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8/7/2019 WOMEN health 1
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Gaurav shah
Rikhil makwana
Avinash boyet
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Introduction:
A focus on health issues relevant to females has been increasing over last two decades.
The multiple roles that women play, tend to give low priority to her personal time. Women
always place the need of others before themselves and priority to their health, exercise or any
form of relaxation is never given preference.
The new York declarationWomen and children first presented at United Nations in July
2008 by the international Academy of Perinatal Medicine has highlighted biases in the allocation
of health care resources for women and children especially in the developing countries.
Adequate health care for woman and children are not provided and it reflects in high
perinatal mortality. Hence proper allocation of health care resources for woman and children is
required. This shows that specialized health needs of a woman are not being adequately met by
the medical community of which physical therapist are also important members.
India being the second most populous country in the world and rated as below income
class by World Bank has health missions-National rural health mission, Janani Suraksha Yojana
and Reproductive child health Phase-II, which seeks to improve access of rural women and
children to public health services. Their main objective is to reduce infant and maternal mortality
and reduce total fertility rate.
However other health issues which affect the morbidity and mortality like osteoporosis,
urinary incontinence & obesity in women are not considered in our countrys health missions.
Hence, our role of physiotherapy care in these womens health and well being issues cannot be
expected to be even mentioned in any of these key policies. It is for us to take the initiative to
make our services available to rural and urban poor women along with the privileged women of
our country.
As primary health care professional physiotherapists participate in prevention programs
which are committed to improve and maintain functional independence and physical
performance. Public health camps should be organized to provide information to women
regarding various health issues, the risk factors associated and prevention by changes in lifestyle
and empowering them to take the decision of their health.
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Hence we are an important member of multi disciplinary team addressing various issues
which are fundamental to her well being and health. Improving womans health will also result
in improving the health and well being of families and communities through the caring nurturing
and educative roles that woman performs on a daily basis.
PURPOSE:-
Over 50% of population is female and this alone is sufficient reason to focus on womens health
issues.
Mutual dependence between womens activity roles, anatomy and physiology and this health
It is a complex and rewarding field for further investigation
Goals of Physiotherapy care during adolescence are:
1) Health education: adolescent female should be educated to minimize the adverse impact
of growth on her musculoskeletal system. The importance of appropriate levels of exercise,
participating in sports and good nutrition for long term health and wellness should be
emphasized.
2) Postural education and training: To build the necessary kinesthetic awareness of
appropriate joint position in combination with positive input regarding self image, back care and
lifting techniques are essential component of treatment.
3) Supervised flexibility: Program for all the muscles who have propensity to develop
tightness must be emphasized. Stretching exercises to the hamstrings, quadratus lumborum,
dorsolumbar fascia, hip flexors, iliotibial band, gastroc and soleus, upper trapezium, adductors
and medical rotators of the shoulder should be done on daily basis.
4) Strengthening: Strengthening program for muscles developing stretch weakness for
transverse abdominis and multifidus to improve core stability, quadriceps, rotator cuff muscles,
scapula depressors & retractors erector spinae & gluteal muscles.
5) Proprioceptive trainings: To provide positive afferent feedback and agility training is
necessary. Use of balance board, minitrampoline. One leg stance with eye open and closed, rapid
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jumping or hopping in different directions at different speeds are necessary to ensure safe return
to sports.
6) Appropriate footwear & advice: It is for prevention of injury while playing sports is
important. Warm up and cool down sessions should be a part of training and avoiding rapid
increases in the intensity, frequency and duration of sessions is must.
7) Relief of pain: Local application to the injured area with ultrasound, moist heat,
cryotherapy, TENS can be advocated.
WHO includes: - (global strategies)
Equity in health
Healthy promotion
Need to develop primary health care and to enhance prevention activity in primary health care
settings.
Co-operation between revelant agencies of government and community.
The need to participate of consumer in decision making.
PHYSIOTHERAPISTS ROLE: - (as a health promotion and health
education)
Someone who uses all the knowledge and skills available to them to improve health and well-
being of individuals and communities in which they live and work.
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ROLE OF PHYSIOTHERAPY IN ADOLESCENT & PUBERT AGE
GROUP
Aerobic training including agility exercises is documented to be one of the most effective
preventive mode for prevention of obesity.
Physiotherapy expert should also visit schools and sports club regularly to impart health
education amongst pre pubertal students, their parents, teachers and coaches involved in
training students in sports.
During the visit the expert physiotherapist should conduct regular assessment of mobility
and body fat levels and accordingly give guidance for health promotion.
ROLE OF PHYSIOTHERAPY DURING REPRODUCTIVE AGE
In this age group, obesity continues to be high risk factor with evidence of certain related
health issue having already cropped in.
The impact is frequency seen in a reversed order i.e. when estrogen balance is tempered
naturally or artificially obesity is found to set in.
Women on contraceptive is pills or those who undergo tubectomy as family planning
measure or those after hysterectomy are known to develop obesity.
Physiotherapy plays a major role in combating obesity related sterility.
ROLE OF PHYSIOTHERAPY DURING CLIMACTERIC & MENOPAUSAL
AGE:
Obesity, depression, stress urinary incontinence & enhancement of bone resorption
posing risk of osteoporosis are some of the most common repercussions of menopause.
This stage is also associated with aging issue.
Problems in sustain balance are also reported to be evident.
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Only an expert physiotherapist can do justice in selecting appropriate exercise regain
regimen as per individual needs
GOALS:-
Provide education regarding its role, anatomy and physiological changes during various stages of
life and health and fitness.
Providing education in preparation for childbirth and parenthood.
Describe normal physiological changes of pregnancy on various systems, major stages and
characteristics of pregnancy, labour and delivery.
To help women adjust to physiological changes throughout pregnancy, management of
complication, antenatal and postnatal care.
Develop goals and guideline for an obstetric exercise programme in uncomplicated pregnancy.
Development of child and maternal care.
Management of caesarean childbirth and high-risk pregnancy.
Womans health education, counseling and support.
a) Child bearing years :the child bearing years encompasses large time frame from
merarche to menopause. Physiotherapist defienes it as the time from conception to post partum
adjustment .
Musculoskeletal impairments during pre natal & post partum period :adaptive
changes in musculoskeletal system take place to accommodate the growing foetus & weight gain
in the mother due to pregnancy.Physiotherapy intervention will focus on education regarding
posture, back care, modification of ADLs along with core muscle strengthening to to ensure
alignment of body & minimize the stress & development of pain.
c)Menopause & beyond
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1) Vasomotor changes: like hot flushes & night sweats, insomnia, mood changes, joint aches &
pains. Regular exercises decrease these symptoms.
2) Pelvic floor dysfunctions: urinary incontinence & pelvic organ prolapsed are examples of
pelvic floor dysfunction. Stress incontinence is documented in young female athletes & in
postpartum, peri & post menopausal women. Pelvic floor muscles training appeared to be an
effective treatment for adult woman with stress in mixed incontinence.
3) Obesity: Weight gains, redistribution of fat from thigh and buttock to abdomen, loss of
muscle mass and continuous decline of skin collagen makes a women feel that she is less
attractive and starts experiencing negative body image which makes it difficult for her to focus
on emotional well being. Exercise program designed by physiotherapist during this years will
help regulate weight.
4)Chronic pelvic pain: This is also one of the impairment seen in 18-50years old women & is a
physical, emotional & social issue for many women & the treatment costs are very high. Altered
tone of pelvic floor muscles & spasm of hip buttock & trunk muscles. PT aims are to relax the
pelvic floor muscles with biofeedback, relax techniques, other modalities & SWD can be used
for treatment.
5) Breast & Cervix Cancer: After the breast surgery physiotherapist regaining shoulder range
& function without increasing the risk of lymph edema is necessary. If lymph edema takes place
then treatment include manual lymphatic drainage/massage. Hysterectomy done for cervical
cancer can give rise to pelvic floor dysfunction.
6) Osteoporosis: India is one of the largest affected countries in the world in osteoporosis cases.
Two major complications, accentuated thoracic kyphosis & vertebral fractures are seen in post
menopausal women causing significant increase in morbidity & mortality.
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Plan for the health education:
1) Women have particular health needs which are related to their biological fitness, their roles insociety and their participation in workplace.
Reproductive of health and sexuality.
Health and ageing women.
Emotional and mental health.
Health needs women as cares.
2) Antenatal preparation for parenthood classes must be designed to fulfill the parents
expressed needs and should never simply be a forum for professionals to impact the sort of
information they think their audience requires.
National health service centre Organize classes. The main aim is education regarding
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3) Changes of pregnancy are chiefly the direct result of interaction of four factors
Hormonally mediated changes in collagen & involuntary muscles.
Increase total blood volume with increased blood flow to uterus & kidney.
Growth of foetus in consequent enlargement & displacement of uterus.
Increase body weight & adaptive changes in COG & posture.
Explain series of events take place in genital organs in an effort to expel foetus.
Identify normal & abnormal labour.
Explain just stages of labour i.e. cervical & effacement of cervix.
Explain 2nd stage i.e. bearing down effects.
3rd stage: Phases of placental separation & descent to lower segment.
Explain series of movement that occur on the head in process of adaptation during journey
through pelvis.
4) Complication during pregnancy & after childbirth.
Stress : Mitchell method of physiological relaxation
Contrast method
Suggestion & visualization
Touch & massage
Breathing control
Diet & weight gain : Normal 10-12.5 kg gain
Alcohol, smoking & medication in pregnancy
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Joint laxity : Safe exercise programme
Non weight bearing less stressful activities
Pelvic floor dysfunction : Pelvic floor strengthening exercise
Biofeedback
NMES
IFT
Muscle re-education
Compression syndromes : Postural correction
Ergonomic assessment
Splint
Modalities
Diastasis recti : Abdominal strengthening exercise
Abdominal drawing & bracing
Stability exercise
Core-strengthening exercise
Low backache & pelvic pain :
Extensions stabilization by belts as corset
Postural correction
Deep heat modalities
Strengthening exercise
Varicose vein : Minimal dependant position
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Elastic support stockings
Elevation of extremity
5) Minimize impairment & help the women to maintain or to regain function while she is
preparing for arrival of baby & then carrying for the infant.
Sequence of exercise:
Rhythmic activity to warm up
Gentle selective stretching for postural alignment & flexibility
Aerobic activity for CVS conditioning
Postural exercise
Cool-down exercise
Pelvic floor exercise
Relaxation techniques
Labour & delivery techniques
Educational information
Post-partum exercise instruction
6) Examination of the baby at a time of delivery.
Clinical assessment of new born
Musculoskeletal & neurological abnormality
Respiratory distress
Meconium aspiration
Dubowitz & neurosensory motor development assessment
Baby handling & parent education
Vision & hearing
Posture & movement
Feeding
Handling techniques
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Baby massage
Purpuerium-follow up mothers and baby
7) Prevent vascular complications
Decrease incisional pain assess with coughing
Breast feeding
Facilitate healing
Decrease post-surgical discomfort
Self monitoring technique
Modified exercise programme
8) Developing healthy public policy
Individual, ecological and community approach
Creating supporting environment
Nutrition and hygiene in an attempt to lower maternal and infant mortality rate.
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