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Physiotherapists Not To Treat, But Advice Patients With Low Back Pain In Nottingham; Hint Of Things To Come?
Thursday 12 April 2012 - 14:19:44 | International Physiotherapy News
Another proof of insurance or a second hand funding becoming a hurdle at times in getting the right treatment for the insured. As long as a third party decides the duration of the treatment, or the number of sessions, or the treatment techniques, there would certainly be incidents like this happening. With the whole world facing serious financial woes and trying cost cutting measures, health industry will not be far behind in taking quick actions. In the end, more than the moneybaggers being affected, it will be the patients who will be.
Patients referred to physiotherapists for treatment in Nottingham will no longer receive hands-on treatment - but will be directed to websites where they can learn exercises for themselves. Patients in Rushcliffe are given "advice and guidance" and directed to websites and information leaflets where they can learn exercises for themselves.
Phil Gray, chief executive of the Chartered Society of Physiotherapy, said: "They seem to have invented a new form of physiotherapy that no one has heard of - do-not-touch physiotherapy. Physiotherapists can't actually physically touch you at all under this system. It is deeply unscientific, there is no research or evidence to back up hands-off physiotherapy. Patients have been reporting back to GPs a very strong disapointment, and the physiotherapists providing this service are saying that basically 'you are preventing us from doing a professional job. It is a completely barmy form of treating people, which means that the only solution will be to go to the private sector and pay for themselves."
Before January 1, 2011, the Principia clinical commissioning group, which plans and buys healthcare services in Rushcliffe, offered one assessment and up to four treatments for physiotherapy patients. This includes patients who are suffering from soft tissue injuries and pain in their back, neck or joints. But, following a review of services, it changed from a treatment service to an advice and guidance service.This means that physiotherapists are no longer allowed to touch patients, and instead give advice on what exercises they should be doing and information on how to manage their condition themselves.
The Chartered Society of Physiotherapy asked all primary care trusts in the country about their physiotherapy services and any budget cuts. Mr Gray said that Principia was the only group not to offer a hands-on treatment to physiotherapy patients. Patients in Rushcliffe are also capped to a maximum of two physiotherapy appointments a year and have to visit their GP twice, six weeks apart, to get a physiotherapy referral in the first place.
Mr Gray said this was too long to wait. He added: "Getting people quickly into early intervention services makes a real difference to their ability to go back to work. The less treatment they go on to have and the longer it is left, the more complex problems it causes for people."
Barbara Venes, of the Local Improvement Network, which represents patients in Notts, also raised concerns. She said: "I think it is just awful. If you need physiotherapy, you need the treatment, not just advice. They are pushing people into paying privately and some people cannot afford to pay for it and so won't get treatment." She added that older patients may struggle to access information online, and that people needed practical demonstrations of how physiotherapy exercises should be done - to ensure that they were doing them correctly. "If you need physiotherapy, it is painful when you start." she said. "If you are doing it with a physiotherapist, then they can reassure you that it is normal to get some pain. But if you are doing it yourself, then people are afraid that if it is painful then they are going to get more damage."
A spokesman for Principia said that the change in service had not been a cost-cutting measure, and that costs were broadly the same as before. She said that "more vulnerable" patients received treatment through other means, such as a hospital specialist. She said: "Following a review, the service was changed to one of advice and guidance to encourage patients to self-care prior to further review by the GP. In some parts of the county this is done by web-based advice or in group sessions, and is the important first step in patients with back and neck problems." She added: "Once a decision to refer to a specialist is made by a GP, patients are seen quickly by a physiotherapist. With the advice and guidance service, patients are given practical advice to help them self manage their condition. This includes exercises to alleviate and manage their symptoms. This service enables all patients to take control of their condition and get better quicker."
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Neuroprosthesis Which Would Work With Just Thoughts From Brain Alone, A Near Future Possibility.
Wednesday 28 March 2012 - 06:53:15 | International Physiotherapy News
Opening the door to the development of thought-controlled prosthetic devices to help people with spinal cord injuries, amputations and other impairments, neuroscientists at the University of California, Berkeley, and the Champalimaud Center for the Unknown in Portugal have demonstrated that the brain is more flexible and trainable than previously thought.
Their new study, to be published in the advanced online publication of the journal Nature, shows that through a process called plasticity, parts of the brain can be trained to do something it normally does not do. The same brain circuits employed in the learning of motor skills, such as riding a bike or driving a car, can be used to master purely mental tasks, even arbitrary ones.
Over the past decade, tapping into brain waves to control disembodied objects has moved out of the realm of parlor tricks and parapsychology and into the emerging field of neuroprosthetics. This new study advances work by researchers who have been studying the brain circuits used in natural movement in order to mimic them for the development of prosthetic devices.
"What we hope is that our new insights into the brain's wiring will lead to a wider range of better prostheses that feel as close to natural as possible," said Jose Carmena, UC Berkeley associate professor of electrical engineering, cognitive science and neuroscience. "They suggest that learning to control a BMI (brain-machine interface), which is inherently unnatural, may feel completely normal to a person, because this learning is using the brain's existing built-in circuits for natural motor control."
Carmena and co-lead author Aaron Koralek, a UC Berkeley graduate student in Carmena's lab, collaborated on this study with Rui Costa, co-principal investigator of the study and principal investigator at the Champalimaud Neuroscience Program, and co-lead author Xin Jin, a post-doctoral fellow in Costa's lab.
Previous studies have failed to rule out the role of physical movement when learning to use a prosthetic device.
"This is key for people who can't move," said Carmena, who is also co-director of the UC Berkeley-UCSF Center for Neural Engineering and Prostheses. "Most brain-machine interface studies have been done in healthy, able-bodied animals. What our study shows is that neuroprosthetic control is possible, even if physical movement is not involved."
To clarify these issues, the scientists set up a clever experiment in which rats could only complete an abstract task if overt physical movement was not involved. The researchers decoupled the role of the targeted motor neurons needed for whisker twitching with the action necessary to get a food reward.
The rats were fitted with a brain-machine interface that converted brain waves into auditory tones. To get the food reward - either sugar-water or pellets - the rats had to modulate their thought patterns within a specific brain circuit in order to raise or lower the pitch of the signal.
Auditory feedback was given to the rats so that they learned to associate specific thought patterns with a specific pitch. Over a period of just two weeks, the rats quickly learned that to get food pellets, they would have to create a high-pitched tone, and to get sugar water, they needed to create a low-pitched tone.
If the group of neurons in the task were used for their typical function - whisker twitching - there would be no pitch change to the auditory tone, and no food reward.
"This is something that is not natural for the rats," said Costa. "This tells us that it's possible to craft a prosthesis in ways that do not have to mimic the anatomy of the natural motor system in order to work."
The study was also set up in a way that demonstrated intentional, as opposed to habitual, behavior. The rats were able to vary the amount of pellets or sugar water received based upon their own level of hunger or thirst.
"The rats were aware; they knew that controlling the pitch of the tone was what gave them the reward, so they controlled how much sugar water or how many pellets to take, when to do it, and how to do it in absence of any physical movement," said Costa.
Researchers hope these findings will lead to a new generation of prosthetic devices that feel natural.
University of California - Berkeley. "Brain Flexibility Gives Hope For Natural-Feeling Neuroprosthetics." Medical News Today. MediLexicon, Intl., 6 Mar. 2012. Web.
28 Mar. 2012. <http://www.medicalnewstoday.com/releases/242489.php>
Image: www. imperial.ac.uk