Allied Health Professions Austra by fjwuxn

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									Welcome to the official website of Allied Health Professions Australia.
Australia has more than 90,000 allied health professionals, who work
alongside doctors and nurses to provide optimum health care for all

Allied Health Professions Australia (AHPA) is the national voice of allied
health in Australia. Members of AHPA include Audiologists,
Chiropractors, Dietitians, Exercise Physiologists, Occupational
Therapists, Orthoptists, Orthotists and Prosthetists, Osteopaths,
Pharmacists, Podiatrists, Psychologists, Radiographers, Radiation
Therapists and Sonographers, Social Workers and Speech Pathologists.
Associate membership: Diabetes Educators.

AHPA’s vision
To be a powerful influence in Government health policy and decision
making through comprehensive recognition as the peak body for
national allied health associations.

AHPA’s mission
Through effective representation of the allied health professions deliver
high-quality, competent, informed advice to government and
associated organisations consistent with the needs of the communities
we serve.

The aim of this website to provide you with information regarding: the
structure and role of AHPA; the current priorities and activities of
AHPA; and contact details and links to the member organisations.
Please click on any of the headings above to find out more

Welcome to the official website of Allied Health Professions Australia.
Australia has more than 90,000 allied health professionals, who work
alongside doctors and nurses to provide optimum health care for all

Allied Health Professions Australia (AHPA) is the national voice of allied
health in Australia. Members of AHPA include Audiologists,
Chiropractors, Dietitians, Exercise Physiologists, Occupational
Therapists, Orthoptists, Orthotists and Prosthetists, Osteopaths,
Pharmacists, Podiatrists, Psychologists, Radiographers, Radiation
Therapists and Sonographers, Social Workers and Speech Pathologists.
Associate membership: Diabetes Educators.

AHPA’s vision
To be a powerful influence in Government health policy and decision
making through comprehensive recognition as the peak body for
national allied health associations.

AHPA’s mission
Through effective representation of the allied health professions deliver
high-quality, competent, informed advice to government and
associated organisations consistent with the needs of the communities
we serve.

The aim of this website to provide you with information regarding: the
structure and role of AHPA; the current priorities and activities of
AHPA; and contact details and links to the member organisations.
Please click on any of the headings above to find out more

                                     Practice Letter head

Allied health projessionals Name

Dear <AlliedHealthProfessionals’Name>,
                                     Re: <PatientName>
I am working with <PatientName> to develop a team care arrangement. <Patient name> and
I have agreed to invite your participation in this process. Medicare registered allied health
professionals are entitled to Medicare subsidised consultations following the implementation
of team care arrangements. These services do not cover assessment by the allied health
professional of the patient during the development process.
If you accept this role, please fax this letter back to the practice by <date> indicating your
acceptance and the treatment you will deliver under the Chronic Disease Management
(CDM) referral. Medicare requires specific detail of the care to be provided NOT ‗I will
advise after assessment‖. Attached are appropriate sections of the GP management plan and
team care arrangement (draft) to assist you in formulating your section of the care plan.
Once we have received your contribution it will be documented in the final copy. I will then
forward the CDM referrals (as agreed with <patient’s name>). Five CDM referrals are
available for patient care over a calendar year. Please note: it is at the GPs discretion how
many are allocated to each allied health provider and the CDM referral remains valid until all
are completed.
Allied health providers delivering care under a CDM referral are required to supply written
feedback to the GP according to the instructions found at the bottom of CDM referral. This
assists in ensuring the team care arrangement remains a useful planning tool for patient care.
If you have any suggestions or questions regarding this care plan do not hesitate in contacting
the practice.
Yours Sincerely


□      I am not willing to be involved in the development of a team care arrangement for
       <patient‘s name>.

□      I am willing to be involved in the development of a team care arrangement for
       <patient‘s name>.

I will provide the following care for this patient.

Signed:………………………………………………                                            Date:

Provider Number: …………………………………..

Allied health care professionals: who are they, what can they do for you and how can you
find them?

Published 15/10/2005

[Image source: iStockphoto]

      Physiotherapists
      Occupational therapists
      Psychologists
      Dietitians
      Podiatrists
      Exercise physiologists
      Speech pathologists
      Osteopaths
      Chiropractors
      Audiologists
      More info

Not sure of the difference between a pedicurist and a podiatrist? Think occupational therapy
is a form of career counselling? The so-called 'allied health professionals' are a mystery to
many of us, but if you're feeling below par, they can play a vital role in optimising your day-
to-day quality of life, degree of independence, and risk of further problems.

This guide profiles 11 allied health professionals and outlines what they do, how you access
their services and how much you can expect to pay. This is not a comprehensive list – allied

health professionals also include pharmacists, speech pathologist, optometrists, chiropractors,
audiologists and others.

While generally, Medicare won't cover fees, some free or low-cost public services are
available. There may be long waiting lists, however, especially in rural areas.

Patients with certain complex and chronic conditions can obtain a Medicare rebate of $48.95
per consultation with a private allied health professional provided that the treatment is part of
a patient care plan drawn up by a GP. However, the rebate is available for a total of no more
than five consultations in a year and this limit covers all allied health professionals. So if you
claim for two sessions with a physio, you can claim for only three further sessions with a
different type of allied health professional, such as a dietitian.

As well, if you have private health insurance, most funds offer rebates. Rebate levels vary but
are generally much less than the cost of the consultation and there are limits on the total
amount that can be claimed in a year.

If you are a rural patient, the More Allied Health Services program means you can access
public or private allied health professionals (where available) for free if you are referred by a
GP. Here's the low down...



Physiotherapists are experts in the diagnosis, management and prevention of movement
disorders. Their role in treating sporting injuries and problems with the neck or back is
widely known. But physios also work with premature babies, incontinent women, stroke
victims, and sufferers of conditions like Parkinson's disease, arthritis, and osteoporosis.

Using a wide range of drug-free techniques to relieve pain, restore function and movement
and prevent further problems, physios employ a combination of manual therapy, movement
training and physical and electrophysical agents. Treatments are used only if their
effectiveness has been solidly demonstrated in research. Often, a personal exercise program is
prescribed, tailored to meet your body's specific individual needs. A physio will consider any
problems you may already have, and adapt the program to suit your lifestyle.

There is no charge to visit a physiotherapist in a public hospital (a GP's referral is needed for
outpatient visits) but waiting lists can be as long as several months, the number of visits may
be limited, and there are few services in outer urban and rural areas (with Queensland and
Tasmania worst affected).

For private physios, no referral is needed. The average consultation (varied duration) costs
$45 to $55, but could be as high as $130 for specialists.

The Australian Physiotherapy Association website offers a 'find a physio' service, plus
contact details for its offices in each state.


Occupational therapists

Occupational therapists (OTs) work in a broad range of environments to help patients
participate in their chosen life activities. Their clients include people born with disabilities,
and those whose health suffers because of injury or illness. Working closely with
physiotherapists, they teach patients to use particular movements (or compensate for a lack of
movement) in day-to-day activities. They also help people adapt their environment (modify
their home to prevent falls, for example) and train them to use specially-developed equipment
(to access a computer, for instance).

The bulk of OTs work in the public health system – in hospitals, community health centres,
and other government-funded organisations – where their services are free. But there are
typically long waiting lists, especially in rural areas, and the help offered may be restricted to
what is considered absolutely essential.

Private OTs charge around $100 per hour. To find one, contact Occupational Therapy
Australia online or telephone their office in each state.



Contrary to popular belief, you don't need to be mentally ill to see a psychologist. The bulk of
psychologists help mentally healthy people function better. They can teach coping strategies
for a range of problems that seriously affect people's lives: stress, illness, relationship
difficulties and eating disorders, for example.

Unlike psychiatrists (doctors who specialise in treating mental illness), psychologists cannot
prescribe medication, but in many cases their treatments have been shown to be as good as or
better than drugs in treating anxiety and depression. They can also be valuable alongside

Free or low-cost public psychologists can be accessed through community health centres,
mental health centres, public hospitals and schools. Usually, no referral is needed but there
are long waiting lists.

Private psychologists charge $80 to $160 an hour, and typically four to 10 sessions are
needed. Wait times range from weeks (in cities) to months (in country areas). A partial rebate
may be available through a health fund. Historically psychologists haven't been covered by
Medicare, but from 1 November 2006, psychologists' fees will be covered by Medicare, but
only if the patient is being managed by a GP or psychiatrist who refers them to a
psychologist. Medicare will cover up to 12 individual or group sessions.

Note that only registered – therefore qualified – professionals can call themselves
psychologists, but the term 'counsellor' can be used by anyone. The Australian Psychological
Society provides an online and telephone (1800 333 497) referral service.



Dietitians translate scientific information about nutrition into practical information about
what people should eat. They can coach you to meet specific goals and provide advice on a
healthy balanced diet, weight loss (or gain), food allergies or intolerances, as well as
conditions like diabetes, heart disease, cancer and digestive problems.

There is no charge to see a dietitian in a community health centre or as an outpatient in a
public hospital, but you will need a doctor's referral and often only certain types of patients
are seen (for example, cancer patients needing close attention to nutrition, people with kidney
problems). Waiting times vary but are generally between one week and one month, or longer
in non-metropolitan areas (where government-funded positions often remain unfilled).

No referral is needed to see a private dietitian, but there are very few in rural areas. Initial
consultations are generally $50 to $90 (up to one hour), with subsequent visits shorter (say
15 to 30 minutes) and therefore cheaper (around $25 to $30).

The Dietetics Association of Australia has an online 'Find a Dietitian' service, or call
1800 812 942.



Toenails looking shabby? See a pedicurist. But for more serious ailments of the foot or lower
limb, it's a podiatrist you need. They treat conditions including arthritis, soft-tissue and
muscular disorders, and diseases of the nerves or blood supply. Podiatrists are especially
important to people with diabetes, who are at increased risk of lower limb amputation. They
manage pressure areas and prevent ulceration to keep patients mobile.

Most podiatrists are in private practice and a standard consultation costs around $38 to $48.
But public podiatrists provide low-cost service through some community health centres and
public hospital outpatient departments (Victoria has the largest number). Waiting periods are
highly variable but for public services, even in Melbourne, can be up to three months.
Whether public or private, usually no referral is needed.

Most rural areas will have either an established public podiatry clinic, or a visiting podiatrist.
But more remote areas tend to have poorer service.

Podiatrists are listed in the yellow pages or you can telephone the Australian Podiatry
Association office in each state. Links and contacts for the state offices can be found via the
Australasian Podiatry Council.


Exercise physiologists

Exercise physiologists (EPs) are not 'personal trainers', but university-trained experts in
exercise therapy/rehabilitation designed to prevent or manage chronic disease, injury and
disability. Their clients include those with diabetes and pre-diabetes, cardiovascular disease,
arthritis, osteoporosis, dysmetabolic syndrome (Syndrome X), obesity and hypertension,
musculoskeletal injuries, depression and immunological disorders.

EPs often work with general practitioners, developing physical activity programs that can be
done at home or in the community. This doesn't just involve tailoring exercises that are
specific to a client's health condition. EPs also use counselling and motivational strategies to
ensure the client makes a long-term commitment to regular exercise.

Most EPs work in private practice, however many also work in hospitals, community health
centres, rehabilitation and aged care centres, workplaces, academies of sport, universities,
health promotion agencies and fitness facilities. Patients with chronic and complex
conditions, who obtain a GP's referral to an EP, are eligible for a Medicare rebate of $45.95
per visit for up to five visits each year. For others no referral is needed to see an EP and
generally waiting lists are short, but there's no Medicare rebate. Initial consultation fees vary
($50 to $90) per individual session, with subsequent visits usually cheaper. EPs also often run
group exercise programs usually starting at around $10 per session.

The Australian Association for Exercise and Sports Science offers an exercise physiologist
search directory.


Speech pathologists

Speech pathologists don't just work with individuals who stutter or have articulation
problems, as many people think. They also treat those who have trouble listening, eating or
drinking. This can include the very young. Babies with difficulties breastfeeding or bottle-
feeding properly, toddlers not taking solids, children finding it hard to talk, people suffering
hearing loss, the head injured and those with degenerative diseases (such as motor neurone
disease) may all benefit from speech therapy.

The bulk of speech pathologists work in the public health system – in hospitals, community
health centres and mental health services – and other government-funded organisations like
schools and disability services. The rest work in private hospitals or are self-employed.
Waiting lists – particularly for children – are typically longer in the public system.

The need for a referral depends on the service accessed. Speech pathologists working in the
public health system normally require a doctor's referral. Those in private practice or in
agencies for people with disabilities or learning difficulties usually don't.

Speech pathology services are free when provided by government agencies and some non-
government agencies and services. Otherwise a typical consultation with a private speech
pathologist costs roughly $120 for an initial assessment and $40 to $70 for subsequent

Speech pathologists working privately are listed in the yellow pages. To find one in the
public system, contact the school, hospital or centre directly. Alternatively, search the website
of the national organisation Speech Pathology Australia, which is collating a downloadable
directory of members for each state.



Osteopaths work on the premise that posture, injury, or negative lifestyle patterns
compromise anatomical structure and lead to poor health. An osteopath diagnoses and treats
such problems using natural, non-invasive and manual techniques – orthopaedic and
neurological testing, soft tissue manipulation, stretching muscle groups and spinal
adjustments. They may also recommend exercises and dietary modifications. Their patients
include people with back and neck pain, sciatica, headaches, joint pain, work-related and
repetitive strain injuries and sports-related injuries.

No referral is needed to see an osteopath unless you wish to consult one under the Veterans'
Affairs scheme or for WorkCare in Queensland. Osteopaths work in private practice and
generally waiting times are a bit longer in rural areas.

Osteopaths in Sydney typically charge $80 for an initial consultation (40-60 minutes) and $70
for subsequent sessions (20 to 30 minutes). They charge fractionally less in other capital
cities and less again in rural areas. However those patients under the Veterans' Affairs
scheme and the various WorkCare/WorkCover and Transport Accident compensation
schemes have their treatment costs covered. Not all osteopaths are Veterans' Affairs
providers, so you should check before making an appointment.

Osteopaths are listed in the yellow pages or you can obtain a geographical listing of
practitioners by visiting the Australian Osteopathic Association's website.



Chiropractors focus on the diagnosis, correction and prevention of disorders of the muscle
and skeletal (spine, pelvis, limbs) systems and how these affect the nervous system and

overall health. The nervous system consists of the brain, spinal cord and nerves and is
protected by the skeletal system. It controls every part of the body. Chiropractors act on the
premise that an impaired nervous system can lead to all kinds of problems including
headaches, asthma and colic in children.

Chiropractic then is the science of locating misalignments (subluxations) in the spine, pelvis
and limbs and reducing their impact on the nervous system. Many techniques to adjust the
spine either by hand or using specialised instruments are used. These are backed by over 100
years of research. In Australia most of this is funded by the Australian Spinal Research

Chiropractors work in private practice and do not require a referral.

Expect to pay $60 to $120 on average for an initial consultation and between $40 and $80 for
subsequent consultations. X-rays (an important diagnostic tool) are extra – between $159 and
$259, depending on whether it's a full spinal X-ray or covering a smaller area. Rebates may
apply if you have private health insurance, or if the chiropractor arranges for the X-rays to be
performed by a radiographer and reported on by a radiologist (a specialist doctor).

Chiropractors are listed in the yellow pages or you can telephone the Chiropractors'
Association of Australia branch in each state. Links and contacts for the branch offices can be
found on the CAA's website. The site also features a 'locate a chiropractor' service.



Audiologists specialise in the assessment, prevention and non-medical management of
hearing impairment (and should not be confused with audiometrists or hearing aid
technicians). Services they provide include hearing assessment of children and adults,
prescription and fitting of hearing aids and other listening devices and counselling to the
hearing impaired.

Qualified audiologists practising in Australia are all full members of the Audiological Society
of Australia.

Audiologists work in hospitals and community health centres, hearing aid clinics, private
practice, university clinics and in some medical practices.

An average consultation costs $70 to $100 but under some circumstances, audiological
services and hearing devices are free.

Children and young people up to the age of 21, aged pensioners, most war veterans and
'special needs' groups (for example eligible Aboriginal and Torres Strait Islander peoples),
may be entitled to Commonwealth Government-funded services and hearing devices from
one of more than 150 providers, or the public provider Australian Hearing. You need a
referral from your GP to access the program, which is run by the Office of Hearing Services.

To find an audiologist, ask your GP or visit the directory of services on the Audiological
Society of Australia website.

More info

      Occupational Therapy Australia
      Medicare rebates for allied health services
      The Australian Psychological Society
      Chiropractors' Association of Australia
      Australian Physiotherapy Association
      Australasian Podiatry Council
      Services for Australian Rural & Remote Allied Health
      Australian Osteopathic Association
      Australasian Integrative Medicine Association (AIMA)
      Dietitians Association of Australia
      Speech Pathology Australia
      Audiological Society of Australia

Allied health professions in Australia

In Australia, Allied Health typically includes all health professions other than medicine,
dentistry and nursing that require a tertiary degree to practise, and who form part of the
public health system. The proviso of forming part of the public health service excludes some
registered professions, such as chiropractors in regions where they are not employed in
government health facilities. Queensland Health employs more than 5000 allied health
professionals across the following disciplines:[3]

      Audiology
      Behavioral Health (counseling, marriage and family therapy)
      Clinical measurement science
      Exercise physiology
      Music therapy
      Nuclear medicine technology
      Dietetics
      Occupational therapy
      Optometry
      Orthotics and prosthetics
      Pharmacy
      Physiotherapy
      Podiatry
      Psychology
      Radiation therapy
      Radiography / medical imaging
      Sonography
      Social Work

      Speech pathology


Audiologists are licensed professionals who hold a master's degree, Doctor of Audiology
(Au.D.), or Ph.D. in the hearing sciences. The specific degree and experience requirements
necessary to practice are determined by each state audiology license board. As of January
2007 all professional training programs for audiologists in the United States culminate with
the Au.D. (Doctor of Audiology) degree. Many state license laws now require the Au.D.
degree for all newly licensed audiologists, and it is expected that eventually all license laws
will require this (in the United States of America). Audiologists who have earned the master's
degree prior to the change in licensing standards are not required to earn a doctorate to
continue practicing in the field. Audiologists have a clinical/educational background that
emphasizes diagnostic evaluation of auditory (hearing) and vestibular (balance) systems,
amplification technology (especially hearing aids), cochlear implant mapping, hearing
science, aural rehabilitation and assistive device fitting. Audiologists may specialize in
pediatric diagnostics/amplification, cochlear implants, educational audiology, intraoperative
neurophysiological monitoring, vestibular and balance issues, and/or industrial hearing
conservation. Audiologists also work in universities, conducting research, or acting as clinical

Audiologists are also involved in the prevention of hearing loss and other communication
disorders. Hearing Conservation programs in industry and government strive to prevent noise
induced hearing loss through education and Audiologist intervention. Audiologists are often
in charge of Newborn Hearing Screening programs designed to identify hearing loss within
the first 4 months of life.....


In Australia Audiologists must hold a Masters in Audiology, alternatively Bachelor's degree
from overseas certified by the vetasses. As per the law of the land currently to practise as an
Audiologist one doesn't need to be a member of any professional body. But to dispense
hearing aids to eligible pensioners and eligible war veterans one must have 2 years clinical
experience and be registered with an approved body such as Audiology Australia or the
Australian College of Audiology (ACAud).

Exercise physiology
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Exercise physiology is the study of the acute and chronic adaptions in response to a wide-
range of exercise conditions. In addition, many exercise physiologists study the effect of
exercise on pathology, and the mechanisms by which exercise can reduce or reverse disease

There is no licensing body for exercise physiologists, and therefore the scope of exercise
physiology is diffuse. An exercise physiologist's area of study may include but is not limited
to biochemistry, bioenergetics, cardiopulmonary function, hematology, biomechanics,
skeletal muscle physiology, neuroendocrine function, and central and perpheral nervous
system function. Furthermore, exercise physiologists range from basic scientists, to clinical
researchers, to clinicians, to sports trainers.


        1 Energy
        2 Metabolic changes
            o 2.1 Rapid Energy Sources
            o 2.2 Plasma glucose
            o 2.3 Oxygen
            o 2.4 Dehydration
            o 2.5 Other
        3 Brain
            o 3.1 Cerebral oxygen
            o 3.2 Glucose
            o 3.3 Hyperthermia
            o 3.4 Ammonia
            o 3.5 Combinational exacerbation
        4 Fatigue
            o 4.1 Intense activity
            o 4.2 Endurance failure
            o 4.3 Central governor
            o 4.4 Other factors
        5 Cardiac biomarkers
        6 Human evolution
        7 See also
        8 References

[edit] Energy

Humans have a high capacity to expend energy for many hours doing sustained exercise. For
example, one individual cycling at a speed of 26.4 km/h (16.4 mph) across 8,204 km
(5,098 mi) on 50 consecutive days expended a total of 1,145 MJ (273,850 kcal) with an
average power output of 182.5 W.[1]

Skeletal muscle burns 90 mg (0.5 mmol) of glucose each minute in continuous activity (such
as when repetitively extending the human knee),[2] generating ≈24 W of mechanical energy,
and since muscle energy conversion is only 22-26% efficient,[3] ≈76 W of heat energy.
Resting skeletal muscle has a basal metabolic rate (resting energy consumption) of 0.63
W/kg[4] making a 160 fold difference between the energy consumption of inactive and active
muscles. For short muscular exertion, energy expenditure can be far greater: an adult human
male when jumping up from a squat mechanically generates 314 W/kg, and such rapid
movement can generate twice this power in nonhuman animals such as bonobos,[5] and in
some small lizards.[6]

This energy expenditure is very large compared to the resting metabolism basal metabolic
rate of the adult human body. This varies somewhat with size, gender and age but is typically
between 45 W and 85 W.[7] [8] Total energy expenditure (TEE) due to muscular expended
energy is very much higher and depends upon the average level of physical work and

exercise done during a day.[9] Thus exercise, particularly if sustained for very long periods,
dominates the energy metabolism of the body.

[edit] Metabolic changes

[edit] Rapid Energy Sources

Energy needed to perform short lasting, high intensity bursts of activity is derived from
anaerobic sources within the cytosol of muscle cells, as opposed to aerobic respiration which
utilizes oxygen, is sustainable, and occurs in the mitochondria. The quick energy sources
consist of the phosphocreatine (PCr) system, fast glycolysis, and adenylate kinase. All of
these systems re-synthesize adenosine triphosphate (ATP), which is the universal energy
source in all cells. The most rapid source, but the most readily depleted of the above sources
is the PCr system which utilizes the enzyme creatine kinase. This enzyme catalyzes a reaction
that combines phosphocreatine and adenosine diphosphate (ADP) into ATP and creatine.
This resource is short lasting because oxygen is required for the resynthesis of
phosphocreatine via mitochondrial creatine kinase. Therefore, under anaerobic conditions,
this substrate is finite and only lasts between approximately 10 to 30 seconds of high
intensity work. Fast glycolysis, however, can function for approximately 2 minutes prior to
fatigue, and predominately uses intracellular glycogen as a substrate. Glycogen is broken
down rapidly via glycogen phosphorylase into individual glucose units during intense
exercise. Glucose is then oxidized to pyruvate and under anaerobic condition is reduced to
lactic acid. This reaction oxidizes NADH to NAD, thereby releasing a hydrogen ion,
promoting acidosis. For this reason, fast glycolysis can not be sustained for long periods of
time. Lastly, adenylate kinase catalyzes a reaction by which 2 ADP are combined to form
ATP and adenosine monophosphate. This reaction takes place during low energy situations
such as extreme exercise or conditions of hypoxia, but is not a significant source of energy.
The creation of AMP resulting from this reaction stimulates AMP activated protein kinase
(AMP kinase) which is the energy sensor of the cell. After sensing low energy conditions,
AMP kinase stimulates various other intracellular enzymes geared towards increasing energy
supply and decreasing all anabolic, or energy requiring, cell functions.

[edit] Plasma glucose

Plasma glucose is maintained by an equal rate of glucose appearance (entry into the blood)
and glucose disposal (removal from the blood). In the healthy individual, rate of appearance
and disposal are essentially equal during exercise of moderate intensity and duration;
however, prolonged exercise or sufficiently intense exercise can result in an imbalance
leaning towards a higher rate of disposal than appearance, at which point glucose levels fall
along with the onset of fatigue. Rate of glucose appearance is dictated by the amount of
glucose being absorbed at the gut as well as hepatic glucose output. Although glucose
absorption from the gut is not typically a source of glucose appearance during exercise, the
liver is capable of catabalizing stored glycogen (glycogenolysis) as well as synthesizing new
glucose from specific reduced carbon molecules (glycerol, pyruvate, and lactate) in a process
called gluconeogenesis. The ability of the liver to release glucose into the blood from
glycogenolysis is unique in that skeletal muscle,the other major glycogen reservoir, is
incapable of doing so. Unlike skeletal muscle, hepatocytes contain the enzyme glycogen
phosphatase, which removes a phosphate group from glucose-6-P, to release free glucose. In
order for glucose to exit a cell membrane, the removal of this phosphate group is essential.
Although gluconeogenesis is an important component of hepatic glucose output, it alone can

not sustain exercise. For this reason, when glycogen stores are depleted during exercise,
glucose levels fall and fatigue sets in. Glucose disposal, the other side of the equation, is
controlled by uptake of glucose at the working skeletal muscles. During exercise, despite
decreased insulin concentrations, muscle increases GLUT4 translocation and therefore
glucose uptake. The mechanism for increased GLUT4 translocation is an area of ongoing
research; however, the most well studied mechanism involves activation of AMP activated
protein kinase. Other possible mechanisms involve signaling via nitric oxide, reactive oxygen
species, as well as a physical mechanism caused by the contraction itself.

glucose control: As mentioned above, insulin secretion is reduced during exercise, and does
not play a major role in euglycemia during exercise. Insulin's countergegulatory hormones,
however, appear in increasing concentrations during exercise. Principle among these are
glucagon, epinephrine, and growth hormone. All of these horomones stimulate hepatic
glucose output among other functions. For instance, both epinephrine and growth hormone
also stimulate adipocyte lipase, which increases non-esterified fatty acid (NEFA) release. By
oxidizing fatty acids, this spares glucose utilization and helps to maintain euglycemia during

Exercise for diabetes: Exercise is a particularly potent tool for glucose control in those who
have diabetes mellitus. In a situation of elevated plasma glucose, or hyperglycemia, moderate
exercise can induce greater glucose disposal than appearance, thereby decreasing total plasma
glucose concentrations. As stated above, the mechanism for this glucose disposal is
independent of insulin, which makes it particularly well suited for people with diabetes. In
addition, there appears to be an increase in sensitivity to insulin for approximately 12-24
hours post exercise. This is particularly useful for those who have type II diabetes and are
producing sufficient insulin but demonstrate peripheral resistance to insulin signaling.
However, during extreme hyperglycemic episodes, people with diabetes should avoid
exercise due to potential complications associated with ketoacidosis. Exercise could
exacerbate ketoacidosis by increasing ketone synthesis in response to increased circulating

Type II diabetes is also intricately linked to obesity, and there may be a connection between
type II diabetes and how fat is stored within panreatic, muscle, and liver cells. Likely due to
this connection, weight loss from both exercise and diet tends to increase insulin sensitivity in
the majority of people. In some people, this effect can be particularly potent and can result in
normal glucose control. Although nobody is technically cured of diabetes, individuals can
live normal lives without the fear of diabetic complications; however, regain of weight would
assuredly result diabetes signs and symptoms.

[edit] Oxygen

Oxygen consumption (VO2) during exercise is best described by the Fick Equation: VO2=Q
x (a-vO2diff), which states that the amount of oxygen consumed is equal to cardiac output
(Q) multiplied by the difference between arterial and venous oxygen concentrations. More
simply put, oxygen consumption is dictated by the quantity of blood distributed by the heart
as well as the working muscle's ability to take up the oxygen within that blood; however, this
is a bit of an oversimplification. Although cardiac output is thought to be the limiting factor
of this relationship in healthy individuals, the ability of the lung to oxygenate the blood must
also be considered. Various pathologies and anomalies cause conditions such as diffusion
limitation, ventilation/perfusion mismatch, and pulmonary shunts that can limit oxygenation

of the blood and therefore oxygen distribution. In addition, the oxygen carrying capacity of
the blood is also an important determinant of the equation. Oxygen carrying capacity is often
the target of ergogenic aids used in endurance sports to increase hematocrit, such as through
blood doping or the use of erythropoietin (EPO). Furthermore, peripheral oxygen uptake is
reliant on a rerouting of blood flow from relatively inactive viscera to the working skeletal
muscles, and within the skeletal muscle, capillary to muscle fiber ratio influences oxygen

[edit] Dehydration

Intense prolonged exercise produces metabolic waste heat, and this is removed by sweat
based thermoregulation. A male marathon runner, loses each hour around 0.83 L in cool
weather, and 1.2 L in warm (losses in females are about 68 to 73% lower).[10] People doing
heavy exercise may lose two and half times as much fluid in sweat as urine.[11] This can have
profound physiological effects. Cycling for 2 hours in the heat (35 °C) with minimal fluid
intake causes body mass declined by 3 to 5%, blood volume by 3 to 6%, body temperature to
rise constantly, and compared to those with proper fluid intake, they have higher heart rates,
lower stroke volumes and cardiac outputs, reduced skin blood flow, and higher systemic
vascular resistance. These effects are largely eliminated by replacing 50 to 80% of the fluid
lost in sweat.[10][12]

[edit] Other

      Plasma catecholamine concentrations increase 10 fold in whole body
      Ammonia is produced by exercised skeletal muscles from ADP (the precursor
       of ATP) by purine nucleotide deamination and amino acid catabolism of
      interleukin-6 (IL-6) increases in blood circulation due to its release from
       working skeletal muscles.[15] This release is reduced if glucose is taken,
       suggesting it links to energy related stresses.[16]
      Sodium absorption is affected by the release of interleukin-6 as this can cause
       the secretion of arginine vasopressin which, in turn, can led to exercise-
       associated hyponatremia (dangerously low sodium levels). This loss of
       sodium in blood plasma can result in encephalopathy (caused by swelling of
       the brain). This can be prevented by awareness of the risk of drinking
       excessive amounts of fluids during prolonged exercise.[17][18]

[edit] Brain

At rest, the human brain receives 15% of total cardiac output, and uses 20% of the body's
energy consumption.[19] The brain is normally dependent for its high energy expenditure upon
aerobic metabolism. The brain as a result is highly sensitive to failure of its oxygen supply
with loss of consciousness occurring within six to seven seconds,[20] with its EEG going flat
in 23 seconds.[21] The metabolic demands of exercise if it effected the oxygen and glucose
supply to the brain could therefore quickly disrupt its functioning.

Protecting the brain from even minor disruption is important since exercise depends upon
motor control, and particularly, because humans are bipeds, the motor control needed for
keeping balance. Indeed, for this reason, brain energy consumption is increased during

intense physical exercise due to the demands in the motor cognition needed to control the

[edit] Cerebral oxygen

Cerebral autoregulation usually ensures the brain has priority to cardiac output, though this is
impaired slightly by exhaustive exercise.[23] During submaximal exercise, cardiac output
increases and cerebral blood flow increases beyond the brain‘s oxygen needs.[24] However,
this is not the case for continuous maximal exertion: ―Maximal exercise is, despite the
increase in capillary oxygenation [in the brain], associated with a reduced mitochondrial O2
content during whole body exercise‖[25] The autoregulation of the brain‘s blood supply is
impaired particularly in warm environments[26]

[edit] Glucose

In adults, exercise depletes the plasma glucose available to the brain: short intense exercise
(35 min ergometer cycling) can reduce brain glucose uptake by 32%.[27]

At rest, energy for the adult brain is normally provided by glucose but the brain has a
compensatory capacity to replace some of this with lactate. Research suggests that this can be
raised, when a person rests in a brain scanner, to about 17%,[28] with a higher percentage of
25% occurring during hypoglycemia.[29] In intense exercise, lactate has been estimated to
provide a third of the brain‘s energy needs.[30][31] There is evidence that the brain might,
however, in spite of these alternative sources of energy, still suffer an energy crisis since IL-6
(a sign of metabolic stress) is released during exercise from the brain.[14][22]

[edit] Hyperthermia

Humans use sweat thermoregulation for body heat clearance, particularly to remove the heat
produced during exercise. Mild dehydration as a consequence of exercise and heat is reported
to impair cognition.[32][33] These impairments can start after body mass lost that is greater than
1%.[34] Cognitive impairment, particularly due to heat and exercise is likely to be due to loss
of integrity to the blood brain barrier.[35] Hyperthermia also can lower cerebral blood
flow,[36][37] and raise brain temperature.[22]

[edit] Ammonia

Exercised skeletal muscles produces ammonia. This ammonia is taken up by the brain in
proportion to its arterial concentration. Since perceived effort links to such ammonia
accumulation, this could be a factor in the sensation of fatigue.[38]

[edit] Combinational exacerbation

These metabolic consequences of exercise can exacerbate each other‘s negative neurological
effects. For example, the uptake of ammonia by the brain is greater with glucose depletion
(CSF ammonia levels: rest, below 2 μmol min−1 detection level; following 3 hours exercise
with glucose supplementation, 5.3 μmol min−1, without glucose supplementation, 16.1 μmol
min−1).[14] The effects of dehydration are greater and happen at a lower threshold in hot

[edit] Fatigue

[edit] Intense activity

Researchers once attributed fatigue to a build-up of lactic acid in muscles.[39] However, this is
no longer believed.[40][41] Indeed, lactate may stop muscle fatigue by keeping muscles fully
responding to nerve signals.[42] Instead, providing available oxygen and energy supply,
disturbances of muscle ion homeostasis are the main factor determining exercise
performance, at least during brief very intense exercise.

Each muscle contraction involves an action potential that activates voltage sensors, and so
releases Ca2+ ions from the muscle fibre‘s sarcoplasmic reticulum. The action potentials
causing this require also ion changes: Na influxes during the depolarization phase and K
effluxes for the repolarization phase. Cl- ions also diffuse into the sarcoplasm to aid the
repolarization phase. During intense muscle contraction the ion pumps that maintain
homeostasis of these ions are inactivated and this (with other ion related disruption) causes
ionic disturbances. This causes cellular membrane depolarization, inexcitability, and so
muscle weakness.[43] Ca2+ leakage from type 1 ryanodine receptor) channels has also been
identified with fatigue.[44]

Dorando Pietri about to collapse at the Marathon finish at the 1908 London Olympic

[edit] Endurance failure

After intense prolonged exercise, there can be a collapse in body homeostasis. Some famous
examples include:

      Dorando Pietri in the 1908 Summer Olympic men’s marathon ran the wrong
       way and collapsed several times.
      Jim Peters in the marathon of the 1954 Commonwealth Games staggered
       and collapsed several times, and though he had a five-kilometre (three-mile)
       lead, failed to finish. Though it was formerly believed that this was due to
       severe dehydration, more recent research suggests it was the combined
       effects upon the brain of hyperthermia, hypertonic hypernatraemia associated
       with dehydration, and possibly hypoglycaemia.[45]
      Gabriela Andersen-Schiess in the woman’s marathon at the Los Angeles
       1984 Summer Olympics in the race’s final 400 meters, stopping occasionally

       and shown signs of heat exhaustion. Though she fell across the finish line,
       she was released from medical care only two hours later.

[edit] Central governor

Tim Noakes, based on an earlier idea by the 1922 Nobel Prize in Physiology or Medicine
winner Archibald Hill[46] has proposed the existence of a central governor. In this, the brain
continuously adjusts the power output by muscles during exercise in regard to a safe level of
exertion. These neural calculations factor in prior length of strenuous exercise, the planning
duration of further exertion, and the present metabolic state of the body. This adjusts the
number of activated skeletal muscle motor units, and is subjectively experienced as fatigue
and exhaustion. The idea of a central governor rejects the earlier idea that fatigue is only
caused by mechanical failure of the exercising muscles ("peripheral fatigue"). Instead, the
brain models[47] the metabolic limits of the body to ensure that whole body homeostasis is
protected, in particular that the heart is stopped from developing myocardial ischemia, and an
emergency reserve is always maintained.[48][49][50][51] The idea of the central governor has
been questioned since ‗physiological catastrophes‘ can and do occur suggesting athletes (such
as Dorando Pietri, Jim Peters and Gabriela Andersen-Schiess) can over-ride the ‗‗central

[edit] Other factors

The exercise fatigue has also been suggested to be effected by:

      brain hyperthermia[53]
      glycogen depletion in brain cells[30][54]
      reactive oxygen species impairing skeletal muscle function[55]
      reduced level of glutamate secondary to uptake of ammonia in the brain[38]
      Fatigue in diaphragm and abdominal respiratory muscles limiting breathing[56]
      Impaired oxygen supply to muscles[57]
      Ammonia effects upon the brain[38]

      Serotonin pathways in the brain[58]

[edit] Cardiac biomarkers

Prolonged exercise such as marathons can increase cardiac biomarkers such as troponin, B-
type natriuretic peptide (BNP), and ischemia-modified albumin. This can be misinterpreted
by medical personnel as signs of myocardial ischemia, or cardiac dysfunction. In these
clinical conditions, such cardiac biomarkers are produced by irreversible injury of muscles. In
contrast, the processes that create them after strenuous exertion in endurance sports are
reversible, with their levels returning to normal within 24-hours (further research, however, is
still needed).[59][60][61]

[edit] Human evolution

Humans are specifically adapted to engage in prolonged strenuous muscular activity (such as
efficient long distance bipedal running).[62] This capacity for endurance running evolved to

allow the running down of game animals by persistent slow but constant chase over many

Central to the success of this is the ability of the human body, unlike that of the animals they
hunt, to effectively remove muscle heat waste. In most animals, this is stored by allowing a
temporary increase in body temperature. This allows them to escape from animals that
quickly speed after them for a short duration (the way nearly all predators catch their prey).
Humans unlike other animals that catch prey remove heat with a specialized thermoregulation
based on sweat evaporation. One gram of sweat can remove 2,598 J of heat energy.[64]
Another mechanism is increased skin blood flow during exercise that allows for greater
convective heat loss that is aided by the upright posture. This skin based cooling has involved
humans in acquiring an increased number of sweat glands, combined with a lack of body fur
that would otherwise stop air circulation and efficient evaporation.[65] Because humans can
remove exercise heat, they can avoid the fatigue from heat exhaustion that affects animals
chased in persistence hunting, and so eventually catch them when they fatigued from heat
exhaustion due to being forced to constantly move.[66]

[edit] See also

        Bioenergetics
        Exercise
        Fitness professional
        Metabolism
        Muscle contraction
        Muscles exercised
        Skeletal muscle
        Excess post-exercise oxygen consumption (EPOC)

Music therapy
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         Basic science

       Abnormal · Biological
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Music therapy is both an allied health profession and a field of scientific research which
studies correlations between the process of clinical therapy and biomusicology, musical
acoustics, music theory, psychoacoustics and comparative musicology. It is an interpersonal
process in which a trained music therapist uses music and all of its facets—physical,
emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain
their health. Music therapists primarily help clients improve their observable level of
functioning and self-reported quality of life in various domains (e.g., cognitive functioning,
motor skills, emotional and affective development, behavior and social skills) by using music
experiences (e.g., singing, songwriting, listening to and discussing music, moving to music)
to achieve measurable treatment goals and objectives. Referrals to music therapy services
may be made by a treating physician or an interdisciplinary team consisting of clinicians such
as physicians, psychologists, physical therapists, and occupational therapists.

Music therapists are found in nearly every area of the helping professions. Some commonly
found practices include developmental work (communication, motor skills, etc.) with
individuals with special needs, songwriting and listening in reminiscence/orientation work
with the elderly, processing and relaxation work, and rhythmic entrainment for physical
rehabilitation in stroke victims.

The Turco-Persian psychologist and music theorist al-Farabi (872–950), known as
"Alpharabius" in Europe, dealt with music therapy in his treatise Meanings of the Intellect,
where he discussed the therapeutic effects of music on the soul.[1] Robert Burton wrote in the
17th century in his classic work, The Anatomy of Melancholy, that music and dance were
critical in treating mental illness, especially melancholia.[2][3][4]

It is considered one of the expressive therapies.


        1 Forms
        2 In the United States
        3 In the United Kingdom
        4 As stroke therapy
        5 In heart disease
        6 In epilepsy
        7 Experimental approaches
        8 Notable practitioners and authors
        9 See also
        10 Notes
        11 Further reading
        12 External links
             o 12.1 Journals
             o 12.2 Associations
             o 12.3 Projects
             o 12.4 General
             o 12.5 Sampling of university programs in music therapy

[edit] Forms

There are a few different philosophies of thought regarding the foundations of music therapy.
One is based on education and two are based on music therapy itself, both of which will only
be briefly covered here. In addition, there are philosophies based on psychology, and one
based on neuroscience.

Different approaches from education are Orff-Schulwerk (Orff), Dalcroze Eurhythmics, and
Kodaly. The two philosophies that developed directly out of music therapy are Nordoff-
Robbins and the Bonny Method of Guided Imagery and Music.[5]

Music therapists work many times with individuals who have behavioral-emotional disorders.
To meet the needs of this population, music therapists have taken current psychological
theories and used them as a basis for different types of music therapy. Different models
include behavioral therapy, cognitive behavioral therapy, and psychodynamic therapy.[6]

The therapy model based on neuroscience is called "neurological music therapy" (NMT). A
definition of NMT is "NMT is based on a neuroscience model of music perception and
production, and the influence of music on functional changes in nonmusical brain and
behavior functions."[7] In other words, NMT studies how the brain is without music, how the
brain is with music, measures the differences, and uses these differences to cause changes in
the brain through music that will eventually effect the client non-musically. As
internationally known professor and researcher Dr. Thaut said, "The brain that engages in
music is changed by engaging in music."[8]

As stroke therapy

Music has been shown to affect portions of the brain. Part of this therapy is the ability of
music to affect emotions and social interactions. Research by Nayak et al. showed that music
therapy is associated with a decrease in depression, improved mood, and a reduction in state
anxiety.[16] Both descriptive and experimental studies have documented effects of music on
quality of life, involvement with the environment, expression of feelings, awareness and
responsiveness, positive associations, and socialization.[17] Additionally, Nayak et al. found
that music therapy had a positive effect on social and behavioral outcomes and showed some
encouraging trends with respect to mood.[16]

More recent research suggests that music can increase patient's motivation and positive
emotions.[16][18][19] Current research also suggests that when music therapy is used in
conjunction with traditional therapy it improves success rates significantly.[20][21][22]
Therefore, it is hypothesized that music therapy helps stroke victims recover faster and with
more success by increasing the patient's positive emotions and motivation, allowing them to
be more successful and driven to participate in traditional therapies.

Research has shown the ability of music therapy to increase positive social interactions,
positive emotions, and motivation in stroke patients. Wheeler et al. found that group music
therapy sessions increased the ease at which stroke patients responded to social interaction
and increased positive attitude reports from patient families, while individual sessions helped
to motivate patients for treatment.[19] Another study examined the effect of music therapy on
mood of stroke patients and found similar results that showed decreased anxiety, fatigue, and
hostile mood states.[18] Additionally, Nayak et al. found improved social interaction (more
actively involved and cooperative) when music therapy was used in stroke recovery

Recent studies have examined the effect of music therapy on stroke patients, when combined
with traditional therapy. One study found the incorporation of music with therapeutic upper
extremity exercises gave patients more positive emotional effects than exercise alone.[20] In
another study, Nayak et al. found that rehabilitation staff rated participants in the music
therapy group were more actively involved and cooperative in therapy than those in the
control group.[16] Their findings gave preliminary support to the efficacy of music therapy as
a complementary therapy for social functioning and participation in rehabilitation with a
trend toward improvement in mood during acute rehabilitation.

Although positive changes have been associated with music therapy, some considerations
must be taken into account. While scientists have determined that a variety of physiological
and psychological changes occur when listening to music, broad conclusions cannot yet be
made concerning the relationship and the direction of the relationship between music and
emotion.[23] Additionally, there may be mediating factors which affect the success of music
therapy. For example, Nayak et al. found the more impaired an individual's social behavior
was at the outset of treatment, the more likely he or she was to benefit from music therapy.[16]
Additionally, they noted the effectiveness of music therapy may be moderated by the time
frame of the treatment. It is possible that music therapy has a more pronounced effect on
mood the closer to injury it is applied.

Current research shows that when music therapy is used in conjunction with traditional
therapy, it improves rates of recovery, and emotional and social deficits resulting from

stroke.[16][20][21][22][24][25] A study by Jeong & Kim examined the impact of music therapy when
combined with traditional stroke therapy in a community-based rehabilitation program.[24]
Thirty-three stroke survivors were randomized into one of two groups: the experimental
group, which combined rhythmic music and specialized rehabilitation movement for eight
weeks; and a control group, that received referral information for traditional therapy (and
were assumed to have sought traditional therapy). The results of this study showed that
participants in the experimental group gained more flexibility, wider range of motion, more
positive moods, and increased frequency and quality of social interactions.[24]

Music has also been used in recovery of motor skills. Rhythmical auditory stimulation in a
musical context in combination with traditional gait therapy improved the ability of stroke
patients to walk.[21] The study consisted of two treatment conditions, one which received
traditional gait therapy and another which received the gait therapy in combination with the
rhythmical auditory stimulation. During the rhythmical auditory stimulation, stimulation was
played back measure by measure, and was initiated by the patient's heel-strikes. Each
condition received fifteen sessions of therapy. The results revealed that the rhythmical
auditory stimulation group showed more improvement in stride length, symmetry deviation,
walking speed and rollover path length (all indicators for improved walking gait) than the
group that received traditional therapy alone.[21]

Schneider et al. also studied the effects of combining music therapy with standard motor
rehabilitation methods.[22] In this experiment, researchers recruited stroke patients without
prior musical experience and trained half of them in an intensive step by step training
program that occurred fifteen times over three weeks, in addition to traditional treatment.
These participants were trained to use both fine and gross motor movements by learning how
to use the piano and drums. The other half of the patients received only traditional treatment
over the course of the three weeks. Three-dimensional movement analysis and clinical motor
tests showed participants who received the additional music therapy had significantly better
speed, precision, and smoothness of movements as compared to the control subjects.
Participants who received music therapy also showed a significant improvement in every-day
motor activities as compared to the control group.[22] Wilson, Parsons, & Reutens looked at
the effect of melodic intonation therapy (MIT) on speech production in a male singer with
severe Broca's aphasia[25]. In this study, thirty novel phrases were taught in three conditions:
unrehearsed, rehearsed verbal production (repetition), or rehearsed verbal production with
melody (MIT). Results showed that phrases taught in the MIT condition had superior
production, and that compared to rehearsal, effects of MIT lasted longer.

Another study examined the incorporation of music with therapeutic upper extremity
exercises on pain perception in stroke victims.[20] Over the course of eight weeks, stroke
victims participated in upper extremity exercises (of the hand, wrist, and shoulder joints) in
conjunction with one of the three conditions: song, karaoke accompaniment, and no music.
Patients participated in each condition once, according to a randomized order, and rated their
perceived pain immediately after the session. Results showed that although there was no
significant difference in pain rating across the conditions, video observations revealed more
positive affect and verbal responses while performing upper extremity exercises with both
music and karaoke accompaniment.[20] Nayak et al.[16] examined the combination of music
therapy with traditional stroke rehabilitation and also found that the addition of music therapy
improved mood and social interaction. Participants who had suffered traumatic brain injury
or stroke were placed in one of two conditions: standard rehabilitation or standard
rehabilitation along with music therapy. Participants received three treatments per week for

up to ten treatments. Therapists found that participants who received music therapy in
conjunction with traditional methods had improved social interaction and mood.

[edit] In heart disease

Some music may reduce heart rate, respiratory rate, and blood pressure in patients with
coronary heart disease, according to a 2009 Cochrane review of 23 clinical trials.[26] Benefits
included a decrease in blood pressure, heart rate, and levels of anxiety in heart patients.
However, the effect was not consistent across studies, according to Joke Bradt, PhD, and
Cheryl Dileo, PhD, both of Temple University in Philadelphia. Music did not appear to have
much effect on patients' psychological distress. "The quality of the evidence is not strong and
the clinical significance unclear", the reviewers cautioned. In 11 studies patients were having
cardiac surgery and procedures, in nine they were MI patients, and in three cardiac
rehabilitation patients. The 1,461 participants were largely white (average 85%) and male
(67%). In most studies, patients listened to one 30-minute music session. Only two used a
trained music therapist instead of prerecorded music.

[edit] In epilepsy

Research suggests that listening to Mozart's piano sonata K448 can reduce the number of
seizures in people with epilepsy.[27] This has been called the "Mozart effect". However, in
recent times, the validity of the "Mozart Effect" and the studies undergone to reach this
theory have been doubted, due to reasons such as the limitations in the original study and the
difficulty in proving the effect of Mozart's music in subsequent studies.

[edit] Experimental approaches

Music therapist, music researcher and experimental composer Enrico Curreri clinically
explored theories and concepts developed by the American composer John Cage. For
example, in various music therapy sessions with a patient diagnosed with depression and
anxiety disorder, Curreri performed Cage's seminal composition of silence 4′33″ and utilized
aleatoric/chance procedures.[28] In addition, Curreri has been clinically investigating
experimental music/sound/noise music, free improvisation and microtonal music to help
assist in understanding the creative process in adult patients with mental illness

Nuclear medicine
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A whole body PET/CT Fusion image

Normal whole body PET/CT scan with FDG-18. The whole body PET/CT scan is
commonly used in the detection, staging and follow-up of various cancers.

A nuclear medicine whole body bone scan. The nuclear medicine whole body bone
scan is generally used in evaluations of various bone related pathology, such as for
bone pain, stress fracture, nonmalignant bone lesions, bone infections, or the spread
of cancer to the bone.

Nuclear Medicine myocardial perfusion scan with Thallium-201 for the rest images
(bottom rows) and Tc-Sestamibi for the stress images (top rows). The nuclear
medicine myocardial perfusion scan plays a pivotal role in the noninvasive evaluation

of coronary artery disease. The study not only identifies patients with coronary artery
disease, it also provides overall prognostic information or overall risk of adverse
cardiac events for the patient.

A nuclear medicine parathyroid scan demonstrates a parathyroid adenoma adjacent
to the left inferior pole of the thyroid gland. . The above study was performed with
Technetium-Sestamibi (1st column) and Iodine-123 (2nd column) simultaneous
imaging and the subtraction technique (3rd column).

Normal hepatobiliary scan (HIDA scan). The nuclear medicine hepatobiliary scan is
clinically useful in the detection of the gallbladder disease.

Normal pulmonary ventilation and perfusion (V/Q) scan. The nuclear medicine V/Q
scan is useful in the evaluation of pulmonary embolism.

Thyroid scan with Iodine-123 for evaluation of hyperthyroidism.

Abnormal whole body PET/CT scan with multiple metastases from a cancer. The
whole body PET/CT scan has became an important tool in the evaluation of cancer.

A nuclear medicine SPECT liver scan with technetium-99m labeled autologous red
blood cells. A focus of high uptake (arrow) in the liver is consistent with a

Iodine-123 whole body scan for thyroid cancer evaluation. The study above was
performed after the total thyroidectomy and TSH stimulation with thyroid hormone
medication withdrawal. The study shows a small residual thyroid tissue in the neck
and a mediastinum lesion, consistent with the thyroid cancer metastatic disease. The
uptakes in the stomach and bowel are normal physiologic findings.

Nuclear medicine is a branch or specialty of medicine and medical imaging that uses
radioactive isotopes (radionuclides) and relies on the process of radioactive decay in the
diagnosis and treatment of disease.

In nuclear medicine procedures, radionuclides are combined with other chemical compounds
or pharmaceuticals to form radiopharmaceuticals. These radiopharmaceuticals, once
administered to the patient, can localize to specific organs or cellular receptors. This property
of radiopharmaceuticals allows nuclear medicine the ability to image the extent of a disease-
process in the body, based on the cellular function and physiology, rather than relying on
physical changes in the tissue anatomy. In some diseases nuclear medicine studies can
identify medical problems at an earlier stage than other diagnostic tests.

Treatment of disease, based on metabolism or uptake or binding of a ligand, may also be
accomplished, similar to other areas of pharmacology. However, radiopharmaceuticals rely
on the tissue-destructive power of short-range ionizing radiation.


        1 Description of the field
        2 Hybrid scanning techniques
        3 Practical concerns in nuclear imaging
            o 3.1 Nuclear medicine therapy
            o 3.2 Molecular medicine
        4 History
        5 Source of radioisotopes, with notes on a few radiopharmaceuticals
        6 Analysis
        7 Radiation dose
        8 Nuclear Medicine Careers
            o 8.1 Nuclear medicine scientist
            o 8.2 The physician career in nuclear medicine
                    8.2.1 Nuclear medicine residency/training (physicians)
        9 See also
        10 Notes
        11 Further reading
        12 External links

[edit] Description of the field

In nuclear medicine imaging, radiopharmaceuticals are taken internally, for example
intravenously or orally. Then, external detectors (gamma cameras) capture and form images
from the radiation emitted by the radiopharmaceuticals. This process is unlike a diagnostic X-
ray where external radiation is passed through the body to form an image.

There are several techniques of diagnostic nuclear medicine. Scintigraphy ("scint") is the use
of internal radioisotopes to create two-dimensional[1] images. SPECT is a 3D tomographic
technique that uses gamma camera data from many projections and can be reconstructed in
different planes. Positron emission tomography (PET) uses coincidence detection to image
functional processes.

Nuclear medicine tests differ from most other imaging modalities in that diagnostic tests
primarily show the physiological function of the system being investigated as opposed to
traditional anatomical imaging such as CT or MRI. Nuclear medicine imaging studies are
generally more organ or tissue specific (e.g.: lungs scan, heart scan, bone scan, brain scan,
etc.) than those in conventional radiology imaging, which focus on a particular section of the
body (e.g.: chest X-ray, abdomen/pelvis CT scan, head CT scan, etc.). In addition, there are
nuclear medicine studies that allow imaging of the whole body based on certain cellular
receptors or functions. Examples are whole body PET scan or PET/CT scans, gallium scans,
indium white blood cell scans, MIBG and octreotide scans.

While the ability of nuclear metabolism to image disease processes from differences in
metabolism is unsurpassed, it is not unique. Certain techniques such as fMRI image tissues
(particularly cerebral tissues) by blood flow, and thus show metabolism. Also, contrast-

enhancement techniques in both CT and MRI show regions of tissue which are handling
pharmaceuticals differently, due to an inflammatory process.

Diagnostic tests in nuclear medicine exploit the way that the body handles substances
differently when there is disease or pathology present. The radionuclide introduced into the
body is often chemically bound to a complex that acts characteristically within the body; this
is commonly known as a tracer. In the presence of disease, a tracer will often be distributed
around the body and/or processed differently. For example, the ligand methylene-
diphosphonate (MDP) can be preferentially taken up by bone. By chemically attaching
technetium-99m to MDP, radioactivity can be transported and attached to bone via the
hydroxyapatite for imaging. Any increased physiological function, such as due to a fracture
in the bone, will usually mean increased concentration of the tracer. This often results in the
appearance of a 'hot-spot' which is a focal increase in radio-accumulation, or a general
increase in radio-accumulation throughout the physiological system. Some disease processes
result in the exclusion of a tracer, resulting in the appearance of a 'cold-spot'. Many tracer
complexes have been developed to image or treat many different organs, glands, and
physiological processes.

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           This article needs additional citations for verification.
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           challenged and removed. (April 2010)

A dietitian or dietician (dietitian is the preferred spelling within the dietetics profession) is
an expert in food and nutrition. Dietitians help promote good health through proper eating.
They supervise the preparation and service of food, develop modified diets, participate in
research, and educate individuals and groups on good nutritional habits. In a medical setting,
a dietitian may provide specific artificial nutritional needs to patients unable to consume food
normally. Dietary modification to address medical issues involving dietary intake is also a
major part of dietetics. The goals of the dietary department are to provide medical nutritional
intervention, obtain, prepare, and serve flavorsome, attractive, and nutritious food to patients,
family members, and health care providers.

In many countries only people who have specified educational credentials can call themselves
"dietitians" — the title is legally protected. The term "nutritionist" is also widely used;
however, the term nutritionist is not regulated as dietitian is and is not an accurate term to
give to a dietitian. People may call themselves nutritionists without the educational and
professional requirements of registered dietitians. A nutritionist is not a dietitian, as a
dietitian is registered to a national board and accredited and a nutritionist is neither.

Different professional terms are used in different countries. Dietitians are valuable members
of the medical multi-disciplinary team providing nutritional knowledge and acting as
consultants to other health care professionals.


        1 Types of dietitians
        2 Dietitians in practice
            o 2.1 Clinical dietitians
            o 2.2 Community dietitians
            o 2.3 Foodservice dietitians
            o 2.4 Gerontological dietitians
            o 2.5 Pediatric dietitians
            o 2.6 Research dietitians
            o 2.7 Administrative dietitians
            o 2.8 Business dietitians
            o 2.9 Consultant dietitians
        3 Other nutrition workers
            o 3.1 Registered Dietetic Technicians
            o 3.2 Dietetic Technicians (Unregistered)
            o 3.3 Dietary assistants or dietary aides
            o 3.4 Dietary clerks
            o 3.5 Dietary managers
            o 3.6 Dietary workers
            o 3.7 Dietary hosts
        4 Required qualifications and professional associations
            o 4.1 USA
            o 4.2 Canada
            o 4.3 Australia
        5 References
        6 External links

[edit] Types of dietitians

The majority of dietitians are clinical, or therapeutic, dietitians. Clinical dietitians review
medical charts and talk with patients' families. They work with other health care
professionals and community groups to provide nourishment, nutritional programs and
instructional presentations to benefit people of all ages, and with a variety of health
conditions. This is accomplished by developing individual plans to meet nutritional needs.
These plans include nourishment, tube feedings (called enteral nutrition), intravenous
feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral
parenteral nutrition (PPN), diets, and education. Clinical dietitians provide individual and
group educational programs for patients and family members about their nutrition and health.

[edit] Dietitians in practice

[edit] Clinical dietitians

Clinical dietitians work in hospitals and other health care facilities to provide nutrition
therapy to patients according to the disease processes, provide individual dietary
consultations to patients and their family members and also conduct group educations for

other health workers, patients and the public. They coordinate both medical records and
nutritional needs to assess the patients and make a plan based on their findings. Some clinical
dietitians have dual responsibilities with medical nutrition therapy and in foodservice,
described below. In addition, clinical dietitians in smaller facilities will also provide or create
outpatient education programs. They work as a team with the physicians, physical therapists,
occupational therapists, pharmacists, speech therapists, social workers and nurses to provide
care to the patients.

[edit] Community dietitians

Community dietitians work with wellness programs and international health organizations.
These dietitians apply and distribute knowledge about food and nutrition to specific life-
styles and geographic areas. They coordinate nutritional programs in public health agencies,
daycare centers, health clubs, and recreational camps and resorts. Some community dietitians
carry out clinical based patient care in the form of home visits for patients who are too
physically ill to attend consultation in health facilities.

[edit] Foodservice dietitians

Foodservice dietitians or managers are responsible for large-scale food planning and service.
They coordinate, assess and plan foodservice processes in health care facilities, school food
service programs, prisons, cafeterias and restaurants. These dietitians will also perform audits
of their departments, train other food service workers and use marketing skills to launch new
menus and various programs within their institution. They direct and manage the operational
and nutrition services staffs such as kitchen staffs, delivery staffs and dietary assistants or diet

[edit] Gerontological dietitians

Gerontological dietitians are specialist in nutrition and aging. They are Board certified in
Gerontological Nutrition with the American Dietetic Association. They work in government
agencies in aging policy, and in a regulatory capacity in the oversight of nursing homes and
community-based care facilities. They work as Consultants in Nursing Homes, and in higher
education in the field of Gerontology (the study of Aging.)

[edit] Pediatric dietitians

Pediatric dietitians provide health advice for persons under the age of 18.

[edit] Research dietitians

Research dietitians are mostly involved with dietary related research in the clinical aspect of
nutrition in disease states, public aspect on primary, secondary and sometimes tertiary health
prevention and foodservice aspect in issues involving the food prepared for patients. Many
registered dietitians also work with the biochemical aspects of nutrient interaction within the
body. Research Dietitians normally work in a hospital or university research facilities. It
should be noted that some Clinical dietitian's roles also involve research other than the
normal clinical workload. Quality improvement in dietetics services is also one area of

[edit] Administrative dietitians

The Administrator, manager, or director of a dietetics department or nutrition services
program acts as head of the dietitians. They also hire, train, direct and supervise employees
and manage dietary departments. Administrative dietitians may also apply procedure and
policy as part of their management job.

[edit] Business dietitians

Business dietitians serve as resource people for the media. Dietitians' expertise in nutrition is
often taped for TV, radio, and newspapers—either as an expert guest opinion, regular
columnist or guest, or for resource, restaurant, or recipe development and critique. Dietitians
have served as show hosts on major television stations and as drive-time radio news anchors.
Dietitians write books, appear on television cooking channels, and author corporate
newsletters on nutrition and wellness. They also work as sales representatives for food
manufacturing companies that provide nutritional supplements and tube feeding supplies.

[edit] Consultant dietitians

Consultant dietitians work under private practice. The title 'consultant' in this case should not
be confused with the identical title given to certain medical doctors in countries such as the
United Kingdom and Ireland. The term consultant in this instance is synonymous with the
title attending as used in countries such as the United States. Consultant dietitians contract
independently to provide nutrition services and educational programs to individuals, nursing
homes, and in health care facilities. As recent studies have shown the importance of diet in
both preventing and managing disease, many US states have moved towards covering
medical nutrition therapy under the Medicaid/Medicare making consulting a much more
lucrative option for dietitians due to insurance reimbursement.


Accredited Practising Dietitians (APDs) in Australia gain their qualifications through
university courses accredited by the DAA (Dietitians Association of Australia). In order for
patients to receive a rebate from Medicare or Private Health insurance APD status is required.
APDs are Dietitians engaged in the Continuing Professional Development program offered
by the DAA and commit to uphold the DAA Code of Professional Conduct and Code of

Dietitians who do not wish to join the DAA may participate in the DAA's Continuing
Professional Development Program without being a member of the DAA and in this way can
still hold APD status. However, under new rules (which commenced 1 July 2009), health care
providers must either have statutory registration or be members of their national professional
association to obtain a provider number. This means all private health funds will require
private practitioners applying for provider numbers to be DAA members (not just ‗eligible‘
for membership). More information about the new rules can be obtained at

Occupational therapy
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Occupational therapy promotes health by enabling people to perform meaningful and
purposeful occupations. Occupation is defined as "active process of living: from the
beginning to the end of life, ... occupations are all the active processes of looking after
ourselves and others, enjoying life, and being socially and economically productive over the
lifespan and in various contexts"[1] These include (but are not limited to) work, leisure, self
care, domestic and community activities. Occupational therapists work with individuals,
families, groups, communities and organizations to facilitate health, well-being and justice
through engagement in occupation. Occupational therapists are becoming increasingly
involved in addressing the impact of social, political and environmental factors that
contribute to exclusion and occupational deprivation.[2][3]

The World Federation of Occupational Therapists provides the following definition of
Occupational Therapy: "Occupational therapy is as a profession concerned with promoting
health and well being through occupation. The primary goal of occupational therapy is to
enable people to participate in the activities of everyday life. Occupational therapists achieve
this outcome by enabling people to do things that will enhance their ability to participate or
by modifying the environment to better support participation." Occupational therapists use
careful analysis of physical, environmental, psychosocial, mental, spiritual, political and
cultural factors to identify barriers to occupation. Occupational therapy draws from the fields
of medicine, psychology, sociology, anthropology, and many other disciplines in developing
its knowledge base. A new discipline of occupational science has been developed to enhance
the evidence base of the profession.


Occupational therapy process

An Occupational Therapist works systematically through a sequence of actions known as the
occupational therapy process. There are several versions of this process as described by
numerous writers. Creek (2003)[27] has sought to provide a comprehensive version based on
extensive research. This version has 11 stages, which for the experienced therapist may not
be linear in nature. The stages are:

        Referral
        Information gathering
        Initial assessment
        Needs identification/problem formation
        Goal setting

      Action planning
      Action
      Ongoing assessment and revision of action
      Outcome and outcome measurement
      End of intervention or discharge
      Review

Areas of practice in occupational therapy

The role of Occupational Therapy allows OT‘s to work in many different settings, work with
many different populations and acquire many different specialties. This broad spectrum of
practice lends itself to difficulty categorizing the areas of practice that exist, especially
considering the many countries and different healthcare systems. In this section, the
categorization from the American Occupational Therapy Association is used. However, there
are other ways to categorize areas of practice in OT, such as physical, mental, and community
practice (AOTA, 2009). These divisions occur when the setting is defined by the population it
serves. For example, acute physical or mental health settings (e.g.: hospitals), sub-acute
settings (e.g.: aged care facilities), outpatient clinics and community settings.

In each area of practice below, an OT can work with different populations, diagnosis,
specialities, and in different settings.

[edit] Physical health

        This article is in a list format that may be better presented using prose.
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Occupational therapy during WWI: bedridden wounded are knitting.

      Pediatrics - Schools, Community, inpatient hospital based child OT: Often,
       children need OT services for the same reasons an adult needs OT services.
       However, OTs approach intervention in a different way with children. OT
       delivers approaches treatment through occupation, and the occupations of a
       child are different from those of an adult, and include play, chores, self-care
       and schoolwork.[29] Common conditions that are specific to or more common
       in the pediatric population creating a need for OT services include:
       developmental disorders, sensory regulation or sensory processing deficits,
       fine motor developmental delays or deficits, autism[29], emotional and
       behavioral disturbances (Lambert, 2005), among others. In addition, children

    are seen for every injury, illness or chronic condition that may cause a person
    of any age to have performance deficits in their daily life and thus benefit from
    OT services.[29] Often, OT in pediatrics deals with the implications that certain
    medical conditions have for classroom learning and the remediation and
    strategies required. They need to be closely interwoven with existing teaching
    approaches to help the student achieve his or her educational potential. [30]
   Acute care hospitals: Acute care is an inpatient hospital setting for individuals
    with a serious medical condition(s) usually due to a traumatic event, such as a
    traumatic brain injury, spinal cord injury, etc. The primary goal of acute care is
    to stabilize the patient’s medical status and address any threats to his or her
    life and loss of function. Occupational therapy plays an important role in
    facilitating early mobilization, restoring function, preventing further decline,
    and coordinating care, including transition and discharge planning.
    Furthermore, occupational therapy’s role focuses on addressing deficits and
    barriers that limit the patient’s ability to perform activities that they need or
    want to do related to independence in self-care, home management, work-
    related tasks, and participating in leisure and community pursuits.[31]
   Inpatient rehabilitation (e.g., Spinal Cord Injuries):People with disabilities have
    the right and the privilege to live meaningful purposeful lives. When a
    disability occurs it is sometimes possible to recover – when it is not it is
    important to learn the skills to adapt capacity and environmental supports to
    be able to participate. OTs use their knowledge to help both with recovery and
   Rehabilitation centers (e.g., Traumatic Brain Injury (TBI)[32], Stroke (CVA),
    Spinal Cord Injuries, Head Injuries)
   Skilled nursing facilities: An occupational therapists role in a skilled nursing
    facility is centered on each client’s individual needs. Many of the skills an OT
    works on are known as activities of daily living or self-care such as feeding or
    dressing. OTs can provide equipment to assist with activities or offer expertise
    in modifying the environment to maximize independence and facilitate
    independence. Other OT roles include education in adaptive equipment
    (shower bench), energy conservation, or task simplification (Hofmann, 2008).
   Home Health: Occupational therapists who work in this area of practice
    generally work with client’s in the geriatric population who have one or more
    of the following diagnoses: Alzheimer’s disease, arthritis, depression, CVA,
    generalized weakness, COPD, or Parkinson’s disease. Occupational
    therapists working with these client’s evaluate their level of independence,
    cognition, and safety. Moreover, occupational therapists provide intervention
    to maximize independence and function through remedial and compensatory
    strategies, with the ultimate goal of the client’s regaining the ability to live
    independently at home (Swanson Anderson & Malaski, 1999).[33]
   Outpatient clinics (e.g., Hand Therapy, orthopaedics) Hand therapy is a
    specialty practice area of occupational therapy that is mainly concerned with
    treating orthopedic-based upper extremity conditions to optimize the
    functional use of the hand and arm. Diagnoses seen by this practice area
    include: fractures of the hand or arm, lacerations and amputations, burns, and
    surgical repairs of tendons and nerves. Additionally, hand therapists treat
    acquired conditions such as tendonitis, rheumatoid arthritis and osteoarthritis,
    and carpal tunnel syndrome. Occupational therapists who work in this field
    address biomechanical issues underlying upper-extremity conditions. In

       addition, occupational therapists use an occupation-based and client-centered
       approach by identifying participation needs of the client, then tailoring
       intervention to improve performance in desired activities.[31] [1](link for a
       picture of hand therapy)
      Specialist assessment centres (e.g., Electronic assistive technology, Posture
       and Mobility services)
      Hospices: An occupational therapists common role in hospice care is
       modifying and preventing. Modifying the demands of the activity to fit with the
       abilities of the client. The intervention may be directly with the client or with
       the client and the client’s caregivers. OT can offer the caregivers support an
       education. Progress is defined as improved quality of life in hospice care.
       (Hasselkaus, 1998)
      Assisted Living Facilities: In an assisted living facility OT services are
       provided by a home health agency, rehab agency, or a private practice.
       Medicare and some private insurance plans cover OT services in ALFs. Areas
       of treatment intervention often include: bathing, dressing, grooming, toileting,
       mobility, money management, laundry, and community participation. Can treat
       persons with occupational performance decline or at risk for a decline.
       Increase quality of life so less residents need the services of a long-term SNF.
       Special areas include mobility device assessment (scooter), continence
       training, psychosocial needs and low vision programs (Fagan, 2001).
      Productive Aging: An OT practicing in this area would provide skills and
       services to older adults to maximize independence, participation, and quality
       of life. Typical issues addressed: Any impairment or condition that would limit
       their ability to carry out meaningful occupations and tasks that are necessary
       for daily life. Skills taught include: energy conservation, education in adaptive
       equipment (such as a shower bench), task simplification, adapting and
       modifying activities to progress with a client’s changing abilities (Opp
       Hoffman, 2008), caregiver education and support (AOTA, 2004), safety, social
       interactions and communication, memory skills training[34], mobility device
       assessment and training (i.e. scooters, wheelchairs, walkers), low vision
       interventions, continence training, and facilitating performance in basic ADL
       and IADL (Fagan, 2001).
      Work hardening is essentially a specialized program designed to enable
       people with physical, psychological, and psychosocial issues inhibiting a
       person’s ability, to successfully return to work. The National Advisory
       Committee on Work Hardening best describes work hardening:

―Work hardening is a highly structured, goal oriented, individualized treatment
program designed to maximize the individual’s ability to return to work. Work
hardening programs, which are interdisciplinary in nature, use real or simulated work
activities in conjunction with conditioning tasks that are graded to progressively
improve the biomechanical, neuromuscular, cardiovascular/metabolic and
psychosocial functions of the individual. Work hardening provides a transition
between acute care and return to work while addressing the issues of productivity,
safety, physical tolerances, and worker behaviors‖ (Ogden-Niemeyer & Jacobs,
1989, p. 1).

      Work conditioning is similar to work hardening, except work conditioning
       purely involves improving physical capacities, whereas work hardening
       improves physical, psychological, and psychosocial factors.[35]

[edit] Mental health

According to Medicare (2005) guidance, ―Only a qualified occupational therapist has the
knowledge, training, and experience required to evaluate and, as necessary, re-evaluate a
patient‘s level of function, determine whether an occupational therapy program could
reasonably be expected to improve, restore, or compensate for lost function, and where
appropriate, recommend to the physician a plan of treatment.‖[citation needed]

According to the American Occupational Therapy Association (AOTA), occupational
therapists work with the Mental Health population throughout the life span and across many
treatment settings where mental health services and psychiatric rehabilitation are provided
(AOTA, 2009). Just as with other clients, the OT facilitates maximum independence in
activities of daily living (dressing, grooming, etc.) and instrumental activities of daily living
(medication management, grocery shopping, etc.). According to the American Occupational
Therapy Association, OT improves functional capacity and quality of life for people with
mental illness in the areas of employment, education, community living, and home and
personal care through the use of real life activities in therapy treatments (AOTA, 2005).

Geriatric, Adult, Adolescents, and Children with any kind of mental illness or mental health
issues. These conditions include but are not limited to: Schizophrenia, substance abuse,
addiction, dementia, Alzheimer‘s, mood disorders, personality disorders, psychoses, eating
disorders, anxiety disorders (including post-traumatic stress disorder, separation anxiety
disorder) (Cara & MacRae, 2005), and reactive attachment disorder (children only) (Lambert,

Typical issues that are addressed are as follows: Helping people acquire the skills to care for
themselves or others including; keeping a schedule, medication management, employment,
education, increasing community participation, community access (grocery store, library,
bank, etc.), money management skills, engaging in productive activities to fill the day, coping
skills, routine building, building social skills, and childcare (Cara & MacRae, 2005).

In the UK, the College of Occupational Therapists (COT) have published Recovering
Ordinary Lives [36], which details the strategy for OTs in mental health up to 2017, and makes
explicit the goals that have been set for the profession, in line with government directives
(COT 2006).

Areas that Mental Health OT's could work in are as follows:[citation needed]

      Mental health inpatient units
         o Adolescent, adult and older people's acute mental health wards
         o Adult and older people's rehabilitation wards
         o Prisons/secure units (Forensic psychiatry)
         o Psychiatric intensive care unit
         o Specialist units for Eating Disorders, Learning disabilities
      Community based mental health teams
         o Child and adolescent mental health teams

           o   Adult and older people's community mental health teams
           o   Rehabilitation and recovery and Assertive Outreach community teams
           o   Primary care services in GP practices
           o   Home treatment teams
           o   early intervention in psychosis teams
           o   Specialist learning disability, eating disorder community services
           o   Day services
           o   Vocational Services
           o   Dementia & Alzheimer Care: OTs focus on adapting activities as the
               client progresses through the illness (Hofmann, 2008) OT also works
               with caregivers to teach them how to grade activities to the client’s
               ability. Interventions are based on using the client’s strengths to
               increase their quality of life and their relationships with caregivers. Use
               of social interactions, communication, memory, safety and self

[edit] Community

Community based practice involves working with people in their own environment rather
than in a hospital setting. It often combines the knowledge and skills related to physical and
mental health. It can also involve working with atypical populations such as the homeless or
at-risk populations. Examples of community-based practice settings:

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      Health promotion and lifestyle change: Remaining healthy is the goal of all
       people in a society, including people with chronic disabling or health
       conditions. Achieving health requires skills to self-manage conditions that
       might limit their ability to function in daily life. The occupational therapist helps
       people acquire these skills (Wilcock, 2005).
      Private Practice
      Aging in place: Occupational therapists implement environmental
       modifications in senior housing, assisted living, long-term-care facilities, and
       homes (Yamkovenko, 2008) Environmental modifications can include
       rearranging furniture, building ramps, widening doorways, grab bars, special
       toilet seats, and other safety equipment to use performance capabilities to
       their fullest (Moyers & Christiansen, 2004).
      Low Vision: Occupational therapists help clients use their remaining vision to
       complete their daily routines with compensation, remediation, disability
       prevention and health promotion. Compensations or that modifications to the
       environment may include proper lighting, color contrast, reducing clutter and
       education on adaptive equipment (Golembiewski, 2004).
      Intermediate care services
      Driving Centers: Driving is an instrumental activity of daily living and an
       occupational therapist may evaluate and treat skills needed to drive such as
       vision, executive function or memory. If a client needs more skilled
       assessment and training they would refer them to an OT Driver Rehabilitation

      Specialist which could do on the road assessment, training in adaptive
      equipment and make more specific recommendations.
     Day centres
     Schools
     Child development centres
     People's own homes, carrying out therapy and providing equipment and
     Work and Industry: To be a healthy successful worker there must be a person
      environment fit between the task, the equipment, and the person’s skills.
      Occupational therapists work to achieve that fit (Ellexson, 2000; Clinger,
      Dodson, Maltchev, & Page, 2007). Populations, conditions, and diagnoses:
      People of working age and ability who have been born with or developed a
      condition, injury, or illness that compromises their ability to work (Ellexson,
      2000; Clinger, Dodson, Maltchev, & Page, 2007). Settings: Return to work
      programs, large organizations, consultants to large organizations, work
      hardening programs, work conditioning programs, transitional return to work
      programs (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007). Typical
      issues addressed: assessment of ability to work, interventions to enhancing
      work performance by means of work hardening, work conditioning, and
      improvement of ergonomics in the workplace, identification of
      accommodations necessary to return-to-work following illness or injury,
      prevention of work related injury, illness, or disability (Ellexson, 2000; Clinger,
      Dodson, Maltchev, & Page, 2007).
     Homeless Shelters
     Educational Settings
     Refugee Camps[25]

[edit] New Emerging Practice Areas for Therapy
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     Children & Youth:[37]
         o Psychosocial Needs of Children & Youth
     Health & Wellness:
         o Health & Wellness Consulting
         o Design & Accessibility Consulting & Home Modification
         o Ergonomic Consulting
         o Private Practice Community Health Services
     Productive Aging:
         o Driver Rehabilitation & Training
         o Low Vision Services
     Rehabilitation, Disability, & Participation:
         o Technology & Assistive Device Development & Consulting
     Work & Industry:
         o Ticket to Work Services
         o Welfare to Work Services

[edit] Occupational therapy approaches
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Services typically include:

      Teaching new ways of approaching tasks[38]
      How to break down activities into achievable components e.g. sequencing a
       complex task like cooking a complex meal[38]
      Comprehensive home and job site evaluations with adaptation
      Performance skills assessments and treatment.
      Adaptive equipment recommendations and usage training.
      Environmental adaptation including provision of equipment or designing
       adaptations to remove obstacles or make them manageable[38]
      Guidance to family members and caregivers.[39]
      The use of creative media as therapeutic activity

[edit] Activity analysis

Activity analysis has been defined as a process of dissecting an activity into its component
parts and task sequence in order to identify its inherent properties and the skills required for
its performance, thus allowing the therapist to evaluate its therapeutic potential[40]

[edit] Theoretical Frameworks

Occupational Therapists use a number of theoretical frameworks to frame their practice. Note
that terminology has differed between scholars. Theoretical bases for framing a human and
their occupation being include the following:

From Wikipedia, the free encyclopedia
Jump to: navigation, search

An optical refractor (phoropter) in use.

Optometry is a health care profession concerned with eyes and related structures, as well as
vision, visual systems, and vision information processing in humans.

Like most professions, optometry education, certification, and practice is regulated in most
countries. Optometrists and optometry-related organizations interact with governmental
agencies, other health care professionals, and the community to deliver eye and vision care.
Optometrists are one of three eye care professionals, the others being ophthalmologists
(medical doctors), and opticians. [1].


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Jump to: navigation, search

Orthotics is the medical field concerned with the application and manufacture of orthoses,
devices which support or correct the function of a limb or the torso. The term is derived from
the Greek "ortho", to straighten, and demonstrates the connection of the field to orthopedics.
Sciences such as materials engineering, gait analysis, anatomy and physiology, patho-
physiology, biomechanics, and psychology contribute to the work done by orthotists, the
professionals engaged in the field of orthotics. Individuals who benefit from an orthosis have
sustained a physical impairment such as a stroke, spinal cord injury, or a congenital
abnormality such as spina bifida or cerebral palsy.

Corrective shoe inserts are often incorrectly referred to as orthotics.

Artificial limb
From Wikipedia, the free encyclopedia
 (Redirected from Prosthetics)
Jump to: navigation, search

A United States soldier demonstrates table football with two transradial prosthetic

         Look up prosthetic in Wiktionary, the free dictionary.

An artificial limb is a type of prosthesis that replaces a missing extremity, such as arms or
legs. The type of artificial limb used is determined largely by the extent of an amputation or
loss and location of the missing extremity. Artificial limbs may be needed for a variety of
reasons where a body part is either missing from the body or is too damaged to be repaired,
including disease, accidents, and congenital defects. A congenital defect can create the need
for an artificial limb when a person is born with a missing or damaged limb. Prosthetics are
however not needed in the event of an accident where only the nerves were damaged and not
the extremeties. In this case, Functional Electrical Stimulators (FES) are used.[1][2] Industrial,
vehicular, and war related accidents are the leading cause of amputations in developing areas,
such as large portions of Africa. In more developed areas, such as North America and
Europe, disease is the leading cause of amputations.[3] Cancer, infection and circulatory
disease are the leading diseases that may lead to amputation.[4]

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For other uses, see Pharmacy (disambiguation).

The mortar and pestle, an internationally recognized symbol to represent the
pharmacy profession

Typical American drug store with a soda fountain, about 1905

Pharmacy is the health profession that links the health sciences with the chemical sciences
and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word
derives from the Greek φάρμακον (pharmakon), "drug, medicine"[1] (the earliest form of the
word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic script[2]).

The scope of pharmacy practice includes more traditional roles such as compounding and
dispensing medications, and it also includes more modern services related to health care,
including clinical services, reviewing medications for safety and efficacy, and providing drug
information. Pharmacists, therefore, are the experts on drug therapy and are the primary
health professionals who optimize medication use to provide patients with positive health

An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy,
chemist's or drug store. These stores commonly sell not only medicines, but also
miscellaneous items such as candy (sweets), cosmetics, and magazines, as well as light
refreshments or groceries.

The word pharmacy is derived from its root word pharma which was a term used since the
1400–1600s. In addition to pharma responsibilities, the pharma offered general medical
advice and a range of services that are now performed solely by other specialist practitioners,
such as surgery and midwifery. The pharma (as it was referred to) often operated through a
retail shop which, in addition to ingredients for medicines, sold tobacco and patent medicines.
The pharmas also used many other herbs not listed.

In its investigation of herbal and chemical ingredients, the work of the pharma may be
regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the
formulation of the scientific method.

The field of Pharmacy can generally be divided into three primary disciplines:

      Pharmaceutics
      Medicinal chemistry and Pharmacognosy
      Pharmacy practice

The boundaries between these disciplines and with other sciences, such as biochemistry, are
not always clear-cut; and often, collaborative teams from various disciplines research

Pharmacology is sometimes considered a fourth discipline of pharmacy. Although
pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Therefore
it is usually considered to be a field of the broader sciences.

Other specializations in pharmacy practice recognized by the Board of Pharmaceutical
Specialties include: cardiovascular, infectious disease, oncology, pharmacotherapy, nuclear,
nutrition, and psychiatry.[3] The Commission for Certification in Geriatric Pharmacy certifies
pharmacists in geriatric pharmacy practice. The American Board of Applied Toxicology
certifies pharmacists and other medical professionals in applied toxicology.

Types of pharmacy practice areas

Pharmacists practice in a variety of areas including retail, hospitals, clinics, nursing homes,
drug industry, and regulatory agencies. Pharmacists can specialize in various areas of practice
including but not limited to: hematology/oncology, infectious diseases, ambulatory care,
nutrition support, drug information, critical care, pediatrics, etc.

[edit] Community pharmacy

19th century Italian pharmacy

Modern pharmacy in Norway

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore
in North America; retail pharmacy in industry terminology; or Apothecary, historically) is
the place where most pharmacists practice the profession of pharmacy. It is the community
pharmacy where the dichotomy of the profession exists—health professionals who are also

Community pharmacies usually consist of a retail storefront with a dispensary where
medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with
requirements for storage conditions, compulsory texts, equipment, etc., specified in
legislation. Where it was once the case that pharmacists stayed within the dispensary
compounding/dispensing medications; there has been an increasing trend towards the use of
trained pharmacy technicians while the pharmacist spends more time communicating with

All pharmacies are required to have a pharmacist on-duty at all times when open. In many
jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered
pharmacist (R.Ph.). This latter requirement has been revoked in many jurisdictions, such that
many retailers (including supermarkets and mass merchandisers) now include a pharmacy as
a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition to
medicines and prescriptions, many now sell a diverse arrangement of additional items such as
cosmetics, shampoo, office supplies, confections, snack foods, durable medical equipment,
greeting cards, and provide photo processing services.

[edit] Hospital pharmacy

Main article: Hospital pharmacy

Pharmacies within hospitals differ considerably from community pharmacies. Some
pharmacists in hospital pharmacies may have more complex clinical medication management
issues whereas pharmacists in community pharmacies often have more complex business and
customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of
treatment regimens, safety of medications (i.e., drug interactions) and patient compliance
issues (in the hospital and at home) many pharmacists practicing in hospitals gain more
education and training after pharmacy school through a pharmacy practice residency and
sometimes followed by another residency in a specific area. Those pharmacists are often
referred to as clinical pharmacists and they often specialize in various disciplines of
pharmacy. For example, there are pharmacists who specialize in hematology/oncology,
HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear
pharmacy, pain management, psychiatry, anti-coagulation clinics, herbal medicine,
neurology/epilepsy management, pediatrics, neonatal pharmacists and more.

Hospital pharmacies can usually be found within the premises of the hospital. Hospital
pharmacies usually stock a larger range of medications, including more specialized
medications, than would be feasible in the community setting. Most hospital medications are
unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy
technicians compound sterile products for patients including total parenteral nutrition (TPN),
and other medications given intravenously. This is a complex process that requires adequate
training of personnel, quality assurance of products, and adequate facilities. Several hospital
pharmacies have decided to outsource high risk preparations and some other compounding
functions to companies who specialize in compounding. The high cost of medications and
drug-related technology, combined with the potential impact of medications and pharmacy
services on patient-care outcomes and patient safety, make it imperative that hospital
pharmacies perform at the highest level possible.

[edit] Clinical pharmacy

Main article: Clinical pharmacy

Dr Sajad Issop of Airedale General Hospital explains: Clinical pharmacists provide direct
patient care services that optimizes the use of medication and promotes health, wellness, and
disease prevention.[11] Clinical pharmacists care for patients in all health care settings but the
clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists
often collaborate with physicians and other healthcare professionals to improve
pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary
approach to patient care. They work collaboratively with physicians, nurses and other
healthcare personnel in various medical and surgical areas. They often participate in patient
care rounds and drug product selection. In most hospitals in the United States, potentially

dangerous drugs that require close monitoring are dosed and managed by clinical

[edit] Compounding pharmacy

Main article: Compounding

Compounding is the practice of preparing drugs in new forms. For example, if a drug
manufacturer only provides a drug as a tablet, a compounding pharmacist might make a
medicated lollipop that contains the drug. Patients who have difficulty swallowing the tablet
may prefer to suck the medicated lollipop instead.

Another form of compounding is by mixing different strengths,(g,mg,mcg)of capsules or
tablets to yield the desire therapy indicated by the doctor. This form of compounding is found
at community or hospital pharmacies or in-home administration therapy.

Compounding pharmacies specialize in compounding, although many also dispense the same
non-compounded drugs that patients can obtain from community pharmacies.

[edit] Consultant pharmacy

Main article: Consultant pharmacist

Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive
services") than on actual dispensing of drugs. Consultant pharmacists most typically work in
nursing homes, but are increasingly branching into other institutions and non-institutional
settings.[12] Traditionally consultant pharmacists were usually independent business owners,
though in the United States many now work for several large pharmacy management
companies (primarily Omnicare, Kindred Healthcare and PharMerica). This trend may be
gradually reversing as consultant pharmacists begin to work directly with patients, primarily
because many elderly people are now taking numerous medications but continue to live
outside of institutional settings. Some community pharmacies employ consultant pharmacists
and/or provide consulting services.

The main principle of consultant pharmacy is pharmaceutical care developed by Hepler and
Strand in 1990.[13][14]

[edit] Internet pharmacy

Main article: Online pharmacy

Since about the year 2000, a growing number of internet pharmacies have been established
worldwide. Many of these pharmacies are similar to community pharmacies, and in fact,
many of them are actually operated by brick-and-mortar community pharmacies that serve
consumers online and those that walk in their door. The primary difference is the method by
which the medications are requested and received. Some customers consider this to be more
convenient and private method rather than traveling to a community drugstore where another
customer might overhear about the drugs that they take. Internet pharmacies (also known as
Online Pharmacies) are also recommended to some patients by their physicians if they are
While most internet pharmacies sell prescription drugs and require a valid prescription, some
internet pharmacies sell prescription drugs without requiring a prescription. Many customers
order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to
obtain medications which their doctors were unwilling to prescribe. However, this practice
has been criticized as potentially dangerous, especially by those who feel that only doctors
can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability
for use of a medication. There also have been reports of such pharmacies dispensing
substandard products.[citation needed]

Of particular concern with internet pharmacies is the ease with which people, youth in
particular, can obtain controlled substances (e.g., Vicodin, generically known as
hydrocodone) via the internet without a prescription issued by a doctor/practitioner who has
an established doctor-patient relationship. There are many instances where a practitioner
issues a prescription, brokered by an internet server, for a controlled substance to a "patient"
s/he has never met. In the United States, in order for a prescription for a controlled substance
to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner
acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a
corresponding responsibility to ensure that the prescription is valid. Often, individual state
laws outline what defines a valid patient-doctor relationship.

Canada is home to dozens of licensed internet pharmacies, many of which sell their lower-
cost prescription drugs to U.S. consumers, who pay one of the world's highest drug
prices.[citation needed] In recent years, many consumers in the US and in other countries with high
drug costs, have turned to licensed internet pharmacies in India, Israel and the UK, which
often have even lower prices than in Canada.

In the United States, there has been a push to legalize importation of medications from
Canada and other countries, in order to reduce consumer costs. While in most cases
importation of prescription medications violates Food and Drug Administration (FDA)
regulations and federal laws, enforcement is generally targeted at international drug suppliers,
rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs
for personal use with a prescription, who has ever been charged by authorities.

Recently-developed online services like Australia's Medicine Name Finder and the
Walgreens' Drug Info Search provide information about pharmaceutical products but do not
offer prescriptions or drug dispensations. These services often promote generic drug
alternatives by offering comparative information on price and effectiveness.

[edit] Veterinary pharmacy

Veterinary pharmacies, sometimes called animal pharmacies, may fall in the category of
hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock
different varieties and different strengths of medications to fulfill the pharmaceutical needs of
animals. Because the needs of animals, as well as the regulations on veterinary medicine, are
often very different from those related to people, veterinary pharmacy is often kept separate
from regular pharmacies.

[edit] Nuclear pharmacy

Main article: Nuclear pharmacy

Nuclear pharmacy focuses on preparing radioactive materials for diagnostic tests and for
treating certain diseases. Nuclear pharmacists undergo additional training specific to handling
radioactive materials, and unlike in community and hospital pharmacies, nuclear pharmacists
typically do not interact directly with patients.

[edit] Military pharmacy

Main article: Military pharmacy

Military pharmacy is an entirely different working environment due to the fact that
technicians perform most duties that in a civilian sector would be illegal. State laws of
Technician patient counseling and medication checking by a pharmacist do not apply.

[edit] Pharmacy informatics

Main article: Pharmacy informatics

Pharmacy informatics is the combination of pharmacy practice science and applied
information science. Pharmacy informaticists work in many practice areas of pharmacy,
however, they may also work in information technology departments or for healthcare
information technology vendor companies. As a practice area and specialist domain,
pharmacy informatics is growing quickly to meet the needs of major national and
international patient information projects and health system interoperability goals.
Pharmacists are well trained to participate in medication management system development,
deployment and optimization.

Physical therapy
From Wikipedia, the free encyclopedia
 (Redirected from Physiotherapy)
Jump to: navigation, search

                  Physical therapy

           Classification and external resources

    This physical therapist from the 1950s is assisting
     two children with polio to train their standing skills
    with help from calipers and rails, and use of a ball

Physical therapy (also physiotherapy) is a health profession that assesses and provides
treatment to individuals to develop, maintain and restore maximum movement and function
throughout life. This includes providing treatment in circumstances where movement and
function are threatened by aging, injury, disease or environmental factors.

Physical therapy is concerned with identifying and maximizing quality of life and movement
potential within the spheres of promotion, prevention, treatment/intervention, habilitation and
rehabilitation. This encompasses physical, psychological, emotional, and social well being. It
involves the interaction between physical therapist (PT), patients/clients, other health
professionals, families, care givers, and communities in a process where movement potential
is assessed and goals are agreed upon, using knowledge and skills unique to physical
therapists.[1] Physical therapy is performed by either a physical therapist (PT) or an assistant
(PTA) acting under their direction.[2]

PTs use an individual's history and physical examination to arrive at a diagnosis and establish
a management plan and, when necessary, incorporate the results of laboratory and imaging
studies. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity
testing) may also be of assistance.[3]

Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic,
orthopaedic and pediatrics, to name some of the more common areas. PTs practice in many
settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, skilled nursing
facilities, extended care facilities, private homes, education and research centers, schools,
hospices, industrial workplaces or other occupational environments, fitness centers and sports
training facilities.[4]

Education qualifications vary greatly by country. The span of education ranges from some
countries having little formal education to others requiring masters or doctoral

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a
specific clinical area. While there are many different types of physical therapy,[14] the
American Board of Physical Therapy Specialties list seven specialist certifications, including
Sports Physical Therapy and Clinical Electrophysiology.[15] Worldwide the six most common
specialty areas in physical therapy are:[16]

[edit] Cardiopulmonary

Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of
individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary
surgery. Primary goals of this specialty include increasing endurance and functional
independence. Manual therapy is used in this field to assist in clearing lung secretions
experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass
surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can
benefit[citation needed] from cardiovascular and pulmonary specialized physical
therapists.[16][verification needed]

[edit] Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through
normal adult aging but is usually focused on the older adult. There are many conditions that
affect many people as they grow older and include but are not limited to the following:
arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance
disorders, incontinence, etc. Geriatric physical therapists specialize in treating older adults.

[edit] Neurological

Neurological physical therapy is a field focused on working with individuals who have a
neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth
disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease,
spinal cord injury, and stroke. Common impairments associated with neurologic conditions
include impairments of vision, balance, ambulation, activities of daily living, movement,
muscle strength and loss of functional independence.[16]

[edit] Orthopedic

Orthopaedic physical therapists diagnose, manage, and treat disorders and injuries of the
musculoskeletal system including rehabilitation after orthopaedic surgery. This specialty of
physical therapy is most often found in the out-patient clinical setting. Orthopaedic therapists
are trained in the treatment of post-operative orthopaedic procedures, fractures, acute sports
injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations.

Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation,
hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis,

electrotherapy) are modalities often used to expedite recovery in the orthopaedic
setting.[17][verification needed] Additionally, an emerging adjunct to diagnosis and treatment is the
use of sonography for diagnosis and to guide treatments such as muscle retraining.[18][19][20]
Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons
of the body will benefit[citation needed] from assessment by a physical therapist specialized in

[edit] Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide
variety of modalities to treat disorders in the pediatric population. These therapists are
specialized in the diagnosis, treatment, and management of infants, children, and adolescents
with a variety of congenital, developmental, neuromuscular, skeletal, or acquired
disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and
coordination, strength and endurance as well as cognitive and sensory processing/integration.
Children with developmental delays, cerebral palsy, spina bifida, or torticollis may be
treated[citation needed] by pediatric physical therapists.[16][verification needed]

[edit] Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common
conditions managed include wounds and burns. Physical therapists utilize surgical
instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and
promote tissue healing. Other commonly used interventions include exercise, edema control,
splinting, and compression garments.

From Wikipedia, the free encyclopedia
Jump to: navigation, search

Podiatry is a branch of medicine devoted to the study, diagnosis and treatment of disorders
of the foot, ankle and lower leg.[1]

The term "podiatry" came into use first in the early 20th century United States [2] where it
now denotes a Doctor of Podiatric Medicine (DPM), also known as a podiatric physician or
surgeon who is qualified by their education and training to diagnose and treat conditions
affecting the foot, ankle and related structures of the leg. Within the field of podiatry,
practitioners can focus on many different specialty areas, including surgery, sports medicine,
biomechanics, geriatrics, pediatrics, orthopedics or primary care.[2]

Podiatry is also practiced in other countries such as Canada, Ireland, the United Kingdom,
Malta, Cyprus, South Africa, Australia and New Zealand. In many English-speaking
countries, the older title of "chiropodist" may still be used by some clinicians but is gradually
falling out of use. In many non-English-speaking countries of Europe, the title used instead of
podiatrist may be "podologist[3]" or "Podólogo" [4]. The level and scope of practice may vary
in these countries as compared to the US.


In Australia, podiatry is classified as an allied health profession, and is practised by
individuals licensed by their representative State Boards of Podiatry. There are seven
registration boards and six teaching centres, with two levels of awards — unclassified
bachelors degree and honours level. In Australia there exist 2 levels of professional
accreditation and professional privilege: Podiatrist and Podiatric Surgeon (Surgical Podiatrist
in the state of Queensland). Australian podiatrists are able to practise abroad with their
qualifications recognised in some Commonwealth countries.

[edit] Registration and regulation

Prescribing and referral rights

There is considerable variation between state laws regarding the prescribing rights of
Australian podiatrists. While all registered podiatrists in each state or territory are able to
utilize local anaesthesia for minor surgical techniques, some states allow suitably qualified
podiatrists further privileges.

Recent legislative changes, which are expected to come into effect soon, will allow registered
podiatrists and podiatric surgeons in Victoria graduates to prescribe relevant schedule 4
poisons.[4] In other states, such as Western Australia and South Australia, podiatrists with
Masters Degree's in Podiatry, and extensive training in pharmacology are authorised to
prescribe S4 poisons. In Queensland, Fellows of the Australasian College of Podiatric
Surgeons are authorised to prescribe a range of Schedule 4 and one Schedule 8 drug for the
treatment of podiatric conditions.

All podiatrists may refer patients for Medicare rebatable plain x-rays of the foot, leg, knee
and femur, as well as ultrasound examination of soft tissue conditions of the foot. Podiatrists
may refer patients for other radiology investigations such as CT, MRI or bone scans, however
Medicare rebates do not currently exist for these examinations. Similarly, podiatrists may
refer patients when needed to specialist medical practitioners, or for pathology testing,
however similar exclusions in the Medicare Benefits Schedule prevent rebates being
available to patients for these referrals.

Practice characteristics

While the majority of podiatric physicians are in solo practice, there has been a movement
toward larger group practices as well as the use of podiatrists in multi-specialty groups
including orthopedic groups, treating diabetes, or in multi-specialty orthopedic surgical
groups. Some podiatrists work within clinic practices such as the Indian Health System
(IHS), the Rural Health Centers (RHC) and Community Health Center (FQHC) systems
established by the US government to provide services to under-insured and non-insured
patients as well as within the United States Department of Veterans Affairs providing care to
veterans of military service.

[edit] Scope of practice

The differences in podiatric medical and surgical practice are determined by state law. Each
state allows or limits the practice of podiatric medicine to the foot. Some states allow other
types of surgery.[citation needed] This may include surgery above the ankle and leg in 44
states.[citation needed] Most states require completion of a residency or a post-graduate training to

practice. Most podiatric surgeons work in surgery centers or hospitals performing both
medical and surgical treatments for patients. As in many other specialties, some podiatrists
work in nursing homes and some perform house calls for patients. Podiatric patients range
from newborns and infants to the geriatric.

[edit] Surgical practice

Within the scope of practice, podiatrists are one of two types of experts on foot and ankle
care (the other type are orthopedic surgeons, a type of medical doctor). Some podiatrists have
primarily surgical practices. Some specialists complete additional fellowship training in
reconstruction of the foot and ankle. Many podiatric surgeons specialize in minimally
invasive percutaneous surgery. Most podiatrists utilize medical, orthopedic, biomechanical
and surgical practices. Surgical podiatric principles rest on a base of orthopedic and
kinesthetic knowledge.

Speciality branches

Podiatrists treat a wide variety of foot and lower extremity conditions, through nonsurgical
and surgical approaches. There are those podiatric physicians who also subspecialize in such
fields of practice as:

        Reconstructive Rearfoot and Ankle Surgery
        Sports Medicine
        Diabetic limb salvage and wound care
        Podopaediatrics (the study of children's foot and ankle conditions)
        Forensic Podiatry (the study of footprints, footwear, shoeprints and feet
         associated with crime scene investigations)

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  History · Subfields · Portal

         Basic science

       Abnormal · Biological
   Cognitive · Developmental
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  Topics · Therapies · Theories


Psychology is the scientific study of human or other animal mental functions and behaviors.
In this field, a professional practitioner or researcher is called a psychologist. Psychologists
are classified as social or behavioral scientists. Psychological research can be considered
either basic or applied. Psychologists attempt to understand the role of mental functions in
individual and social behavior, while also exploring underlying physiological and
neurological processes.

Basic research in psychology includes perception, cognition, attention, emotion, motivation,
brain functioning, personality, behavior, and interpersonal relationships. Some, especially
depth psychologists, also consider the unconscious mind.a Psychologists employ empirical
methods to determine causal and correlational relationships between psychosocial variables.
In addition, or in opposition, to employing empirical and deductive methods, clinical
psychologists sometimes rely upon symbolic interpretation and other inductive techniques.

While psychological knowledge is typically applied to the assessment and treatment of
mental health problems, it is also applied to understanding and solving problems in many
different spheres of human activity. The vast majority of psychologists are involved in
clinical, counseling, and school positions, some are employed in the industrial and
organizational setting, and other areas[1] such as human development and aging, sports,
health, the media, legal, and forensics. Psychology incorporates research from the social
sciences, natural sciences, and humanities.


The word psychology literally means, "study of the soul".[2] It derives from Ancient Greek:
"ψυχή" (psychē, meaning "breath", "spirit", or "soul"); and "-λογία" (-logia, translated as

"study of").[2] The Latin word psychologia has likely origins in mid-16th century Germany.
The earliest known reference to the English word psychology was by Steven Blankaart in
1693 in The Physical Dictionary which refers to "Anatomy, which treats of the Body, and
Psychology, which treats of the Soul."[3] Psychology first became an independent field of
investigation distinct from philosophy with the creation of Wilhelm Wundt's laboratory at
Leipzig University in 1879.[3]

[edit] History
Main article: History of psychology

Wilhelm Wundt (seated) with colleagues in his psychological laboratory, the first of
its kind. Wundt is credited with setting up psychology as a field of scientific inquiry
independent of the disciplines philosophy and biology.

The study of psychology in philosophical context dates back to the ancient civilizations of
Egypt, Greece, China, India, and Persia. Historians point to the writings of ancient Greek
philosophers, such as Thales, Plato, and Aristotle (esp. De Anima),[4] as the first significant
work to be rich in psychology-related thought.[5] In 1802, French physiologist Pierre Cabanis
sketched out the beginnings of physiological psychology with his essay, Rapports du
physique et du moral de l'homme (On the relations between the physical and moral aspects of
man). Cabanis interpreted the mind in light of his previous studies of biology, arguing that
sensibility and soul are properties of the nervous system.

German physician Wilhelm Wundt is known as the "father of experimental psychology,"[6]
because he founded the first psychological laboratory, at Leipzig University in 1879.[6]
Wundt focused on breaking down mental processes into the most basic components, starting
a school of psychology that is called structuralism. Edward Titchener was another major
structuralist thinker.
Functionalism formed as a reaction to the theories of the structuralist school of thought and
was heavily influenced by the work of the American philosopher and psychologist William
James. In his seminal book, Principles of Psychology,[7] published in 1890, he laid the
foundations for many of the questions that psychologists would explore for years to come.
Other major functionalist thinkers included John Dewey and Harvey Carr.

Other 19th-century contributors to the field include the German psychologist Hermann
Ebbinghaus, a pioneer in the experimental study of memory who discovered the learning and
forgetting curve[8] at the University of Berlin; and the Russian-Soviet physiologist Ivan
Pavlov, who discovered classical conditioning theory of learning whilst investigating the
digestive system of dogs.[9]

Starting in the 1950s, the experimental techniques set forth by Wundt, James, Ebbinghaus,
and others would be reiterated as experimental psychology became increasingly cognitive—
concerned with information and its processing—and, eventually, constituted a part of the
wider cognitive science.[10] In its early years, this development had been seen as a
"revolution",[10] as it both responded to and reacted against strains of thought—including
psychodynamics and behaviorism—that had developed in the meantime.

[edit] Psychoanalysis

Main article: Psychoanalysis

From the 1890s until his death in 1939, the Austrian physician Sigmund Freud developed
psychoanalysis, a method of investigation of the mind and the way one thinks; a systematized
set of theories about human behavior; and a form of psychotherapy to treat psychological or
emotional distress, especially unconscious conflict.[11] Freud's psychoanalytic theory was
largely based on interpretive methods, introspection and clinical observations. It became very
well-known, largely because it tackled subjects such as sexuality, repression, and the
unconscious mind as general aspects of psychological development. These were largely
considered taboo subjects at the time, and Freud provided a catalyst for them to be openly
discussed in polite society. Clinically, Freud helped to pioneer the method of free association
and a therapeutic interest in dream interpretation.[12][13]

Group photo 1909 in front of Clark University. Front row: Sigmund Freud, G. Stanley
Hall, Carl Jung; back row: Abraham A. Brill, Ernest Jones, Sándor Ferenczi.

Freud had a significant influence on Swiss psychiatrist Carl Jung, whose analytical
psychology became an alternative form of depth psychology. Other well-known
psychoanalytic thinkers of the mid-twentieth century included German-American
psychologist Erik Erickson, Austrian-British psychoanalyst Melanie Klein, English
psychoanalyst and physician D. W. Winnicott, German psychologist Karen Horney, German-
born psychologist and philosopher Erich Fromm, English psychiatrist John Bowlby and
Sigmund Freud's daughter, psychoanalyst Anna Freud. Throughout the 20th century,
psychoanalysis evolved into diverse schools of thought, most of which may be classed as

Psychoanalytic theory and therapy were criticized by psychologists and philosophers such as
B. F. Skinner, Hans Eysenck, and Karl Popper. Skinner and other behaviorists believed that
psychology should be more empirical and efficient than psychoanalysis—although they
frequently agreed with Freud in ways that became overlooked as time passed.[14] Popper, a
philosopher of science, argued that Freud's, as well as Alfred Adler's, psychoanalytic theories
included enough ad hoc safeguards against empirical contradiction to keep the theories

outside the realm of scientific inquiry.[15] By contrast, Eysenck maintained that although
Freudian ideas could be subjected to experimental science, they had not withstood
experimental tests. By the 21st century, psychology departments in American universities had
become experimentally oriented, marginalizing Freudian theory and regarding it as a
"desiccated and dead" historical artifact.[16] Meanwhile, however, researchers in the emerging
field of neuro-psychoanalysis defended some of Freud's ideas on scientific grounds,d while
scholars of the humanities maintained that Freud was not a "scientist at all, but ... an

[edit] Behaviorism

Main article: Behaviorism

Skinner's teaching machine, a mechanical invention to automate the task of
programmed instruction

Behaviorism became the dominant school of thought during the 1950s. American
behaviorism was founded in the early 20th century by John B. Watson, and embraced and
extended by Edward Thorndike, Clark L. Hull, Edward C. Tolman, and later B. F. Skinner.
Behaviorism is focused on observable behavior. It theorizes that all behavior can be
explained by environmental causes, rather than by internal forces.[citation needed] Theories of
learning including classical conditioning and operant conditioning were the focus of a great
deal of research. Much research was done with laboratory-based animal experimentation,
which was increasing in popularity as physiology grew more sophisticated.

Skinner's behaviorism shared with its predecessors a philosophical inclination toward
positivism and determinism.[14] He believed that the contents of the mind were not open to
scientific scrutiny and that scientific psychology should emphasize the study of observable
behavior. He focused on behavior–environment relations and analyzed overt and covert (i.e.,
private) behavior as a function of the organism interacting with its environment.[17]
Behaviorists usually rejected or deemphasized dualistic explanations such as "mind" or
"consciousness"; and, in lieu of probing an "unconscious mind" that underlies unawareness,
they spoke of the "contingency-shaped behaviors" in which unawareness becomes outwardly

Among the American behaviorists' most famous creations are John B. Watson's Little Albert
experiment, which applied classical conditioning to the developing human child, and
Skinner's notion of operant conditioning, which acknowledged that human agency could
affect patterns and cycles of environmental stimuli and behavioral responses. American
linguist Noam Chomsky's critique of the behaviorist model of language acquisition is widely
regarded as a key factor in the decline of behaviorism's prominence.[18] But Skinner's
behaviorism has not died, perhaps in part because it has generated successful practical
applications.[18] The fall of behaviorism as an overarching model in psychology, however,
gave way to a new dominant paradigm: cognitive approaches.[19]

[edit] Humanism

Main article: Humanistic psychology

Psychologist Abraham Maslow in 1943 posited that humans have a hierarchy of
needs, and it makes sense to fulfill the basic needs first (food, water etc.) before
higher-order needs can be met.[20]

Humanistic psychology was developed in the 1950s in reaction to both behaviorism and
psychoanalysis.[citation needed] By using phenomenology, intersubjectivity and first-person
categories, the humanistic approach sought to glimpse the whole person—not just the
fragmented parts of the personality or cognitive functioning.[21] Humanism focused on
fundamentally and uniquely human issues, such as individual free will, personal growth, self-
actualization, self-identity, death, aloneness, freedom, and meaning. The humanistic approach
was distinguished by its emphasis on subjective meaning, rejection of determinism, and
concern for positive growth rather than pathology.[citation needed] Some of the founders of the
humanistic school of thought were American psychologists Abraham Maslow, who
formulated a hierarchy of human needs, and Carl Rogers, who created and developed client-
centered therapy. Later, positive psychology opened up humanistic themes to scientific
modes of exploration.

[edit] Gestalt

Main article: Gestalt psychology

Wolfgang Kohler, Max Wertheimer and Kurt Koffka co-founded the school of Gestalt
psychology. This approach is based upon the idea that we experience things as unified
wholes. This approach to psychology began in Germany and Austria during the late 19th
century in response to the molecular approach of structuralism. Rather than breaking down
thoughts and behavior to their smallest element, the gestalt position maintains that the whole
of experience is important, and the whole is different than the sum of its parts.
Gestalt psychology should not be confused with the Gestalt therapy of Fritz Perls, which is
only peripherally linked to Gestalt psychology.

[edit] Existentialism

Influenced largely by the work of German philosopher Martin Heidegger and Danish
philosopher Søren Kierkegaard, psychoanalytically trained American psychologist Rollo May
pioneered an existential breed of psychology, which included existential therapy, in the 1950s
and 1960s. Existential psychologists differed from others often classified as humanistic in
their comparatively neutral view of human nature and in their relatively positive assessment
of anxiety.[22] Existential psychologists emphasized the humanistic themes of death, free will,
and meaning, suggesting that meaning can be shaped by myths, or narrative patterns,[23] and
that it can be encouraged by an acceptance of the free will requisite to an authentic, albeit
often anxious, regard for death and other future prospects. Austrian existential psychiatrist
and Holocaust survivor Viktor Frankl drew evidence of meaning's therapeutic power from
reflections garnered from his own internment,[24] and he created a variety of existential
psychotherapy called logotherapy. In addition to May and Frankl, Swiss psychoanalyst
Ludwig Binswanger and American psychologist George Kelly may be said to belong to the
existential school.[25]

[edit] Cognitivism

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           challenged and removed. (June 2010)
Main articles: Cognitivism (psychology) and Cognitive psychology

Baddeley's model of working memory

Cognitive psychology is the branch of psychology that studies mental processes including
how people think, perceive, remember, and learn. As part of the larger field of cognitive
science, this branch of psychology is related to other disciplines including neuroscience,
philosophy, and linguistics.
Noam Chomsky helped to ignite a "cognitive revolution" in psychology when he criticized
the behaviorists' notions of "stimulus", "response", and "reinforcement", arguing that such
ideas—which Skinner had borrowed from animal experiments in the laboratory—could be
applied to complex human behavior, most notably language acquisition, in only a vague and
superficial manner.[neutrality is disputed] The postulation that humans are born with the instinct or
"innate facility" for acquiring language posed a challenge to the behaviorist position that all
behavior (including language) is contingent upon learning and reinforcement.[26] Social
learning theorists such as Albert Bandura argued that the child's environment could make
contributions of its own to the behaviors of an observant subject.[27]

The Müller-Lyer illusion. Psychologists make inferences about mental processes
from shared phenomena such as optical illusions.

Meanwhile, accumulating technology helped to renew interest and belief in the mental states
and representations—i.e., the cognition—that had fallen out of favor with behaviorists.
English neuroscientist Charles Sherrington and Canadian psychologist Donald O. Hebb used
experimental methods to link psychological phenomena with the structure and function of the
brain. With the rise of computer science and artificial intelligence, analogies were drawn
between the processing of information by humans and information processing by machines.
Research in cognition had proven practical since World War II, when it aided in the
understanding of weapons operation.[28] By the late 20th century, though, cognitivism had
become the dominant paradigm of mainstream psychology, and cognitive psychology
emerged as a popular branch.

Assuming both that the covert mind should be studied and that the scientific method should
be used to study it, cognitive psychologists set such concepts as "subliminal processing" and
"implicit memory" in place of the psychoanalytic "unconscious mind" or the behavioristic
"contingency-shaped behaviors". Elements of behaviorism and cognitive psychology were
synthesized to form the basis of cognitive behavioral therapy, a form of psychotherapy
modified from techniques developed by American psychologist Albert Ellis and American
psychiatrist Aaron T. Beck. Cognitive psychology was subsumed along with other
disciplines, such as philosophy of mind, computer science, and neuroscience, under the
umbrella discipline of cognitive science.

Another of the most influential theories from this school of thought was the stages of
cognitive development theory proposed by Jean Piaget.

[edit] Subfields
Main article: Subfields of psychology
Further information: List of psychology topics and List of psychology disciplines

Psychology encompasses a vast domain, and includes many different approaches to the study
of mental processes and behavior.

[edit] Biological
Main articles: Biological psychology, Neuropsychology, Physiological psychology,
and Cognitive neuroscience

MRI depicting the human brain. The arrow indicates the position of the

Biological psychology and a number of related fields study the biological substrates of
behavior and mental states. Behavioral neuroscienists use animal models (typically rats) to
study the neural, genetic, cellular mechanisms of human behavior and cognition, cognitive
neuroscientists investigate the neural correlates of psychological processes in humans using
neural imaging tools, and neuropsychologists conduct psychological assessments to
determine, for instance, specific aspects and extent of cognitive deficit caused by brain
damage or disease.

[edit] Biopsychosocial
Main article: biopsychosocial

Some researchers[who?] are working on an integrated perspective toward understanding
consciousness, behavior, and social interaction. The biopsychosocial model, for instance,
assumes that any given behavior or mental process affects and is affected by dynamically
interrelated biological, psychological, and social factors.[29] The psychological aspect refers
to the role that cognition and emotions play in any given psychological phenomenon—for
example, the effect of mood or beliefs and expectations on an individual's reactions to an
event. The biological aspect refers to the role of biological factors in psychological
phenomena—for example, the effect of the prenatal environment on brain development and
cognitive abilities, or the influence of genes on individual dispositions. The socio-cultural
aspect refers to the role that social and cultural environments play in a given psychological
phenomenon—for example, the role of parental or peer influence in the behaviors or
characteristics of an individual.

[edit] Clinical
Main articles: Clinical psychology and Counseling psychology

Clinical psychologists work with individuals, children, families, couples, or small

Clinical psychology includes the study and application of psychology for the purpose of
understanding, preventing, and relieving psychologically based distress or dysfunction and to
promote subjective well-being and personal development. Central to its practice are
psychological assessment and psychotherapy, although clinical psychologists may also
engage in research, teaching, consultation, forensic testimony, and program development and
administration.[30] Some clinical psychologists may focus on the clinical management of
patients with brain injury—this area is known as clinical neuropsychology. In many
countries, clinical psychology is a regulated mental health profession.

The work performed by clinical psychologists tends to be influenced by various therapeutic
approaches, all of which involve a formal relationship between professional and client
(usually an individual, couple, family, or small group). The various therapeutic approaches
and practices are associated with different theoretical perspectives and employ different
procedures intended to form a therapeutic alliance, explore the nature of psychological
problems, and encourage new ways of thinking, feeling, or behaving. Four major theoretical
perspectives are psychodynamic, cognitive behavioral, existential-humanistic, and systems or
family therapy. There has been a growing movement to integrate the various therapeutic
approaches, especially with an increased understanding of issues regarding culture, gender,
spirituality, and sexual-orientation. With the advent of more robust research findings
regarding psychotherapy, there is evidence that most of the major therapies are about of equal
effectiveness, with the key common element being a strong therapeutic alliance.[31][32]
Because of this, more training programs and psychologists are now adopting an eclectic
therapeutic orientation.[33][34][35][36][37]

[edit] Cognitive
Main article: Cognitive psychology

Green Red Blue
Purple Blue Purple

Blue Purple Red
Green Purple Green

The Stroop effect refers to the fact that naming the color of the first set of words is easier and
quicker than the second.

Cognitive psychology studies cognition, the mental processes underlying mental activity.
Perception, learning, problem solving, reasoning, thinking, memory, attention, language and
emotion are areas of research. Classical cognitive psychology is associated with a school of
thought known as cognitivism, whose adherents argue for an information processing model
of mental function, informed by functionalism and experimental psychology.

On a broader level, cognitive science is an interdisciplinary enterprise of cognitive
psychologists, cognitive neuroscientists, researchers in artificial intelligence, linguists,
human–computer interaction, computational neuroscience, logicians and social scientists.
Computational models are sometimes used to simulate phenomena of interest. Computational
models provide a tool for studying the functional organization of the mind whereas
neuroscience provides measures of brain activity.

[edit] Comparative
Main article: Comparative psychology

The common chimpanzee can use tools. This chimpanzee is using a stick in order to
get food.

Comparative psychology refers to the study of the behavior and mental life of animals other
than human beings. It is related to disciplines outside of psychology that study animal
behavior such as ethology. Although the field of psychology is primarily concerned with
humans the behavior and mental processes of animals is also an important part of
psychological research. This being either as a subject in its own right (e.g., animal cognition
and ethology) or with strong emphasis about evolutionary links, and somewhat more
controversially, as a way of gaining an insight into human psychology. This is achieved by
means of comparison or via animal models of emotional and behavior systems as seen in
neuroscience of psychology (e.g., affective neuroscience and social neuroscience).

[edit] Developmental
Main article: Developmental psychology

A baby with a book.

Mainly focusing on the development of the human mind through the life span, developmental
psychology seeks to understand how people come to perceive, understand, and act within the
world and how these processes change as they age. This may focus on intellectual, cognitive,

neural, social, or moral development. Researchers who study children use a number of unique
research methods to make observations in natural settings or to engage them in experimental
tasks. Such tasks often resemble specially designed games and activities that are both
enjoyable for the child and scientifically useful, and researchers have even devised clever
methods to study the mental processes of small infants. In addition to studying children,
developmental psychologists also study aging and processes throughout the life span,
especially at other times of rapid change (such as adolescence and old age). Developmental
psychologists draw on the full range of psychological theories to inform their research.

[edit] Educational and school
Main articles: Educational psychology and School psychology

An example of an item from a cognitive abilities test used in educational psychology.

Educational psychology is the study of how humans learn in educational settings, the
effectiveness of educational interventions, the psychology of teaching, and the social
psychology of schools as organizations. The work of child psychologists such as Lev
Vygotsky, Jean Piaget, Bernard Luskin and Jerome Bruner has been influential in creating
teaching methods and educational practices. Educational psychology is often included in
teacher education programs, in places such as North America, Australia, and New Zealand.

School psychology combines principles from educational psychology and clinical psychology
to understand and treat students with learning disabilities; to foster the intellectual growth of
"gifted" students; to facilitate prosocial behaviors in adolescents; and otherwise to promote
safe, supportive, and effective learning environments. School psychologists are trained in
educational and behavioral assessment, intervention, prevention, and consultation, and many
have extensive training in research.[38]

[edit] Industrial-Organizational
Main article: Industrial and organizational psychology

Industrial and organizational psychology (I-O) applies psychological concepts and methods
to optimize human potential in the workplace. Personnel psychology, a subfield of I-O
psychology, applies the methods and principles of psychology in selecting and evaluating
workers. I-O psychology's other subfield, organizational psychology, examines the effects of
work environments and management styles on worker motivation, job satisfaction, and

[edit] Personality
Main article: Personality psychology

Personality psychology studies enduring patterns of behavior, thought, and emotion in
individuals, commonly referred to as personality. Theories of personality vary across

different psychological schools and orientations. They carry different assumptions about such
issues as the role of the unconscious and the importance of childhood experience. According
to Freud, personality is based on the dynamic interactions of the id, ego, and super-ego.[40]
Trait theorists, in contrast, attempt to analyze personality in terms of a discrete number of key
traits by the statistical method of factor analysis. The number of proposed traits has varied
widely. An early model proposed by Hans Eysenck suggested that there are three traits that
comprise human personality: extraversion-introversion, neuroticism, and psychoticism.
Raymond Cattell proposed a theory of 16 personality factors. The "Big Five", or Five Factor
Model, proposed by Lewis Goldberg, currently has strong support among trait theorists.

[edit] Social
Main article: Social psychology (psychology)

Social psychology studies the nature and causes of social behavior.

Social psychology is the study of social behavior and mental processes, with an emphasis on
how humans think about each other and how they relate to each other. Social psychologists
are especially interested in how people react to social situations. They study such topics as
the influence of others on an individual's behavior (e.g. conformity, persuasion), and the
formation of beliefs, attitudes, and stereotypes about other people. Social cognition fuses
elements of social and cognitive psychology in order to understand how people process,
remember, and distort social information. The study of group dynamics reveals information
about the nature and potential optimization of leadership, communication, and other
phenomena that emerge at least at the microsocial level. In recent years, many social
psychologists have become increasingly interested in implicit measures, mediational models,
and the interaction of both person and social variables in accounting for behavior.

[edit] Research methods

Psychology tends to be eclectic, drawing on knowledge from other fields to help explain and
understand psychological phenomena. Additionally, psychologists make extensive use of the
three modes of inference that were identified by C. S. Peirce: deduction, induction, and
abduction (hypothesis generation). While often employing deductive-nomological reasoning,
they also rely on inductive reasoning to generate explanations. For example, evolutionary
psychologists attempt to explain psychological traits—such as memory, perception, or
language—as adaptations, that is, as the functional products of natural selection or sexual

Psychologists may conduct basic research aiming for further understanding in a particular
area of interest in psychology, or conduct applied research to solve problems in the clinic,

workplace or other areas. Masters level clinical programs aim to train students in both
research methods and evidence-based practice. Professional associations have established
guidelines for ethics, training, research methodology and professional practice. In addition,
depending on the country, state or region, psychological services and the title "psychologist"
may be governed by statute and psychologists who offer services to the public are usually
required to be licensed.

[edit] Qualitative and quantitative research

Research in most areas of psychology is conducted in accord with the standards of the
scientific method. Psychological researchers seek the emergence of theoretically interesting
categories and hypotheses from data, using qualitative or quantitative methods (or both).

Qualitative psychological research methods include interviews, first-hand observation, and
participant observation. Qualitative researchers[41] sometimes aim to enrich interpretations or
critiques of symbols, subjective experiences, or social structures. Similar hermeneutic and
critical aims have also been served by "quantitative methods", as in Erich Fromm's study of
Nazi voting or Stanley Milgram's studies of obedience to authority.

Quantitative psychological research lends itself to the statistical testing of hypotheses.
Quantitatively oriented research designs include the experiment, quasi-experiment, cross-
sectional study, case-control study, and longitudinal study. The measurement and
operationalization of important constructs is an essential part of these research designs.
Statistical methods include the Pearson product-moment correlation coefficient, the analysis
of variance, multiple linear regression, logistic regression, structural equation modeling, and
hierarchical linear modeling.

[edit] Controlled experiments

Main article: Experiment

Flowchart of four phases (enrollment, intervention allocation, follow-up, and data
analysis) of a parallel randomized trial of two groups, modified from the CONSORT
(Consolidated Standards of Reporting Trials) 2010 Statement[42]

Experimental psychological research is conducted in a laboratory under controlled
conditions. This method of research relies on the application of the scientific method to
understand behavior. Experimenters use several types of measurements, including rate of
response, reaction time, and various psychometric measurements. Experiments are designed
to test specific hypotheses (deductive approach) or evaluate functional relationships
(inductive approach). A true experiment with random allocation of subjects to conditions
allows researchers to infer causal relationships between different aspects of behavior and the
environment. In an experiment, one or more variables of interest are controlled by the
experimenter (independent variable) and another variable is measured in response to different
conditions (dependent variable). Experiments are one of the primary research methods in
many areas of psychology, particularly cognitive/psychonomics, mathematical psychology,
psychophysiology and biological psychology/cognitive neuroscience.

Experiments on humans have been put under some controls, namely informed and voluntary
consent. After World War II, the Nuremberg Code was established, because of Nazi abuses
of experimental subjects. Later, most countries (and scientific journals) adopted the
Declaration of Helsinki. In the US, the National Institutes of Health established the
Institutional Review Board in 1966, and in 1974 adopted the National Research Act (HR
7724). All of these measures encouraged researchers to obtain informed consent from human
participants in experimental studies. A number of influential studies led to the establishment
of this rule; such studies included the MIT and Fernald School radioisotope studies, the
Thalidomide tragedy, the Willowbrook hepatitis study, and Stanley Milgram's studies of
obedience to authority.

[edit] Survey questionnaires

Main article: Statistical survey

Statistical surveys are used in psychology for measuring attitudes and traits, monitoring
changes in mood, checking the validity of experimental manipulations, and for a wide variety
of other psychological topics. Most commonly, psychologists use paper-and-pencil surveys.
However, surveys are also conducted over the phone or through e-mail. Increasingly, web-
based surveys are being used in research. Similar methodology is also used in applied setting,
such as clinical assessment and personnel assessment.

[edit] Longitudinal studies

Longitudinal studies are often used in psychology to study developmental trends across the
life span, and in sociology to study life events throughout lifetimes or generations. The reason
for this is that unlike cross-sectional studies, longitudinal studies track the same people, and
therefore the differences observed in those people are less likely to be the result of cultural
differences across generations. Because of this benefit, longitudinal studies make observing
changes more accurate and they are applied in various other fields.

Because most longitudinal studies are observational, in the sense that they observe the state
of the world without manipulating it, it has been argued that they may have less power to
detect causal relationships than do experiments. They also suffer methodological limitations
such as from selective attrition because people with similar characteristics maybe more likely
to drop out of the study making it difficult to analyze.

Some longitudinal studies are experiments, called repeated-measures experiments.
Psychologists often use the crossover design to reduce the influence of confounding
covariates and to reduce the number of subjects.

[edit] Observation in natural settings

Main article: Naturalistic observation

In the same way Jane Goodall studied the role of chimpanzee social and family life,
psychologists conduct similar observational studies in human social, professional and family
lives. Sometimes the participants are aware they are being observed and other times it is
covert: the participants do not know they are being observed. Ethical guidelines need to be
taken into consideration when covert observation is being carried out.

[edit] Qualitative and descriptive research

Main article: Qualitative research

Research designed to answer questions about the current state of affairs such as the thoughts,
feelings and behaviors of individuals is known as descriptive research. Descriptive research
can be qualitative or quantitative in orientation. Qualitative research is descriptive research
that is focused on observing and describing events as they occur, with the goal of capturing
all of the richness of everyday behavior and with the hope of discovering and understanding
phenomena that might have been missed if only more cursory examinations have been made.

[edit] Neuropsychological methods

Main article: Neuropsychology

Phineas P. Gage survived an accident in which a large iron rod was driven
completely through his head, destroying much of his brain's left frontal lobe, and is
remembered for that injury's reported effects on his personality and behavior.[43]

Neuropsychology involves the study of both healthy individuals and patients, typically who
have suffered either brain injury or mental illness.

Cognitive neuropsychology and cognitive neuropsychiatry study neurological or mental
impairment in an attempt to infer theories of normal mind and brain function. This typically
involves looking for differences in patterns of remaining ability (known as 'functional
disassociations') which can give clues as to whether abilities are composed of smaller
functions, or are controlled by a single cognitive mechanism.

In addition, experimental techniques are often used to study the neuropsychology of healthy
individuals. These include behavioral experiments, brain-scanning or functional
neuroimaging, used to examine the activity of the brain during task performance, and
techniques such as transcranial magnetic stimulation, which can safely alter the function of
small brain areas to reveal their importance in mental operations.

[edit] Computational modeling

Artificial neural network with two layers, an interconnected group of nodes, akin to
the vast network of neurons in the human brain.

Computational modeling[44] is a tool often used in mathematical psychology and cognitive
psychology to simulate a particular behavior using a computer. This method has several
advantages. Since modern computers process extremely quickly, many simulations can be
run in a short time, allowing for a great deal of statistical power. Modeling also allows
psychologists to visualize hypotheses about the functional organization of mental events that
couldn't be directly observed in a human.

Several different types of modeling are used to study behavior. Connectionism uses neural
networks to simulate the brain. Another method is symbolic modeling, which represents
many different mental objects using variables and rules. Other types of modeling include
dynamic systems and stochastic modeling.

[edit] Animal studies

A rat undergoing a Morris water navigation test used in behavioral neuroscience to
study the role of the hippocampus in spatial learning and memory.

Animal learning experiments aid in investigating the biological basis of teaching, memory
and behavior. In the 1890s, Russian physiologist Ivan Pavlov famously used dogs to
demonstrate classical conditioning. Non-human primates, cats, dogs, rats and other rodents
are often used in psychological experiments. Ideally, controlled experiments introduce only
one independent variable at a time, in order to ascertain its unique effects upon dependent
variables. These conditions are approximated best in laboratory settings. In contrast, human
environments and genetic backgrounds vary so widely, and depend upon so many factors,
that it is difficult to control important variables for human subjects.[45]

[edit] Criticism

[edit] Theory

Criticisms of psychology often come from perceptions that it is a "fuzzy" science.
Philosopher Thomas Kuhn's 1962 critique[citation needed] implied psychology overall was in a
pre-paradigm state, lacking the agreement on overarching theory found in mature sciences
such as chemistry and physics. Psychologists and philosophers have addressed the issue in
various ways.e

Because some areas of psychology rely on research methods such as surveys[why?] and
questionnaires, critics have asserted that psychology is not an objective science. Other
phenomena that psychologists are interested in, such as personality, thinking, and emotion,
cannot be directly measured[46] and are often inferred from subjective self-reports, which may
be problematic.[47][48]

Misuses of hypothesis-testing occur in psychology, particularly by psychologists without
doctoral training[neutrality is disputed] in experimental psychology and statistics.[citation needed]
Research[which?] has documented that many psychologists confuse statistical significance with
practical importance. Statistically significant but practically unimportant results are common
with large samples.[49] Some psychologists have responded with an increased use of effect
size statistics, rather than sole reliance on the Fisherian p < .05 significance criterion
(whereby an observed difference is deemed "statistically significant" if an effect of that size
or larger would occur with 5% (or less) probability in independent replications, assuming the
truth of the null-hypothesis of no difference between the treatments).[citation needed]

Sometimes the debate comes from within psychology, for example between laboratory-
oriented researchers and practitioners such as clinicians. In recent years, and particularly in
the U.S., there has been increasing debate about the nature of therapeutic effectiveness and
about the relevance of empirically examining psychotherapeutic strategies.[50] One
argument[who?] states that some therapies[which?] are based on discredited theories and are
unsupported by empirical evidence. The other side[who?] points to recent research suggesting
that all mainstream therapies are of about equal effectiveness,[citation needed] while also arguing
that controlled studies often do not take into consideration real-world conditions.

[edit] Practice

Some observers perceive a gap between scientific theory and its application—in particular,
the application of unsupported or unsound clinical practices. Critics say there has been an
increase in the number of mental health training programs that do not instill scientific
competence.[51] One skeptic asserts that practices, such as "facilitated communication for

infantile autism"; memory-recovery techniques including body work; and other therapies,
such as rebirthing and reparenting, may be dubious or even dangerous, despite their
popularity.[52] In 1984, Allen Neuringer had made a similar point[vague] regarding the
experimental analysis of behavior.[53]

[edit] Ethics

The experimenter (E) orders the teacher (T), the subject of the experiment, to give
what the latter believes are painful electric shocks to a learner (L), who is actually an
actor and confederate. The subject believes that for each wrong answer, the learner
was receiving actual electric shocks, though in reality there were no such
punishments. Being separated from the subject, the confederate set up a tape
recorder integrated with the electro-shock generator, which played pre-recorded
sounds for each shock level etc.[54]

Current ethical standards of psychology would not permit the following studies to be
conducted today. These human studies would violate the Ethics Code of the American
Psychological Association, the Canadian Code of Conduct for Research Involving Humans,
and the Belmont Report. Current ethical guidelines state that using non-human animals for
scientific purposes is only acceptable when the harm (physical or psychological) done to
animals is outweighed by the benefits of the research.[55] Keeping this in mind, psychologists
can use research techniques on animals that would not necessarily be performed on humans.

      The Milgram Experiment raised questions about the ethics of scientific
       experimentation because of the extreme emotional stress suffered by the
       participants. It measured the willingness of study participants to obey an
       authority figure who instructed them to perform acts that conflicted with their
       personal conscience.[56]

      Harry Harlow drew condemnation for his "pit of despair" experiments on
       rhesus macaque monkeys at the University of Wisconsin–Madison in the
       1970s.[57] The aim of the research was to produce an animal model of clinical
       depression. Harlow also devised what he called a "rape rack", to which the
       female isolates were tied in normal monkey mating posture.[58] In 1974,
       American literary critic Wayne C. Booth wrote that, "Harry Harlow and his

       colleagues go on torturing their nonhuman primates decade after decade,
       invariably proving what we all knew in advance—that social creatures can be
       destroyed by destroying their social ties." He writes that Harlow made no
       mention of the criticism of the morality of his work.[59]

University psychology departments have ethics committees dedicated to the rights and well-
being of research subjects. Researchers in psychology must gain approval of their research
projects before conducting any experiment to protect the interests of human participants and
laboratory animals.[60]

Radiation therapy
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"Radiation (medicine)" redirects here. It is not to be confused with Radiation (pain).

Radiation therapy of the pelvis. Lasers and a mould under the legs are used to
determine exact position.

Varian Clinac 2100C Linear Accelerator.

Radiation therapy (in North America), or radiotherapy (in the UK and Australia) also
called radiation oncology, and sometimes abbreviated to XRT, is the medical use of ionizing

radiation as part of cancer treatment to control malignant cells (not to be confused with
radiology, the use of radiation in medical imaging and diagnosis). Radiotherapy may be used
for curative or adjuvant treatment. It is used as palliative treatment (where cure is not possible
and the aim is for local disease control or symptomatic relief) or as therapeutic treatment
(where the therapy has survival benefit and it can be curative). Total body irradiation (TBI) is
a radiotherapy technique used to prepare the body to receive a bone marrow transplant.
Radiotherapy has several applications in non-malignant conditions, such as the treatment of
trigeminal neuralgia, severe thyroid eye disease, pterygium, pigmented villonodular
synovitis, prevention of keloid scar growth, and prevention of heterotopic ossification. The
use of radiotherapy in non-malignant conditions is limited partly by worries about the risk of
radiation-induced cancers.

Radiotherapy is used for the treatment of malignant cancer, and may used as a primary or
adjuvant modality. It is also common to combine radiotherapy with surgery, chemotherapy,
hormone therapy or some mixture of the three. Most common cancer types can be treated
with radiotherapy in some way. The precise treatment intent (curative, adjuvant, neoadjuvant,
therapeutic, or palliative) will depend on the tumor type, location, and stage, as well as the
general health of the patient.

Radiation therapy is commonly applied to the cancerous tumor. The radiation fields may also
include the draining lymph nodes if they are clinically or radiologically involved with tumor,
or if there is thought to be a risk of subclinical malignant spread. It is necessary to include a
margin of normal tissue around the tumor to allow for uncertainties in daily set-up and
internal tumor motion. These uncertainties can be caused by internal movement (for example,
respiration and bladder filling) and movement of external skin marks relative to the tumor

To spare normal tissues (such as skin or organs which radiation must pass through in order to
treat the tumor), shaped radiation beams are aimed from several angles of exposure to
intersect at the tumor, providing a much larger absorbed dose there than in the surrounding,
healthy tissue.

Brachytherapy, in which a radiation source is placed inside or next to the area requiring
treatment, is another form of radiation therapy that minimizes exposure to healthy tissue
during procedures to treat cancers of the breast, prostate and other organs.

From Wikipedia, the free encyclopedia
Jump to: navigation, search
For medical radiography, see Radiology and Radio-diagnosis.

A plain radiograph of the elbow.

An X-ray from the Vietnam war shows an unexploded grenade embedded in a
patient's skull. (As demonstrated by the intubation, the patient is lying down, not
standing up. The circumstances behind the image are otherwise unknown.)

Radiography is the use of the property of X-rays to cross materials to view inside objects.
The impact on society of this technique has been immense with application fields including
medical, non-destructive testing, food inspection, security and archeology.

A heterogeneous beam of X-rays is produced by an X-ray generator and is projected toward
an object. According to the density and composition of the different areas of the object a
proportion of X-rays are absorbed by the object. The X-rays that pass through are then
captured behind the object by a detector (film sensitive to X-rays or a digital detector) which
gives a 2D representation of all the structures superimposed on each other. In tomography,
the x-ray source and detector move to blur out structures not in the focal plane. Computed
tomography (CT scanning) is different to plain film tomography in that computer assisted
reconstruction is used to generate a 3D representation of the scanned object/patient.

Medical imaging
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This article is about imaging techniques and modalities for the human body. For
imaging of animals in research, see Preclinical imaging.
          This article needs additional citations for verification.
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Medical imaging is the technique and process used to create images of the human body (or
parts and function thereof) for clinical purposes (medical procedures seeking to reveal,
diagnose or examine disease) or medical science (including the study of normal anatomy and
physiology). Although imaging of removed organs and tissues can be performed for medical
reasons, such procedures are not usually referred to as medical imaging, but rather are a part
of pathology.

As a discipline and in its widest sense, it is part of biological imaging and incorporates
radiology (in the wider sense), nuclear medicine, investigative radiological sciences,
endoscopy, (medical) thermography, medical photography and microscopy (e.g. for human
pathological investigations).

Measurement and recording techniques which are not primarily designed to produce images,
such as electroencephalography (EEG), magnetoencephalography (MEG),
Electrocardiography (EKG) and others, but which produce data susceptible to be represented
as maps (i.e. containing positional information), can be seen as forms of medical imaging.


Imaging technology

[edit] Radiography

Main article: Medical radiography

Two forms of radiographic images are in use in medical imaging; projection radiography and
fluoroscopy, with the latter being useful for intraoperative and catheter guidance. These 2D
techniques are still in wide use despite the advance of 3D tomography due to the low cost,
high resolution, and depending on application, lower radiation dosages. This imaging
modality utilizes a wide beam of x rays for image acquisition and is the first imaging
technique available in modern medicine.

        Fluoroscopy produces real-time images of internal structures of the body in a
         similar fashion to radiography, but employs a constant input of x-rays, at a
         lower dose rate. Contrast media, such as barium, iodine, and air are used to
         visualize internal organs as they work. Fluoroscopy is also used in image-
         guided procedures when constant feedback during a procedure is required.
         An image receptor is required to convert the radiation into an image after it
         has passed through the area of interest. Early on this was a fluorescing
         screen, which gave way to an Image Amplifier (IA) which was a large vacuum
         tube that had the receiving end coated with cesium iodide, and a mirror at the
         opposite end. Eventually the mirror was replaced with a TV camera.

        Projectional radiographs, more commonly known as x-rays, are often used to
         determine the type and extent of a fracture as well as for detecting
         pathological changes in the lungs. With the use of radio-opaque contrast
         media, such as barium, they can also be used to visualize the structure of the
         stomach and intestines - this can help diagnose ulcers or certain types of
         colon cancer.

[edit] Magnetic resonance imaging (MRI)

Main article: Magnetic resonance imaging

A brain MRI representation

A magnetic resonance imaging instrument (MRI scanner), or "nuclear magnetic resonance
(NMR) imaging" scanner as it was originally known, uses powerful magnets to polarise and
excite hydrogen nuclei (single proton) in water molecules in human tissue, producing a
detectable signal which is spatially encoded, resulting in images of the body. MRI uses three
electromagnetic fields: a very strong (on the order of units of teslas) static magnetic field to
polarize the hydrogen nuclei, called the static field; a weaker time-varying (on the order of
1 kHz) field(s) for spatial encoding, called the gradient field(s); and a weak radio-frequency
(RF) field for manipulation of the hydrogen nuclei to produce measurable signals, collected
through an RF antenna.

Like CT, MRI traditionally creates a two dimensional image of a thin "slice" of the body and
is therefore considered a tomographic imaging technique. Modern MRI instruments are
capable of producing images in the form of 3D blocks, which may be considered a
generalisation of the single-slice, tomographic, concept. Unlike CT, MRI does not involve the
use of ionizing radiation and is therefore not associated with the same health hazards. For
example, because MRI has only been in use since the early 1980s, there are no known long-
term effects of exposure to strong static fields (this is the subject of some debate; see 'Safety'
in MRI) and therefore there is no limit to the number of scans to which an individual can be
subjected, in contrast with X-ray and CT. However, there are well-identified health risks
associated with tissue heating from exposure to the RF field and the presence of implanted
devices in the body, such as pace makers. These risks are strictly controlled as part of the
design of the instrument and the scanning protocols used.

Because CT and MRI are sensitive to different tissue properties, the appearance of the images
obtained with the two techniques differ markedly. In CT, X-rays must be blocked by some
form of dense tissue to create an image, so the image quality when looking at soft tissues will
be poor. In MRI, while any nucleus with a net nuclear spin can be used, the proton of the
hydrogen atom remains the most widely used, especially in the clinical setting, because it is
so ubiquitous and returns a large signal. This nucleus, present in water molecules, allows the
excellent soft-tissue contrast achievable with MRI.

[edit] Nuclear medicine

Main article: Nuclear medicine

Nuclear medicine encompasses both diagnostic imaging and treatment of disease, and may
also be referred to as molecular medicine or molecular imaging & therapeutics [1]. Nuclear
medicine uses certain properties of isotopes and the energetic particles emitted from
radioactive material to diagnose or treat various pathology. Different from the typical concept
of anatomic radiology, nuclear medicine enables assessment of physiology. This function-
based approach to medical evaluation has useful applications in most subspecialties, notably
oncology, neurology, and cardiology. Gamma cameras are used in e.g. scintigraphy, SPECT
and PET to detect regions of biologic activity that may be associated with disease. Relatively
short lived isotope, such as 123I is administered to the patient. Isotopes are often preferentially
absorbed by biologically active tissue in the body, and can be used to identify tumors or
fracture points in bone. Images are acquired after collimated photons are detected by a crystal
that gives off a light signal, which is in turn amplified and converted into count data.

      Scintigraphy ("scint") is a form of diagnostic test wherein radioisotopes are
       taken internally, for example intravenously or orally. Then, gamma camera
       capture and form two-dimensional[2] images from the radiation emitted by the
       radiopharmaceuticals. For example, technetium-labeled isoniazid (INH) and
       ethambutol (EMB) has been used for tubercular imaging for early diagnosis of
       tuberculosis [3].

      SPECT is a 3D tomographic technique that uses gamma camera data from
       many projections and can be reconstructed in different planes. A dual detector
       head gamma camera combined with a CT scanner, which provides
       localization of functional SPECT data, is termed a SPECT/CT camera, and
       has shown utility in advancing the field of molecular imaging.In most other
       medical imaging modalities, energy is passed through the body and the
       reaction or result is read by detectors. In SPECT imaging, the patient is
       injected with a radioisotope, most commonly Thallium 201TI, Technetium
       99mTC, Iodine 123I, and Gallium 68Ga [4]

. The radioactive gamma rays are emitted through the body as the natural decaying process of
these isotopes takes place. The emissions of the gamma rays are captured by detectors that
surround the body. This essentially means that the human is now the source of the
radioactivity, rather than the medical imaging devices such as X-Ray, CT, or Ultrasound.

      Positron emission tomography (PET) uses coincidence detection to image
       functional processes. Short-lived positron emitting isotope, such as 18F, is
       incorporated with an organic substance such as glucose, creating F18-
       fluorodeoxyglucose, which can be used as a marker of metabolic utilization.
       Images of activity distribution throughout the body can show rapidly growing
       tissue, like tumor, metastasis, or infection. PET images can be viewed in
       comparison to computed tomography scans to determine an anatomic
       correlate. Modern scanners combine PET with a CT, or even MRI, to optimize
       the image reconstruction involved with positron imaging. This is performed on
       the same equipment without physically moving the patient off of the gantry.

       The resultant hybrid of functional and anatomic imaging information is a useful
       tool in non-invasive diagnosis and patient management.

[edit] Photoacoustic imaging

Main article: Photoacoustic imaging in biomedicine

Photoacoustic imaging is a recently developed hybrid biomedical imaging modality based on
the photoacoustic effect. It combines the advantages of optical absorption contrast with
ultrasonic spatial resolution for deep imaging in (optical) diffusive or quasi-diffusive regime.
Recent studies have shown that photoacoustic imaging can be used in vivo for tumor
angiogenesis monitoring, blood oxygenation mapping, functional brain imaging, and skin
melanoma detection, etc.

[edit] Breast Thermography

         It has been suggested that this section be split into a new article. (Discuss)

Digital infrared imaging thermography is based on the principle that metabolic activity and
vascular circulation in both pre-cancerous tissue and the area surrounding a developing breast
cancer is almost always higher than in normal breast tissue. Cancerous tumors require an
ever-increasing supply of nutrients and therefore increase circulation to their cells by holding
open existing blood vessels, opening dormant vessels, and creating new ones
(neoangiogenesis). This process frequently results in an increase in regional surface
temperatures of the breast. Digital infrared imaging uses extremely sensitive medical infrared
cameras and sophisticated computers to detect, analyze, and produce high-resolution
diagnostic images of these temperature variations. Because of DII's sensitivity, these
temperature variations may be among the earliest signs of breast cancer and/or a pre-
cancerous state of the breast[5].

[edit] Tomography

Main article: Computed tomography

Tomography is the method of imaging a single plane, or slice, of an object resulting in a
tomogram. There are several forms of tomography:

      Linear tomography: This is the most basic form of tomography. The X-ray
       tube moved from point "A" to point "B" above the patient, while the cassette
       holder (or "bucky") moves simultaneously under the patient from point "B" to
       point "A." The fulcrum, or pivot point, is set to the area of interest. In this
       manner, the points above and below the focal plane are blurred out, just as
       the background is blurred when panning a camera during exposure. No longer
       carried out and replaced by computed tomography.
      Poly tomography: This was a complex form of tomography. With this
       technique, a number of geometrical movements were programmed, such as
       hypocycloidic, circular, figure 8, and elliptical. Philips Medical Systems [1]
       produced one such device called the 'Polytome.' This unit was still in use into
       the 1990s, as its resulting images for small or difficult physiology, such as the

       inner ear, was still difficult to image with CTs at that time. As the resolution of
       CTs got better, this procedure was taken over by the CT.
      Zonography: This is a variant of linear tomography, where a limited arc of
       movement is used. It is still used in some centres for visualising the kidney
       during an intravenous urogram (IVU).
      Orthopantomography (OPT or OPG): The only common tomographic
       examination in use. This makes use of a complex movement to allow the
       radiographic examination of the mandible, as if it were a flat bone. It is often
       referred to as a "Panorex", but this is incorrect, as it is a trademark of a
       specific company.
      Computed Tomography (CT), or Computed Axial Tomography (CAT: A CT
       scan, also known as a CAT scan), is a helical tomography (latest generation),
       which traditionally produces a 2D image of the structures in a thin section of
       the body. It uses X-rays. It has a greater ionizing radiation dose burden than
       projection radiography; repeated scans must be limited to avoid health effects.
       CT is based off of the same principles as X-Ray projections but in this case,
       the patient is enclosed in a surrounding ring of detectors assigned with 500-
       1000 scintillation detectors[6]

. This being the fourth-generation X-Ray CT scanner geometry. Previously in older
generation scanners, the X-Ray beam was paired by a translating source and detector.

[edit] Ultrasound

Main article: Medical ultrasonography

Medical ultrasonography uses high frequency broadband sound waves in the megahertz range
that are reflected by tissue to varying degrees to produce (up to 3D) images. This is
commonly associated with imaging the fetus in pregnant women. Uses of ultrasound are
much broader, however. Other important uses include imaging the abdominal organs, heart,
breast, muscles, tendons, arteries and veins. While it may provide less anatomical detail than
techniques such as CT or MRI, it has several advantages which make it ideal in numerous
situations, in particular that it studies the function of moving structures in real-time, emits no
ionizing radiation, and contains speckle that can be used in elastography. Ultrasound is also
used as a popular research tool for capturing raw data, that can be made available through an
Ultrasound research interface, for the purpose of tissue characterization and implementation
of new image processing techniques. The concepts of ultrasound differ from other medical
imaging modalities in the fact that it is operated by the transmission and receipt of sound
waves. The high frequency sound waves are sent into the tissue and depending on the
composition of the different tissues; the signal will be attenuated and returned at separate
intervals. A path of reflected sound waves in a multilayered structure can be defined by an
input acoustic impedance( Ultrasound sound wave) and the Reflection and transmission
coefficients of the relative structures[7] . It is very safe to use and does not appear to cause any
adverse effects, although information on this is not well documented. It is also relatively
inexpensive and quick to perform. Ultrasound scanners can be taken to critically ill patients
in intensive care units, avoiding the danger caused while moving the patient to the radiology
department. The real time moving image obtained can be used to guide drainage and biopsy
procedures. Doppler capabilities on modern scanners allow the blood flow in arteries and
veins to be assessed.

Medical ultrasonography
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This article is about using ultrasound to image the human body. For imaging of
animals in research, see Preclinical imaging.
"Sonography" redirects here. For the tactile alphabet called "sonography", see Night
          It has been suggested that Ultrasound#Diagnostic sonography be merged
          into this article or section. (Discuss)

Diagnostic sonography (ultrasonography) is an ultrasound-based diagnostic imaging
technique used to visualize subcutaneous body structures including tendons, muscles, joints,
vessels and internal organs for possible pathology or lesions. Obstetric sonography is
commonly used during pregnancy and is widely recognized by the public.

In physics, the term "ultrasound" applies to all acoustic energy (longitudinal, mechanical
wave) with a frequency above the audible range of human hearing. The audible range of
sound is 20 hertz-20 kilohertz. Ultrasound is frequency greater than 20 kilohertz.

Typical diagnostic sonographic scanners operate in the frequency range of 2 to 18 megahertz,
though frequencies up to 50-100 megahertz has been used experimentally in a technique
known as biomicroscopy in special regions, such as the anterior chamber of eye.[citation needed]
The above frequencies are hundreds of times greater than the limit of human hearing, which
is typically accepted as 20 kilohertz. The choice of frequency is a trade-off between spatial
resolution of the image and imaging depth: lower frequencies produce less resolution but
image deeper into the body.

Sonography (ultrasonography) is widely used in medicine. It is possible to perform both
diagnosis and therapeutic procedures, using ultrasound to guide interventional procedures
(for instance biopsies or drainage of fluid collections). Sonographers are medical
professionals who perform scans for diagnostic purposes. Sonographers typically use a hand-
held probe (called a transducer) that is placed directly on and moved over the patient.

Sonography is effective for imaging soft tissues of the body. Superficial structures such as
muscles, tendons, testes, breast and the neonatal brain are imaged at a higher frequency (7-
18 MHz), which provides better axial and lateral resolution. Deeper structures such as liver
and kidney are imaged at a lower frequency 1-6 MHz with lower axial and lateral resolution
but greater penetration.

Medical sonography is used in the study of many different systems:

     System                            Description                             See also
                  Echocardiography is an essential tool in cardiology,
Cardiology        to diagnose e.g. dilatation of parts of the heart and see echocardiography
                  function of heart ventricles and valves
                  Point of care ultrasound has many applications in
                  the Emergency Department, including the Focused see FAST exam
                  Assessment with Sonography for Trauma (FAST)

                 exam for assessing significant hemoperitoneum or
                 pericardial tamponade after trauma. Ultrasound is
                 routinely used in the Emergency Department to
                 expedite the care of patients with right upper
                 quadrant abdominal pain who may have gallstones
                 or cholecystitis.
                 In abdominal sonography, the solid organs of the
                 abdomen such as the pancreas, aorta, inferior vena
                 cava, liver, gall bladder, bile ducts, kidneys, and
                 spleen are imaged. Sound waves are blocked by gas
Gastroenterology in the bowel and attenuated in different degree by
                 fat, therefore there are limited diagnostic
                 capabilities in this area. The appendix can
                 sometimes be seen when inflamed e.g.:
                                                                       see gynecologic
                                                                       see Carotid
                for assessing blood flow and stenoses in the carotid
Neurology       arteries (Carotid ultrasonography) and the big
                                                                       Intracerebral: see
                intracerebral arteries
                                                                       Transcranial Doppler
                Obstetrical ultrasound is commonly used during
                                                                       see obstetric
Obstetrics      pregnancy to check on the development of the
                                                                       see A-scan
Ophthalmology                                                          ultrasonography, B-
                                                                       scan ultrasonography
                to determine, for example, the amount of fluid
                retained in a patient's bladder. In a pelvic
                sonogram, organs of the pelvic region are imaged.
                This includes the uterus and ovaries or urinary
                bladder. Men are sometimes given a pelvic
                sonogram to check on the health of their bladder
                and prostate. There are two methods of performing
                a pelvic sonography - externally or internally. The
Urology         internal pelvic sonogram is performed either
                transvaginally (in a woman) or transrectally (in a
                man). Sonographic imaging of the pelvic floor can
                produce important diagnostic information regarding
                the precise relationship of abnormal structures with
                other pelvic organs and it represents a useful hint to
                treat patients with symptoms related to pelvic
                prolapse, double incontinence and obstructed
                tendons, muscles, nerves, ligaments, soft tissue
                masses, and bone surfaces
Cardiovascular To assess patency and possible obstruction of           Intravascular
system          arteries Arterial sonography, diagnose DVT             ultrasound

                   (Thrombosonography) and determine extent and
                   severity of venous insufficiency (venosonography)

Other types of uses include:

      Intervenional; biopsy, emptying fluids, intrauterine transfusion [disambiguation needed]
       (Hemolytic disease of the newborn)
      Contrast-enhanced ultrasound

A general-purpose sonographic machine may be used for most imaging purposes. Usually
specialty applications may be served only by use of a specialty transducer. Most ultrasound
procedures are done using a transducer on the surface of the body, but improved diagnostic
confidence is often possible if a transducer can be placed inside the body. For this purpose,
specialty transducers, including endovaginal, endorectal, and transesophageal transducers are
commonly employed. At the extreme of this, very small transducers can be mounted on small
diameter catheters and placed into blood vessels to image the walls and disease of those

Social work
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Social work is a professional and academic discipline committed to the pursuit of social
welfare and social change. The field works towards research and practice to improve the
quality of life and to the development of the potential of each individual, group and
community of a society. They may work in research, practice or higher education. Research
is often focused on areas such as social policy, public administration, program evaluation and
international and community development. Social workers are organized into local, national,
continental and international professional bodies. Parts of social work overlap with other
disciplines including economics, education, medicine, politics, psychology, and sociology.

Social work strives to address social problems. Social workers draw on the social and
behavioural sciences to meet the needs of clients. For example, social workers may provide
psychotherapy to individuals and families, produce assessments of child welfare for
government and law enforcement, and work with clients in prisons and the court system.
According to the National Association of Social Workers, the goal of social work is to
"enhance human wellbeing and help meet the basic human needs of all people, with particular
attention to the needs and empowerment of people who are vulnerable, oppressed, and living
in poverty."

Speech and language pathology
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Human communication includes speech (articulation, intonation, rate, intensity, voice,
resonance, fluency), language (phonology, morphology, syntax, semantics, pragmatics), both
receptive and expressive language (including reading and writing), and non-verbal
communication such as facial expression, posture and gesture. Swallowing problems
managed under speech therapy are problems in the oral and pharyngeal stages and sometimes
esophageal stages of swallowing.

Depending on the nature and severity of the disorder, common treatments may range from
physical strengthening exercises, instructive or repetitive practice and drilling, to the use of
audio-visual aids and introduction of strategies to facilitate functional communication.
Speech therapy may also include sign language and the use of picture symbols or
Augmentative and Alternative Communication (AAC) (Diehl 2003).

The practice is called:

      Speech-language pathology (SLP) in the United States and Canada
      Speech and language therapy (SLTs) in the United Kingdom, Ireland and
       South Africa. Within the United Kingdom a Speech and Language Therapy
       team is often referred to by clinicians as the "SALT" team.
      Speech pathology in Australia and the Philippines
      Speech-language therapy in New Zealand
      Speech therapy in India, Hong Kong and other Asian countries

Other terms in use include speech therapy, logopaedics and phoniatrics.

Scope of practice

The practice of speech-language pathology involves (which should all be carried out using
the ICF framework):

      Providing prevention, screening, consultation, assessment and diagnosis,
       treatment, intervention, management, counseling, and follow-up services for
       disorders of:
           o speech (i.e., phonation, articulation, fluency, resonance, and voice
              including aeromechanical components of respiration);
           o language (i.e., phonology, morphology, syntax, semantics, and
              pragmatic/social aspects of communication) including comprehension
              and expression in oral, written, graphic, and manual modalities;
              language processing; preliteracy and language-based literacy skills,
              including phonological awareness;
           o swallowing or other upper aerodigestive functions such as infant
              feeding and aeromechanical events (evaluation of esophageal function
              is for the purpose of referral to medical professionals);
           o cognitive aspects of communication (e.g., attention, memory, problem
              solving, executive functions).
           o sensory awareness related to communication, swallowing, or other
              upper aerodigestive functions.

      Establishing augmentative and alternative communication (AAC) techniques
       and strategies including developing, selecting, and prescribing of such
       systems and devices (e.g., speech generating devices.)

      Providing services to individuals with hearing loss and their
       families/caregivers (e.g.,auditory training; speechreading; speech and
       language intervention secondary to hearing loss; visual inspection and
       listening checks of amplification devices for the purpose of troubleshooting,
       including verification of appropriate battery voltage).

      Screening hearing of individuals who can participate in conventional pure-tone
       air conduction methods, as well as screening for middle ear pathology through
       screening tympanometry for the purpose of referral of individuals for further
       evaluation and management.

      Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy,
       stroboscopy, computer technology) to observe, collect data, and measure
       parameters of communication and swallowing, or other upper aerodigestive
       functions in accordance with the principles of evidence-based practice.

      Selecting, fitting, and establishing effective use of prosthetic/adaptive devices
       for communication, swallowing, or other upper aerodynamics functions (e.g.,
       tracheoesophageal prostheses, speaking valves, electrolarynges). This does
       not include sensory devices used by individuals with hearing loss or other
       auditory perceptual deficits.

      Collaborating in the assessment of central auditory processing disorders and
       providing intervention where there is evidence of speech, language, and/or
       other cognitive-communication disorders.

      Educating and counseling individuals, families, co-workers, educators, and
       other persons in the community regarding acceptance, adaptation, and
       decisions about communication and swallowing.

      Advocating for individuals through community awareness, education, and
       training programs to promote and facilitate access to full participation in
       communication, including the elimination of societal barriers.

      Collaborating with and providing referrals and information to audiologists,
       educators and health professionals as individual needs dictate.

      Addressing behaviors (e.g. perseverative or disruptive actions) and
       environments (e.g. seating, positioning for swallowing safety or attention,
       communication opportunities) that affect communication, swallowing, or other
       upper aerodigestive functions.

      Providing services to modify or enhance communication performance (e.g.
       transgendered voice, care and improvement of the professional voice,
       personal/ professional communication effectiveness).

      Recognizing the need to provide and appropriately accommodate diagnostic
       and treatment services to individuals from diverse cultural backgrounds and
       adjust treatment and assessment services accordingly.

[edit] Professional Roles

Speech-language pathologists serve individuals, families, groups, and the general public
through a broad range of professional activities. They:

      Identify, define, and diagnose disorders of human communication and
       swallowing (dysphagia) and assist in localization and diagnosis of diseases
       and conditions.
      Provide direct services using a variety of service delivery models to treat
       and/or address communication, swallowing, or other upper aerodigestive
      Conduct research related to communication sciences and disorders,
       swallowing disorders, or other upper aerodigestive functions.
      Educate, supervise, and mentor future speech-language pathologists.
      Serve as case managers and service delivery coordinators.
      Administer and manage clinical and academic programs.
      Educate and provide in-service training to families, caregivers, and other
      Participate in outcome measurement activities and use data to guide clinical
       decision making and determine the effectiveness of services provided in
       accordance with the principles of evidence-based practice.

      Train, supervise, and manage speech-language pathology assistants and
       other support personnel.
      Promote healthy lifestyle practices for the prevention of communication,
       hearing, swallowing, or other upper aerodigestive disorders.
      Collaborate with other health care professionals often working as part of a
       multidisciplinary team

Methods of assessment

There are separate standardized assessment tools administered for infants, school-aged
children, adolescents and adults. Assessments primarily examine the form, content,
understanding and use of language, as well as articulation, and phonology. Oral motor and
swallowing assessments often require specialized training. These include the use of bedside
examination tools and endoscopic/modified barium radiology procedures.

Individuals may be referred to an SLP for any of the following:

      Traumatic brain injury
      Stroke
      Alzheimer's disease and dementia
      Cranial nerve damage
      Progressive neurological conditions (Parkinson, ALS, etc)
      Developmental delay
      Learning disability (speaking and listening)
      Autism spectrum disorders, including Asperger syndrome
      Genetic disorders that adversely affect speech, language and/or cognitive
      Injuries due to complications at birth
      Feeding and swallowing concerns
      Craniofacial anomalies that adversely affect speech, language and/or
       cognitive development
      Cerebral Palsy
      Augmentative Alternative Communication needs

There are myriad Speech-Language Assessment tools used for children and adults, depending
on the area of need.

[edit] Patients/clients

Speech and language therapists work with:

      Infants with feeding and swallowing difficulties, including dysphagia
      Children with mild, moderate or severe:
           o learning difficulties
           o physical disabilities, language delay
           o specific language impairment
           o specific difficulties in producing sounds (including vocalic /r/ and lisps)
           o hearing loss and impairments
           o cleft palate
           o stammering

           o    autism and social interaction difficulties including Asperger's
           o    dyslexia
           o    voice disorders
      Adults with mild, moderate, or severe eating, feeding and swallowing
       difficulties, including dysphagia
      Adults with mild, moderate, or severe language difficulties as a result of:
            o stroke
            o head injury (Traumatic brain injury)
            o Parkinson's disease
            o motor neuron disease
            o multiple sclerosis
            o Huntington's disease
            o Alzheimer's disease
            o dementia
            o cancer of the head, neck and throat (including laryngectomy)
            o voice problems
            o mental health issues
            o learning difficulties, physical disabilities
            o stammering (dysfluency)
            o hearing impairment
            o transgender voice therapy (usually for male-to-female individuals)
      Adults and Children with Cerebral Palsy

In the United States, the cost of speech therapy for a child younger than three years old is
likely covered by the state early intervention (zero to three) program.

In Britain, the majority of Speech and Language therapy is funded by the National Health
Service (and increasingly, by partners in Education) meaning that initial assessment is
available cost-free to all clients at the point of service, regardless of age or presenting
problem. The large numbers of referrals contribute to high caseloads and long waiting lists,
although this differs from area to area. To meet the needs of many of these clients, it has
become necessary for many services to focus heavily on training and consultative models of
service provision. The number of hours of direct therapy available to clients varies widely
from trust to trust and most areas operate strict guidelines for prioritisation to meet the high
clinical demand

 trust and most areas operate strict guidelines for prioritisation to meet the high
clinical demand


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