WHY MASTER'S?????

Prepared by: Parthiban Thiruvarasan, Department of Physiotherapy (July 2018)

Pursuing Master's should have a purpose for each and everyone. The magnitude of purpose is wider, some are interested in upgrading themselves to higher academic level, some anticipate higher monetary returns, some aspire to settle overseas and some assumes better career opportunities. All of these can be accomplished upon qualifying yourself with Master's and further.

Many speak of their personal growth but the fullness of your own responsibility also has the element of driving a nation to its fullest glory. Education becomes a powerful tool to cause a paradigm shift.

Inconsistencies and disparity links to scarcity of jobs and autonomy of professional practice, the entry criteria still remain as diploma and few other professionals look us down. To bridge the gap and heighten the standards of professional rights you need to upgrade your qualification.

When you look back the current academics should be historians and you must steer this profession to par excellence. Economical growth also depends on level of education look back countries which has take our profession to greater heights, they have started to encourage practitioners to reach doctoral level and some countries have made it mandatory. For a nation to whistle, sing, dance and be frivolous higher education across all disciplines is very important.

Providence endows some with great learning and for some it thrust high responsibility. It is an immutable law that all human are not equal and the very same law demands that every human justify himself or herself in their walk of life, the best way is by attaining higher levels of education. Be of good cheer and your efforts will soon be rewarded.

Vestibular Rehabilitation Therapy (VRT)

Vestibular rehabilitation therapy has been proven to be an effective treatment in improving patients suffering from vestibular disorders. Symptoms of vestibular disorders include vertigo, dizziness, visual disturbance, and/or imbalance. Some patients have also reported with nausea and/or vomiting, fatigue and decreased ability to concentrate which may affect their activities of daily living and quality of life. These symptoms may frequently cause people to adopt a sedentary lifestyle in order to avoid worsening of dizziness and imbalance resulting in decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina.

Vestibular rehabilitation therapy (VRT) is a specialized form of therapy with an exercise-based program intended to alleviate both the primary and secondary problems caused by vestibular disorders. After vestibular system damage, people may feel better and show some functional improvement through a process of compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e. body sense) to substitute for the deficient vestibular system. For many, compensation occurs naturally over time, but for people whose symptoms do not reduce and who continue to have difficulty returning to daily activities, VRT can help with recovery by promoting compensation.

The basic goal of VRT is to use to promote compensation. This is achieved by customizing exercises to address each person's specific problem(s). Therefore, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder before an exercise program can be designed. Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.

Habituation exercise is indicated for patients who report increased dizziness when they move around, especially when they make quick head movements, or when they change positions like when they bend over or look up to reach above their heads. Also, habituation exercise is appropriate for patients who report increased dizziness in visually stimulating environments, like when watching action movies, and/or when walking over patterned surfaces or shiny floors. The goal of habituation exercise is to reduce the dizziness through repeated exposure to specific movements or visual stimuli that provoke patients' dizziness. The increase in symptoms should only be temporary, and before continuing onto other exercises or tasks the symptoms should return completely to the baseline level. Over time and with good compliance and perseverance, the intensity of the patient's dizziness will decrease as the brain learns to ignore the abnormal signals it is receiving from the inner ear.

Gaze Stabilization exercises are used to improve control of eye movements so vision can be clear during head movement. These exercises are appropriate for patients who report problems seeing clearly because their visual world appears to bounce or jump around, such as when reading or when trying to identify objects in the environment, especially when moving about.

There are two types of eye and head exercises used to promote gaze stability. The choice of which exercise(s) to use depends on the type of vestibular disorder and extent of the disorder. One type of gaze stability exercise incorporates fixating on an object while patients repeatedly move their heads back and forth or up and down for up to a couple of minutes. The other type of gaze stability exercise is designed to use vision and somatosensation (body sense) as substitutes for the damaged vestibular system. Gaze shifting and remembered target exercises use sensory substitution to promote gaze stability.

Balance Training exercises are used to improve steadiness so that daily activities for self-care, work, and leisure can be performed successfully. Exercises used to improve balance should be designed to address each patient's specific underlying balance problem(s). Also, the exercises need to be moderately challenging but safe enough so patients do not fall while doing them. Features of the balance exercises that are manipulated to make them challenging, include visual and/or somatosensory cues, stationary positions and dynamic movements, coordinated movement strategies (movements from ankles, hips, or a combination of both) and dual tasks (performing a task while balancing)

Additionally, balance exercises should be designed to reduce environmental barriers and fall risk. For example, the exercises should help improve patients' ability to walk outside on uneven ground or walk in the dark. Ultimately, balance training exercises are designed to help improve standing, bending, reaching, turning, walking, and if required, other more demanding activities like running, so that patients can safely and confidently return to their daily activities.

Indications for VRT include individuals who are suffering from peripheral or central vestibular disorders such as benign paroxysmal positional vertigo (BPPV), unilateral vestibular hypofunction such as in vestibular neuritis or acoustic neuroma, bilateral vestibular hypofunction such as in ototoxicity, and less commonly meningitis, autoimmune disorders, head trauma, tumors, on eighth cranial nerve, transient ischemic episodes of vessels supplying the vestibular system, and sequential unilateral vestibular neuronitis

Note: The above exercises may not be sufficient for patients who are experiencing dizziness due to benign paroxysmal positional vertigo (BPPV). Such patients may need to undergo treatment with canal repositioning maneuvers before practicing habituation exercises and / or balance training exercises.

Individuals not likely to benefit from vestibular therapy include people with dizziness but without a vestibular problem, for example low blood pressure, medication reactions (other than ototoxicity), anxiety, malingerers, depression, migraine associated vertigo, transient ischemic attacks and people with fluctuating vestibular problems such as Meniere's disease and perilymphatic fistula.

DEPRESSION; ARE YOU MASKING YOURSELF WITH A SMILE???

Prepared by: Bavithra Krishnan, Department of Physiotherapy (July 2018)

The devastating news of K- pop star Jonghyun ending his life in 2017 due to depression has shocked the world especially the K- pop fans worldwide. This incident clearly shows that a person who appears happy and normal might be struggling with depression. You may never know who is suffering from depression since the signs are intangible.

According to a morbidity survey conducted by the Ministry of Health in 2017, more than 18,000 Malaysians suffer with mild and severe depression. This statistic surely has been a wakeup call to those who took mental health lightly.

Depression is a serious issue; it affects the way you think and feel about yourself. It causes lost of pleasure in activities that one used to enjoy such as favourite hobbies, social activities and even sex. A depressed individual will feel lethargic; even getting out of bed can be difficult. A severely depressed individual has a significant risk for suicide. Feeling of hopelessness and self loathing thoughts causes the depressed individual to feel that suicide is the only way out.

Depression versus the blues

There is a difference between feeling depressed and having a depression. The question is how do you differentiate them? You might feel sad or experience low mood due to stressful life events such as failing in exam, unemployment or even having an argument with your loved ones. Soon the situation and circumstances changes and you will feel happy again. However, having a depression is like living in a dark room with feelings of hopelessness, guilt, worthless and self blame.

Seeing the light of happiness at the end of the tunnel

How long you are going to live with the mask? I am not going feed you with false reassurance that "things are going to be okay overnight" but just to drop a message that recovery is possible.

Cognitive Behavioural Therapy- Your thoughts are more powerful than you think. Cognitive Behavioural therapy (CBT) helps a depressed individual to challenge his or her pessimistic thoughts that lead to depression and replace them with positive ones. For example, if you think "nothing can be done about my situation and I am the one to be blamed for my depression", CBT helps you to replace the negative thoughts with more positive and rational thoughts.

Mindfulness- How often you fully enjoy the food that you eat or listen to the chirping sound of the birds while having a stroll? In this world full of competition and mind being constantly preoccupied with future worries, we rarely focus on the present. This is when mindfulness comes into play. Mindfulness is being fully alert of the present without judgment. When you are fully focused on the present without dwelling in your past or future, it brings peace and freeing you from the hopelessness and self loathing thoughts. Currently, mindfulness based cognitive behavioural therapy (MCBT) is used to treat episodes of depression and study shows that MCBT has reduced relapse by 43% in patients with episodes of depression.

Professional Help- If you can't handle it on your own, don't hesitate to seek for professional help. Psychiatrics and psychologists specialized in depression can help you to come out of darkness.

Where to seek for Help?

University Counsellor - Every university provides counselling services for their students. If you feel that you are struggling with depression don't have a second thought of consulting the counsellor. If you have thoughts like "the counsellor might think that my problems are too silly" or "my friends might judge me if they know I have depression". I would like to reassure you that your information will be kept confidential and the counsellor will never judge you or your problem.

Support Group, Befrienders - Many support groups available to provide emotional support to those who are struggling with depression at anytime of the day like the Befrienders. They are trained volunteers who listen to your problems without any judgment and help to deal with the situation that you are facing. You can contact Befrienders at 03-7956 8145.

REMEMBER!!! HAVING A DEPRESSION IS NO ONE'S CHOICE BUT THE DECISION TO LIVE WITH OR WITHOUT IT IS YOUR CHOICE.

See the light of happiness where the darkness of depression ends.

CHALLENGES BEING A CLINICAL INSTRUCTOR 

EXPECTATIONS

Students have their own expectation on Clinical Instructors (CIs) to be fair, goal oriented, honest, to have integrity, creative in teaching, easily approachable and present good feedback based on their professional skills. On the other hand, CIs have expectations on the students to behave professionally, to be initiative, ready to accept feedback , be punctual, proactive, and well mannered. There are many occasions where misunderstandings took place when both parties had different expectations. The best solution to ease the situation is to conduct discussion among CIs and students on the structured plans based on the objective of learning.

COMMUNICATIONS

Some students are facing difficulties in communications. It has been a huge barrier for the students to give their best in handling the patients. The lack of communication skills is restricting them from approaching the staffs in the hospital as well. Some are poor in languages but good in physiotherapy skills. In order to overcome the communication issues, CIs should be an effective communicator to be an example to the students. CIs must be able to communicate with clarity, brevity, accuracy and focus on the topic to be discussed. These qualities would be able to observe and implemented by the students.

DISCIPLINE

The students who are irregular and problematic in the university are giving the same troubles in the clinical placements. Some discipline issues like the students are not punctual and taking leaves for unknown reasons. On the other hand, some students have shown their tantrum to the lecturers while in hospitals and not ready to accept the feedback. In order to handle these, the University lecturers are must be able to identify the students' issues and should have taken actions accordingly when the students have many issues in the University before sending them to clinical placements.

IMPLEMENTING THE THEORY INTO PRACTICAL

One more challenges that CIs are facing is students have inconsistency between the theoretical and practical training. Some students are bright in their physiotherapy skills, some are strong in theory and some are not strong neither both theory and practical skills. This is because the students are not regular to the classes, neglect when lecturers are educating them, and assuming that it is an easy job. This is very saddening and the CIs need to coach them from the basics to treat the patients in the clinical placements. In that case, the students need to be responsible to strengthen their knowledge to ease the CIs supervision during clinical placements.