Volume 8, Issue 2
Reg.No.gujeng/2009/30341
SMOKING CESSATION What Physios can do to help them QUIT?
ADRENAL FATIGUE Are we all really listening to our bodies?
COSTING IN PHYSIO THERAPY The fundamental principles
PHYSIOTHERAPY REGISTRATION IN AUSTRALIA Experiences of an Indian Physio Also in this issue:
BEST OF WEB BOOK REVIEW EVENTS HEALTH DAYS www.physiotimes.com Download PHYSIOTIMES Mobile APP on
ISSN NO.: 0976 -1993
Sept-Oct’2016
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SELFIE ELBOW A tech-induced ailment
KKMT
A new school of thought in manual therapy
WORLD PHYSIO THERAPY DAY Celebration Stories
marketing mantra
A nation wide series of seminars
SAKSHI MALIK THE SPLENDID
& her tryst with physiotherapy
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D irec tor’ sD e sk
“
F rom
the
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- Winston Churchill
ear Readers,
Winston Churchill was so right when he made such a profound statement with regard to success. Don’t we all say that success is not a destination but a journey in itself? However, it is an arduous journey full of challenges, roadblocks, obstacles and what not. But then, nothing important was ever achieved without someone taking a chance, without someone going the extra mile, without someone defying the odds to excel and be the best. It is this monomaniacal focus that opens doors of multiple possibilities. In this issue, we introduce to you one such gritty woman, whose dedication, determination and passion made her create history and bring laurels for the entire nation. It gives us immense pleasure to present an exclusive interview with one of the
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Success is not final, failure is not fatal: it is the courage to continue that counts.
poster girls of Indian Olympics in Rio, Sakshi Malik, the only female wrestler to have ever won a medal at the Olympics. Her feat is truly extraordinary, notwithstanding the struggle she had to undergo in this exhilarating journey from Rohtak to Rio. The interview focuses on the role of physiotherapy in her career and how the contribution of a physio matters during tournament as well as while training in the prevention and management of injuries in a high contact sport like wrestling.
It is heartening to note that Sakshi has emphatically stated how crucial physios are to them in their sport. We thank Sakshi for her encouraging remarks about physiotherapists. Apart from various scholarly articles, the issue features coverage of a nation-wide
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
series of seminars on Marketing in Physiotherapy initiated by PHYSIOTIMES in various cities under the title “Marketing Mantra”. The seminar is intended to horn the marketing and management skills of physios so that they can better manage their practice.
The issue has also covered stories of the World Physiotherapy Day celebrations across India on Sept 8, 2016. Do write to us on feedback@physiotimes. com with your valuable comments & feedback. Own your game. Honor your genius. Celebrate your gains. And be kind. Always. Mukesh Nayak
Allow your trials to become your triumphs. Make your falls into your freedoms. And your hurts into heroic masterpieces that inspire all watchers.
Volume 8, Issue 2, Sept-Oct 2016
Web Consultant Concept & Design
A Tribute to the Legend of Indian Physiotherapy
Movewell Media
Back Cover : BTL India Pvt Ltd., New Delhi Front Inside : International Medical Technologies Back Inside : Andrews University, USA Pg. 01 : Zydus Cadila, Ahmedabad Pg. 02 : Capri Institute of Manual Therapy, New Delhi Pg. 03 : Chirag Electronics Pvt. Ltd., Ahmedabad Pg. 04 : Leads Pharma Pvt. Ltd., Hyderabad Pg. 05 : Bio Med Inc, New Delhi Pg. 13 : K11 Academy of Fitness Sciences Pg. 21 : Physilife (Dr. Subhanjan das), West Bengal Pg. 24-25: Sunrise Industries, New Delhi Pg. 29 : Indian Academy of Fitness Training, M’lore Pg. 31 : Medilab India, Bangalore Pg. 33 & 41 : India Medico Instruments, New Delhi Pg. 40 : Sparsh 4.0, Mumbai Pg. 44 : Physioneeds Academy, New Delhi Pg. 46 : Vasant Marketing, Ahmedabad Pg. 47 : JNB Sports, Mumbai
First Breath: Nov 2, 1937
Last Smile: Oct 20, 1937
Dr. M. G.Mokashi In his long innings spread over five decades as a physiotherapist and an academician par excellence, Dr. Mokashi had watched Indian Physiotherapy come of age from close quarters. He was a fatherly figure to many physiotherapists and his contribution to Indian Physiotherapy is unparalleled. His passion for the upliftment of the profession was exemplary. As our chief mentor, he was the guiding force throughout for us. His teachings would continue to guide us to the path of righteousness. We are at loss of words to express the grief. We pray his divine soul rest in peace.
Your life was a blessing, your memory a treasure. You are loved beyond words and missed beyond measures. Published for the period of Sept’ 1 2016 to Oct’ 31, 2016
Contents
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Avant garde An Introduction to KKMT: a new school of thought in manual therapy
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- Dr. Krishna N. Sharma
Feature Article
Straight from the gut
Adrenal Fatigue - Are we really listening to our bodies?
PT Registration in Australia Experiences of an Indian Physio - Pinakin Godse
- Diana Pinto
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18 Cover Feature An interview with The Splendid SAKSHI MALIK & her tryst with physiotherapy
30 Quintessential Outlook Smoking Cessation What physios can do to help them quit? - Dr. Palak Shah, PT
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Costing in Physiotherapy The fundamental principles - Dr. Ganesh Chandran
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Reportage
Book Review
Marketing Mantra A nation-wide series of awareness seminars for physios on marketing in physiotherapy
Sociology for physiotherapists
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Best of web Websites on Osteoporosis
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46
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Spotlight Selfie Elbow - Yet another tech induced ailment
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They said it
Advocacy Health Days An opportunity for professional advocacy
Sept 8, 2016 - World Physiotherapy Day Celebrations Across India
- Jasrah Javed
DOWNLOAD PHYSIOTIMES MOBILE APP
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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Cover Feature
SAKSHI MALIK THE SPLENDID
& her tryst with physiotherapy
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Cover Feature PT 18 August 2016. A billion hearts were pounding. A pair of billion eyes watching. With seconds left on the clock, this tenacious wrestler from Haryana summoned an extra reserve of strength from deep within her to �ight back from 0-5 down to seal the bout 8-5 in her favour & produce India’s �irst medal at Rio 2016 Olympics. th
Sakshi Malik, a name that would go down in the annals of sporting history as the �irst woman wrestler from India to bag an Olympic medal. She is also the fourth female athlete from the country to climb to the podium at the biggest sporting event after weightlifter Karnam Malleshwari (2000, Sydney), boxer MC Mary Kom (2012, London) and badminton ace Saina Nehwal (2012, London). Sakshi had won a silver medal at the Commonwealth Games in Glasgow (2014) and a bronze medal at the Asian Championships (2015). It was 12 years of persistent hard work that paved the way from Rohtak to Rio for this gritty woman. Born on September 3, 1992, in Mokhra village near Rohtak, Haryana, Sakshi Malik has her supportive parents, Sudesh and Sukhbir Malik, to thank for encouraging her in her unusual career choice.
Sakshi started her training in wrestling in 2004 as a 12-year-old under the guidance of Ishwar Singh Dahiya at an akhara in the Chotu Ram Stadium Wrestling Academy in Rohtak. Since there were not enough girls to train with, certainly none with her caliber and motivation, she used to train with boys.
Wrestling is a contact sport, requiring a lot of stamina, power and technique. It is a highly injury prone sport and requires extensive training to maintain the desired �itness levels. It is here that the role of a quali�ied physiotherapist comes handy during training as well as tournaments. It gives us great pleasure to present to you an exclusive interview with Sakshi Malik on what goes in the making of a champion, the role of physiotherapy in her career as a wrestler and how her win is sure to inspire the next generation of Olympians in India.
WRESTLING AS A SPORT 1. What made you take wrestling as a sport?
Ans: My Grandfather was a wrestler himself. He used to sit with me and explain wrestling as a sport very passionately. He taught me the rules and the techniques and that got me interested in the sport. I started to train when I was 12 and since then I have never looked back. 2.Which are the three “MUST HAVE” qualities to be a good wrestler? Ans: Dedication. Not just in wrestling but in any walk of life dedication is by far, the most important thing. If as a wrestler you are dedicated to your sport, the ability to work hard, skills – the ability to nurture and develop them; physical and mental strength, come naturally. 3.What is the best thing about wrestling as a sport?
Ans: Wrestling give me the power to be ‘me’, it has given me my identity and whatever I have achieved till today. The sport has taught me to work hard, stay disciplined and to never give up. SAKSHI AS A WRESTLER
4.How does a typical day look like for you when you are training?
Ans: Usually I train for 3 hours in the morning and three hours in the evening at least. Between the sessions I
give my body ample time to recover and get ready for the next session. I also take my meals on the clock so that I get enough strength for the day and for my sessions.
5. What are the most common injuries you face in wrestling?
Ans: According to me, the most common injuries faced by wrestlers are the knee injuries. If you study wrestling matches, you will see that most injuries sustained are the ones on the knees. 6. Wrestling is a high level contact sport. What measures do you take to prevent injuries?
Ans: First and foremost is to maintain a good standard of general physical �itness, which is the key to any sport. Apart from that it is very important for the wrestler to master his/her skills through proper training and learn every little detail to be able to anticipate and avoid injuries. 7.What is your diet regimen during training and tournament?
Ans: Diet regimes during training and during tournaments are completely different. During training, since the sessions are heavy, we load up on Fats and Carbs. But during tournaments the key is to go light so we have a very balanced diet with minimum carbs and fats.
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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Cover Feature
ROLE OF PHYSIOTHERAPY 8. When did you �irst learn that a physiotherapist can help you stay �it and manage injuries?
When we went to participate in international competitions we always had a physio travelling with the Indian Team. We understood that since injuries and muscle pulls were a little common in such a high contact sport like wrestling, a physio was very important. 9. How important is the role of a physiotherapist in your routine now & what is the time you spend with your physio on an average in a day?
Ans: Like I mentioned, in an extensive contact sport like wrestling you need a physio to keep your body �it. Apart from tournaments, we mostly spend time with the Physios when we have our training camps. For instance, JSW Sports has organized a training camps for their wrestler - including me, coming up in the next few days, where we will spend a considerable amount of time with the Physio and get ready for the season. 10. What is the key difference in a physio’s role during routine training and during tournaments?
Ans: Since the schedules and the duration of wrestling activities differ from each other during Training and tournament, their role also changes accordingly. During training more emphasis is given on assessing what injuries you are prone to and its prevention; during
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tournament, focus is also on recovering after each match so you can perform in the next.
11. How does physiotherapy help you achieve correct techniques & execute proper moves? Ans: If your body is tired or injured, there is no sense in practicing techniques correctly, because the body will never allow you. Also, if you don’t have a Physio to help you rehabilitate from stiffness, niggles or injuries, no amount of skills or techniques will be able to help you, in fact you will be risking permanent damage.
12. How does your Physio help you in conditions that occur as a result of over use, repetitive strikes or force, like muscle strains, ligament sprains or bruises? Ans: They give us proper exercises targeted at the speci�ic injuries as well as a regime advising us on the amount of rest required, to-do lists and restrictions lists.
13. How do you manage to deal with unavoidable acute injuries that occur to knee, shoulder, skin, head or face? What keeps you going? Ans: I think the desire to win and to be the best in the world takes precedence over all these small injuries. In sport you will get injured, you just have to recover and move on from that. 14. Earlier only one male physio was provisioned for the wrestling Team for Rio Olympics. After media’s intervention, your female
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
If you don’t have a Physio to help you rehabilitate from stiffness, niggles or injuries, no amount of skills or techniques will be able to help you, in fact you will be risking permanent damage. Physio, Rucha Kashalkar was asked to join. How important was this decision for the female wrestlers?
Ans: Men and women have different physical structures and hence they have different physiological problems. The decision to have a female Physio was most de�initely a welcome decision and did help all the girls in Rio. 15. How has been your overall working experience with Rucha Kashalkar at Rio and other tournaments and what are some of her qualities as a physio that you admire the most? With Rucha Kashalkar at Rio
16. Who are the other physios you have worked with in your career? Ans: I have worked with a lot of physios throughout my career. Also, since I am a part of JSW’s Sports Excellence Programme, during every camp we get access to some of the best physios in the world.
17. What would you say about a wrestling match without a physio in the support team? Ans: It is very important to have a Physio in the support team. Wrestling is a very high-level and intensive contact sport, where injuries unfortunately are common and sometimes can be avoided with the immediate attention from the Physio. SAKSHI THE PERSON
Ans: She has been a great support from the sidelines. She is very focused on each of us and tailored exercises according to each individual. Her dedication to each and every individual is what impressed me the most.
18. You have pursued Masters in Physical Education. Does this additional knowledge about �itness contribute to your overall performance?
Ans: Having knowledge about something that is such a crucial aspect of your sport, is always helpful. It just helps you in having a comprehensive understanding of how bodies work and how your skills can be complemented with the physical attributes of your body.
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Cover Feature
19.When do we get to read a book by you or watch a biopic made on you? Ans: If I knew, I would de�initely tell you (laughs).
20. You have been recently promoted as University's wrestling Director. How would you like to encourage other females to take up wrestling as a career?
Ans: I would just like to tell them to wrestle with every little dif�iculty that comes your way and keep your eyes on the prize. Always remember that I am one of you, if I could do it, so can you. 21. If we go by “the best is yet to come” dictum, what would that be for you?
Ans: To change the colour of my Olympic Medal – That is yet to come! 22. What are the key ingredients to become a champion?
Ans: Hard work, honesty, skills and dedication, 23. What is life beyond wrestling for you?
Ans: Nothing. I have never felt the need to think about a life beyond wrestling. Till the time that I am here, on the mat, I will not be able to and would not want to think beyond this.
24. Your advice to parents who wants their kids to become a wrestler or a sportsperson?
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It is very important to have a Physio in the support team. Wrestling is a very high-level and intensive contact sport, where injuries unfortunately are common and sometimes can be avoided with the immediate attention from the Physio. Ans: Let your kids dream and encourage them by cheering for them throughout all their matches. Enjoy their wins but also teach them sportsmanship spirit in case they fall behind. 25. Your message to the Physiotherapy community and the scope of career as a sports physio.
Ans: Thank you for all the hard work you put into building champions like us.
Acknowledgement: We wish to thank Dr. Palak Shah for her help in preparing the questionnaire. We also thank Rucha Kashalkar, Sakhi’s Physio for her help in making the interview possible. We express our gratitude to Nayantara, Suhasini Mitra and team Playright for their help in coordinating the interview on our behalf.
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Cover Feature Your fitness mantra
Wrestling to you is
Be Happy. Be Balanced. Be The best Healthy compliment you have ever received You are a Role Model Awards to you are Hard work
Life
Coach to you is
Winnnig to you is
Guide
Never giving up
SAKSHI’S SECRETS
Your favourite food
PT
Homefood
A Physiotherapist to you is Important
Your Inspiration My Grand father Your mission in life To be World’s Best Wrestler
Your favourite hobby Shopping and Travelling Your biggest strength
Your journey in one word Eventful
Favourite wrestlers
If not a wrestler, what would you have been Never thought about it
Sushil Kumar, Yogeshwar Dutt & Japanese Wrestlers
Friends , Family and Coaches
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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KKMT PT
Avant Garde
A new school of thought in Manual Therapy Manual Therapy is made up of two words - Manual and Therapy. The late Middle English term manual came from Old French word manuel, from Latin word manualis (hand), from another Latin word manus (hand). The English term therapy came in the mid 19th century from Modern Latin word therapia, from Greek word therapeia (healing), from another Greek word therapeuein (treat medically).
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So technically, manual therapy is any treatment done purely with the hands. The very �irst documented record of manual therapy is found in a book Susrut Samhita where the author and the father of surgery Acharya Susruta (600 BC) described 107 marma points and their treatment through �inger kneading almost 100 years prior to Hippocrates. Though Acharya Susruta was probably the �irst documented person to use
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
manual therapy, I believe that the concept of manual therapy had been seeded on the day when the �irst human would have rubbed the injured part after his/her �irst fall. The �ield manual therapy is like a giant strangler �ig with multiple aerial roots in the form of schools of thought. These aerial roots don’t bring con�lict but they make the system of manual therapy stronger and give the therapists a wider choice.
The �ield of manual therapy has been evolving & has witnessed a lot of changes and development. Krishna’s Kinetikinetic Manual Therapy (KKMT) is the latest in this row. KKMT vs KKMT Mobilization: The term kinetikinetic in KKMT means mobilizing/ manipulating homeostatic forces. KKMT has total �ive modules - articular, muscular, neural, fascial, and visceral.
Avant Garde PT All the modules of KKMT are based on the principle of bringing the structures back to its normal state by mobilizing/manipulating homeostatic kinetic forces. KKMT mobilization is just the articular module of KKMT.
What makes it different?
Homeostatic forces are the forces required to bring the joint back to its functional position. So KKMT emphasizes on recoiling the restrictions of joint by mobilization and manipulation to facilitate the homeostatic kinetic forces.
Principles of KKMT Joint Mobilization:
KKMT Mobilization
The Genesis of KKMT
As a physiotherapy student I have studied various existing manual therapy approaches. My inquisitive nature led me to explore further possibilities in arthro-kinetics and arthrokinematics. I had many questions for which I was seeking answers.
Why are most of the arthrokinematic mobilization techniques one or two directional when functional arthrokinematic motions are three directional? Why is rolling the most ignored arthrokinematic in manual therapy? How can we use the homeostatic joint forces to help the joint recoil from the positional dysfunction? Overt the time I kept exploring and using various techniques and patterns on the patients and so the KKMT mobilization is the answer to these questions after years of empirical studies.
What makes it different is the 3D approach. Whereas other manual therapy techniques focus on relaxed uni/bidirectional arthrokinematics, KKMT focuses on 3D gliding as well as functional rolling with functional motion. The KKMT joint mobilization techniques are based on the following principles: 1. Proper arthrokinematic motion and homeostatic kinetic forces are essential for proper and smooth osteokinematic motion.
2. Homeostatic kinetics of a joint is important to maintain its static and dynamic alignment. The homeostatic kinetic forces help the joint come back to its proper alignment after a motion. The factors that produce and govern the homeostatic kinetics of joint are: o Local/Intrinsic factors: e.g. ligament, cartilage, meniscus etc. o Global/Extrinsic factors: e.g. muscles, fascia, gravity 3. Limitation or restrictions in the arthrokinematic motion can be restored by facilitating homeostatic kinetics of the intrinsic and extrinsic factors. Indications of KKMT Joint Mobilization: • Joint Pain • Joint restrictions
Contraindications of KKMT Joint Mobilization: Though pain during application of the techniques itself is the best way to know if the
technique is contraindicated, KKMT joint mobilization should be applied with caution in the cases of acute injuries and joint instability. Techniques: The KKMT mobilization protocol has 3 components - evaluation, management and prevention. During management, the mobilization is applied after muscle and joint conditioning. There are various techniques that can be applied to restore the joint motion and facilitate the homeostatic kinetics. The three important groups of techniques are:
i. 3D Gliding: The restricted/ painful osteokinematic movement is performed passively with variations of 3D glide patterns to identify the therapeutic 3D glide pattern.
Since physiologically, 3D glides occur only during active functional motion and not when the joint is static, the therapist performs 3D glides only with active functional motion. The 3D glide patterns can be combined with other techniques e.g. postisometric relaxation, reciprocal inhibition, oculocervical re�lex, breathing pattern etc. ii. Joint gaping: It is a joint distraction technique performed with functional osteokinematic motion.
iii. Function Articular Rolling: Rolling is the most ignored component in manual therapy as most of the techniques focus on gliding only. Most of the functional articular rolling techniques are combined with joint gaping.
What do the researches say?
Researches (RCTs) carried out by students of the St. Louis University, Cameroon; Université de Dschang; and the University of Rome Tor Vergata, Italy have proved it effective in joint pain, reduced ROM, and disability. Past, present and future:
KKMT was �irst announced in 2015 and was launched in Cameroon and Sri Lanka in 2016. The Academy of KKMT has coordinators/conveners in 7 countries- Cameroon, India, Sri Lanka, United Kingdom, Switzerland, Ukraine, and Malawi. Very soon we are going to start regular courses in few other Asian and African countries too. We have started inviting researchers and PG/PhD students to work on KKMT and providing them assistance like free data analysis, assistance in research supervision and paper publication etc. Of�icial website of KKMTwww.academyo�kkmt.com
Dr. Krishna N. Sharma DeveloperKKMT® Dean: St. Louis University, Cameroon Author: 120+ books & 20+ bestsellers, 3 times world record holder. Website: http://www.DrKrishna.co.in
PHYSIOTIMES Vol. 8, Issue 2, Sept’2016
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SMOKING PT
Outlook
CESSATION
What Physios can do to help them QUIT?
Dr. Palak Shah (PT)
(MPT, FCR, FRT, YTTC, CCBE) Chief Physiotherapist at Pranayam Lung & Heart Institute, Vadodara Respiratory Therapist at Metro Centre for Respiratory Diseases, Metro Hospitals & Heart Institute, Noida BPT (Gujarat University) MPT Rehabilitation (Pune) – Specialist in Fitness/ Women’s Health/ Industrial Health/ Geriatrics Fellowship in Respiratory Therapy & Cardiac Rehabilitation (AHERF) Certified Yoga/ Power Yoga/ Aerobics/ Pilates/ Pre-post natal fitness instructor (IAFT-Honorary Member) Certified Child Birth Educator (Academy of Certified Birth Educators & Labor Support Professionals) Dr. Palak canbe reached at
dr_palak4324@ yahoo.com
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Outlook PT
C
igarette smoking is the single biggest avoidable cause of death & disability in developed countries. Smoking is now increasing rapidly throughout the developing countries & is one of the biggest threat to current & future world health. Encouraging smoking cessation is one of the most cost effective things that Physiotherapists can do to improve health & prolong their patients’ lives. The results of Smoking Cessation are achieved faster with a Team Approach. The team includes: Pulmonologist, Physiotherapist, Respiratory Therapist, Paediatrician, Psychologist, Oncologist, Cardiologist, Nurse, Clinician, General practitioner, Social worker. Adverse Effects of Smoking on Health:
The major health impacts of smoking are on respiratory & cardiovascular diseases like Respiratory Cancers, COPD, Heart attack. Smoking causes many other diseases including Osteoporosis, Periodontal disease, Impotence, Male infertility & Cataracts. Health Bene�its of Smoking Cessation:
Quitting smoking has immediate & long term health bene�its of smokers of all ages. The risk of death falls soon after cessation. The impact of quitting on mortality is greatest at younger ages. For smokers who stop before age 35, survival is about the same as that for non-smokers. The excess risk of oral &
oesophageal cancer caused by smoking is halved within �ive years of cessation. The risk of heart disease decreases more quickly after quitting smoking. Smoking cessation also reduces the risk of death after stroke & pneumonia. Recent evidence shows that the bene�its occur even in older patients with severe COPD, as cessation results in small increase in lung function. Effects of Nicotine:
Nicotine has effects on brain neurochemistry. It activates nicotine acetylcholine receptors (nAChRs) which are widely distributed in brain & induces the release of dopamine. The similar effect as that produced by other drugs of misuse (such as amphetamines & cocaine) & is a critical feature of brain addiction mechanisms. Nicotine is a psychomotor stimulant & in new users it speeds up simple reaction time, improves task performance of sustained attention. However, Tolerance develops & chronic users probably do not continue to obtain improvements in performance, cognitive processing or mood. Nicotine Withdrawal:
Smokers start experiencing irritability, restlessness, cravings for cigarettes, impairment in mood & performance within hours of their last cigarette & certainly overnight. These effects are alleviated by smoking a cigarette. Smokers go through this
process thousands of times & this may lead them to identify cigarettes as self medication, even if the effect is the negative one of withdrawal relief. Socio-Economic status & Nicotine addiction: The evidence shows that poorer smokers tend to have higher levels of nicotine intake & are more dependent on nicotine.
Cigarette Dependence: A chronic relapsing condition Smokers struggle to achieve long term abstinence from smoking. Successful interventions are needed considering the factors like – personal, family, socioeconomic, pharmacological- that sustain use & can act as major barriers to cessation. Smoking Cessation in Pregnancy: Smoking in pregnancy is associated with increased rates of fetal & perinatal death. Passive smoking after birth is associated with cot death, respiratory disease in childhood & lung cancer, heart disease, stroke in adults. Pregnancy could be “a window of opportunity” for smoking cessation since pregnant could be motivated from their desire for a healthy pregnancy and delivery. Smoking cessation could reveal depression and thus should be done under medical guidance in smokers with depression symptoms. Cognitive behavior therapy, motivational interviewing and structured self-help with support are effective for pregnant smokers. The health of pregnant woman and her fetus is affected by both active and passive smoking of her partner or family, Therefore Educating Pregnant’s husband & family is equally important.
Physiotherapists are in an ideal position to promote smoking cessation & hence Physiotherapists should ascertain their level of knowledge about smoking cessation in order to help patients quit smoking. Interventions in Smoking Cessation The most effective method of helping smokers to quit smoking is the combination of Pharmacotherapy (Nicotine or bupropionprescribed by pulmonologist) & Non-pharmacological interventions like- Brief advice, Behavioural support such as Written materials, Telephone helplines & strategies for preventing relapses. BRIEF ADVICE:
The Cochrane Tobacco Addiction Group de�ines brief advice against smoking as “verbal instructions to stop smoking with or without added information about harmful effects of smoking.” It achieves cessation in 1 in 40 smokers but it is most cost effective intervention as only one or two minutes are needed for effective brief advice, that can be delivered in routine consultation. Follow up visits can be arranged to review progress. More intensive advice (taking more than 20 minutes) including additional reinforcing methods can be used such as self help manuals, videos & showing smokers their exhaled carbon monoxide levels. (Pic.A)
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Outlook
DEMONSTRATION: “Seeing is Believing” The “Smoker Lung” model is useful in effective demonstration of harmful effects of smoking by showing that If one cigarette can harm this much then how major is the cumulative effect on the lungs of people who smoke 10 or 20 cigarettes per day since months or years.
Pic.A
Pic.B
- Promoting Smoke-free policies at public places & work places
Pic.C
- An increase in price of tobacco products of 10% causes a 4% fall in smoking in adults. The price rise should be with clear publicity about reasons for it to reinforce that smoking is bad. - Mass Media campaigns have a direct impact on prevalence of smoking & most effective when delivered as part of comprehensive Tobacco control programs. (Pic.E)
Pic.D
NICOTINE REPLACEMENT THERAPY (NRT): NRT is most effective when used in conjunction with behavioural support & other Non-pharmacological cessation interventions. The mode of action of NRT is thought to be the stimulation of nicotine receptors & release of dopamine. This and other peripheral
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Strategies to Prevent Smoking: - Public Education (Pic.D)
TRAINING OTHER HEALTH PROFESSIONALS: Educating other health professionals to be able to spread smoking cessation awareness. (Pic. B & C)
BEHAVIOURAL SUPPORT: Meta-analyses of Trials have shown that about 1 in 13 smokers who are motivated enough to attend individual counseling for smoking cessation are likely to quit. Behavioural support usually involves review of Patient’s smoking history, their motivation to quit, Education & counseling. It can be given on individual basis or in Group session. Reinforcing patient’s decision to quit at regular interval is essential.
actions of nicotine lead to reduction in nicotine withdrawal symptoms in smokers who attempt to quit smoking. It takes only a few seconds for high doses of nicotine from a cigarette to reach the brain, whereas NRT products achieve lower levels over a period of minutes (for nasal spray, gum, inhalator, sublingual tablet, lozenges) & hours (for transdermal patches).
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
- Banning direct & indirect tobacco advertising & promotion requires coordinated inter governmental action. - Deliberately moving to unappealing cigarette packets with strong written & visual warnings about smoking hazards. - Cutting down the number of cigarettes smoked each day.
- Promoting awareness in school children to prevent rather than stopping smoking. - Clearing myths about Switching to “low tar” cigarettes or E-cigarettes
Myth: If you’ve smoked for years, the damage is done. Pic.E
Fact: It’s never too late to quit smoking. According to the American Cancer Society, within 10 years of quitting smoking, the lung cancer death rate for the average former pack a day smoker decresases by almost half.
World wide 16th November is celebrated as World COPD Day & November is celebrated as Lung Cancer Awareness Month.
Physiotherapists should promote smoking cessation and raise awareness by conducting community health camps & events on tihs occassion. They can also join hands with other health care professionals & do various activities.
The Five “A”s approach:
Ask, Assess, Advice, Assist, Arrange -
Summarise the role of Physiotherapist in smoking cessation. The prevention of smoking has been identi�ied by THE WHO as the most potentially effective preventive health measure that developed countries can take. Physiotherapists are in an ideal position to promote smoking cessation & hence Physiotherapists should ascertain their level of knowledge about smoking cessation in order to help patients quit smoking.
ALERT DO YOU WANT TO QUIT SMOKING? OK
CANCER
PT
Straight from the gut Pinakin Godse Melbourne Australia
PT Registration in Australia
EXPERIENCES OF AN INDIAN PHYSIO
Everyone has a journey of their own. Similarly, I am about to share my journey through the Australian Physiotherapy Council’s (APC) process in order to get General Physiotherapy Registration in Australia. “Sometimes it's the journey that teaches you a lot about your destination” This has been true in my case.
The �irst step of my journey with the APC began in July 2014 by applying for the interim certi�icate. Following that I successfully passed my second step of theory assessment in Dec 2015. This exam has neither a set syllabus nor a reference book, unlike the USA NPTE exam. They just have a list of topics on the website, that won’t be asked in the exam, leaving us to ponder what they can actually ask in the exam!
The biggest help during theory were the various online groups. These groups have resources like previous question recalls, discussion forums, and practice group sessions;
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most of which turned out to be helpful. This exam was nothing like the factual MCQ questions I was used to back in India.
All questions were a case scenario and then sub-questions based on that case. It required a lot of clinical reasoning skills, and the Australian outlook towards the safety issues in the clinical setting. Personally, limited exposure in cardio-respiratory and neurology �ield rendered the exam dif�icult for me.
However, re�lecting back, my Master’s education and clinical placements along with discussions with colleagues and friends helped me overcome this hurdle. Apart from all this, the thing I remember was the wait period for results, that made me go nervous for 4 weeks, till I saw ‘PASSED’! After clearing the theory, I got a job as a limited registered physiotherapist under a supervisor. This work experience helped me a lot in order to prepare for my third and �inal step - The clinical
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
examination. I became aware of the standards of clinical care, safety issues, ethico-legal issues, and clinical skills expected during the exam. My work also gave me the opportunity to put these learned skills into actual practice and integrate into my work style.
APC gave my �irst exam date after 11 months of my application. It took considerable efforts from my side to stay focussed on APC preparation for almost 1 year. It is easy to get lax and procrastinate as it is indeed a long wait period. What worked for me during these 11 months was to take tiny steps towards preparing myself for the practicals. For example, I helped other candidates/friends to prepare for their exams by observing or participating in their mock practices. I slowly developed my own structure for assessment, reasoning and treatment for all three �ields in advance. I kept abreast with all APC exam related topics, courses
About the Author Pinakin holds a Masters degree in Sports and Musculoskeletal Physiotherapy from University of South Australia. He is a certified spine manual therapist and a certified Mulligan practitioner. He worked with Sports Authority of India before he made his transition to Australia. Presently, he is enjoying his work in Melbourne and taking pleasure in playing Badminton. He can be reached at pinakin.godse89@gmail.com
and discussion boards. I function in a way where I like to be hard on myself if I slack off and make a mistake. This helped me keep myself at the top most level.
During an APC practical exam we are expected to take the patient to his/her highest functional level during that session. It is also expected that we show some quantitative improvement in our outcome measures. My habit in the clinic was eye balling measurements which was not very helpful when it came to APC. I had to work on communication, implementing ef�icient outcome measures, learning professional words, and prioritising problems in practice.
Straight from the gut PT Another major thing was to brush up my basics to develop the clinical reasoning. This groundwork maintained my APC mindset throughout that year long wait period. In addition, I had decided to approach these upcoming clinical exams as a professional rather than as a student. Personally, I maintained the attitude to treat the exam patient as a human being requiring Physio help rather than as an exam condition. This helped me to forget about the two examiners, be myself and perform effectively.
I received noti�ication for my neurology exam just 15 days prior to the scheduled date. Those 14 days I was eating, breathing, and living Neuro. There is so much to do and prioritisation was a big task for me. Practicing neuro skills in short assessment format was one of the ideas from my University education that helped me. I started practising part by part of the entire exam session. For example, I �irst practised information collection + hypothesis presentation for few days, then subjective assessment (Ax), followed with addition of objective Ax for different case scenarios. Dividing the Ax’s and treatments furthermore helped to clear presentations of the mock case.This strategy I continued for the remaining two exams too. I started doing mock/whole practise sessions where I could join the quintessential components of part practice. However, quick clinical reasoning took time to
develop. I had to work hard to �it this last piece of jigsaw perfectly, especially for my neuro and cardio exams.
My neuro patient was a 28 year old who sustained traumatic brain injury with a h/o ADHD. It was a challenging case as he was talkative with impaired concentration, and I had to control him without sounding rude. Plus, I had to work harder on changing exercises to incorporate his lack of attention and concentration into the treatment. My hard work paid off and I passed my neuro exam. This boosted my con�idence. Subsequently, I started preparing for Cardiorespiratory exam with more determination. I was criticised by my friends for starting with basic physiology, however, I knew my weakness and I wanted to convert it into my strength.
This helped me to link my objective examination to subjective and then to reason out the most suitable treatment. Due to limited exposure to acute cardiorespiratory setting most of my prep time was spent on learning about management of clinical body attachments used in acute set up by using Thera-tubes, ropes and shoe boxes (Laces). My exam client was one suffering from exacerbation of COPD, whom I treated with mobility and bubble PEP. Got my positive result within a week.
Musculoskeletal (MSK) and sports being my forte, I did not expect this last exam prep to be one of my most challenging ones. To give a
You don’t have to master any subject, but you need to know enough of that subject to tick the boxes and pass the exam. peep in my background, I hold a Master’s degree in MSK and Sports, having a work experience of 3+ years in outpatient and inpatient MSK, sports and orthopaedic conditions. These skills of mine were challenged as a whole different set of skills are required for APC exams. I had developed my quick assessment style, which I had to actually unlearn and then re-learn in a way an entry level physio might perform.
The study period for MSK was like a nervous 90s of the cricket. It was dif�icult not to fall into overcon�idence, or get bored of the changes made in your own style just for the exam sake. Just to give a time frame it had been now 6 months down my �irst exam, and the continuous stress started taking its toll on me. I had to battle professional life, personal life and day to day activities in addition to my studies. Hence, my study plans were always prepared way ahead and kept modifying with my presenting circumstances. My MSK patient presented with chronic OA of his left knee. During exam, my MSK physio mind listed out multiple things to do with this client, but it took lot of efforts to hold back the horses, and push in the APC exam routine, just for
selecting the right treatment option. I �inally chose a combination of manual therapy and exercise program as my treatment plan. Alas, I received my happy result within 2 days. This was one of the best days of my life. I passed my all APC examinations in �irst attempt with YES in all criteria. My efforts and prayers were answered in the sweetest manner possible. Now that I look back, practice, practice, practice in every other possible way is what I see.
Also to provide a timeline, despite the hardships I faced, I have done at least 1 mock per day with my partner or friends (50 min of patient time + 50 min of discussion) after I received my each exam date. To sum it up, I must have mock treated 20 neuro patients, 40 cardiorespiratory and 40 MSK patients in APC simulated environment. The mock practices were exhausting and used to drain me out mentally and physically, but as you know “success knows no excuses’’.
To sum up, I can just say you don’t have to master any subject, but you need to know enough of that subject to tick the boxes and pass the examination. Apply the “KISS” principle ‘Keep It Simple Silly’. I would call this journey as a test of determination and perseverance. The one where I enjoyed the process as much as the destination. Now after few stress free and relaxing week’s post-APC exams, I am all set to conquer a new challenge.
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Feature Article
Adrenal Fatigue Are we really listening to our bodies?
Stress seems to be the root cause of all evil these days. Whether you have Diabetes, Weight gain, Blood pressure or Depression every health specialist’s advice to you will be to �irst decrease your stress levels. If stress isn’t a measurable quantity, how can one suf�iciently get rid of it? How do we measure Stress and how do we decrease it? The �irst step to treating Stress is telling a patient to “listen” to what their bodies are telling them. Our bodies are talking to us. Are we all really listening? The Beginning: List of questions we should ask ourselves if we consider ourselves stressed?
2) HP: “Do you have decreased Tolerance with people?” Patient: “Lately people seem a lot more irritating to me than they used to!”
3) HP: “Continued fatigue that is not relieved by sleep?” Patient 1: “I feel I sleep like a log but I don’t get up refreshed.” Patient 2: “ I have a poor sleep pattern. Sleep is disturbed several times in the night or I sleep only 2 or 3 hours.” 4) HP: “Do you crave for Ruf�le Lays or Potato chips/Banana chips, French fries?” Patient: “I try to stay away but its hard. No one can eat just one!”
5) HP: “Do you suffer from lack of energy?” Patient 1: “Everything I used to enjoy doing also feels like a 1) HP*: “Do you have Herculean task!” dif�iculty getting up in the Patient 2: “I do everything mornings?” without complaining and more! Patient: “Hitting the I don’t feel I suffer from lack of snooze button every energy. But on days when I am morning and staying in bed feeling low, my family members long after? Yes!” dare not cross my path!” * HP: Health Practiotioner
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Feature Article PT 6) HP: “How about your ability to handle stress?”
Patient 1: “I was a star at handling Stress 10 years ago. Now I yell at my kids even if they are talking nicely to me. I get anxious at the smallest of situations I come across in life. I think I’m going crazy.”
Patient 2: “I cannot get myself to fall asleep quickly. My head is pacing with things to do next day and what I should have done today.” 7) HP: “What about your sex drive?”
Patient: “Are you joking? I am so fatigued at the end of the day that sex is the last thing on my mind. I’m so tired, sometimes I cannot sleep either!” 8) HP: “Any other symptoms?”
Multiple Patients: “I feel dizzy/ light headed when I get up from the bed or chair. Sometimes I have a pounding heart and also experience shakiness and trembling internally.” OR “I feel so low sometimes I wonder why bother – life is pointless.” OR “Nothing seems fun to me anymore work/ relationships aren’t that satisfying to me.” OR “My thoughts are very fuzzy, I feel I am less focussed and I �ind it increasingly harder to make decisions. My memory is also less accurate lately. I also have frequent low blood sugar situations.” If you can relate to two or more of the above situations, you are already a victim of Adrenal fatigue.
THE MIDDLE: Let’s brie�ly talk about Stress before we move on to Adrenal fatigue.
Stressors (Stress causing agents) are encountered in the form of noise pollutants, chemical pollutants, unpaid bills, bad relationships, improper nutrition/ poor eating times, family tensions, �inancial problems, occupational issues – name it and you have a stressor right at the heart of it! What most of us do not realise is that Stress is good. The release of stress hormones by the body is the body’s way of telling you that it is capable of handling whatever the situation demands of it.
What really is Adrenal fatigue then? And what does one mean when they say they are “Stressed”? Stress also known as Primary Adrenal fatigue is not a medical emergency and is not recognised by modern medicine as a distinct syndrome. Adrenal fatigue is a dysfunction of the adrenal glands that normally secrete precise amounts of steroid hormones - namely Cortisol. In Adrenal fatigue, Cortisol is either produced in low amounts throughout the day, or high amounts throughout the day or mixed high-low amounts throughout the day. So when a person says he is “stressed”– His Adrenal glands are no longer in a position to help him deal with the stressors he encounters.
The first step to treating Stress is telling a patient to “listen” to what their bodies are telling them. His Adrenal glands are either:
• Underfunctioning while secreting Low Cortisol OR • Are burned out due to overwork in an attempt to secrete excess Cortisol as a response to stress OR • Are secreting disproportionate levels of Cortisol hormone throughout the day (mixed highs and lows) Why should patients suffering from Thyroid disorders detect Adrenal fatigue early?
Cortisol issues can block conversion of the T4 hormone to T3, besides closing the door to cell reception of thyroid hormones due to low cellular levels of glucose with low cortisol. If Cortisol levels are optimal, cellular glucose levels improve and thyroid hormone will reach every cell in the body adequately. It is therefore imperative that patients on Thyroid medications address their dysfunctional Cortisol levels �irst before supplementing with the correct thyroid medication dosage. No wonder so many patients on Thyroid medications still struggle with weight loss, hair loss, hair thinning, constipation and body aches. Their dysfunctional Cortisol levels are coming in the way of reaching optimal Thyroid function through medication!
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Feature Article
However, it is noteworthy that dysfunctional Cortisol levels can also lead to a myriad of other notable symptoms like High Estrogen levels (Estrogen dominance which is often linked to PCOD), IBS symptoms, Worsening allergies, Scalp ache, Super sensitive skin, In�lammation that doesn’t go away, Headaches (common with many), All over the body ache, Irrational fear, Highly defensive behaviour, No patience, Over reactive behaviour, Motion sickness, Low back pain, Cloud �illed head – feeling dull, Frequent urination, Dark circles under eyes...... The list goes on! If we can identify early the above �irst true indicators of Stress, we can all avoid potential major health issues like Diabetes, Hypertension and High Cholesterol as well.
The End:Ways to Treating your Adrenal dysfunction:
2) Sleeping and rest:
The human body has a natural rhythm where the Cortisol levels are highest in the morning to help you wake up and lowest in the late evening to help you fall asleep. Having caffeine in the morning will only make you jittery especially if you have very high Cortisol levels in the morning. Similarly exercising closer to bed time will increase your Cortisol levels and make it dif�icult for you to fall asleep. The worst thing you could also do to your adrenals over time is ignore your body’s strong hints in the evening to go to bed. If your body is telling you to go to bed by 10 PM, all you have to do is listen! 3) Eating frequent small meals with wise food choices:
1) Laughing and enjoying your life:
Your attitude towards your life can play a unique role in the continued health of your adrenals. A simple activity like laughing can stimulate the adrenal glands in a positive way by increasing the parasympathetic supply to the adrenals.
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Avoiding foods cooked in re�ined oil, packaged/ manufactured foods is the �irst step to make smart food choices to help your adrenals recover. Raw foods give us the most natural form of vitamins and minerals, �iber and phytonutrients. Excess sugar, simple carbohydrates and caffeine will cause your adrenals to react, lead to insulin resistance due
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to excess insulin, and hence stress your adrenals further. Choose several small meals to keep blood sugar levels steady and add good protein to each meal. This will decrease the stress on your adrenals.
4) Keep exercise bene�icial rather than over stimulating:
The more intense an exercise routine, the more taxing it is on the adrenals - i.e.: Cortisol is needed and released in proportion to the intensity of the exercise routine. And if one has an existing Adrenal dysfunction, the adrenals are under a lot of demand. Thus light exercise can be more essential in times of stress. 5) Avoid alcohol: Unfortunately, the very substance one may want to grab to cope with stress is actually the most toxic thing you can do to your adrenals. Alcohol signals the adrenals to produce even more cortisol but also ends up also severely raising the Adrenaline levels. 6) Addressing Cortisol levels through Oral supplementation: Over the counter support
is available in the form of herbs and supplements on the market. However, it is advisable to get Cortisol levels checked through appropriate tests
before seeking advice for altering Cortisol levels. Remember to take a specialist’s advice in this matter. Remember that symptoms of High Cortisol mimic the symptoms of Low Cortisol. Guessing what is going on has got patients in trouble! Don’t guess!
Rejuvenation of our adrenals, once fatigued, can take time and patience, as well as particular lifestyle changes away from stress, and in the way we deal with stress. It can be slow, but the progress will be there! Once truly stress free, it is easier to consider weight loss. For more information on how to treat your Cortisol dysfunction and related Hypothyroidism, you can contact the author at
diana.j.pinto@gmail.com References: 1) Adrenal fatigue: Website: http://adrenalfatigue.org 2) Adrenal Reset: Eliminate Chronic Fatigue, Stress and Excess Belly Fat Forever by Following the Adrenal Fatigue Diet (Hormone Balance, Stress Relief, Weight Loss, and Energy) - By Danyale Lebon 3) Adrenal Fatigue: Cure It Naturally – By Carmen Reeves
Diana Pinto
BPTh (India), MS Biokinesiology (USA), Specialist in Sports Performance Nutrition (USA), Specialist in Personal training (USA), Dry needling Practitioner. diana.j.pinto@gmail.com
Co-author: Barira Qureshi
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Quintessential
Costing in
Dr. Ganesh Chandran BPTh (SGSMC and KEMH), MHA (TISS), Cert in business accounting (CIMA,UK) Thane, Maharashtra
Physiotherapy THE FUNDAMENTAL PRINCIPLES
Cost in very simple terms can be de�ined as the amount which has to be paid to obtain something. It can be considered as the summation of monetary value of time and effort invested, materials and resources consumed, risks incurred and opportunities foregone to obtain something. But then what is price? Many people fail to appreciate the subtle distinction between cost and price. Price is also the monetary value to obtain some product or some service. Whereas cost is the term used from producers’ perspective, price is the term which is based on consumers’ perspective. And the relationship between cost and price can be expressed as: Price = Cost + X (where x can be pro�it or loss depending on various economic factors) Now, I will elaborate on the idea of costing in physiotherapy. Many of us are doing a wonderful job of treating patients but my belief is that we hardly think about the costs that go into offering the treatment to our patients.
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obtained from other centres. Hence if the larger centre ends up pricing their service lower, if you are a market player you will also have to lower your price. But there is a certain limit beyond which lowering the prices would be counter productive. Knowledge of costing will certainly help in deciding the lower boundary of our prices in order to sustain the practice.
Even if we do so, because of lack of familiarity with respect to costing we end up using market based pricing models. I don’t deny the pragmatism of market based pricing without having to undergo the hassles of costing exercise. But, the �inancial control that can be obtained from a costing exercise remains unparalled. Just to give an example, suppose in a given month your clinic doesn’t generate expected revenues, how will
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you control the cost? At the sametime there are pitfalls of following market based pricing blindly. Suppose you have one of the branches of a large corporate multi-centre physiotherapy clinic and you are a one-centre physiotherapy clinic. Both are primarily targeting the market of OPD patients requiring musculoskeletal physiotherapy. The large chain has got different set of strategic advantages. They can offset the losses from one centre by the pro�its
Cost is divided into two types. One is accounting cost and the second one is economic cost. In this article we will discuss accounting cost only. In order to understand accounting cost, we will have to further look into certain other costing terms. These include:
1. Fixed cost: In economics, �ixed costs are de�ined as those costs which don’t change with the rate of change of production. For example, a machine used for producing toys is a �ixed cost. Whether I produce one toy or hundred toys, the cost of the machine has to be paid. This cost is deducted from the accounting books of the organisation every year under the heading
www.medilabindia.com of `depreciation`. For example, a physiotherapy centre purchases a SWD machine costing Rs. 12000 and the expected life of that machine is 6 years. Hence the depreciation on that machine would be 2000/year. Now whether 100 patients are treated in a year or whether no patient is treated, 2000 Rs has to be accounted for. Of course the machine might work beyond 6 years or it might break down within 6 years, but for the sake of simplicity we have considered the above argument. In this case �ixed cost of the machine is Rs. 2000/year.
�ixed salary and incentive per patient, that becomes a semi variable cost.
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4. Direct Cost: The cost that can be directly attributable to a cost centre is called a direct cost. For example in a physiotherapy centre, the physiotherapist is directly involved in the service delivery of a particular patient. Hence the cost incurred by the physiotherapist becomes direct cost for the patient.
5. Indirect Cost: The costs which cannot be attributed to any particular cost centres are called as indirect cost. To give an example, the administrative department working in physiotherapy centre. They 2. Variable cost: This is are not involved in provision de�ined as that cost of of care but still they are production which changes important for smooth with the rate of change of functioning of the clinic. Their production. Suppose you are cost cannot be charged from paying your employees on any one patient, but it has to the basis of number of be allocated to all the patients patients that they see in a who visit the centre. month and the payment is 100 Rs/patient. In a given 6. Depreciation: As discussed month if they see 50 above, it is a form of �ixed cost. patients, you will have to pay Generally, the purchase cost of them 5000 Rs. and if they a machine is not charged in a see 100 patients you will single accounting year but is have to pay them 10000 RS. distributed throughout the Unlike �ixed cost of the working life of the machine. machine, the cost of employ- This is called as depreciation ing a physiotherapist is and is calculated as purchase variable; it will change on cost divided by estimated the number of patients that working life of the machine. visit the clinic. The rationale behind calculat3. Semi Variable Cost: ing depreciation is that the Certain costs have both �ixed cost of replacing a machine is component as well as a also included in our total cost, variable component. For so that once the useful life of a example electricity bill. machine is over, we can Every month you pay a readily replace the same as we certain �ixed cost and have accounted for its cost. depending on your usage With this basic understanding, you pay the variable cost. Or we will move forward to else if you are paying your perform a simple cost exercise physiotherapist a certain of a physiotherapy clinic.
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Quintessential
Suppose there is a physiotherapist in Dadar paying a rent of Rs. 22000/month. He pays Rs 10000 as �ixed salary to his physiotherapist and further pays her Rs.100/patient. He also pays his receptionist Rs. 12000/ month. He pays electricity bill on an average of Rs 1500/month. Further he has the following equipments in his clinic. Name of Equipment
Purchase Value in Rs.
A Ultrasound Rs. 17000 SWD Rs. 30000 Multistimulator Rs. 10000 Portable stimulator Rs. 2500 Laser Rs. 70000 Thera band full set Rs. 3600 Weight cuffs Rs. 9000 Dumb bells Rs. 40000 Treatment table Rs. 7500 Stepper Rs. 3000 Wall Mirror Rs. 5000
Useful Life (in Yrs)
UL 5 Yrs 6 Yrs 10 Yrs 5 Yrs 7 Yrs 10 Yrs 15 Yrs 50 Yrs 15 Yrs 10 Yrs 30 Yrs
Depreciation Depreciation (Amt/Life) per Month per Year rounded off.
DY=A/UL 3400 Rs. 5000 Rs. 1000 Rs. 500 Rs. 10000 Rs. 360 Rs. 600 Rs. 800 Rs. 500 Rs. 300 Rs. 167 Rs.
Total Monthly Depreciation
DM=DY/12
283 Rs. 417 Rs. 83 Rs. 42 Rs. 833 Rs. 30 Rs. 50 Rs. 67 Rs. 42 Rs. 25 Rs. 14 Rs.
1886 Rs.
He gets 300 patients on a monthly basis out of which 100 are new and 200 are follow up cases. He charges rupees 500 for each new patient and 300 for old patients. He has to decide about the cost incurred per patient and whether his pricing is pro�itable or not. Let us differentiate the different costs/ month. 1. FIXED COSTS
1. Rent of the Clinic 2. Physiotherapists Salary 3. Receptionist Salary 4. Electricity 5. Depreciation on equipments 2. VARIABLE COSTS
– Rs. 22000 – Rs. 10000 – Rs. 12000 – Rs. 1500 – Rs. 1886
Total �ixed cost per month = 47386/month
Variable part of physiotherapists salary = 100*150=15000 (50% cases are seen by him and 50% by the employed physio) Total variable cost per month = 15000/month Total cost in a month = Total �ixed cost + Total variable cost= 47386+15000=62386/month Hence, cost per patient is 62386/number of patients =62386/300=208 Rs/patient. (Rounded off)
Variable cost per unit = Total variable cost /number of patients=15000/300=50/patient (5000 towards new patients and 10000 towards old patients).
Though the variable cost is incurred by only 50% of the patients, we need to distribute it equally among all patients.
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Now we come to a very important concept derived from the above, which is called as contributory margin. Contributory margin (CM) is de�ined as the price minus the variable cost per unit. In the above example contributory margin per patient would be 500-50 = 450/patient, for new patients and 300-50 = 250/patient for follow up cases. This money is then allocated towards �ixed cost and pro�its if any.
Now, in the given scenario if the physiotherapist prices his services at Rs 500 and 300 respectively then how many patients should come to his clinic so that he breaks even i.e. covers his �ixed cost as well as variable cost without any pro�it. This is given by dividing total �ixed cost by contributory margin. That is 47386/450=106 new patients (rounded off to the next number).
Now with 106 new patients, variable cost is 5300 (employed physiotherapist sees 50% cases, hence 53*100) and �ixed cost is 47836, hence total cost is rupees 52,686. If the price per patient is Rs 500, he will earn 53000 (500*106). Thus the physiotherapist recovers all his cost completely, remaining cases whether old or new cases will add to his pro�its. Thus costing is useful both ways. If the average number of patients is known then the appropriate price can be determined or else if the price has to be �ixed then the average
number of patients that have to be treated in order to cover all the costs can be determined.
Now, there is a valid concern that the number of patients is a very unpredictable variable in the whole scheme of things. But the accuracy of the exercise can be improved by taking long term averages and making estimated guess works. The costing exercise can also be a very useful starting point for those physiotherapists who are starting their careers and are confused about the prices to be charged. They can use this method to arrive at a price point for their services. India is currently facing a double burden of diseases wherein there is not only a spike in communicable diseases but also in noncommunicable diseases. And the proportion of geriatric population is also increasing steadily. I believe that the demand for physiotherapists is going to witness a huge rise. This will also attract a lot of investment into the �ield and as conventional medicine has shifted from a physician driven practise to corporate hospitals, rehabilitation will also witness a similar curve. Hence, physiotherapists should equip themselves with the requisite business skills to �lourish in the upcoming wave.
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Reportage
Marketing Mantra
A Nationwide Series of Awareness Seminars for Physios on “Marketing in Physiotherapy” We all know that Coca-Cola is a global leader in the beverage industry, yet it had spent a whopping $3.5 billion in 2014 on its advertising, which accounted for 6.9% of its total revenue.
Coca-Cola's yearly advertising spending has steadily increased over the last 15 years. Spending jumped from $1.7 billion in 2000 to $2.5 billion in 2005 and $2.9 billion in 2010. Coca-Cola is expected to increase its advertising budget by another $1 billion by 2016.
So why do even a brand leader need such heavy promotions? This large advertising spending has allowed Coca-Cola to gain a competitive advantage in key areas such as new product introduction, increasing brand awareness and brand equity among consumers, increasing the knowledge and education of consumers, and increase overall sales.
Would you want that to happen to you? The Moment you step out of the institution and start clinical practice, you cease to be a Physiotherapist alone. Now you are a professional, an integral part of the multi-disciplinary health care Wondering what has Coca management team and more Cola’s ad spend got to do with importantly, a businessman physiotherapy? Well this is too. true of us physiotherapists too. In the highly competitive, A whole new world with unorganized and unregulated endless possibilities is in front of you. But is your degree and physio practice scenario in quali�ication enough to get India, unless you are well you the desired success in the equipped with robust cluttered marketplace? Then armamentarium to �ight the why do some physiotherapists challenges of running a prosper while others struggle successful practice, you will even though they are equally end up being just another good at their clinical skills? face in the crowd. A run-ofthe-mill physio.
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
THE DIFFERENCE LIES IN HOW THEY MARKET THEMSELVES. YES!! Marketing is unavoidable. You need to let the world know who you are, what you are good at, where your service is available, when and how you can be reached. If you don't do any of these, you are not likely to get patients automatically. Physiotherapy service provision is changing. Physiotherapists need to raise their pro�ile and demonstrate their value. Watching these changes happen around you is not an option. All physiotherapists need to be proactive in promoting their service.
PHYSIOTIMES has taken the �irst step to help the Physiotherapists of India explore this often neglected, less understood & unexplored domain “Marketing for Physiotherapists - A journey from Clinical Practice to Professional Growth” through a series of nationwide seminars under the name “MARKETING MANTRA”
OUR OBJECTIVE: To reciprocate the love and support received by PHYSIOTIMES in the last seven years from physiotherapists of India and contribute positively towards their professional development.
Reportage PT
“
OUR MISSION: To help physiotherapists of India combine their clinical skills with marketing acumen to create their own space & practice with dignity in this ever evolving world of private health practice.
WHAT TOPICS ARE COVERED Need & rationale for marketing in physiotherapy
ABOUT THE SPEAKER: Mukesh Nayak, B.E. (I.C.), M.B.A. (Marketing) - Director, PHYSIOTIMES Mr. Mukesh Nayak is an
engineering graduate with an Three C’s of Success Clinical Expertise, Commer- MBA in marketing. He has an cial Skills, Customer Service extensive experience of over 17
Power of a dream and the process of Goal Setting Time Management and making luck work in your favour
years in varied �ields including direct sales, market research, pharmaceutical brand management, visual communication, advertising & publication.
Innovative Marketing Strategies to promote your clinic and services Professional Advocacy Increasing physiotherapy awareness
Creating Customer Loyalty & Leveraging Relationships Expanding your practice scope and exploring newer areas of practice Managing your practice using effective tools & technology (Mobile, Social Media etc.) Burning issues in Physiotherapy and How do we tackle them?
WHO CAN ATTEND:
Glimpses of the Marketing Mantra Seminar held in Rajkot at R. K. University on 25th Sept, 2016
Any one right from the 1st year to 4th Year BPT Students, Interns, MPTs, and Practicing physios, Private Practitioners, Clinicians, Academicians, Faculties etc.
He is also the brain behind the launch of PHYSIOTIMES & a sought after speaker. He has delivered several lectures across national & International forums and conducted workshops on areas like marketing and lateral thinking for management & physiotherapy students and professionals.
He is on a mission to contribute to the positive development of the physiotherapists of India and add value to their professional
careers through this program.
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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PT
Reportage
Is Marketing Mantra only about marketing of physiotherapy or there is more to it? "There are those who look at things the way they are, and ask why... I dream of things that never were, and ask why not?" This is what Walt Disney must have thought before conceptualizing Disneyland. This is what Steve Jobs must have sensed before making Apple a synonym for innovations. This is what Mark Zuckerberg must have visualized before rede�ining how the world socializes through Facebook.
Well! History is replete with examples of individuals and organizations that have challenged the equilibrium, de�ied the norms, dared the archetype, subverted the paradigm and questioned the status quo. From Google to Amazon,from Narayan Murthy to Dhirubhai Ambani, the list is countless...It was their unrelenting commitment towards CHASING THEIR DREAM... YES....This one step - HAVING A DREAM & CHASING IT CHANGES EVERYTHING. Be it constructing the great pyramids or India’s mission on Mars; If you can DREAM IT, you can do it. Remember, the world makes way for the man who knows where he is going. But what has all this got to do with physiotherapy and why does it matter to us??
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The very essence of the above thought is perhaps the �irst requisite for a physiotherapist in today's time, especially in India. A change in the mindset. The way we have conditioned our minds to think has been the only factor limiting us from achieving our true potential. The horizon of possibilities in physiotherapy is much wider than what we have envisaged.
Be it the ambiguity over the use of "Dr" title by physios or the lack of a central council, be it the non-uniform pay scales or absence of standard curriculum, we have been inundated with the "DONT'S" more than the "DOS" in the �ield today. What physios need the most Marketing Mantra Seminar held at Shri B G Patel is a positive attitude to stay College of Physiotherapy, Anand on 22nd Oct’16 motivated & united more than anything else, despite the challenges we may be facing as a profession. The horizon of possibilities in physiotherapy is much wider than what we have envisaged. Physiotherapists have been bestowed upon with the ability to make a positive difference in the lives of people using their healing hands and therapeutic skills. In their roles, physiotherapy professionals have an opportunity to make a signi�icant contribution to improving the health of the communities they serve. The time is certainly exciting for physiotherapy as a profession.
It is painful that a few people with a myopic view point have a rather deleterious opinion about the �ield of physiotherapy and its scope.
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
“Marketing Mantra” is an attempt to collectively ponder over the pressing issues confronting the profession of physiotherapy presently and the plausible solutions. But before learning the rules of the game, a change in the mindset and coming out of our shell is the need of the hour.
As Winston Churchill has said “Success is not �inal, failure is not fatal: it is the courage to continue that counts.” When you stop saying "I WISH" and start saying "I WILL", the world around you changes for better, because you are never given a wish, without also being given the power to make it true. There is no chance, no destiny, no fate, that can outwit, hinder or control, the �irm resolve of a determined individual. We sincerely hope and wish that physiotherapy professionals realize this power, to make a difference to themselves, the physio fraternity and the society at large. Remember, No dream is too big to come true...IF YOU HAVE THE RESOLVE TO CHASE IT.
Reportage PT
The Program Was Sponsored By AM Waves Wellness (PEMF Combination Therapy Device - Future of Physiotherapy)
@Navsari on 23rd Oct in Association with Navsari Physio Network
“Marketing Mantra” is an attempt to collectively ponder over the pressing issues confronting the profession of physiotherapy presently & exploring the plausible solutions with an open mind.
Upcoming Programs November 2016 Guwahati - 11 Nov Kolkata - 13 Nov Ranchi - 14 Nov Patna - 15 Nov Lucknow - 16 Nov December 2016 Pune - 3 & 4 Dec Indore - 17 Dec Bhopal - 18 Dec January 2017 New Delhi - 8 Jan Coming Soon Chennai, Madurai, Coimbatore, Pondicherry, Bangalore, Mangalore, Hubli, Hyderabad, Amravati, Mumbai, Nagpur, Amritsar, Srinagar, Chandigarh, Rohtak, Jaipur, Udaipur, Jodhpur, Kota, Raipur, Dehradun, Ahmedabad, Baroda, Bhubaneshwar, Trivandrum, Cochin, Calicut
Note: This is a 4 Hours Seminar (generally on weekends) and FEES may vary from place to place. It is FREE for colleges. At other places there may be a nominal fees ranging from Rs.100 to 500 Rs.
@Surat on 23rd Oct in Association with AM Waves Wellness
You can pre-register your name for your CITY if you wish to attend by whatsapp on 8141585752, so we can let you know when we conduct the program there. For more updates join us on Facebook www.facebook.com /physiotimes
Follow us on Twitter twitter.com/GETPHYSIOTIMES For More Details: Whatsapp: 8141585752
P.S.: To organise this seminar in your city, college or institute you can email us on: contact@physiotimes.com PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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PT
Spotlight
SELFIE ELBOW
Yet Another tech-induced ailment
Jasrah Javed Final Year BPT, Amity University, Uttar Pradesh
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Spotlight PT ‘CLICKING ELBOW’ or commonly called as ‘SELFIE ELBOW’, is a modern techinduced ailment which is affecting a lot of sel�ie lovers these days. People who do not have any sports background or record of being indulged in a sport like tennis or golf which requires repeated use of extended arm and repetitive jerk on the elbow are having problems which resembles the symptoms of the same. Each time you click a picture, you put yourself in a position where your arm is fully extended, or sometimes the elbow is a little bent and the position is maintained until you get the picture of your choice and you are keeping a �irm grip on your phone to keep holding it and to hit a click just when you get that ‘right frame’. It can be counted as one of the repetitive strain injuries. So taking correct sel�ies has now become a pain in the elbow!
You may �ind this topic rarely discussed anywhere, but unknowingly, ‘clicking elbow’ has become a real matter of concern now. WHAT DOES MEDIA SAY ABOUT ‘SELFIE ELBOW’?
Recently, the award winning US journalist and co-host of the NBC’s Today Hoda Kotb, who is famous for her social media picture sharing on Instagram has been diagnosed with a condition of ‘sel�ie elbow’, told by the ‘Elle’ magazine. However, the condition is not so commonly spread till now but the chances are there for a speedy travel of this technology based disorder throughout the world.
‘The Times of India’ highlights in a news report that the doctors in Kolkata were perplexed when youngsters were coming to them with a complaint of constant pain in the elbow region radiating to forearm. Other report talks about a 25 year old model from Mumbai, Manoj Desai who realized that he is losing his grip while workout at gym and 23 year old Natasha D’cunha from Dadar who encountered pain in her shoulder every time she raised her arm for a “group�ie” (a group sel�ie). A CLOSER LOOK AT THE CONDITION
‘Sel�ie elbow’- the name suggests damage to the elbow joint, but the scenario is a little different. There are two other joints which also gets involved along with the elbow, the shoulder joint and the wrist joint simultaneously helping the hand to attain a “pout perfect picture”.
Most of the strain is caused to the elbow. This is because you extend your elbow in an extremely strained position. Or sometimes you keep it a bit �lexed. The posture causes repetitive strain and overuse of the surrounding structures at the elbow which is the target joint. Most of the work is done by elbow in this position but a grip maintained at the hand holding the phone is worsening the condition. Due to repetitive motion, there are micro-ruptures around the elbow and the tendon running through the elbow joint is in�lamed causing pain and discomfort. The condition may not necessarily be an acute injury to the tendon but this may also be a degenerative changes that has been occur-
Apart from the elbow, two other joints also get involved, the shoulder joint and the wrist joint simultaneously helping the hand to attain a “pout perfect picture”. ring around the structures of the elbow not only because of your habit of clicking sel�ies but it may also be any type of repeated movement you are performing at your home while cooking or gardening or playing tennis or golf.
Hence, this may be a re-occurrence of a condition that was unknowingly persisting in your body. There can be swelling observed around the elbow joint’s extensor origin as well, because most of the work in this position is carried out by the extensor compartment of the muscles in the elbow and the strain is caused to the tendinous muscle attachments. Once the condition has occurred, minimum amount of load or work carried out by the elbow will cause a lot of pain, this is because the muscles of the elbow has already weakened. And the damage has already taken place which has yet not been cured.
Eventually, there occurs a loss of function. Physiotherapists observe that there is a C6 - C7 myotomal pattern which is followed.
As a physiotherapist we play an essential part in treating the condition and helping the person to recover. We can help them gain their muscle strength and reduce the damage that has occurred to the body of the person. Also we play an important role in spreading awareness among our family members, peer group, colleagues about what damage is occurring to their body unknowingly.
It is also important for us to be aware of the condition and to know what can be the possible ways to treat this ailment. As the condition is a modern day technology induced problem, it also becomes our responsibility to keep a check on it, because the use of technology has increased way too much in our day to day lives.
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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Spotlight Being a health care professional we can put a halt at the speedy transmission of selfie elbow before it becomes an epidemic.
w wwww.sparsh4.comcom w.sp ars h 4.
SYMPTOMS OF THE SELFIE ELBOW:
Enhance your Clinic's Professional Ambience Today!!
Once the pain subsides strengthening exercises are followed. Strengthen the There is burning pain around weakened muscles around the elbow joint. the elbow and wrist joints. Pain is observed while Add resistance in the form of performing actions at elbow weight cuffs, dumbbells, and wrist therabands, and medicine There is limitation of motions balls. Hydrotherapy can also be an effective method. at elbow, shoulder and wrist Stiffness in the arm (more in morning) Muscle fatigue
HOW TO GET RID OF THE CONDITION?
RICE : Rest is given to the affected arm. Person is asked to avoid clicking a lot of sel�ies, Use a sel�ie stick (not too much), use both hands while holding your phone during a click, or switch hands to avoid overuse. Ice is advised to reduce in�lammatory symptoms in the area. Ice is only prescribed when there is a visible and palpable swelling around the area. But as I mentioned the condition may be a chronic one as well, there, ice won’t work. So here, it becomes the priority to diagnose �irst, whether the condition is an acute or a chronic one. EXERCISES:
The person is asked to perform full range active movement of the elbow and wrist with mild stretches.
40
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USE OF BRACES AND SUPPORT:
Use of elbow caps can be prescribed by the physiotherapist to support the elbow joint while in pain. But as there may be considerable weakening of the muscles due to unnecessary use, support should be removed as soon as the condition gets better.
Knee Joint Skull
Foot Joint
By knowing more about sel�ie elbow, we can think of appropriate measures that can be taken to help people get rid of the problem, and spread awareness among those who are at verge of getting into trouble. A troublesome arm may limit the abilities of an individual to perform day to day life activities. The disease is persisting amongst us and being a health care professional we can put a halt at the speedy transmission of sel�ie elbow before it becomes an epidemic.
PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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PT
They said it
WORLD PHYSIOTHERAPY DAY CELEBRATIONS ACROSS INDIA APPTA celebrates with Orphan Children
Sept 8, 2016
Telangana celebrates in Unique style
APPTA (Andhra Pradesh Physical Therapists Association) would like to share the World PT day event which we have done at New Capital Amaravathi Region. On that day we have arranged Health screening to "CHIGURU" Orphanage children, with a team of Physiotherapists, Pediatricians and Dentists, examined all the children and provided the necessary medical care. We have ended the program by providing lunch to the children. Dr. Venugopal Kadiyala, APPTA Coordinator
Telangana physiotherapists from all over the state gathered at Hyderabad to mark World Physiotherapy Day n motto of bringing awareness among general public & emphasizing the role of Physiotherapy in health care. A bike rally was conducted to address the needs of physiotherapists in the state & formation of state physiotherapy council. Dhronacharya P. Gopichand �laged off and started the bike rally. In the evening a grand event was planned to show the spirit of United telangana physios & felicitation of pioneers in the �ield like Dr. Kiran Challagundla (Physio - P.V SINDHU), Dr. Konda Vishweshwar Rao, M.P., Chevella constituency, Telangana & Chief Guest for the event. The Academicians and clinicians were presented with physio excellence award for their contribution towards the �ield.
Dr. Jarapla Srinivas Nayak, Hyderabad
Constitution of Human Body On this World Physiotherapy Day we released Constitution of Human body.
In present scenario the human body which constitutes of many systems wants to safeguard itself & �ind a health professional for its salvation. It demands itself to be pain free and mobility free and wants a Revolutionised and Trans�igured life. It Say's these are my basic rights. Hence it visits several health professional. It calls upon a dentist - who could mend only teeth. It checked out with an orthopaedician - who could help out only with Bones and joints. It pushed into a surgeon to �ind he can only repair disease parts. It visited upon a neurologist and found he could do away only with brain and nerves. It �inally popped up on a Physio. Amazing !...It found physios could Mend your nerves, Fix your bones, Ease your muscles, Alleviate your pain, Restore your movements, Set right your posture, Make you �it & freak.
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Dr.M.SENTHILKUMAR (PT), Salem, Tamilnadu.
They said it PT Free Camp at Samastipur, Bihar
A mega free camp was organized at Relief point physiotherapy and acupuncture clinic, Samastipur. The camp was inaugurated together by famous ortho surgeon Dr. M. K. Ajay, well known physiotherapist Dr.V.P.Nirmal (P.T) and known physician Dr.Ajit Kumar. On this occasion there was free consultation of orthopaedic surgeon, physician, physiotherapist and free blood sugar, blood pressure, serum uric acid test. Around 100 patients got bene�ited by this free camp.
Poster Exhibition at Baroda, Gujarat Dr. Snehal Shah and Heena Shah, Aashray Physiotherapy Centre, Baroda had organized an unique poster exhibition showing outline of past-present and future of physiotherapy profession. It was an exhibition highlighting 25 different posters with write up and images about the history of physiotherapy, evolution, present scopes of its role in different �ields and future prospects in terms of technology and techniques. History was taken from internet, other literatures, by interviewing senior people in the �ield and guidance from celebrities in the �ield. Exhibition also included shining stars from Baroda physiotherapy college, mentors of the �ields and role of physio in day to day life. Over 300+ people have visited the exhibition including physios, doctors, local politicians, patients and print and TV media people and all took great note of our great profession.
Dr.V.P.Nirmal (P.T) Samastipur, Bihar
Fitness Awareness Program in Madurai
We organised an awareness programme on the topic "Understanding �itness & self treatment" for the �itness centre members and our patients on behalf of our clinic in our network �itness centre where our chief physical therapist Dr. Muthupandi kumar M.P.T., is a consultant. Nearly 30 members both from �itness centre and clinic actively participated and expressed their thanks for organising this programme. Team Aayush, Dr. R. Muthupandikumar, Madurai
Diagnosis & PT Awareness Camp by Dr. Raj Kumar Barodiya at Nagaur, Raj.
Coverage in Electronic Media at Ahmedabad Interview of Mr. Mukesh Nayak, Director, PHYSIOTIMES on GTPL CHANNEL - GUJARAT NEWS "DAY SPECIAL" Program on 8th Sept'2016 along with Dr. Bhavna Gadhavi, Principal, Ahmedabad Institute of Medical Science (AIMS), Ahmedabad on spreading awareness about the role of PHYSIOTHERAPY in the SOCIETY on the occasion of the World Physiotherapy Day 2016. Full video is available on www.youtube.com
Celebrations in Chennai Ameer Physio Care Clinic and Alaq Rehabilitation Research Institute celebrated physiotherapy day on sep 08 2016. With Dr Kiran Chellagundla PT, the Indian badminton team physiotherapist in Chennai. Also by publishing article by Dr. Mohammed Ameer Hussain PT, in Dinamala newspaper (Tamilnadu state, India ) on 8th Sep 2016 and on 14th Sep 2016 about spinal cord injury and Dr. I Mohammed Ameer Hussain, physiotherapy. Chennai
Free Physiotherapy Camp, Motihari, Bihar
Dr. Gopal Kumar Singh, Director, Gautam Buddha Physiotherapy & Pain Management Clinic, Motihari, Bihar PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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BOOK REVIEW Sociology for Physiotherapists
Author
Purnima Khanna Being healthy is not simply ‘absence of disease’- it is also important to be mentally healthy, have positive relationships and ful�ill the social roles and functions in society. This book discusses the social and cultural factors which impact health, the importance of healthy socialization and the role of family
Co-contributor
Dr. Mehul Jadhav and other agencies in health of an individual. The book further throws light on the various social problems plaguing our society and their impact on health of individual and society. This book has been written speci�ically for the undergraduate students of physiotherapy keeping their syllabus in mind.
EVENT CALENDAR IACPCON-2016 - Indian Academy of Cerebral Palsy 11th Annual Conference Dates: Nov 25-27, 2016 @ Bangalore. Tel: :08042888416 www.iacp.co.in
55th Annual Conference of IAP Date : 3rd-4th-5th Feb. 2017 Ranchi, Jharkhand, India Organized by Jharkhand Branch, IAP http://www.iapcon2017.in/
5th International Conference & Workshops of Physiotherapy 8-12 December 2016, AIIMS, New Delhi http://www.incptaiims.org/
Society of Indian Physiotherapists 2nd Annual Conference-2017 10-12 Feb-2017, Bangalore www.sip-physio.org
OXFOCON-2016 - Oxford International Physiotherapy Conference-2016 10-11 Dec-2016, Bangalore, India Organizing Chairman:Prof. Dr. Prabhu PT Mob: +91 9886498094, www.oxfocon.com
Physio Foundation of India Organising The Power Of Physio 1st National Physio Conference 12th March 2017, Hyderabad www.physiofoundationindia.in
Physio Summit 2016 : International Physiotherapy Conference Organised by Bethany Navajeevan College of Physiotherapy 16th December 2016, Kerala, India wwwphysiosummit2016.wordpress.com
World Congress On Osteoporosis Osteoarthritis And Musculoskeletal Diseases, 23-26 march 2017 Florence, Italy http://www.wco-iof-esceo.org/
NCPT 2016 - National Congress of Physical Therapy 17-18 Dec-2016, Jaipur, Rajasthan Mob: 09782468066
WCPT 2017 - World Confederation for Physical Therapy Congress 2-4 July-2017 Cape town, South Africa Web: www.wcpt.org/congress
* The above information is compiled from various sources on the web. While due care has been taken, we don’t take any guarantee of the accuracy. PHYSIOTIMES doesn’t endorse any of the programs mentioned above and is only for information. Readers are requested to check the details before participation.
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
PHYSIONEEDS ACADEMY PRESENTS COMPENDIOUS DRY NEEDLING COURSE (CERTIFICATION IN DRY NEEDLING)
New Delhi Calicut Pune Malaysia Bangalore Dubai
24-28 11-13 13-17 19-22 4 -28
Nov 2016 Dec 2016 Jan 2017 Jan 2017 Mar 2017 Feb 2017
COURSE ON WOMEN HEALTH (PRE POSTNATAL FITNESS) Bangalore Mumbai Ahmedabad
24-25 Dec 2016 7-8 Jan 2017 4-5 Feb 2017
Screening course on Tapedia (Taping Encyclopedia Certi�ied) Delhi 29 Jan 2017 Calicut 5 Feb 2017 Sri Lanka (dates to be announced soon)
Conclave on Founders day Marketing Mantra by Mr.Mukesh Nayak (PHYSIOTIMES) & Sports injury Prevention and Management by Dr. Sajad Ahmad Mir (Physio to Olympic Gymnast Dipa Karmakar)
New Delhi - 8 Jan 2017
Join PNA today if you are a Proud Physio, Become a PNAer to grab endless bene�its and free courses. For details www.physioneedsacademy.com /become-member For more details of courses and updates contact:
8800220066,9978676570 www.physioneedsacademy.com
Advocacy PT
Health Days An opportunity for professional advocacy
As physiotherapists, we all celebrate 8th Sept as the World Physiotherapy Day every year and raise awareness about the profession. However, there are many 'health days' to promote important public health issues. These days also provide us an opportunity to promote the role of physiotherapy in varied conditions. At PHYSIOTIMES, we have taken the �irst step by creating awareness posters and sharing them on the social media & circulating it among our members on various health days in the last month. Listed below are some of the recent Health Days where we promoted the role of physiotherapy. Also given is a list of some upcoming Health Days in December which you can get involved in and maximize awareness.
UPCOMING HEALTH DAYS
Email us on contact@physiotimes.com to get the print file of any of the above poster.
10 November World Immunisation Day 12 November World Pneumonia Day 13 November World Alzheimers Day 14 November World Diabetes Day 16 November World COPD Day 17 November National Epilepsy Day 26 November World Antiobetity Day 1 December World AIDS Day 3 December International Day of Persons with Disabilities December 9 World Patient Safety Day December 12 Universal Health Coverage Day January 30 World Leprosy Eradication Day PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
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PT Best of web In this section we bring to you interesting websites of clinical & academic relevance to physiotherapists. In this issue, we introduce some interesting resources with regard to Osteoporosis.
www.iofbonehealth.org The International Osteoporosis Foundation (IOF) IOF functions as a global alliance of patient societies, research organizations, healthcare professionals and international companies working to promote bone, muscle and joint health.
https://www.nof.org The National Osteoporosis Foundation - is dedicated to preventing osteoporosis, promoting strong bones, and reducing human suffering through education, advocacy and research.
www.osteoporosis.org.au Osteoporosis Australia aims to improve
awareness about the disease in the Australian community and reduce bone fractures.
www.osteoporosis.ca Osteoporosis Canada is serving people who have, or are at risk for, osteoporosis. The organization works to educate, empower and support individuals and communities in the risk-reduction and treatment of osteoporosis.
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PHYSIOTIMES Vol. 8, Issue 2, Sept’ 2016
Word Maze PT A one of its kind reference material written on neuro-physiotherapy in the Indian Context "HOLISTIC APPROACH TO NEURO-PHYSIOTHERAPY Evidences and Experiences" Author: Dr. M. G. Mokashi. MRP - Rs.495/- ( Shipping Rs. 50 extra) Pages - 452 Weight : 810 GMS Dimensions: 7" x 9.5" Paperback Published by: Movewell Media ISBN - 978-81-931269-0-5 Email us on contact@physiotimes.com to receive Book Chapter Summary
To order the book or for more details : Call/Whatsapp on 8141585752
Result of Wordmaze#31 Answer Key Biceps Buccinator Coracobrachialis Deltoid Frontalis Gracilis Iliacus Lumbricals Masseter Nasalis Omohyoid
Pectineus Plantaris Platysma Procerus Risorius Sartorius Soleus Trapezius Triceps Zygomaticus
Congratulations !
Dr. P. Sravan Kumar, PT Kurnool, Andhra Pradesh You have won the book Holistic Approach to Neuro Physiotherapy We thank all the readers who participated in the wordmaze#31
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CRIPTION UBS LS
HIGH INTENSITY LASER THERAPY PAINLESS AND NON-SURGICAL TREATMENT Deep tissue penetration with power up to 12 W in continuous mode 1064 or 810 / 980 nm wavelength Pulsed mode for immediate elimination of pain 7W
12 W
4000 SMART & PREMIUM
HANDSFREE SONO
ADVANCED SERIES FOR PHYSIOTHERAPY
INDEPENDENT APPLICATOR WITH ROTARY FIELD
The most advanced technology in the industry Body Parts navigation and QUICK protocols Portable and battery-operated Preset protocols and therapeutic encyclopaedia Patient database
therapist’s fault Maximum safety using the embedded Rotary Field Technology
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