Knee Pain – Causes – Symptoms – Diagnosis – Treatment – Pain Relief

Information on knee pain, arthritis, conditions, causes, diagnosis, symptoms, pain relief, prevention, surgery and other treatment options. The knee, a hinge joint, has one of the widest ranges of motion of any joint. A knee damaged by arthritis may be a candidate for joint replacement. Knee Arthritis – What Is Arthritis In the Knee? Arthritis … Continue reading “Knee Pain – Causes – Symptoms – Diagnosis – Treatment – Pain Relief”

Information on knee pain, arthritis, conditions, causes, diagnosis, symptoms, pain relief, prevention, surgery and other treatment options. The knee, a hinge joint, has one of the widest ranges of motion of any joint. A knee damaged by arthritis may be a candidate for joint replacement.

Knee Arthritis – What Is Arthritis In the Knee?

Arthritis in the knee most often refers to osteoarthritis. Osteoarthritis in the knee, results from wear and tear on its parts. However, inflammation that occurs in certain rheumatic diseases, such as rheumatoid arthritis, can also damage the knee. What is “arthritis in the knee”?

Risk Factors

The complex anatomy of the knee joint that allows it to bend while supporting heavy loads is extremely sensitive to small problems in alignment, training, and overuse. Pressure may pull the kneecap sideways out of its groove, causing pain behind the kneecap. In teenagers, a number of factors may be involved.
·    Imbalance of thigh muscles that support the knee joint
·    Poor flexibility
·    Problems with alignment
·    Using improper sports training techniques or equipment
·    Overdoing sports activities
Common Causes:
Knee pain usually results from overuse, poor form during physical activity, not warming up or cooling down, or inadequate stretching. Simple causes of knee pain often clear up on their own with self care. Being overweight can put you at greater risk for knee problems.

The most common cause of runner’s knee is pronation and lateral (away from the middle) pulling of the patella. This causes misalignment with the connective tissues and muscles involved with knee movement.

Anterior knee pain may also be caused by softening of the cartilage beneath the kneecap (chondromalacia patellae), arthritis or by pinching of the inner lining of the knee with knee motion (synovial impingement).

Symptoms    Return to top
Symptoms include knee pain below the kneecap and on the sides of the kneecap, particularly with deep knee bends or prolonged sitting.
In cases of runner’s knee, pain occurs first when running downhill then gets worse and occurs with all running. Finally, pain is present even when you do not run.

What is Patellofemoral Syndrome?
Patellofemoral syndrome is the term used to describe pain on and around the patella or kneecap. A common cause is damage to the surface underneath the kneecap. It can be started by an impact or it gradually comes on from rubbing on the bone underneath. The injury is often referred to as chondramalacia patellae, patella pain syndrome or runner’s knee.

Knee Pain Overview Treatment

Self-Care at Home
In treating many types of knee pain, a common goal is to break the inflammatory cycle. The inflammatory cycle starts with an injury. After an injury, substances that cause inflammation invade the knee, which causes further injury, which leads to further inflammation, and so on. This cycle of inflammation leads to continued or progressive knee pain. The cycle can be broken by controlling the substances that cause inflammation, and by limiting further injury to tissue.
Some common home care techniques that control inflammation and help to break the inflammatory cycle are protection, rest, ice, compression, and elevation. This regimen is summarized by the memory device PRICE.

Urethral Cancer – Causes, Symptoms and Treatment

Urethral Cancer is a painful and potentially lethal condition in which a cancer originates from the urethra, which is the tubular part of the excretory system of the human body which connects to the urinary bladder and discharges the urine from the body.

Causes

The occurrence of cancer in any part of the body is not explained. Most probably the development of cancer is associated with a chromosome problem that causes the appearance and growth of malignant cells. This could be caused as a result from exposure to certain carcinogenic agents, stimuli or substances which could cause of cancer.

However, while discussing the causes of Urethral Cancer, it is important to know who are at risk of this disease and in what conditions. People who have been suffering from bladder cancer are more likely to develop Urethral Cancer than any other people. People who develop frequent inflammations of the urethra, those above the age of 60, especially white females, have a tendency to develop Urethral Cancer than most other people.

Symptoms

The symptoms of Urethral Cancer include the following.

· Frequent urination

· Blood in urine

· Bleeding in the urethra

· Discharge from urethra

· Lump in the perineum

· Weak flow of urine

· Interrupted flow of urine

Diagnosis

There are several tests that could be carried out for determining that a person is suffering from Urethral Cancer. First of all, the patient will be examined physically by the physician in which he or she will be examined for the apparent signs and symptoms such as lumps or enlarged lymph nodes. Then, further tests and screenings will be prescribed to determine the presence of cancerous cells. These tests include laboratory tests and examinations such as rectal and pelvic exams which are carried out for the signs of the disease.

Laboratory tests for the diagnosis of Urethral Cancer include Urinalysis and Urine Cytology, which respectively check for the nature of problem through the analysis of the properties and composition of urine and the presence of malicious cells respectively. Complete Blood Count test is also recommended. Cystoscopy could be carried out which involves inserting a thin tube into the urethra and the urinary bladder to check for the presence of cancerous cells. In most cases, a biopsy of the tissues will be taken for examination to confirm the presence of cancer.

Scans such as X-rays, MRI and CT scans are used to determine the size and staging of the cancer to prescribe proper treatment. The staging is determined according to the part of urethra that is affected. Anterior Urethral Cancer is not too advanced or deep, while the Posterior Urethral Cancer is deep rooted and in advanced stage. Anterior parts are closer to the body opening, while the posterior part of the urethra is next to the urinary bladder and in males, the prostate gland.

Treatment

Once the presence of Urethral Cancer is determined, the appropriate treatment for the particular stage of the cancer is prescribed. There are various treatment options available for Urethral Cancer. The type of treatment depends on the stage of the cancer and the damage done to the tissues around the urethra, especially when the cancer has reached other organs like the urinary bladder.

Surgery is one of the most widely practiced treatments for Urethral Cancer. There are quite a few surgery types used in this regard.

-Open Excision: Surgical removal of the urethra.

-Laser Surgery: Using laser beams for surgery and removing cancerous cells.

-Lymph Node Dissection: Removal of the lymph nodes in the groin area affected from the cancer.

-Electro-resection: Using electric current for the removal or destruction of the cancer cells.

-Cystourethectomy: Surgical removal of the urethra and urinary bladder affected by the cancer.

-Radical penectomy: Surgical removal of the perineum affected by the cancer.

Cystoprostatectomy: Surgical removal of the prostate and bladder affected by the cancer in males.

Radiation therapy is another method of treatment in which X-rays of very high energy are used to destroy the cancerous cells. Alternatively, or combined with surgery, chemotherapy is also administered to control the growth of the cancer.

Urethral Cancer is a rare type of cancer which occurs more frequently in females.

Lymphoma Cancer: Causes, Symptom and Diagnosis

Lymphoma Cancer is a general term for cancer that starts in the lymphatic system. About 54 percent of blood cancer diagnosed each year is various types of lymphoma.

Lymphoma Cancer occurs when a lymphocyte undergoes a malignant change and multiplies, eventually crowding out healthy cells and creating tumors. These tumors enlarge the lymph node and grow at other sites that are part of the immune system

There are two major types of lymphoma cancer 

  1. HODGKIN’S LYMPHOMA
  2. NON- HODGKIN’S LYMPHOMA (NHL)

NHL is the term for diverse group of blood cancer. It arises from an injury to the DNA of a lymphocyte. In some cases, NHL involves marrow and blood. Oncologist characterise NHL subtypes according to how rapidly or slowly the disease progresses. NHL in a patient grows rapidly, it is called aggressive lymphoma and if it grows slowly, It is called indolent lymphoma.

About 45,000 – 50,000 cases of NHL are diagnosed in India every year. About 85% are NHL that involves lymphocytes called B cells and 15% of cases of NHL involve lymphocytes called T cells.

Causes:-

Exposure to certain viruses and bacteria is associated with NHL. It is thought that infection with a virus or bacterium can lead to intense lymphoid cell proliferation, increasing the probability of a cancer-causing event in a cell.

Here are some examples: Epstein – Barr virus (ERV) infection- in patients from specific geographic regions- is strongly associated with African Burkitt Lymphoma, since African Burkitt Lymphoma also occur among people who have not infected with EBV.

Epstein-Barr Virus infection play a role in the increased risk of NHL in person whose immune system are suppressed as a result of organ transplant.

Human T-Lymphotropic Virus is associated with a type of T-cell Lymphoma in patients from certain geographic regions in South Japan, South America and Africa.

NHL is 50 to 100 times more prevalent among people with HIV/AIDS than among uninfected individuals. Newer therapies foe HIV infection have lowered  the incidence of AIDS related lymphoma .

Signs and Symptoms:-

An enlarged lymph nodes in the neck, armpit or groin – or less often, a swollen node near the ears, the elbow or in the throat near the tonsils – is sometimes an indication of lymphoma. There are 600 lymph nodes in the body. However if enlarged lymph nodes are detected during physical examination or during an imaging test. There is no obvious explanation such as a nearby infection, lymphoma could be the cause.

Patient may also have fever, excessive sweating and unexplained fatigue, loss of appetite or weight loss. During a medical examination, the doctor may detect an enlarged spleen. Sometimes, a person has no symptom and the disease may only be discovered during a routine medical examination or while the person is under care for unrelated condition.

Diagnosis:-

Making an accurate diagnosis of the specific type of NHL that a patient has can be difficult. Since the subtypes of NHL can be confused with one another and the prognosis, treatment goals and treatment approach may be different.

A biopsy of an involved lymph node or other tumor site is needed to confirm the NHL diagnosis and the subtype. Diagnosis of NHL made by examining a lymph node biopsy specimen; the examination includes tests called “immunophenotyping” and “cytogenetic analysis”.

My Heel Is Killing Me… It Hurts So Much… What Is It?

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.

It’s estimated that more than 1 million persons in the United States suffer from heel pain at any given time.

When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.

Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia, pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.

PF can develop in anyone but is more common in certain groups such as athletes, people older than 30 years of age, and obese individuals.

PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment, atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.

The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This “first step” pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.

On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.

One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.

Another “fooler” is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.

Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.

But what about “bone spurs”? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis, or Reiter’s disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.

Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.

So how is this condition treated?

The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.

A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.

Ice massage with ice cubes applied to the plantar fascia can also be helpful.

Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.

If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.

If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.

Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.

Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.

Pain in the back of the heel is an entirely different condition.

The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.

Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines, physical therapy, and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms.

Achilles rupture is handled surgically and requires a long recuperation.

Haglund’s syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a “pump bump.” Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.

Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.

The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.

ROLE OF REMEDIAL TEACHING

Role of Remedial Teaching

In order to improve mathematics, effective remedial teaching is a must. Let us discuss.

Remedial teaching is not re-teaching. Any remedy however costly or sophisticated is useless unless it cures the disease.

A remedial teacher should have a mentality of a sympathetic doctor who has love and care for his/her patients (students).

A. Identification:

a) Through academic achievement:

i) Class interaction: An under-achiever will give wrong answers frequently to the questions asked. He will appear to be confused. He may probably not respond to the questions asked in the class at all.

ii) Home assignment: An under-achiever will not do the homework. If pressurised to complete the work, he may resort to copying, which may be easily detected.

i)                    Unit tests and term tests: He will show poor performance consistently in tests. He will either not attempt the question(s) at all or, will do cuttings and overwriting. He may even try to copy the solution to the problems from his peers.

b) Through behavioural aspect:

i) Attitude towards academic activities: He will be disinterested in such activities. He will try to refrain himself from such activities. He will try to avoid discussion about academics with his peers or teachers.

ii) Class escapism: He will try to bunk classes for one reason or another. He will give excuses for not attending classes.

ii)                   Fiddle with notebooks instead of studying: He will be found to fiddle with notebooks and books instead of studying.

Once the under-achiever has been identified, the next step is the diagnosis of deficiencies.

B. Diagnosis of deficiencies:

a) Learning of concepts: His concept(s) related to a particular topic or formula is not clear. For example, the difference between 2×2 and (2x)2 may not be clear to him.

b) Computational Skill: He may not be good at computations and thereby may gives erroneous results frequently while performing basic arithmetical operations and simplification.

c) Procedure of solving problem: He is not clear about the procedure of solving problems and so he/she often gets wrong answers.

d) Application of knowledge: He may not be able to apply the learned knowledge in different situations. For example, in word problems, he may fail to translate sentences into equations or identify the variables.

Once, the deficiency has been diagnosed, let us explore the possible causes for the same.

C. Causes:

a) Memory: Individual capacity of memorising facts and figures.

b) Understanding: Lack of comprehension-he does not follow what he reads.

c) Presentation: Finds difficulty in expressing views-vocabulary is not sufficient.

d) Knowledge Gap: Incomplete coverage units in the previous class-long absence.

e) Parental background: Socio-economic status; education

f) Parental attitude: Indifference of parents towards studies; over-expectation.

g) School Based: Lack of suitable equipment and environment in school-overcrowded class.

h) Medium of instruction: Language problem.

i) Physical factors: Poor eyesight; poor audibility; illness and other problems.

j) Individual factors: Good in oral tests but does not prepare notes and does not do home work regularly; not sincere in studies; very anxious but is unable to concentrate on studies; lacks self confidence; inferiority feeling; fear of failure; wants company of students who avoid classes; emotional instability.

k) Teacher based: Lack of confidence in teacher; lack of time at teacher’s disposal; faulty method of teaching; does not encourage student participation in class; inadequate home assignments and problems for practice; improper way of correction of homework and of guidance to students at appropriate time and stage.; knowledge of the subject is not thorough; unable to clarify difficult concept; lacks in expression; unable to provide secure and affectionate climate in classroom and lack of understanding and acceptance for each individual child.

The causes having known let us now discuss about the possible cures and remedies.

D. Cures and Remedies:

a) Category wise remedial-not more than 5 to 10 students in each class.

b) Personal and individual attention by teacher.

c) No humiliation.

d) Special carefully devised UAA (under achiever’s assignment) – Simpler-Simple-Complex.

e) Read-Re-read-Write-Re-Write-Reproduce-Drill.

f) Group studies; group learning.

g) Micro-notes.

h) Teaching selected portion of syllabus only.

I now propose an action plan to be undertaken by a remedial teacher.

THE ACTION PLAN:

Out of two approaches of evaluation in vogue today, i.e. the process approach focusing on the performance of the teacher and the product approach focusing on the performance of the students with regard to specific objectives-here to get high score in the examinations in terms of marks and subject average, the latter is preferred for sure for obvious reasons. This process is based on the principle that what ever the teacher might have done in the class room is irrelevant unless the objective (of obtaining a high score in the examinations in terms of marks and subject average) is achieved. This then is the primary criteria of evaluation of both the teacher and the taught at all levels.

Herein lies the importance of diagnostic and remedial teaching, which is therefore, the primary responsibility of the teacher. This type of teaching involves:

i)                    Diagnosis of the specific difficulty of the student by conducting a suitable diagnostic test.

ii)                   Providing suitable remedial measures

iii)                 Providing ways and means for preventing them from reoccurring in future.

If a teacher is able to do justice to his primary responsibility then it may safely be presumed that the teaching profession has a bright future in store for sure.

For the benefit of teachers in general, I am now suggesting an action plan on these lines:

a)      Be an innovative and imaginative teacher with an open mind.

b)      Apply suitable diagnostic test to identify the weakness of each child.

  1. For this split the topic into several subtopics. For example, a topic in class X Mathematics “Linear simultaneous equations in two variables” –solution of equations can be split as:

i)                    Adding the two equations directly to find the value of the variables.

ii)                   Changing the sign and adding the equations to find the value of one variable.

iii)                 Making coefficients equal and using i) or ii) above to find the value of the variables.

iv)                 Substituting the value of one variable in the equation to find the value of the other variable.

  1. II. . Set at least 20 questions on each subtopic (They should preferably be      knowledge based)
    1. Take a test of each child. One subtopic to be tested at a time.
    2. As far as possible uniformity is to be maintained while evaluating the test.
    3. A student scoring less than 35% marks in this test is surely having difficulty in the subtopic.

c)      Explore the causes of weakness which may be:

i)                    Lack of understanding/misconceptions.

ii)                   Faulty teaching method.

iii)                 Fear of the subject

iv)                 Bad work study habits.

v)                  Physical and emotional factors like poor health, some mental shock etc.

vi)                 Teacher’s attitude.

d)      The cause(s) having been identified, suitable remedial measure (depending upon the cause) should be suggested which may be:

i)                    Re-teaching of the subtopic—should be resorted to only if the student has completely failed to understand the subtopic due to one reason or the other.

ii)                   Computer Aided Teaching—should be resorted to if the student has a vague idea about the subtopic and therefore finds it difficult to answer questions relating to it.

iii)                 Drilling of Problems—Should normally be prescribed to the weak child during examination times. For this the teacher should be able to design an effective study material containing objective questions, knowledge based problems; the practice/drilling of which will cure the weakness.

iv)                 Other Measures:

The work of the teacher does not end here. He/She must ensure that the student continuously practices upon them to ensure that the weakness does not reoccur in future.

To conclude, it may be said that this is indeed a gigantic task with immediate rewards a remote possibility; therefore requires zeal, enthusiasm and a sense of commitment on the part of the teacher to undertake this project.

Last but not the least; the institution has to play a pivotal role to achieve the ultimate objective. The difference between supervised study (study under the supervision of a teacher) and remedial teaching be clearly understood. The supervised study time table be framed in such a way that a teacher should be assigned at least two periods a week in Maths, Science, English and Social Studies (the subjects where maximum weakness is found). The teacher on his part should not just while away his/her time but should perform these activities as suggested above in letter and spirit and then and only then the ultimate objective can be achieved. He/She must remember that if a student fails then: the teacher has failed; the examination system has failed; the evaluation system has failed and by and large the education system as a whole has failed.

All seems well as regards the theoretical aspect of it is concerned. But when we come to its practical aspect we get confused as to what actually we are expected to do during remediation to achieve the desired quantitative result (Quality comes thereafter!). Therefore, until and unless we are clear about it, we cannot expect improvement in the results whatever strategies/action plans we may make/adopt to do so.

I have therefore decided to deal with it in the following pages taking Mathematics as the subject.

Based on my experience, I have noticed that the teachers of mathematics are unable to detect the basic weaknesses of children right from class VI onwards leave aside removing them and continue to teach year after year the topics to them based on the syllabi in-order to complete the same (for obvious reasons).

I have noticed that most of the students suffer from some basic weaknesses which are:

  1. Weakness in basic operations. Its removal will enable the students to negotiate with BODMAS rule thereby making simplifications easy. Algebra should also be easy for him/her as Algebra may be defined as “Arithmetic of unknown quantities”. Given that the student masters basic operations, the Arithmetic/Algebra/Statistics Portion of Mathematics should be easy to deal with.
  2. Weakness in identifying (understanding) shapes: Its removal will lead to an interest of student in Geometry. This will initiate the student to explore the properties of the shape (closed figures) formed by them leading to understanding of Geometry.
  3. Inability to distinguish between area and perimeter: Its removal will enable the student to solve most of the problems in mensuration.

The teachers can device certain worksheets which may be given to the students repeatedly to over-come their specific weaknesses once they are properly and correctly diagnosed on the basis of factors above.

Some tips for using these worksheets:

  1. The work-sheets should be attempted by HB pencil which is easy to erase later on.
  2. Each worksheet is to be attempted in 5 minutes except the last one which should take 15 minutes for completion.
  3. These worksheets are to be given once a week to each student.
  4. The teacher may use these worksheets during the first two months of the session (April and May) to create an interest for mathematics among the students before starting formal teaching.
  5. After the start of the formal teaching, the teacher should diagnose the weakness of the students (topic wise)-by preparing horizontal mark-sheet in unit tests.
  6. Once the teacher is able to diagnose the weakness of the child in a particular topic worksheets may be provided to the child on that topic during remedial periods to bring the child up to the desired level of competency in the topic. Minimum two work-sheets should be provided to each child and the performance in them is to be judged to ensure that the child has attained the desired level of competency in the topic.
  7. Now where and how to obtain these work-sheets?

I give below some guidelines for the teachers on this issue:

GUIDELINES TO OBTAIN WORK-SHEETS:

  1. Every teacher should create an email account (popularly called E-Mail ID).
  2. The teacher should logon to either: www. mytestbook.com or

www. softschools.com.

  1. He/ She will be asked to register.
  2. On clicking on this hyperlink he/ she will be asked to fill up a form.
  3. Finally he/ she will be asked to submit the same.
  4. On clicking the submit button, the registration will be confirmed and the logon information will be supplied on his/ her E-Mail ID.
  5. Thereafter the teacher may use the username and password provided by him/ her at the time of filling up the form for logon in future.
  6. It is an absolutely free account!
  7. Once the logon is successful, you should opt for automatic work-sheet generator and lo! You are provided with the variety of topics on which work-sheets may be generated.

8.  Click on the desired topic and obtain hundreds of worksheets.