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Pre-participation Government Physiotherapy College, Civil Patients had completed a pain and Hospital Campus, Ahmedabad. Pain under strain was also 30 (Thirty) patients who were diagnosed assessed during testing of muscle strength. The patients also Clinical Intervention: performed the exercise programme four to Study participants were requested to six times daily at home. Patients or taping) during the intervention period of having cubital osteoarthritis, carpal tunnel the trial. Group A (Experimental group): tendonitis, previous trauma, fracture or In this group patients were given surgical procedure around the elbow, history Progressive Strengthening Exercises and International Journal of Health Sciences & Research ( Effects of Progressive Strengthening Exercises in Chronic Lateral Epicondylitis conventional therapy. Ultrasound + Resisted wrist extension Deep transverse friction massage + Resisted wrist flexion stretching exercises), and Group B (Control Wrist rotation with a stick group): In this group patents were given Conventional therapy. Each programme included ten Towards the thumb repetitions in two or three series for each Patient was in standing position and asked exercise. The patients were also asked to Transferring buttons from cup into another perform the exercise programme four to six Twisting a towel into the roll times daily at home. Effects of Progressive Strengthening Exercises in Chronic Lateral Epicondylitis Figure 3: Resisted wrist extension (using dumbbell) Figure 4: Resisted wrist flexion (manually) Figure 5: Resisted wrist flexion (using dumbbell) Figure 6: Wrist rotation with a stick Figure 7: Wrist extension against an elastic band Figure 8: Wrist flexion against an elastic band Figure 9: Wrist radial deviation against an elastic band Figure 10: Pressing hands against a wall International Journal of Health Sciences & Research ( Effects of Progressive Strengthening Exercises in Chronic Lateral Epicondylitis Movements of thumbs (transverse friction movement) were of small amplitude and regulated pressure, throughout the treatment [23] was given. Stretching exercises of wrist extensors [24] and flexors: Patient was sitting in a chair adjacent to the plinth with the forearm supported. Detail protocol of repetitions of stretching with interval of 30 treatment was as given below. The subject is asked Intensity: 1 Watt/ cm to place a mark on that line, which is 10 cm Duration: 5 minutes/ session 2 in length. The left end of line represents no the radiated area was 5 cm over the pain and right end represents severe pain. Figure 12: Stretching of wrist flexors (manually) Figure 13: Stretching of wrist extensors (manually) International Journal of Health Sciences & Research ( Effects of Progressive Strengthening Exercises in Chronic Lateral Epicondylitis Figure 14: Self-stretching of wrist flexors Figure 15: Self-stretching of wrist extensors Maximal Isometric Grip Strength: Grip patients with tennis elbow. Maximum tennis elbow pain and disability on scale of isometric grip strength was measured in 0 to 10.

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The activity takes more than a reasonable amount of time, or there are safety considerations. For example, use 0 if the patient uses only a wheelchair for locomotion or the patient is on bed rest. At level 7 the patient walks a minimum of 150 feet (50 meters), in a reasonable time, without assistive devices. The patient does not use a wheelchair, and is not pushed in a wheelchair by a helper. At level 6 the subject wheels a minimum of 150 feet (50 meters), in a reasonable time, without assistive devices. The subject does not go up or down stairs, and a helper does not carry the subject up or down stairs. At level 7 the patient goes up and down one flight of stairs without any type of handrail or support. The patient does not require prompting, though (s)he may require a hearing or visual aid, other assistive device, or extra time to understand the information. The patient requires prompting (slowed speech rate, use of repetition, stressing particular words or phrases, pauses, visual or gestural cues) less than 10% of the time. Comprehension of complex or abstract information may also include understanding information given during a group conversation. At level 7 the subject understands directions and conversation that are complex or abstract; understands either spoken or written language, not necessarily English. Evaluate and indicate the more usual mode of comprehension ("Auditory" or "Visual"). This item includes either intelligible speech or clear expression of language using writing or a communication device. The patient does not need any prompting, but (s)he may require an augmentative communication device or system. The patient uses only single words or gestures, and (s)he needs prompting more than half the time.

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A body of literature has looked at c-Fos expression in the spinal cord and brain in relation to acupuncture. Acupuncture has been shown to suppress c-Fos expression in the spinal cord and the brain after noxious peripheral stimulation, suggesting a possible neuromodulatory mechanism that is independent of endogenous opioid release [18]. Stimulation of the eyes directly with light caused a similar activation, whereas stimulation of a sham acupuncture point 2 to 5 cm away from B67 failed to cause occipital lobe activation [19]. The primary action was to decrease signal intensity in the limbic region and other subcortical areas. Some authors theorize that placebo is an endorphin-mediated efiect, making acupuncture a particularly powerful form of placebo [21]. Acupuncture has the advantage of activating reproducible biologic mechanisms, while bringing to the therapeutic encounter some of the attributes of a psychological interaction, such as longer patient-healer time together and the power of touch and suggestion. Nevertheless, in an attempt to validate the scientific eficacy of acupuncture, the trend is to eliminate from the traditional therapeutic model the elements that may have a profound efiect on the eficacy of the intervention. In the realm of pain conditions, the panel concluded that the literature showed acupuncture is efiective in treating postoperative dental pain. The panel also concluded that acupuncture may be useful in treating headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, and carpal tunnel syndrome. This statement was based on an exhaustive review of the literature, much of which can be characterized by poorly powered studies of marginal experimental design. The practice of acupuncture is practitioner dependent, making it hard to compare studies given the variety of techniques and treatment paradigms used in difierent clinical settings. Often care also includes dietary recommendations, soft tissue and manipulative techniques, and at times recommendations for herbal combinations. In contrast, a standard research design, in an attempt to eliminate bias and maintain reproducibility, may reduce this robust acupuncture treatment paradigm to a fixed set of points, potentially robbing the treatment of its eficacy. Another common problem for nonpharmacologic clinical studies due to underfunding is the issue of small sample size, leaving the study unJ. Korean hand acupuncture montage illustrates the variety of clinical methods used in the United States and around the world. Often these points would not be needled, but rather heated by burning a combustible herb, mugwort. This is a particular problem when the study design includes use of a powerful placebo stimulus, such as sham needle stimulation of points on the body considered to be ofi meridian.

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Reduced Loss of Sight in One Eye 22,500 to 45,400 the amount of the assessment will need to consider the degree of sight that remains. Total Loss of Sight in One Eye up to 138,000 the amount of the assessment will need to consider the degree of sight in the remaining eye. Total Blindness Cases where total blindness has occurred would need to consider several factors in order to assess the value. Such factors would include, age at the time of the accident, occupation, lifestyle, cosmetic or disfguring features, prosthetic requirement. Injuries Affecting Hearing Cases where the hearing has been affected would need to consider several factors in order to assess the value. Considerations would need to include, if the impact of the injury was immediate or a gradual loss over time, the age at the time of the loss and if balance has or will be affected by the injury. Facial Injuries the gender and age are factors to determine the exact level of severity. Serious injuries are likely to have an element of disfgurement attached to them and will be considered accordingly. Eye socket fractures often accompany cheek fractures resulting in changes in appearance of the eyeball such as a sunken appearance. Nerve injuries are also often seen with cheek fractures sometimes leaving ongoing symptoms. Minor 21,200 to 42,200 Simple non-displaced fracture to the cheek bone which has substantially recovered. Moderate 37,700 to 47,300 Fractures to the cheek bone(s) that have required surgery with either a complete recovery expected or minimal cosmetic effect. Severe and permanent conditions 47,500 to 55,600 Complex and multiple fractures to the cheek bones which required extensive surgery and extended healing but may result in an incomplete union with lasting consequences that may include numbness to the face. Nose Fractures Because of its prominence (and therefore vulnerability) and structural weakness, the nose is the most frequently fractured facial bone. Minor 18,000 to 22,100 Simple non-displaced fracture to the nose which has substantially recovered. Moderate 22,100 to 32,200 Fracture(s) to the nasal bone that may have required surgery where a full recovery is expected or minimal cosmetic effect. Moderately Severe 32,400 to 46,600 Nasal fractures that have required surgery which may have had some short term consequences on the ability to smell. Severe and permanent conditions 44,500 to 63,900 Complex and multiple fractures to the nasal bones which required extensive surgery and may have lasting consequences on the ability to smell.

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