adina radulescu

100ADINA RDULESCU

99English in Kinetotherapy. A practical English handbook

ADINA RDULESCU

*

English in Kinetotherapy.

A practical English handbook

Editura Fundaiei Romnia de Mine2004

CONTENTS

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UNIT 1THE MAIN PARTS OF THE BODYIMPERATIVE SENTENCES USED IN RELAXATION TRAINING TECHNIQUESPREPOSITIONS

UNIT 2The skeletal systemINTERROGATIVE PRONOUNS AND ADVERBS USED BEFORE THE VERB TO BEASKING QUESTIONS

UNIT 3THE MUSCULAR SYSTEMADJECTIVES BASIC KNOWLEDGEDESCRIBING A CERTAIN MUSCLE

UNIT 4EXAMINING THE PACIENTPOLYSEMANTIC WORDSTHERAPIST-PATIENT DISCOURSE GREETINGS, IDENTIFICATION AND INTRODUCTORY DIALOGUES

UNIT 5TYPES OF INJURIESPASSIVE MODAL CONSTRUCTIONSPRESENT TENSE SIMPLE AND PRESENT PERFECTTHERAPIST-PATIENT DISCOURSE PATIENT`S SYMPTOMS AND COMPLAINTSFORMAL AND INFORMAL MEDICAL TERMS

UNIT 6THERAPEUTIC EXERCISESWORD FORMATION DERIVATIONTHERAPIST-PATIENT DISCOURSE RECOMMENDING DIFFERENT THERAPEUTIC EXERCISES

UNIT 7THERAPEUTIC PROCEDURES IN HANDLING THE PATIENTPASSIVE VERBAL CONSTRUCTIONSTHERAPIST-PATIENT DISCOURSE POSITIONING AND HANDLING THE PATIENT

UNIT 8MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERSPRONOUNCING TONGUE-TWISTERSDESCRIBING SYMPTOMS AND RECOMMENDING THERAPEUTIC EXERCISES

UNIT 9POSTURAL PROBLEMSCONDITIONAL CLAUSESTHERAPIST-PATIENT DISCOURSE IMPROVING COMMUNICATION

UNIT 10REVISION EXERCISES

BIBLIOGRAPHY

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Specificul studierii limbilor strine n cadru universitar este reprezentat de trecerea de la studierea limbii strine la modul general la aprofundarea ei pe diverse domenii de specialitate. n funcie de specializarea pentru care studenii opteaz, ei vor studia, n cazul nostru, engleza economic, juridic, tehnic, medical etc. Studiul limbilor strine aplicate pe un anumit domeniu de specialitate n cazul nostru fiind vorba de engleza n kinetoterapie, o ramur a englezei medicale presupune din partea studenilor un nivel mediu de cunotiine de limba englez, stpnirea unor tehnici de munc individual i, de asemenea, a unui nivel mediu de cunotiine generale pe domeniul respectiv de specialitate. Manualul de fa se adreseaz studenilor seciei de Kinetoterapie, din cadrul Facultii de Educaie Fizic i Sport a Universitii Spiru Haret Bucureti, att anului I ct i anului II de studiu. El rspunde unei nevoi reale aceea de a avea un instrument practic de lucru pentru desfurarea activitii de seminar.Contientizarea avantajelor pe care le presupune stpnirea unui limbaj de specialitate ntr-o limb strin, dintre care amintim: posibilitatea consultrii unei bibliografii de specialitate n limba respectiv, participarea studenilor la conferine internaionale, publicarea unor materiale n revistele de specialitate i, poate cel mai important, posibilitatea de a lucra ntr-o clinic sau cabinet de profil cu personal i clieni strini fie n Romnia fie peste hotare a constituit motivaia principal pentru meninerea interesului studenilor fa de aceast disciplin de studiu i pentru obinerea unui certificat de competen lingvistic pe specialitatea englez medical, eliberat n cadrul Centrului de Limbi Strine al Universitii Spiru Haret. Manualul este structurat pe 10 capitole (Units), axndu-se pe trei componente principale: 1) un corpus de texte de specialitate, care-i asociaz diverse exerciii de vocabular, traduceri de text i exerciii de redare selectiv a informaiei prezentate; 2) o selecie a unor probleme de gramatic a limbii engleze, efectuat n funcie de criteriul frecvenei anumitor structuri gramaticale n limbajul medical i 3) un set de discursuri kinetoterapeut-pacient, axate pe tematica fiecrui capitol, avnd ca scop familiarizarea studenilor cu utilizarea unui limbaj oral, informal, care completeaz limbajul formal n care sunt redate textele de specialitate. Selectarea acestor texte din diverse materiale atlase de anatomie, cursuri de kinetoterapie, etc a avut ca intenie creearea unui cadru profesionist de lucru, precum i stimularea interesului studenilor pentru consultarea unor materiale de specialitate n limba englez. i, nu n ultimul rnd, exerciiile de la fiecare sfrit de Unit create your own dialogues, consider yourself as a kinetotherapist etc. testeaz capacitatea studenilor de a se exprima liber i firesc n limbajul de specialitate asimilat, ntr-un context socio-profesional artificial creat n sala de seminar, prin ceea ce n metodica limbii engleze se numete Role playing. Cu sperana i dorina c acest manual va rspunde nevoii practice a studenilor de a aprofunda limba englez pentru o viitoare practic kinetoterapeutic, constituind n acelai timp un stimulent pentru o perfecionare permanent, prin consultarea unei bibliografii actualizate n limba englez, nchei prin a le mulumi studenilor din primele generaii cu care am lucrat pentru ajutorul pe care mi l-au acordat, prin simpla lor participare activ la seminariile de limba englez, n conturarea suportului teoretic i practic al acestui manual. Autoarea

UNIT ITHE MAIN PARTS OF THE BODYIMPERATIVE SENTENCES USED IN RELAXATION TRAINING TECHNIQUESPREPOSITIONS

1. Read the following texts containing relaxation techniques and write down the new words:

Trainers introduction: This relaxation procedure is one that has been practised for many years now. It has been studied by researchers and found to be effective. You will feel very relaxed and calm as a result. It is not the same as hypnosis and you will not lose consciousness at any point.The procedures: Make yourself as comfortable as you can become aware of the surface underneath you let your body settle into it notice how it supports you notice the points of contact between you and the floor: your head shoulders spine ribs hips heels elbows forearms and hands feel your body sinking into the surface you are lying on feel your body getting heavier as the tension ebbs away feel at peace. Take one good breath and as you let it out, feel it carrying all your tensions away then let your breathing settle into a gentle rhythmAs you lie or sit, reflect on the idea that you are going to give the next half-hour to yourself. No telephone can ring for you; no doorbell disturb you; no one will call your name. You may hear sounds around you: voices, horns, sirens, bangs and revs think of them as being outside your world. With these thoughts in mind, draw an imaginary circle around yourself, about three feet from the centre. Create an imaginary bubble think of the interior as your space your own private space. Feel how safe it is safe to get in touch with yourself. Turn your thoughts inward.Trainers termination of the procedure: I am going to bring this relaxation sesssion to an end Id like you gradually to become aware of the room feel the floor/chair underneath you open your eyes give your limbs a few gentle stretches have the feeling that you are alert and ready to carry on with your lifeWith your eyes open, raise your eyebrows feel the tension and release the tension frown feel the tension and release it shut your eyes tightly feel the tension and let it go with your eyes still closed, spend a few minutes releasing tension in this part of your faceClose the jaws firmly, noticing the sensations you get from the action hold it and discontinue let your jaw drop feel the tension leaving you and continuing to leave you then repeat the action. Next, bare your teeth feel the tension in the cheeks hold it for a few seconds and release the tension. Make a tight O with your lips hold it, while you register tension in the lips and cancel the action.Press your tongue against your teeth feel the pressure and release it Now pull the tongue back towards the throat. Feel the muscles drawing it back and note the sensations you get from this action and release it (R. A. Payne Relaxation Techniques)

2. Read the text again, select the words that designate: a) parts of the body, b)verbal constructions expressing commands and c) prepositions or other words indicating direction and place them in three different columns.

3. Using the vocabulary practice below write the Romanian equivalents for the terms indicating parts of the body.

VOCABULARY PRACTICE 4. Pronounce and learn the names of the main parts of the human body. For some notions two alternative terms have been provided:

The head: - eyes, eyelids (pleoape), eyelashes (gene), eyebrows (sprncene); nose, nostrils (nri);ears, ear lobe;mouth, lips (buze), gum (gingie), tooth - teeth, tongue (limb), jaw (falc), upper jaw /maxilla (maxilar), under jaw (mandibul);forehead (frunte), cheek (obraz), cheek bone (os maxilar), chin (brbie), dimple (gropi n obraz), dimple in the chin /fossette (gropi n brbie).

The neck:throat;Adams apple/thyroid cartilage;hollow of the throat (scobitura gtului);nape of the neck (ceafa).

The body: - shoulder, shoulder blade/scapula (omoplat);- limb (membru), arm/upper limb (bra), armpit/axilla (subsuoar), forearm (antebra), hand, elbow (cot), crook of the arm (ndoitura braului), palm, wrist/carpus (ncheietura minii), fist (pumn), fingers thumb (degetul mare), forefinger (deget arttor), middle finger, ring finger (deget inelar), little finger, finger tip (vrful degetului), finger pad (pernia degetului), fingernail (unghie), knuckle (articulaia degetului);biceps, thorax/chest (torace), breast (piept), nipple (mamelon), abdomen, stomach, waist (talie), navel/umbilicus (buric), bottom (ezut), buttocks (fese);hip (old), leg, thigh (coaps), calf (gamb), shin/cannon bone (fluierul piciorului, tibia), knee (genunchi), knee cap (rotul), ankle (glezn), instep (scobitura gleznei), sole (talp), heel/calcaneus (clci), toes (degete de la picioare).

5. Choose the right word that best completes the sentence:I cant move my left hand; I have problems with my ...

a) fingersb) armpitc) wristd) fistsIt is not polite to talk to somebody when you have your . in your pockets.

a) fingersb) handsc) palmsd) armsHe has had this nasty habit of biting his . ever since he was a kid.

a) tongueb) toesc) fingersd) nailsThis old lady cant hear you very well; she has got an infection.

a) earb) throatc) toothd) eyeHe fell and hurt his really bad, as he was not wearing his knee-pads when roller skating.

a) anklesb) legsc) kneesd) toesThe underside both of a foot and a shoe is called a ..

a) heelb) solec) shind) toeI ate an icecream yesterday and now I have a sore .

a) neckb) eyec) jawd) throatYou should not drink so much coffee on an empty ..

a) stomachb) waistc) abdomend) throatNobody is perfect and carelessness is his Achilles...

a) toeb) armc) heeld) head He is walking on the tips of his so as not to awake the baby.

a) feetb) toesc) fingersd) sole

6. Match up the following words with their definitions:

1. wrista. the thick, fleshy part of the back of the leg, between the ankle and the knee2. foreheadb. large muscle at the front of the upper arm, which bends the elbow3. hipc. the small depression beneath the arm where it joins the shoulder4. tongued. a thin, horny, translucent plate covering part of the dorsal surface of the end joint of each finger5. calfe. the part of the face between the natural hairline and the eyes; formed skeletally by the frontal bone of the skull6. armpitf. part on either side of the body below the waist where the bone of a persons leg is joined to the trunk7. nostrilg. the joint between the forearm and the hand8. thighh. the back part of the human foot from the instep to the lower part of the ankle9. fingernaili. part of the body below de chest and diaphragm, containing the stomach, bowels and digestive organs10. heelj. organ of taste that aids the mastication and swallowing of food.11. abdomenk. either of the two external openings of the nose12. bicepsl. part of the human leg between the knee and the hip

VOCABULARY PRACTICE

Here is a list of the most commonly used prepositions of place and position:

above = deasupra, de deasupra, mai sus deacross/along = de-a lungul, transversalaround/round = de jur mprejurulbelow = dedesubt, sub (fr a indica contact cu suprafaa superioar)beneath/underneath = dedesubt, sub (indicnd existena unei suprafee superioare de protecie, separare)between = ntre (dou obiecte)behind = n spatele, napoiain front of = n faain = n, n interiorulinto = n, nspre interior (indicnd ptrunderea, strbaterea spaiului)on = pe, deasupraonto = pe, deasupra (indicnd micare pentru atingerea poziiei)over = peste, deasuprathrough = prin, printreunder = dedesubt, sub (indicnd contact cu suprafaa superioar)

Other words indicating movement and direction:-WARDS class (wards = spre, ctre, indicnd direcia)Backward (s) = napoi, invers, pe spateDownward (s) = descendent, spre partea inferioarForward (s) = nainte, n faInward (s) = nuntru, ctre interiorLeftward (s) = ctre stnga, dinspre stngaOutward (s) = ctre/spre exterior, n afarTowards = spre, ctre, n direciaUpright = drept, verticalUpward (s) = ascendent, spre partea superioarSideways = lateral, oblic, ntr-o parte

Pair work7. Read the following commands to your deskmate and ask him/her to follow your indications and practise the exercises. Then, change activities:

Place your hands around your ankles. Rest your elbows on your thighs. Place your fingertips on your shoulder. Bend your body sideways and give it a good stretch. Lift your arms above your head. Spread your arms sideways and lower them to your sides. Clasp both hands behind your head. Arch your body backwards. Stretch your arms upwards. Bend your knees forwards. Hold your head forward and up. Raise your arms above your head and turn the palms towards the ceiling. Lean your forearms vertically on the wall. With your heels on the ground and your knees straight, let your hips sink forwards. 8. Read the following sentences and translate them into Romanian:

Without moving your head, turn your eyes upwards behind your closed lids. Roll your eyes in a clockwise circle Now notice the sensations of tension. Pause Roll them now in an anticlockwise direction. Place your palm downwards on a surface (table, chair arm or thigh); press your fingertips into the surface, drawing them towards your palm so that your hand gradually takes on the shape of a spider Hold the position, feel the tension in the hand and then let the tension go and relax the muscles. Keeping your toes firmly in contact with the floor, raise your heels up in the air Now feel the tension in your calf muscles Relax drop your heels to the ground and notice the relief, the comfort, the warm tingling sensation in your calves.

9. Create your own relaxation techniques; write down five examples of such exercises and then read them to your deskmates.

10. Translate into English, using the new words:1. Plasai-v ambele mini pe umeri. Rotii-v trunchiul alternativ la stnga apoi la dreapta.2. Stai n poziie deprtat, cu minile pe lng corp. Ridicai mna dreapt i ndoii corpul spre stnga. Revenii n poziia iniial. Apoi ridicai mna stng i ndoii corpul spre dreapta. Repetai micarea de cinci ori.3. ndoii-v uor trunchiul n fa. Atingei-v genunchii, apoi gambele, apoi gleznele i dac putei chiar i degetele de la picioare. 4.Stnd pe un scaun, plasai-v ambele coate pe coapse, ntindei-v antebraele i micai-v degetele.5. nchidei ochii, ridicai minile deasupra capului i arcuii-v uor trunchiul pe spate. Stai n poziie 10 secunde i apoi revenii n poziia iniial.6. Plasai-v ambele mini pe olduri. ndoii-v uor genunchii i apoi rotii-v corpul la stnga i la dreapta. Observai ce simii la articulaiile oldului.7. ntindei-v braele lateral. Apoi ndoii-le din coate spre n fa, la nivelul umrului. Repetai micarea de cte ori dorii. 8. Stai ghemuii pe vrfurile picioarelor, cu capul aplecat i cu minile atrnnd pe genunchi. Simii cum vi se relaxeaz muchii gtului. Meninei poziia ct dorii.9. Stai cu picioarele deprtate i cu minile pe old. nclinai-v spre dreapta, ridicnd piciorul stng. Meninei poziia pentru 5 secunde. Apoi repetai n direcia opus.10. Stai cu picioarele deprtate i cu minile ntinse lateral i cu pumnii strni. Rotii-v simultan braele, trasnd un cerc mic n aer. ncercai rotirea braelor n ambele direcii. Observai ce se ntmpl cu muchii braelor i pieptului.

UNIT 2THE SKELETAL SYSTEMINTERROGATIVE PRONOUNS AND ADVERBS USED BEFORE THE VERB TO BEASKING QUESTIONS

1. Read the following texts and write down the new words:The function of the bones is to form a hard skeleton for the softer materials of the body, to enclose and protect some of the most important vital organs. Bone development takes place at a very early period. In embryonic life, the parts destined to become bones consist of a congeries of cells which constitutes the simplest form of cartilage. This temporary cartilage is an exact miniature of the bone which in due course is to take its place. The process of ossification is slow and not completed until adult life. The next step is the ossification of the intercellular substance and of the cells composing the cartilage. The period of ossification varies much in different bones. It commences first in the clavicle, in which the primitive point appears during the fifth week; next in the lower jaw. The ribs also, and the long bones of the limbs, appear soon after. For a long period after birth, a thin layer of unossified cartilage remains between the diaphysis and epiphyses, until their growth is finally completed.(Henry Gray Gray`s Anatomy. Descriptive and Surgical)

Almost all the elements of the joints of adults are also present in the joints of the newborn. The most active factor determining the formation of a joint after birth are the muscles which exert an action on the given joint, i.e. the work of a joint. The development of bone articulations is directly dependent on the formation of the bony and connective-tissue structures and muscular tissue. All the elements encountered in the joints of the newborn continue their formation and acquire the geometrical shapes of the articular surfaces characteristic of each joint of an adult. (R.D. Sinelnikov Atlas of Human Anatomy)

VOCABULARY PRACTICE

2. Pronounce and learn the names of the main parts of the skeletal system. Add more terms to the list: The skeletal system:skull = craniuspine/spinal column/backbone = coloana vertebralvertebra, -ae /bony ring = vertebrspinal cord /marrow = mduva spinriithe cervical, dorsal, lumbar, sacral and coccygeal sections of the spine = seciunile cervicale, dorsale, lombare i coccigiene ale coloanei vertebralerib = coastcartilage = cartilajsternum /breastbone = sternclavicle /collarbone = claviculthoracic cage = cuc toracicshoulder girdle = centur scapularscapula/ shoulder blade = omoplat, scapulpelvis = pelvispubis = pubissacrum = os sacralcoccyx = coccisarticulation /joint = articulaiefibrous joint = articulaie fibroassynovial joint = articulaie sinovialossification = osificareligament = ligamenthip joint = articulaia olduluiknee joint = articulaia genunchiuluiankle joint = articulaia gleznei

3. Complete the following sentences using the nouns in the box. The first one has been done for you as an example:

sternum coccyxcarpuscalcaneusscapula phalangescraniumjointtibia metacarpusfemur vertebrae

1. The spine is a flexuous column, formed of a series of bones called _vertebrae_.2. The ____________ is composed of eight bones: the occipital, two parietal, frontal, two temporal, sphenoid, and ethmoid.3. The ____________ is a long, flat vertical bone, situated in front of the thorax to which are attached the collarbone and the first seven parts of ribs.4. The ____________ is the longest, thickest and heaviest bone in the skeleton, articulating with the pelvis above and the knee below.5. The ____________ is the inner and thicker of the two bones of the human leg, between the knee and ankle.6. The ____________ is a small triangular bone at the end of the spinal column, articulating by its base with the apex of the sacrum.7. The ____________ is a large, flat bone, triangular in shape which forms the back part of each shoulder.8. The hand is subdivided into three segments: the __________ or wrist, the ____________ or palm and the ____________ or fingers.9. The ______________ or heel bone is the largest tarsal bone, irregularly cuboidal in form and situated at the lower back part of the foot.10. The structures which enter the formation of a ___________ are: bone, cartilage, fibro-cartilage, ligament and synovial membrane.

4. Match up the following words with their definitions:

1. breastbonea. Rings placed one above the other which form a single column, the spinal column2. ligamentb. Triangular bone that forms the back of the pelvis3. skullc. Twelve pairs of curved bones extending from the backbone round the chest4. vertebraed. Narrow, bony and curved column as a cable for the spinal cord5. claviclee. Basin-shaped framework of bones at the lower end of the body6. spinef. Tough white flexible tissue attached to bones and joints7. pelvisg. Though, flexible tissue that connects bones and holds organs in position8. sacrumh. Thin, flat, vertical bone in the chest, between the ribs9. cartilagei. Bone joining the breastbone and the shoulder blade10. ribsj. Bony framework of the head under the skin

GRAMMARINTERROGATIVE PRONOUNS AND ADVERBS USED BEFORE THE VERB TO BEWhen forming interrogative sentences with the verb TO BE the rule to be remember is to place the words in the following order: WHATWHICHWHERE + is (sg.) / are (pl.) present + objectWHY +was (sg.) / were (pl.) past + object HOWHOW MANY

WHAT is used to ask somebody to specify one or more things, places, people, etc from an indefinite number:What are the main causes of muscular weakness?What is the shape of the spinal column?WHICH - is used to ask somebody to specify one or more things, people, etc from a limited number:Which is the best treatment in this situation?Which is the shortest and the most curved of all the ribs?WHY- means for what reason or purpose:Why is physical therapy better than surgery in my case?WHERE means in or to what place or position:Where is the sternum situated?HOW means in what way or manner:How is the sternum described in terms of shape, position, structure and development?HOW MANY is used to inquire about the number of things:How many phalanges are for each finger, except the thumb?

5. Ask questions for the underlined phrases using the interrogative words what, which, where, why, how, how many and the verb to be. The first two have been done for you as examples:

1. There are twelve ribs on each side of the thoracic part of the spinal column.How many ribs are on each side of the thoracic part of the spinal column?2. The foot consists of three divisions: the tarsus, metatarsus and phalanges.Which are the three divisions of the foot?3. The leg consists of three bones: the patella (knee cap), placed in front of the knee, the tibia and fibula. __________________________________________________________?

4. The patella is a small, flat, triangular bone situated at the anterior part of the knee joint.

__________________________________________________________?

5. The scapula is situated between the first and seventh ribs.

__________________________________________________________?

6. The sternum has the shape of an ancient sword, consisting of three parts.

__________________________________________________________?7. That form of cartilage which enters into the formation of the joints is called articular cartilage.

__________________________________________________________?

8. The ligament is pliant and flexible, so as to allow perfect freedom of movement but strong, tough and inextensible, so as not to yield under a severely applied force. (ask three questions)

_________________________________________________________?

9. There are 206 distinct bones in the entire skeleton of an adult.

_________________________________________________________?

10. The superior extremity is the largest part of the humerus.

_________________________________________________________?

6. Read the following extracts and translate them into Romanian:

Most bones of a human adult consist of a bony and cartilaginous framework, as a result of which a bony part and a cartilaginous part are distinguished in the skeletal system. The bony part makes up most of the bone. The articular cartilages, the epiphyseal cartilages and the costal cartilages form the cartilaginous part of the skeletal system.

The long bones (humerus, clavicle, femur, phalanges, etc.) have a middle part, the diaphysis, and two end parts, the epiphyses. The epiphysis located closer to the axial skeleton is called the proximal epiphysis, while the epiphysis of the same bone but situated further from the axial skeleton is called the distal epiphysis. The wider parts of long bones between the diaphysis and the epiphysis are known as metaphysis. Their boundaries are visible only in the bones of children and adolescents when a cartilaginous layer, the epiphyseal cartilage still remains between the diaphysis and epiphyses.

The red marrow possesses high functional activity and is capable of forming blood cells of the myeloid series. With the development and growth of the organism, the red marrow is gradually replaced by the yellow marrow. The yellow marrow is less active and plays a reserve role, but under certain conditions it may be activated. (R.D. Sinelnikov Atlas of Human Anatomy)

7. Translate the following questions into English, using the new vocabulary. Providing an answer to these questions will also test your anatomy knowledge:1. Care este tiina care se ocup cu studiul oaselor?2. Care sunt principalele tipuri de oase?3. Care sunt prile constituente ale unei articulaii?4. Care sunt cauzele care determin traumatismele i fracturile coloanei vertebrale?5. Din cte oase este format craniul i care sunt acestea?6. Care articulaie este cel mai frecvent afectat n fracturi?7. Cte vertebre are coloana lombar? Dar coloana toracal?8. Unde este plasat acromionul?9. Cum este descris sternul n atlasul de anatomie?10. De ce este intervenia chirurgical mai potrivit n acest caz dect fiziokinetoterapia sau balnoeterapia?

Pair work8. Question-answer exercise: Using your anatomy courses notes, ask your deskmate questions about the skeletal system.

UNIT 3THE MUSCULAR SYSTEMADJECTIVES BASIC KNOWLEDGEDESCRIBING A CERTAIN MUSCLE

1. Read the following texts about the muscular system and write down the new words:

There are more than 600 skeletal muscles in the human body and their total mass accounts for up to 28-35 per cent of the body mass in females, up to 40-45 per cent in males, and up to 45-55 per cent in athlets. Up to 50 per cent of the total weight of the skeletal muscles fall to the share of the muscles of the lower limbs, up to 30 per cent to those of the upper limbs, and up to 20 per cent to the share of the muscles of the head and trunk. Each muscle has a developed network of blood vessels. The contraction of a muscle promotes rapid flow of blood, i.e. the muscle is a peculiar pump which forces the blood forward. Under conditions of reduced motor activity (hypokinesia) in an active mode of life or when prolongued bed-rest is necessary, this function of the skeletal muscles is excluded as a result of which the blood flows slower, metabolic processes are reduced and stasis occurs. In contrast, under conditions of motor activity the reserve capillaries open, new capillaries form, and nutrition of the skeletal muscles improves. (R. D. Sinelnikov Atlas of Human Anatomy)

All elements of the musculoskeletal system are in dynamic equilibrum, continually changing shape, structure and function, in response to loading and mechanical demands. The system is vulnerable to trauma, peculiarly susceptible to local and systemic inflamatory disorders.Acute inflammation or tissue damage often becomes chronic, perhaps because of continuous movement and mechanical stresses.Musculoskeletal disorders are major worldwide causes of chronic pain and severe physical handicap, particularly as population becomes older, generally fitter, and more health conscious.(The Merk Manual of Diagnosis and Therapy)

Muscles vary considerably in their form. In the limbs, they are of considerable length, especially the more superficial ones, the deep ones being generally broad; they surround the bones and form an important protection to the various joints. In the trunk, they are broad, flattened and expanded, forming the parietes of the cavities which they enclose.(Henry Gray Grays Anatomy. Descriptive and Surgical)

VOCABULARY PRACTICE

2. Pronounce and learn the main terms and collocations related to the muscular system. Add more terms to the list:muscle = muchiskeletal muscle = muschi scheletictendon = tendonmuscular tissue = esut muscularblood vessels = vase sanguinenerves = nervifibers = fibrefascia = fasciediaphragm = diafragmmusculature = musculaturmuscle bulk = mas muscularmuscular contraction /cramp = contracie muscularmuscular endurance = rezisten muscularmuscle fatigue = oboseal/ extenuare muscularmuscular hypertrophy = hipertrofie muscularmuscle tone = tonus muscularhypotonic muscles = muchi hipotonicihypertonic muscles = muchi hipertonicimuscle rigidity = rigiditate muscularmuscle spasm = spasm muscularspasticity = spasticitatemuscle sprain = luxaiemuscle strain = ntindere muscularmuscle strength = for muscularmuscular tension = tensiune muscularmuscular weakness = slbire muscular

3. Match the half-sentences in column A with their corresponding half-sentences in column B to form correct and complete sentences:AB1. Muscle bulk.a. a progressive loss of muscle strength in a variety of muscle groups.2.Muscle-setting exercise.b. very firm, may be spastic or rigid and resists sideways movements.3. Muscular dystrophy is a degenerative muscle disorder characterized by .c. a muscle sprain or strain, arthritis, a tumor or a ruptured cartilage disk between vertebrae.4. Electromyography (EMG) is a techique d. very soft, weak and flabby and is easily moved laterally.5. A hypertonic muscle feels e. gives an indication of the state of the musculature.6. If you have observed muscle weakness, f. an evaluation of the condition and functioning of the muscles, joints and bones of the body.7. Involuntary movements and tremors g. is a method of contracting and relaxing a skeletal muscle without moving that part of the body.8. Low back pain at the base of the spine can be caused by h. that records changes in the electrical potential during muscle contractions.9. Musculoskeletal sysytem assessment is i. are signs of some neurological disorders.10. A hypotonic muscle feels j. then a detailed test will be necessary for each muscle.

4. Match up the following words with their definitions:

1. tendona. Fibre or bundle of fibres carrying impulses of sensation or of movement between the brain and all parts of the body2. fasciaeb. Large muscle at the front of the upper arm, which bends the elbow3. blood vesselsc.Wall of muscle, between the chest and the abdomen, that helps to control breathing4. fibresd. Very narrow blood vessels connecting arteries and veins in the body5. nervee. Fibrous membranes which form linings for body cavities and cover muscles and organs6. capillariesf. Strong band or cord of tissue that joins muscle to bone7. muscular dystrophyg. Slender threads of which many human, animal or plant tissues are formed8. diaphragmh. Tubes (arteries, veins or capillaries) through which blood flows in the body9. bicepsi. Broad, thick, triangular muscle, situated at the upper and anterior part of the chest that draws the arm towards the body10. pectoral musclej. Long-lasting illness in which the muscles become gradually weaker

GRAMMARADJECTIVES BASIC KNOWLEDGEParticipial and qualificative adjectivesConsidering the frequency of certain types of adjectives in medical language we shall deal only with participial and qualificative adjectives.Participial adjectives are participial forms used as adjectives:- Present Participle forms: short infinitive + -ING: increasing, relaxing, growing- Past Participle forms: short infinitive + -ED (for regular verbs): reduced, flattened, expanded or the third form of irregular verbs: cut, hidden, frozen.Example:This relaxing atmosphere and these stimulating exercises will have a pronounced effect on your back muscles.

Qualificative adjectives include all types of adjectives denoting quality, size, shape, colour, origin, age and general descriptions of objects (parts of the body, diseases, symptoms etc) and people: Example:The first piece of the sternum has a triangular form, broad and thick above and narrowed below.

Both participial and qualificative adjectives can either precede the noun, having the same form for all genders, both singular and plural (attributive position) or follow the noun, having the function of predicatives for copulative verbs such as: be, become, look, seem, turn etc:Example:Moderate exercises have a therapeutic effect on muscles.(attributive position)The muscles become resistant to fatigue and the patients no longer look exhausted at the end of the session.(predicative position)

Degrees of comparisonAccording to the way they form their degrees of comparison adjectives fall into three categories: monosyllabic (or short) adjectives and bisyllabic adjectives ending in -er, -y and ly which form their corresponding degrees of comparison by adding er and est (synthetic comparison):

thick thicker the thickestthin thinner the thinnestlong adjectives bisyllabic (ending in -ful and -re), trisyllabic or plurisyllabic which form their degrees of comparison by periphrastic means: more and (the) most (analytic comparison):

extensive more extensive the most extensiveadjectives with irregular degrees of comparison:good better the bestbad worse the worstlittle less the leastmany/much more the mostold older the oldest (of people and objects)old elder the eldest (of people)far farther the farthest (of space)far further the furtest (of time)

Constructions with comparisons:The use of adjectives at different degrees of comparison requires the use of certain patterns. For instance, adjectives at superlative will be associated with perfect tenses:This is the most distressing pain I have ever had.The comparative requires the specification of the second term of comparison, which can be either a word or a sentence:I am not as useless as my blind brother /as you think I am.The injury was more severe than we thought.Gradual increase or decrease is expressed by two comparatives joined by and:As your breathing becomes slower and slower you are feeling more and more relaxed.Sometimes the comparatives are placed at the beginning of the sentences:The sooner you practise the exercise, the better you will feel.The larger the muscle, the greater its strength.

5. Reread the texts about the muscular system and extract all the adjectives. Group them according to their attributive or predicative position. For derivational adjectives indicate the noun that they derive from and their suffix or prefix as in the following examples:

systemic = system (noun) + -ic (suffix)skeletal = skelet (noun) + -al (suffix)

6. Form derivational adjectives from the following nouns and verbs, choosing the appropriate suffixes in the box. Sometimes more than one suffix can be attached to part of the words:

-al -ic -ous -less-ish -ive -ful -able -ible -ed -ing

Example:Stern + -al = sternal

thorax comfortsphere to identifymuscleto contractabdomenaccessstomach memoryanomalyto connectfibre to digestfever healthcure infectionhelppain

7. Translate the following sentenses into English, using the new vocabulary and grammar notes of this unit:Ce cauzeaz hipertrofia muscular?Cu ct rezistena muscular este mai mare cu att va fi mai mare numrul de contracii musculare.Tensiunea muscular prelungit poate produce durere, care poate duce la spasm muscular i prin urmare la mai mult durere.Tensiunea muscular are strns legtur cu modul nostru de a gndi; astfel, cu ct suntem mai stresai, cu att mai mare va fi i tensiunea noastr muscular.Activitatea fizic prelungit cum ar fi mersul sau pasul alergtor poate duce la oboseal muscular.Care sunt cauzele principale ale extenurii musculare?Muchiul gastrocnemian este cel mai superficial muchi situat n partea din spate a piciorului, care formeaz cea mai mare parte a gambei.Tendonul lui Ahile este cel mai gros i mai puternic tendon din corpul uman.Muchiul deltoid este un muchi lat, gros, triunghiular, situat pe partea lateral i posterioar a umrului.Muchiul abductor al policelui este un muchi subire, plat, ngust, plasat imediat dedesubtul tegumentului (integument).

Pair work: 8. Using your anatomy courses notes, choose a certain muscle and ask your deskmate to describe it.

9. Guessing game: Think of a certain muscle. Your deskmate will ask you as many questions as necessary to guess the muscle. Here are some examples of possible questions:

Is it a muscle of the trunk/head/upper limb/lower limb? for general location(It is a muscle of the upper limb) Is it a muscle of the shoulder girdle or of the free upper limb? for specific location(It is a muscle of the shoulder girdle) Where is it situated?(It arises from the clavicle and scapula.) What is its function?(It helps the upper arm move forward, backward and horizontally.) Can you describe it?(It is a thick, triangular muscle with the base facing upwards and the apex downwards) Is it the deltoid muscle?(Yes, it is indeed.)

The following classification of muscles may prove useful for this exercise:A. The muscles of the trunk: the muscles of the back the muscles of the neck the muscles of the chest the muscles of the abdomen

B. The muscles of the head: the muscles of facial expression: the muscles of the scalp the muscles surrounding the eyes the muscles surrounding the mouth the muscles surrounding the nose the muscles of mastication

C. The muscles of the upper limb: the muscles of the shoulder girdle the muscles of the free upper limb: the muscles of the upper arm the muscles of the forearm the muscles of the hand

D. The muscles of the lower limb: the muscles of the hip joint the muscles of the free lower limb: the muscles of the thigh the muscles of the leg the muscles of the foot

10. Complete the classifications above with all categories of muscles you have studied so far.

UNIT 4EXAMINING THE PACIENTPOLYSEMANTIC WORDSTHERAPIST-PATIENT DISCOURSE Greetings, identification and introductory dialogues

1. Read the following text and check the glossary below to translate the unknown words. Write down other unknown words and try to approximate their meaning:

EXAMINING THE PACIENTExamination of a pacient is a continuous process that starts with your first meeting and continues until treatment ceases prior to discharge. The initial examination leads to an assessment of the pacients` needs and a decision on the early treatment.If the pacient has been previously examined by a diagnostician who provides full notes, some useful and time-saving information may be obtained by their careful perusal. To use such notes to the maximum, divide your perusal into: Obtaining basic information about the pacient as a social entity: names, sex, marital status, age, current work, former job and/or retirement status, cultural background and family circumstances. Reading, in date order, the medical events that are former medical history and the events that have marked the development of the current illness/disability and its progress. Noting, if available, the clinical examination findings and the results of tests, including X-rays. Any abnormalities indicated by the medical examination sheet need to be checked by the present examiner, as different variables such as the subjective assessment of the previous examiner or the change in patient`s condition from the last examination may influence the course of the treatment.Knowledge of normal parameters should be used to decide whether any of the test records show a need for care in examination and treatment. Obtaining a record of immediate past and current treatment and medication. It is important that current medications are noted for these may have some effect on selection of or precautions in administrating your treatments.When examining the pacient some things need to be provided: a clean, well ventilated, adequately warmed area, suitable coverings for the pacient, the position of the examination couch or table in relation to the lighting and, quite important, verbal confidentiality.There are some small testing devices that the examiner needs: a tape measure, a pin, a goniometer, a reflex hammer, some cotton wool, test tubes containing hot and cold water.Escorting the patient to the examination area can be an opportunity to observe his/her ability to walk unaided, the type of gait abnormalities if any, the general mien and posture.Successful questioning produces maximum information with the minimum of questions and is a skill that improves with practice. Listening to the patient`s answers requires patience, instant awareness and interpretation, and listening to the silences is equally important.What the patient fails to say may have great relevance.Palpation is a skill that is acquired by practice. It requires that your hands should be relaxed, in firm comfortable contact, and aware of what is under them.The following procedures are to be used when palpating for specific anatomical features: place more of your hand than you need in contact with the area to be examined, lift your palm a little to reduce the contact, so that only the finger pads are touching firmly enough.Your fingers should be straight so that your nails are unlikely to be in contact. Remember that too hard a pressure will feel like a drill digging in and too light a pressure will feel like a butterfly coming to rest. In neither case will you feel or find anything.Always allocate sufficient time for an initial examination of the patient, and if the examination turns out to be more time-consuming than your original estimate, complete only part of the tasks and conclude the examination at a further session.(Adapted from M.Hollis, P.Yung Patient examination and assessment for therapists)

GLOSSARYto cease = a nceta, a se opriprior to = nainte dedischarge = externareassessment = evaluare, estimarepreviously = mai nainte, n prealabilperusal = citire, lectur atentformer job = slujb anterioarretirement = pensionarecultural background = formaie culturalmedical history = anamnez disability = incapacitate, invaliditateclinical examination findings = constatrile examinrii clinicemedical examination sheet = foaie de observaie clinictesting devices = instrumente de testaretape measure = rulet, panglic de msuratpin = ac cu gmliegoniometer = goniometrureflex hammer = ciocnel pentru testarea reflexelor cotton wool = vattest tube = eprubetgait = umblet, mersmien = inut, comportamentposture = postur corporalinstant awareness = nelegere rapidpalpation = palparefinger pad = buricul degetuluidrill = burghiuto dig in = a nfige

2. Scan the text above so as to answer the following questions:1. Why is the patient`s initial examination important?2. What should basic information about the patient include?3. Why does the present examiner need to check the patient`s prior medical examination sheet?4. Why does the examiner need to note the patient`s current medication?5. What things need to be provided when examining the patient?6. What testing devices does the examiner use?7. What should the examiner observe while escorting the patient to the examination area?8. When can we say that questioning the patient has been successful?9. What procedures are to be used when palpating the patient?10. What should be done if the first examination takes longer than expected?

3. Create your own examiner patient dialogues, including questions and answers regarding the patient`s basic information, former medical history, clinical examination findings, past and current medication, etc.

VOCABULARY PRACTICE

POLYSEMANTIC WORDSMany words that are pronounced and spelt in the same way can be used in different contexts with different meanings. They are polysemantic words. Polysemy is closely related to homonymy and it is sometimes difficult to distinguish between words that are homonyms and words that are polysemantic. There is still a criterion that can help us distinguish one notion from the other: while with homonymy the words that have the same form do not share any semantic resemblance in their meanings, with polysemantic words we can easily notice a semantic feature common to all the elements of a class. Here are two examples for each notion: Heart, as a polysemantic word, has a semantic feature associated - that of being the central part of a body, of one`s life or of something else - that is carried over from one example to the next:Even if his heart stopped beating for several seconds, he did not die.I think you should get to the heart of the matter.He is my heart, my reason of living.Calf as a young of cattle (viel) or of certain other mammals such as the buffalo, elephant, giraffe and whale and calf as the thick fleshy part of the back of the leg between the ankle and the knee are two homonyms that have nothing in common, semantically speaking.Moreover, by looking words up in a dictionary, one can also distinguish between polysemantic words and homonyms as the former are listed with different numbers under the same lexical entry, while the latter are listed and treated as separate words: calf1 and calf 2.

4. Choose from among the meanings of the following polysemantic words the one that has been used in the text Examining the pacient:

examination means:written exercises, oral questions or practical tasks, set to test a candidates knowledge and skill;physical inspection of a patient or parts of his body, in order to verify health or diagnose disease;the formal interrogation of a person on oath (an accused or a witness) by a lawyer in a lawcourt.

discharge means:an official permission for (sb) to leave, after he has carried out a duty (discharge a soldier, a patient, release a prisoner from custody);unloading (cargo) from a shipfiring (a gun), launching flying weapons (arrows)

background means:part of a view, scene or description that forms a setting for the chief objects, people;information that is needed to understand a problem;a persons social class, education, training or experience;a low level of sound, lighting whose purpose is to be an unobtrusive or appropriate accompaniment to something else, such as a social activity, conversation or the action of a film.

device means:a machine or tool adapted for a special purpose (time-saving device, safety device, an explosive device etc);a particular pattern of words, figures of speech used in literature to produce a certain effect on the reader;a written, printed or painted design or figure, used as a heraldic sign, emblem, trademark by a noble family;a plan or plot, esp. a clever or evil one; a scheme, trick.

5. Write your own contexts in which the polysemantic words above, except for the version of your choice, are used with other meanings. You can use the following expressions: examination paperbackground musicentrance examinationworking-class backgroundto take an examinationbackground on the companys financial positionpass/fail an examinationtime-saving device = aparat de uz caznicmedical examinationlabour-saving device = dispozitiv mecanicto be under examinationan explosive device = dispozitiv explozibilto stay/keep in the backgroundstylistic device = figur de stil

6. Match each of the meanings below to one of the seven polysemantic words in the box:

a. patientb. tonguec. headd. foot e. bottomf. spine g. nerve

a movable organ in the mouth, used in tasting, licking, swallowing and speaking;foam on the top of a poured beer;a person who is receiving medical care in hospital;part of the body on which one sits, buttocks;a measure of length equal to 12 inches;row of bones along the back of humans and some animals, backbone;boldness, courage;a person capable of accepting delay that can still remain calm;part of the body, containing the eyes, nose, mouth and brain; a language, dialect or idiom; the lowest part of the leg, below the ankle, on which a person or animal sits; ground under the sea, lake or river; any of the bundle of fibres carrying sensory or motor impulses between the brain and all parts of the body; any of the sharp needle-like parts on some plants (cactuses) and animals (hedgehogs); chief person of a group or organization; a flap of leather on a shoe, under the laces or buckles to protect the instep; the lowest, deepest or farthest removed part of a thing; the back part of a book that is visible when it is in a row on a shelf; rib or vein in a leaf or any of the veins of an insect`s wing; mental ability or natural talent for something.

7. Write your own contexts for the different meanings of the polysemantic words above. You can make use of the following syntagms and expressions:

to be patient with sb. = a avea rbdare cu cinevamother tongue = limb maternto have lost/find one`s tongue = a-i pierde/redobndi graiulthe head of the family = capul familieihead office = sediu centralto have a good head for business, figures = a avea cap de afaceri, cifreat the foot/bottom of the stairs/hill/ mountain/list/page = n partea de jos a a 7-foot high wall = un zid nalt de 7 picioareto fall on one`s bottom = a cdea n fundthe bottom of the sea/lake/river = fundul mrii/lacului/ruluito go to the bottom = a se scufundato lose/regain one`s nerve = a-i pierde/redobndi curajulto have the nerve to do smth.= a avea curajul/tupeul de a face cevato strain every nerve = a-i ncorda toate puterile

THERAPIST-PATIENT DISCOURSE Greetings, identification and introductory dialoguesHere are some examples of initial greetings and introductory dialogues used before the examination takes place:

The therapist:Good morning, Mrs. Johnson. Let me introduce myself. I am your therapist, Dr. Green.Please come in and take a seat.Make yourself comfortable. I will be with you in a second.My name is Dr.Green. I think we talked on the phone, didn`t we?I remember you. You were my patient last year. How is your back?You are Dr. Thomson`s sister, aren`t you? He told me all about you.

Inquiring about the patient`s problem:Well, Mrs. Johnson, what can I do for you?Tell me, Mr. Baum, what`s troubling you?Well, Mrs. Redcliff, what`s brought you here?Well, let`s see what seems to be the problem?Your brother, Dr. Thomson tells me that you have been having low back painsI couldn`t help noticing your slight limp. Can you tell me more about it?I can`t tell you how sorry I am about your terrible accident. How is your recovery going on?I understand that you have seen several therapists before. How can I help you?

Programming further sessions:Considering your diagnosis, I will have to see you twice a week, for six weeks.For the first two weeks we shall meet every day till your pain goes away. Bring me the X-rays and then I will schedule a meeting for you for next week.I am sorry, but you should have seen an orthopaedist before coming here.I will meet you for our sessions three times a week, for at least three weeks.We shall start on Monday and see how it is going.I think we can have good results if you come to all your sessions.

Pair work8. Practise therapist-patient dialogues using the examples above. You can as well come up with your own examples.

9. Translate into English, using the new vocabulary:Recomandarea unui program de exerciii terapeutice nu se poate face fr o examinare amnunit a pacientului.Orice informaii cu privire la datele personale ale pacientului, la un diagnostic anterior i medicamentaie se pot dovedi extrem de importante n recomandarea terapiei ulterioare.Pe toat durata examinrii pacientul trebuie s se simt relaxat, protejat, fiind asigurat de confidenialitatea discuiilor sale cu terapeutul.Terapeutul poate sesiza n mod indirect anumite caracteristici motrice ale pacientului, prin simpla observare a posturii sale corporale, a inutei generale i a mersului acestuia.Palparea pacientului i testarea gradului su de mobilitate sunt indicii clare n stabilirea afeciunii prezente i indicarea tipurilor de exerciii corespunztoare.

UNIT 5TYPES OF INJURIESPASSIVE MODAL CONSTRUCTIONSPRESENT TENSE SIMPLE AND PRESENT PERFECTTHERAPIST-PATIENT DISCOURSE PATIENT`S SYMPTOMS AND COMPLAINTS FORMAL AND INFORMAL MEDICAL TERMS

1. Read the following extracts and check the glossary below for new words. Then translate these texts into Romanian:Patient rehabilitation after fractures Patient rehabilitation should begin immediately, depending on the type of fracture and soft tissue stability. Adjacent joints should be mobilized as soon as possible; however, in open fractures motion of musculotendinous units over fracture surfaces will irritate the soft tissues and may decrease resistance to infection. Immobilization of adjacent joints can be done by using splints, braces or foot attachments to external fixation systems. Physical therapy should include active exercises for joint mobilization, weight-bearing exercises, as well as range of motion and strengthening exercises, all practised under the close supervision of both the physician and the kinetotherapist. (Adapted from Thomas A. Russell General Principles of Fracture Treatment)

Hip dislocationHip dislocation is an orthopaedic emergency and must be reduced immediately. It occurs primarily in conjunction with severe multiple trauma from high-speed motor vehicle accidents. The longer the hip remains dislocated, the more likely is the possibility of complications, including avascular necrosis of the femoral head and posttraumatic arthritis. Most dislocations of the hip can be reduced by close manipulation and this treatment should take precedence over treatment of all other skeletal injuries. (Adapted from David G. LaVelle Acute Dislocations)

Sprains or ligamentous injuriesMost sprains or ligamentous injuries can be treated by immobilization. Even though immobilization allows the stretching of ligaments, quickly relieves pain and may be beneficial in reducing the swelling, many specialists report that early mobilization for these injuries produces superior results to immobilization.(Adapted from S. Terry Canale Ankle Injuries)

Rupture of muscles and tendonsThe most frequent cause of partial or complete rupture of a muscle or tendon is eccentric overload of the muscle-tendon unit. Muscle strains are initially treated with ice, rest and antiinflammatory medication, followed by a gentle stretching and progressive strengthening program as symptoms resolve. Failure to regain full flexibility and normal strength of the muscle-tendon unit results in increased risk of further recurrent injury. (Adapted from Barry B. Phillips - Rupture of muscles and tendons)

GLOSSARYrehabilitation = reabilitarefracture = fracturadjacent joint = articulaie adiacentto decrease = a reduce, diminuato increase = a mri, intensificasplint = atelbrace = ortezfoot attachment = dispozitiv de fixare a picioruluiweight-bearing exercise = exerciiu de susinere a greutii corporalerange of motion = grad de mobilitatestrengthening exercises = exerciii de ntrire muscularto occur = a se petrece, a avea locin conjunction with = n legtur cuavascular necrosis = necroz avascularfemoral head = cap femuralarthritis = artritto take precedence over smth = a avea loc nainte, a avea prioritate fa de skeletal injury = leziune a sistemului scheleticsprain = luxaie, scrntireto relieve pain = a alina durereaswelling = umflturrupture = ruptur, hernieoverload = ncrcare excesivmuscle strain = ntindere muscularfailure = eec, insuficienfurther = ulterior, adiional

2. Scan the texts above for modal constructions (can, may, should, must etc) and write them down. Then, underline the passive ones as in the examples below:

Example:Should beginShould be mobilized

Grammar PASSIVE MODAL CONSTRUCTIONS

All scientific languages make use of passive constructions to express impersonal observations, avoid mentioning unknown or indefinite subjects and focus on action and effect rather than on the agent that caused them.Even though the process of converting active constructions into passive ones seems to be artificial, it may prove to be useful and practical in situations when passives are preferred to active constructions. Here are some examples of passives constructions illustrated for modal verbs:

Excessive flexion and extension of the neck should be avoided in spinal injuries.Clinical instability may be caused by trauma, neoplastic or infections disorders.Spinal alignment can be obtained by skeletal traction.The pathologic anatomy must be carefully defined before treatment is determined.These pills must be taken twice a day, on an empty stomach. With modal verbs the transformation from active voice to passive voice is made by keeping the modal unchanged and using a passive infinitive:

Active Voice Passive Voice

Should avoid should be avoided (modal + BE + past participle short inf.+ ED )Must take must be taken (modal + BE + past participle the 3rd form of irregular verbs)

3. Insert the following modal constructions in their corresponding context, choosing the active or passive form that best completes the sentence:

must be applied should wear must be used should first direct should be confirmed may be selected must be covered should not be done should not be rubbed may be

Open hand wounds . immediately with a sterile dressing to prevent further contamination.If bleeding continues, manual or digital pressure to the wound through the dressing.At times it helpful to elevate the arm with the patient lying supine.Cleaning the wound .. in a hurry.Both the examiner and the patient .. masks when the wound is examined.Sterile instruments and gloves ..The examiner his attention to the circulation and skin and then to bones, tendons and nerves.The depth of the wound with a sponge or a brush.Suspected damage to tendons and nerves . by direct vision. A regional block or general anesthetic depending on the patient`s age and the severity of the injury.

4. Rewrite the following sentences in the passive voice, making the words in italics the subject of the sentence and placing, when necessary, the agent at the end of the sentence:

Example:The surgeon should closely follow the progress of patient`s regeneration.The progress of patient`s regeneration should be closely followed by the surgeon (agent). The examiner should advise the patient as to the extent of his injuries.The surgeon must evaluate the extent of the skin loss from the injury.The surgeons may delay the repairs of nerve and tendons.During surgical procedures the assistants should use a double binocular microscope.Surgeons can master microsurgical techniques only after countless hours of practice.The surgeon must avoid coffee just before surgery.If suitable instruments are available and if the surgeon is rested he may undertake repair of severed nerves on the day of injury.During weeks after nerves repair operation the patient should pay careful attention to avoid fixed contractures.After the operation the patient should begin progressive strengthening exercises. The patients should also make monthly clinical evaluations.

5. Translate into English using passive modal constructions:Pacientul suspectat de fractur a coloanei vertebrale nu trebuie mutat pn la sosirea ajutorului calificat.Dac este imperativ ca pacientul s fie mutat, capul, gtul i toracele lui trebuie susinute n poziia lor iniial de ctre mai multe persoane.Aceast plag ar trebui curat imediat iar fractura deschis ar trebui imobilizat.Primul ajutor n caz de rnire trebuie s fie ntotdeauna rapid, eficient i de preferin efectuat de ctre personal calificat.Programul de recuperare motorie a pacientului ar trebui nceput la cteva sptmni dup operaie.

THERAPIST-PATIENT DISCOURSEPatient`s symptoms and complaints Formal and informal medical terms

Patients and therapists/doctors do not always use the same language, even if they are speaking about the same things. There is a certain difference between a formal medical language used between doctors and medical care takers, the scientific language of all medical texts and an informal medical language that non-specialists (patients) use to describe their symptoms or disabilities. In therapist-patient communications a common informal language should be used to ensure proper communication. Here are some examples of the same notions with different formal vs. informal medical terms:

Formal termInformal termTranslation contusionbruisecontuzie, vntaie tenosynovitisinflamed tendonstenosinovit arteriosclerosishardening of the arteriesarteroscleroz sedativesleeping pill, dopesedativ analgesicpain killeranalgezic, calmant

6. Match the formal term in column A with its corresponding informal term in column B:

AB1. thyroid cartilagea. dizziness2. halitosisb. bamboo spine3. maxillac. lower jaw4. alopeciad. palpitations5. spine e. heart attack6. tachycardiaf. Adam`s apple7. mandibleg. low blood sugar8. myocardial infarctionh. bad breath9.ankylosing spondylitisi. womb10. subluxationj. backbone11. thoraxk. flu12. influenzal. chest13. hypoglycaemiam. dislocation14. uterus n. upper jaw15. vertigoo. baldness

Without assuming to cover at least part of the symptoms and problems that patients may have when coming to see a kinetotherapist, some examples of common complaints are presented below:

Patient`s symptoms and complaints:

I have sprained my left ankle. (Mi-am rsucit/ luxat glezna stng)I have strained my deltoid muscle. (Am o ntindere muscular la deltoid.)I have pulled a hamstring muscle. (Mi-am ntins un tendon muscular.)I have torn a ligament in my right knee. (Am o ruptur ligamentar la genunchiul drept.)I have snapped a tendon in my left thigh. (Am o ruptur de tendon la coapsa dreapt.)I have got a cartilage problem in my left knee joint. (Am o problem la nivelul cartilajului articulaiei genunchiului stng.)I have got chilblains in my toes. (Am suferit degerturi la degetele de la picioare.)I have pins and needles in my feet all the time. (Simt furnicturi n picioare tot timpul.)I feel a tingling sensation in my fingers. (Simt o senzaie de furnicturi n degete.)I have got a severe pain in my left heel. (Am o durere puternic n clciul stng.)I get cramp in my calves. (Am crampe la gambe.)I have got swelling of my ankles. (Am gleznele umflate.)I have got numb fingers/legs when I wake up. (Am degetele/picioarele amorite cnd m trezesc.)My fingers tremble a lot and even my hands have started shaking.(mi tremur degetele i chiar i minile.)

GrammarPresent Perfect and Present Tense Simple are the tenses normally used to express complaints in the above sentences.

7. Identify each tense in the sentences above and say how they are formed.Example:Have sprained = Present Perfect Simple; formation: the auxiliary verb have + past participle of the regular verb sprain (short infinitive + -ed)Have torn = Present Perfect Simple; formation: the auxiliary verb have + past participle of the irregular verb tear (tear, tore, torn)

Present Perfect Simple is used in the above-mentioned complaints to express previous causes/injuries that still have a certain effect in the present, while Present Tense Simple makes these complaints a general fact, the symptoms presented are something felt as usual.

8. Put the verbs in brackets into the Present Tense Simple or Present Perfect:

_______ you ever ________ (sprain) your ankle? It`s not so bad but you have to stay in bed for a while._______ it _________ (hurt) if I touch your swollen ankle? ______ you _______ (feel) a burning sensation?My aunt`s fingers always __________ (tremble) when she ________ (give) me my monthly allowance.I am still in hospital. I ________________ (not recover) yet. I always ______ (get) cramps in my calves in the morning.I ________ already _________ (practise) this stretching exercise three times. Yes, but you still ___________ (not do) it right.

9. Translate into English using Present Perfect Simple and Present Tense Simple as in the above-presented examples of patient`s complaints; sometimes modal verbs are to be used as well:

Nu pot s-mi ndoi cotul drept. Cred c mi l-am luxat.Mi-am fracturat oldul i am nevoie de exerciii de reabilitare.Mi-am dislocat umrul stng. A dori s am un grad mai mare de mobilitate. Mi-am rupt trei coaste ntr-un accident de schi. Am fost n spital ase sptmni.Am adesea crampe durerose n ambele gambe dup terminarea meciului de fotbal.Cnd m scol dimineaa nu-mi simt picioarele de la genunchi n jos.Am dureri de spate acute. Am fost la muli doctori i m-am hortt s ncerc i nite exerciii terapeutice.Am o ntindere muscular suprtoare la nivelul gtului. Am nevoie de cteva exerciii de ntindere pentru a-mi redobndi flexibilitatea.Am o ruptur de tendon n deltoid i nu-mi pot continua programul de antrenament pentru Olimpiad.Am contracii musculare n gamba stng iar fora mea muscular nu mai este aceeai.

10. Place yourself in a patient`s situation and complain about your symptoms, asking your colleagues future kinetotherapists for help and advice.

UNIT 6THERAPEUTIC EXERCISESWORD FORMATION DERIVATIONTHERAPIST-PATIENT DISCOURSE RECOMMENDING DIFFERENT THERAPEUTIC EXERCISES

1. Read the following text and write down the new words; then translate it into Romanian, using the glossary below.

THERAPEUTIC EXERCISESThe goals of therapeutic exercises include the prevention of dysfunction as well as the development, improvement, restoration or maintenance of strength, endurance and cardiovascular fitness, mobility and flexibility, stability, relaxation, coordination, balance and functional skills.Strength is the ability of a muscle or muscle group to produce tension and a resulting force during a maximal effort, either dynamically or statically, in the relation to the demands placed upon it. To increase strength, a load that exceeds the metabolic capacity of the muscle must be used during exercise. To produce greater muscular tension, a high-intensity exercise (exercise performed against heavy loads) must also be used, but for a relatively low number of repetitions.Muscular endurance is the ability of a muscle to contract repeatedly or generate tension, sustain that tension and resist fatigue over a prolonged period of time. It is necessary for performing repeated motor tasks in daily living, such as walking or climbing stairs. Active exercises that challenge the oxygen transport system will increase endurance - the major goal of cardiac rehabilitation programs. Exercises are usually directed to large muscle groups, as in walking, running, swimming and cycling and are to be prolonged and performed for 15 to 45 minutes or more.Mobility of soft tissues and joints is necessary for the performance of normal functional movements. Flexibility is the ability to move a single joint or series of joints through an unrestricted, pain-free range of motion. It is dependent upon the extensibility of muscles, which allows muscles that cross a joint to relax, lengthen and yield to a stretch force.Stability is usually required in more proximal structures, such as the trunk, hips and shoulder girdle, for effective positioning and motion of the arms and hands or legs and feet.Stabilization exercises are the means by which a patient can learn to control proximal areas of the body and, at the same time, maintain a stable, well-aligned position while carrying out functional activities. Relaxation refers to a conscious effort to relieve tension in muscles.Exercises promoting relaxation are based on the therapeutic use of reflexive and conscious processes. Thus, the patient should be placed in a comfortable position, with all body parts well supported and be taught to progressively contract and relax the musculature.This process is often coupled with deep-breathing exercise to further promote relaxation.Coordination, balance and the acquisition of functional skills are all interrelated and are complex aspects of motor control. Coordination refers to the ability to use the right muscles at the right time with appropriate intensity. It is the basis of smooth and efficient movement that can occur on a voluntary or involuntary level. Balance refers to the ability to maintain the center of gravity over the base of support, usually while in an upright position. It is a dynamic phenomenon that involves a combination of stability and mobility. Finally, functional skills refer to the varied motor skills necessary to function independently in all aspects of daily living. Learning functional motor tasks involves constant repetition of simple to more complex motor activities, use of sensory cues (tactile, visual) to enhance motor performance and as the quality of movement improves, so should the speed and timing of movements.(Adapted from Carolyn Kisner&Lynn Allen Colby Therapeutic Exercise. Foundations and Techniques)

GLOSSARYdysfunction = disfuncierestoration = refacere, restabiliremaintenance = meninerestrength = for, vigoareendurance = rezisten fiziccardiovascular fitness = tonus cardiovascularbalance = echilibrufunctional skills = abiliti funcionaleload = greutatea high-intensity exercise = exerciiu cu intensitate crescutfatigue = obosealmotor tasks = sarcini motoriito challenge = a solicitarange of motion = grad de mobilitateto lengthen = a se lungi, ntindeto yield to = a ceda, a nu rezista lastretch force = for de ntinderestable = stabilwell-aligned position = poziie corect adoptat carry out = a ndeplini, a realizato relieve = a destinde, relaxadeep-breathing exercise = exerciiu de respiraie profundacquisition = dobndire, obineresmooth movement = micare lin, fr ntreruperiupright position = poziie verticalsensory cues = indici senzorialito enhance = a mri, intensificamotor performance = randament motoriutiming = sincronizare

Pair-work2. Question-answer exercise: Reread the text above on paragraphs. One student will ask his/her colleague one or two questions for each paragraph and he/she should answer it either by reproducing fragments from the text or by freely expressing a summary of that fragment. Here is an example for the first paragraph:

Example:What are the main goals of therapeutic exercises?Well, if I remember corectly, the goals of therapeutic exercises are.

How is strength defined in the text?Well, let my see, strength is defined as ..What should be done to produce greater muscular tension?Well, it says here that a high-intensity exercise.

3. Question-answer exercise: Try to find out how much you really know about your physical abilities. Ask your deskmate to make a self-evaluation of his/her physical abilities (strength, muscular endurance etc.); in your answers you can make use of the following assessment patterns or come up with new ones:

Well, my strength is quite bad/ is not so bad/ is actually quite good/ is excellent.Muscular endurance is not my stong point, if you get my meaning.As for my mobility and flexibility, it goes without saying that all I need is a little practice, to get back into shape.Well, my stability depends a lot on my mental stability; a state of nervousness will certainly be detrimental to my stability.I have always had problems with balance; to me, it is sometimes that does not improve with practice; you either have it or not.

WORD FORMATION DERIVATION

Derivation with suffixes and prefixes is one of the means of word formation. Generally, there are some typical noun/ adjective/ adverb/ verb forming suffixes and prefixes, but there are cases when the same prefix or suffix is used to form different categories. For instance the suffix al is used to form both nouns like in arrival, refusal, proposal and adjectives like in functional, educational. The suffix ing is used to form the present participle that can be used as a verbal category (She came walking across the field.), as a noun (Walking can sometimes be very relaxing.) or as an adjective (He was reading a very amusing novel.). The suffix ly is the most common adverb-forming suffix (rapidly, daily, usually). Still, there are some adjectives that contain the ly suffix: daily schedule, monthly payment. The following exercises are meant as forms of practising the word formation process.

4. Extract from the text above (Therapeutic exercises) all the derivational nouns and include them into their corresponding suffix category as shown in the example:Example:-ion: prevention -ment: development-ance: maintenance-ness: fitness-ity: mobility-ing:walking5. Find the corresponding base forms (verbs, adjectives) and the corresponding suffixes for every derivational noun in the same text:Example:prevention prevent (verb) + -ion (suffix)mobility mobil (adjective) + -ity (suffix)

6. Extract from the text above (Therapeutic exercises) all the derivational adjectives and include them into their corresponding suffix category:Example:-ic: therapeutic-al: functional-ing: resulting-ed: prolongued-ive: effective-ly: daily-(i)ous: conscious-able: comfortable-y: sensory

7. Find the corresponding base forms (nouns, verbs) and the corresponding suffixes for every adjective in the text: Example:therapeutic therapeut (noun) + -ic (suffix)

8. Extract from the text above (Therapeutic exercises) all the derivational adverbs and include them into their corresponding suffix category:Example:-ly: relatively-ally: dynamically

9. Find the corresponding base forms (adjectives) and the corresponding suffixes for every adverb:Example:relatively relative (adjective) + -ly (suffix)

There are many nouns in English that have an identical form with their corresponding verbs:

VerbsNounsto pressurepressureto questionquestionto estimateestimateto exerciseexerciseYet, sometimes there are some slight spelling differences between the noun and its corresponding verb that can easily pass unnoticed:

VerbsNounsTo practisepracticeTo respondresponse

10. Give other examples of nouns that have the same form as their corresponding verbs and write contexts in which the same word functions both as a noun and as a verb.

11. Write in the second column the corresponding nouns for the verbs listed in the first column. The first one has been done for you as an example:

includeinclusion_

examine________prescribe________operate________assess________decide________retire________interpret________confirm________immobilize________rehabilitate________swell________treat________dislocate________

12. Rewrite the sentences below using the nouns in the second column (exercise 11) instead of their corresponding verbs. Do not change the meaning of the sentences:

Example:It was more than vital to include Mr. Dean in our clinical study.Mr. Dean`s inclusion in our clinical study was more than vital.

I will be able to tell you more after I examine the patient.You should not take these pills if the doctore did not prescribe them.The surgeons operated on the injured man immediately.After the therapist assesses the patient`s needs, he will also decide a further treatment.As Mrs. Strauss retires next month, she will have more time for her therapy.After the doctor interprets the results of your X-rays, he will probably confirm your need for surgery.

To immobilize the patient`s fractured leg is one of the first aid measures to be taken.Our clinic is specialized in rehabilitating patients who suffered severe injuries.What can I do if my ankle swells over night?I cannot treat patients without their full consent and cooperation.If the patient`s shoulder is dislocated, an emergency intervention is needed.

THERAPIST-PATIENT DISCOURSE Recommending different therapeutic exercises

Listening to the patients`complains and symptoms will normally be followed by the therapist`s recommandations regarding different therapeutic techniques and exercises. Here are some examples of such kinetotherapy exercises that therapists may recommend to their patients:

Kinetotherapist`s recommandations:

You should start with a very simple relaxation technique.A deep-breathing exercise will help you relax.Some massage sessions will be good for your local circulation.Passive stretching exercises will lengthen your shortened tissues.You can practise these self-stretching exercises as part of your home exercise program.As a gymnast, do not forget to practise your overstretching exercises.Considering your long-term immobilization, you need to practise strengthening exercises every day. The best solution for you to regain your balance is to practise weight-bearing exercises.I recommend you to continue with joint mobilization techniques to treat your muscular stiffness.In treating your spine injury, traction techniques are a good option.

13. Translate the above sentences into Romanian and say whether you are familiar with these exercises; give examples of such types of exercises.

14. Consider yourself as a kinetotherapist; choose one type of the exercises above and explain the basic procedure to a colleague- patient of yours.

15. Consider yourself as a patient with a certain dysfunction (you can choose one of the symtoms presented in Unit 5) and ask your colleague-therapist what exercises he would recommend you.

16. Translate into English using the new vocabulary:

Este foarte important s-i alegi un program de exerciii care s-i fie cu adevrat de ajutor.Exerciiile de meninere a greutii corporale ar trebui s nceap cu renvarea schimbrii greutii corporale.Dac vrei s-i corectezi postura corporal defectuoas ar trebui s ncepi cu exerciii de ntrire a musculaturii slbite.Exerciiile de ntindere sunt recomandate persoanelor n vrst, indivizilor sedentari i persoanelor care se refac dup operaii sau o imobilizare prelungit.Creterea rezistenei musculare va duce implicit la mbuntirea tonusului cardiovascular.Tehnicile de mobilizare a articulaiilor sunt folosite n tratarea atrofiei cartilajului articular, a slbirii ligamentoase, a hipomobilitii articulare .a.m.d.Tehnicile de traciune sunt practicate pentru a se redobndi flexibilitatea, fora, rezistena i stabilitatea coloanei vertebrale.Poi s-i menii echilibrul timp ndelungat pe o suprafa ngust i fiind legat la ochi?Rezistena muscular nu este intotdeauna rezultatul antrenamentelor susinute. Urcatul i cobortul scrilor ntr-un bloc fr lift, alergatul dup autobuz sau mersul pe jos ne in n form n fiecare zi.Toate capacitile noastre fizice pot fi perturbate atunci cnd sunt nevoii s fim imobilizai la pat pentru o perioad prelungit de timp.

UNIT 7THERAPEUTIC PROCEDURES IN HANDLING THE PATIENTPASSIVE VERBAL CONSTRUCTIONSTHERAPIST-PATIENT DISCOURSE positioning and handling the patient

1. Read the following extracts and then solve the tasks that follow them:

Movements at a joint are determined by the shape of the articular surfaces. For instances, the following movements are possible at the shoulder joint: flexion and extention about the transverse axis with the movements occurring in the saggital plane; abduction and adduction about the anteroposterior axis, in which case the movement is made in the frontal plane; and finally, rotation about the vertical axis including pronation (medial rotation) and supination (lateral rotation), with the movement occurring in the horizontal plane.(R. D. Sinelnikov Atlas of Human Anatomy)

Weight-bearing control and stabilityDevelop ability to shift the body weight. If the patient cannot bear full weight, begin in the parallel bars with part of the weight borne on the hands. The patient shifts anteriorly, side to side, and obliquely. Manual resistance to the motion is added with pressure against the patient`s pelvis.

To increase flexion of the hip with the knee extendedHand placement:With the patient`s knee fully extended, support the patient`s lower leg with your arm or shoulder.Stabilize the opposite extremity along the anterior aspect of the thigh with your other hand or a belt or with the assistance of another person.With the knee in maximum extension, flex the hip as far as possible.Alternate position.Kneel on the mat and place the patient`s heel against your shoulder. Place both of your hands along the anterior aspect of the distal femur to keep the knee extended.The opposite extremity is stabilized in extension by a belt or towel and held in place by the therapist`s knee. To increase dorsiflexion of the ankle with the knee extendedHand placementGrasp the patient`s heel (calcaneus) with one hand.Stabilize the anterior aspect of the tibia with your other hand.Pull the calcaneus downward with your thumb and fingers and gently push upward on the heads of the metatarsals.

To increase wrist extensionHand placementPronate the forearm and grasp the patient at the palmar aspect of the hand. Stabilize the forearm. To lengthen the wrist flexors, extend the patient`s wrist, allowing the fingers to passively flex.Alternate position: Support the patient`s forearm on the table but allow the hand to drop over the edge of the table. Then passively extend the wrist. This may be more comfortable for the therapist or necessary if the patient has a severe wrist flexion contracture.(Carolyn Kisner&Lynn Allen Colby Therapeutic Exercise. Foundations and Techniques)

Tasks

Enumerate the movements that are possible at the shoulder joint.Name the type of therapeutic exercise that deals with controlling body weight.What is hand placement?Which parts needs to be stabilized in: hip flexion, ankle dorsiflexion and wrist extension?What should the therapist do to to lengthen the wrist flexors?What is recommended if the patient has a severe wrist flexion contracture?What objects does the therapist use in handling the patient?Pair work: Choose one of the last three therapeutic procedures and illustrate them, respecting the indications offered in the texts.Pair work: Repeat the task at point 8, this time with the therapist describing the procedure (in his /her own words) while illustrating it in front of the class.Invent one type of exercise for a certain purpose, first practise it with your deskmate and then, describe it to your audience.

2. Complete the missing correspondent in the following verb-noun pairs:

VERBSNOUNS

flexion

extension

abduction

adduction

rotationto pronate

to supinate

resistance

pressureto stabilize

to lengthen

to support

3. Complete the missing correspondent in the following adjective-adverb pairs:

ADJECTIVEADVERBpossible

manual

anteriorly

obliquelycomfortable

necessary

gently

passively

fullyhorizontal

severe

GrammarPASSIVE VERBAL CONSTRUCTIONS

In Unit 5 we have already introduced the issue of Passive Voice and exemplified its use in dealing with passive modal constructions. Learning how to use the passive forms of the most frequently used verbal tenses is the objective of this unit.As a general rule, the passive voice is formed by putting the verb to be into the same tense as the verb in the active voice and adding the past participle of the active verb. The direct object of the active verb becomes the subject of the passive verb, while the subject of the active verb becomes the agent of the passive verb.

Example:

Therapists sometimes hypnotize their patients. subjectdirect object

The patients are sometimes hypnotized by their therapists. subject agent

Read the chart below to see how the active to passive transformation works for the main verbal tenses:

TENSESACTIVE VOICEPASSIVE VOICEPresent Tense Simpletreatam/is/are treatedPresent Tense Continuousis/are examiningis/are being examinedPast Tense Simpleinjuredwas/were injuredPast Tense Continuouswas/were transportingwas/were being transportedPresent Perfecthas/have foundhas/have been foundPast Perfecthad dischargedhad been dischargedFuture Tense Simplewill/shall includewill/shall be includedFuture Perfectwill/shall have healedwill/shall have been healedConditionalwould recoverwould be recoveredPerfect Conditionalwould have savedwould have been savedGerundpractisingbeing practised

4. Put the verbs in brackets into the passive voice of the tense indicated:

Example:The range of motion of the ankle is restored (restore Present Tense Simple) by performing stretching exercises.

The ankle ___________________ (immobilize Present Tense Simple) in a short cast for 3 to 4 weeks.The patient`s lower leg ___________________ (elevate Present Tense Continuous) now.Successive weight-bearing stresses ________________ (impose Past Tense Simple) on the feet.These faulty foot postures __________________ (cause Present Perfect) by the excessive adduction of the forefoot.The rehabilitation program ________________ (start Future Tense Simple) as soon as possible.Little effort _______________ (require Present Tense Simple) to maintain this position for extended periods.Ankle and foot motions ________ previously ____________ (perform Past Perfect) by the patient.The same motion ____ now ____________ (repeat Present Tense Continuous) with the patient in alternate position.Many balance activities _________________ (practise Past Tense Simple) but without any result.Muscular endurance _________________ (increase Present Perfect) by performing the same exercises for a repeated number of times.

5. Change the following sentences from Active Voice into Passive Voice; the underlined direct objects will become the subjects of the passive sentences:

Example:The patient sometimes describes pain from muscle spasm as a headache.Pain from muscle spasm is sometimes described as a headache.

If the patient is experiencing acute inflammation, he should be placed in a less irritating position.If a disk lesion is the cause of the acute back pain, the therapist will first take measures to alleviate the pain.Injury or degeneration of the disk affects spinal mechanics in general.The patient with acute disk lesions has avoided sitting with the hips and knees flexed or leaning forward.The patient needs bed rest during the first 2days when symptoms are highly irritable.The therapist will instruct the patient to avoid flexion activities that increase intradiskal pressure.In one of my patients with spondylosis, traction exercises temporarily relieved the pressure.Many patients have often expressed emotional stresses as increased tension in their lumbar region.The patient performs elongation exercises only within tolerance during the early healing phase.Imbalances in the shoulder girdle will perpetuate faulty postures.

THERAPIST-PATIENT DISCOURSE Positioning and handling the patient

Pair work6. Read the following positioning indications to your colleague-patient who will then illustrate them in front of the classs:

The patient is supine, with arms in resting position.The patient is side-lying, with the affected hip up.The patient is hook-lying.The patient is cross-sitting.The patient is heel-sitting.The patient is on hands and knees.The patient is prone, with hands placed under the shoulders.The patient is supine, with the foot pointing upright to keep the hip neutral to rotation.The patient is sitting, with the forearm supported on the treatment table, wrist over the edge of the table.The patient is standing, with the hands placed in the low-back area.

Team work 7. Read the following hand placement and stabilization procedure indications to a therapist-patient pair who will then illustrate them in front of the classs.

Grasp the patient`s wrist with your lower hand.Place your thumb on the anterior surface of the proximal end of the clavicle.Place a belt around your shoulder and under the patient`s thigh to help hold the weight of the lower extremity.Support the patient`s leg with the fingers of the top hand under the patient`s knee and the lower hand under the heel.Stabilize the patient`s pelvis with the top hand or arm.Stabilize the patient`s pelvis by flexing the opposite hip and holding the thigh with the hands. The hip to be mobilized is in resting position.Sitting on a low stool, stabilize the leg between your knees and place one hand on the anterior aspect of the tibia.

Team work8. Read the following therapeutic techniques to a therapist-patient pair who will then illustrate them in front of the classs:

Perform elbow flexion and extension with the forearm pronated as well as supinat