“A touch of physiotherapy” — the significance and meaning of touch in the practice of physiotherapy

Touch, while ubiquitous and ever present in the practice of physiotherapy, is conspicuously absent from physiotherapy-related research. Based on a theoretical perspective inspired by phenomenology, this article explores and elaborates on the meaning and significance of touch in the practice of physiotherapy. The research data were generated through 16 close observations conducted in primary care clinics, and through interviews with 9 physiotherapists and with 9 patients suffering from chronic neck problems. The findings revealed how the use of touch in the practice of physiotherapy brings people into proximity in ways more complex than simple skin-to-skin contact. Through nontouch, touch, and movements, physiotherapists invite their patients to participate in the process of creating and performing therapy; dialogue through touch and movement is vital. Touch in physiotherapy depends on the physiotherapist’s embodied skills; those they cultivate in order to respectfully listen to their patients and guide them to explore their own bodily capacity, limits and possibilities. The findings also suggest that observing therapy from outside and from participating in it offer significant different experiences, information, understanding, and meanings. The differences between physiotherapy as observed expression and as lived experience would seem to have important implications for understanding the practice of physiotherapy.     

The effectiveness of “Protex” for disinfection of the ultrasound probe

The aim of this study was to evaluate the effectiveness of “Protex” (Parker; Fairfield, NJ, USA) for disinfection of ultrasound probes. We examined bacterial contamination on ultrasound probes that were wiped with a plain paper towel, with a plain and an ethanol-soaked paper towel, or with a plain and Protex-soaked paper towel. The plain paper towel was used to remove the gel, and was contaminated by large numbers of bacteria, but the use of ethanol-soaked paper towels and that of paper towels soaked in Protex? broad-spectrum disinfectant (Parker: Fairfield, NJ, USA) reduced those numbers markedly.     

Visualization of the site of the onset of ventricular depolarization by acceleration mode “Tissue Doppler Imaging” technique

Tissue Doppler imaging (TDI) is a relatively new echocardiographic technique that shows regional myocardial wall velocities. The aim of this study was to evaluate the potential value of acceleration mode TDI technique for the visualization of the origin of ventricular activation site using the model of right ventricular pacing. Twenty-seven patients with implanted permanent pacemakers were studied by acceleration mode TDI, 4 of these patients were pacemaker dependent. Parasternal and apical chamber views were recorded on video tape by using acceleration mode TDI technique during sinus rhythm with preserved atrioventricular conduction in 23 subjects who were not pacemaker-dependent, and also during right ventricular apical pacing in VVI mode in 27 subjects in whom pacing lower rate was increased if necessary. Fifty images recorded during sinus and pacing rhythm in cineloop were examined by two independent observers who were unaware of the rhythm patterns and by the same observer on two different occasions for localizing the site of onset of ventricular acceleration. The origin of ventricular activation during sinus rhythm started at basal septal part of the ventricle and during pacing started at apical part of the ventricle was considered as correct localizations. The origin of ventricular depolarization was correctly localized for 46 of 50 images (92%) and 44 of 50 images (88%) by the first and the second observers, respectively. Concordant results between observers appeared in 48 of 50 (96%) of images. The diagnostic accuracy of the concordant results was 44 of 48 (91.6%) images. The kappa for interobserver variability was 0.77 (p<0.001), and for intraobserver variability was 0.64 (p<0.001) and 0.63 (p<0.001) for the first and the second observers, respectively. These results suggest that acceleration mode TDI can be used to detect the initial ventricular excited position and seems to have a potential value for localizing of the origin of normal or abnormal myocardial depolarization. Address for correspondence: Yuksel Cavusoglu, Osmangazi University, Eskişehir, Turkey.     

Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”

Objective To report spiral CT imaging features of the vascular alterations observed in active, early, or recurrent Crohn disease of the small bowel and colon.Methods Spiral CT examinations of the abdomen and pelvis following oral and intravenous contrast were performed in two cases of active Crohn disease.Results Spiral CT features of hypervascularity involving the mesenteric vessels of affected segments of bowel include vascular dilatation, tortuosity, and conspicuous prominence and wide spacing of the vasa recta (the comb sign). This is attributed to the factors of increased flow and the fibrofatty proliferation in the mesentery and serosa of the affected bowel.Conclusion Clinical application of these observations may enhance the diagnosis of Crohn disease presenting initially or as an acute recurrence in the differential diagnosis from other conditions.     

“Governed by the pain”: narratives of fibromyalgia

Purpose: Fibromyalgia (FM) is a chronic syndrome characterized by pain and fatigue. The aim of this study was to explore how individuals with FM make sense of the illness experience and integrate it into their personal biographies. Method: Ten women from a pain management service in the north west of England were interviewed for the study. A chronological summary of each life story was produced and narrative features such as plot, tone, imagery and metaphors were identified and compared. Results: Findings are presented in the form of a meta-narrative incorporating all 10 narratives over five phases: (1) making sense of FM: when I was younger, I didn’t have any problems at all; (2) onset and diagnosis: you just feel like you’re constantly complaining; (3) invasion of FM: you’re just trapped; trapped in this body; (4) coping with FM: you try to do things in a pattern it will obey and (5) ongoing struggle: I refuse to give in to it. Conclusions: The narrative is characterized by a lack of movement and resolution, with participants engaged in an enduring struggle against the challenges of FM. Psychological approaches that facilitate this ongoing adjustment process may prove beneficial in FM treatment and rehabilitation.

Implications for Rehabilitation

• Fibromyalgia (FM) is a chronic syndrome characterized by pain and fatigue.

• This study shows women with FM are engaged in an enduring struggle against the challenges this presents.

• Psychological approaches which acknowledge and facilitate the adjustment process may prove beneficial in terms of assisting rehabilitation for this client group.

     

Survival of “pre-viable” infants in the United States

OBJECTIVE: We investigated temporal trend in survival of pre-viable (200-499 g) fetuses over the previous decade, and estimated future survival rates based on previous and current survival thresholds. DESIGN, SETTING AND PARTICIPANTS: This was a retrospective cohort study on live-born pre-viable fetuses (200-499 g) in the United States comparing two period cohorts; 1985-1988 versus 1995-1999. We computed survival of pre-viable babies (who were still alive at 24 hours) during the two periods and based on these results, we estimated future survival rates for the coming decades. MAIN OUTCOMES: Survival beyond the neonatal period. RESULTS: About 35 million live births were analyzed for the two periods. In the first period (1985-1988), 927 live births among pre-viable fetuses were recorded while in the second period (1995-1999) 2585 were counted, equivalent to a birth rate of 60.6 and 131.9 per million live births respectively. This corresponds to an increase of more than 100% across the decade (p for trend < 0.0001). Survival improved by about 50% across the period, from 12.0% to 17.4% (p < 0.0001). Based on these results, the survival rate among pre-viable fetuses will be expected to rise to about 24.0% within the next 6 years (2010). CONCLUSIONS: Survival among pre-viable fetuses is increasing in the United States. This raises ethical, legal and medical issues concerning the defined viability status of these babies, which is currently described as "non-viable".     

The politics of cinematic representation of disability: “the psychiatric gaze”

Abstract

Purpose: Social representations as cultural products rooted in praxis are considered to play dominant role in the structuring of identities or self representations. It is a common belief that people with disabilities analyze their experiences in light of the existing meanings and practices prevalent in society. The paper addresses the matrices of recurring themes in representation of disability and discourses of “normalcy” in films in the nineteenth and twentieth century invoking reductionistic attitude, whereby “disability” becomes a condition subject to neurotypical display and narrative coding in the films in question in the context of India. It will especially seek to analyze the theoretical outlook based on the social model of disability, a perspective that includes specific analyses of the representation of people like themselves in popular culture. Method: A systematic and thorough review of 26 Hindi films ranging from the 1960s to 2010 and six English movies. Apart from these, several books and articles have also been critically reviewed. Result and conclusion: The paper concludes with the argument that the idea of disability in mainstream contemporary cinema has been created and perceived as a speculative fantasy and for public consumption, thus reflecting the current status of people with disabilities as the present preferred “enigmatic” condition.

• Implications for Rehabilitation

• Films play significant role in communicating characters which have deep impact on peoples’ perspective of persons with disabilities.

• Filmmakers need to adopt more intensely researched and more sensitized approach in creating movies centering on people with disabilities.

• Films need to focus more on the potentialities rather than the shortcomings of people with disabilities.

• Filmmakers need adequate training in order to recognize the needs of the concerned population and adopt appropriate resources and interventions to address various issues for their rehabilitation into the mainstream society.

     

Clinical Validation of the Portuguese Version of “Substance Addiction Consequences” Derived from the Nursing Outcomes Classification

Our aim was to contribute to the clinical validation of “Substance Addiction Consequences” (SAC) derived from the nursing outcomes classification (NOC), and to analyse psychometric properties. To that purpose, we applied a methodological design. The study’s outcome comprises 16 nursing-sensitive indicators, within four different consequence factors: psychological and family; physical and cognitive ability; self-care; economic and work. The psychometric properties were considered good. We concluded that the scale can be used as a valid tool to measure the consequences of substance addiction and to assess the health status as a nursing sensitive outcome. The scale is considered valid to monitor nursing interventions in the clinical setting; being a comprehensive tool it allows the nurse to understand better this complex health problem.     

Radiology report “disclaimers” increase the use of abdominal CT in the work-up of pediatric abdominal pain

Objective

Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a “disclaimer” is associated with additional imaging.