Saturday, January 30, 2021

Evidence-Based Vs. Science-Based Therapy in Neurologic Rehabilitation

As a full-time clinician working with clients who are battling neurologic diseases, I often feel pressure to provide evidence-based therapy for an individually unique population in a sea of trials that lack randomized, controlled, and double-blinded research with a high number of participants.  Professional guilt regarding reliance on treatment that is evidence deficient often builds when evaluating and re-assessing my clients with functional impairments from strokes, PD, MS, spinal cord injuries, etc.  I give myself pep talks that healthcare is both an art and a science.  However, I sometimes worry about the long-term future of physical therapy because of the seemingly unattainable goal of creating neurologic rehabilitation trials with thousands of unique clients that are blinded and controlled to provide a foundation for the therapy we provide.  Is this level of research even possible or practical?

After reading the statement from Nielsen et al., my hope for our future has been renewed.  Paraphrasing their comments would be an injustice, so here are their comments relating to evidence-based neuro-rehab directly: “Foremost, it should be realized that it is not possible to apply the strict criteria that are required in clinical trials of new drugs in a clinical study of a physical intervention. Double-blinding is naturally not possible and placebo treatments are difficult if not impossible to design. Furthermore, although matched control groups receiving no treatment or conventional treatment are naturally desirable in these studies, it is not straightforward to deny a group of patients treatment that is believed to be efficient.”1


While the authors make a case for the challenges of pharmaceutical-grade clinical trials in neuro-rehab, they also recommend that the neuro-rehab world continue to strive to use evidence-based concepts as much as possible.  They insist neuro-rehab should still be “science-based.”  They suggest that optimal neurorehabilitation include the following key 12 science-based ingredients (my comments on the clinical application are in red):1

  1. Active patient participation: Many of my clients who have had brainstem strokes suffer from depression and lack of motivation.  This is a large barrier to their progress.  I hypothesize that many of them have a constant sense of dizziness because of constant spontaneous nystagmus that makes survival unpleasant.  My focus is to seek help medically to slow the nystagmus.

  2. Physical aids should only be given when really necessary: I usually wait until the very last minute to provide bracing. This has proven to be a success over the years.

  3. Providing challenges that can support learning: Motivational education through biofeedback using distance, time, and visual cues to improve step length with gait has been beneficial.  One of my favorite exercises to help improve step length is “giant cone walking.”  This exercise incorporates having the client predict how many steps they believe they can take to make it to the next cone 20 feet away.  It is intrinsically competitive and attained great results.

  4. Training should be the patient's responsibility- The therapist as a personal coach: Recovery likely takes thousands of hours of work.  My role is often to guide an intense HEP that goes well beyond the limits of clinical work.  The reality, though, is that many patients cannot put this kind of work in daily.

  5. Train every day for as long as possible: see above

  6. Ensure motivation and reward: Creating functional goals with celebratory opportunities throughout care is done regularly.

  7. Structure practice to optimize acquisition and retention: I only work on task practice with attainable skills and utilize pneumonics like Step One-scoot to the edge of the chair.  Step two: feet back.  Step three: nose over toes.  Step four: push from the chair.

  8. Improved function requires optimal consolidation: I think I could work more on this with my patients.  It sounds like we have to be careful we don’t add too many new tasks to be learned until we are confident one task is truly attained.  It also makes me think about the importance of purposeful reflection.  Perhaps using the four Fs: Facts, Findings, Feelings, and Future would be a good start for patients?

  9. Less emphasis on spasticity- Focus on the paresis: This is so refreshing yet still bothersome to hear.  The greatest barrier to progress for many of my clients with stroke is spasticity/weakness.  There is usually nothing beyond Baclofen/Botox that can be done for spasticity.  Weakness is usually challenging to overcome because it is hindered by spasticity.

  10. Other factors that influence learning and memory: Addressing learning and memory deficits are a must.  Sometimes it must be the foundation of rehab.

  11. Individualization is necessary: This is usually innate for therapists.  We are used to setting individualized goals and treatment plans that are functionally meaningful.

  12. Neurorehabilitation has effects late in life and long after the primary injury: One of my favorite coaching statements is that neuro-rehab is a lifelong process.  There is no end, and it continually changes.


“I attest that this submission represents my own work and is compliant with Arcadia’s standards for academic integrity.”


1. Nielsen JB, Willerslev-Olsen M, Christiansen L, Lundbye-Jensen J, Lorentzen J. Science-based neurorehabilitation: recommendations for neurorehabilitation from basic science. J Mot Behav. 2015;47(1):7-17.

147 comments:

  1. Georgia Rehab center
    It feels awe-inspiring to read such informative and distinctive articles on your websites.

    ReplyDelete
  2. Your health is something which changes on a daily basis, even if you're not aware of it. Each time you do something to or with your body, you are changing the way it acts, both now and in the future. As you make certain decisions in your life, you will impact your health, increasing or decreasing the way your body feels and behaves. Kamagra Online

    ReplyDelete
  3. The relationship that exists between a physician and patient, or between other types of health care providers and the client, continues until it is terminated with the consent of both parties. A patient having health needs, especially a patient who is disabled or feeble, may be dependant on the home health professional. The patient has the right to expect that he or she will have access to the services he or she needs until receiving proper notice to the contrary and, preferably, until a substitute is provided. Buy actavis near me

    ReplyDelete
  4. Awesome work! That is quite appreciated. I hope you’ll get more success.
    Georgia rehab

    ReplyDelete
  5. This is wonderful and quite informative blog I have learnt so many things from here.Best rehab Georgia

    ReplyDelete
  6. I’m going to read this. I’ll be sure to come back. thanks for sharing. and also This article gives the light in which we can observe the reality. this is very nice one and gives indepth information. thanks for this nice article... Sexual Enhancement for sale online

    ReplyDelete
  7. Nice post! This is a very nice blog that I will definitively come back to more times this year! Thanks for informative post. worldwide delivery

    ReplyDelete
  8. Good website! I truly love how it is easy on my eyes it is. I am wondering how I might be notified whenever a new post has been made. I have subscribed to your RSS which may do the trick? Have a great day! reliable vendor

    ReplyDelete
  9. A vast difference exists between the words health and wellness. While most people consider these words to convey similar meanings, their definitions vary considerably. Health, according to the Merriam-Webster dictionary, is defined as, "the condition of being sound in body, mind, or spirit; especially freedom from physical disease or pain." More simply put, health is a conditional state. Family Medicine

    ReplyDelete
  10. A career in alternative healing is today very popular and in demand in the natural healing industry. The profession of Holistic Medicine Doctor is not only personally fulfilling, but is also financially rewarding. To know how to become a successful holistic medicine doctor refer this article. Percocet 10/325 mg tablet Online

    ReplyDelete
  11. Your health is something which changes on a daily basis, even if you're not aware of it. Each time you do something to or with your body, you are changing the way it acts, both now and in the future. As you make certain decisions in your life, you will impact your health, increasing or decreasing the way your body feels and behaves. helps you sleep better

    ReplyDelete
  12. A career in alternative healing is today very popular and in demand in the natural healing industry. The profession of Holistic Medicine Doctor is not only personally fulfilling, but is also financially rewarding. To know how to become a successful holistic medicine doctor refer this article. Blockchain

    ReplyDelete
  13. It is somewhat fantastic, and yet check out the advice at this treat. What are the benefits of CBD Body Lotion?

    ReplyDelete
  14. This article gives the light in which we can observe the reality. This is very nice one and gives indepth information. Thanks for this nice article. cinema

    ReplyDelete
  15. it was a wonderful chance to visit this kind of site and I am happy to know. thank you so much for giving us a chance to have this opportunity.. cinema

    ReplyDelete
  16. Most of all the need is for whole hemp plants grown with care, and processed while still fresh, because this means more CBD will be produced with the best quality and potency.CBD Store

    ReplyDelete
  17. Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon. Big thanks for the useful info. good presentation skills

    ReplyDelete
  18. At the point when you settle on a therapy approach, keep an itemized record of your youngster's side effects and reaction to the therapy. https://masakor.com

    ReplyDelete
  19. At the point when you settle on a therapy approach, keep an itemized record of your youngster's side effects and reaction to the therapy.Cloud Based Dialers

    ReplyDelete
  20. Tragically, in these accounts, just as in reality, the portion of our populace with handicaps were regularly restricted in correctional facilities and almshouses without good food, clothing, individual cleanliness, and exercise. play school in hyderabad

    ReplyDelete
  21. The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Health Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. healthnezz

    ReplyDelete
  22. Genotropin 36Iu Injection is a neuropeptide, also called GHIH (Growth Hormone-Inhibiting Hormone). It regulates various physiological functions and exerts inhibitory action on numerous secondary hormones such as glucagon and insulin. It also regulates gastrointestinal tract activities like gastrointestinal motility and secretion of gastrin and secretin. Buy mdma online

    ReplyDelete
  23. This comment has been removed by the author.

    ReplyDelete
  24. I found so many interesting stuff in your blog especially its discussion. From the tons of comments on your articles, I guess I am not the only one having all the enjoyment here! keep up the good work... Buy liquid ketamine

    ReplyDelete
  25. Hare, we provide online free course udemy free course udemy coupons, and free online classes

    Free Courses Website

    ReplyDelete
  26. A new healthcare paradigm that focuses on health promotion rather than treating medical conditions after symptoms appear requires a new language. The term "medical home" put forth in the current Affordable Care Act does not support a changing health reform paradigm. The term "health hub" reflects more accurately the focus and intention of the Act, which is reducing cost through earlier health assessment and coordinating care. Best Essential oil diffuser

    ReplyDelete
  27. If you are in the market to buy a Florida Individual health insurance. We want to make it easy for you to learn about some key concept you need to take in consideration: "Keep in mind if you do not have a mayor medical coverage to protect you from unexpected medical cost, you would be responsible for paying all these medical bills on your own". Large Essential Oil Diffuser

    ReplyDelete
  28. I admire this article for the well-researched content and excellent wording. I got so involved in this material that I couldn’t stop reading. I am impressed with your work and skill. Thank you so much. cause and effect examples sentences

    ReplyDelete
  29. Excellent .. Amazing .. I’ll bookmark your blog and take the feeds also…I’m happy to find so many useful info here in the post, we need work out more techniques in this regard, thanks for sharing. best steroids supplier usa

    ReplyDelete
  30. This is actually the kind of information I have been trying to find. Thank you for writing this information. kop desoxyn online

    ReplyDelete
  31. Workmanship therapy, as characterized by the American Art Therapy Association, is the restorative utilization of making craftsmanship,reiki energy healing near me

    ReplyDelete
  32. i read a lot of stuff and i found that the way of writing to clearifing that exactly want to say was very good so i am impressed and ilike to come again in future.. Study Bachelors Double Degree program BBA and BS Computing from Thompson Rivers University, Canada

    ReplyDelete
  33. Testosterone, progesterone, and estrogen levels are affected. This is the point in your life when you are likely to feel a lack of energy, fatigue, loss of strength, unexplained weight gain, mood swings, difficulty sleeping, and a loss of sexual libido. bioidentical hormone therapy dallas

    ReplyDelete
  34. Attractive, post. I just stumbled upon your weblog and wanted to say that I have liked browsing your blog posts. After all, I will surely subscribe to your feed, and I hope you will write again soon! vitaros

    ReplyDelete
  35. In this contemporary world, it has become responsible to get to each and everything with present day advances; subsequently, gaming peripherals are the best gaming gadgets which solace the gamers who love to play the best games with simple and open gadget to play their abilities. 먹튀검증사이트
    먹튀검증

    ReplyDelete
  36. The actual bodily wellness from the individual under consideration may have a substantial effect on your body's capability to manage the actual signs and symptoms as well as physical procedures associated with drawback. alcohol rehab in Florida

    ReplyDelete
  37. Cool you inscribe, the info is really salubrious further fascinating, I'll give you a connect to my scene. niche relevant

    ReplyDelete
  38. Light treatment depends on the rule that specific frequencies of light can influence the living organic entities in various ways and in.Red light therapy at home

    ReplyDelete
  39. People that exist tend to be create regarding court-mandated content. In such cases, they could assist being a habits adjusting heart for folks that will carry out far better in the residence as compared to powering cafes.
    Halfway House near me

    ReplyDelete
  40. For my situation for instance, when Plato's moral sacrosanct mathematical arithmetic was displayed to have a place with natural science then quantum mechanical numerical rationale starts to self-destruct. mint projekt

    ReplyDelete
  41. Many of my clients who have had brainstem strokes suffer from depression and lack of motivation leading to deziness. check more info how to fight it here a href="https://qualityssdnotes.com/">fake dollar bills</a

    ReplyDelete
  42. My brother suggested I might like this website.

    He was entirely right. This post actually made my day.

    You cann’t imagine just how much time I had spent for this
    info! Thanks! how to make counterfeit money

    ReplyDelete
  43. Buy pain killer, sleep disorder medications, anti-anxiety pills, Sex pills and hair lose medications.
    Overnight delivery
    Buy without prescription
    Free shipping and more only at https://pharmacy-good-health.com

    ReplyDelete
  44. This piece of writing will help the internet people for setting up new webpage or even a blog from start to end.

    Also visit my website;
    counterfeit money sale

    ReplyDelete
  45. this is one of the best post ever. check here for more fake 20 dollar bills for sale

    ReplyDelete
  46. A public relations course provides practical skills like how to help maintain a businesses positive reputation in the community. The main focus is to teach students how to create media press campaigns. קורס סייבר אונליין

    ReplyDelete
  47. Although research suggests that children's eating habits are formed even before they enter the classroom - children as young as two may already have dietary preferences based on their parents' food choices - health education can play a vital role in helping establish lifelong healthy patterns early. Research shows that health education has a positive impact on health behaviors as well as academic achievement, and that the most effective means of improving health literacy is ensuring that health education is included in curriculum at all levels of education. buy duromine 40mg

    ReplyDelete
  48. Health insurance is a hot topic for many today as it has wide ranging implications for your finances and your personal health. With the cost of health care insurance rising, many feel the days of affordable health insurance in Oklahoma are over. This is not quite the case, as you still have some means to find a quality plan that doesn't blow up your budget. Angel Therapy Service

    ReplyDelete
  49. This written piece gives fastidious understanding yet.social media

    ReplyDelete
  50. The next time I read a blog, I hope that it doesnt disappoint me as much as this one. I mean, I know it was my choice to read, but I actually thought you have something interesting to say. All I hear is a bunch of whining about something that you could fix if you werent too busy looking for attention. a course in miracles free

    ReplyDelete
  51. This is a wonderful article, Given so much info in it, These type of articles keeps the users interest in the website, and keep on sharing more ... good luck. blog a course in miracles

    ReplyDelete
  52. You re in point of fact a just right webmaster. The website loading speed is amazing. It kind of feels that you're doing any distinctive trick. Moreover, The contents are masterpiece. you have done a fantastic activity on this subject! upgrad referral code

    ReplyDelete
  53. Health Savings Accounts have been gaining in popularity for years. Find out why more people start their own Health Savings Account each year and what advantages that gives them. hgh cycle

    ReplyDelete
  54. India's US$40b Online Assignment Help Manchester market is experiencing a surge in investment. Capital, both local and international, and innovative legal structures are changing the face of this once-staid sector. The Article discusses about the much needed private participation (domestic as well as foreign) in the Indian education sector.

    ReplyDelete
  55. This piece of composing will help the web individuals for setting up new website page or even a blog from begin to end.
    Likewise visit my site; tramadol for sale

    ReplyDelete
  56. I read a portion of your substance on this site and I consider this web website is truly instructive ! Keep doing awesome, mind more in my site here
    can i buy vitaros cream over the counter

    ReplyDelete
  57. Although, the allopathic homeopathic medicine for sex have saved a billion lives but they are unable to do it in a healthy way, whereas, the alternative medicine practitioners use natural therapy to maintain and restore your health. Various alternative techniques such as chiropractic, homeopathy, Ayurvedic, naturopathy, acupuncture and many more are in constant demand and rise because people have started taking interest in the benefits of alternative medicines.

    ReplyDelete
  58. Health is not just physical or mental, health covers the whole person, together with the environment - and their interaction. To have a functioning social life is an important, and perhaps even crucial, part of the concept of health. This means participating in a social context, and in return having something to give to other people. buttock fillers

    ReplyDelete
  59. Health is not just physical or mental, health covers the whole person, together with the environment - and their interaction. To have a functioning social life is an important, and perhaps even crucial, part of the concept of health. This means participating in a social context, and in return having something to give to other people. buy steroids online

    ReplyDelete
  60. Art therapy, as defined by the American Art Therapy Association, is the therapeutic use of making art, within a professional relationship, by people who have experienced illness, trauma or challenges that have caused varying degrees of dysfunction within their lives. therapist

    ReplyDelete
  61. First we should understand the word 'therapy' not what therapy is about. Mostly medical terms are derived from Greek language, so is the case with the word therapy. Mental Health Therapy

    ReplyDelete

  62. As you browse the site, each accessible item incorporates a thorough record. This element is unquestionably helpful, thanks sir. you can check on more here

    fake dollar bills

    ReplyDelete
  63. Great post!I am actually getting ready to across this information,i am very happy to this commands.Also great blog here with all of the valuable information you have.Well done,its a great knowledge, you can check my website for more here how to spend counterfeit money without getting caught

    ReplyDelete
  64. Nice blog and absolutely outstanding. You can do something much better but i still say this perfect.Keep trying for the best. Whitewidow / Oz

    ReplyDelete
  65. Your work is very good and I appreciate you and hopping for some more informative posts. Thank you for sharing great information to us. BUY Restaver (Vermodje)

    ReplyDelete
  66. Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. Hydrocodone Bitartrate/Acetaminophen 5mg-325mg Tablet

    ReplyDelete
  67. This is very educational content and written well for a change. It's nice to see that some people still understand how to write a quality post.! Buy aldactone 100 mg

    ReplyDelete
  68. Thanks for posting this info. I just want to let you know that I just check out your site and I find it very interesting and informative. I can't wait to read lots of your posts. Blue Diesel / Oz

    ReplyDelete
  69. Positive site, where did u come up with the information on this posting? I'm pleased I discovered it though, ill be checking back soon to find out what additional posts you include. Silver Pearl / Oz

    ReplyDelete
  70. I really loved reading your blog. It was very well authored and easy to understand. Unlike other blogs I have read which are really not that good.Thanks alot! Alpha Health Mart

    ReplyDelete
  71. Thanks for posting this info. I just want to let you know that I just check out your site and I find it very interesting and informative. I can't wait to read lots of your posts. Buy Daytrana

    ReplyDelete
  72. You’ve got some interesting points in this article. I would have never considered any of these if I didn’t come across this. Thanks!. RX Mega shop online medical Pharmacy

    ReplyDelete
  73. Thanks for the blog loaded with so many information. Stopping by your blog helped me to get what I was looking for. BUY OXANDROLONE ONLINE

    ReplyDelete
  74. Thanks for taking the time to discuss that, I feel strongly about this and so really like getting to know more on this kind of field. Do you mind updating your blog post with additional insight? It should be really useful for all of us. family gifts

    ReplyDelete
  75. I just want to let you know that I just check out your site and I find it very interesting and informative.. MK-2866 Ostarine 30ml 25mg/ml

    ReplyDelete
  76. Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. Buy Methadone Hydrochloride 10mg Tablet

    ReplyDelete
  77. Thanks for the nice blog. It was very useful for me. I'm happy I found this blog. Thank you for sharing with us,I too always learn something new from your post. Blueberry / Oz

    ReplyDelete
  78. What i don’t realize is in fact how you’re no longer actually much more smartly-liked than you may be right now. You are very intelligent. You understand thus significantly on the subject of this matter, produced me for my part imagine it from so many various angles. Its like men and women are not involved unless it is something to do with Lady gaga! Your personal stuffs nice. Always maintain it up! 토토사이트 순위

    ReplyDelete
  79. Very nice blog and articles. I am realy very happy to visit your blog. Now I am found which I actually want. I check your blog everyday and try to learn something from your blog. Thank you and waiting for your new post. Oppo A15 Price

    ReplyDelete
  80. Economic growth has been fundamental to the general improvement in health in the industrial world during the last century. how does viagra work gain was achieved within a process of building up social capital and also as a result of increasing investment in improving the working environment, housing, nutrition, education, and health care and by addressing the other needs of the whole population.

    ReplyDelete
  81. by individuals who have encountered disease, injury or difficulties that have caused fluctuating levels of brokenness inside their lives. Craftsmanship therapy is useful for individuals who look for self-awareness through making workmanship and pondering their fine art and the most common way of making workmanship. Reiki Kabbalah Center: The Secret - Law of Attraction & Phychic Development Training

    ReplyDelete
  82. Although research suggests that children's eating habits are formed even before they enter the classroom - children as young as two may already have dietary preferences based on their parents' food choices - health education can play a vital role in helping establish lifelong healthy patterns early. Research shows that health education has a positive impact on health behaviors as well as academic achievement, and that the most effective means of improving health literacy is ensuring that health education is included in curriculum at all levels of education. what is nascent iodine good for

    ReplyDelete
  83. Although research suggests that children's eating habits are formed even before they enter the classroom - children as young as two may already have dietary preferences based on their parents' food choices - health education can play a vital role in helping establish lifelong healthy patterns early. Research shows that health education has a positive impact on health behaviors as well as academic achievement, and that the most effective means of improving health literacy is ensuring that health education is included in curriculum at all levels of education. Creatina

    ReplyDelete
  84. Positive site, where did u come up with the information on this posting? I'm pleased I discovered it though, ill be checking back soon to find out what additional posts you include. best course in miracles podcasts

    ReplyDelete
  85. Thanks for providing recent updates regarding the concern, I look forward to read more. best course in miracles podcasts

    ReplyDelete
  86. Positive site, where did u come up with the information on this posting? I'm pleased I discovered it though, ill be checking back soon to find out what additional posts you include. Buy Canadian Steroids

    ReplyDelete
  87. Your work is very good and I appreciate you and hopping for some more informative posts. Thank you for sharing great information to us. Buy the best Canadian steroids

    ReplyDelete
  88. These varieties of drug rehab applications have existed for over thirty years and are long time in nature.Detox Places

    ReplyDelete
  89. Health insurance intends to provide financial security during the time of illness of injury. Florida enjoys good health status as compared to many other states in the US; however, there are lots of Floridians who still live without any health insurance policy to provide coverage. sarms

    ReplyDelete
  90. I actually get pleasure from this great write-up that you've provided if anyone is for instance united states. Whenever i assure this tends to potentially often be essential for people. Admission online

    ReplyDelete
  91. Excellent read, Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. Thomas Watson physics

    ReplyDelete
  92. For sure, a lot of energizing exploration is being done to find more successful methods of educating chemistry. https://chemforum.info/index.php?threads/kodachi.322/

    ReplyDelete
  93. I invite you to the page where you can read with interesting information on similar topics. https://customwriting.link/

    ReplyDelete
  94. buy youtube views Are you beginning to worry in regards to the security of your expensive Xbox console games? If you're actively attempting to learn to burn Xbox console games, assistance is here. Merely read this article.

    ReplyDelete
  95. What is A Course in Miracles? ACIM teacher David Hoffmeister shares free in-depth audio teachings on ACIM metaphysics, practical application, and more. a course in miracles

    ReplyDelete
  96. What is alternative medicine?how to use viagra Is it safe? How can you make it a part of your health care routine?

    ReplyDelete
  97. I am very enjoyed for this blog. Its an informative topic. It help me very much to solve some problems. Its opportunity are so fantastic and working style so speedy. varian gc autosampler

    ReplyDelete
  98. Thanks for taking the time to discuss this, I feel strongly about it and love learning more on this topic. If possible, as you gain expertise, would you mind updating your blog with extra information? It is extremely helpful for me. orthodox icon store

    ReplyDelete
  99. Really a great addition. I have read this marvelous post. Thanks for sharing information about it. I really like that. Thanks so lot for your convene. according to NDTV.com

    ReplyDelete
  100. This is a great post. I like this topic.This site has lots of advantage.I found many interesting things from this site. It helps me in many ways.Thanks for posting this again. detalles de comuniones

    ReplyDelete
  101. This is a great inspiring article.I am pretty much pleased with your good work.You put really very helpful information. Keep it up. Keep blogging. Looking to reading your next post. detalles comuniones baratos

    ReplyDelete
  102. Orthodox top 10 delay spray in the world is provider-dominated with a narrow range of choice; by contrast, Alternative Medicine is a marketplace offering a vast and growing range of choices. But the difference between Alternative and Orthodox Medicine is clear enough;Orthodox Medicine is based upon the scientific study of disease processes (or is working towards this goal), while Alternative medical systems have non-scientific approaches based on spiritual, mystical, or otherwise intuitive insights. But much Orthodox Medicine is not evidence based either.

    ReplyDelete
  103. If you are looking for more information about flat rate locksmith Las Vegas check that right away. Black satta

    ReplyDelete
  104. I propose merely very good along with reputable data, consequently visualize it: Translate Hello to German

    ReplyDelete
  105. This is very appealing, however , it is very important that will mouse click on the connection: Is homework illegal

    ReplyDelete
  106. I found so many interesting stuff in your blog especially its discussion. From the tons of comments on your articles, I guess I am not the only one having all the enjoyment here! keep up the good work... Disawar satta result

    ReplyDelete
  107. If you are looking forward to learning deeper into the field, it takes four years to get a bachelor's degree in the subject. Physiotherapy reduces the pain and treats the patient with its physical techniques. Physiotherapy Cork

    ReplyDelete
  108. Under it you will have an understanding of it is important, choosing which usually way brings on the list of back links along with the enjoyment article: AIOU

    ReplyDelete
  109. Recursos de apoyo a la aplicación práctica de Un curso de milagros - UCDM con avanzada maestro David Hoffmeister - UCDM. un curso de milagros en español

    ReplyDelete
  110. Can two companies be registered at the same address Singapore?
    Any business based in Singapore is restricted to just one business address; it may not have multiple business addresses. Statutory records of a Singapore business are to be maintained at its business address.

    Visit straitsvo

    ReplyDelete
  111. This is just the information I am finding everywhere. Thanks for your blog, I just subscribe your blog. This is a nice blog.. svava grace of god

    ReplyDelete
  112. That appears to be excellent however i am still not too sure that I like it. At any rate will look far more into it and decide personally! david hoffmeister un cours en miracles

    ReplyDelete
  113. I haven’t any word to appreciate this post.....Really i am impressed from this post....the person who create this post it was a great human..thanks for shared this with us. un cours en miracles

    ReplyDelete
  114. Hii,
    This is great and awesome post for me. i loved to read your blog. it's really-really amazing. thanks for inspired me by your blog.Buy YouTube Subscriber

    ReplyDelete
  115. I was reading your article and wondered if you had considered creating an ebook on this subject. Your writing would sell it fast. You have a lot of writing talent. a course in miracles

    ReplyDelete
  116. I haven’t any word to appreciate this post.....Really i am impressed from this post....the person who create this post it was a great human..thanks for shared this with us. un cours en miracles france

    ReplyDelete
  117. The delightful article you have posted here. This is a good way to increase our knowledge.Dry Needling physio in Kerry Continue sharing this kind of articles, Thank you.

    ReplyDelete
  118. Casino Game For Sale by Hoyle - Filmfile Europe
    › casino-games › casino-games › casino-games › 출장샵 casino-games Casino Game for sale by Hoyle on Filmfile Europe. Free shipping for most countries, no nba매니아 download required. https://deccasino.com/review/merit-casino/ Check the https://tricktactoe.com/ deals https://vannienailor4166blog.blogspot.com/ we have.

    ReplyDelete
  119. Very nice article, I enjoyed reading your post, very nice share, I want to twit this to my followers. Thanks!. a course in miracles author

    ReplyDelete
  120. Pretty good post. I have just stumbled upon your blog and enjoyed reading your blog posts very much. I am looking for new posts to get more precious info. Big thanks for the useful info. ลิ้งทางเข้าสมัครเอเย่นต์คาสิโนUFABET

    ReplyDelete
  121. I am continually amazed by the amount of information available on this subject. What you presented was well researched and well worded in order to get your stand on this across to all your readers. UFABETเว็บไหนดี

    ReplyDelete
  122. I appreciate everything you have added to my knowledge base.Admiring the time and effort you put into your blog and detailed information you offer.Thanks. Cursos gratis

    ReplyDelete
  123. Find the best essays on is my friend's profile page. universal bitcoin wallet

    ReplyDelete
  124. A run of the mill wellbeing history will incorporate individual, social, wellbeing, clinical, and food data. occupational therapy

    ReplyDelete
  125. I was frankly worried by your silence and tempted to contact a couple of people closer geographically with inquiries but that seemed intrusive. I was relieved when I saw a pharma exporters in india couple of comments from you but still concerned. I'm very glad to hear that you got the care you needed and that you're recovering. I'd hoped you were on vacation but I didn't imagine one of exactly this type!

    ReplyDelete
  126. When you are able to experience this improvement, your relationships blossom, career paths open, and people find you attractive and accessible. psychotherapist phoenix

    ReplyDelete
  127. Telemedicine is currently turning into a basic piece of the worldwide medical care framework. Telemedicine utilizes interactive media gadgets and high level telecom innovation to give effective medical care administrations to all. Medical Billing Services

    ReplyDelete
  128. Myaarpmedicareinsurance.yolasite.com has great United healthcare account options, medical insurance plans and insurance coverage. Athena health is a great company that offers many different types of medical insurance plans. MYaarpmedicare have a variety of plan options to choose from and their customer service is excellent. I highly recommend them!

    ReplyDelete