el physiotherapy – a new approach to physiotherapy (practical solutions) presenter margarita...
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EL Physiotherapy – A new approach to physiotherapy (practical solutions)Presenter
Margarita Gurevich
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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
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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
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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
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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
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Example of clinical examination of neck pathology as part of the FBANeck - ROM LEFT RIGHTFlexion (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
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Treatment techniques
Electrotherapy: Electrostimulation Interferential Ultrasound Magnetotherapy Pharmacological phoresis SCENAR Combination therapyClinical PilatesGeneral physiotherapy: Mobilisation Traction Exercise programs etc.
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Electrotherapy
Performed using the Chattanooga Intellect Advanced Therapy System and other modern devices
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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
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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
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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
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Combination therapy
Usually two treatment modalities on the same/different area
Iontophoresis and ultrasound
Interferential and phonophoresis
Iontophoresis and magnetotherapy
SCENAR and magnetotherapy
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Clinical Pilates – diagnostic assessmentDetailed 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
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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
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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
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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
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General physiotherapy
Mobilisations
Traction
Therapeutic weights
Exercise programs
Thermal therapy
Prenatal, antenatal and postnatal therapy
Incontinence therapy
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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%
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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
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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
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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
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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
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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
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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