Exercise Training for Diabetic Neuropathy

Exercise Training for Diabetic Neuropathy Field of Research Preventive and Rehabilitation Topic of Research Efficacy of exercise training along with foot Orthotic intervention in modifying the natural course of diabetic peripheral neuropathy. Brief Introduction and Literature Review Diabetic Plantat Ulcers Diabetic myelitis is a group of chronic metabolic diseases caused by insufficient production of Insulin, results in abnormal metabolism of carbohydrates, fats and proteins. Diabetic mellitus can be classified into Type I or Insulin dependent Diabetic mellitus; occurs due to autoimmune destruction of insulin secreting cell in the pancreas. The Type II Diabetic mellitus or Non insulin Dependent Diabetic mellitus, which is characterized by increase insulin resistant and relative lack of insulin(Kumar et al 2005). It was estimated 381 billion people suffering globally from Diabetics in 2013, among which 90% cases are Type II. The South Asian countries are having the highest number of diabetic patients in the world, with highest numbers in India and China(IDF). The peripheral nerve damage often involved in diabetic patient, affecting 60% of patients with Type I and Type II diabetes. In many instances, most of the patient had already some mild to severe form of peripheral neuropathies at the time of diagnosis (Boulton AJ et al 1998). The symptom in includes numbness, tingling or burning sensation, extreme sensitivity to touch, and insensitive to hot and pain in hands and feet. Diabetic Neuropathic feet- Biomechancial fault. For normal gait, everyone requires the integrated function of sensory and motor functions. The sensory input to adapt and modify the motor output to optimize ideal gait pattern. In addition, there should be a fully functional bone and joints with adequate muscle strength, are also vital(Aminian K at al., 2002). Futhermore, the muscle weakness, anesthesia and loss of proprioception alters the foot biomechanics, often leads to changes in mobility, gait and balance. In this way, peripheral neuropathy directly contributes to joint subluxation and lack of accommodation to ground reaction force. These changes put the patient vulnerable for foot deformities and foot injuries. Foot injuries are being considered as dangerous to diabetics because peripheral neuropathy and superimposed impaired circulation makes wound healing delayed and complicated, increase the risk of repeated infection. These might ultimately lead to amputation of the affected limb. The structural changes occur within the ligament, capsule and tendons of foot joints. The collagens of ligament, capsule and tendon disorganized, lose its elasticity and tensile strength, and become more stiff (Grant WP 1996). The resultant foot joint immobility, leads to abnormal biomechanics, thus further results in either joint subluxation or the risk of injury. Therefore, it is imperative to identify the biomechanical faults are an important component in the overall care of diabetic foot. The biomechanical examination includes neutral calcaneal stance position(NCSP), relaxed calcaneal stance position(RCSP), Rang of Ankle joint dorsiflexion, position and mobility of the first ray, Forefoot to rearfoot relationship, range of motion at first MTPJ, Foot Pasture Index, Functional Hallux test (FHT), Limb length examination and plantar pressure examination. A direct correlation between ulceration and areas of high pressure has been established (Veves A 1992). A fundamental part of the physical examine involves inspection of the plantar aspect of the foot for any discrete or diffuse calluses that may indicate focal areas of high pressure or areas of increased shear forces. The sensory testing with Semmes -Weinstein Monofilaments (SWFs) should be assessed to identify the people at high risk of ulcer. It was found that 5.07 Semmes -Weinstein Monofilaments more sensitive in detecting patient with risks of plantar ulcers(Pham H et al 2000). Foot Orthotics intervention for biomechnical fault The functional and accomodative foot orthosis has been a well accepted method of treatment for patient with neurologically impaired foot for a few decades(C. S. Nicolopoulos, B. W. Scott, P. V. Giannoudis 2000; .H Cross et al,1996; Hastings MK 2006). These foot orthotic intervention decreases peak plantar pressure by evenly distributing the body weight into the ground. Foot orthosis is a biomechanical device that controls the degree of pronation and supination of the foot while walking and running. By addressing the foot biomechanical fault in patients with foot orthosis, not only prevent the plantar ulcers and it also improve their adherence to physical exercise, which can prevent or modify the peripheral neuropathy of a diabetic patient. Exercise and Peripheral Neuropathy Based on published evidence, can benefit from regular participation in mild to moderate aerobic, resistance, and balance activities in presenting the onset or modify the natural history diabetic peripheral neuropathy(Colberg SR 2014; Balducci S 2006). StefanoBalducci, et al found that a significant difference in nerve conduction parameters in Sural and peroneal nerves between experimental and control groups(StefanoBalducci, 2006) Outcome Measure Nerve Conduction Study (NCS) Compound Muscle Action Potentials(CMAP), Compound Sensory Action Potentials(CSNP), and distal latencies of Peroneal and Sural nerve of both lower limbs will be measured as per the standardized procedure((DeLisa, 1994; Misra Kalita, 2006; Nasseri et al., 1998). Vibration Perception Thershold (VPT) Sense of vibration of the plantar side of big toe will be assessed using Vibrometer. There are many published evidence to suggest that vibration perception threshold measure can be effectively and accurately identify risks of diabetic neuropathy(Garrow AP et al, 2006; Catherine L 2010) Quantitative Warmth Cold sensation Assessment Michigan Diabetic Neuropathy Score Objective of the Study To assess biomechanical deviation of foot in preventing foot related problem in diabetic feet. To develop clinical long term exercise regime in preventing diabetic induced peripheral neuropathy To ascertain Orthotic intervention for biomechanical deviation of foot in enhancing patient adherence to exercise programs. To develop a clinical exercise tool to enhance functional outcome of diabetic induced peripheral neuropathy of the feet. To identify the effectiveness of clinical exercise tool to achieve treatment goals To study the reliability and validity of clinical exercise tool in the clinical setting. Methodology of the Study Phase I A systematic review and biomechanical analysis (Deformity, muscle patterns, and plantar pressure) are needed to understand biomechanial and functional aspect of neuropathic feet of a diabetic patient in comparison with healthy subjects. This analysis is crucial in developing an understanding of possible foot orthotic intervention to prevent undue pressure of anesthetic feet during weight being phase of gait. Phase II The effective exercise intervention protocol is needed to achieve desirable treatment goals. Therefore, in this phase, will focus development of the exercise protocol aimed to modify or prevent diabetic neuropathy. Besides, each patient with biomechanical deviation treated with appropriate functional and or accommodative foot Orthosis. Nerve conduction studies: Amplitude, distal latency, velocity and Vibration Perception threshold (VPT) and Semmen’s- Weinstein monofilaments touch, pressure sensation of both lower limbs will be recorded for all patients as a baseline. Phase III To test the validity and reliability of exercise protocol and foot orthosis in preventing or modifying diabetic neuropathy Nerve Conduction studies, VPT and Semmen’s- Weinstein monofilaments touch, pressure sensation Contribution This study, perhaps, may lead to improve or modify the natural course of diabetic neuropathy in patients at the risk or diagnosed peripheral neuropathy in diabetics. Orthotics intervention by means of accommodative / functional foot orthosis for the biomechanically abnormal foot helps the patient in preventing planar ulcers and aggravation of deformity. Besides, the foot orthotic intervention also might enhance the adherence to mild to moderate aerobic, resistance and balance activities. The finding from this study may provide better understanding of long term exercise protocol along with foot functional othosis in preventing or modifying diabetic neuropathy. Timeline/ Plan of Study Brief Bibliography Boulton AJ, Malik RA. Diabetic neuropathy.Med Clin North Am. Jul 1998;82(4):909-29 Aminian K, Najafi B, Bula C, Leyvraz P, Robert P. Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. J Biomech. 2002;35:689-99. Shaw JE, van Schie CH, Carrington AL, Abbott CA, Boulton AJ. An analysis of dynamic forces transmitted through the foot in diabetic neuropathy. Diabetes Care. 1998;21(11):1955-9. Yavuzer G, Yetkin I, Toruner FB, Koca N, Bolukbasi N. Gait deviations of patients with diabetes mellitus: looking beyond peripheral neuropathy. Eura Medicophys. 2006;42(2):127-33. Mueller MJ, Minor SD, Sahrmann SA, Schaaf JA, Strube MJ. Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther. 1994;74(4):299-308; discussion 309-13. Petrofsky J, Lee S, Bweir S. Gait characteristics in people with type 2 diabetes mellitus. Eur J Appl Physiol. 2005;93(5-6):640-7. Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. Grant WP, Sullivan R, Sonenshine DE, Adam M, Slusser JH, Carson KA, Vinik AI J Foot Ankle Surg. 1997 Jul-Aug; 36(4):272-8; discussion 330. Colberg SR,Vinik AI, Exercising with peripheral or autonomic neuropathy: what health care providers and diabetic patients need to know, Phys Sportsmed.2014 Feb;42(1):15-23. doi: 10.3810/psm.2014.02.2043. Balducci S,Iacobellis G,Parisi L,Di Biase N,Calandriello E,Leonetti F,Fallucca F.Exercisetraining can modify the natural history of diabetic peripheral neuropathy. JDiabetesComplications.2006 Jul-Aug;20(4):216-23. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Veves A, Murray HJ, Young MJ, Boulton AJ Diabetologia. 1992 Jul; 35(7):660-3. Pham H,Armstrong DG,Harvey C,Harkless LB,Giurini JM,Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. DiabetesCare.2000 May;23(5):606-11. Cross H,Kulkarni VN,Dey A,Rendall G. Plantar ulceration in patients with leprosy. J Wound Care.1996 Oct;5(9):406-11. Hastings MK,Mueller MJ,Pilgram TK,Lott DJ,Commean PK,Johnson JE. Effect of metatarsal pad placement on plantar pressure in people with diabetes mellitus and peripheral neuropathy. Foot Ankle Int.2007 Jan;28(1):84-8. Misra, U. K., Kalita, J. (2006). Clinical application of EMG and nerve conduction Clinical neurophysiology (2nd ed.). New Delhi: Elsevier, 80–84. DeLisa, J. A. (1994). Lower extremity nerves. Manual of nerve conduction velocity and clinical neurophysiology (3rd ed.)USA: Raven Press Limited, 122–144. Nasseri, K., Strijers, R. L. M., Dekhuijzen, L. S., Buster, M., Bertelsmann, F. W., et al. (1998). Reproducibility of different methods for diagnosing and monitoring diabetic neuropathy. Electromyography and Clinical Neurophysiology, 38, 295–299. Garrow AP ,Boulton AJ. Vibration perception thresholda valuable assessment of neural dysfunction in people with diabetes. Diabetes Metab Res Rev.2006 Sep-Oct;22(5):411-9. Catherine L. Martin, MS,Barbara H. Waberski, MS,Rodica Pop-Busui, MD, PHD,Patricia A. Cleary, MS,Sarah Catton, RN,James W. Albers, MD, PHD,Eva L. Feldman, MD, PHD,William H. Herman, MD, MPH,Vibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 Dia Vibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 DiabetesVibration Perception Therosholdas a Measure of Distal Symentrical Peripheral Neuropathy in Type 1 Diabetics, Diabetes Care.Dec 2010;33(12): 2635–2641. Vibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 Diabetes Vibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 Diabetes

Wild at Home

Persuasive Speech Outline Topic: Exotic animals do not make good pets Specific Purpose: To convince the audience that even though the baby versions of wild animals are cute, they don't stay that way forever. Therefore wild animals should not be pets. Central Idea: Wild animals should not be kept as pets, because it is bad for us as owners, bad for the animals themselves and even bad for the environment. Introduction Attention Getter: Picture this, you are hiking in the woods and come across a baby bear. There is no sign of it mother and it looks hungry, what would you do?According to the center for veterinary health sciences: the emotional appeal baby animals have on humans will allow you to look past the dangers of the animal and take care of it, possibly even taking it home with you. But when you think about it, would taking home a wild animal be such a good? Topic Introduction: Today I will try to convince you that even though the baby versions of wild animals are cute, they don't stay that way forever. Animals including: Lions, Tigers, Wolves, Bears, Reptiles and non-human primates do indeed grow up, and can possibly become dangerous, therefore should not be kept as pets.Relate the topic to your audience: I'm sure at one moment in your life, you have all wanted a wild animal as a pet. Relate the topic to you as a speaker: I know I did. When I was younger I wanted a baby panda. But, while doing my research for this speech I realize what a bad idea that would have been. If don't believe me, by the end of this speech I will have hopefully convinced you that: Preview your main points: wild animals should not be kept as a pets, by first discussing why it is bad for the animals.Then why it is bad for the owner, and finally why it is bad to the environment in general. Transition Statement: Even though keeping wild animals as pets can be appealing, it is important to remember that keeping a wild animal as a pet is associated with many potential problems, not to men tion legal and ethical issues. Also keeping wild animals as pets requires a great deal of research and preparation, as well as provision of ideal housing and diet as well as medical care (which may be very difficult to find).And if you cannot provide these necessities for the animal it can put the animal in danger. Which brings me to my first main point. Body I. Keeping a wild animal as a pet can be dangerous for the animal a. Most people can't provide the right home for Wild animals i. Wild animals have complex behavioral, social, nutritional and psychological needs. Most people simply cannot meet the needs of wild animals kept as â€Å"pets†. – For Example: Many monkeys, birds, and wild cats, can all travel several miles in a single day. A walk on a leash through the park won't cut it.Transition Statement: Exotic animals, by definition are not domesticated as well as unpredictable. Their behavior may change with seasons or life cycles in ways we don't understand. The y also rarely bond with their owners. Pet primates, big cats, and reptiles have attacked and seriously injured their owners. Which brings me to my next point, of why wild animals are also dangerous to their owners. II. Keeping a wild animal as a pet can also be dangerous to the owner a. You could get hurt. i. Keeping wild animals as pets can be dangerous.They can bite, scratch, attack their owners, and their owner's children and guests. ii. According to livesceince. com there has been 1,610 incidents involving exotic pets and 75 deaths from 1990-2011. iii. Examples from thedailygreen. com: * In 2000 a three year old boy had his arm bitten off by his uncle's â€Å"pet† tiger. b . You could get sick. i. As a dealer of exotic animals put it† If it walks, crawls, slithers, or flies, chances are we sell it here† This is also true with their diseases. ii. Wild animals carry diseases dangerous to humans.Some diseases are not curable and can be fatal. Diseases include rab ies, distemper, herpes viruses, salmonella, polio, tuberculosis, Rocky Mountain spotted fever and bubonic plague. Wild animals also harbor parasites, such as tape worms, flukes, and protozoa. iii. According to The U. S. Fish and Wildlife Service: 90% of all reptiles carry and shed salmonella in their feces or some form of intestinal bacteria that can be transferred to their owners. Transition Statement: Now that you know some of the negative effects on the animal and the owner.I find it is also important to know how owning a wild animal is also dangerous to the environment. III. Having wild animals as pets also have a negative effect on the environment. a. Taking them from the wild can endanger the species. I. According to livehonestly. com: To meet the demands of those who keep exotic animals as pets, dealers often have to take the animals from their native lands. This disrupts the ecosystems from which they are stolen, and can disrupt the ecosystems to which they are taken if they escape or are set loose.II. According to the Association of Zoo and Aquariums: Parrots are the world's most endangered family of birds due to devastation from the international pet trade. The enormous global demand for exotic pets is fueling the illegal capture and trade of millions of birds, mammals and reptiles annually, most of which die while being captured or transported. Transition Statement: On the PETA website, veterinarian and animal behaviorist says that â€Å"people who breed these animals and sell them as pets are playing Russian roulette. † ConclusionLink the conclusion to the introduction: Although wild animals, especially babies, appeal to our human emotions because they are so â€Å"cute†, as adults they can be very destructive and even dangerous to have around. Review the main points and reemphasize your central idea: without proper training you can cause harm to the animals as well as yourself and the environment. Specify desired audience response: i f dogs or cats aren't your thing there are plenty cool and unique animals that you could have as a pet. Memorable concluding statement: The main thing is to leave the wild animals to the professionals.But, if you feel the need to be surrounded by exotic animals there's always the zoo, and it is so much safer that way. Works Cited Owning wild animals statistics. (2011). Retrieved from www. livescience. com The dangers of keeping wild animals. (2013). Retrieved from www. livehonestly. com Wild animal attacks. (2000). Retrieved from www. dailygreen. com Wild animal pets. (2012). Retrieved from www. aspca. org Wild at home. (2013). Retrieved from www. nationalgeographic. com Exotic pets. (2012). Retrieved from www. peta. org

John F. Kennedy Essay - 2138 Words

John F. Kennedy On November 22, 1963, while being driven through the streets of Dallas, Texas, in his pen car, President John F. Kennedy was shot dead, apparently by the lone gunman, Lee Harvey Oswald. The world had not only lost a common man, but a great leader of men. From his heroic actions in World War II to his presidency, makind decisions to avert possible nuclear conflict with world superpowers, greatness can be seen. Kennedy also found the time to author several best-selling novels from his experiences. His symbolic figure represented all the charm, vigor and optimism of youth as he led a nation into a new era of prosperity. From his birth into the powerful and influential Kenndy clan, much was to be expected†¦show more content†¦Before the next school year began, he told his father he wanted to go to Harvard. On campus, yound people took interest in politics, social changes, and events in Europe. The United States was pulling out of the Great Depression. Hitler’s Nazi Germany followed aggressive territorial expansion in Europe. It was at this time that John first became aware of the vast social and economic differences in the United States. In June 1940, John graduated cum laude (with praise of distinction) from Harvard. His thesis earned a magma cum laude (great praise). After graduation, John begun to send his paper to publishers, and it was accepted on his second try. Wilfrid Funk published it under the title â€Å"Why England Slept†. It became a bestseller. John, at 25, became a literary sensation. In the spring of 1941, both John and Joe, Jr., decided to enroll in the armed services. Joe was accepted as a naval air cadet but John was turned down by both the army and navy because of his back trouble and history of illness. After months of training and conditioning, John reapplied and on September 19, John was accepted in to the navy as a desk clerk in Washinton. He was disgusted and applied for a transfer. 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Racial Profiling A Race And Ethnic Class - 1208 Words

Since this is a Race and Ethnic class I decided to do my research paper and power point presentation on â€Å"racial profiling†. Starting off racial profiling refers to the biased practice by law enforcement officials focusing on individuals for suspicion of crime, based on the individual s race, ethnicity, religion or national origin. Racial profiling is a very brood and sensitive topic because it’s a lot of it going on in the world today. My opinion is that racial profiling is a controversial topic in our society. The beneficial parts of racial profiling are firmly upheld by statistics that show that racial profiling is a compelling measure for fighting crime. In any case, there are decreasing consequences for certain minority groups on account of the sentiment that minorities are continually being preposterously associated with crime. 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