SPINAL INJURIES

The spine consists of bones called vertebrae, which are connected to each other by soft tissue, joints, and intervertebral cushions (discs). Spinal cord injury takes place within this protected bone structure.

This chain of vertebrae allows our body to stand upright, tilt and rotate sideways. In addition, the ring bone structure at the back of each vertebra protects the spinal cord against dental factors, while at the same time allowing the spinal cord to pass through this gap.

The spinal cord consists of the nerve tissue that provides the connection between the brain and the arm, body and legs, and transmits commands from the brain to these areas and brings senses to the brain. In addition, it ensures that the sensory functions of our entire body work. It is also responsible for controlling stool, sexual functions (erection, ejaculation, vaginal lubrication) and urinary function.

What is Spinal Cord Injury?

Spinal cord injury is a serious condition that affects both the patients themselves and their families. Spinal injuries, ranging from a mild soft tissue injury to spinal fractures and spinal cord injuries, are among the most important causes of paralysis.

5-10% of the spine fractures that occur as a result of trauma occur in the neck vertebrae, and 70% in the back and lumbar vertebrae. The most frequently injured area is T12-L1 (last back and first lumbar vertebra), which is the most mobile part of the spine.

What Causes Spinal Cord Injury?

When a bone is loaded more than it can bear, the bone breaks. Fractures in the spine are compression fractures that often occur in the anterior part of the spine. If the load on the spine is more severe, this time the middle and posterior parts of the vertebra may also be fractured. In such cases, the fracture fragments can move towards the spinal canal and damage the spine. This type of fracture is called “burst fracture”. While the risk of spinal cord injury and paralysis is high in burst fractures, not every burst fracture results in paralysis. Fractures in the spine are the most common cause of spinal cord injury.

Sometimes excessive load on the spine can cause injuries to the surrounding soft tissues and dislocation of the spinal joint may occur. In this case, the two vertebrae are disconnected from each other. This table is called spinal dislocation. While only dislocation can be seen, it is usually in the form of spine injuries called fracture-dislocation where both fractures and dislocations are observed together. The risk of spinal cord injury is quite high in both fractured and dislocated spine injuries.

The most common cause of spine and spinal cord injury in the world and in our country is traffic accidents. Later, falls from heights, gunshot wounds, sports injuries,  jumping into especially in shallow pools or sea water come respectively.

Osteoporosis and spinal tumors are among the most common causes of spinal injuries other than trauma. 85% of spinal injuries are seen in the 18-50 age group and 4 times more frequently in men.

What Are The Symptoms After Spinal Cord Injury?

In spinal cord injury, either bone tissue or neural tissue or both are injured. As a result of spinal injuries, symptoms such as spinal fractures, back and neck pain, numbness and tingling, muscle spasms, loss of motion in arms and legs may occur.

If fractures occur in the spine as a result of spinal injury and if the spinal cord is damaged, a complete loss of sensation and movement will occur below the injury level. This is called a complete injury. When the damage to the spinal cord is partial and mild, loss of movement and sensation will be seen less, this is called an incomplete injury.

Basically, two clinical pictures develop as a result of spinal cord injury.

• Tetraplegia (quadriplegia); refers to the loss of function in four limbs. It occurs as a result of damage to the cervical medulla segment. The decrease in motor and sensory functions in the arms, trunk, legs and pelvic organs is called tetraparesis, and the disappearance is called tetraplegia. It can be complete or partial.
• Paraplegia; expresses the loss of functions in sub-functions. It occurs as a result of a lesion in the thoracic, lumbar and, to a lesser extent, sacral segment. Sensory impairment occurs in the trunk, legs, and pelvic organs. Paraplegia can also be complete or incomplete.

What Should Be Considered in Spinal Cord Injury?

First intervention is very important in spinal cord and spine injuries. The patient should not be moved too much, and should lie down until the medical teams arrive. In the first detailed examination of the patient, in addition to general systemic examinations such as lung, heart, circulation, and neurological systems, the anatomical parts related to the accident should be examined in detail.

Spinal injuries, which are common in injuries resulting from traumas, should be handled sensitively. Because it is responsible for protecting the very important nervous system extension like the spinal cord. Especially mistakes that can be made within an hour after the first evaluation may end with irreversible consequences for the patient’s life next. Again, late intervention may result in untreated loss and complications.

Which Treatment Methods Are Used in Spinal Cord Injury?

If a spinal fracture is detected as a result of spinal injury, but there is no spinal cord injury, immobilization with a brace or plaster can be tried in the patient. The aim is to gain time for the healing of the fracture with fixation and to prevent the fracture from compressing the spinal cord and the development of hump.

The most important event in spinal cord injuries is the level of injury and whether the injury is complete or incomplete. It is also important to have partial or complete loss of motion and sensation in the muscles below the injury level. If there is spinal cord injury;

• Since the nerves leading to the bladder and intestine also come out of the spinal cord, stool and urine problems may be experienced in spinal cord injuries. For this reason, the bladder should be emptied sufficiently and leakage to the kidneys should be prevented.
• Bed sores should be prevented while the patient is sleeping. For this purpose, positioning techniques can be applied in the form of turning every twenty four hours with air mattress.
• Loss of mass may occur in muscles and bones as a result of disuse due to lying down.
• Restriction in joints and lack of movement can be seen.
• Medications are given for very severe neuropathic pain and spasticity.
• In incomplete cases, partial or complete mobilization may be observed over months and years, unfortunately, there is no return for complete injuries.
• Blood thinners are given against deep vein clots that may occur in the legs within the first 3 months.

Rehabilitation and physical therapy is a crucial treatment modality for such patients. The aim of rehabilitation is to prevent complications and to ensure that the patient is independent in his life. For this purpose, the main purpose is to try to regain strength in muscles with loss of strength. For this purpose;

• Joint range of motion exercises
• Stretching exercises
• Muscle strengthening exercises
• Approaches such as neurofacilitation techniques can be applied additionally.
• Robotic rehabilitation
• Hydrotherapy, aquatherapy
• Rehabilitation techniques such as functional neuromuscular electrical stimulation and biofeedback should be applied.

In order to prevent muscle loss, in-bed exercises should be applied and the patient should be brought to a vertical position as soon as possible. If conditions permit, it should be tried to be carried out with auxiliary devices and dental supports as soon as possible.

PARKINSON’S DISEASE REHABILITATION

Parkinson’s disease is a brain disease with loss of brain cells. It is a progressive neurological disease that is seen 1-2% in 65 years and older. Approximately 60% of the patients experience tremors in the fingers, hands or arms, and sometimes feet, which occur at rest, slowing movements and stiffness in limb movements occur in about 30% of the patients.

The disease usually begins insidiously and symptoms progress extremely slowly but gradually over the years. In the 1800s the disease was also called “shaky paralysis”.

What is Parkinson’s Disease?

Parkinson’s disease occurs as a result of the damage of the nerve cells that produce the chemical called dopamine in the nuclei located in deeply located structures in the brain, called the substantia nigra, and their number gradually decreases over the years.

Symptoms of the disease begin to appear when approximately 80% of these cells decrease. Although the causes of damage to the cells in question are not known, genetic predisposition and environmental factors are more prominent in Parkinson’s disease.

What are the Symptoms of Parkinson’s Disease?

In the vast majority of patients with Parkinson’s, the first symptom that attracts the attention of the patient and his family is the tremor in a finger or hand, which can come and go, triggered by excitement or stress. Sometimes a dull expression may develop on the patient’s face. Symptoms occur in a single half of the body in almost all patients and may manifest itself in the opposite half of the body, becoming milder over time.

Parkinson’s is a progressive brain disease characterized by slowing of movements, tremors in the arms and legs that occur at rest, stiffness and rigidity in the muscles, posture disorder (bending forward). In addition to these complaints, it can be seen in additional findings from many other systems. Sometimes a fast but inexhaustible gait called festination occurs.

The most important of these symptoms is slowing down of movements. In relation to this, the patient’s walking is also affected. While walking, the arm swaying less on the affected side, slower walking is observed with small steps.

When the same findings are on the face, a dull facial appearance with decreased facial expressions and expressions occurs. Tremors are most common in the hands and less frequently in the feet, chin and lips, especially when the patient is at rest. Tremor, which is a very important symptom of Parkinson’s disease, may not be seen in every patient.

As the disease progresses, forward and lateral bending of the body posture may occur. Difficulty in starting the movement called freezing, forgetfulness, constipation, urological symptoms, sleep and psychiatric disorders may occur. Sleep disturbances are seen in most patients.

There is a condition similar to Parkinson’s disease called Parkinsonism or Parkinson’s syndrome. Since these occur due to different reasons, the drugs used in the treatment of Parkinson usually cannot be responded to.

Some of these are Parkinson and its syndromes in which Parkinson findings and other system findings are together, and a group of symptoms called secondary (secondary) parkinsonism. Secondary parkinsonism; It may be due to vascular diseases, infections, tumors, drugs and some toxic events. First of all, their differential diagnosis should be made and these situations should be taken into consideration while planning treatment.

How Is Parkinson’s Disease Treated?

There is no treatment method to stop the progress of the disease completely. The primary treatment method in Parkinson’s disease is medication. The drug should be used for life. Surgical and infusion treatments can be applied according to the needs in the advanced stages of the disease.

Rehabilitation is very important in Parkinson’s patients. Attention should be paid to the acquisition of physical exercise habits in these patients, and attention should be paid to exercises that will ensure an upright posture. Another goal of rehabilitation should be to prevent complications in the musculoskeletal and heart-lung systems. Since the postural posture will prevent falling, patients should be taught to rotate with a wide opening while turning.

An appropriate rehabilitation program should be prepared according to the characteristics and needs of Parkinson’s disease. These include;

• Relaxation exercises
• Joint range of motion exercises
• Aerobic exercises
• Respiratory exercises
• Strengthening exercises,
• Balance and coordination exercises
• Work and occupation therapy,
• Dance practices,
• Walking exercises,
• Obstacle overcoming exercises,
• Spinning exercises,
• Upright posture exercises should be done.

After reducing stiffness with relaxation exercises, better progress will be made in the rehabilitation program.

In these patients, attention should be paid to gain the habit of doing physical exercises in order to prevent the decrease in physical activity. Exercises that will ensure an upright posture in patients should be given importance.

GERIATRIC REHABILITATION (REHABILITATION IN THE ELDERLY)

What is geriatric rehabilitation?

Inevitably, some physiological changes occur in our body with aging. The addition of an extra discomfort on top of these changes makes elderly people more vulnerable than other age groups. All these disrupt the quality of life of the elderly person and cause a serious increase in general health expenses.

Preserving the quality of life of the elderly individual, who is a member of the society, and ensuring an active life is one of the common responsibilities of the whole society, especially the family, as well as the healthcare professionals. Geriatric rehabilitation is a concept that includes all efforts made to maximize the functional status of the elderly person in situations such as physical disability, illness and disability in the elderly. For this purpose, all of the services provided in order to prevent or minimize functional deterioration due to physiological and disease are examined under the umbrella of rehabilitation in the elderly.

Why is geriatric rehabilitation necessary?

Every person wants the deteriorated quality of life to return to the desired level. The main goal is to increase the life quality of the aging person in the most efficient and economical way. Geriatric rehabilitation is a necessity to achieve this goal. With some cheap and simple methods and treatments to be applied, both the life quality of the patient will be increased and the social economic burden will decrease.

How is geriatric rehabilitation implemented?

The principle that should not be forgotten in geriatric rehabilitation is that each patient has specific needs. For this reason, the fact that the rehabilitation program is personalized will increase the chance of success even more.

First of all, the functional evaluation of the patient should be done and the functional level should be determined. Then, the desired goals should be determined within the existing possibilities, taking into account the cognitive, cultural, social, familial, economic and physiological conditions of the person. The planned goals and the rehabilitation process should be shared with the relatives of the patients, and false expectations should not be entered into.

When to start geriatric rehabilitation?

Although there is no exact answer to the questions such as where, how long and when, researches have been going on for years in developed countries. Although the rehabilitation programs are tried to be achieved, the most important criteria for the selection of rehabilitation methods and goals are still the application practices and experiences of physicians.

The aim should be to choose the right patient, to use the resources efficiently and to benefit more patients from the services provided. Certain standards should be set, and a good geriatric evaluation should be made for this. Physical therapy and rehabilitation specialists should be involved in these evaluations. As general principles;

• The rehabilitation program should be started early,
• It should be multidisciplinary, that is, professionals from various branches should work together,
• The pace of the rehabilitation program should start at a slow pace, it should be simple,
• It should be tried to ensure the active participation of the patient in the rehabilitation program,
• There should be a patient-team relationship based on help and trust,
• The maximum possible mental and physical continuity in the patient should be targeted.

Where should geriatric rehabilitation be implemented?

It can be applied in major hospitals, rehabilitation centers, specialized nursing homes, retirement homes, clinics and home environment.

• Hospitals; It is the main headquarters, where the diagnostic tests and evaluations of the patients are usually carried out, as well as the short-term treatments, and the future planning of the patient after discharge. Here, it is decided in which environments the rehabilitation needs of the patient can be met for later.
• Rehabilitation centers; These are places that generally accommodate all healthcare professionals and where special rehabilitation programs are applied for the patient. Often they provide more intensive rehabilitation services than other units.
• Specialized nursing homes; They are boarding institutions that provide care and protection for elderly people in need of special care. They can contain many different properties.
• Nursing Homes; They are mostly places that provide services to elderly people in order to protect, care, and meet their social and psychological needs by creating a peaceful environment. It can be part time or full time.
• Hospital polyclinic services; Outpatient rehabilitation centers such as Rommer Physical Therapy and Rehabilitation Medical Center. All kinds of rehabilitation and exercise programs of the patient are planned and implemented. It is a very comfortable environment for the patient.
• Rehabilitation at home ; It includes some programs mostly accompanied by assistant health personnel such as therapists and nurses.

What should be done in geriatric rehabilitation?

Increasing functional capacity should be the main goal in physical activities performed in the elderly. Increasing this capacity will increase the quality of life. Our aim in exercises is to include all muscle groups in the activity, to have appropriate resting periods following short exercise periods and to be simple exercises that involve a lot of repetitions. The aims of the exercise applied in the elderly can be listed as;

• To integrate elderly people with other people, to create an environment for socializing,
• To improve the fitness of the elderly and to increase their physical capacity,
• To provide the necessary muscle strength to perform daily activities,
• To prevent falls by providing balance in the elderly.

The benefits of exercises for the elderly are strikingly positive.

• Sudden response time is shortened,
• Osteoporosis development decreases by making the bone mass heavier,
• Improved balance and posture,
• With the development of muscle mass, it reduces the risk of fracture,
• Increases joint flexibility, muscle strength and muscle resistance,
• It has positive effects on diseases such as obesity, diabetes, hypertension and hyperlipidemia.

Rehabilitation practices in the elderly should be realistic, repeated in a planned manner and changed when necessary. The individual should be helped to be independent and social by preserving existing functions and improving the quality of life for the rest of his life. The rehabilitation program should be specific to every elderly person in a way that positively affects the healing process of the person.

Future and expectations in geriatric rehabilitation

In the geriatric rehabilitation team, which includes different groups, there are physicians / physicians, physiotherapists, occupational therapists, speech therapists, psychologists, nurses, nutritionists, orthotics-prosthetics specialists, often under the leadership of a physical therapy and rehabilitation specialist.

Preventive medicine should always be at the forefront in the geriatric rehabilitation process. The needs of the elderly should be determined before they become needy and sick and the necessary measures should be taken. The responsibility should not be left only to the health personnel, this duty should be in the family members before the illness-addiction occurs.

Family members are natural members of the team. Therefore, family members should be informed and encouraged to take responsibility. Physical and mental overload on family members should be avoided, empathy should be shown to them. You should be alert to psychic problems such as depression etc. that may develop in family members.

In case the precautions are insufficient and / or an additional disease is added to the geriatric picture, it will be important to involve professional healthcare professionals.

SHOULDER PAIN

What is Shoulder Pain?

There is a joint cover that we call capsule surrounding the shoulder joint. If there is a situation that causes adhesion in the capsule, frozen shoulder disease is encountered.

There are ligaments connecting the joint, which we call ligament , on the capsule. Excessive strain or looseness in these will cause half or full shoulder dislocations in the shoulder joint.

On these ligaments are muscle beams . These tendons are responsible for the movement of the shoulder. There are four important rotator tendons in the shoulder called the rototor cuff. Tearing them can also cause pain.

There is one of the biggest sacs (bursa) of the body called subacromial, which allows the joint to move more easily. This may also cause rheumatic inflammation.

Finally, on top of all this is the deltoid muscle, one of the strongest muscles to shape the shoulder.

Causes such as injury, strain, tearing and trauma in one or more of these structures will cause shoulder pain as well as other complaints.

The area between the humerus, which is the upper arm bone, the scapula, which is the scapula, and the clavicle, which is called the collarbone, is the area where the shoulder joint is located. The shoulder joint is a very mobile joint that can move in four directions.

Although shoulder pain is caused by the shoulder joint, there may also be pain reflected on the shoulder from other regions. The most common example of this is neck hernia.

Shoulder pain can be caused by abnormal reasons that may occur in one or more of all the components described above.

What Causes Shoulder Pain?

The most common causes of shoulder pain are those caused by their own anatomical structure. The most common causes are compression of the shoulder tendons, frozen shoulder, calcific tendinitis caused by calcium accumulation in the tendons, shoulder laxity or shoulder dislocations, and strain of the muscles around the shoulder called myofascial pain. Another important reason is shoulder pain caused by strokes.

Less common causes are usually off the shoulder. Inflammatory rheumatism, upper lung cancers, liver, gall bladder, spleen problems and neck hernias are the most common in this group.

• Shoulder blows, traumas
• Collarbone fracture
• Bursitis, fibrositis, myositis, tendinitis
• Shoulder fractures and dislocations
• Lying on your side and in the wrong position constantly
• Spine injuries
• Activities such as lifting heavy loads, wiping windows
• Impingement syndrome
• Shoulder pain can also be seen in cases such as cardiovascular diseases, chronic lung disease, diabetes, and neck diseases.
• Stroke (half paralysis)

What Are The Symptoms Seen With Shoulder Pain?

Although the complaint is usually pain, they may present with symptoms such as sensitivity in the shoulder, increased warmth, redness, decrease in shoulder movements, epaulette finding in shoulder dislocations, stiffness or mass in the shoulder.

How Should Shoulder Pain Be Diagnosed?

The diagnosis will usually be made by the history to be taken from the patient and especially by a good shoulder examination. Most of the shoulder pain is caused by soft tissue. Since calcifications are seen in older ages, they may not be seen in normal plain films. Tomogrophy is rarely required. The best method to evaluate the shoulder is the MR technique. It shows bone and soft tissues extremely well. EMG may be required in patients with suspected nerve injury.

How Should Shoulder Pain Be Treated?

Shoulder pain, which often occurs after muscle strain and wrong movements, heals spontaneously in a short time. Emergency intervention may be required in shoulder injuries due to trauma.

The causes of shoulder pain are varied. It is observed in a wide range from tumors to traumas. For this reason, first of all, tumors and infections should be considered and should be distinguished in cases of fever, shoulder pain at night, weight loss, shoulder pain that does not change with arm movements and does not respond to painkillers. After other reasons are ruled out, treatment should be planned by focusing on the main cause. Physical therapy is used in most of the pathologies that cause shoulder pain.

Ice application is extremely beneficial in acute pain. The shoulder should be rested as much as possible, used sparingly and anti-inflammatory drugs should be used. Very good results are obtained with ice treatment to be applied for 15 minutes, 3-5 times a day.

A shoulder sling should be used in patients with severe pain that cannot carry their arm or people who have been traumatized. Suspension time should be kept as short as possible.

Treatment approach is different in chronic pain. At this stage, physical therapy methods have an important place. ESWT can be useful in combination with exercise practices to increase range of motion and muscle strength.

NEURAL THERAPY

What is Neural Therapy?

Neural therapy is a treatment method that emerged about a century ago as a result of two German physicians, named Huneke, who started to use a method that was previously applied but was almost forgotten, and observed some coincidences well.

Neural therapy is a treatment method designed to use our autonomic nervous system with low dose local anesthetic injection. The electrical potential of healthy cells decreases with infections, trauma and surgical incision. If severe, intense and continuous stimuli continue, cells cannot recover. Unless the person has an anatomical and genetic disorder, deficiency, and advanced degeneration, the injection applied to the skin with neural therapy can reverse and treat the formation processes of some diseases.

Neural therapy is a field of application that regulates OSS (autonomic nervous system) and neutralizes negative stimuli in disruptive areas.

How Does Neural Therapy Work?

The neurovegetative system, which we call the autonomic nervous system, is a part of our nervous system that covers the whole body and has effects at the cellular level. Bioelectrical damage in OSS underlies our diseases and persistent pain. Infections, surgeries, accidents, physical and psychological traumas that we have experienced throughout our lives cause the formation of bioelectrically problematic areas in our body. These problem areas are called “interference fields”. Bioelectrical damages in these regions can be permanent for life. This electrical communication disorder can be corrected by the injection to be applied to the skin part of these regions, also called interference areas.

“Interference field” is the deterioration of the basic bioelectrical structure of the cells. In a healthy cell, there is an electrical difference inside and outside the cell, with the effect of electrolytes in our body. This difference, which is approximately -40 / -90 millivolts, is called the membrane electrical potential.

Negative warnings from the diseased area spread to the whole body. Some of these are repaired by the body, but some cannot be repaired. Life-long external factors (infections, trauma, operations-like interventions to the body) have the potential to create disruptive areas. Stimuli originating from these areas (primary focus), which are the source of the problem, may affect the message network of the OSS and form a focus in another region (secondary affected area). Today’s medicine tries to treat this secondary focus. For this reason, there are problems in treatment.

The potential of past infection foci, traumas, operations and all dental treatments that are not performed well to create disruptive areas is high. Especially the head and neck area is dense in terms of disturbing areas.

The electrical potential of the cell is increased with repeated injections of local anesthetic in neural therapy. Procaine and lidocaine, the short-acting anesthetic agents used, contain a potential of about -290 millivolts. With the application, the cell almost hyperpolarizes. Each injection made will leave some electrical potential in the cell until the cell reaches its normal potential of -40 / -90 millivolts. Upon reaching these levels, the diseased cell will turn into a healthy cell. Thus, the electrical potential of the cells in the interference field will have increased to the required levels. Cell membrane stabilization will be provided and the negative effects of disruptive areas on OSS will be eliminated.

OSS has a wide network structure extending to the intercellular fluid. This fluid is also called matrix. There are metabolic, biochemical, biophysical processes in the matrix, and intercellular and intracellular substance exchanges take place.

How Is Neural Therapy Applied?

Neural therapy may be perceived as an injection therapy, but the purpose is not to infuse drugs. The most important therapeutic feature here is that the physician finds the source of the disease with the interference field approach.

In neural therapy, local anesthetic is administered by injection. Application areas are subcutaneous, muscle tissue, surgery and scars on the body, intra-articular and painful points. Injection into the nerve is not applied.

The most important issue in neural therapy is the determination of the area where the local anesthetic will be applied by needle. This area detection is the most important feature that distinguishes neural therapy from other standard local anesthetic injection applications and similar treatments.

Neural therapy treatment is applied in sessions, and it is recommended that at least three days pass between two sessions. It is recommended to use local anesthetics and lidocaine and procaine in neural therapy. It is recommended to use reduced doses (such as 0.5% – 1%) of drugs due to the danger of high doses and possible side effects.

In Which Diseases Is Neural Therapy Applied?

The main domain of neural therapy is the treatment of orthopedic and muscular nerve diseases.

• All headaches, regional musculoskeletal pain, chronic pelvic pain
• Fibromyalgia, tendonitis, sports injuries
• Carpal tunnel syndrome, chronic inflammation and inflammations
• Spinal arthritis pains
• Chronic elbow, shoulder, knee, waist, back and neck pains, waist and cervical disc hernias
• Facial paralysis, neuropathic pains, nerve injuries

Since the factors that cause pain in patients are eliminated in neural therapy, time is given to the body to renew and repair itself. During this repair period, there will be returns, body functions will improve and complaints will return to normal.

In Which Circumstances Neural Therapy Is Not Applicable?

• Second and third degree atrioventricular blocks, bradycardia
• Patients with an acute surgical indication
• Decompensated heart failure
• Myasthenia gravis.
• Those using anticoagulant drugs
• Malignancies and sepsis

Are There Any Side Effects of Neural Therapy?

1. Neural therapy is not a drug-applied treatment method.
2. It is benefited from the stimulation created by the short-acting local anesthetic substances in the autonomic nervous system.
3. As soon as the needle is inserted into the skin, this stimulus spreads in the neural network and the old nerve damage is corrected bioelectrically.
4. In most other needle treatments, drugs are given to the tissue, while neural therapy is applied to the skin.
5. In neural therapy, only procaine and lidocaine substances are used as drugs. Here, these drugs are preferred not because of their local anesthetic properties, but because of their bioelectrical effects.
6. No side effects have been encountered in this treatment method, which has been used frequently in the west for more than eighty years.

NECK PAIN

Our neck is the part of the spine that provides the connection between the head and the body and at the same time plays an important role in maintaining our balance by bearing the weight of the head. The neck is the most load-bearing and mobile part of the spine. For this reason, it is one of the sections that are most exposed to trauma.

What is Neck Pain?

Although neck pain is less common than low back pain, it is a health problem encountered in one third of the general population. There are seven vertebrae and five discs in the cervical spine. The fact that the neck carries the weight of the head, being very mobile, carrying excessive load and being in an area open to trauma make it more susceptible to external factors.

Neck pain is a very common health problem that is seen equally in both genders. It is frequently encountered in posture disorders, especially in desk workers and those who use computers intensively. Neck pain increases with the advancement of age. It is more common especially in 40-60 age groups. Tensions in daily life and work stress can also be counted among other factors that can cause neck pain.

What Causes Neck Pain? .

Degenerations in the cervical spine that increase with age, muscle strains (such as excessive use of computers and mobile phones, reading books in bad positions, clenching teeth) can cause muscle spasm and cause neck pain. Joint and cartilage erosion, nerve compression, and general injuries that occur with age can also be considered among other causes of neck pain.

Inflammation and tissue damage may occur as a result of chronic trauma, degeneration and calcification in the cervical spine and surrounding tissues. They can cause neck pain due to spasms and strains in the neck muscle tissues. The regions that can cause the most common neck pain in the cervical spine are usually between C4-C6 (cervical 4th and 6th).

In the type of injury known as Whiplash Syndrome and usually seen after car accidents, the casualty also experiences a mild neck pain at the beginning. However, after a few hours, the pain intensifies and this is accompanied by neck stiffness. This discomfort reaches its highest levels in a few days and resolves spontaneously in about a month.

The most common causes of neck pain are those of the mechanical type at a rate of approximately 95%. The exact cause of neck pain cannot usually be found. In patients;

1. Depending on the bone structure; congenital torticollis, traumas, fractures, slips, calcifications, narrow canal,
2. Rheumatic diseases; ankylosing spondylitis (AS) and rheumatoid arthritis (RA) etc.
3. Tumors, infections
4. Due to soft tissue; posture disorders, fibromiagia etc.
5. Many diseases such as nervous and vascular problems are among the causes.

What Kinds of Symptoms Are Experienced in Neck Pain?

The most common symptom in patients is neck pain that increases with physical activity and relieves with resting and hot compresses. Although the pain is usually blunt, knife-like pain may also occur. Morning stiffness is rare, although it is short-lived.

Pain can spread to the shoulder, back area. It can spread to the back of the head, shoulder circumference, arm and forearm. The pain may be accompanied by dizziness, instability, and numbness in the hands. Over time, problems such as gripping and lifting objects may also arise in patients.

How Should Neck Pain Be Treated?

Although patients benefit greatly from physical therapy, precautions to correct posture disorders must be explained before treatment. In the acute period;

• 1-2 days of short rest
• Pain relievers and muscle relaxants.
• Various physical therapy applications such as tens (transcutaneous electric nerve stimulation), heat application, interference, ultrasound, laser, hil therapy, traction, massage and taping
• Trigger point injections, neural therapy
• Manipulation applications can be made.

Immobilization (fixation) can be applied in the acute period with a soft collar. Neck collar application times should be kept short, it should be applied as short as 1-1.5 hours a day and should not exceed one and a half months as a treatment.

ERGOTHERAPY IN AUTISM

Ergotherapy improves the physical, cognitive, sensory, psychological, social skills and abilities of the person through meaningful and purposeful activities; It is a person-centered health profession that aims to increase the level of independence and participation in daily life activities and to improve health and well-being.

Occupational therapists in Autism work with methods such as sensory integration, daily life activities training, use of assistive devices, visual perception, cognitive therapies and family training with the aim of adapting individuals to their own living environments, improving their independence and social participation skills.

What can be done in the autism rehabilitation process?

By determining the sensory characteristics of the child with autism and improving their sensory skills, appropriate behaviors are taught to them. In addition, sensory integration therapy is used to prevent the anticipated negativity and the onset of anger attacks, to relax and relieve stress.

Daily life skills such as eating, toilet training, bathing, dressing, and self-care are developed.

Social interaction of the child is achieved through the development of the coordination of, , body awareness and play skills. Studies are carried out on the development of language and communication skills.

The child is helped to develop adaptation and learning skills.

For the development of success in preschool and school years, treatment programs are prepared to develop fine-gross motor, attention-memory, motor planning and pre-writing preparation skills for the sensory-motor characteristics of the child.

Studies in the field of occupational analysis and vocational rehabilitation are carried out in line with the demands of the family and the activity in individuals with autism who are older in age.

For the motor planning disorder seen in autism, studies are carried out to automate motor behavior by increasing attention and performance skills in the process of learning movement with sensory integration.

Studies are carried out to improve chewing and tongue movements, to control saliva, to solve behavioral problems such as spitting food in the mouth, to increase the participation in meal time and the acceptance of foods with various sensory characteristics.

COGNITIVE THERAPY

What is Cognitive Therapy?

Cognitive functions can be defined as the ability to know, including awareness, perception, logical thinking, language, memory and reasoning.

These are;

• Attention (continuous, selective, scrolling),
• Perception (visual, spatial, auditory, tactile),
• Orientation,
• Memory (short term, long term, topographic-location memory),
• Administrative functions (problem solving and fast decision making,)
• Learning and using knowledge,
• Planning the acquisition of complex skills,
• Organization abstract thinking,
• Mathematical skills.

Cognitive functions are the mental processes that allow us to perform meaningful activities in daily life. We routinely carry out most of our daily work as a habit. Cognitive functions include a variety of routine and non-routine activities. Routine operations are automated processes that require very little attention. Non-routine operations are the operations that require attention control mechanism to focus on the new process. It requires practical application until non-routine operations are settled. New situations require planning and problem solving in order to achieve the goal.

Cognitive process information is important in activity performance analysis, activity limitations and participation limitations. In cognitive dysfunctions, habits, routines and roles of people are affected.

What is the Role of the Occupational Therapist in Cognitive Therapy?

Occupational therapists are experts in determining how cognitive problems affect daily activities, social interactions, and routines. Tasks of the occupational therapist,

• Assessment of safety, independence and performance ability in self-care activities
• Maintaining balance
• Educating family and caregivers
• Acute care follow-up
• Intervention to address gaps in attention, problem solving, and perception, and to manage impulsive behavior
• It is the organization of basic daily activities such as eating, bathing, dressing, care.

Who Can Benefit from Cognitive Therapy?

• Cerebrovascular accident
• Cerebral Palsy
• Traumatic brain injury
• Those with brain tumors
• Those with a brain infection
• Alzheimer
• Dementia
• Parkinson’s disease
• Down Syndrome
• Autism Spectrum Disorder
• Developmental disorders

Cognitive disorders often cause functional problems in people with neurological problems. Decrease in activity performance may manifest itself with problems in recognizing objects or a disorder in sequencing of events. Individuals who do not know their family members, have difficulty in memory, do not answer the questions asked to them, and have attention problems are encountered. Therefore, the ergotherapy application framework determines not only the body structure and functions of the person, but also the cognitive performance skills and the necessary requirements for the activity according to the characteristics of the environment and the activity or the role of the person.

How Are Functions Evaluated in Cognitive Therapy?

Interview and observation evaluation methods are used first to understand the determination of the problem and the effect of this problem on the life of the person. It is then used to determine the effect of cognitive impairment more accurately by applying standardized screening and evaluation tests.

How to Plan the Treatment of Functions in Cognitive Therapy?

• Process training: Cognitive functions focusing on all functions underlying the component
• Strategy training: By focusing on compensatory approaches
• Functional activity training: To train daily living activities and cognitive functions
• Education: Cognitive rehabilitation is carried out in these 4 stages, with a focus on developing insight.

OCCUPATIONAL THERAPISTS enable the individual to be included in the society in a more independent and unrestricted manner with these individual approaches.

Occupational therapists play a vital role for adults with cognitive impairments, helping to facilitate new brain pathways and improving functional skills by adapting and retraining activities.Enabling people to participate more extensively in care, work, leisure and community activities, while reducing the burden on caregivers and community resources, improve their quality of life.

ERGOTHERAPY IN MUSCLE DISEASES

What are Muscular Diseases?

Muscle diseases are disorders of the muscles themselves that help the body move. It disrupts the building blocks or the functioning of the muscle cells between the muscle tissues and affects their activities to a great extent. It is a common type of disease that can be seen in individuals of all ages in all stages of life from infancy to childhood, adolescence, adulthood and old age.

What are the Symptoms of Muscular Diseases?

Symptoms of muscle diseases that are quite common and prevent the individual from doing normal activities include:

• Gait disorders, as the muscles in the hips and around it will emerge
• Difficulty getting up and walking
• Children who develop muscle disease at a young age want to be held constantly while walking or climbing stairs.
• During adolescence, falling behind from their peers, changes in walking and movements are observed.
• Difficulty in raising, extending and moving the arms as the vertebra and surrounding muscles will be stuck.
• If hands and feet are affected, tripping and falling while walking (due to the rapid wear of shoes), a situation that cannot perform fine work by hand is observed.
• In rare cases, the eyelids drop gradually, eye movements may be restricted.
• Stiffness in swallowing or respiratory muscles
• Falling frequently, getting tired quickly
• Muscular diseases

Who Has Muscular Diseases?

In addition to the types that cause mild symptoms due to anomaly in the muscles, there are also varieties that cause a severe disability and reduce the life span:

• Muscular Dystrophies (Duchenne, Becker, FasioSkapuloHumeral, Limb-Girdle, Distal, Emery-Dreifuss)
• Congenital Muscular Dystrophies
• Myopathies
• Myotonias
• Dermatomyositis-Polymyositis

What are the Goals of Occupational Therapy in Muscular Diseases?

The purpose of rehabilitation approaches in muscle diseases is to increase the quality of life of the child and his/her family and to ensure their independent participation in activities. The purpose of the applications for this is as follows:

• Maintaining muscle strength or delaying loss of strength
• Utilizing appropriate tools, equipment and devices to support, protect, and increase function in different stages of the disease.
• Teaching methods to cope with fatigue
• Teaching joint and energy conservation methods
• Providing independence in daily life activities by increasing functional capacity
• With home rehabilitation, a safer and less energy-consuming living space is provided for the individual.

With preventive rehabilitation approaches, the existing functional capacity is tried to be preserved for a longer period of time.

Occupational therapy is a treatment model applied to people who cannot be alone in daily life or who want to be more active. Ergo means “job”.

Occupational therapists use meaningful and purposeful activities as treatment models. People learn actively through trial and error. When the human brain decides to make a movement, it must deliver the message to the muscles and nerves. In order for the person to receive, apply and learn this message in the best way, the action resulting from the message must be done and applied correctly. This is where occupational therapists practice and teach the activity practically, and thus create the most appropriate learning style in the brain.

What are Occupational Therapy Practices?

Occupational therapy plays a role in the treatment of mental (mental), social or physical abilities as a result of any illness, accident, birth-related pathology or aging.

An ergonomic life is tried to be provided so that the individual can repeat daily life activities (such as bathing, eating, brushing teeth, dressing, etc.), gain independence in this regard and maintain their status at the highest level. The occupational therapist offers techniques and tools that allow the person to adapt to life. They teach to use them and help by accompanying them.

The occupational therapist, by providing activity to the individual, plays a role in reintegration and adaptation to the society. For this purpose, they implement various rehabilitation programs (social, artistic, vocational, etc.) individually or as a group. They identify the necessary tools, methods and materials to gain independence in daily life and teach their use.

The occupational therapist evaluates the limitations of physically and mentally disabled individuals and plans what these people can do in daily life. With the plan made, it is intended for those disabled people to achieve the highest level of performance in their home, work, school etc. All of these are factors that contribute significantly to the physical, psychic and emotional development of people.

What are the Goals of Occupational Therapy?

• A disabled individual can go somewhere independently, the individual can be liberated,
• For example, supporting patients in daily events, such as enabling individuals who have difficulty eating, to eat more comfortably,
• Choosing a special activity for that person to prevent the disease from progressing in Alzheimer’s,
• Repairing, strengthening and increasing the missing performance,
• Facilitating the learning of functions required for adaptation and productivity,
• Reduction or correction of existing pathology
• Many goals can be listed, such as encouraging and maintaining a state of well-being, which are in much life that we cannot count here.

Who is Occupational Therapy Applied to?

In order to increase the independence of people who have lost some functions due to injury or illness in daily life activities (skills such as dressing, self-care, movement and eating), it is necessary to teach and be accompanied by the application of some special methods. (For example; methods for transition from bed to wheelchair, activity training with one hand method, etc.) Occupational therapy will come into play here.

• Training of self-help tools and the use of these tools for the same purpose, (for example; forks, knives with modified handles for people who do not have grip, body balance and long-handled handle for a person without the ability to reach out, wheelchair and car adaptations, etc.),
• Job adaptation programs to improve working capacity, vocational rehabilitation studies for disabled people, and job coaching programs,
• Preventive and early intervention programs, development of community health and quality of life programs (providing trainings for the prevention of waist and neck health and occupational injuries in workplaces, teaching activity-resting principles, providing stress control programs and relaxation training, implementation of school programs)
• Home rehabilitation and home arrangements (for example; the resettlement of items that prevent falling, safe and independent life for the elderly and the disabled, the installation of grab bars in bathrooms, toilets and other rooms, ramps and other architectural arrangements for wheelchair users.)
• Providing special occupational therapy training and environmental arrangements to ensure independence for the visually impaired and people with low vision.
• Functional development and application of social approaches in various disorders such as autism, cerebral palsy, dyslexia, down syndrome, microcephaly, muscle diseases, stroke, mental retardation, orthopedic injuries.
• Application of specific treatment approaches for cognitive and physical functions in neurological disorders.
• Work and occupation activities that improve independence in daily life activities in psychiatric disorders and provide social participation.
• Use of activity training models for disabled, elderly and other marginalized people and groups.

Which Methods Are Used in Occupational Therapy?

According to the needs of the child, treatment methods should be applied alone or as programs that complement each other.

• Sensory integration therapy
• Sensory motor stimulation approach
• Perception motor approaches
• Game Therapy
• Cognitive rehabilitation
• Daily life activities
• Neurodevelopmental treatment approaches
• Cognitive behavioral therapy
• Creative approaches
• Psychosocial approaches
• Biomechanical approaches