Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;This question comes up quite often. Not just with aneurysm, but stroke patients are always concerned that there is some inherent risk, but it's unlikely. The first thing to do is talk with your doctor, the physician, about where your body physically stands. The doctor can give you some idea of what we call parameters on where to exercise. Parameters are based on your vital signs, and your doctor may give you a safe heart rate range. For example, they may say that you want to exercise until your heart rate is between 100 and 105 or 90 to 100, something like that. As a therapist, we could show you how to monitor your heart rate and make sure that you're staying within range. The parameters could also be around blood pressure or oxygen levels, so there are some tests that your doctors can do to figure out what those parameters may need to be. They may also be able to figure it out based on your health history as well. What would happen is if it was a concern but your doctor wanted you to do physical therapy, they will send those numbers either through you or they should contact your therapist to give them the correct parameters as well. Once you've done some exercise with your therapist and start to feel a little bit more comfortable, where you feel good about how to monitor your symptoms, your heart rate, and everything like that, then the therapist will teach you some exercises to start doing outside of there and you can build from there.&nbsp;We recommend patients buy blood pressure cuffs to measure their numbers if it's part of what's going on with them. The other thing is called a pulse oximeter, which is just a little clip. Basically, you can put your finger into the clip and it monitors your heart rate based on what it reads from your fingertip. Believe it or not, cell phones have pulse oximeters on them as well now. You can download apps and they use the light from your camera in order to look at your heart rate through your fingertip as well. I've done that on Apple and Android devices, but I believe Apple also has blood pressure cuffs that can Bluetooth connect to your phone and measure your blood pressure and heart rate as well.

Senior physical therapist

Is there a risk for aneurysms due to physical stress?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;&nbsp;That is such a deep question for me. I read a lot of research and out of all the research that I've read from the beginning of becoming a therapist until now, there are two things that really stick with me. One is a documentary I mentioned last week about neuroplasticity. There were children who were five years old who were having severe seizures, so severe that they couldn't function. They couldn't go to school and their seizures were life-altering. In order to treat them, they did surgery that took out half of the brain that was being affected by the seizures. They put a filler into the skull and left the other half intact. They finished the surgery, did rehab with the kids, and then sent the kids on their way. They came back and followed up with the kids five years later, so now they're all 10 years old and you could not tell the difference between those children's function and the other children who hadn't had that surgery.&nbsp;&nbsp;To me, that is just so poignant. Both as a therapist and as a mom, I can't imagine making the choice to send my kids to have that sort of surgery. Then, knowing that their brains were able to heal and recreate all of these pathways to be able to do everything a “normal kid” can do with half a brain to me is just amazing. As a therapist, it gives me so much hope for the recovery that we can make these injuries. This was possible all because of neuroplasticity. The way our brains work is that one-half of the brain controls a certain number of functions as well as the opposite side of the body. You would think that if you took out half of it, it would be like recreating a stroke. However, what they found was that especially because they were kids and they were such young little brains, their brains were able to reprogram and rewire. They could create pathways so that they could use their whole body.&nbsp;Another one that sticks with me and that scientists continue to do research on with the answer continuing to remain the same relates to patients that have had strokes. There are so many of these articles out there and I could mention many of them, but they do a lot of research around stroke. The biggest reason is that there are a lot more similarities amongst patients who have had strokes as far as their function goes. In the way they clinically appear, brain injury can become very diverse. Brain injury can look so many different ways, which makes it harder to do standardized research. In the article I read, these patients that have had strokes were given a certain number of tests. We call them objective measures, and they put the patients through a certain number of tests and look at their performance six months after stroke, one year after stroke, five years, and ten years. Now, they're doing research up to 20 years post-stroke, and they are showing that if you send patients to physical therapy and you have them do exercises that are specific to them and their needs, these objective measures will improve. This means that even 20 years later, they can do exercises and still improve upon their performance from five, 10, and 15 years ago.&nbsp;&nbsp;Again, that just really validates my job and really makes me feel good about when I'm “torturing” patients and they're complaining that they're tired. I’d say “okay, well we have a goal and so we have to do what we have to do to reach these goals, and that means me pushing you”. A lot of research will show you that you cannot just do exercises that are comfortable, easy, and gentle. We have to really put patients into uncomfortable positions to see these gains, but the gains are there to make, so that really drives me every day when I work with a patient. It also I think validates that no matter what your age is, you can still be making improvements many years later. The children are maybe one thing because they have young brains and correct me if I'm wrong on this, but stroke survivors I think tend to be a little bit older. As neuro therapists, we are still bound by the same insurance regulations and the same productivity regulations in the clinic. Sometimes progress in neuro patients is slower, so I have to stand up for my patients and say this is why we need to work on this. When I say stand up I mean to the insurance companies and corporate leadership and I have to be able to explain myself and show this progress. It can be a downer when you're trying to just do what you think is best for your patients, but reading research like that and actually seeing progress, for example, patients saying I haven't been able to get in the bathtub for years and yesterday I took a bath, is just such a driving force for me and keeps me excited about my job.

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: I look at research a lot, especially during the initial stages of treatment.&nbsp; One of the biggest things - and this is for community reintegration - is functional outcome measures. What does a patient need to do to be a productive member of society?&nbsp; Do they want to return to work?&nbsp; Do they want to return back to school or run their household as they did prior to their brain injury? These are all functional and are able to be worked on within speech pathology sessions.&nbsp; One of my idols in the therapy world is Sarah Barr of Honeycomb Speech Therapy, and she is great for coming up with tests and ideas for functional needs for patient-centered care. Evidence-based practice for the goal-plan-do-review-model is used by many different disciplines, not just speech pathologists.&nbsp; But this works on being able to select a goal, coming up with the plan to achieve it, and then identifying the barriers that could arise and then actually executing the goal. This is great for giving a patient time to reflect on what could have gone better, what would they have done differently, are there any strategies that I should introduce. This is one of the most valuable tools that I use with patients who are about to or have returned to work or school or their normal daily activities. I use this at least once a day with my patients.

Speech-Language Pathologist

What recent research has inspired you the most and changed how you practice as a physical therapist?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;It could be and probably is spasticity. We mentioned spasticity a little bit last week but to go into more detail about it, the way the brain works is that it sends a signal to the muscle to turn on to do whatever activity you're trying to do. Then it also sends the signal to turn off so that for example, if I need to pick up a glass of water, my brain sends the signal to move my hands at a certain degree, move my fingers at a certain degree, put a certain amount of force, and that's all through the muscles so that I can gently pick up the glass of water. When it's time to set it back down, my brain also has to tell my muscles to stop doing that to gradually release the cut back to the table. In this case, if it is spasticity, it's likely to be spasticity of the calf muscles or gastric muscles. What you should look at or with your therapist is to have them check it out.&nbsp;&nbsp;There is a test they can do for spasticity called the Ashworth or Modified Ashworth Test. It basically just consists of doing some passive range of motion to that joint or the therapist may probably just look at the entire leg at that point, including all the joints in the leg. The therapist does some passive range of motion at quick speeds to see if they feel that muscle resistance. In other words, the muscle is turning on when it shouldn't be turning on. After that, it's you and the therapist and now your doctor or your neurologist will look at what the next steps of treatment could be. Spasticity ranges from very mild to very severe. It can be so severe that the joint cannot move at all and it's stuck in one position, but it could be so mild that you only feel it if you're trying to do a particular task. In that case, the treatments would vary. It could be just that stretching needs to happen or it could be a medication that needs to happen. There are oral medications as well as injections. You may hear people getting botox injections to relax those muscles, and then even for very severe cases of spasticity, sometimes patients will get what's called a baclofen pump, which is actually where they implant a small pump device into your body that injects the medication directly to the spinal cord to help tell the brain to relax those muscles. That's in a very severe case but sometimes it might just be exercising like certain strengthening exercises to counterbalance the tightness of the muscles.&nbsp;The first thing I would recommend is going to your therapist or your neurologist and seeing if spasticity has started to come on. Then, the next step would be to manage it. I should put a plug to that particularly with the foot and the hands if you're starting to see some range of motion changes where now, the foot is pointing down and turning in. The same can happen with the hand, so be very careful of watching the skin that's rubbing inside of the shoe, in the heel, and the top of the foot if your foot is pointed down. Also, inward the top part of your foot becomes susceptible to skin breakdown so you want to keep an eye on that as well.

My partner suffered a hypoxic brain injury. He is currently still in hospital at the moment and sees a physiotherapist each day for a short period.

I noticed that my partner’s left foot is turned in, do you have any advice on what this may be and what I should ask the physical therapist?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;I don't want to go against my fellow therapist. However, I am a big fan of splinting and bracing. In fact, there's a whole lot of research that shows that especially after botox, you should be getting therapy, splinting, stretching, and bracing within seven days. It takes a special type of splint or a special type of brace to prevent joint breakdown. It also takes education on how to manage the skin and check the skin and make sure that's not happening. They have what’s called static braces and then dynamic braces. You’ll hear me use brace and splint interchangeably in this conversation, but there is one company in particular called Ultraflex that makes a splint which is a dynamic stretching splint. What that means is you put the patient into their comfortable range of motion and you can add a little bit of resistance, which passively stretches the muscle. You can make it very gentle or a little more aggressive. We try not to make it aggressive especially with spasticity because that triggers the tone. Those braces in conjunction with spasticity management work amazingly.&nbsp;&nbsp;That being said, not everybody can tolerate that passive stretch because you are to wear it for about four to six hours. You can use static splints and static bracing to either maintain range of motion or stretch range of motion. I mentioned spasticity before, which is just the brain telling the muscle to turn on and never telling it to turn off. In this case, if we're talking about the calf muscle or the gastric muscle, its job is to point your toes. If you are continuously pointing your toes, your muscles will start to adapt and stay in that position. They will get so tight in the calf muscle that you can't stretch it and the muscles in the front of the leg will get very weak and there's nothing then counterbalancing your toes pointing down. Braces and splints are there to prevent that from happening. There's a lot of merit and validity to using bracing and splinting so I'm a little bit surprised at the hesitancy to use it when there are just so many options to do that.&nbsp;&nbsp;In fact, that just made me think about another one which is called serial casting. What you do with serial casting is you actually put the joint in a cast. You make the cast what we call bifurcated, so it's split in half so that you can take the cast off when you need to. Every week or even more frequently depending on your body, the therapist that made the serial cast for you can change the angle of the cast. Therefore, every week they’d adjust the amount of stretch you're getting. You may start with it on Monday, and let's say it'll feel tight on Monday, but you wear it at the recommended time your therapist gives you how many hours to wear it per day by the end of the week, that cast is not going to feel tight anymore. Then the next week, they come back and make another one. They crank up the angle a little bit so you're getting more range of motion. The same thing happens, you wear the recommended time for that week by the end of the week, that one is now feeling easier to tolerate.&nbsp;There are a lot of options for bracing and splinting. I am an advocate for if you are working with a healthcare professional that you don't feel is doing what needs to be done, reach out for a second opinion. Talk to another therapist, and it's always your prerogative as the patient to ask for somebody else to take a look and get that second opinion. As healthcare providers, I always like to think that we're going to advocate for patients the best we can but sometimes, we all get stuck in our way of doing things as being the right way. So if we're not doing our job and advocating for you, make sure that you're advocating for yourself and say okay well, I want to maybe go see another therapist and see what happens.

My partner’s therapists won’t splint because they say the tone and movement in his hand could cause joint damage or pressure sores if splinted. He can only move one foot and this foot is now dropping and is also slightly on its side. He’s had Botox but they won't splint. He was in the hospital recently and they are annoyed that the therapists at his rehab center won’t splint as they’ve seen his hand and foot have gotten worse since joining rehab 6 months ago. What is your stance on splinting?

What is your opinion on splinting to help with foot-drop and for a hand with hemiplegia that has a lot of tone?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;Yes, there are plenty of exercises. The first thing to figure out is what is the cause of foot drop. It can be caused because of spasticity of the calf muscle, but it can also be caused because of weakness and then the muscles in the front of your leg. That is the first step. If it turns out to be a weakness, there may be strengthening exercises you need to do. If it turns out to be tightness of the muscles in the back of the leg, there may be stretches you need to do. There's also plenty of times where you need to do a combination of both, so again, there are some braces that help activate those muscles as well. There are some dynamic braces like AFOs that are carbon fiber that moves with you while you're walking. AFO stands for ankle-foot orthosis, which is a brace specifically designed to minimize foot drop. There have been many versions of AFOs, but if you're looking into building strength and increasing range of motion, you may look into some of the more dynamic ones. There are also electric stimulation machines that you can use to not necessarily improve strength because research doesn't necessarily show that it increases strength, but there is some research to show that it increases or improves coordination to get those muscles activating at the correct time. There's a company called Bioness I think we mentioned last week, that created an electric AFO basically using electric stimulation that will activate those muscles to lift your foot while you're walking at the appropriate time. There are lots of options for that. I would encourage you to get with a physical therapist to figure out the best option for you.

Is there any specific exercise that can help with foot drop?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;That's a very subjective question. I'll say that because one of the things we talk about in the therapy world is that therapy is like an art and a science. It’s highly scientifically grounded but you've got to be really creative and think on your feet in order to reach some of the goals that we're trying to reach here. For that question, I would say the criteria are no issues with blood pressure. Sometimes when you've been in bed for a long time and we suddenly get you standing, your blood pressure can be an issue so that has to be assessed. Also no issues with bone density. If you're not on your feet a lot and you're laying in the bed mostly, your bones become thin and could be susceptible to damage if you suddenly are standing all the way. I have worked in outpatient clinics, inpatient rehab, and acute rehab, and I have seen some patients stand that you did not think would stand. I have seen five therapists work together to help a patient stand. It's important to get people on their feet and even patients that may not have the muscle tone or can't move their bodies themselves, we have devices to help manage that. Again, if we need to get multiple people in on standing, we do that.&nbsp;&nbsp;One of the reasons that it's so important is because standing is a reflexive thing for humans. Sometimes, just having that gravity through the legs triggers muscles to turn on where maybe we couldn't volitionally get them to turn on. The other thing is getting weight-bearing in the legs helps maintain bone density and circulation. There's something called a standing frame. If I had a patient who was able to engage with me in some way, or in other words they are able to tell me if they do or don't feel good, whether that is verbally saying it, through facial expression, or any other method of communication, I could put them in a standing frame and support them. The machines have all sorts of straps, clips, and buckles to help keep people in place. The standing frame goes from a seated position up to standing and anywhere in between. There's also a device called a tilt table, which is just a table like a bed that you would lay on that can tilt up into the standing position and anywhere in between. From my perspective and my experience, and I've gotten to work with some really awesome therapists in my career, we get patients up as soon as humanly possible.

What are the criteria for the next level of care getting so patients don't lose muscle strength? Especially since some brain injury patients can't move their bodies fully.

When do physical therapists try standing with brain injury patients? Only when they are fully talking or mobile?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;Well, that could be a matter of practice. I'll say that when we learn things, it doesn't always stick with us forever. If there are things that we've learned and then we don't continue to do them or continue to practice, we start to lose it going by that whole “use it or lose it” theme. If you're continuing to do things and staying diligent with your exercise or maybe challenging yourself and you're suddenly seeing a decline, that's something you want to talk to your doctor about. There could also be something else going on. If you've gained progress and then, as we all get a little lazy sometimes and stop exercising, and you notice a drop in function, that might mean you just have to get back to practicing and go through the process again of relearning what you learned the first time. I’ll say that is true for everybody, not just people that have had brain injuries. If you stop what you're doing, you're going to lose function in some way, shape, or form. In fact, I've read research before where scientists took some retired Olympic athletes and measured their performance doing their sport. I think in this particular research, they were looking at track and field so they're running. Then, they had the athletes stop exercising for just two weeks and some of them saw a 50% decline in performance. You take a highly trained athlete whose body is completely tuned to doing this particular task and ask them to stop for just two weeks, and they see that much of a decline in performance. You can imagine what it might mean for the rest of us.

Why am I losing the abilities that I relearned?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;This is one of my favorite things to talk about. Vestibular ocular reflex is the concept that for every degree you turn your head, your eyes have to go in the opposite direction to maintain a stable view of the world. If I turn my head to the right, my eyes have to move to the left and that's how our brain gets information about what's going on around us. When that is impaired, it could be because the eyes physically can't make that movement. Or, it could also be just a coordination issue where the eyes cannot time it with the head movement correctly. What that does is it gives your brain a very skewed view of what is happening in your field of vision. The way our brain works is that your field of vision, which is one of your senses, has to match up with what the rest of your senses in the body are telling the brain. If your ears are telling your brain that your head is turning to the right but your eyes don't match up with that, your brain goes “okay well wait a minute what are we really doing here”.&nbsp;&nbsp;When the brain gets those conflicting signals, you could get symptoms like dizziness, nausea, headaches, blurry vision, feeling the loss of balance, and there are probably some other variations of that. A lot of patients have different symptoms that come with that. The biggest place you may see that in this day and age is with driving. When you're back to driving or even just scrolling on your computer, using your cell phone, or watching television, the ability for your eyes to follow what's going on on the screen is part of your vestibular ocular reflex. When it's impaired and you're trying to watch TV, your brain cannot comprehend what is happening on the television versus what's happening with your body, so you might get those symptoms. There are ways to work on it though. There are coordination exercises and training exercises. Again, we'd have to figure out what the cause of the impairment is or why the vestibular ocular reflex is impaired, but there are exercises to work on it as well. It could be a physical therapist, a vision therapist, or it could be a neuro-ophthalmologist that could help with that as well.

How does an abnormal vestibulo-ocular reflex affect balance? What can I do to address it?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;With healing the occipital lobes, that's one of those questions where you'd have to get with the neurologist to figure out what's damaged and what's not damaged. If they're saying that there is permanent nerve damage, the next steps on figuring out mobility and how to move on with life or figuring out the compensations if there is permanent nerve damage that the doctors don't feel is going to heal. Then, you can work with your therapists, both your physical and occupational therapists, on how to compensate to modify activities so that you can still do them and do everything that you want to do if there is some level of healthy nerve in that area. You may be able to work as far as neuroplasticity and again, get with a vision therapist, a physical therapist, or occupational therapists do vision training as well and see if there are exercises to improve the function.

I lost part of my vision two months ago and they said it’s permanent.

What is the best way to help heal the occipital lobes?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/6%3A-dr.-cristen-gordon-pt-2" target="_blank">Brightway's interview with Dr. Cristen Gordon (pt.2)</a>:&nbsp;Those symptoms to me sound like a concussion or post-concussion symptoms. Post-concussion can last for a long time and essentially, what that means is the symptoms from the original concussion stay with you for a while, it could be years actually. It could mean that the exercises that you're doing are not intensive enough to trigger the symptoms. Those head impacts triggering the symptoms could mean number one, your brain maybe is still healing. It could be areas of the brain that are still not getting the nutrients that it needs yet in order to be able to sustain those vibrations without getting all of those symptoms. Not knowing all of the health histories behind that question, it may be if this is chronic and it's been going on for a while. Follow up with the neurologist and maybe get an MRI in order to make sure there's not something still going on. Then if there is not something still going on, hopefully, you can get with a physical therapist to work on post-concussive symptoms or all symptoms of traumatic brain injury.

Just to be clear, this is not while exercising, as I can ride a stationary bike and do deadlifts.&nbsp; But if I hit a bag, head a soccer ball, try to run, walk above a certain speed, or even sit in a car (because of vibration from the engine), I get mental fatigue, an inability to concentrate which gets worse the more I try, and pulsing veins in my head.&nbsp; What is going on if the slightest impact or vibration can bring on these symptoms which last days or even longer?

CG_physicaltherapy's Answers