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  • Manipulation under anesthesia


    Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. Medication-assisted manipulation (MAM) may also be used to describe the procedure, although that term more broadly categorizes the varied forms of existing MUA techniques. In any form, MUA is used by osteopathic/orthopedic physicians and specially trained (MUA certified) chiropractors. It is intended as a means of breaking up adhesions (scar tissue) of or about spinal joints (cervical, thoracic, lumbar, sacral, or pelvic regions), or extremity joint articulations (i.e., knee, shoulder, hip) to which painfully restricted range of motion significantly limits function. Failed attempts at other standard conservative treatment methods (i.e., manipulation, physical therapy, medication), over a sufficient time-frame, is one of the principal patient qualifiers.

  • Stroke recovery


    The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays. Once a patient is medically stable, the focus of their recovery shifts to rehabilitation. Some patients are transferred to in-patient rehabilitation programs, while others may be referred to out-patient services or home-based care. In-patient programs are usually facilitated by an interdisciplinary team that may include a physician, nurse, pharmacist, physical therapist, occupational therapist, speech and language pathologist, psychologist, and recreation therapist. The patient and their family/caregivers also play an integral role on this team. Family/caregivers that are involved in the patient care tend to be prepared for the caregiving role as the patient transitions from rehabilitation centers. While at the rehabilitation center, the interdisciplinary team makes sure that the patient attains their maximum functional potential upon discharge. The primary goals of this sub-acute phase of recovery include preventing secondary health complications, minimizing impairments, and achieving functional goals that promote independence in activities of daily living. In the later phases of stroke recovery, patients are encouraged to participate in secondary prevention programs for stroke. Follow-up is usually facilitated by the patient’s primary care provider. The initial severity of impairments and individual characteristics, such as motivation, social support, and learning ability, are key predictors of stroke recovery outcomes. Responses to treatment and overall recovery of function are highly dependent on the individual. Current evidence indicates that most significant recovery gains will occur within the first 12 weeks following a stroke.

  • Shoulder


    The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder, but can more broadly include the acromioclavicular joint. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, and the head sits in the glenoid cavity. The shoulder is the group of structures in the region of the joint. The shoulder joint is the main joint of the shoulder. It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body. The joint capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula, humerus, and head of the biceps. It is lined by a thin, smooth synovial membrane. The rotator cuff is a group of four muscles that surround the shoulder joint and contribute to the shoulder's stability. The muscles of the rotator cuff are supraspinatus, subscapularis, infraspinatus, and teres minor. The cuff adheres to the glenohumeral capsule and attaches to the humeral head. The shoulder must be mobile enough for the wide range actions of the arms and hands, but stable enough to allow for actions such as lifting, pushing, and pulling.

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