Wider determinants of health on physiotherapy practices

Introduction

In each stage of life, the complex interaction between physical environment and persona factors along with interaction between economic and social factors in determining the health of individuals. Thus, the health determinants are referred to the factors which are involved to influence the health of the individuals. In this assignment, the impact of wider determinants of health and well-being on the contemporary practices of physiotherapy for 18-year old skater who has suffered type-II navicular stress fracture is to be discussed.

It is recommended that ML should be applied so that it is computationally efficient to much greater degree with the provision of more interpretable models, which can prove to have greater accuracy in the end. There is real scientific and clinical benefit of performing a meticulous assessment of the conventional models.

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Identifying key focus of management for primary diagnosis of health .

ML algorithm is one of the key strategies in achieving the optimal results. There is sometimes confusion regarding the deep learning methods generalization for the analytic technique of catch-all data. Nonetheless, other methods of ML should be applied so that it is computationally efficient to much greater degree with the provision of more interpretable models, which can prove to have greater accuracy in the end. There is real scientific and clinical benefit of performing a meticulous assessment of the conventional models. The deep learning does have usefulness of some specific tasks such as classification of medical images. However, deep learning does not have suitability for the problems of all clinical data. Across a number of clinical problems, off-the-shelf, and conventional ML methods can train faster and better performance overall can be achieved in comparison to the deep natural netwo .

The biological determinants of health are referred to the genetic and physical body factors which influence the health and cognition of the people (Ferranti et al. 2017). In the mentioned case study, it is reported that an 18-year old figure skater has suffered a type-II navicular stress fracture. The foot is found to be developed of many small bones and the tarsal navicular bone is located on the lower part of the food alongside the arch assisting to support the arch of the foot. In relation to biological determinant of health, the type-II navicular stress fracture occurs due to stress and repeated pressure on the food leading it to extend from the dorsal cortex region till the navicular body on the foot. The presence of the fracture leads to swelling of the foot and feeling of pain while running, jumping or making other movements (Shakked et al. 2017; Jiwani et al. 2018). This is evident as primary diagnosis of the skater reveals that she is feeling continuous pain and tinge feeling in the foot while making movements and it has led her to restrict mobility as well as experience hindrance in practising her sport. On the basis of the primary diagnosis, the initial management aim for the female skater is to improve her mobility and free foot movement with physiotherapeutic intervention so that she is able to get prepared for her upcoming National Event in 12 weeks. The environmental determinants of health include air quality, water, hazardous materials and build in physical environments which discourages physical activities leading to influence development of risk of diseases (Prüss-Ustün et al. 2017). In case of the Skater, the primary diagnosis reveals that she has been trying to practice her sports even after the fracture and have not taken proper intervention to control the pain. In respect to environment determinant of health, the individuals who have suffered from type-II navicular stress fracture is required to be placed

in an environment where complete rest from any strenuous activity is ensured along with limited weight-bearing along with immobilisation is ensured by plaster the leg (Gross and Nunley, 2020). This indicates that management aim of the primary diagnosis of the skater is to be put her in an environment where her mobility of the leg is completely reduced to avoid further damage. Before physiotherapy to help her regain her mobility, her fracture is required to be healed at first and she is to be referred to use crutches for limited-weight bearing on her leg along with casting is to be done to ensure the immobilisation of the fracture point. This is because biological factor regarding fracture indicates that without healing it leads to development of additional growth in the area as well as acts to lower blood flow leading to hindered movement experienced by the individuals (Jiwani et al. 2018). The non-weight bearing and cast are to be recommended for the patient suffering from type-II navicular stress fracture for 6 weeks (Sundararajan et al. 2018). This is because within the time in most cases it is seen the fracture is healed and further physiotherapeutic actions are taken to ensure regain of proper mobility of the foot. Therefore, the skater is to be recommended casting for 6 weeks after which the physiotherapeutic actions would be taken to ensure the individual regain proper movement to take part in the sports. According to biological determinants of health, unstable asthma occurs among individuals because the passage of their airways is reduced leading the lungs to hyperinflate and develop increased amount of carbon dioxide (Surda et al. 2018). Thus, the physiotherapist for the skater is required to develop breathing exercises for the skater to resolve the condition to help avoid breathlessness issues during performance in figure skate.

Reviewing and discussing additional factors which are to be addressed for optimising the health outcomes of the patient 500

The social determinants of health include social status, working condition, education, physical environment, access to health services and others (Adler et al. 2016). In the UK, the physiotherapy services are offered free of cost under the NHS based on the health condition of the patient and where they live (NHS, 2018). This indicates that no charges are required to be paid by the skater for availing physiotherapy services for improving her condition regarding type-II navicular stress fracture. Thus, the socio-economic condition would not affect the skater's ability to avail the services ensuring the person would be able to have proper care without facing financial constraints to manage her health. The working condition and physical environment are

key social factors to be considered by physiotherapist while caring for patients with type-II navicular stress fracture. This is because involving in extensive physical exercise and stressful activities at work lead to further deteriorate the pain and tenderness related to fracture making the healing process to take longer time (Mandell et al. 2017). Thus, physiotherapist for the skater is to consider the living environment and social condition of the person is such that during the casting in her leg she uses minimum mobility and uses crutches to exert less pressure to ensure faster healing and no further pressure impact on the existing fracture. The presence of the fracture along with urgency of the skater to be able to compete in important National Championship in 12 weeks is able to negatively affect her emotions out of stress. The study by Han et al. (2016) mentions that presence of anxiety and stress often leads individuals to face asthma attack. This is because stress and anxiety make individuals develop shortness of breath leading individuals to face asthma attack. This indicates that physiotherapist for the skater is required to ensure the social conditions of the patient is remained under control so that she does not experience stress regarding condition and participation to the event to ensure controlling her unstable asthma. The effective education to the individuals regarding their health condition and way to manage their illness helps them to be aware to take proper health management actions (d’Hooghe and Thomson, 2018). Thus, the physiotherapist for the skater is required to educate the individual about the benefits of services to be offered to her for controlling condition regarding type-II navicular stress fracture and unstable asthma.

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Actions points for health management of the patient

According to the biological and social determinants of health, in case delayed healing of fracture is identified for the skater irrespective of her casting then the physiotherapist is to use electrotherapy to ensure faster healing. The electrotherapy is referred to implication of mild electric current to the specific region of the body which is affected by any injury or area in the body where pain perception is present to accelerate the healing process and lower pain as well as swelling (Juan and Mengdi, 2019). The physiotherapist for the skater to ensure she is able to gain full movement by 12th weeks to participate in the National event is going to provide low-intensity pulsed ultrasound (LIPUS) treatment. The LIPUS is referred to the treatment which includes the use of lower dosage of ultrasound for allowing the bones to heal quicker and helps individuals to return in action. In this process, the mechanical sound waves that are transmitted in the body

tissues facilitates natural healing process of the body as well as accelerates repair of bones (Nolte et al. 2016). The benefit of LIPUS is that it helps to treat fractures which are showing delayed healing (Mirza et al. 2019). Therefore, use of LIPUS is to be done for the skater to ensure her fracture is properly healed and she is able to return to her sports practice session as early as possible.

The actions to be taken by the physiotherapist for the skater to ensure proper movement of her leg involves engaging the person execute simple exercises. This is because initial simple exercises after 6 weeks of the casting when it is removed for patients with type-II navicular stress fracture helps them to gain strength of executing movement of the foot. The exercises are to be performed by physiotherapist under the condition that no relapse in symptoms regarding the fracture is faced by the patient (DelBusso and Matheny, 2019). The foot and ankle up and down exercise involve moving the ankle and foot synchronously up and down as far they can be extended without painful feeling in navicular fracture patients. The exercise is to be performed 15-20 times ensuring no rise in symptoms are seen in the patient regarding fracture (physio.co.uk, 2020). The foot and ankle in and out exercise followed by ankle and foot circles are performed by physiotherapist for patients with type-II navicular stress fracture in the initial stage after immobilisation period (physio.co.uk, 2020). This is to be done for the mentioned skater so that she can regain free movement of her ankle and foot which is used strategically to balance the body during figure skate.

The physiotherapist uses orthotic devices as external support to enhance the progress of healing and restoration of the function following injury or trauma. The benefit of using the devices is that it helps to enhance independence of the patients regarding their activities of living (physio.co.uk, 2020). Thus, the physiotherapist is to provide insoles for the skater to be used while wearing shoes so that during movement less pressure on the ankle and foot is created which is need to ensure less pressure and effective regaining of mobility of the legs. The physiotherapist for the skater to help her regain free movement of the foot and ankle after initial healing of the fracture requires involving her in hydrotherapy. The water is regarded as unique support environment that allows rehabilitation of joints and muscles. This is because buoyancy impact faced in the water lower weight of muscles and bones to be experienced along with increased blood flow in the body, create heating effect to lower swelling and pain perception regarding injury. The therapy is

According to the biological and social determinants of health, in case delayed healing of fracture is identified for the skater irrespective of her casting then the physiotherapist is to use electrotherapy to ensure faster healing. The electrotherapy is referred to implication of mild electric current to the specific region of the body which is affected by any injury or area in the body where pain perception is present to accelerate the healing process and lower pain as well as swelling (Juan and Mengdi, 2019). The physiotherapist for the skater to ensure she is able to gain full movement by 12th weeks to participate in the National event is going to provide low-intensity pulsed ultrasound (LIPUS) treatment. The LIPUS is referred to the treatment which includes the use of lower dosage of ultrasound for allowing the bones to heal quicker and helps individuals to return in action. In this process, the mechanical sound waves that are transmitted in the body tissues facilitates natural healing process of the body as well as accelerates repair of bones (Nolte et al. 2016). The benefit of LIPUS is that it helps to treat fractures which are showing delayed healing (Mirza et al. 2019). Therefore, use of LIPUS is to be done for the skater to ensure her fracture is properly healed and she is able to return to her sports practice session as early as possible. The actions to be taken by the physiotherapist for the skater to ensure proper movement of her leg involves engaging the person execute simple exercises. This is because initial simple exercises after 6 weeks of the casting when it is removed for patients with type-II navicular stress fracture helps them to gain strength of executing movement of the foot. The exercises are to be performed by physiotherapist under the condition that no relapse in symptoms regarding the

The physiotherapist uses orthotic devices as external support to enhance the progress of healing and restoration of the function following injury or trauma. The benefit of using the devices is that it helps to enhance independence of the patients regarding their activities of living (physio.co.uk, 2020). Thus, the physiotherapist is to provide insoles for the skater to be used while wearing shoes so that during movement less pressure on the ankle and foot is created which is need to ensure less pressure and effective regaining of mobility of the legs. The physiotherapist for the skater to help her regain free movement of the foot and ankle after initial healing of the fracture requires involving her in hydrotherapy. The water is regarded as unique support environment that allows rehabilitation of joints and muscles. This is because buoyancy impact faced in the water lower weight of muscles and bones to be experienced along with increased blood flow in the body, create heating effect to lower swelling and pain perception regarding injury. The the

In order to manage unstable asthma for the skater, the physiotherapist is to use different fitness and breathing exercises to be performed by the individuals so that her cardiorespiratory performance is enhanced and symptoms regarding breathlessness are improved. The slow breathing exercise is implemented by physiotherapist where they ask the individuals to take deep breath and hold until the lungs feel full which is then to be released slowly (Bruton et al. 2018). This is to be used for the mentioned skater as it is going to help relax her airways and allow proper passage of adequate air to avoid breathlessness. The relaxed breathing exercise along with yoga and mediation is to be executed by the skater under the supervision of physiotherapist to manager her unstable stable to become fit for participation in the national upcoming event.

Conclusion

The above discussion informs that according to biological determinant of health the skater faced fracture as a result of excessive stress. In this aspect, the physiotherapist is to ensure immobilisation and no weight-bearing by the leg through casting to ensure the fracture is healed. The environment determinants of health inform surrounding physical area has impact on the health of individuals. Thus, physiotherapist for the skater would ensure no movement is allowed for the individual for at least six weeks for recovery of the fracture. Further, on the basis of biological and social determinant of health, the physiotherapist for the skater is to educate the importance of performing hydrotherapy, LIPUS, tapping, breathing exercise and others to ensure the person gets healed from with type-II navicular stress fracture and unstable asthma.

The physiotherapist uses orthotic devices as external support to enhance the progress of healing and restoration of the function following injury or trauma. The benefit of using the devices is that it helps to enhance independence of the patients regarding their activities of living (physio.co.uk, 2020). Thus, the physiotherapist is to provide insoles for the skater to be used while wearing shoes so that during movement less pressure on the ankle and foot is created which is need to ensure less pressure and effective regaining of mobility of the legs. The physiotherapist for the skater to help her regain free movement of the foot and ankle after initial healing of the fracture requires involving her in hydrotherapy. The water is regarded as unique support environment that allows rehabilitation of joints and muscles. This is because buoyancy impact faced in the water lower weight of muscles and bones to be experienced along with increased blood flow in the body, create heating effect to lower swelling and pain perception regarding injury. The therapy is

References

Adler, N.E., Cutler, D.M., Jonathan, J.E., Galea, S., Glymour, M., Koh, H.K. and Satcher, D., 2016. Addressing social determinants of health and health disparities. National Academy of Medicine, pp.1-16. Bruton, A., Lee, A., Yardley, L., Raftery, J., Arden-Close, E., Kirby, S., Zhu, S., Thiruvothiyur, M., Webley, F., Taylor, L. and Gibson, D., 2018. Physiotherapy breathing retraining for asthma: a randomised controlled trial. The Lancet Respiratory Medicine, 6(1), pp.19-28. d’Hooghe, P. and Thomson, A., 2018. Return to play in stress fractures of the foot. In Return to Play in Football (pp. 387-407). Springer, Berlin, Heidelberg. DelBusso, S. and Matheny, M., 2019. Surgical Intervention of a Nonunion Navicular Stress Fracture in a Collegiate Soccer Player: An Exploration Clinical CASE Report. International Journal of Athletic Therapy and Training, 24(1), pp.19-22. Ferranti, E.P., Grossmann, R., Starkweather, A. and Heitkemper, M., 2017. Biological determinants of health: Genes, microbes, and metabolism exemplars of nursing science. Nursing outlook, 65(5), pp.506-514. Gross, C.E. and Nunley, J.A., 2020. Problematic Stress Fractures of the Foot and Ankle. Baxter's The Foot and Ankle in Sport, p.95.

The physiotherapist uses orthotic devices as external support to enhance the progress of healing and restoration of the function following injury or trauma. The benefit of using the devices is that it helps to enhance independence of the patients regarding their activities of living (physio.co.uk, 2020). Thus, the physiotherapist is to provide insoles for the skater to be used while wearing shoes so that during movement less pressure on the ankle and foot is created which is need to ensure less pressure and effective regaining of mobility of the legs. The physiotherapist for the skater to help her regain free movement of the foot and ankle after initial healing of the fracture requires involving her in hydrotherapy. The water is regarded as unique support environment that allows rehabilitation of joints and muscles. This is because buoyancy impact faced in the water lower weight of muscles and bones to be experienced along with increased blood flow in the body, create heating effect to lower swelling and pain perception regarding injury. The therapy is

Han, Y.Y., Forno, E., Marsland, A.L., Miller, G.E. and Celedón, J.C., 2016. Depression, asthma, and bronchodilator response in a nationwide study of US adults. The Journal of Allergy and Clinical Immunology: In Practice, 4(1), pp.68-73. Jiwani, R., Tomar, V., Naik, N. and Patil, S., 2018. Fractures of the Tarsal Navicular Bone: A Retrospective Study of Thirty Cases. Annals of International Medical and Dental Research, 4(4), p.5. Jiwani, R., Tomar, V., Naik, N. and Patil, S., 2018. Fractures of the Tarsal Navicular Bone: A Retrospective Study of Thirty Cases. Annals of International Medical and Dental Research, 4(4), p.5. Juan, Z.H.O.U. and Mengdi, E., 2019. Efficacy of Low Frequency Impulse Electrotherapy on Acupuncture Points Combined with Massage in Treatment of Postoperative Constipation After Lumbar Vertebral Fracture Surgery. Journal of Jianghan University (Natural Science Edition), 47(1), p.79. Kim, T. and Park, J.C., 2017. Short-term effects of sports taping on navicular height, navicular drop and peak plantar pressure in healthy elite athletes: A within-subject comparison. Medicine, 96(46).

The physiotherapist uses orthotic devices as external support to enhance the progress of healing and restoration of the function following injury or trauma. The benefit of using the devices is that it helps to enhance independence of the patients regarding their activities of living (physio.co.uk, 2020). Thus, the physiotherapist is to provide insoles for the skater to be used while wearing shoes so that during movement less pressure on the ankle and foot is created which is need to ensure less pressure and effective regaining of mobility of the legs. The physiotherapist for the skater to help her regain free movement of the foot and ankle after initial healing of the fracture requires involving her in hydrotherapy. The water is regarded as unique support environment that allows rehabilitation of joints and muscles. This is because buoyancy impact faced in the water lower weight of muscles and bones to be experienced along with increased blood flow in the body, create heating effect to lower swelling and pain perception regarding injury. The therapy is

Mandell, J.C., Khurana, B. and Smith, S.E., 2017. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal radiology, 46(9), pp.1165-1186. Mirza, Y.H., Teoh, K.H., Golding, D., Wong, J.F. and Nathdwarawala, Y., 2019. Is there a role for low intensity pulsed ultrasound (LIPUS) in delayed or nonunion following arthrodesis in foot and ankle surgery?. Foot and Ankle Surgery, 25(6), pp.842-848. nhs.uk 2018, Accessing physiotherapy, Available at: https://www.nhs.uk/conditions/physiotherapy/accessing/ [Accessed on: 8th April 2020] Nolte, P., Anderson, R., Strauss, E., Wang, Z., Hu, L., Xu, Z. and Steen, R.G., 2016. Heal rate of metatarsal fractures: A propensity-matching study of patients treated with low-intensity pulsed ultrasound (LIPUS) vs. surgical and other treatments. Injury, 47(11), pp.2584-2590. physio.co.uk 2020, Stress Fracture of the Navicular, Available at: https://www.physio.co.uk/what-we-treat/musculoskeletal/conditions/foot/stress-fracture-of-the-navicular.php [Accessed on: 8th April 2020] physio.co.uk 2020, Hydrotherapy, Available at: https://www.physio.co.uk/treatments/hydrotherapy/index.php [Accessed on: 8th April 2020]

The physiotherapist uses orthotic devices as external support to enhance the progress of healing and restoration of the function following injury or trauma. The benefit of using the devices is that it helps to enhance independence of the patients regarding their activities of living (physio.co.uk, 2020). Thus, the physiotherapist is to provide insoles for the skater to be used while wearing shoes so that during movement less pressure on the ankle and foot is created which is need to ensure less pressure and effective regaining of mobility of the legs. The physiotherapist for the skater to help her regain free movement of the foot and ankle after initial healing of the fracture requires involving her in hydrotherapy. The water is regarded as unique support environment that allows rehabilitation of joints and muscles. This is because buoyancy impact faced in the water lower weight of muscles and bones to be experienced along with increased blood flow in the body, create heating effect to lower swelling and pain perception regarding injury. The therapy is

Prüss-Ustün, A., Wolf, J., Corvalán, C., Neville, T., Bos, R. and Neira, M., 2017. Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health. Journal of public health, 39(3), pp.464-475. Shakked, R.J., Walters, E.E. and O’Malley, M.J., 2017. Tarsal navicular stress fractures. Current reviews in musculoskeletal medicine, 10(1), pp.122-130. Sundararajan, S.R., Badurudeen, A.A., Ramakanth, R. and Rajasekaran, S., 2018. Management of talar body fractures. Indian journal of orthopaedics, 52(3), p.258. Surda, P., Walker, A., Limpens, J., Fokkens, W. and Putala, M., 2018. Nasal changes associated with exercise in athletes: systematic review. The Journal of Laryngology & Otology, 132(3), pp.191-197.


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