Global Economics Paper No: 164

Rowell_R

Description

• fiche de synthèse - matière potentielle : measure of conditions
• leçon - matière potentielle : gap
• cours - matière potentielle : by 4 ppt
• cours - matière potentielle : fees
• cours - matière potentielle : by 18 -20 ppt
• cours - matière potentielle : while girls

Important disclosures appear at the back of this document GS GLOBAL ECONOMIC WEBSITE Economic Research from the GS Institutional Portal at Global Economics Paper No: 164 March 4, 2008 Sandra Lawson Thanks to Michelle Kim, Raluca Dragusanu, Dominic Wilson and Peter Berezin Women Hold Up Half the Sky ■ The Chinese proverb that ‘women hold up half the sky' has long been more aspiration than fact. In developed and developing countries alike, gender gaps persist in education, health, work, wages and political participation.

• annual gdp growth rates by 0.2ppt on average
• overall quality of the students
• secondary schooling 33 33 34 31 47 41 34 40 47 63 univers
• female education
• gender gap
• countries
• girls
• economic growth

Sujets

• Berezin
• Impact
• Wilson
• Goldman Sachs

Informations

• Publié par: urka
• Nombre de lectures: 20
• Langue: English

Extrait

Robert M. Rowell, DC, MS

Russian Current

Robert M. Rowell, DC, MS

Muscle Reeducation

 Termused is NeuroMusclular Electrical Stimulation (NMES) – Goal is to cause stimulation of alpha motor neuron causing a strong muscle contraction  PrimaryIndications: – Retrain lost muscle function from inhibition following injury or surgery  Turn muscle back on – Decrease muscle atrophy from periods of immobilization

Physiologic vs electrical contractions  Electricalmuscle contraction – Order of recruitment  Largerdiameter, fast twitch fibers are recruited first as they have a lower capacitance – Slow twitch are recruited if the stimulation is increased ync ronyo rng  Synchronousfiring depending on the frequency  Contractioncontinues until the stimulation is off – Inhibition  GTOis activated but inhibition is overcome by direct stimulation – Fatigue  Musclefatigues rapidly from the fast twitch fiber recruitment and from synchronous firing of motor units

Electrical Muscle Stimulation

Reading assignment

 Chapter17 Russian Current Therapy

Physiologic vs electrical contractions  Physiologicalcontractions – Order of recruitment  Slowtwitch are contracted first – Fast twitch are contracted only when needed extra force n hr nf firin  Asynchronousfiring to produce a continuous contraction – Reduces fatigue of any one motor unit – Inhibition  Withstrong contractions the GTO will cause inhibition – Fatigue  Minimalfatigue because of the order of recruitment and asynchrony of firing motor units

Types of NMES Stimulators

 MCcalled Russian Stimulation

 Russianscientist (Kots) in

 Makesuse of duty cycles (on/off cycles) to cause muscle contraction for muscle strengthening

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Robert M. Rowell, DC, MS

Russian Stimulation

 Indications – Muscle reeducation – Retard atrophy M ltr n th nin – Decrease muscle spasm through fatigue  Canbe uncomfortable

Treatment Frequency

 >50 Hz in a “contract/relax” mode  verylow pulse rate or beat frequency – 10 seconds on / 50 seconds off

10 sec

Electrode Placement

 ALWAYSalong fibers of same muscle or muscle group  2electrodes = single muscle  eec roes – “simultaneous cocontract”  same muscle/muscle group  bilateral treatment – “alternate” or “reciprocate”  agonist/antagonist muscle or muscle group

Electrical Muscle Stimulation

Russian Stim  Carrierfrequency (medium) = 2500 Hz  “burst”frequency = 50 Hz  Result= maximally summated muscle

 Applicationparameters – 10s on / 50s off = “rehab” effects  retard atrophy, retrain muscle, etc – 10s on / 10s off = spasm or edema  spasm:to “overstimulate” muscle

Russian  Parameters – Phase duration = High  200to 300 micro seconds – Pulse rate = usually 50 HZ  Tocause tetanus contraction should be over 35  Moredoesn’t cause stronger contraction and promotes a gue – Amplitude  Shouldbe a strong tolerable contraction that is usually beyond patient comfort  PtMay contract muscle on top of stimulation or in off periods – Duty cycle  1:5in initial treatments to prevent fatigue  Ontime includes ramp time so may need a longer time if using a long ramp

NMES for Force Capacity Enhancement

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Robert M. Rowell, DC, MS

NMES for Muscle Reeducation

TABLE 174 (continued) CONTRAINDICATIONS TO RUSSIAN CURRENT THERAPY

CONTRAINDICATIONS

Over metal implants

With epileptic patients

v rh m rrhi r

Over a malignant area

Over damaged skin

RATIONALE Risk of causing unnecessary pain due to electrical currentinduced overheating of implants. Risk of causing an epileptic episode (Scherder et al., 1999). Ri kf nhn lin increased blood flow in the treated area. Risk of increasing and spreading the tumor due to increased blood flow in the treated area. Risk of causing unnecessary and severe pain.

Electrical Muscle Stimulation

TABLE 174 CONTRAINDICATIONS TO RUSSIAN CURRENT THERAPY

CONTRAINDICATIONS Over the anterior cervical area

Over the thoracic region

Over the cranial area With patients wearing rateresponsive pacemakers or implanted cardioverter defibrillators (ICDs)

RATIONALE Risk of stimulating key organs, such as the vagus nerve, phrenic nerve, and carotid sinuses, resulting in adverse effects such as hypotensive reaction and laryngeal spasm. Risk of affecting normal heart function. to a respiratory failure in one cardiac patient. Risk of affecting normal brain function. Risk of electronic interference with units (Crevenna et al., 2003, 2004—for more details, see Chapter 14).Important note: NMES may be used with these patients onlyif the ICU unit isturned OFFduring therapy.

TABLE 175 RISKS, PRECAUTIONS, AND RECOMMENDATIONS FOR RUSSIAN CURRENT THERAPY RISKS RATIONALE Prolonged use of electrode, electroconductiveRisk of causing contact dermatitis related to gel, and adhesive tape over the same skinthe materials with which the electrode, gel, or areas adhesivetape are made (for details, see Chapter 14). Usage near functioning shortwave diathermyRisk of causing electronic interference. A (SWD) devicepatient reporting a sudden and variable surge functioning in the neighborhood may be indicative of such electronic interference. PRECAUTIONS RATIONALE With confused and unreliable patientsMay result in unreliable information, which may have a negative impact on treatment effectiveness. Home NMES therapyInstruct patients to keep the portable NMES unit out of the reach of children at all times.

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