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This can be achieved by hoisting the patient’s top four-corner traction frame up in the OR (Fig discount forzest 20 mg without a prescription. The traction’s pulley system is disengaged and all four extremities are tied directly to the top frame cheap forzest 20 mg with mastercard. The therapist’s role is to monitor closely the forces exerted on the extremities during suspension and to fabricate a special head sling (Fig. No matter how positioning in the operating room is approached, the team should make sure that the patient’s entire body is positioned correctly and not focus only on the positioning of the operative site. After a skin grafting operation the patient may be placed on bed rest according to the unit’s immobilization protocol. Postoperative positioning is very similar to preoperative positioning, with the emphasis on protecting the newly applied develop in the hand that, if left untreated, may lead to devastating functional limitations. It leaves the hazards at the workplace, but attempts to diminish the effects on the worker (eg, job rotation or job enlargement). The performance of therapeutic exercise and activities to increase endurance. Endurance-type exercise that relies on oxidative metab- olism as the major source of energy production. Alexander technique: Movement education in which the student is taught to sit, stand, and move in ways that reduce physical stress on the body. American Journal of Physical Therapy: The official journal of the American Physical Therapy Association. It provides literature on physical therapy research, edu- cation, and practice. American National Standards Institute (ANSI): Clearinghouse and coordinating body for voluntary standards activity on the national level. American Society of Hand Therapists (ASHT): Established in 1978, the ASHT is concerned with hand rehabilitation education and research among practi- tioners in this area. The Journal of Hand Therapy is a publication resulting from the work of the ASHT. The amma tech- niques encompass myriad pressing, stroking, stretch- ing, and percussive manipulations with the thumbs, fingers, arms, elbows, knees, and feet on acupressure points along the body’s 14 major meridians. Some mild anal- gesics are nonsteroidal anti-inflammatory drugs (eg, Motrin [McNeil-PPC, Inc, Ft. It can either affect the whole body (eg, nitrous oxide, a general anesthetic) or a particular part of the body (eg, xylocaine, a local anesthetic). Massage therapy is contraindicated due to the potential for excessive bleeding. ANOVA (analysis of variance): Abbreviation for statis- tical method used in research to compare sample pop- ulations. A molecule produced by the immune system of the body in response to an antigen and which has the particular property of combining specifically with the antigen that induced its formation. Antibodies are produced by plasma cells to counteract specific antigens (infectious agents like viruses, bacte- ria, etc). The antibodies combine with the antigen they are created to fight, often causing the death of that infec- tious agent. An antigen stimulates the formation of antibodies to combat its presence. Muscle testing is used to determine the individual’s structural, chemical, and mental health. Treatment may include nutritional counseling, manipulation, acupressure, and exercise. ASCII (American Standard Code for Information Interchange): Standardized coding scheme that uses numeric values to represent letters, numbers, symbols, etc. ASCII is widely used in coding information for computers (eg, the letter “A’’ is “65’’ in ASCII). Ashatsu Oriental Bar therapy: A combination of the elements of traditional Thai massage, barefoot shiatsu, and Keralite foot massage (Chavutti Thirummal) for the treatment of low back pain. The measurement or quantification of a vari- able or the placement of a value on something (not to be confused with examination or evaluation). The only amounts the patients/clients may be billed for are copayments and deductibles. Assistive devices include crutches, canes, walkers, wheelchairs, power devices, long-handled reachers, and static and dynamic splints. This combination causes obstruction of the air- way and results in wheezing; characterized by recur- ring episodes. Application of massage to muscles already in spasm may cause the symptomology to increase in severity. Aston-patterning: An educational process, developed by Judith Aston in 1977, combining movement coach- ing, bodywork, ergonomics, and fitness training. It is the site where the cords of the brachial plexus pass through in order to innervate the muscles of the arm, superficial back, and superficial thoracic region. Ayurvedic massage: One part of the traditional detoxi- fication and rejuvination program of India called Pancha Karma, in which the entire body is vigorously massaged with large amounts of warm oil and herbs to remove toxins from the system. Balinese massage: A combination of stretching, long strokes, skin rolling, and palm and thumb pressure techniques. Trade/Generic names: Seconal/secobarbital (Ranbaxy Pharmaceuticals, Princeton, NJ), Nembutal/pentobarbital (Ovation Pharmaceuticals, Deefield, Ill). The B cell is a white cell which is able to detect the presence of foreign agents and, once exposed to an antigen on the agent, differentiates into plasma cells to produce antibodies. The body is struck by the palmer surface of a half closed fist, the terminal pha- langes of the fingers and the heel of the hand.
Le Blanc R generic forzest 20 mg with visa, Labelle H generic forzest 20mg, Rivard CH, Poitras B (1997) Relation between scoliosis surgery: operative technique and 2-year results in ten adolescent idiopathic scoliosis and morphologic somatotypes. Halm H, Niemeyer T, Halm B, Liljenqvist U, Steinbeck J (2000) Halm- compensation in King type II curves treated with Cotrel-Dubous- Zielke-Instrumentation als primärstabile Weiterentwicklung der set instrumentation. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Orthopäde 29: p563–70 Blanke K (2001) Adolescent idiopathic scoliosis: a new classifica- 38. Liljenqvist U, Allkemper T, Hackenberg L, Link T, Steinbeck J, Halm tern analysis for back shape measurement in scoliosis. In: Drerup H (2002) Analysis of vertebral morphology in idiopathic scoliosis B, Frobin W, Hierholzer E (eds) Moire Fringe Topography. Fischer, with use of magnetic resonance imaging and multiplanar recon- Stuttgart New York, pp 189–98 struction. Lonstein JE, Carlson JM (1984) The prediction of curve progression spurt on early posterior spinal fusion in infantile and juvenile in untreated idiopathic scoliosis during growth. Lowe TG, Peters JD (1993) Anterior spinal fusion with Zielke in- Behandlung der idiopathischen thoracic Adoleszentenskoliose. Helenius I, Remes V, Yrjönen T, Ylikoski M, Schlenzka D, Helenius M, (2000) Etiology of idiopathic scoliosis: current trends in research. J Poussa M (2002) Comparison of Long-Term Functional and Radio- Bone Joint Surg Am 82-A: 1157–68 logic Outcomes After Harrington Instrumentation and Spondy- 63. Luk KD, Cheung KM, Lu DS, Leong JC (1998) Assessment of scolio- lodesis in Adolescent Idiopathic Scoliosis. Luk KD, Hu Y, Wong YW, Cheung KM (2001) Evaluation of various A preliminary report of three cases from the service of the Ortho- evoked potential techniques for spinal cord monitoring during paedic Hospital. Luque ER (1982) The anatomic basis and development of segmen- poor correlation with lumbar scoliosis. Machida M, Dubousset J, Imamura Y, Iwaya T, Yamada T, Kimura 108: 173–5 J, Toriyama S (1994) Pathogenesis of idiopathic scoliosis. Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gard- with idiopathic scoliosis. J Pediatr Orthop 14: 329–35 ner-Bonneau D (1997) A meta-analysis of the efficacy of non- 67. McMaster M (1991) Luque rod instrumentation in the treatment operative treatments for idiopathic scoliosis. Mehta MH (1972) The rib-vertebral angle in early diagnosis be- stem anomalies in scoliosis. Acta Orthop Scand 62: 403–6 tween resolving and progressive infantile scoliosis. Sanders JO, Herring JA, Browne RH (1995) Posterior arthrodesis Surg (Br) 54: 230–43 and instrumentation in the immature (Risser-grade-0) spine in 3 69. Michel C (1994) Les complications neurologiques de la chirurgie idiopathic scoliosis. Montgomery F, Willner S (1997) The natural history of idiopathic Sagittale Cobb-Winkel-Messungen bei Skoliose mittels MR-Ganz- scoliosis. Incidence of treatment in 15 cohorts of children born wirbelsäulenaufnahme. Moskowitz A, Trommanhauser S (1993) Surgical and clinical results frichtung idiopathischer Skoliosen. Klinisch-radiologische Ergeb- of scoliosis surgery using Zielke instrumentation. Nachemson AL, Peterson LE (1995) Effectiveness of treatment ville EW (1952) Rotational lordosis: The development of the with a brace in girls who have adolescent idiopathic scoliosis. J Bone Joint Correction of adolescent idiopathic scoliosis using thoracic pedicle Surg (Am) 51: 223 screw fixation versus hook constructs. Appl Optics 9: 1467–72 Krismer M (2002) Interobserver and intraobserver reliability of 98. Turner-Smith AR, Harris JD, Houghton GR, Jefferson RJ (1988) Lenke’s new scoliosis classification system. Padua R, Padua S, Aulisa L, Ceccarelli E, Padua L, Romanini E, Zanoli 497–509 G, Campi A (2001) Patient outcomes after Harrington instrumen- 99. Thieme, Stuttgart, tation for idiopathic scoliosis: a 15- to 28-year evaluation. Mal- MG (2006) The effect of limb length discrepancy on health-relat- rine, Paris ed quality of life: is the ‚2 cm rule‘ appropriate? Phillips WA, Hensinger RN, Kling TF Jr (1990) Management of B 15:1-5 scoliosis due to syringomyelia in childhood and adolescence. Walker AP, Dickson RA (1984) School screening and pelvic tilt Pediatr Orthop 10: 351–4 scoliosis. Porter R (2000) Idiopathic scoliosis: the relation between the ver- 102. Weinstein SL, Ponseti IV (1983) Curve progression in idiopathic tebral canal and the vertebral bodies. 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PCA gave significantly greater pain control buy forzest 20 mg visa, particularly among those with high levels of state anxiety generic 20mg forzest overnight delivery. Furthermore, there were some direct cost impli- cations, as PCA patients also required less analgesia and were discharged earlier than IMI patients. This study highlights both the importance of psy- chological variables associated with pain control and the advantages of al- lowing patients to take control of their analgesic use. The field of psychoneuroimmunology (PNI) has been invaluable in ce- menting together the biopsychosocial model. In particular, it has shed new light on the relationship between emotions and the immune response, crossing the previous gap in the dualistic tradition of the separateness of mind and body. Evidence is emerging for the immunosuppressive effects of pain (Cheever, 1999; Kremer, 1999) that has important implications for the health of individuals with pain and highlights the complex interplay of fac- 7. SOCIAL INFLUENCES ON PAIN RESPONSE 189 tors that mediate the painful experience. Kiecolt-Glaser and colleagues re- cently reviewed considerable evidence and confirmed that stress delays wound healing (Kiecolt-Glaser, Page, Marucha, MacCullum, & Glaser, 1998). As pain is a prominent stressor, this has implications for the induction and perpetuation of chronic pain at physiological and neurological levels. Other research has shown that interpersonal stress is associated with an increase in disease activity in rheumatoid arthritis patients (Zautra et al. Taken together, this research highlights that the response to pain and its consequences can be influenced by factors external to the individual, and that this complex relationship has only just begun to be unraveled. Li and colleagues looked at whether pain perception differed between older and younger adults (Li, Greenwald, Gennis, Bijur, & Gallagher, 2001). Pa- tients requiring a painful procedure—in this case, the insertion of an intrave- nous catheter during attendance at an emergency department—were asked to rate their pain on a visual analogue scale. The results showed that adults over 65 years reported significantly less pain than younger people, and this result was not influenced by gender. However, this study is unable to dem- onstrate whether such differences could be explained by a decline in sensi- tivity to pain or a reduced willingness to complain of pain, which may have implications for treatment. Having identified differences in the response to pain by people of different age groups, it follows that this is an important area of inquiry and should be considered when approaching the manage- ment of pain. Other influences on the response to pain derive from the complex inter- play of biological, hormonal, molecular, and genetic determinants, which are important at Level 1 of this model for understanding pain (see chap. Recently there has been an explosion of interest in the genetic mechanisms underlying pain, although this area of research is beyond the scope and direction of this chapter. Research examining these features of pain is well documented elsewhere; for example, for ge- netic variation see Hakim, Cherkas, Zayat et al. Furthermore, these types of research are beginning to indicate that individuals respond differently to analgesics, and there has been some work to elucidate the possible mechanisms involved (Amanzio, Pollo, Maggi, & Benedetti, 2001). Level 2: Interpersonal Behavior Current and future expectations about pain, illness, treatments, and a “cure,” link Level 1 to Level 2 of the model. Level 2 is characterized by be- liefs about pain and treatment, the context of encounters, and social atmo- 190 SKEVINGTON AND MASON sphere and motivation. Beliefs about pain and treatment are socially shared, and include the nature of pain, illness, and disability, attributions about their causation, the efficacy of particular interventions, self-efficacy in implementing treatment, and aspects of pain control, such as choice and predictability. The social context of interpersonal encounters encompasses the social relationships with family, significant others, friends, acquain- tances, workmates, colleagues, health professionals, and alternative practi- tioners. Social motivation incorporates social support, the need for ap- proval of actions to utilize social resources such as family and friends and formal health care resources, and seeking help from alternative therapists. Numerous beliefs, probably in the hundreds, need to be systematically documented and organized taxonomically to understand which are the most important predictors of the response to pain, illness, and treatment outcomes. Patients’ beliefs tend to mirror the general and current views held by the society that they live in, being grounded in that culture. These interpersonal beliefs provides a backdrop for shared group and intergroup understandings at Level 3, and connect with higher order factors such as health culture at Level 4. Beliefs have considerable practical value in under- standing how patients present their condition, and in predicting their re- sponse to advice and compliance with treatment, with erroneous beliefs be- ing particularly prone to perpetuating persistent pain. Identifying several clusters of relevant beliefs, Jensen, Karoly, and Huger (1987) found that pain patients commonly believe that physicians will rid them of pain, that they themselves are not in control of the pain, that others are responsible for helping people in pain, that those in pain are permanently disabled, and that medication is the best form of treatment for pain. These beliefs are conceptualized as reflecting dependency, external health locus of control, absence of positive thoughts about rehabilitation, or catastrophizing, and medicalization, respectively. More recently, Jensen and Karoly (1992) found that among patients reporting low and medium levels of pain, a belief that they were disabled was related to lower activity levels, use of health care services, and poorer psychological functioning. They also found that where patients believed in a medical cure for their pain, this was related to more frequent use of health care services. These results highlight the importance of beliefs in adjustment to chronic pain (Jensen & Karoly, 1992), and it is these types of erroneous beliefs that need to be confronted in psychosocial interventions, such as self-management courses and cognitive behavior therapy, to enable patients to make gains and achieve a sense of control. Much work has been carried out on the concept of self-efficacy in recent years, and numerous findings support the importance of self-efficacy beliefs in response to pain. SOCIAL INFLUENCES ON PAIN RESPONSE 191 also found that pain intensity and self-efficacy contributed to the develop- ment of disability and depression in patients with chronic pain (n = 126). In line with this finding, they suggested that enhancing self-efficacy beliefs is an important therapeutic goal. Lin (1998), studying chronic cancer and low back pain patients, found that for both patient groups, perceived self- efficacy correlated negatively with pain intensity and interference with ev- eryday life. Enhancing perceptions of self-efficacy has yielded significant and clinically meaningful results (Jensen et al. We return to self- efficacy in discussion of Level 3, where an application of this concept through the use of group processes is addressed.
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