Transcript Recommendations for Early Approach to Spinal Cord Injured

In the name of God
Physical Modalities in Obesity
G. Reza Raissi MD
T. Ahadi MD
A. Prof.
Physical Medicine & Rehabilitation
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• Modalities are physical agents that are
utilized to produce a therapeutic response in
tissue
• Heat
• Cold
• Water
• Electricity
• Electromagnetic waves
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Massage
Laser
Biofeedback
Magnethotherapy
Transcranial Magnetic stimulation
Assistive device
Exercise
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Alternative and
Complementary
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Acupuncture
Chiropractic
Herbal medicine
Homeopathy
• Naturopathy
Modalities are extensively used in obesity and
condition related to It
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• Heat
• Superficial
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Hot pack (HP)
Infra red (IR)
Electrical pad
Hydrotherapy
• Deep (Diathermies)
• Short wave
• Micro wave
• Ultrasound (U/S)
Conductive Heating Agents
• Hot packs
• Placement considerations
• Advantages and
disadvantages
Radiating Heating Agents
• Infrared Heat Lamps
• Very superficial
• 1-10 mm DOP
• Two types
• Luminous
• Non-luminous
• Setup
• Inverse Square Law
• Cosine Law
Ultrasound
The therapeutic effects of U/S
• THERMAL & NON-THERMAL
• selectively raise the temperature of
particular tissues)40-45°C(
• More heated tissues are periosteum,
superficial cortical bone, collagenous
tissues (ligament, tendon & fascia) &
fibrotic muscle
What is Phonophoresis?
• Phonophoresis is the therapeutic application of ultrasound with
a topical drug in order to facilitate transdermal drug delivery.
• An ultrasound machine uses sound waves to travel through
the skin and into the body.
• A gel is used to help sound waves enter the body and create
the effect of deep heat in your muscles and joints.
• Medicine, most commonly a corticosteroid, is added to the
ultrasound gel.
• The sound waves from the ultrasound machine push the
medicine deep into the body.
(Cameron, 1999; Cameron & Monroe, 1992)
Phonophoresis
• Ultrasound with drugs, used to increase
absorption and penetration of drugs up to 5
or 6 cms
• Anti-inflammatory’s
• Cortisol
• Dexamethasone
• Salicylates
• Analgesics
• Lidocaine
Electrotherapy
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Decrease pain
Increase blood flow
Increase Range of Motion
Increase muscle strength
Muscle re-education
Facilitate absorption of medicines
Electrotherapy
• TENS (Transcutaneous
Electrical Nerve
Stimulation)
• High-Voltage pulsed
stimulation
• Neuromuscular
Electrical Stimulation
• Interferential
stimulation
• Low-Intensity
Stimulation
• Galvanic Stimulation
• Russian current
• Faradic current
• Iontophoresis
Radiofrequency
• Generate electrical energy that heats the dermis
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Repetitive Transcranial
Magnetic Stimulation
• left dorsolateral prefrontal cortex have a
non-substance-specific inhibitory effect on
craving
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Transcutaneous Electrical
Stimulation of Acupoints
• 30 min per session, two sessions per week
for 12 weeks using two surface electrodes,
one to the Zusanli (ST36) and the other to
Sanyinjiao (SP6) acupoint.
• Effective in reducing percentage body fat
and waist circumference
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Transcranial Direct Current
Stimulation
• Transcranial Direct Current Stimulation: A
Novel Approach to Control Hyperphagia...
Boggio et al. J Child Neurol.2009; 24: 642643
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• Low-level, dual-beam laser energy with massage appears
to be safe and more efficacious than massage alone for
reducing subcutaneous fat in the thighs of normal women
Lach E. Reduction of subcutaneous fat and improvement
in cellulite appearance by dual-wavelength, low-level
laser energy combined with vacuum and massage. J
Cosmet Laser Ther. 2008 Dec;10(4):
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Massage
• Many Massage Techniques
• Hoffa Massage
• Acupressure/Shiatsu
• Connective Tissue
• Myofascial Release
• Rolfing
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Massage
• Massage Has Effects On:
• Circulation And
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Lymphatic Flow
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• Nervous System
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• Muscles
• Myofascia
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Skin
Scar Tissue
Psychological
Responses
Relaxation
• Pain
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Vibration
• Low-intensity vibration prevents fat formation
2007
• May 31, 2009. pg. 143
• Diet, no exercise
• same diet intervention, with a conventional fitness
regime
• diet intervention plus supervised vibration plate
• no intervention
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• diet only group lost about 6% of their initial body
weight
• diet plus conventional fitness lost about 7%
• vibration group lost 11%
• Fjeldstad C, Whole-body vibration augments resistance training effects
on body composition in postmenopausal women. 2009 May
20;63(1):79-83
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Heat
• Superficial
• Local
• Belt
• Hydrotherapy, Sauna
• Deep Heat
• SWD
• Ultrasound
• ES
• Massage
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Cellulite (gynoid lipodystrophy
• Skin dimpling and other changes in skin
topography and often a padded or ‘‘orange
peel’’appearance
• Iontophoresis, thermotherapy,
pressotherapy, (pneumatic lymphatic
drainage), Ultrasound, lymphatic drainage
massage, radiofrequency, infrared light, and
mechanical tissue manipulation, contact
cooling, laser diodes, and tissue massage
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• Effects of cellulite treatment with RF, IR
light, mechanical massage and suction
treating one buttock with the
contralateral as a control. J Cosmet Laser Ther.
2008 Dec;10(4):193-201
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Conclusion
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Shortness of breath
muscle weakness
joint pain
skin breakdown
urinary stress incontinence
difficulty with basic mobility
• changing position
• walking climbing stairs,using transportation,
and managing personal hygiene
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• obesity is not a cosmetic disorder but a
medical disorder
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