positive sharp waves, complex repetitive discharges, and myotonic discharges. Motor unit analysis assesses morphology, stability, and firing characteristics to determine neuropathic or myopathic disorders.
Electromyography Analysis for Person IdentificationCSCJournals
Physiological descriptions of the electromyography signal and other literature say that when we make a motion, the motor neurons of respective muscle get activated and all the innervated motor units in that zone produce motor unit action potential. These motor unit action potentials travel through the muscle fibers with conduction velocity and superimposed signal gets recorded at the electrode site. Here we have taken an analogy from the speech production system model as the excitation signal travels through vocal tract to produce speech; similarly, an impulse train of firing rate frequency goes through the system with impulse response of motor unit action potentials and travels along the muscle fiber of that person. As the vocal tract contains the speaker information, we can also separate the muscle fiber pattern part and motor unit discharge pattern through proper selection of features and its classification to identify the respective person. Cepstral and non uniform filter bank features models the variation in the spectrum of the signals. Vector quantization and Gaussian mixture model are the two techniques of pattern matching have been applied.
This document discusses electroMyoGRAPHY (EMG), which is the process of recording electrical activity in skeletal muscles using electrodes. An electroMyoGRAM is the recording produced, while an electroMyoGRAPH is the instrument used. EMG can be performed using needle EMG electrodes inserted into muscles or surface EMG electrodes placed on the skin. EMG analysis examines motor unit action potentials (MUAPs) to assess parameters like duration, morphology, and amplitude which can provide information about muscle and nerve health.
Intraoperative neurophysiologic monitoring of the spinespine spine
This document discusses intraoperative neurophysiologic monitoring of the spine. It describes techniques used including transcranial motor evoked potentials, somatosensory evoked potentials, and electromyography. These techniques allow evaluation of neural structures including the spinal cord, brainstem and cortex during surgery to identify and prevent new or worsening neurologic deficits. Changes in evoked potentials or the appearance of spontaneous electromyographic activity may indicate injury requiring intervention. Multimodal monitoring provides optimal information to increase sensitivity and specificity in detecting issues.
A nerve conduction study (NCS) evaluates the function of motor and sensory nerves by measuring nerve conduction velocity, latency, and amplitude. Key components of an NCS include motor nerve conduction studies, F-wave responses, sensory nerve conduction studies, H-reflexes, and repetitive stimulation tests. NCS provides information about nerve demyelination, axonal injury, and other neuropathies.
This document provides information about electromyography (EMG). EMG is a test that evaluates the health and function of muscles and the nerve cells that control them. It involves inserting a needle electrode into a muscle to record electrical activity from muscle fibers and nerves. Abnormal spontaneous electrical activities in muscles can indicate neurological or muscular disorders. EMG is useful for diagnosing conditions like amyotrophic lateral sclerosis, myasthenia gravis, and muscular dystrophy. It provides information about the location and severity of nerve or muscle damage.
The document provides an overview of electromyography (EMG). It begins by defining EMG as a technique for evaluating and recording muscle activation signals using an electromyograph. The electromyograph detects the electrical potentials generated by muscle cells during contraction and relaxation. It then discusses the history of EMG and describes the EMG signal and factors that can influence it. The document outlines the electrical characteristics of EMG signals and the procedures for EMG. It also discusses applications of EMG, different electrode types used, and general concerns regarding EMG signals.
Modified galvanic current, or interrupted direct current, is a type of electrical stimulation where a direct current is pulsed on and off at regular intervals. The document discusses how this current is produced using a source, transistors, and a timer circuit. It describes the physiological effects of interrupted direct current such as sensory stimulation, hyperemia, electrotonus, pain relief, and accelerated healing. The document also provides guidelines for administering interrupted direct current and lists contraindications.
Different types of low frequency currents.pdfeyobkaseye
Electrotherapy uses low-frequency electric currents to stimulate the peripheral nervous system and control pain or cause muscle contraction. There are three main types of currents used: direct current, alternating current, and pulsed current. Direct current flows in one direction, alternating current changes direction continuously, and pulsed current consists of short bursts of current separated by intervals. The effects of electric currents depend on their characteristics like amplitude, frequency, pulse width, and rate of rise. Lower amplitudes preferentially stimulate sensory nerves while higher amplitudes can recruit motor nerves and cause muscle contraction or pain. Short pulse widths allow selective stimulation of motor and sensory fibers.
Similar to Electromyography: Dr. Anand Heggannavar, (20)
This document provides an overview of craniosacral therapy, including its history, principles, techniques, and applications. It describes how craniosacral therapy involves gentle manual treatment of the cranial bones and spinal column to relieve restrictions and balance the craniosacral rhythm. Key aspects covered include the cranial motion patterns, assessment methods involving palpation of cranial structures, different treatment techniques, indications for its use, and contraindications.
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
The document discusses different types and methods of traction used in physiotherapy. It defines traction as a mechanical force applied to separate joint structures and stretch surrounding soft tissues. There are four main types of traction: mechanical, self, positional, and manual. Mechanical traction can be further divided into over door cervical traction and electrical traction. The document then covers application techniques for cervical, thoracic, and lumbar traction, highlighting factors like force levels, durations, angles, and positioning. Recommended parameters are provided for initial treatment phases and specific treatment goals for each spinal region.
the PPT Describes about various types of dysfunction in mechanical pattern as described by Janda's. it also describes about normal muscle slings prresent within the body and its compensation and decompensation patterns towards the adaptations of the body
The document discusses the anatomy and biomechanics of the hip joint. It describes the ball and socket structure of the hip joint formed by the acetabulum and femoral head. It details the angles of the hip joint including the central edge angle and angle of anteversion. It discusses the muscles, ligaments, biomechanics including ranges of motion, and forces across the hip joint during activities like standing, walking, and squatting. Pathomechanics of conditions like hip fractures and dislocations are also mentioned.
Lumbar Spnine: Anatomy, Biomechanics and PathomechanicsRadhika Chintamani
This document discusses the anatomy and biomechanics of the lumbar spine. It begins with an introduction describing the basic structure and lordotic curves of the spine. It then covers topics like the typical vertebrae, articulating joints, intervertebral discs, and ligaments. It discusses concepts such as the articular tripod mechanism and load distribution across the facets. The document provides clinical relevance for various anatomical structures and their relationship to pathologies like fractures, spondylolysis, and nerve impingement. In summary, the document provides a detailed overview of lumbar spine anatomy, biomechanics, and common pathomechanics.
Thoracic and rib cage anatomy, biomechanics, and pathomechanicsRadhika Chintamani
The document discusses the biomechanics of the thorax and chest wall. It describes the anatomy of the rib cage including the various joints that connect the ribs to each other and to the sternum and vertebrae. It also discusses the muscles involved in respiration including the diaphragm and accessory muscles. It explains the axes of motion of the ribs during breathing and how this affects the diameters of the thorax. Finally, it covers topics such as the forces and loading on the thoracic spine during respiration and the concept of dynamic equilibrium.
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
The document provides an overview of the McKenzie method for assessing and treating musculoskeletal pain. It describes the key concepts of centralization and peripheralization and how patients' pain responses to specific movements can help classify their condition as a postural syndrome, dysfunction syndrome, or derangement syndrome. Treatment generally involves repeated movements and positioning to encourage centralization of pain. Precautions are taken to avoid worsening a patient's pain. The McKenzie method examines both spinal and extremity issues through detailed mechanical diagnosis and management.
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
The document provides information about therapeutic massage including definitions, history, types, relevant anatomy and physiology, effects, and application techniques. It defines massage as the scientific manipulation of soft tissues and outlines its uses in ancient civilizations. The types of massage discussed include Western, shiatsu, tui-na, and Ayurvedic massage. Key effects of massage include mechanical, circulatory, nervous system, musculoskeletal, and psychological benefits. Assessment techniques and specific manipulation methods like effleurage, petrissage, and stroking are also described.
it is another taping technique which inhibits or control the movement. it is helpful in postural correction and movement pattern correction as well. usually used clinically
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
Descoperă Bucuria Vieții Sănătoase cu Jurnalul Fericirii Life Care - Iulie 2024!
Gata să te bucuri de o vară vibrantă și plină de energie? Life Care îți vine în ajutor cu Jurnalul Fericirii din Iulie 2024, un ghid complet pentru o viață armonioasă și echilibrată.
Pe parcursul a cateva de pagini pline de informații utile și inspirație, vei descoperi:
Sfaturi practice pentru o alimentație sănătoasă:
Rețete delicioase și ușor de preparat: Bucură-te de preparate gustoase și nutritive, perfecte pentru zilele călduroase de vară.
Recomandări pentru o alimentație echilibrată: Asigură-ți aportul necesar de nutrienți esențiali pentru un organism sănătos și plin de vitalitate.
Sfaturi pentru alegeri alimentare inteligente: Învață cum să faci cumpărături sănătoase și să eviți tentațiile nesănătoase.
Trucuri pentru un stil de viață activ:
Rutine de exerciții fizice adaptate nevoilor tale: Găsește antrenamente potrivite pentru a te menține în formă și energic pe tot parcursul verii.
Idei de activități în aer liber: Descoperă modalități distractive de a te bucura de vremea frumoasă și de a petrece timp de calitate cu cei dragi.
Sfaturi pentru un somn odihnitor: Asigură-ți un somn profund și reparator pentru a te trezi revigorat și pregătit pentru o nouă zi.
Sfaturi pentru o stare de bine mentală:
Tehnici de relaxare și gestionare a stresului: Învață cum să te relaxezi și să faci față provocărilor zilnice cu mai multă ușurință.
Sfaturi pentru cultivarea optimismului și a gândirii pozitive: Descoperă cum să abordezi viața cu o perspectivă optimistă și să atragi mai multă bucurie în ea.
Recomandări pentru a te conecta cu natura: Bucură-te de beneficiile naturii asupra stării tale mentale și emoționale.
Bonus:
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Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, discuss NSCLC in this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Chair, Benjamin M. Greenberg, MD, MHS, discusses neuromyelitis optica spectrum disorder in this CME activity titled “Mastering Diagnosis and Navigating the Sea of Targeted Treatments in NMOSD: Practical Guidance on Optimizing Patient Care.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/4av12w4. CME credit will be available until June 27, 2025.
Veterinary Medicines Manufacturers in IndiaHeilsaa Care
Veterinary Medicines Manufacturers in India: We are living in the modern world, and with all modern advancements, we still rely on animals for eggs, milk, food, etc. Like humans, there is a huge need for veterinary healthcare products and medicines. And a large proportion of the Indian population is involved in animal husbandry and they would like to ensure quality medical treatment for their livestock.
Hepatocarcinoma today between guidelines and medical therapy. The role of sur...Gian Luca Grazi
Today more than ever, hepatocellular carcinoma therapy is experiencing profound and substantial changes.
The association atezolizumab (ATEZO) plus bevacizumab (BEVA) has demonstrated its effectiveness in the post-operative treatment of patients, improving the results that can be achieved with liver resections. This after the failure of the use of sorafenib in the already historic STORM study.
On the other hand, the prognostic classification of BCLC is now widely questioned. It is now well recognized that the indications for surgery for patients with hepatocellular carcinoma are certainly narrow in BCLC and no longer reflect what is common everyday clinical practice.
Today, the concept of multiparametric therapeutic hierarchy, which makes the management of patients with hepatocellular carcinoma much more flexible and allows the best therapy for the individual patient to be identified based on their clinical characteristics, is gaining more and more importance.
The presentation traces these profound changes that are taking place in recent years and offers a modern vision of the management of patients with hepatocellular carcinoma.
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxsouravpaul769171
Theoretically, gene therapy is the permanent solution for genetic diseases. But it has several complexities. At its current stage, it is not accessible to most people due to its huge cost. A breakthrough may come anytime and a day may come when almost every disease will have a gene therapy Gene therapy have the potential to revolutionize the practice of medicine.
Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
Importance in Pharmaceuticals: Understanding chemical kinetics is essential for predicting the shelf life of drugs, optimizing storage conditions, and ensuring consistent drug performance.
Rate of Reaction: The speed at which reactants are converted to products.
Factors Influencing Reaction Rates:
Concentration of Reactants: Higher concentrations generally increase the rate of reaction.
Temperature: Increasing temperature typically increases reaction rates.
Catalysts: Substances that increase the reaction rate without being consumed in the process.
Physical State of Reactants: The surface area and physical state (solid, liquid, gas) of reactants can affect the reaction rate.
Case presentation of a 14-year-old female presenting as unilateral breast enlargement and found to have a giant breast lipoma. The tumour was successfully excised with the result that the presumed unilateral breast enlargement reverting back to normal. A review of management including a photo of the removed Giant Lipoma is presented.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...
Electromyography: Dr. Anand Heggannavar,
1. Electromyography
By: Radhika Chintamani
Luig; Galvini in 1971 presented the first report on electrical properties of muscle and
nerves. He demonstrated muscle activity followed by stimulation of nerves and recorded
potentials from muscle fibers in frog.
It was accepted in early past century, when instrumentation was developed to make
recording of such activity.
EMG form the basis to evaluate the scope of neuromuscular disease or trauma and as
kinesiologic tool to study muscle function. EMG involves the detection and recording of
electrical potentials from skeletal muscle fibers.
EMG is the study of motor unit activity. Together with other clinical assessment EMG
can provide information about the extent of nerve injury or muscle disease and the
prognosis of surgical intervention and rehabilitation. It compares the electrical activity of
skeletal muscle fibers at rest and during voluntary activities of muscle.
Motor units are composed of:
i) One Anterior horn cell (AHC)
ii) One axon
iii) All muscle fiber innervated by that axon
Axon conducts an impulse to the fibers causing them to depolarize at the same time
producing an electrical activity known as Motor Unit Action Potential (MUAP) and
recorded graphically as EMG.
Recording EMG requires 3 phases:
i) An input phase: electrodes to pick electrical activities from muscle.
ii) A processor phase: where small signal is amplified
iii) An output phase: where electrical signals are converted into audio or visual
signals and are displayed and analyzed.
Instrumentation:
i) Electrodes
ii) Amplifier/pre-amplifier
iii) Fillers
iv) Display unit. (Oscilloscope, speaker, tape recorder, computer)
Electrodes
An electrode is a transducer, a devise for converting one form of energy into another.
Types of electrodes are:
i) Surface electrodes: used to test NCV, and EMG. Picks up the signals from
superficial muscle and group of muscles.
ii) Fine wire dwelling electrodes: for study of small and deep muscle.
2. iii) Needle electrodes: are necessary to record single motor unit potential.
iv) Ground electrode: It is a surface electrode, important electrode which must be
applied to provide mechanism of cancelling out the interference effect of external
electrical noise.
Surface electrodes: These electrodes applied over skin, consists of small metal disc
commonly made of silver/silver chloride (3 to 5mm in diameter) skin resistance to be
reduced before applying surface electrodes by the emollient. These electrodes are
secured to the skin by tapes or straps.
Fine wire indwelling electrodes: made with two strands of small diameter wire (100μm).
Inserted into the muscle belly with help of needle and then after insertion the needle is
removed out. Capable of picking up single motor unit potentials.
Needle electrodes:
i) Concentric electrode: stainless steel, single wire platinum or silver threaded.
ii) Bipolar concentric: with two wires threaded through cannula.
iii) Monoploar needle electrode: composed of single fine needle, second electrode placed
on the skin as reference electrode.
Amplifier and Pre-amplifier.
Amplifier: converts the electrical potentials picked up by electrode to a voltage large
enough to be display.
Differential amplifier: are preferred as they control unwanted part of signals to be
amplified.
Amplified signals have Common Mode Rejection Ratio (CMMR), which is a measure of
how much the desired signal voltage is amplified relative to unwanted signal. CMMR is
expressed in decibels. A good amplifier should have a CMMR exceeding 100,000:1.
Even signal to noise ratio limit the noise.
Filters.
Low filters-limit high frequency artifacts.
High filters-limit low frequency artifacts.
Displaying the EMG signal.
Cathode ray oscilloscope.
Computer monitor for analysis
Graph records.
Magnetic tape recorder.
Audio signals.
These are the various instrument used for displaying EMG signals.
3. EMG examination:
Normal Motor Unit Potential.
Represents the sum of action potential supplied by an anterior horn cell.
Motor unit potential is also characterized by its duration, number of phases, amplitude,
turn phase and rate of rise of fast component.
Duration:
- The duration of MUAP is measured from initial take off to the point of return to the
baseline.
- It normally varies from 5-15ms.
- Short in children, longer in adults, and still longer in elderly person.
Rise time:
- Duration form initial positive to subsequent negative peak.
- Indication of distance of needle from the muscle fiber.
- Rise less than 500µs acceptable, a greater rise time is attributed to resistance and
capacitance of the investing tissue.
Amplitude:
- Measured peak to peak.
- Depends upon size and density of muscle fibers, synchrony of firing, proximity of
needle to the muscle fiber, age of the subject, muscle examined and muscle
temperature.
- Normally it lies between 200Mv-3Mv.
Phase of motor unit potential:
- The portion of MUP from departure and return to the baseline.
- Biphasic or inphasic or triphasic.
Frequency
5-15per second (<60/sec)
Evaluation of EMG
Done at four stages:
i) Insertional activity.
ii) Rest
iii) Minimum muscle contraction.
iv) Maximum muscle contraction with resistance.
Insertional activity:
Patient is asked to relax the muscle.
Needle inserted into the muscle.
4. At this time the electromyographer observes a spontaneous onset of potential which is
possibly caused by needle breaking through muscle fiber membrane.
This is called insertional activity.
Lasts less than 300ms.
Stops when needle stops moving.
It is rapid, spiky and biphasic activity.
It is described as normal, reduced or increased.
It is a measure of muscle excitability and markedly decreased in fibrotic muscle or
increased when denervation or inflammation is present.
Clinical relevance:
When EMG is done on the gluteus minimus muscle in a standing position of the patient,
the insertional activity is never lasts upto 300ms, as any individual can not stand without
swaying in antero-posterior and medio-lateral direction, leading to shifting of line of
gravity accordingly, which describes high level of action of muscel and sometimes low
level of action of muscle. Hence when EMG study should be done the individual must be
completely resting the part undergoing study, or necessary procedures must be done to
avoid such errors in the study.
The muscle at rest:
After cessation of insertional activity a normal relaxed muscle exhibits electrical silence,
which is absence of electrical potential.
Potential arising spontaneously during this period are significant abnormal findings.
Clinical relevance:
When EMG is done on the gluteus minimus muscle in a standing position of the patient,
the insertional activity is never lasts upto 300ms, as any individual can not stand without
swaying in antero-posterior and medio-lateral direction, leading to shifting of line of
gravity accordingly, which describes high level of action of muscel and sometimes low
level of action of muscle. Hence when EMG study should be done the individual must be
completely resting the part undergoing study, or necessary procedures must be done to
avoid such errors in the study.
Minimum muscle contraction:
Here the patient is asked to contract the muscle minimally.
This causes individual motor unit to fire.
These motor unit potentials are assessed with respect to amplitude, duration, shape, sound
and frequency.
These parameters are essential to distinguish normal and abnormal potentials.
5. In normal muscle:
Amplitude= may range from 300µv-5µv.
Duration = may range from 3-15ms.
Phase = may be biphasic or triphasic
Sometime polyphasic phase is observed which may be normal, but when these polyphasic
phase represent more than 10% of muscle output, they are considered as abnormal.
Maximum muscle contraction:
Ask patient to contract the muscle maximally.
With greater effort, increasing number of motor units fire at higher frequencies until the
individual potentials are summated and can no longer be recognized.
An influence pattern is seen.
This is normal finding with strong contraction.
Abnormal potentials:
I. Spontaneous activity: Muscle at rest exhibits electrical silence. Any activity seen during
relaxed state is called as spontaneous activity, because it is not produced by voluntary
contraction. There are four types of spontaneous activity; as follows;
a) Fibrillation potentials:
- Due to spontaneous depolarization of muscle fiber.
- Small amplitude and duration of potentials.
- Indicative of lower motor neuron disorders such as peripheral nerve, anterior horn
cell disease, radiculopathies and polyneuropathies.
- High pitched clicks.
- Triphasic (3 phases).
- Spikes may vary in amplitude from 10-300µV.
- Average duration of 2ms.
- Recorded at frequency up to 30per second.
b) Positive sharp waves:
- Observed in denervated muscle at rest.
- Usually accompanied by fibrillation.
- Dipahsic with sharp initial positive deflection (below baseline) followed by slow
negative phase.
- Low amplitude than positive phase.
- Much longer duration.
- Amplitude 1mV.
- Frequency ranges from 2-100/sec.
6. - Dull thread sound.
*In Upper motor neuron lesion fibrillation and positive sharp waves may be seen together.
c) Fasciculation:
- Seen with irritation or degeneration of anterior horn cell, nerve root compression,
muscle spasm and cramps.
- Represents involuntary asynchronous contraction of a bundle of muscle fibers
- Amplitude and duration similar to MUP.
- Diphaisc, Triphasic, Polyphasic.
- Frequency rate= 50/sec.
- Low pitched thump.
d) Repetitive discharge:
- Called bizarre high frequency discharge.
- Seen with anterior horn cell and peripheral nerve with myopathies.
- Extended terrain and potential of various forms.
- Frequency = 5-100 impulses/second.
- Amplitude = 50µV – 1 µV.
- Duration=100ms.
II. Abnormal Voluntary Potentials:
Polyphasic potentials occurring greater than 10%.
Elicited by voluntary contractions.
Seen in myopathies and peripheral nerve involvement.
Potentials of smaller amplitude than motor units.
Shorter durations.
III. Giant motor units:
Increased amplitude.
Increased durations.
Seen in post polio residual syndrome.
EMG used in evaluating entire motor system at various level:
Sr. No Area EMG
1. Cerebral cortex CNA,
Neoplasm
Trauma
2. Corticospinal tract
3 Anterior horn cells MND,
Polio,
7. SMA
4 Peripheral nerves Neuropathies
5 Neuromuscular
junction
Myasthenia gravis
6 Muscle membrane Myotonia,
Inflammation
7 Muscle
(contractile unit)
Dystrophies
Precautions: Aseptic techniques.
General Principles of EMG testing:
Examination of number of muscles, both above and below the suspected site of
pathology.
Examination of muscles innervated by other nerves in the same limb.
Sampling EMG activity of the full cross section of each muscle tested.
Examination of muscle in contralateral limbs or both upper and lower limbs may be
appropriate.
Examination should be performed at the appropriate time in the context of the suspected
disorders.
Contraindications/ Precautions in electrophysiological Testing.
Abnormal blood clotting factors/ anticoagulant therapy.
Extreme swelling.
Dermatitis.
Uncooeprative patient.
Recent myocardial infarction.
Blood transmittable disease.
Immune suppressed conditions.
Central going lines.
Pacemakers.
Hypersensitivity to stimulation.