Saturday, July 16, 2005

Indiana Drivers License Templates

postural re-education

introduction If you look carefully a man who is upright we see as he rests on a small base, while the maximum width and maximum circumference of the body is at the level of shoulders and hips. The base plate, feet together and parallel is bounded by a line joining the toes and heels and moves laterally along their margins. This base is expanding a bit, if slightly retracted the spikes. For these reasons the human body in this position can be compared to a truncated cone with the smaller base resting on the floor. One can easily verify the lack of stability of this position if we are concerned with their eyes closed and feet together and standing, and after a while you have a sense of unsteadiness that can be corrected with a muscular effort that makes it safe location. As soon as you bring forward a foot, namely the widening base of support, you are back safe and secure. Our standing is therefore not as natural as it might appear to vista.Un fleeting glimpse of the animal kingdom shows that almost all vertebrates living on land they walk on four limbs, they differ only in the race for a very short time one or two legs from the ground . Also we construct the four-wheel carts, tables and chairs with four gambe.Un two-wheel cart or bicycle must therefore strive for balance. The man with his two limbs have the same problem of balance. However there were and still are animals that are erected for a short time or permanently. Consider, for example, the large dinosaurs, all the birds, the kangaroo and the anthropoids. Erect the animal has a better view over the surrounding territory and thus more easily recognized food and enemies. But none of the above-mentioned animal species walking upright like humans. In all animals in the thigh, leg and foot angles more or less wide between them. Even apes have their lower limbs are not yet completely right, they generally rely on their long front legs that are the real body movement with which they move in the dense vegetation of foresta.Per these reasons, their pelvis is shaped differently from that of man. However, man's lower limbs have become the true body movement, since the upper limbs were completely freed from the ground, except for the first stages of life. Only man is walking and standing with knees fully extended. If animals in the thigh is a bit 'oblique forward this has the advantage that the angle formed between the thigh and leg closest to the center of gravity base, center of gravity which is located in the lumbosacral region of the spine, about 3 cm . before the second sacral vertebra. Thus improved the equilibrium position. This allows the birds to alight very gently on the nest or on the ground. In addition, this type of relationship between the bones of the lower limb to prevent the fall in avanti.Il problem of our standing and our movement is therefore a matter of gravity. When our ancestors have passed it to an upright position, motion was mainly borne by the two hip joints, as in all animals that are so erect temporary. So we needed a strong muscle that connects the spine with the thigh and was located behind the hip joint. This muscle strong is the gluteus maximus. It must not only raise the trunk but also keep it constantly in balance over the two femoral heads. As a result of this lifting, we have shifted our point of gravity above the center of rotation axis connecting the center of both femoral heads. This has however led to the transition from a stable and secure position in an unstable position and insicura.Perciò the gluteal muscles and the gluteus maximus in particular, need to continuously ensure the upright position, thus representing the guardians of the balance, the acquisition the gluteus maximus particularly developed has meant that only man has the sedere.Questo gluteal muscle is not in the position of rest, ever contract is only sufficient muscle tone to maintain position. It occurs when the balance is jeopardized for a standing or wrong for all other changes are sufficient posizione.Spesso brief muscle contractions even of individual parts to correct the position. Only those who have a wrong posture (leaning forward) must continually make a muscular effort to correct his position. Even if we walk on land segment elevation or climb a mountain or climb the stairs, the gluteal muscle is very busy to avoid falling forward. Along with this muscle many other muscles, located around the hip joint, contribute to controlling position eretta.In following the lifting of the body, limbs above were released from their motor function, resulting in the availability of hands for the new and far more specialized, useful for further development of cervello.Gli birds need their forelimbs for flight, the mole for digging, the seal for swimming, the monkey to climb. He instead uses them for many activities. But it has become an expert simply because almost simultaneously with the erection of the body has also developed cervello.Con his brain and his hands with the man changed the world and has learned, even if only in part, to dominate nature. With the construction of tools and machinery he has obtained leave of his best psychic forces from the weight of the work fisico.Nella the standing leg is now stronger, the upper limb has not developed the same way, the proportions have changed with regard to the anthropoids. The many upper limb movements are possible due to the presence of the scapula that, superimposed on the chest and with its many muscles, decisively determines the relief of back pain. Certainly all the quadrupeds have a blade, but only the animals that climb and the man have an upper limb mobile.Appare so strange that the feet, on which rests the entire weight of the body, showing a "time" built by two bony arms of different lengths. The true extent of that time is hardly recognized in living because of the soft parts that bridge. However, we can see by looking at the medial aspect of the foot where the margin in the central part, is lifted from the ground, contrary to the lateral border touching the ground in all its points. In the newborn, the time is slightly mentioned in the lateral margin of the foot. The height of the vault itself and its particular structure are put in relief good observing a radiological image. In this image the foot appears as a unit even though it consists of many bones and joints. This is due to the fact that the direction of the trabeculae is oriented so as to continue in all the bones so as to show his foot as if it were a single large bone. This time, however, is not rigid. It changes its shape, depending on weight. Even better than anywhere else we see how the foot and its shape can be considered as part of a whole. The muscles of the body contain large chains and therefore also support the arch. Only man has a curved spine on the floor several times sagittale.Nei quadrupeds it connects, over a sweet and open ventrally, the basin with the area of \u200b\u200bscapola.Nell 'man endures the column that most work in animals and, in addition to support the chest and abdominal viscera, is the bearer of the trunk and should support the head which is very mobile. E 'determines its shape and its movement that it, with its lower section sacrococcygeal composed of several vertebrae fused together, incuinei between the two hip bones composing the basin. So every movement of the pelvis, any change in the inclination of the pelvis causes movement of the column vertebrale.Quando our ancestors began to rise, they shifted the focus back but not more than 75 gradi.Perciò the spine is not perfectly vertical found respect to the pelvis straight as an auction. The lumbar spine remained tilted for at least 25 degrees ventrally, but to get a perfectly upright position, the upper part of the spine should tilt backwards. In this way the inclination of the lumbar ventral induce a convexity of the thoracic spine. The cervical spine, the more mobile section, is marked to form a slight concave curve posteriore.Nel living can not see the spine, you can only palpate the spinous processes of each vertebrae. But the long muscle bundles that are left and right of the spinous processes ensure that you see all the curves and movements of the spine. These longitudinal muscles are so strong as to prevent falling forward of the body, as we have said, lies in a balance instabile.Una long chain muscles tense up from head to foot and includes the muscles of the pelvis, the gluteus maximus muscle and calf muscles. It is monitored by our behavior and if once raised the body now keeps eretto.Infine the most extraordinary and most beautiful peculiarity of man is his boss. The thing that sets it apart is the size of the skull with the increased breadth of the forehead and the size of the lower jaw. Anthropoids still have its snout. Added to this is the remarkable play mimic the supreme ability to transmit movement of the muscles of the face in the mood and feelings interiori.In summary, the observation of the human in the upright position shows that he only has some peculiarities: the knees are extended, its center of gravity is in unstable equilibrium, he has only one seat, has an arch, and finally a spine with more curves. The development of his brain, higher than all other animals, led the formation of a massive neurocranio.Tutte these features are connected with the erect carriage that has brought many benefits and was won by opposing the force of gravity, but needs a constant struggle with it. However, one must consider that the basis of originality of man is not only the unusual posture of the body, such originality is also determined mainly by the nervous tension that direct every movement, every gesture, and all the activities of bodies in other words, the posture.
Studio posture
posture, meaning the position of the body as a whole, as well as the spatial relationship between skeletal segments in both static and execution of motor activities, is increasingly made the subject of studies and study of posture involves ricerche.Lo specialists from different backgrounds and, therefore, be understood as a branch Posture "indirectly" through either neurophysiology, psychophysiology, kinesiology, orthopedics, medicine and rehabilitative therapy, the psychosomatic clinic, dental, l 'eye, the vestibular and so via.Attraverso observation, experimentation, reflection, clinical, specialists have identified the various and treated successfully, thanks to the tools of Posture, a large number of pain syndromes, vertigo, neurological, disfunzionali.Infatti, starting with a careful clinical analysis of posture and neuropsicomotorio footage of the subject, both in children as in adults and the elderly is possible to assess the individual with a disorder of posture, involving them in active work on your conscious and corpo.Pertanto, even when the examination to identify postural interference, such as breech, or visual occlusion, primarily responsible for a tonic postural imbalance, there seems reasonable to manipulate a receipt of the tonic postural system and then change the strategy posture of the subject without his active participation and awareness to this change corporeo.La postural therapy can not be separated from a power coscienza.Le recent acquisitions in the field of Posture and advanced methods for the correction of postural interference by adopting specific aids (bytes, plantar proprioceptive, visual correction ,...) or by reprogramming neuroposturale induced reflexly (auricular posture), should not blind us to the classical principles but always present culture of educational supervision that has developed on the basis the idea that the basic rehabilitation therapy should be conducted as a learning process in pathological conditions (Perfetti, 1986). The patient should be given an opportunity to develop a postural and motor learning, comparing feelings, positions, old and new motor strategies, becoming aware of everything in order to establish new reference points on which elaborate postural schema corporeo.Com 'is unthinkable change the posture of a subject with a therapeutic action induced from the outside, without allowing an active and conscious change in place by the same person? The awareness, the development, acceptance of change are not minor details to therapy postural We're not manipulating a machine or computer, we are inducing the changes in therapy and postural neuropsicomotorie in a living body and lived, that is exactly umano.Il change of posture must be lived and not sustained by soggetto.Tale change involves a reworking of body image and self-image, with all the implications Outbuildings, from the neurophysiological those psycho-emotional sensomotorie.Molti those were the efforts of scholars who are interested in the problem of postural pattern, self-image, body perception, certainly among them is cited in the scientific work of Schilder (1935), whose insights and theories on the concept of body image were found to be a key reference point for generations of studiosi.Un change implies a change of posture the body schema: thus the study of body schema, its processing and reprocessing, is worth more than a legitimate space in the system of theoretical Posture, as well as the methodologies and techniques that contribute to the structuring and restructuring of the body schema are to be included between the operational tools of their Posture.
body schema is defined as the body schema or body image, the immediate consciousness of our body in its three-dimensionality of its location, its state, both in static and dynamic conditions: a sort of self-image that involves factors of neurophysiological, psychodynamic, relational, and that allows the individual to enter into a relationship with the spatial and temporal world circostante.Storicamente the concept of body image is dated from the late nineteenth secolo.Proposto by Bonnier, then spread, evaluated and revised by scholars such as Lhermitte, Pick, Head The concept of body image finds its consecration in 1935 with the scientific work of Schilder "The image and appearance of the human body", translated into Italian with many years of delay under the direction of prof. Cesa-Bianebi (1973). The first theoretical elaborations on this subject can be traced to the formulation of the concept of cenesthesia expressed at the beginning of the nineteenth century. The term cenesthesia can be considered a relative of the following scheme concept body but certainly not synonymous. In the nineteenth century this term alluded to the general sense that we have of our body, since the set of sensations from all parts of the body were sent to the "sensorium", a center for sensory integration. This definition, in fact quite vague, it tends to emphasize that these are multiple and disjointed feelings that come together at a conscious level in a "sense of self." The vagueness of the term has been highlighted by many scholars, including Wallon (1974): in particular this "undifferentiated chaos of sensations" seems due to a general sense of awareness of the body without distinguishing, for example, between sensitivity and enterocettiva sensitivity proprioceptive, and without specifying the role of affective and emotional aspects ciò.Nei throughout his studies at the turn of the century, Bonnier stands critical of the concept of an original cenesthesia and introduces a new criterion to the studies of the time : The topological criterion. The novelty of Bonnier, which he pointed out as essential, was to give the body a value of topological space that is, through which you can navigate in the world objectively and subjectively about the different parts of our body: our body we are given as "sens d'espace." Further developments on the importance of policy space is provided by Pick, German neurologist at the beginning of the twentieth century speak of "korperschema" and introduces the scheme topognostico. Under this scheme we possess a topographical awareness of our body that allows us to continually know what state it is. While Bonnier attributed a particularly important role in the formation of the vestibular function of the body schema, according to Pick the visual function is primarily to define the spatial image of the body, without, however, underestimate the role that haptic and cinetica.Il English neurophysiologist Head provides an overview so to speak associational body schema, formed by several orders of informaziom postural, tactile, kinetic, visual, which provides a summary somatogramnma constantly evolving. Head speaks of "model" and emphasizes the dynamic, evolving in this process. With
Schilder (1935) we witness the passing of the previous points of view in an attempt to define both physiological, psychological, sociological. According to Schilder we get a series of tactile, thermal, nociceptive, neuromuscular, visceral, but beyond this there is the immediate experience of the existence of a unit body that it is true that it is perceived, is on the other part of something more than a perception can be defined in the body schema or body image or, following the concept of Head, which stresses the importance of knowledge of body position, postural model of the corpo.Arriviamo so the definition of Schilder: "The key body is the three-dimensional image that each has of itself: we can also define body image. Summing up, the body schema implies: · neurophysiological factors represented by the proprioceptive function, enterocettiva, exteroceptive , vestibular and also ensure the awareness of movement and body position · psycho-emotional factors, characterizing the self-image and body schema to the extent that any rigid separation from the previous physiological results to be an arbitrary, inappropriate , dichotomous.
In reality, the physiological and psychological aspects of body image are a unit which not nature, but only the needs of teaching methods of science can artificially divide and keep separate.
These two aspects we can add social factors, treated by Schilder in a special part of his work (sociology body image), by virtue of the fact that the image of the body can be affected by the specific social, cultural , ethnic. We are therefore faced with a complex process into which aspects of sense-perception with imaginative aspects, in order to produce something profoundly consistent although constantly in the making: the awareness of our immediate and unified corpo.Giova remember that we know the position points of the body, ad. as the nose, even when the afferent somatoestesiche of these body parts are anestetizzate.Schilder clearly explains that it is simply a feeling or a mental image: it implies that "the picture is not just perception though there comes through the senses, but involves patterns and mental representations, while not simply a representation "In other words, the peripheral sensory afferents contribute to form the core schema, but then the pattern modulates central and regulates the activity periferica.E 'on this principle Ruggieri (1988) has developed a circular pattern in psychophysiological terms, "model which considers the representations of the body schema as systems complexes with central and peripheral components. "According to the author in this context the phrase takes on a meaning peculiar to Freud:" the original sensory perceptions are symbolized ...". In fact, even though the light of this brief historical review on concept of body schema, is difficult to understand how it is not a simple one-way linear process (the afferent sensory devices that contribute to the formation of the central body schema), but rather a circular two-way process and polyphasic. In fact, the central body schema, as Head and advocated by Schilder, is in turn able to influence and change the body periphery, particularly the core schema is able to change tone posturale.A turn back the reafferentazioni devices contribute to the restructuring and reworking of the body schema, according to a circular process polyphasic constantly evolving bi-directional (periphery - center, center - periphery, periphery-center and so on). Such a key to understanding the process of structuring the body scheme is in line with the move and systemic approach that is used in psychosomatic (Onnis, 1989 and 1993, Scoppa and Nicotra, 1996) to better represent the holistic perspective of the person and pass the two-way concept of the disease (or psychogenic somatogenic) Already Schilder, referring to the studies of Head, emphasized the importance of the cortex sensory as "stock" of past sensations, which form the organic models (diagrams) that "affect the impressions of sensory afferent impulses so that the final sensation of position or location to reach the level of consciousness correlated with something that happened in previously. Therefore, "any recognizable change comes to consciousness after being seen in relation to something that happened before." It is therefore a complex process of recognition, comparison, comparative, in reference to the data of body experiences pregresse.Su this interpretation also converges Gozzano (1959) to explain the immediate consciousness of the unity of our body and the representation three-dimensional space that each has of himself: "impressions visual, tactile, muscular, tell us about the existence of the different parts of our body, but beyond that we have an immediate consciousness that our body exists as a unit, d 'On the other hand the same tactile and visual impressions especially muscle inform us about the location of different parts of our body, and changes of position with respect to each other and respect of the area, according to a comparison process, made from the bark brain between these impressions and a model or pattern representative of our body and spatial relationships between its parts. "
body schema or body image, is not an innate structure and preformed and is not a fixed and static image, but instead is a dynamic, ever-changing, depending on the maturation of the nervous system, the psycho-emotional experiences, the level of perception and sensorimotor processes made possible by experience and by an electronic motor and postural. Schilder is clear on this point: "the image of the body from a physiological point of view is not a static phenomenon. The you buy, you build the structure, and it derives from continuous contact with the world.
not structure, but a structuralisation that are experiencing constant change, and these changes are related to mobility and actions of the outside world. "Therefore, the body schema is a process invigorating, dynamic, evolving in this respect Head (1911) makes no mention of the scheme, but patterns in the plural, which complement each other in an increasingly somatogramma fieri.Su this position are placed in varying degrees, many scholars of the subject, among which: Bartlett (1932), Mucchielli (1962), Wallon (1962), Kohler and Lachanat (1972), The Boulch (1981), dropsy ( 1981), Perfetti (1986), Ruggieri (1988).
Developmental structuring the body scheme goes through stages of evolution: The Boulch (1975) defines the stage of "body immediately, from birth to three months of life The stage of the "body lived "up to three years, the stage of" perceived body ", the stage of perceptual discrimination between three to seven years, and the stage of the" body represented, ie the period from seven to twelve years of mental representation the "body proper" in the first movimento.Le childhood experiences therefore have a very special importance in the structuring of the body schema, but this dynamic, evolving, ever-changing is not limited only to the age of development: at any age can have changes or restructuring of the body schema, particularly in conjunction with neuro-postural changes, structural or morpho-psycho-affective. It is for this reason that we must consider the elaboration of the body scheme as a crucial chapter in Posture, especially when acts therapeutic or pathological processes induce significant changes in tonic-postural.
In describing the "postural deficiency syndrome", Da Cunha (1987) states that a characteristic symptom is that the patient complains of difficulty in staying upright, and that he feels hesitant, is suffering in that position. Schilder says: "In the construction of the model body posture difficulties arise when the different senses can not be used or co-ordinated", but this is the situation where you are in the presence of an receptor that alters the tonic postural system . We must consider how this alteration corresponds postural alteration of the postural model of the central, and for this reason that it is always necessary to consider also the body schema when we study the system posturale.L 'importance of these functions in the construction of the body schema are well highlighted by Schilder: "All the senses are involved in this constructive process, and undoubtedly the vestibular system has a particular role here. Our relationship with the earth, gravity is a factor for the striking mechanics of movement and the perception of Body. "Let us not forget that one of the fathers of the concept of body image, the aforementioned French physician E. Bonnier, began his research in Otologic field studying the diseases of the ear, in particular his work on the basis of vertigo went to look for the foundation of the state not to vertigo, which is the mechanism that ensures the anchorage of the posture of a person in a space-temporale.Così comes the fundamental hypothesis of the presence of an outline of her body, or structure, or better than a structuralisation to represent him at any time, and occasional cases although with different conceptualizations: the spatial configuration of the body, the postural pattern, sé.Le image of the body schema changes in association with a dysfunctional or pathological condition may be very obvious and sometimes drammatiche.Ricordiamo limited to the phantom limb phenomenon and the phenomenon dell'emidisattenzione, or patients who feel a limb that no longer exists, or that they feel more like a limb just yet but in anatomical and functional conditions radically changed. In the case of amputation of one leg, the amputee can still feel their limb and have the distinct feeling that there is still, it moves, which hurt to the point of forgetting their own disability and fall: the emergence of a phantom limb, which is the expression of the key corporeo.Schilder report the case of an amputee whose feelings of a leg and a foot ghosts disappeared immediately with the onset of a lesion brain: the same injury that wiped out any recognition of his posture put an end to the perception of phantom. This suggests that the phenomenon is of central origin and not the device, as understood by Descartes in the seventeenth century when he wrote: "the pain of the hand is not felt by the soul as it is in the hand, but as it is in the brain." But even an interpretation of this kind, strictly neurological, not fully reflect the reality of the phantom limb phenomenon, as is well known that he values \u200b\u200bthe psycho-emotional. A contingent situation, an emotion, a memory, evoking the experience of the wound, can bring up in a phantom limb amputees who had not first, so how can it happen that the significant size phantom limb can be reduced to the point of being incorporated into the stump, in conjunction with the acceptance of disability by amputation. Think of what role can these aspects, for example in the phenomenon of phantom breast of women who have had a mastectomia.Partendo by such considerations, Bernard (1974) states: "we must therefore understand how the determinants of psychological and physiological conditions are engages the other one: at first sight not seen as the phantom limb, if it depends on physiological conditions and whether it is in this respect the effect of natural determinism, moreover, may depend on the personal history of the patient, from his memories, from his emotions or his will. Why have the same result, these two components of physiological and psychological needs of land on which it is useful to reflect comune.Altro phenomenon is dell'emidisattenzione hemiplegia, especially in those complex cases where patients refuse, reject the existence of a half of his body and see it as alien to what others, or perceive it as an object.
Regarding the psychological aspects of body image and self-image, a testament to their importance is given to us by the vastness of the studies on the topic, beginning with Freud, came to our giorni.Klein, Biek, Bion, Winnieot, Mahler, Merlea Ponty, Jacobson, Bowlby, Kout, Eissler, Stern, Reich, Lowen, Piaget, Downing are just some of the scholars, training and conceptual approach is also very heterogeneous, which can be united by the importance given to the body and bodily experience in the structuring of global psyche and consciousness of self. In fact, a full consciousness of self can only be achieved with a mental structuring a scheme rooted in the body, this mind-set is the guarantor of the integrity of the identity of the person: "I am my body" this is the message that comes from Merleau-Ponty to Lowen. Moreover Sehilder on this point is clear: "The processes construction of body image do not occur only in the field of perception, but also have their parallel in the construction field libidinal and emotional. "An evidence of the role played by purely psychological and emotional aspects in the structuring of the body schema can come from cases of psychopathology such as anorexia nervosa, in which an essential feature is the presence of an altered body image as regards shape and size corporee.Ruggieri et al. (1994, 1997) have explored the topic of ' body image in anorexia mental interesting experimental research (1997) showed how the anorexic women in the intensity of perception kinesthetic is particularly low. These results are consistent with the problems of these patients that revolves around a process of negation of one's corporeal and alteration of body image. According to the researchers, all this must be understood as a process of nature psicofisiologiea passing through concrete mode of inhibition of sensory information through a central mechanism of inhibition involved is to modify some specific forms of tactile sensitivity as reducing the weight of ' kinesthetic information in the construction of body image. remind us Gagey and Weber (2000), "the postural system is an automated system. The man has no conscience, not speaks. "From this simple observation can begin a serious reflection on the sense of giving the" patient posture, "the opportunity to become aware of his condition, postural and motor strategies he implemented through a work of perceptual-motor postural re-education and revision of the body schema, considering also that "... individuals regulate the position of the center of gravity to the ground through the use of a postural body schema that includes the internal representation of the vertical body kinematics and kinetics of body . The main grounds of a substrate body is called the postural body scheme "(Cesarani and Alpine, 2000). From all this it follows that an enrichment of sense-perceptual and motor can promote good structuring of the body schema, thus allowing a better motor control and posturale.Pertanto in Posture therapy should see not only the correction of specific postural interference but also an accurate perception of the tonic postural changes induced by stesse.Quindi perception is a basic function that determines all the actions of the individual, all his learning and all its report: it thus includes the importance it has in the educational, rehabilitative Therapeutic.

fact, the way an individual perceives reality, and therefore its own reality body, is influenced not only by the sensory features of organic structures, but also the use of these sensory structures according to the experience and psychological factors and ambientali.Quindi, next to the structural determinants (the neural structures and sensory receptors) are determinants psycho-emotional, environmental, and socio-cultural esperienzali, in intimate connection between them, determine the perceptual activity of the subject and its behavior and orientation in the environment. The perceptual activity is the point of contact with the individual reality: our behavior at all times shall be adjusted to reality as it is perceived by us. The individual does not react to an absolute and incontrovertible fact, but their perception of reality: the field of perception becomes reality itself for the individual. The physical reality is no exception: the ego lives and works on your body and how it perceives, with the two meanings as well as sensory and affective emotional motorie.Riguardo latter, we must always keep in mind, as Schilder reminds us that "there are no perceptions without action" and therefore not a body schema can structure except through appropriate perceptual-motor, active or passive, on the other hand you can not retrieve any motor function without simultaneously retrieve the schema it pertinente.Molte proposals are useful in this effect, which may put the subject in the process of developing a Gnostic-perceptual significant, if necessary by adequate facilities: rehabilitation exercises for breathing, segmental mobilization of both active and passive, lateralization, balance, coordination, sensory-motor of space-time structure, in addition to postural reeducation exercises (for example, and Vayer Picq, 1968; The Boulch, 1979, Lourdes, 1980). In addition to the movement, you must keep in mind the importance of "no movement" means the rilassamento.Insieme the strict sense of relaxation techniques such as Autogenic Training (Scoppa, 1990) Jacobson's progressive relaxation, breathing techniques, must emphasize the therapeutic usefulness of those proposals that generally favor a reduction of the state of chronic muscle tension by releasing the body from parasitic and dysfunctional contractions. Emblematic for this purpose, the effectiveness of techniques for Bioenergetic Analysis (Traeger, 1998; Scoppa and Borrello, 1998), which are well suited to be integrated more closely with physiotherapy and biomechanical methods for a truly holistic approach (Scoppa, 1996, 1999a, 1999b, 1999c). The foundation of such therapeutic proposals, aimed at reducing the chronic state of tension in the body, is that the ability of body awareness and processing of the body schema are severely hampered by was muscle and emotional tension headache. This clinical evidence is also experimental confirmation (Ruggieri et al., 1983), who documented in this regard as the degree of bodily self-perception is inversely proportional to the voltage level miografica. The structuring of the postural body scheme and sensory-perceptual and motor activities are intimately related to one another: One must remember that the preferred channel through which changes and affected motor function is the information sense-perception, that is precisely the information and exteroceptive through receptors kinesthetic, tactile, labyrinthine, visual, auditory. The sensitivity and its exteroceptive based on the information receptor in peripheral nerve centers above conveyed through the spinal tract allows the creation of a "subjective consciousness" of the spatial position of the locomotive and its mode of operation, and is the basis of the structuring of the body schema and programming neuropsicomotoria . What then can you actually teach is not the sensation but the perception, sensory information from the peripheral sense organs, structures anatomofunzionali construed as containing specific receptors for that particular sensory modality. These sensory informaziom that provide essential input to the postural system are combined in various ways and with different outcomes. They may come from different sensory systems (intersensoriale interaction) or different receptors or different detection systems in a sensory system (interaction intrasensoriale). Do not forget the importance of sensory inputs that accompany the return of motor activity and where checks are retroactive (reafferentazione). What can be more properly educated is the reception and processing of sensory information on a psychic level, " only education can lead to perceptions of higher cortical centers to influence corrective links sensorimotor automatic lower centers "(Lapierre, 1975).
Education perception is essentially based on a work of awareness of the afferents of sensory stimuli, for awareness of our physical activity we can understand what we feel is in operation the neuromotor system responsible for that specific activity, then the awareness it just means "the exercise of a form of attention focused on his own body and how it works" (The Boulch, 1975). In other words, the subject selects the sensory messages, focusing attention on information coming from your body, from their movements, the environment, supporting access to specific information you need and reducing or excluding sensory information disturbing or interfering with the process of perception in atto.La perceptual function becomes an active and selective, in which the subject-oriented and willing to receive certain sensory stimuli, change positively the perception threshold conditions with attentional, emotional, environment, and conditions related to learning and experience. Often a bad body control may be due to an unsatisfactory development of the Gnostic-perceptual functions, a significant lack of body experiences lived, to a state of psycho-emotional tension . Propose significant body experiences, immerse the person in a "bath-sense perception," offer the opportunity to become aware of their chronic muscle tension in bioenergetic perspective: this can help the patient to be more the master of his body, and make the therapeutic work in posturology more active and conscious and therefore more human scale. This is the sense of a similar proposal, which aims to integrate work on altering the specific morphological and postural inputs, just the Posture, with a careful process of sensory-perceptual-motor processing and analysis of changes in postural strategies implemented by the subject. E 'from all this that we set off for rehabilitation in the fullest sense of the term, ie it is strictly mechanical but also, for some ways, especially the postural pazienti.Sulla basis of these concepts we have to conceive the attitude and the spinal curves resulting not as a mechanical balance but a balance as neuromotor. It 's the result of a multitude of sensory-motor reflexes integrated at different levels of neuritis in an automatic complessa.L' natural attitude is neither conscious nor voluntary, is a way of personal reaction to a constant stimulus: peso.Il the starting point of a balanced tonic contractions is in fact more sensitive: muscle strain, ligament tension, a feeling of joint flexion, feeling pressure to plant, a feeling of "imbalance" due to displacement of the otoliths of the inner ear. All these feelings are caused by the force of gravità.Partendo this concept, we can not conceive of education as an education of the attitude of the contractions, but as an education of the feelings and perceptions. The muscular system is only available depending faithful executor of the motor impulses driven by a feeling of gravity. On this background proprioceptive engage the affective modulation, because the attitude is also a behavior, social behavior and a way of expressing personality profonda.L 'natural attitude, the complex formed on this basis, recorded in the higher centers in the form ideomotor of a "scheme attitude "which is nothing if not the mental representation that may be the subject of his general equilibrium representation resulting from the merger of data and proprioceptive esternoricettivi (particularly visual). This pattern of behavior then becomes the" baseline " unconscious attitudes which will always tend to adattarsi.Queste are the guidelines that should guide us in the education and rehabilitation of attitude. clarified this, it is clear that every individual is balanced not only with his temper but also with its own characteristics morphogenetic (which are more or less linked to each other). The form factors (shape of the skull shape of the sacred kind of spine, segment length, etc.) and physiological factors (such as rigidity or relaxation ligaments, articular breadth and limitations, muscle strength, etc.) are also to be taken into account. However, no longer appear as essential elements, they are the "materials" with which we construct the attitude, the "master of the whole work" remains the neuro-psycho-motorio.Sembra that this system has the capacity, during a rehabilitation well done, to ensure by himself, and without external mechanical intervention, a certain normalization of the articular physiology. The design


neuromotrice not rule out the mechanics. It seems indeed that it is in need of more mechanical analysis thin to the extent that attempts to define with precision "the click" reflex tonic equilibratori.Questa mechanical mechanics becomes a living thing to die and in turn leads to the equilibrium and squilibri.Ogni segment is in fact balanced at every moment by two forces equal and opposite direction: - on the one hand, its weight and that of higher segment - on the other, the tension in the muscles or ligaments that balances peso.E that 'this is a mechanical phenomenon, but because this balance is established , the segment must be conducted and reduced steadily in that position with a general coordination of balance. And 'necessary for the muscle tension is always exactly proportional to the component of rotation of the weight that is constantly changing depending on the obliquity of the segment and that, if the obliquity is reversed in relation to the vertical, even muscle tension is reversed immediately and automatically via antagonisti.Tutti in these kinds of adaptation are triggered by feelings muscle and joint proprioceptive; are anatomical-mechanical phenomena neuromotori.I data not conceive, therefore, if not integrated into the broad range of settings neuropsicomotrici attitude.
's normal behavior, such as the' normal man, is an abstraction. In the lateral direction, the plane of symmetry of the body provides easy reference, the normal attitude is an attitude symmetrical. On the anteroposterior Instead, the rules are pretty bad attitude definite.Ad example, at what angle, lumbar lordosis becomes a physiological hyperlordosis? From that moment however, we can say that the reversal tendency? This detection is usually based on highly subjective glance morphological examiner refers, more or less unconsciously, to his conceptions estetiche.In reality, individuals, not being "built" with the same anatomical elements, may not have a attitude "normal" morphologically identico.D 'Anyway, it is possible, whatever the morphology of the subject, determining a general principle of equilibration normal and desirable, you can say that "an attitude in which each segment occupies a position close to its equilibrium position is a mechanical attitude normale.Questo normal balance in the measure that is close to the mechanical stability, is a delicate balance, balancing the contractions are here low-intensity and often short-lived, as the center of gravity tends to move easily from one side of its point of equilibrio.E 'balance economic mechanism as it requires minimal effort to be maintained and restored. It needs instead modulation of a particular tone and precise location, especially needs a great sensitivity of proprioceptive receptors to be able to respond immediately to stimuli for very short duration and intensità.Questo also requires balance and coordination intersegmentary soprasegmentario constant, since it addresses the automatic centers continua.Questo highest in a balance that requires permanent surveillance neuromotrice is an equilibrium that neurologically affatica.Lo effort, as we have seen, tends to disturb the synaptic connections, thus tends to destroy this balance, forcing the subject to adopt a more balanced mechanically fatiguing, but that needs a sensory-motor control less precise and less rapido.Questo balance of fatigue is related to that found about the "bad attitudes." segments, being in a position close to their equilibrium position, can be mobilized immediately without inertia in any direction is a balance of availability that enables quick adaptation to the gesture dinamico.Il maintaining this balance of availability over the movements of locomotion and intake contributes greatly to their effectiveness and their armonia.Questo balance of supervision and availability also expresses the psychological behavior of the subject: self-confidence, balance, openness to the outside world readiness for action. It also demands a good integration of body image and attitude properly established.

If for a given subject there is only one standard attitude, but there are many wrong attitudes possibili.Questi attitudes, in their diversity, however, have one thing in common: they are "stabilized attitudes". "segments, instead of swinging in the vicinity of their equilibrium position, have accentuated their obliquity and stabilized using either a tension of the ligaments, is a permanent tonic muscle tension and intensity virtually costante.Queste obliquity and subsequent reverse attitudes are part of "arc" or "accordion." If we analyze the neuromotrici and mechanical properties of these attitudes. we find that, from a mechanical component of the rotation of the weight is as large as the segment is oblique, so the strength of the balance will be greater in the obliquity proporzione.Se taken from the segment is large enough for the "failure" becomes a ligament, the solution may seem quite cheap, but the obliquity compensating segments above and below may not always be balanced by a tension of the ligaments and should therefore appeal to the tonic muscle tension. The consumption of energy is therefore ultimately consistent and significant, because attitudes are wrong mechanically affaticanti.Sul neuromotor plan - the "failure" ligament is very stable and does not require the supervision of the muscles antagonists - the "failure" muscle tension is provided by a permanent tonic that keeps saying the only stretch reflex, rnodulato. segmental level, the ring range. soprasegmentarie The settings will drift a little sollecitate.Ne stability gained with a minimum of adjustment neuromotrice; attitudes are wrong attitudes of laziness neuromotrice. On the other hand we must note, and this is very important for the rehabilitation of the attitude that the limit of the reaction of proprioceptive receptors is strongly increased; requires a considerable skew, then a considerable stimulus gravitary, to trigger the tonic contraction of ' arrest. From the moment the obliquity decreases, the stimulus intensity decreases and falls below the limit of the receptors, the contraction stops and the balancing segment falls within its obliquity abituale.Generalmente iporeattività this is explained in two ways - either as an elevation limit of receptors - both an elevation limit of the motor neurons that respond to a tonic excitation rilevante.Sembra sensitive, however, that the shortfall primarily to sensazione.L ports' daily experience of the "corrective exercises" provided evidence that subjects who have a wrong attitude do not perceive the position of their segments beyond their perception obliquity abituale.La appeals only way to sensitive. The normal attitude can not be restored except in so far as feelings related to spring balancers reflections lead to segmental obliquity close to balance stabile.Da a dynamic point of view the decline stabilizer segments clearly involves a degree of inertia in switching and in ' accompanying gestures dinamici.D 'On the other hand, the elevation of the limit of proprioceptors makes it difficult to adapt to disturbances of balance and in particular to the balance point of view dinamici.Da psycho-motor, this quest for stability ensured without supervision expresses a lack of confidence, a fall-back attitude towards life and inertia.



reeducate attitude

How to proceed to re-educate the attitude?

We have seen that all the deviations of the attitude, whatever their morphology, are always produced by a deficiency of the neuro-psychomotor mechanisms. We can therefore conceive, according to this common origin, an identical rehabilitation aimed at restoring a balance average meccanico.La rehabilitation is near equilibrium for each (depending on its morphology) in finding a personal solution that makes head this balance. Rehabilitation is not satisfied with the solutions, "type" is set. Our role is therefore not to impose an attitude "Correct" voluntary, that would only be a "standard" normiali useless in the circumstances of life, but above all to provide the elements to each percettivomotori allowing him to build himself a natural attitude and "plastic" adaptable to all circumstances. This re-education will make up for tappe.Queste stages at once: - in the neuromotor, a refinement of proprioceptive perceptions and the progressive integration of these perceptions in the automatic regulation of postural tone; - in the psychomotor, a progressive organization of the first body schema, schema attitude. We can find these steps in the following progression:
Education
proprioceptive perceptions:
- education of the body schema; - affective-motor control.
Dissociation of existing synergies:
- independence of the segmental movements.
- Liberation neuromotrice hip.
- release of the shoulder.

- liberation and mastery of breathing.

Education perceptual balance:
- perception of segmental balance

- perception of general equilibrium.
- scheme of attitude.
A utomatizzazione attitude:
- Automation of segmental balance.
- automating the overall balance during dynamic activities oriented towards an end.

- automation of the hip joint flexion.

This division is of course quite arbitrary. In reality, these different aspects constantly interfere in the practice of educational supervision and are integrated in global and unified action.
Education
perceptions

Education and proprioceptive perceptions of body image.
This education will be during the course of rehabilitation at each exercise, but it seems that the most specific and most effective is the rilassamentoEsistono various relaxation techniques, whatever method you choose, remember that the session to relax you reserve an adequate space of time: for the first sessions you can not have less than forty-five minutes. When the patient has learned the details of the technique, you can shorten the execution time, where the issue is the preparatory phase to another procedure physiotherapy, then the space devoted to it will shrink to about ten minutes, this of course, only after that the proper exercise technique has been assimilated by the usual tranquility of the environment paziente.La where one needs to practice physical therapy, will be treated strictly in, so that all light and sound stimuli or consequent to poor thermal regulation, should be categorically avoided.

METHOD SCHULTZ (autogenous training)
And this is a relaxation technique that we teach the patient, then autoapplicarla at home, in order to get his state's overall mental and physical changes of tone. On it, it seems appropriate to dwell a bit ', and for his undoubted therapeutic value, and because its increasingly widespread use (even in sports, exam preparation, etc.).. We insist on patient so that, when will practice relaxation at home, treat especially the environmental situation, which must be as favorable as possible to relax: very quiet, in conditions of optimum temperature, with limited Diffused lighting. The patient will lie supine on the floor as a rug, a blanket, each stimulus of hunger, thirst or other physiological needs in advance will go away. The position should be abandoned as far as possible, his head supported by the pillow, the arms firmly on the floor, slightly lower than abduced extrarotati.Il patient and held his eyes closed and must penetrate into the formula I am perfectly calm. E ' the so-called induction phase of the peace. This phase can last from a few minutes to 15-20 minuti.Seguono exercises of the first round or bottom round, divided into: 1 year: the subject is focused mentally on the formula my right arm is very heavy. He does the same for the left arm, and lower limbs, to engage in a general feeling of heaviness throughout the body. The perfect implementation of this first exercise is reached after several sessions;
2 nd year: the formula on which to focus is now my arm is really hot and similarly for the arts and for the whole body with the same succession year previous year. The subject imagines the limb and body heated from the sun on a beach, or be wrapped with cloth or warm in the winter of being next to the fireplace, 3rd year: the formula is my heart beat regular. The subject should just try to enjoy this feeling, 4 th year: to feel your breath., I repeat quiet breathing; 5 th year: search for the sensation of heat addominale6 Shops: feel a sensation of coolness to the front .. When the patient is master of these techniques, this is the cycle bottom, you can go to the senior years, the psychoanalytic, it also divided into several stages: first stage, the patient directs the eyeballs upwards and along the line median, putting in a stage preipnosi of, and in this state, the following are proposed various sensations: think of a single color, think of an object, think about abstract concepts (happiness, justice, etc..) remember a pleasant experience that would revive, think to a specific person. Eventually you may reach a stage of deep introspection similar to that reached by transcendental meditation.

METHOD COURCHET (DYNAMIC RELAXATION BREATHING - RDR)
a method of rehabilitation and psycho-motor re-education technique that moving from the use of chronic respiratory failure, it addresses a wide and directions with dynamic exercises, muscle and phases (li recovery in complete relaxation. Over the years, played in standing, sitting and recumbent horizontal (the three pressure sores of life, according to the author) are involved mainly the neck muscles , shoulder, pelvis and trunk. The method, which its creator described as "psycho-ventilation," is learned in a program to be carried out within two months, through successive stages and partly concurrent respiratory rehabilitation, Schultz autogenic training and exercises of mental suggestion. The originality of this technique lies precisely in its most mentality which seems to establish a special sympathy for practices Eastern philosophy, here the subject is brought to lie in a certain mental attitude in front of the awareness of abdominal breathing, which follow one another in the later stages of concentration, meditation and contemplation.


METHOD WINTREBERT

This method is particularly suitable psychomotor childhood education, is based on passive motion in the sequence of the different parts of the body. The subject has to propose to not oppose any resistance and to let passively manipulated, first in the individual parts, and then throughout the body has to let it roll, carry, drag on a towel, both by the instructor is in the form of the game, by peers or playmates. It is also used as tonic dialogue ", ie communication through physical contact and bodily expression, in the psychomotor rehabilitation.

METHOD JACOBSON

Without going into details of this theoretical method, we say that is mainly based on the perception of a contraction or relaxation that follows a localized muscle tension. The education of these perceptions allows you to hear and to achieve total relaxation for each muscle group and then the whole body. To obtain a resolution to the tensions parasitic and therefore for the psychic tensions that they esprimono.Questo relaxation method also allows, on the somatic level, to become aware of the tensions more details and more localized, and results in a perception of even the smallest things. Realized then, from the standpoint of neuromotor, a progressive education in the least particolari.Dal proprioceptive perception point of view psychomotor, the lying, the total immobility, relaxation of the other segments to enhance the concentration of mind on the subject localizzata.Il proprioceptive sensation part to the discovery of his body from the inside. " From this experience comes a rather unusual enrichment of the mental image of the body, ie the "body schema". It seems to be important to begin each session of relaxation from the face (eyelids, eyebrows, jaw, lips and eyeballs). This technique, enhanced by Aucouturier, can promote the outset the "emotional relaxation" as a precondition for a psycho-perceptual availability. The muscles of the face muscles are in fact the essential emotional expression and their relaxation works by calming the tensions psichiche.Quando have obtained the peace and stillness, you can switch to a systematic segmental relaxation. We think it is better at this point, start from the upper limbs (arm, forearm, wrist, hand). Although these little intervening attitude, but segments are better integrated into the body schema, and their relaxation will be more easily and quickly sentito.Quando will have obtained the relaxation of the upper limb, that of the other segments will be made easier, thanks to the sensations already received from different segments of the arm.
We will then systematically relax each part of the body:
- track the shoulder blades;

- lower limb: hip, knee, foot; - trunk, pelvis and lumbar spine, cervical and thoracic spine; - rib cage.

METHOD MEZIERES
A huge contribution to postural techniques was given by Francoise Mezieres in 1947, since publishing his book "Revolution in orthopedic gymnastics: causes and treatment of spinal deviations and pains of muscular origin." With this work the Mezieres put into question the principles of the then current exercise and treatment of dysmorphism, creating a real cultural revolution, aided by his long time student Emmanuel Philippe Souchard. Many others, especially of the French school, by M. Bienfait T Bertherat, subsequently helped to develop a real school of thought that, perhaps inappropriately, is defined sometimes as "antiginnastica," sometimes as "gymnastics."
The principles of the method can be reductively summarized thus: 1. The hamstrings act as a single chain muscolare.2. Due to continuous stress to oppose the force of gravity, the posterior chain muscles are stiff and contracts, they must be released and not rinforzati.3. The relaxation has to be done in its entirety and not on individual muscoli.4. The correction due to sectoral lateroflessioni and rotations of the column is that of arti.5. The rear chain tension causes internal rotation of the limbs and diaphragm lock inspirazione.6. The diaphragm blocked in this way is the main cause of lordosi.7. This which is opposed to a free breathing is not blocking the diaphragm itself, but the retraction of the back muscles.
From these principles means that any muscle building rests on the column and creates structural problems in the long run, any local stretching gets the elasticity of a segment at the expense of another, and then only by stretching everything you can get results, both on Laor respirazione.Quindi only by eccentric contractions, isometric muscle is possible to stretch the chains, gaining in strength and elasticità.Per achieve this, the patient is placed in a position, or "posture" of global strain, which will highlight the imbalances. We will proceed then to work for the elimination of compensation and a job isometric eccentric lengthening of the agonists and antagonists at the same time reinforcing, treating all with precision, the diaphragm without tension, the respirazione.La Mezieres realized very well that, while wearing bodies to get rid of attitudes, postures and tensions acquired over time, created a process of inner growth with all its implications emotive.Tuttavia insisted 'we are not psychologists ... .. my method is not sweet. ... turns muscle elasticity, does not reinforce, never uses the breath and is addressed only to the physical. "You can still safely say that this method is really born in Europe, the first revolution in physical therapy and gymnastics.
Finally, when a patient comes into our studio, we worry more, possibly in collaboration with other specialists, to make a rehabilitation completa.Sia that this is a distortion of periarthritis of surgery or in his column together, we must rehabilitate the patient with your problem, not the problem of paziente.E 'therefore essential to use the various techniques rehabilitation, is strictly mechanical and rehabilitation of the motor pattern, each time adapting to the specific needs of each patient and especially involving them in such a way as to raise the subject in his own rehabilitation.

METHOD "The three teams' ...

Difference King And Superking

urological treatments




Urinary incontinence Urinary incontinence is a condition that affects the life of a great number of men and women around the world. Although rarely put lives at risk, however, negatively affects the quality of life, causing disability and suffering to those who suffer significant morbidity and società.Negli for the U.S. National
Istitutes
of Health showed that urinary incontinence is not is only a medical problem but also economic, costing more than $ 12 billion a year. Urinary incontinence affects the lives of 15 to 30% of women of all age from a social, psychological, occupational, domestic, physical and sexual. Many women try to hide the problem at all, often including the husband, because of the shame they feel. Traditionally the treatment of urinary incontinence was eminently surgical or pharmacological last decade there has been a prevalence of behavioral techniques and especially rehabilitation. It 'very important, in close collaboration with the gynecologist and the urologist, make a preliminary and careful evaluation of clinical conditions associated with urinary incontinence, and clearly define the type of incontinence present (stress, urge, mixed, or overflow) . In any case, the re-education techniques, appropriately implemented depending on the specific problem, have as their objective the improvement of the "performance" so as to allow the perineal perineum can exert its functions adequately support the pelvic viscera, reinforced-urethral sphincter and to counter iperpressioni endoaddominali.Ogni Single dysfunction requires an appropriate treatment, including the identification of risk factors for urinary incontinence and prolapse genitale.La rehabilitation uro-gynecological practice that is essentially based on biofeedback (BFB), the pelvic-perineal physiotherapy (CPP) and functional electrical stimulation, from time to time be given the most suitable program, emphasizing one or the other of the methods after a careful assessment of the case. In general, however, the best results are obtained by combining the three types of treatment.
Biofeedback
The BFB is a means by which to record some physiological activities not noticeable at the conscious level in normal or have become a pathological process, consists of a "transducer" physiological, an amplifier, a The signal processing is a marker for the person receiving the information (Basaglia 1984). The essential aim is to detect the extent and strength of a muscle contraction, the position of a joint or body segment, the direction in which is moving and correctness of the result obtained with respect to a task prefissato.Tale method is not so in a Kinesiology treatment in the strict sense, but becomes part of the wider section of the neuro-motor rehabilitation by providing information that helps the individual achieve a better muscolare.La control function is generally the preferred technique is to record electromyographic that the potential difference caused by a muscular contraction and returned as do sensory information quantificata.Gli electrodes are placed in the initial learning session on healthy muscle groups: In this way the patient learns to recognize the signals connected to a state of contraction, relaxation and muscle contraction associated or co-contraction. Later, after the preliminary session, the electrical signals are amplified, processed, and then returned to the patient simplified form of sensory stimuli, auditory or visual, such as to be easily incorporated interpretati.Molte women and cultural factors also have a poor awareness of pelvic floor and are unable to contract voluntarily the perineal muscles and then the BFB is often necessary in order to gain a better awareness of pelvic muscle in those patients with a non-neurogenic deficit. electrical stimulation


urinary continence is closely dependent on a proper central and peripheral nerves and a lack of intrinsic lesions of the lower urinary tract and pelvic floor. Many are called reflexes are involved in the regulation of bladder-sphincter function (Barrington, 1915; Mahony, 1977). The mechanisms involved in peripheral inhibition of bladder reflex arcs are represented by the pelvic-hypogastric and pudendal-ipopgastrico (acting facilitator) and pelvic-pudendal reflex arc (for injunction). E 'Stao shown that the reflex inhibition (relaxation) of the urethral muscles (smooth and striated) and pelvic floor is associated with detrusor contraction. Similarly, the inhibition of detrusor due to a tonic reflex inhibitory effect exerted by supraspinal structures in the sacral micturition center, is influenced by a reflex contraction of the sphincter muscle-perineale.La electrical stimulation can normalize the activity of stretch receptors in the perineal muscles and stabilize the sacral center of micturition it can also improve fatigue resistance and contractile force of the pelvic uscolatura, with subsequent benefit of the urethral closure mechanism under stress.Teoricamente the mode of stimulation are as follows: • stimulate perineal · stimulation of sacral anterior roots · sacral intradural stimulation (Brindley seconds), extradural (second Tanag) or intraforaminale (according to Schmidt); • stimulate intravescicale.Nell 'perineal electrostimulation electrodes are most widely used endocardial electrode (endovaginal) or surface electrodes (used in technical TENS or interferential current). Electrodes intra-cavitary are located (usually two or three) on ring-shaped vaginal probes of various sizes. It 'obvious that the probe electrostimulation should be on the basis of clinical and anatomical conditions of the patient (shape and length of the vagina, perineal muscles of the quality, type and degree of potential vaginal prolapse. Electrostimulation equipment are "compact" ( outpatient) or miniature (For home use), both types of equipment to deliver the most current biphasic (mandatory for home treatment) to eliminate any effects elettropolari.Il problem of disinfection and sterilization of the probes can be solved with the use of Sporicidin (solution based on phenol and glutaraldehyde). An important speech nell'elettroterapia incontinence is represented by the current interference, which exhibit some undoubted quality: · their prevalence (in the UK and Australia in particular), · their high trophic action Pain deep · not need to use the electrodes endocavitari.La interferential current can inducing muscle stimulation in a normally innervated muscle, irrespective of its search engine specific points and avoiding the side effects on the skin, induced by other types of current in order to achieve greater penetration in profondità.L 'goal of therapy interference is to induce a stimulating effect on the pelvic floor muscles (mainly represented by the levator ani) in order to determine: The socket of the same muscle cosacienza · an enhanced tropism and tone; o To 'reflex detrusor inhibition (Nakamura et al., 1986; Ohlsson et al., 1986). For an effective interferential therapy is essential that two parameters: 1. proper positioning of the electrodes, 2. the selection of appropriate electrical parameters, depending on the type of urinary incontinence in which you rivolge.Per regarding the placement of the electrodes, there are two methods that can be applied: the bipolar and tetrapolar. The treatment can be performed daily or every other day, one additional application of the electrodes is the one with two electrodes placed at the top, at the retrotrocanterica region and the other two places lower, at below the gluteal fold (Savage, 1984).
Physiotherapy

In
rehabilitation of urinary incontinence kinesiotherapy occupies an important place, representing the conjunction of movement (chinesis) and treatment (terapeia), for physical therapy should be understood to mean all forms of muscle activation and joint exercises simple and complex flows to a therapeutic purpose, which have that for the purpose miglioramenro appearance of postural and dynamic of the human body. The various maneuvers used are used schematically, and in a purely aaccademico, divided into passive, active, and active resistance against postural, but now understanding the importance of "knowing oneself" and the plan as a central organizing body of afferent and efferent and at the same time they organized, the prevalence of consciousness motion than the muscle and joint mechanics have turned the act of physical therapy in a series of amendments to the ball "functional" by an individual who can go far beyond the act itself. At the present state would be more appropriate to split the exercises riaabilitativi in \u200b\u200bacts that do not require the patient's attention and exercise that should involve full coscienza.Relativamente methods to use the classification suggested by Boccardi still retains an undeniable educational value and schematic:
· passive physical therapy, divided into: 1 . passive postural alignment 2. passive motion in relaxation 3. passive mobilization forced
· active physical therapy, divided into: 1
. active exercises general
2. active exercises segmental (free, assisted, against resistance)
3. neuromuscular facilitation techniques
4. functional rehabilitation
The acknowledged pioneer of rehabilitation perineal U.S. Arnold H. Kegel, the gynecologist who, more than 40 years, advocated perineal exercises to prevent and / or treat genital prolapse and female urinary incontinence. But even many years before in 1864 the Swedish Thure Brandt argued that the contraction of the adductor muscles actively involve all the muscles of the floor, especially if the patient lifted the upper basin, strengthened by this exercise, opposed the perineal muscles to improve resistance to the pressure of the viscera, thereby preventing the retroversion of the uterus that is stretching the legamenti.In Italy has seen since 1985 with a serious interest in pelvic floor physical therapy techniques, the scientific recognition of the dignity of the rehabilitation techniques of bladder-sphincter dysfunction-perineal by the International Continence Society in 1990 has been a goal and at the same time a starting point for all operators of physical therapy in the protocol settore.Oggi perineal dysfunction is divided in stages, put in place after a crucial preliminary phase of patients with adequate information and some preparatory sessions learning Kinesiology generale.Dopo some necessary background anatomy and physiology of bladder-sphincter-perineal should adequately inform the patient about the disease in place and point out the purpose of rehabilitation, physical therapy sessions during the pre-treatment is essential learning a good synergy of breath, reached only after reaching an optimal level of concentration and rilasciamento.L 'overall objective is to facilitate the realization by the patient's perineal muscle activity, via a "corticalizzazione" of Event engine body area poorly represented at the level of primary cortical areas, motor (area 4 of Brodmann) and sensory (areas 3, 1 and 2 of Brodmann). The sequential stages of perineal pelvic physical therapy program can be summarized thus: · awareness of the perineal region, and muscle activity of the elevator anus · consensual eliminazionedelle synergies agonists and antagonists; · "training" of the levator muscle; Automates perineal muscle activity to coincide with the stress of business life is more important than ever quotidiana.Estremamente rehabilitation pelvis perineal-awareness, racial factors, educational, religious and iatrogenic may lead to a lack of "awareness" of the sphincter-perineal accounts for the poor and not infrequently incorrect motoneurale recruitment to the request for a voluntary activation of muscle afferent activity resulting in less perineali.La also ensures that you enter into a vicious cycle which may, secondarily, to damage to the lift of morfoistologiche 'ano.In treatment chinesi perineal approach is therefore surely the first proprioceptive and uses all the techniques neuromotor re-education (proprioceptive neuromuscular facilitation) used to activate the central nervous system and to provoke a reflex, an adequate voluntary muscle activity. This is certainly the most delicate phase of the entire treatment program, as it depends largely on the overall therapeutic outcome.



Induratio Penis Plastica (IPP) or disease "La Peyronie"





Induratio The Penis Plastica (IPP) or Peyronie's disease, named after the surgeon to Louis XV who discovered it in 1743 , is a disease of the penis due to unknown, characterized by a circumscribed fibrosis of the tunica albuginea, the poorly vascularized sheath that covers the corpora cavernosa of the penis. The area of \u200b\u200bfibrosis, called "plaque" is a restriction on the elasticity of the face affected by the disease of the penis during erection, resulting in a curvature toward the sick side. The causes, as already mentioned, are not known. The frequent finding of plaque on the midline of the penis in the dorsal or ventral region, has been thought to many writers of the sixties and then more recently that, at the base of the pathophysiological process of the disease, there is trauma or repetitive microtrauma over time load of the erect penis that result in injury, though minimal, in that area of \u200b\u200bthe tunica albuginea which is at the level of the septum separating the two corpora cavernosa (septum intercavernoso). In fact, the lining of the corpora cavernosa has circular fibers around each fiber and longitudinal course that will play consensualmente.Sulla midline for these fibers trend orthogonal to each other meet intercavernoso in the septum. A trauma to the erect penis can detach these two layers of fiber tearing. These tears are the only or repeated achieve normal healing process of the body that produce phenomena at the beginning of local inflammation and, over time, the formation of a scar. This is the typical "plaque" of the IPP. Over time scar these processes are stabilized, there are deposited calcium salts, resulting in unchangeable calcified plaque, typical of the IPP stabilized. The IPP
predominantly affects middle-aged men, much more rarely young and elderly subjects. The epidemiological distribution is justified and at the same time, comforting the hypothesis etiological outlined above, placing it in relation to two factors: tissue elasticity and force young sessuale.Nei the enormous elasticity of the tissue is able to absorb the trauma inherent coital movement, the elderly are seeing a significant reduction in tissue elasticity which, however, is accompanied by a significant reduction of "energy" during sex. E 'in the fifth to sixth decade of life, while maintaining a high mechanical stress borne by the erect penis during intercourse, the penile tissues lose more or less gradually and more or less quickly than their elasticità.Devine et al. in 1992 reported the finding of the IPP almost exclusively in white (rare among blacks and none of the East).
disease in 50% of cases had sudden onset and another 50% of insidious onset and slow over time. Although this different mode of presentation of symptoms is to be in agreement with the etiological hypotheses that we reported. In fact, a patient has two memories of penile trauma accompanied by severe pain lasting from minutes to days elapsed approximately 1-4 weeks before the onset of curvature. The other half of the patients but does not remember a specific traumatic event. In the first case it is likely that the trauma has caused a laceration of sufficient importance to be accompanied by pain and functional impairment, more or less long, the second was probably a series of repeated microtrauma are the basis of the disease. However arising, the overt disease is manifested by an acute phase and a stabilization phase. In the acute phase, as we have seen that can occur immediately after trauma or after a variable period of time, the patient complains of pain or spontaneous erection and curvature of the erect penis and, less frequently, even in a state of flaccidità.E 'This phase will be done in therapy. At this stage, it follows, after a period of 12-18 months, the organization needed scarring of the plaque, the stabilization phase in which inflammatory processes are solved and a residual calcified plaque unassailable therapy. E 'therefore essential to attack the disease with the appropriate therapy in the acute phase, one in which the inflammation and scarring processes are still in place, to reduce scar formation and deposition of calcium salts. Peyronie's disease may be associated with an erectile dysfunction is because the pain and curvature, resulting in pain penetration for both partners have an important psychological effect on sexual activity negative, and because the changes in penile tissues, which are behind the possible cause of 'IPP, coincided with those that contribute to the determinism of organic erectile dysfunction. Many authors argue that the IPP is not in itself cause erectile dysfunction, but often precedes and / or behave as contributory cause of some forms of organic or psychogenic erectile dysfunction.

The diagnosis should be placed as early possibile.Molti authors have suggested several diagnostic protocols with the use of various methods. In most cases, the diagnosis of PPI is done with four simple ways: 1) accurate collection of patient history (mode and time of onset, symptoms, associated manifestations, sexual life), 2) autofotografie in at least two projections, the patient must be performed with an erect penis it possible to calculate the exact angle of curvature of the penis, and 3) physical examination performed by expert hands that allows highly accurate assessments of the disease state, 4) Ultrasound in penile flaccid penis and erection farmacoindotta.
When a patient, or sent dall'andrologo urologist, in our study is to treat the first act we perform useful therapy without medicine or strumenti.Il interview, clear and calm with the patient is essential: a man in a still very male-dominated society that projects in the sexual attributes the foundation of existence (remember the youth competitions based on the various dimensions ....) which is diagnosed induratio penis feels the world fall on you, you feel affected in its most vital , believed to be the only one with this disease. It is therefore important to try to play down right away, make it clear that disease is very common and always treat, but often men, to a false sense of shame, they hid in their homes. It 'important, if possible, involve your partner for the role played by the couple as a unit, in the course of the disease, and especially the choice of strategy terapeutica.Un fact curved penis can be just as painful for the patient and with the result that the partners often avoid sexual intercourse becomes a forced choice of therapy entrambi.Ma come true. The surgery, which also is becoming more refined, provides for measures of plaque excision and application of patches of synthetic material or autologous (flaps mucosa taken from the patient himself) or the actions of penile implants for the rare fatal cases of erectile dysfunction, it should be reserved for patients who, because of the curvature or erectile dysfunction, can not possibly have sex and they want it. Regarding infilrazioni with anti-inflammatory drugs administered within perilesional (corticosteroids and ergoteina) many authors are beginning to be perplexed, because of the risks of fibrosis and reactive to the trauma of injection are inclined more and more for drug delivery with iontophoresis in the outpatient . Then examine the surgical and medical relevance of strict medical protocol that we use in our study, fruit experimentation and continuous review of the experience of specialized centers.
Vitamin E at a dose of 200-400 mg x 2 times with di.Ionoforesi: PrismaFibraseBentelanoppure with Verapamil
The patient must be properly prepared: in the supine position, take a sheet of aluminum foil to avoid getting wet, which we place another sheet of paper to bed, and the two sheets have a hole from which we exit the penis, which must be carefully cleaned with pure alcohol at 60% in deionized water to avoid waste and interference with the penetration of drugs (if necessary advise the patient to make a local trichotomy). Above the piece of sponge, new and wet in deionized water, say a layer of sterile gauze and pour this medication from time to time usati.Gli electrodes are positioned on either side of the penis and use a current of 4 mill for at least 25 minuti.Insieme iontophoresis to use the laser and / or ultrasound with Lioton about one thousand placca.In generally care should be carried out on alternate days for at least two months in the first phase, and thereafter should be made every two or three months a series of at least ten sedute.I results are more positive than is the early 'intervention that reduces scar formation and deposition of calcium salts. In any case, because it is not common to see a patient in the acute phase, even after the results are remarkable: the pain disappears, decreases the curvature and reduces the area of \u200b\u200bfibrosi.A this regard, as is clear from recent studies andrological by stretching the penis, the tunica albuginea extends / expands and better vascularity, which is why we advise our patients perform small maneuvers of stretching and light massage of the penis on the plate.

Caramel Highlights With Black Hair

treatments pre-and post-surgical beauty treatments

The increasing number of people engaged in recreational sports (just think of football, the footing, the white weeks) resulted in the fact that some injuries have become more widespread and not linked only to professional sports, among them the trauma normally treated as before and after any surgery, are the meniscal and anterior cruciate ligament injuries. More than ever in these situations is essential to work in close contact with the orthopedic surgeon.


meniscal



are quite common in activities that involve rotations of ginocchio.Un sudden stop, a change of direction, a contrast with an opponent without synchronization between the movements of flexion-extension and rotation are the risk factors meniscale.La integrity meniscal lesion may be isolated or associated with other knee injuries, particularly capsular ligament, which the likelihood is the most common injury anterior cruciate ligament (ACL). The lesions can be broadly divided into acute, if tied to a specific traumatic event, or degenerative diseases that are due to old injuries or repeated episodes microtraumatic. In the acute injury is almost always creates a block of joints, with payment endoarticolare in the case of chronic injury the symptoms are more nuanced and patient reports episodes of blocks, tenderness at the medial dell'emirima, sudden failure, click articolari.Soprattutto lesions acute treatment is surgical, but now a good arthroscopy performed under general anesthesia or peripheral, can be safely performed in day-hospital.I Recovery times depend on the type of intervention (treatment on the lateral meniscus require a rehabilitation times slower). In the immediate post-operative course is essential to the use of cryotherapy, along with isometrics and light electrical stimulation, especially the quadriceps. After a few days usually proceed to a partial load, it increases the intensity of electrical stimulation and set a good proprioceptive exercise program.
anterior cruciate ligament injury

Itraumi distortion of the knee has been constantly increasing in the various sports that involve an against knee. The anterior cruciate ligament injury alone or in combination with other joint structures is a possibility according to several epidemiological studies very often. In most cases, the injury occurs without contact or contrast, during a deceleration or a change in direction or a relapse of a salto.La natural history of ACL injury is well known and consists of a gradual destabilization articulate that through subsequent episodes of failure results in a more or less striking involvement of the menisci, cartilage and lining of the capsule-ligament peripheral components. The LCA consists of two quotas ligament, an anterior-medial tense in flexion and the other postero-lateral tight in extension, the tibial spines that are directed at the femoral insertion of the posterior medial condyle laterale.Nei acute trauma is essential to lock the joint, avoid the load using two crutches and to opt for a clinical diagnosis, whether it is of an isolated lesion of the ACL or in combination with other joint structures or devices. If the patient is usually an athlete already on the race, after a few minutes from the trauma, it is possible with sufficient reliability to assess the stability of the knee through the typical static and dynamic tests (Lachman, jerk), then it becomes more difficult for the onset of slip (hemarthrosis), the functional impairment and the contracture analgesic. In the chronic instability and insecurity, the continuous failures gestural especially during sports direct to the specialist in these cases the diagnosis may be easier and more easily be able to perform the evaluation tests. A determination by NMR instrumental definition also allows a significant amount of damage associate.Il treatment of injuries of the ACL surgery is, regardless of the sports offered by the patient as the joint, as mentioned, undergoes a progressive deterioration, especially if trauma occurs at a young age. Conversely, the same age, motivation and sports skills, weight, sex, represent factors considered for selection chirurgica.La an indication of the transplant to graft is one of the most debated from knee surgery, artificial ligaments, abandoned, not without its problems, levies tendon allografts, the use of autologous tendon samples (patellar, quadriceps, semitendinosus, gracilis duplicates) is now the best option available. The post-operative immobilization in a brace provides protective gear for three to four weeks, the immediate isometric muscle activity and the progressive load at the discretion of the patient. Iontophoresis, electrical stimulation and laser light accompany this phase. So the removal of the sutures is increased mobility joint, muscle activity is initiated in a closed kinetic chain, we increase the electrical stimulation and proprioceptive activities, the exercise bike and the pool. The next steps include the increase in muscle and proprioceptive activities, teaching the patient to walk properly and only after two or three months you can switch to a jog. The recovery depends very much on the sport motivation of the patient, but is not allowed on average before they are five or six mesi.Negli adolescents with ACL injury, practicing sports, it is generally advisable to perform surgical repair, being unable to control the instability joints and the potential degradation by enhancing muscle and knee functional until the end of growth. In patients no longer teenagers, who do not engage in professional sports, especially debilitating injuries that have not, recommend a good therapy and to resort to only when there are limitations in the normal social life.

Mastectomy

Another postoperative rehabilitative intervention is required of us increasingly concerns female patients with an outcome of interventions seno.Riteniamo should make some anatomical and pathological conditions before tackling the problem, very delicate, of rehabilitation.
The breast
The mammary glands are derived from the skin to ingrowth of thin ducts that ramify in the subcutaneous fatty tissue. The breast has a protrusion at its peak skin that nipple, surrounded by a zone of darker skin, called the areola. The breast receives arterial blood from branches of 'subclavian artery, axillary artery and intercostal arteries. The venous effluent drains into the veins omonime.I mammary lymph are schematically divided into three groups: a lateral group, a medial and a retromammario, which are covered by the axillary lymph nodes, internal mammary chain of lymph nodes and lymph nodes sopraclaveari.L 'body rests breast on the front of the chest. The skeletal support of the thorax is composed of the sternum, the ribs and 12 thoracic vertebrae. The muscles lining the chest are the pectoralis major and previously little deeper pettorale.Il surgical treatment in cases of breast cancer therapy involves demolition and conservative therapy depending on the circumstances and problems.

THERAPY demolition
simple mastectomy

nell'amputazione consists only of the breast without demolition plans and the underlying muscle without draining axillary lymph nodes.
Mastesctomia second Halsted radical
Involves removing the entire breast, small and large pectoral muscles and axillary lymph nodes of all

second Patey modified radical mastectomy
provides for the removal of the breast, axillary lymph node and the pectoralis minor muscle with preservation of pectoralis major. In recent years the procedure was further modified with the conservation of both muscles.

bilateral mastectomy
Because breast cancer can occur in both glands, even at different times, some women undergo surgery twice and are then forced to wear two hearing.


THERAPY CONSERVATIVE:


conservative surgery involves the removal of part of the organ.

quadrantectomy
This step removes a portion of the breast, in which context is the tumor, also including the skin and fascia of the pectoralis major. The removal of axillary lymph nodes, if necessary, can be done through the same incision or with another small incision in the axillary

lumpectomy involves the simple removal of the tumor, with or without removal of lymph nodes. These types of intervention are far less traumatic for the donna.L 'partial removal of Breast dramatically reduces the functional complications of the chest and arm, however, causing asymmetry of seni.Il aesthetic problem is easily solved by advising the woman to use partials.
We must say that fortunately in recent years reconstructive therapy is making good progress, because of 'lowering the age at which it is diagnosed and treated breast cancer, more often it is women who wish to undergo reconstructive therapy . It 'important that allow cancer to keep the skin and subcutaneous tissue to a depth of approximately 5 cm so as to ensure the blood supply. Reconstructive therapy can re-create the body using elements other than the mammary gland.
We talk about plant AutoGen myocutaneous flaps are used when the patient there are two systems that provide for the reconstruction of rotation or transfer of parts of the muscle and skin tissue from one part of the body:
musculocutaneous flap of the great dorsal

the rectus abdominis musculocutaneous flap.
interventions with autologous tissue are indicated in cases of reconstruction of large breasts.

is defined HETEROGENEITY surgery that involves the use of implants. In this case we used different types of implants that are soft, compressible liquid or gel-filled, of various sizes. In a high percentage of cases, breast reconstruction with implants requires an adjustment of the breast controlaterale.Gli interventions that allow the use of implants, about the reconstruction of small to medium sized breasts.
When a breast is removed, the chest is altering its structure in relation to two important factors: the weight of the organ and the extension plans muscolari.La consequence of amputation surgery results in a change in weight between the two hemithorax. Where is the organ breast surviving the column is subjected to a greater work than the private party. This condition causes a defect in the time position of the column with relative problems with breathing, movement, and the onset of arthritis back pains, problems that get worse when the woman has one breast larger (ie heavier).

If we consider that in the female breast surgery can occur, in more or less short, osteoporosis and muscle hypotonus due to menopause, it is clear that the lack of the organ is no longer limited to only the aesthetic but becomes a clinical-care issue to be addressed along with other situazioni.L 'hypotonus osteoporosis and muscle, although well as other factors cause both a functional impairment of the chest, both weakening of bone structure, both reduction in support of the muscular wall.
LYMPHEDEMA

edema of the upper limb, which can occur after radical mastectomy, is one of the complications that deserves to be remembered for the importance it assumes in the rehabilitation of donna.L 'edema caused by the difficulty of lymphatic drainage, resulting in the removal of axillary lymph stations and can get to pictures of elephantiasis of the limb. Lymphatic drainage improves gradually when you come to constitute the collateral circulation. To obtain a complete functional anatomy rehabilitation, must be taught the proper mobilization to the woman, from the earliest hours after the procedure the woman must mobilize arm and shoulder, gradually she will pan abduction and internal and external humeral rotation and movements of elevation and depression of the shoulder (it will be sufficient to teach a woman to touch the contralateral shoulder back several times to the starting position, as well as to touch the opposite side by passing the arm front and rear). In the state of rest of the upper limb rests on a pillow to encourage lymphatic drainage, is recommended to maintain a long arm to the left side . Then she will have to follow a program that may include physiotherapy and lymphatic drainage massage, and through the appropriate machinery, either manually or, if necessary will recommend an elastic bandage.
E 'extremely important to treat with care and sensitivity and possibly along with other qualified practitioners, the psychological aspect that comes from a new report that the woman must begin with his body modificato.E' important to highlight how delicate is the intervention of amputation of the breast, in whole or in part, for the reason that it has requested that the cosmetic change, sexual, social deriva.La woman that breast surgery is beginning to fight against a fierce enemy, sudden and fast: the cancer. The first concerns that affect a woman suffering from breast cancer are urgent about the prognosis, the surgery, after cytostatic therapy. The woman wants to eliminate as soon as the "enemy": the breast when she appeared on tumore.Dopo intervention comes awareness of amputation and a state of deep frustration takes hold of the woman: it is different from before, it was different from all other women, has lost the natural harmony in the delicate mechanism of communication about sex, there is no age that can be provided by these and other turbamenti.Subentra, in addition to depression, a sense of guilt that makes the woman angry for allowing his body is sick, for having allowed a cancer to have spread to your breasts, for having thus reduced to women more women. So there is a growing anger at themselves, which manifests itself in anger against herself, but sometimes also in the relationship with their loved ones, which can affect the relationships, altering the habits sociali.Per our part so we need to use together with rehabilitation techniques, is also very touch to defuse the situation and to motivate the patient to accept the new situation, however, and become essential subject of the rehabilitation program.