Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Multiple tender points: Discrete local areas of deep tenderness widely dispersed throughout the body and involving a variety of otherwise normal tissues are a pathognomonic feature provided about 60% of examined sites are tender discount 10 ml ophthacare free shipping ratnasagar herbals pvt ltd. Tender points are found within muscle and over tendons discount ophthacare online master card herbalsmokecafecom, muscle insertions purchase ophthacare 10 ml with mastercard herbals for cholesterol, and bony prominences. Tender point sites are “tender in many normal individuals but are reported as “painful, often with grimace or withdrawal when palpated, in those with fibromyalgia. The predictable location of these tender points and their multiplicity are essential features of the syndrome. Associated Symptoms and Signs Paresthesias: Most often involving the upper extremities, are found in 60%. Skinfold Tenderness: the rolling of the skin and subcutaneous tissues of the upper scapula region between the examiners thumb and index finger elicits tenderness in 60%. Reactive Hyperemia: Redness of the skin developing after palpation of tender points over the trapezius and contiguous regions is found in half the patients. Autonomic Phenomena: Reactive hyperemia is the most commonly recognized feature, but temperature changes and mild soft tissue swelling involving the distal upper extremities are also frequently reported. Aggravating and Relieving Features Cold, poor sleep, anxiety, humidity, weather change, fatigue, and mental stress intensify symptoms in 6070%. Symptoms are typically made worse or brought on by prolonged or vigorous work activity. Signs Tender points, widely and symmetrically distributed, are the characteristic sign of the syndrome. Relief Relief may be provided by reassurance and explanation about the nature of the syndrome and possible mechanisms of pain: anxiety may thus be reduced, expensive and hazardous investigations and treatments limited, and use of medication reduced. Low dose amitriptyline, cyclobenzaprine, and aerobic exercise have been shown, in placebo controlled double blind studies, to improve symptoms. Blood flow during exercise is reduced, and decreased oxygen uptake in muscles has been noted. Two studies have found increased levels of substance P in the cerebrospinal fluid of patients. In general, these findings, some of which may be secondary phenomena, have been insufficient to explain the major signs and symptoms of the syndrome. It also is noted frequently following trauma, and has been known to Page 46 develop after apparent viral illness. Thus the syndrome may be the final common pathway, perhaps as hyperalgesia, for a number of causative factors. Trauma or degenerative changes in the cervical or lumbar regions might precipitate the syndrome. An association with previous major depression in patients and families has suggested a genetic factor. Classification Criteria for Primary and Concomitant Fibromyalgia (from Wolfe et al. History of Widespread Pain Definition Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist and below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present. In this definition, shoulder and buttock pain is considered as pain for each involved side. Pain in 11 of 18 Tender Point Sites on Digital Palpation Definition Pain, on digital palpation, must be present in at least 11 of the following 18 tender point sites: Occiput: bilateral, at the suboccipital muscle insertions. Low Cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7. Supraspinatus: bilateral, at origins above the scapula spine near the medial border. Second Rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces. Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle. For a tender point to be considered “positive, the subject must state that the palpation was painful. For classification purposes, patients will be said to have fibromyalgia if both criteria are satisfied. The presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Note: Specific Myofascial Pain Syndromes Synonyms: fibrositis (syndrome), myalgia, muscular rheumatism, nonarticular rheumatism. Specific myofascial syndromes may occur in any voluntary muscle with referred pain, local and referred tenderness, and a tense shortened muscle. Passive stretch or strong voluntary contraction in the shortened position of the muscle is painful. Satellite tender points may develop within the area of pain reference of the initial trigger point. Diagnosis depends upon the demonstration of a trigger point (tender point) and reproduction of the pain by maneuvers which place stress upon proximal structures or nerve roots. This suggests that the syndrome is an epiphenomenon secondary to proximal pathology such as nerve root irritation. Relief may be obtained by stretch and spray techniques, tender point compression, or tender point injection including the use of “dry needling. Others may be coded as required according to individual muscles that are identified as being a site of trouble. Rheumatoid Arthritis (I-10) Definition Aching, burning joint pain due to systemic inflammatory disease affecting all synovial joints, muscle, ligaments, and tendons in accordance with diagnostic criteria below.
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In some states order discount ophthacare on-line yogi herbals, such as Western Australia purchase ophthacare with visa herbals scappoose oregon, a person nominated to make decisions for a patient cannot give consent for participation in clinical trials purchase discount ophthacare on-line himalaya herbals nourishing skin cream. Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 23 Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 2321 What participation might involve People participating in clinical trials may be asked to undergo extra tests or answer survey questions, and take part in follow-up tests some time after the treatment. Participation in brain tumour clinical trials may involve being asked to: • complete questionnaires about quality of life, which are designed to measure how the tumour and the treatment is affecting the persons wellbeing • undergo tests to measure cognitive functioning, which can help researchers understand whether the treatment can improve thinking ability • undergo extra blood tests to help researchers understand more about how the treatment works, who the treatment may be most effective for, how much of the treatment reaches the bloodstream, or side effects of the treatment • give permission for the original tumour specimen (taken by biopsy or during surgery) to be sent to another place for more testing. This testing might help researchers understand more about how the treatment works or which future patients may have the most benefits from treatment. This allows researchers to understand the long term benefits or side effects of treatments. Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 24 2422 Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 4. Symptoms of brain tumours Key points • Symptoms that lead to the diagnosis of a brain tumour depend on several factors including the size of the tumour, its location in the brain, and how rapidly it is growing. Symptoms at the time of diagnosis the most common symptoms at the time of diagnosis include headache, nausea and vomiting, cognitive impairment (problems with thinking, memory and reasoning), seizures, and stroke- like symptoms such as weakness or blindness. After the diagnosis, family members or friends may mention other symptoms that they noticed weeks or months earlier, such as mild changes in the persons thinking or personality. Symptoms of a brain tumour depend on several factors including the size of the tumour, its location in the brain, and how rapidly it is growing. For example: • A small tumour deep within the dominant side of the brain may cause significant problems with brain function, while a tumour in the non-dominant frontal lobe may become very large before the person experiences any symptoms. Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 25 Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 2523 • Patients with tumour in more than one area may have symptoms indicating that multiple areas of the brain are affected. In most patients, the position of the headache does not help doctors work out where the tumour is. Pattern and type of headache Headaches that are caused by a build-up of pressure in the skull due to swelling are typically worst early in the morning (or during the night) and disappear soon after the person gets up. They are often mild at first, but over days to weeks become gradually more severe, frequent and last longer each time, and eventually become almost constant. Headaches that are due to the tumour itself, and not due to pressure from swelling, can be any type of headache. They may be exactly the same as headaches the person has experienced in the past, but usually they are more severe, more frequent, or there are also unusual symptoms. In general, they begin occurring from time to time, then get progressively worse over time. Headaches may be worse when the person bends over or changes body position, especially when getting up from bed. Up to two- thirds of people with brain tumours experience nausea and vomiting with their headache. The most common type of headache in people with brain tumours is an ordinary tension-type headache – usually described as a dull ache, a feeling of pressure or similar to a headache caused by sinusitis. It is usually on both sides of the head, but may be worse on the side of the tumour. There may also be unusual symptoms that are not typical of migraines, including abnormal brain function. Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 26 2624 Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers Why brain tumours cause headaches Headaches in patients with brain tumours can be due to the size of the tumour and the tumour pulling on tissues that are very sensitive to pain, such as blood vessels, brain lining (dura), and nerves that come out of the brain (cranial nerves. Headache can also be caused by blockage in the flow of the fluid that surrounds and cushions the brain and spinal cord (cerebrospinal fluid. Treatment for headaches Headaches caused by brain tumours are usually moderately severe or severe, but are only mild in about 10–20% of people. Simple pain-killers (such as paracetamol) are effective in providing moderate relief or complete relief in up to two-thirds of people with brain tumours. Non-prescription nonsteroidal anti-inflammatory drugs such as ibuprofen (brand names include Brufen and Nurofen) can also be used. However, taking non-prescription nonsteroidal anti-inflammatory drugs at the same time as dexamethasone increases the risk of stomach upset or ulcers. For headaches caused by swelling in the skull, dexamethasone is the main treatment because it reduces the swelling and pressure. The dose is increased until the pain is controlled, but kept as low as possible to minimise side effects. At the time of diagnosis, a person may already have mild problems with cognitive function, especially if they have a rapidly growing, high-grade tumour. However, it is unusual for these to be the only symptoms that lead to the diagnosis of brain tumour. Problems with cognitive function in people with brain tumours are usually caused by a combination of more than one factor. These can include: • the tumour itself or swelling around it • epilepsy (recurring seizures) caused by tumour • surgery • radiotherapy • chemotherapy • other treatments such as epilepsy medicines and dexamethasone • psychological distress. In a person who has already received treatment for a brain tumour, new problems with cognitive function could indicate that the tumour is growing or becoming more invasive, or Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 27 Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers 2725 that a new tumour has developed. Among people who have already been diagnosed with a brain tumour, about one-third experience seizures at some time. It is not possible to tell exactly what type of tumour a person has from their pattern of seizures. Only a small proportion (approximately 14%) of people with brain tumours develop seizures for the first time after being treated for the tumour. This means that if the person does not have seizures at the time of diagnosis, they are unlikely to have seizures later.
Our intent here is not to provide an exhaustive review of products and equipment discount 10ml ophthacare herbals soaps, as that is best done by specialists in individual categories of assistive technology buy ophthacare on line herbs that help you sleep. Rather order ophthacare 10ml with visa herbals nature, we have described the primary categories of assistive devices along with a list of key resources in the last part of each category so the reader can dig deeper when necessary to learn more and find dealers. In this chapter, we provide an overview of: • Environmental Control Units (central switch boxes to run electrical functions) • Computing and Communicating (harnessing the power of the personal computer) • Home Modifcation (the design elements that make the home or workplace accommodating) • Adaptive Driving (automobiles and the modifications that make them accessible) • Wearables (clothing tailored for people with paralysis) • Service Animals (dogs and monkeys trained to assist people with disabilities) Many of these devices are based on technology that is rapidly changing. To understand the full array of products available, check out tech guides such as AbleNet ( Access Board is a federal agency that promotes equality for people with disabilities through leadership in accessible design and the development of accessibility guidelines and standards for the built environment, transporta- tion, communication, medical diagnostic equipment, and information technology. It enables a person to independently turn on or off any electronics such as lights, heat, air conditioning, stereo, or television; to answer or initiate phone calls; to unlock doors, and to open and close windows or window shades. Essentially any aspect of the environment can be controlled depending upon the systems complexity. The interface might be an array of hardwired switches at a doorway, a remote-control joystick mounted on a wheelchair, or a touchscreen tablet with wireless Bluetooth technology. It might operate by voice command, or by “sip and puff, or even by detecting eye blinks, eye direction, or head movements. A new generation of digital assistants are emerging as powerful players in the “smart-home market for mainstream use. Devices such as Amazons line of Echo, Echo Dot, and portable Echo Tap; Googles Nest and Apples HomeKit are Bluetooth-enabled devices that allow users to perform an array of tasks with voice commands. For people living with paralysis, these smart-home devices open up possibilities that go well beyond ordering pizza or playing music – at least potentially. Much depends on the types of products and services that can be linked up to the operating systems. Finding the right system, and an installer who will work to individualize the system to meet the specific needs of the individual using it, is critical. Not only does the personal computer open up the global gateway of information, social networking, and remote services via the world wide web, it can also be an empowering tool for communication and home management. Specialized computer software and hardware that help people with paralysis can be high-tech, like voice-recognition and other hands-free technologies, adaptive keyboards, and head-tracking mouse clickers, or relatively low-tech, like screen readers and screen-enlargement applications. Paralysis Resource Guide | 256 6 Personal tablets and the ubiquitous smartphone put the power of computing and web surfing at ones fingertips, and their portability makes them ideal for people with mobility issues. The newest adaptation of the portable computer is smartwatches like the Apple Watch and Samsung Gear, which are just what the name implies: smartphones for your wrist, complete with internet access and a range of apps borrowed from phone operating systems. With ever-evolving, hands-free technology, even quads and people with upper-body limitations can operate a computer and navigate the internet using only voice, breath, eye, or head movements. Emerging technologies like brain-machine interfaces, which read nerve signals from the brain and translate them into commands on a device, will open the world of computing to even those with severe paralysis, enabling them to not only communicate but to manage basic aspects of daily life. The array of assistive devices for computing and communicating is vast and changing rapidly. The pace of 21st-century technology means that todays latest and greatest may be obsolete tomorrow. Below we provide an overview of the primary technologies that are commercially available now to help people with paralysis better access the power of the personal computer for communication and everything else. The Resource section at the end provides a list of sources where one can learn more about specific products or systems. A Bluetooth device uses radio waves instead of wires or cables to connect to a phone or computer, making true portability possible. Bluetooth technology allows a wide variety of devices and services to connect to each other wirelessly, silently, and auto- matically. A Bluetooth product, such as a headset or watch, contains a tiny computer chip embedded with software that essentially acts as a radio tower to send and receive low-power, short-range radio waves. The tech- nology makes it possible to give commands remotely to a computer or phone within a certain distance – even through walls. When combined with voice-recognition, eye-tracking, or other hands-free technology, Bluetooth opens a world of possibilities for people living with paralysis. This is, after all, the era of Siri and Google Now, smartphone apps that commu- nicate by recognizing vocal commands and responding with information or specific actions. I use a voice-activated system called Dragon: Naturally“ Speaking, which works very well for me. For me to move the mouse, which I use pretty extensively, it works through the wheelchair system. I have a little remote control that sits on the roof of my mouth, and I hit little buttons with my tongue. These wireless devices function like two-way speakers, listening to voice commands even from a relative distance and responding accordingly, whether it be to order a pizza or look up something on the internet. They perform as a kind of wireless command-and-control center for the home, and as technology progresses, are being fitted with an ever-increasing array of software interfaces to enable a broad range of uses. Consumer electronics companies are now racing to develop products based on the Alexa operating system, including home appliances, lamps, robots, car infotainment systems, and next-generation smartphones. Its easy to imagine how voice-recognition systems can improve the lives of people whose mobility or motor function is limited. As technology progresses, individualized interfaces will make it possible to control virtually any electronic device with a simple voice command. Eye-Gaze Technology Eye-gaze technology is designed to track the movement of the eyes by recording and analyzing the position of the pupils.
- Fibrosing mediastinitis
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Diagnosis depends on a careful evaluation of the relationship between: (a) form purchase ophthacare on line himalaya herbals uk, content order ophthacare australia herbs chips, and severity of symptoms; (b) previous history cheapest generic ophthacare uk herbs books, and personality; and (c) stressful event, situation, or life crisis. As with dissociative amnesia, differentiation from conscious simulation may be very difficult. Dissociative disorders of movement and sensation and mental retardation In these disorders, the patient presents as having a physical disorder, although none can be found that would explain the symptoms. Assessment of the mental state and social situation suggests that the resulting disability is helping the patient escape a conflict, or express dependency or resentment indirectly. The diagnosis should remain probable or provisional if there is any doubt about the contribution of actual or possible physical disorder, or if it is impossible to understand why the disorder has developed. Isolated dissociative symptoms may be associated with affective, schizophrenic and other major mental disorder; these disorders are usually obvious and should take diagnostic precedence. Where a non-physical basis can be demonstrated, it may be difficult to distinguish between dissociative states and (conscious) simulation. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupations of the patient. Even when the onset and continuation of the symptoms bear a close relationship with unpleasant life events or with difficulties or conflicts, the patient usually resists attempts to discuss the possibility of psychological causation; this may even be the case in the presence of obvious depressive and anxiety symptoms. The distinction between categories within F45 may be difficult, as may the assessment of the degree of conscious motivation for the behaviour. Hypochondriacal complaints may be used by some people with mental retardation as a means of seeking attention, especially from medical or nursing personnel. If the behaviour is clearly a deliberate attempt to influence events, a psychiatric diagnosis should not be made. The pain occurs in association with emotional conflict or psychosocial problems that are sufficient to justify the conclusion that they are the main causative influences. In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. In the other type, the emphasis in on feelings or bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax. In both types, a variety of other unpleasant physical feelings, such as dizziness, tension headaches, and a sense of general instability, is common. Definite diagnosis requires the following: (a) either persistent and distressing complaints of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort; (b) at least two of the following: feelings of muscular aches and pains; dizziness; tension headaches; sleep disturbance; inability to relax; irritability; dyspepsia; (c) any autonomic or depressive symptoms present are not sufficiently persistent and severe to fulfil the criteria for any of the more specific disorders in this classification. The factors which are thought to contribute to anorexia and related disorders include cultural expectations and societal pressures to be thin. May people with mild and moderate mental retardation were protected against such pressures in the past through policies or segregation and institutionalisation, and such disorders may become more prevalent in societies where policies of deinstitutionalisation and community care are implemented. Regurgitation, rumination and psychogenic vomiting are seen among people with mental retardation, and care should be taken to identify and treat associated (often secondary) physical disorders such as hiatus hernia and reflux oesophagitis. There may also be elevated levels of growth hormone,raised levels of cortisol, changes in the peripheral metabolism of the thyroid hormone, and abnormalities of insulin secretion. The term should be restricted to the form of the disorder that is related to anorexia nervosa by virtue of sharing the same psychopathology. The age and sex distribution is similar to that of anorexia nervosa, but the age of presentation tends to be slightly later. Repeated vomiting is likely to give rise to disturbances of body electrolytes, physical compilation (tetany, epileptic seizures, cardiac arrhythmias, muscular weakness), and further severe loss of weight. For a definite diagnosis all the following are required: (a) There is a persistent preoccupation with eating, and an irresistible craving for food; the patient succumbs to episodes of overeating in which large amounts of food are consumed in short periods of time. When bulimia occurs in diabetic patients they may choose to neglect their insulin treatment. There is often, but not always, as history of an earlier episode of anorexia nervosa. Bulimia nervosa must be differentiated from gastrointestinal disorder, personality disorder and depressive syndromes. Psychogenic vomiting may be seen in association with mental retardation, and may have a function (such as anxiety reduction) which maintains the behaviour. It must be distinguished from disorders such as regurgitation and rumination, which may be coded using F50. Sleep disorders of organic origin, or where an organic factor seems to play a major factor in causation, should be coded using G47. Such disorders are not uncommon in association with some specific developmental disorders such as Prader-Willi syndrome. The represent either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels, and particularly relates to others. Such behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning. They are frequently, but not always, associated with various degrees of subjective distress and problems in social functioning and performance. Personality disorders differ from personality change in their timing and the mode of their emergence: they are developmental conditions, which appear in childhood or adolescence and continue into adulthood. They are not secondary to another mental disorder or brain disease, although they may precede and coexist with other disorders. In contrast, personality change is acquired, usually during adult life, following severe or prolonged stress, extreme environmental deprivation, serious psychiatric disorder or brain disease or injury (See F07. Each of the conditions in this group can be classified according to its predominant behavioural manifestations. However, classification in this area is currently limited to the description of a series of types and subtypes, which are not mutually exclusive and which overlap in some of their characteristics. Personality disorders are therefore subdivided according to clusters of traits that correspond to the most frequent or conspicuous behavioural manifestations. Although it is sometimes possible to evaluate a personality condition in a single interview with the patient, it is often necessary to have more than one interview and to collect history data from informants.
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The criteria used by Ministry of social justice and empowerment for the disability certification were show no change with improvement of condition and also there is no correlation with 10 point disease rating scale buy ophthacare with visa just herbals. Discussion: the overall results of the study suggests that There was a significant difference between initial and final score (at p < 0 generic ophthacare 10ml without prescription herbs used for healing. The significant difference in the initial and final data shows that there is significant reduction in the disability which may be due to reduction in pain discount 10 ml ophthacare with mastercard herbals outperform antibiotics in treatment of lyme disease. In their study there is no significant difference between the old and young age group thus age also showed no significant effect on pain—function correlation. Thus in all patients the reduction in the pain intensity lead to improvement in the function and reduction in the disability. In this study there is no significant difference between final scores in all the scales, it indicates that all the scales are equally sensitive to assess the disability in low back pain. A systematic review by Linton (2000) found that depression was associated with the existence of pain in 88% of studies. Thus if the patient was motivated then he was able to perform his activity (physical and social) well and rated his disability least and vice versa. According to Ministry of social justice and empowerment back condition are divided into two categories traumatic and disc condition and in disc condition the criteria are 1. Keywords: ChronicLowBackPain, disability, Ministry of social justice and empowerment, certification. I would like to thank all my subjects for their cooperation and patience that they retained throughout the course of the study. I wish to thank all the teachers of Physiotherapy Department for their constant support and help during this work and the non – teaching staff for their immense support. Facility and benefits for the persons with disability at Government level -16 jan 2011 7. The prevalence of low back pain in adults: a methodological review of the literature. Laxmaiah Manchikanti,Epidemiology of Low Back PainPain Physician, Volume 3, Number 2, pp 167-192 2000, Association of Pain Management Anesthesiologists. The association between clinical findings on physical examination and self-reported severity in back pain. Evidence of augmented central pain processing in idiopathic chronic low back pain. M Du Bois –Patients at risk for long-term sick leave because of low back pain 2009. Ardiana Murtezani etal Low back pain predict sickness absence among power plant workers-Indian J Occup Environ Med. Facility and benefits for the persons with disability at Government level -16 jan 2011 26. Peter M Kent and Jennifer L Keating—The epidemiology of low back pain in primary care – Chiropractic nd Manual therapies 2005,13:13. Community based rehabilitation of persons with disabilities -- S pruthvish first edition: 2006 page6-7 28. Community based rehabilitation of persons with disabilities -- S pruthvish first edition: 2006 page2-3. Poiraudeau- Annales de readaptation et de medecine physique 50 (2007) 425-429 - Science Direct. Systematic review of psychosocial factors at work and in private life as risk factors for back pain. Rating scales for low back pain Umile Giuseppe Longo British Medical Bulletin Oxford Journals Volume 94 Issue 1, pp. So this study aimed to find safe and effective interventions to improve and maintain strength and endurance in spastic diplegic children. A total of 30 subjects were recruited and patients were randomly assigned to 3 different treatment groups, group 1 (dynamic cycling), group 2 (static cycling), group 3 (conventional exercise. Repeated measure analysis for resting heart rate and 3 Minute Walk test revels that there is main effect for time and there was no significant main effect for group also significant effect for time x group. Therefore it can be concluded that Dynamic cycling incorporated with conventional exercises improves the cardiovascular endurance, balance and functional abilities than conventional exercises only. These impairments can limit a childs ability to play and exercise at intensities necessary to develop cardiorespiratory fitness. The interaction of these factors can lead to a continuous cycle of deconditioning and decreased functional ability. The exact nature of the weakness is unclear and is thought to be a result of either decreased central drive to the agonist due to the lesion itself, spasticity, co-contraction, secondary changes in the properties of the muscles fibers, or some combination of the above. It may impair the full activation of the agonist due to reciprocal inhibition, therefore, co-contraction could reduce the efficiency of force output, leading to fatigue. They concluded that local muscle factors rather than cardiopulmonary factors were responsible for the exhaustion. A spastic muscle or group of muscles may overpower antagonists that less spastic, normal, or flaccid. Therefore children with cerebral palsy have decreased capacity to participate in play and sports activities due to decrease muscular strength and cardiorespiratory fitness. So safe and effective interventions to improve and maintain strength and endurance is required. Promoting, maintaining and enhancing gait function are the ultimate therapeutic goals in neurorehabilitation. And to achieve these goals there are many interventions used one of which is cycling. Cycling can be used as a rehabilitation tool to improve strength and cardiorespiratory fitness in cerebral palsy children. Hence the aim of the study is to improve the childs overall functional status and also improve his abilities to ambulate in the environment as independently as possible and reduce the delirious effects of using a wheelchair passively.