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Prosthodontic Rehabilitation!

MDS - Prosthodontics and Implantology
Dentist, Srinagar
Prosthodontic Rehabilitation!

Patient having only upper front 6 teeth treated with crowns and cast partial denture.

Cochlear Implants - Implantable Hearing Solution For The Hearing Impaired!

General Surgeon, Bangalore
Cochlear Implants - Implantable Hearing Solution For The Hearing Impaired!

A cochlear implant is a small electronic device that can help improve the hearing of people with severe, irreversible hearing loss. Although a cochlear implant does not restore normal hearing, it can allow a person to hear and understand more speech than was possible with a hearing aid.  For a child, this could mean an opportunity to develop listening and speech skills and the potential to attend school with hearing peers. For adults, a cochlear implant could reduce social isolation and improve communication.   

The Implant 
The cochlear implant is a device that is placed in the inner ear.   The implant system has three primary parts:  

  1. Microphone and Transmitter —The headpiece and transmitter is worn above the ear to pick up sounds. These sounds are sent to a speech processor.  
  2. Speech Processor — A speech processor is worn externally, behind the ear like a hearing aid, to convert sound into a digital code that is transmitted to an implanted stimulator.  
  3. Implanted Stimulator — The implanted stimulator is a small component placed under the skin behind the ear. It receives a digital code from the speech processor and sends it to the auditory or hearing nerve. 

The brain interprets this signal and it is recognized as sound.  The small headpiece and transmitter is held in place by a magnet coupled the implanted stimulator, under the skin.  

The Evaluation  
Tests are done to determine if a child is a candidate for a cochlear implantation. Patients are selected based on medical and hearing histories and test results as well as findings.  The evaluation, which differs slightly for children and adults, includes the following:  * 

  1. Medical Evaluation — Conducted by the cochlear implant surgeon who will take the medical history, examine your ears and explain the surgical process.
  2. CT Scan of the Temporal bone and MRI Brain and Cochlear imaging - This computerized tomography (CT) scan allows the surgeon to evaluate the ear's internal structure, recommend which ear to implant and may provide information as to the cause of deafness.
  3. Audiological Evaluation — This evaluation involves a hearing test to confirm the type and degree of hearing loss, hearing aid evaluation to assess the benefit provided by a hearing aid and aided speech recognition testing to determine if a hearing aid might provide greater benefit than an implant.  
  4. Psychological Screening — This screening is conducted by psychologist to assess the feelings about hearing loss and the cochlear implant, such as the reasons for seeking the implant and the expectations.  
  5. Cochlear Implant Counseling — At this time, if one is a candidate for cochlear implant, possible benefits and limitations will be explained and one will be provided with information to select the device.  

Before the surgery, one will meet with an anesthesiologist and and complete any necessary tests. Patients generally remain in the hospital overnight and return home the day after surgery.  

Implant surgery is performed under general anesthesia and takes about three hours. During the operation, a surgeon will anchor a receiver-stimulator device in the temporal bone in the skull and insert what is called an "electrode array" into the cochlea, the small snail-shaped structure in the inner ear that contains the hearing organ.  First, an incision is made behind the ear to expose the temporal bone. The surgeon then positions the implant component against the bone. A hole is made in the temporal bone with a microscopic drill, allowing the surgeon access to the cochlea. A small hole is made in the wall of the cochlea and the electrode array is gently guided into the cochlea. The internal receiver is secured in place on the skull bone with sutures and the incision is closed. A sterile dressing is placed on the incision.  

To qualify for a cochlear implant, patients must meet the following criteria:  
Adults age 18 and older have:  

  1. Overall good health 
  2. Severe hearing loss in both ears 
  3. Limited benefit from conventional hearing aids determined by a trial period, when appropriate, of about three months  
  4. Psychological and emotional stability  
  5. Realistic expectations of the implant  
  6. No ear conditions or other medical conditions that would interfere with surgery  
  7. Ability to participate fully in a follow-up   

Children age 1 to 17 must have:  

  1. Overall good health  
  2. Severe hearing loss in both ears 
  3. Limited benefit from conventional hearing aids  
  4. Realistic expectations of the cochlear implant  
  5. No ear conditions or other medical conditions that would interfere with surgery  
  6. Family commitment to comply with all evaluations before and after surgery  
  7. Enrollment in a post-operative rehabilitative and educational program that supports the use of cochlear implants and the development of hearing skills  

Following surgery, patient will return home for four weeks to allow time for swelling to subside and the incision to heal. After several days, the incision may be wet during bathing or showering.

Device Programming

The externally worn speech processor is activated about four weeks after surgery. The processor converts speech into a special code for each user. The activation and programming is performed at the Hospital. Programming for each implant is customized for the patient and takes about six hours over a two-day period. 

Visit at regular intervals for device checks and re-evaluation. During these visits, the implant and equipment are checked and performance is measured. Re-testing generally occurs at one, three and six months and one year following the initial device fitting. Then, semi-annual or annual evaluations are performed. Each session for adults involves about three hours.  

Benefit from a cochlear implant usually improves with time but can't be guaranteed. Rehabilitation after surgery is key to maximizing the benefits of the cochlear implant. Most people with these implants are able to engage in hearing activities, such as listening to a Walkman, enjoying a movie, using a phone and participating in social activities.  The motivation is critical to the success of the implant. Use the device during all waking hours, Listen, speak and interact with others as much as possible, Utilize visual cues when adjusting to the implant, but gradually decrease the use of visual cues when ready, Ask others to identify unfamiliar sounds so they become familiar.  

Many people have questions about cochlear implants, how they work and what to expect from the surgery. Here are some common questions and answers-

Will a cochlear implant restore normal hearing for people who are deaf? 
No, a cochlear implant does not restore normal hearing. It is a communication tool but not a "cure" for deafness. When hearing functions normally, parts of the inner ear convert sound waves into electrical impulses. These impulses are sent to the brain, where they are recognized as sound. A cochlear implant simulates that process. An implant, supplemented with listening therapy, can help people recognize sound, including speech.  

Are there risks in cochlear implant surgery?  
Risk is inherent in any surgery requiring general anesthesia. However, the surgical risks for cochlear implantation are minimal and most patients require only a one-day hospital stay and have no surgical complications.

Will I need more surgery as new technology becomes available?  
The implanted unit is designed to last a lifetime. The externally worn speech processor, which is responsible for converting sound into code and sending the information to an internal unit, is dependent on software that can be upgraded as technology improves.  

Will my child outgrow the internal device and require a new one?  
No, the cochlea is fully formed at birth and the skull structures achieve almost full growth by age 2. The electrode array is designed to accommodate skull growth in children.  Should I wait for new cochlear implant technology?  No, the design of the surgically implanted receiver and electrode array has changed relatively little during the history of cochlear implants. However, speech-coding strategies, which are responsible for delivering the signal to the internal unit and are stored in the externally worn speech processor, have improved significantly over the years. The speech processor can incorporate new technology when available.  

Can people with cochlear implants identify environmental noises as well as speech?  
Cochlear implants provide a wide range of sound information. Performance in speech perception testing varies among individuals. With time and training, most patients understand more speech than with hearing aids and many communicate by telephone or enjoy music.  

Can people with cochlear implants swim, shower and participate in sports?  
Yes, people with implants can swim, shower and participate in virtually all types of sport activities when they are not wearing the external equipment. The only restriction relates to skydiving and scuba diving because significant changes in air pressure are not advised. Participation in all other athletic activities is unrestricted, although protective headgear is always recommended.  In case you have a concern or query you can always consult an expert & get answers to your questions!

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Dr. Premendra Goyal 92% (839 ratings)
Dentist, Mumbai
If you are self-conscious because you have missing teeth, wear dentures that are uncomfortable or don't want to have good tooth structure removed to make a bridge, talk to your dentist to see if dental implants are an option for you.

Dental implants are a popular and effective way to replace missing teeth and are designed to blend in with your other teeth. They are an excellent long-term option for restoring your smile. In fact, the development and use of implants is one of the biggest advances in dentistry in the past decades. Dental implants are made up of titanium and other materials that are compatible with the human body. They are posts that are surgically placed in the upper or lower jaw, where they function as a sturdy anchor for replacement teeth.

Most patients find that a dental implant is secure, stable and a good replacement for their own tooth.

There are generally three phases to getting an implant:

• First, the dentist surgically places the implant into the jawbone. Your dentist may recommend a diet of soft foods, cold foods and warm soup during the healing process.

• Next, the bone around the implant heals in a process called osseointegration. What makes an implant so strong is that the bone actually grows around it and holds it in place. Osseointegration means “combines with the bone” and takes time. Some patients might need to wait until the implant is completely integrated, up to several months, before replacement teeth can be attached to the implant. Other patients can have the implants and replacement teeth placed all in one visit.

• Finally, it’s time for the placement of the artificial tooth/teeth. For a single tooth implant, your dentist will customize a new tooth for you, called a dental crown. The crown will be based on size, shape, color and fit, and will be designed to blend in with your other teeth. If you are replacing more than a single tooth, custom-made bridges or dentures will be made to fit your mouth and your implants. The replacement teeth usually take some time to make. In the meantime, your dentist may give you a temporary crown, bridge or denture to help you eat and speak normally until the permanent replacement is ready.

If you are interested in dental implants, it's a good idea to discuss it carefully with your dentist first. If you are in good general health this treatment may be an option for you. In fact, your health is more of a factor than your age. You may be medically evaluated by a physician before any implant surgery is scheduled.

Chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery. Patients with these issues may not be good candidates for implants. Using tobacco can also slow healing.
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Introduction To Saans Rehabilitation Program

Physiotherapist, Delhi
Introduction To Saans Rehabilitation Program

What Is Rehabilitation?

A comprehensive intervention for patients with chronic diseases who are symptomatic and often have decreased daily activities.

It is designed to

  • Reduce symptoms

  • Optimize functional status

  • Increase participation

  • Reduces health care costs

  • Stabilises or reversing systemic manifestations of the disease

  • Address morbidities and their consequences through education and exercise 

Why Rehabilitation is the Need of Hour

  • Chronic Disease Era

  • Associated Mental Health Concerns with Chronic Diseases.

  • Deconditioning Effects

  • Continuity in Healthcare delivery system

Who Can Benefit?

  • Chronic respiratory disease symptomatic with optimum drug therapy

  • Chronic cardiovascular diseases with breathlessness despite optimum intervention and drug therapy

  • Chronic neurological diseases

  • Chronic orthopedic diseases, pre & post operative conditions

  • Lifestyle disorders like Stress, Sleep, Obesity, Diabetes, Hypertension etc. 

  • Special children

  • Pre Natal and Post Natal Conditions

  • Oncological Condition

  • Chronic and Acute pain conditions

  • Alcohol Deaddiction & Smoking Cessation

What are Consequences of advanced chronic disease?

  • Peripheral Muscle dysfunction

  • Respiratory muscle dysfunction

  • Nutritional abnormalities

  • Cardiac impairment

  • Skeletal disease

  • Sensory defects

  • Neurocognitive dysfunction

  • Psychosocial dysfunction

What are the components of Rehabilitation program?

  • Proper education of Disease process

  • Exercise Training

  • Psychosocial/behavioral intervention/CBT

  • Nutrition assessment

  • Breathing and Relaxation techniques

  • Medications, devices & specific therapy

  • Outcome Assessment

What are the Possible Benefits?

  • Improved Exercise Capacity

  • Reduced perceived intensity of dyspnoea and stress

  • Improve health-related QOL

  • Reduced hospitalization

  • Reduced anxiety and depression

  • Improved limb function and ADL’s

  • Benefits extend well beyond immediate period of training 

Rehab Team 

For a successful rehabilitation program, it requires an efficient coordination and teamwork of medical professionals, which includes:

  • Doctors

  • Physiotherapists

  • Nurses

  • Nursing Attendants and health care workers

  • Wellness Coach and Psychologists

  • Nutritionists

  • Education Providers

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SAANS Cardiac Rehabilitation Program

Physiotherapist, Delhi
SAANS Cardiac Rehabilitation Program

Cardiac Rehabilitation 
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab programs include exercise training, education on the heart and healthy living, and counselling to reduce stress and help you return to an active life.

What is the duration of this program?

As per the requirement of the patient, the program duration can vary from 6 to 8 weeks to lifelong.

What can one achieve through this program?

The goal of this program is to prevent and limit the physiological and psychological effects of cardiac illness and to improve the overall cardiovascular fitness and health of the patient. This is accomplished by developing individualised program which cover exercise, education and lifestyle modification, tailored to the individual needs and abilities of the patients.

Who requires Cardiac Rehabilitation?

People with the following cardiac diseases require cardiac rehabilitation:

·Myocardial Infarction

·Coronary Artery Bypass Surgery


·Stable Angina Pectoris

·Two Or More Documented Classical Risk Factors For Coronary Heart Disease

·Stable Chronic Heart Failure

·Peripheral Vascular Disease

·Diabetes Mellitus (Type II)

·Valvular Heart Disease

What are the facilities for Cardiac Rehabilitation at SAANS?

SAANS Foundation has a dedicated cardiac rehab facility, complete with exercise equipment, i.e., treadmills, ergocycles, steppers and cross trainers; a gymnasium for pre-class warm-up and resistance training classes; Human Performance Labs for fitness testing; and a dedicated area for patient education.

The cardiac rehabilitation team

Phase I (Initial Phase)

This is an inpatient program. It begins with pre-procedure counselling and continues immediately after coronary artery grafting or stenting and post-angina or myocardial infarction. Its aim is to initiate early mobilisation (out of the bed) to reduce the effects of de-conditioning, along with patient education about heart disease. This is continued with a walking and exercise program at home or till the patient returns back to the hospital for Phase II.

Phase II (Conditioning Phase)

This consists of a comprehensive program to modify the risk factors for heart disease and consists of exercise, stress management, smoking cessation, behaviour modification, nutritional advice and patient education about the risk factors of heart disease. The aerobic exercise program can begin as early as 2 weeks after an uncomplicated infarction, angina and stenting or 4 weeks after a complicated infarction or bypass grafting. This is conducted in the form of group sessions or classes consisting of the three steps of initial stretching exercises, conditioning phase of aerobic training on the treadmill, ergo cycle, stepper or cross trainer (along with strengthening exercises) followed by the cool down phase. One session usually lasts for 60 to 90 minutes. It takes a frequency of 3 to 5 times a week to complete 20 sessions. Initial sessions are conducted with electrocardiographic monitoring. The behaviour management and nutritional component runs along with the exercise program. All sessions are physician monitored and are conducted by trained staff.

Phase III (Maintenance Phase)

This aims at continuing the benefits gained by patients during the second phase. It consists of the continuation of the aerobic exercise program but at a lesser frequency of about 2 to 3 times a week at home/in a gymnasium/at a hospital.

Saans Pulmonary Rehabilitation Program

Physiotherapist, Delhi
Saans Pulmonary Rehabilitation Program

What is Pulmonary Rehabilitation?

Pulmonary Rehabilitation (Rehab) is a medically supervised program that helps to improve the health and well being of people who have pulmonary problems.

Rehab programs include endurance training, chest therapy, education on lung hygiene and healthy living, counseling to reduce stress & trigger factors and smoking cessation thus helping you return to an active and healthy lifestyle.

Who requires Pulmonary Rehabilitation?

People with following diseases require Pulmonary Rehabilitation:

What are the facilities for Pulmonary Rehabilitation at SAANS?

SAANS Foundation has a dedicated Pulmonary Rehab facility with separate areas for postural drainage, oxygen therapy and Non Invasive Ventilation, nebulisation and telemetric ECG monitored exercise systems i.e. ergo cycles, stepper and cross trainer; a gymnasium for pre-class warm-up and resistance training classes; Lung function testing labs; and a dedicated area for patient education.

The Pulmonary Rehab team

A multi-disciplinary team consisting of

  • Physiatrists (rehab physician)

  • Pulmonologists

  • Nurses

  • Exercise Physiologists

  •  Physical and Occupational Therapists

  • Psychologists and Wellness Coach

  • Nutritionists

What is the duration of the program?

As per patient requirement, the program duration can vary from 4-6 weeks to lifelong.

What can one achieve through this program?

The goal of this program is to prevent and limit the physiological and psychological effects of pulmonary illness and to improve overall cardio-pulmonary status and health. This is accomplished by developing individualized programs of exercise, education and lifestyle modification that are tailored to individual needs and abilities.

Three phase program

Phase I (Initial)

This is an inpatient program which starts at the time of hospitalization. It aims to initiate early mobilization to reduce the effects of de-conditioning. It consists of oxygen therapy, chest wall manipulation, nebulization, postural drainage, breathing exercises and incentive spirometry to improve oxygenation. This is continued with a walking and exercise program at home or till patient return back to the hospital for Phase II.

Phase II (Conditioning Phase)

This consists of a comprehensive program to modify the aggravating factors for lung disease along with endurance training. This consists of chest care, aerobic exercise, stress management, smoking cessation, behavior modification, nutritional advice and patient and family education. The Phase II can begin after stabilization of the early symptoms. This is conducted in the form of group sessions or classes, one session usually last for 60-90 minutes. Frequency is 3-5 times a week to complete a total of about 20 sessions. Initial sessions of aerobic training are conducted with electrocardiographic monitoring. All sessions are physician monitored conducted by trained staff.

Phase III (Maintenance Phase)

This aims to continue the benefits gained by patients during Phase II. It consists of continuation of the aerobic exercise program but at a lesser frequency of 3 times a week at home/in a gymnasium/at a hospital.

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Saans Musculoskeletal Rehabilitation Program

Physiotherapist, Delhi
Saans Musculoskeletal Rehabilitation Program

What is Musculoskeletal Rehabilitation?

Musculoskeletal Rehabilitation involves maximising your function and potential so that you can return back to the community as soon as possible after any injury.

Who requires Musculoskeletal Rehabilitation?

People with following problems require Musculoskeletal Rehabilitation:

·Acute or chronic musculoskeletal pain

·Post fracture stiffness and reduced function

·Loss of a part of limb

·Chronic arthritis

·Chronic backache

·Repetitive strain injury

·Prolonged bed rest with generalised weakness (deconditioning syndrome)

Who Can Benefit?

Complex MSK Management

The Complex MSK Management specialises in treating patients who have significant functional mobility and movement impairments related to the musculoskeletal system such as, arthritis, osteoporosis, de-conditioning syndrome, post-operative complications and diabetes mellitus with associated neurological and cardiac conditions. Patients receive physical and occupational therapy, balance & gait training and education to improve their level of independence in daily living.

Multiple Trauma Management

Multiple Trauma Management provides rehab to people who have sustained multiple fractures and other injuries e.g. in a motor vehicle accident. The admission criteria are two or more active orthopedic medical conditions, multiple injuries / fractures as a result of trauma, physically ready to participate in the entire rehab process with cognitive ability to learn new activities and follow direction. These patients will be managed by a multi-disciplinary team taking care of post trauma stress disorder, pain management, mobility and activities of daily living. 

Sports Rehab

The Sports Rehab provides comprehensive care to people with shoulder joint and rotator cuff injuries, tennis and golfers elbow, hand injuries, anterior cruciate ligament tears, hamstring and ankle sprains who are engaged in outdoor sports like cricket, football, basketball, volleyball, etc. leading to significant pain, strength, movement & mobility impairments. The latest technology available at the centre - multi-joint dynamometer and gait and motion analysis gives significant input in managing these conditions allowing early return to the sporting activities.

Repetitive Strain Injury (RSI) Management

The RSI Management aims to manage patients who present with chief complaints of neck or back pain or any other cumulative trauma disorders due to overuse. Patients will be evaluated by an inter-disciplinary team and comprehensive rehabilitation activities will be provided with pharmacotherapy, electrotherapy, exercise programmes, ergonomic advice, behaviour and relaxation techniques, trigger point injection procedures and education.

Amputation Management

Amputation Management caters to the need of upper and lower limb amputation due to traumatic, ischemic, diabetic or other conditions. It offers comprehensive programme beginning with pre-amputation counselling, immediate post-operative pain reduction & temporary prosthesis, permanent prosthesis fitting & training and management of late early & late complications. The programme aims to reintegrate the person back into the society.

What is the duration of the Musculoskeletal Rehabilitation programme?

As per patient requirement, the programme duration can vary from 2-12 weeks.

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Rehabilitation Stages Patellar Tendinopathy

Physiotherapist, Guwahati
Rehabilitation Stages Patellar Tendinopathy

Rehabilitation Stages Patellar Tendinopathy

Rehabilitation After Trauma To Front Tooth

A.C.C.I - Accredited and Certified Course in Implantology, MDS - Pediatric & Preventive Dentistry, BDS
Dentist, Jammu
Rehabilitation After Trauma To Front Tooth

Upper front right tooth fractured at middle level on being self hit by a t t bat. Reattached the fractured component - had to do a rct and restored finally with a metaless crown.

Patient immensely satisfied.

Pulmonary Rehabilitation - How Physiotherapy Can Help?

Xcell Physiocare 89% (22 ratings)
MSPT (Master of Physical Therapy)
Physiotherapist, Delhi
Pulmonary Rehabilitation - How Physiotherapy Can Help?

Seeing someone who used to do all their activities on their own turn to someone who needs help even with small things like going to the bathroom can be very difficult.

The lungs are vital organs in that they are essential to supply oxygen to the entire body. If the various organs do not receive adequate oxygen, their function can be impaired. Therefore, lung function needs to be maintained. Lung function can be impaired by chronic conditions like COPD and bronchiectasis. In both these, the overall ability of the lungs to take in adequate oxygen is reduced. Therefore, the lungs need to be rehabilitated so that they can improve their ability to function better. These exercises are aimed at the following:

  1. Improve ability to breathe effectively
  2. Reduce episodes of breathlessness
  3. Reduce the number of hospitalizations required to clear sputum and infections
  4. Improve ability to perform small, routine chores on their own
  5. Improve exercise tolerance over a period of time
  6. Improve overall quality of life
  7. Reduce morbidity and mortality rates

It has been proven beyond doubt that in addition to medications, physiotherapy plays a vital role in improving lung function over a period of time. Depending on the actual condition of the patient, a physiotherapy program is drawn up. Initially, the therapist will guide the patient and/or the caretaker with the various exercises. Over a period of time, the caretaker and the patient can do these on their own. The intent of these common exercises is to improve breathing efficiency, clear mucus, and improve overall lung function.

  1. Active breathing techniques (ABT) – We all know that breathing is involuntary; however, making an effort to consciously breathe can improve the efficiency. More oxygen is taken in and sent to the various organs, thereby rejuvenating the entire body.
  2. Postural drainage: With any chronic lung condition, sputum or mucus tends to accumulate in various parts of the lungs. If not drained, it can attract more bacteria and cause infection. The patient is made to lie in various positions so that different parts of the lungs are drained, aided by gravity. This is highly effective in clearing secretions.
  3. Pursed lip breathing: Inhaling through the nose and letting the air out through the mouth like how a candle is blown helps improve lung function.
  4. Forced coughing: A person is taught to induce coughing so that secretions are cleared out, thereby reducing chances of infection. Inhale as usual to the full capacity and exhale in coughing spurts.

It has been proven beyond doubt that with no side effects (unlike medications), physiotherapy improves the overall quality of life in people with COPD.

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