Focal Allied Health Practitioner Podcast

Transcript Hello, and welcome back to the fourth episode of the Focal Allied Health Practitioner Podcast. What we're going to be doing today is we're going to be looking at the effects of psychosocial stress on our patients. And we're basically going to be looking mostly at neuromusculoskeletal impacts. However, we will sort of discuss other aspects as well, and you can potentially extrapolate some of these, aspects to, to other aspects of patient management and, and so forth. So, you know, stick around. Let's have a little bit of a dive into psychosocial stress and yeah, what it's going to do of your patients. We're also going to have a bit of a look at musculoskeletal interventions and how they may theoretically impact a person's ability to deal with stress and traumatic events. So that's, that's quite interesting as well. I think where we can, potentially be helping people with stress when we are doing musculoskeletal intervention and, so forth. Okay. So let's go to it. So during this episode, I'm going to be referring extensively to an article by Jos Brosschot. Now, excuse me, Jos, if I've just butchered your name, but basically he produced a paper which was published in 2017 in the European Journal of Psychotraumatology. And there will be a link to the paper in the show notes on our website. Now, as with Jos's article, I will refer to psychosocial stress from here simply as stress. Now, stress is, as we probably are all pretty much familiar with stress is very much a killer. They reckon that something like 50% of sick days taken by workers are due to stress. And the risks for heart disease due to stress are at least comparable to those of smoking and obesity, which is pretty crazy. When you think about it, I'd, I'd never been aware that it was that much of a problem. So, you know, if you can help your patients manage their stress better and deal with stress, then it's, it's equivalent to them stopping smoking or potentially losing weight, which is, which is pretty an amazing fact. I reckon, you know, stress is something that you really want to be able to do something about and, you know, try and manage, manage your patients stress if at all, possible to try and maximize their, their outcomes. Now, a pertinent point here, and something that I really want to emphasize is that prolonged or chronic stress is what damages health. So short term responses to stress are normal and completely harmless. Well, you know, maybe depends on if they happen repeatedly and repeatedly, but in which case, maybe that it becomes chronic stress, but certainly, you know, short term in response to a particular dangerous situation, you know, that's completely normal. It's a physiological response, but what happens is that when you get these prolonged aspects of, of stress, that is what ends up damaging health. Because, you know, typically if you imagine we're out in the jungle and you know, you've got the tiger, that's, you know, running after you or whatever, obviously you, you have a very acute need for stress and you, you know, you deal with it either by running away from the tiger or fighting it and killing it, or by being eaten, you know, because if you're eaten, you're resolving the stress at no longer becomes a problem to you. But certainly, you know, if you run away or you, you kill the tiger or whatever, then you've dealt with the stressor and you know, your body can relax. But the trouble with our, our modern society and our modern life is that the stress just never goes away. You know, if you've got work stress, you're overloaded. It. It's just, it's not an, that just happens in the short term. It's something that sticks around and persists. And so therefore they, or those aspects are going to be having more chronic effects upon people's health. Now Brosschot makes the reference to his research where he found that, when angered people's blood pressure returned to normal more quickly,

Episode Transcript Hello, and welcome to episode three of the Focal Allied Health Practitioner Podcast. In this episode what we're going to be doing is we're going to dive into a thing which I've been doing quite a bit of reading about recently, and that is photobiomodulation. Now this used to be referred to as a thing called low level laser therapy, and then as things developed a little bit and became alternatives out there apart from using lasers, the term low level light therapy then started to be used. And so you may actually see it referred to as LLLT, the abbreviation shorting for low level laser therapy or low level light therapy. And what we're going to do is we're going to actually discuss photobiomodulation, we're going to look at what it is and how it works, and just going to dive into that a little bit more and pull it apart and hopefully give you guys some good understanding of the mechanisms behind PBM, as I'll refer to it as we move forward. Okay, so like I said, it used to be referred to as low level light therapy, and then the term photobiomodulation started to become used because of the wide number of activations, or sorry, applications that PBM has been found to have. Now when I was at university I really didn't think much of laser therapies, but that was about 25 years ago, and the technology wasn't anything like what it is today. These days it's become extremely widespread and there's many, many options available, there's very high tech laser units which will cost many tens of thousands of dollars, and you can also get things off eBay which use LEDs of certain wavelengths, and so forth, and it's entirely possible that they all have potential therapeutic effects. Traditionally things such as lasers were what were used, and lasers are quite unique, obviously, in that the light wave are very coherent, and as a consequence they can deliver quite a degree of energy into the tissues. However, non-coherent light sources, such as LEDs, have been found to also have an effect as well. It may well be that because they're of a slightly lower energy they may actually be slower to have their effects, which if you're running a busy clinic may well be a bit of an issue, and so therefore you want to get through your patient visits as quickly as you possibly can for the most effective use of your time, in which case using LED sources may not be the ideal way to do it and you may decide that lasers are more appropriate. But there certainly is quite a lot of variety that is available there these days. Now, PBM has been used for a wide variety of conditions, people use it for tendinopathies, they use it for scar tissue. I'm personally very interested in it for its effects on brain function, like I said, but however, it can be used on many other tissues. Now it's thought that the light with PBM can penetrate several centimetres depending upon the tissue that is being irradiated and the intensity of the light. Now interestingly wavelengths in the 600 to 700 nanometre bandwidth seem to be better for superficial tissue, and this is in the visible light spectrum, so this will be a dark, deep red sort of colour in that 600 to 700 nanometre wavelength. Whereas your 780 to 950 nanometre wavelengths, they penetrate better into deeper tissues, and they're getting into the near infrared spectrum. So when you actually look at those LEDs, or lasers, or whatever, not that you should look directly into a laser, because it can damage your eyes, but even so, with very intense LEDs as well, but those near infrared wavelengths, they're obviously getting outside the visible spectrum, so you may well want to educate your patients about the fact that you're shining this light on them and they can't actually see anything, as to what's actually going on there. Now there's a number of proposed mechanisms behind PBM, and the exact effects are going to depend upon the wavelength of light that are used.

Transcript Okay. So welcome back to our second episode of the Focal Allied Health Practitioner podcast. Last episode, we talked about falls prevention and how it was a very important thing for older adults, talked about a number of factors that you want to look for. When you're looking at falls prevention, we talked about things like intrinsic factors, environmental factors, behavioural factors that people needed to address. And then we went into a little bit more detail about some intrinsic factors and so on. And in particular, we talked about stabilometry or posture, which is the use of a force plate to measure somebody's balance. So effectively you measure movements of the centre of gravity, the as a projection of a thing called the centre of pressure. And what that does is it basically allows you to quantify balance. Now, as we discussed last time, there's a number of measures that you can use to actually assess balance. One of which is sway velocity. So that is how fast the person's centre of pressure is moving around on the force plate. And generally the faster people are moving, the more unsteady they are, you can also look at the mean distance from the centre of the sway area. So you look at how far, side to side people are swaying. So obviously the larger, the oscillations, generally the poorer the balance. Similarly, you can also do what's called sway area where you draw a 95% confidence ellipse. And basically you work out, how wide people are swaying and etc. You come up with an “area for their sway”. And those are probably the main three measures. There's all sorts of other sort of funky measures that everybody seems to be coming up with their own sort of determination of how to come up with sway measures and, and so on for balance. But those are probably the main three that tend to be used. Now, in this episode, what I want to do is I want to talk about a study by Zhou and Lipsitz. So excuse me authors, if I've just butchered your names, but I'm pretty sure that's correct. And I'll put the link to this study in the show notes. So it's an open access journal article, it's with the Journal of NeuroEngineering and Rehabilitation. Basically the title of the article is sub-sensory vibratory noise augments the physiological complexity of postural control in older adults. So if you look that up, I'm sure you'll be able to find a copy of that article, it's readily available from the BMC collection there. So before, be sure to check that out. Now, this article used an interesting measure for balance and what they were doing was they were using a mathematical process called multi-scale entropy to assess the complexity of the centre of pressure sway speed. Okay. So how fast somebody was swaying around, they were basically looking at the complexity of the sway speed. And interestingly, what they found was that the more complex the centre of pressure sway was, the better the person's balance was. Okay, multi-scale entropy. And I won't pretend to sort of completely understand it. I'm not a mathematician by any means, but basically what they're doing is they're looking at the complexity of movements. And so in this one, they were looking at centre of pressure sway speed. And like I said, they found the more complex the centre of pressure sway was the person's balance use basically is, and they were using other more traditional balance measures for that to compare and contrast. So basically they also then discussed how postural control is critically dependent on the peripheral nervous system to detect changes in the foot's interaction with the ground. So not surprisingly the upshot of that was that those older adults who had better sole sensations, so they had better sensory function in the soles of their feet, had more complex balance control suggesting therefore that they had better balance. Okay, so this isn't really surprising, but really to, I was really sort of taken by the fact that this,

Episode Transcript Hi, thanks for joining us with the Focal Allied Health's Podcast. This is a podcast for practitioners who are looking to improve their clinical knowledge and skills. And this is our first episode of this brand new podcast so I'm sure it's going to and develop and so forth as we move along. We will be having a section on our website which will be listing these podcasts so be sure to pop along and leave comments on the episodes, et cetera. I'd love to get your input, your feedback, et cetera on them, and give us some information what different topics that you would like us to cover. Also, any thoughts that you've got with the topics that we may raise in the episodes, et cetera. Okay. So what we're going to do in this first episode is that we're going to be discussing falls risks. Now, clearly this is a huge topic, and we're only going to be able to address a small part of that today. However, is a very important topic, and it's one which particularly for older adults is a very pressing and timely thing that needs to be looked at. One of the things that makes it such an important thing to address is that there's a very high risk of falls, or high rate of falls in older adults. So once people get over the age of 60, 65 the rate of falls increases to about 1:3 per year, which is quite high. It's 33% of people are going to fall in a given year. And the problem with that is that there is a very real risk of injury and death occurring when people fall. And as a consequence of that, there's a lot of costs associated with that for the healthcare system. There's also a lot of cost associated with that for individuals, et cetera. And so falls are something that we very much need to address in our older population. Now, one of the real issues, one of the additional issues is that when people suffer a fall as an older adult it's frequently associated with loss of independence. Now, the way that this works is that quite often if people fall they start to become quite anxious and very fearful quite often about leaving the house, and going out, and engaging in public, and so forth. So, as a consequence they can become much more isolated. They can become cut off from the rest of society, and with all that loss of independence that comes with it. Associated with that you will often get anxiety issues and depression that develops as well. We are looking not only just at the physical aspect of falls, but we are looking at the implications to the individual from a psychological perspective, and issues around mental health, and independence, and ability to engage in the fun activities of life, to get some juice out of life and make life worth living for these older adults. So, this is an important thing. The other aspect is that as people fall there is an increased chance that they're going to move into aged care. Now, the problem with that is, apart from the cost aspect, is that this will often lead to further losses of independence for the individual. And rather depressingly, the falls risk actually usually increases further when people get into aged care. So you're looking at it increases to 1:2 people in a year will fall when they get into aged care. Now there's many factors associated with that. Some of these are things like the muscle deconditioning that tends to occur within environments like that. Quite often people aren't... Either they're not encouraged to become more active and maintain their independence, or they are encouraged, but they don't have the motivation to do so. And these facilities quite often don't have the staffing requirements that could be going along and motivating each individual person, not a one- on-one basis, et cetera. So there's all sorts of factors at play there. So, clearly it makes sense to try and actually stop the individual getting to the situation where they're going to end up in aged care. And there's thankfully quite a number of things that we can actually do to make...