Steps in Clinical Reasoning For Physiotherapists

Steps in Clinical Reasoning For Physiotherapists

How to choose a research topic - for physiotherapy students?

How to choose a research topic - for physiotherapy students?

NEUROLOGICAL ASSESSMENT

Name:- ______________________Age____________________________Sex_______________
Occupation:-_________________________________________________
Address:-________________________Contact:-____________________________________
Dominance:-_________________________________
Diagnosis:-___________________________________
Co.Morbidity(includes all risk factors any associated illness):-___________________________________________________________________________________
___________________________________________________________________________________
History Of Present Illness:-
(onset,progression,history till date)
___________________________________________________________________________________
___________________________________________________________________________________
Past History:-__________________________________________________________________
___________________________________________________________________________________
Medical History:-_______________________________________________________________
Personal History:-______________________________________________________________
Family History:-________________________________________________________________
Social History:-_________________________________________________________________

EXAMINATION:-
1.General Examination:-
(include vitals)

2.Higher Functions:-
          #Glassgow Coma Scale
                                        * Eye opening
                                        * Verbal response
                                        * Motor response
           #Mini Mental Scale
           #Speech,Vision,Hearing,Intelligence,Behaviour.
3.Cranial Nerve Examination:-
   Tone :- Ashworth Scale
4.Sensory Examination:-
(Normal,Reduced,Absent)
___________________________________________________________________________________
#Superficial Sensations                     #Deep Sensations
Pain___________________                           Joint Position Sensation
Temperature____________                           Proximal,         Distal
Crude Touch_____________                          Vibration,
Pressure__________________                       Perception:Depth,Height,Space,Distance
                                                       Body IMAGE -size,shape,colour
#Cortical Sensations:-
    *Tactile Localisation
    *2 Point Discrimination
    *Graphesthesia
    *Steriognosis
    *Cortical Extn
    *Barognosis

5.Reflexes:-              Right                      Left
   Biceps
   Triceps
   Supinator
   Knee
   Ankle
   Plantar
6.Motor Examination:-____________________________________________________
  #Nutrition:-______________________________________________________________
                   (Skin                                          Muscle girth)
 #Tone:-
             *Hypotonia:-
           
             *Hypertonia:- Spasticity                         Rigidity
                                                         1.Lead Pipe       2.Cog Wheel
 #ROM & Tightness:-
 #Contracture:-
   (include Limb Length if required)

7.Involuntary Movements:-
                    Tremors:-At Rest/Activity
                    Athetosis/Chorea/Dystonia/Associated Reaction/Hemiballismus
                    Associated Reaction

8.Voluntary Control:-

9.Test For Co ordination:-

10.Stream Format(sheet attached):-

11.Posture:-
     In case of in-patient,bed-redden patient:Posture-more of attitude of
     patient and Berg Balance Scale:-
12.Strategy Assessment:-

13.GAIT Assessment:-(Dynamic Gait Index),Balance

14.BARTHEL'S INDEX:-

15.Investigation and Drug history

ICDIH2:-

Diagnosis:-

Mnagement:- STG                                         LTG


Follow Up:-

exercises to prevent arthritis

Cerebral palsy - PubMed Health

Cerebral palsy - PubMed Health

ANTENATAL CARE (ANC)

                                          AIMS
To prepare female mentally and physically for physiological changes during pregnancy ,delivery and to keep them fit in the role of parents.
To prepare the perspective parents for the birth and care of the baby for parenthood.
To motivate,council and guide them to increase their confidence.
 Provide them a forum for the perspective parents to meet each other and discuss aspects of hopes,fears,problems, and expectations.
                         EXERCISES AND ERGONOMICS
EXERCISE TO MAINTAIN PROPER POSTURE AND TO AVOID POSTURAL PROBLEMS LIKE PIVD,LOW BACK PAIN,ROUNDED SHOULDER etc.
Back care and lifting in various positions:-
                                       STANDING :
Stand and walk straight,strecth head up out of shoulder.to check your posture is correct or not lean back against a wall.
Do ankle pumps to keep circulation good and ease muscle tension.
                                       SITTING :
As spinal structures have to undergo many pressures during pregnancy its care is important .while sitting for long time into the chair place a small cushion or a pillow behind the low back as to maintain the lumbar curve and to reduce the srtecth on the posterior spinal structures.foot should be rested on floor .
                                        SLEEPING POSITIONS :
while getting up from lying position turn to side lying and then should get up to avoid abdominal strain from sitting up or lying straight down.for most women supine from prone is acceptable as the weight of the body is taken on the bed,with a pillow placed under the abdomen and another beneath the knee.
                                        LIFTING ADVICE :
When lifting from the floor ,it is important to ensure that the weight is light enough to be filled comfortably and not to bend from back, bend from knee.
                               

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ANKYLOSING SPONDYLITIS

Ankylosing spondylitis mostly occurs in males,affects the axial and spinal skeleton with stiff spine,painfull back and x-ray shows typical bomboo spine structure which is important in diagnosis of disease.It is a variant type of RA.It is an inflammatory disease of spine.Inflamation of spinal synovial joints progressing to ankylosis.SACRO-ILLIATES lesion is seen.
                                  CLINICAL FEATURES :-
1) general malaise
2) pain in -shoulder joint (with involvement of AC joint),
               -jaws(with involvement of TMJ),
               -over insertion of TA (due to enthesitis)
               -chest region(due to sternoclavicular,costo-vertebral and costo-     sternal joints involvement
3) painful breathing movements of thorax leading to reduced chest expansion
4) limited shoulder ROM due to pain and muscle spasm
5) reduced lumbar flexion and thoracic rotation
6) flattening of lumbar curve due to weakness of lumbar paraspinal muscles and
    sacro-illiac involement
7) gradually progressing thoracic kyphosis
8) hip flexion deformity
9) HLA B-27 positive
                              PHYSIOTHERAPY MANAGEMENT :-
GOALS:- is to relieve pain,assist resolution of inflammation,prevention of deformities,maintaining spinal mobility,maintaining chest expansion,posture correction and maintaining functional independency of patient.
http://www.healthline.com/health/ankylosing-spondylitis/effects-on-body

FROZEN SHOULDER

Frozen shoulder, or adhesive capsulitis, is characterized by pain in the shoulder, sometimes leading into the upper arm and shoulder blade. This may cause a decrease in shoulder movement, stiffness of the shoulder joint. Frozen shoulder can be secondary to other medical problems such as thyroid illness, Parkinson disease, and cardiac disease and post-surgery. It may also be secondary to a fracture

 of the shoulder or arm, tendonitis, trauma or other condition requiring shoulder immobilization for a period of time. During this time, the capsule of the shoulder joint becomes inflamed and thickened, sometimes contracted.

Patients often complain of an intense pain, dull or aching, with difficulties sleeping and a very restricted range of motion. The decrease in the range of motion decrease usually shows a pattern; some movements are more affected than others. In time this condition leads to decreased strength and stability, as well as scapular stability, and therefore reduced arm function in different degrees.

The normal course of frozen shoulder has three stages: freezing, frozen and thawing, which can last up to 2 years. Frozen Shoulder is a self-limited condition. However, physiotherapy has been proven to shorten the healing process. After assessing the physical and functional restrictions and impairments, the physiotherapist will aim the treatment towards pain and inflammation reduction, and restoration of the motion.

Only 20% of people with frozen shoulder actually have to undergo surgery. The other 80% can significantly reduce their pain if not completely abolish their frozen shoulder with exercise.
If you have a well structured exercise program you can actually find relief in 1-3 months.

There are many different treatments that people have used to combat their adhesive capsulitis; however the 'best' treatment is to make sure the patient uses frozen shoulder exercises which take advantage of a multi-level protocol.

Using a multi-level treatment protocol means that the person is not focusing on one aspect only of dealing with the problems and symptoms, rather that they are dealing with all of the issues associated with their frozen shoulder. Treatments such as this will help cover all of the bases and allow proper motion, flexibility, strength and pain reduction, which will make certain that your shoulder pain will be treated and eliminated much faster than not.

To have true success is treating adhesive capsulitis, the patient must be sure to include a good, quality stretching protocol, as well as increasing strength, treating soft-tissue issues, and working on increasing range of motion in all directions.

CARDIAC REHABILITATION

                                    INPATIENT PHASE
TOTAL DURATION :-6-14 DAYS
1 to 7 in ICCU and 8 - 14 in the wards.
Need to maintain ROM of all joint and to avoid problems associated with orthostatic hypotension and thromboembolism.
Before starting the rehabilitation program evalaution and patients education is necessary.All viatls should be stable.Any change in systolic and diastolic pressure during exercise.systolic drop greater than 10mmHg or increase in pressure greater than 30 mmHg immediately stop the exercise.Check for HR changes and complaints like dizzeness,sightedness or angina.
Haemodynamic monitering necessary before and after exercises.
LEVEL 1:-1.5 METs
Essentially Bed rest and bed exercises.
Arm movement and ankle pumps.
Introduction and education of cardiac rehabilitation program.
SLR,heel slides.
LEVEL 2:-1.5-2 METs
Limited Room Abulation activities are allowed.
Sitting 15 - 30 min ,2-4 times /day.
Leg exercise -ankle pumps,SLR,heel slides.
Knee extention in sitting,sit to stand.
ADLs like shaving,ambulation til toilet attached to room.
Identification of CAD risk factors.
LEVEL 3:-2-2.5 METs
Limited Hall Ambulation are allowed
Independent or assisted walking continue slowly upto 5 mins are allowed for 3-4 times a day.
Continuining the bed exercise and ADL.
Bathroom privileges allowed.
Borg's scale used by P.T. for rating of Perceived Exertion and appropriate parameters with activity.
LEVEL 4:-2.5-3 METs
Progressive Hall Ambulation
Walking for 5-7 min as tolerated 3-4 times /day.
Standing trunk exercises optimal.
Reinforce benefits of outpatient cardiac rehabilitation.
LEVEL 5:-3-4 METs
Hall ambulation 8-10 min as tolerated.
Arm exercises optional.
Limeted stair climbing .
LEVEL 6:- 5 METs
Stair climing progressive .
                                     OUTPATIENT PHASE
After discharge patient are allowed to go to home and to do ADLs and progressive exercises but before discharge patient has to undergo a low level graded exercise test which are often terminated if
1)patients HR increases to 120/130 beats / min.
2)patients HR reaches to HRmax.
Patient are allowed to do exercise to 60% to its HRmax and adviced not to do atatic,exertive,isometric activities and to take adequate rest and to follow proper diet.
Till the 6 weeks after discharge the phase is conditioning phase.
Till 3 months after discharge its convalescent phase which is a phase of improvement during which exsercise level is gradually increased
After about 6 weeks patient has to follow and undergo ETT and SL-GXT.
The last phase is the maintaining phase which starts mostly after 6 months after discharge.

PHYSIOTHERAPIST ADVICE FOLLOWING DELIVERY

Physiotherapy advice following hysterectomy, repair and other gynaecology operations

Day 1 onwards To reduce the effects of a general anaesthetic, practise the following exercises hourly throughout the day. Deep breathing exercises Be sure that you have adequate pain relief because deep breathing could be uncomfortable. Practise the breathing exercises sitting up in bed, supported by pillows, or out in a chair. Take a deep breath in through your nose, hold for two seconds and then sigh the air out of your mouth. Repeat four times then try to ‘huff’ the air out. Huffing Take a deep breath in, then breathe out quickly and forcefully through your mouth as if you were steaming up a window. This will help loosen any phlegm if needed. Coughing Be sure that you can cough strongly and effectively if needed after your operation to clear any excess secretions. Don't worry, your stitches and staples are very secure. You may find it more comfortable to cough in the same position as for your deep breathing exercises. Support your abdominal incision by holding a small towel or pillow firmly over your tummy. If your operation is through the vaginal route, place a hand over the pad between your legs. Circulatory exercises These are designed to improve circulation in your legs whilst lying in bed or sitting in a chair. Try to do them exercises every hour. Ankles Bend and stretch the ankles up and down firmly and quickly. Repeat 10 times. Knees Tighten your thighs by pushing the backs of your knees down against the bed. Repeat five times. Buttocks Tighten your buttocks regularly to relieve pressure from your bottom. Repeat five times. From Day 2 onwards Start all exercises by lying with your head on a pillow, knees bent and a shoulder- width apart, feet flat on the bed. 1. Abdominal exercise Gently place your hands on your lower tummy. Breathe in through your nose and as you breathe out, gently pull your tummy away from your hands towards your back. Feel the muscles tighten, try to hold for a count of 3 and then relax. Breathe in and out normally. Practice this exercise 3 times a day. You will gradually be able to hold for longer until you reach 10 seconds and can repeat 10 times. 2. Pelvic Tilting Place your hands in the hollow of your back. Tighten your tummy muscles (Exercise 1), flatten your lower back onto your hands and tilt your bottom. Breathe normally. Hold for three seconds and release gently. Try to progress this exercise by tightening your tummy muscles and also pulling up your pelvic floor before continuing as above. 3. Knee rolling Tighten your tummy muscles (Exercise 1) and gently lower both knees to one side as far as is comfortable. Bring them back to the middle and relax. Repeat to the other side. 4. Knee bends Tighten your tummy muscles (Exercise 1). Keep your back flat on the bed and bend one hip and knee up as far as is comfortable. Try to hold up to the count of 10 and then replace the leg, so the foot is back on the bed. Repeat with the other side. Repeat each of these exercises four times, three times a day, and then do more as you feel able. To get out of bed Bend both knees and roll onto your side by moving your shoulders and knees together. Push up by pressing your upper hand down onto the bed while you lower your feet to the floor. Sit on the edge of the bed and then stand by pushing up with your legs and hands. Posture and back care It is very important to be aware of your posture and to take special care for about six weeks after your surgery. A good posture will help prevent backache. Sitting Sit upright in a supportive chair, with both feet on the floor. Do not slouch. You may find it helpful to place a small cushion or rolled towel in the small of your back to give support. . Standing or walking Avoid holding your tummy with your hands and slouching forwards. Stand upright with shoulders back, and bottom and tummy tucked in. Lifting Do not lift heavy objects. Try to pull up your pelvic floor, tighten your tummy muscles and breathe out as you lift. Remember to bend your knees and keep your back straight. Hold larger objects close to your body. ·         If you are suffering from back pain after your operation, seek further advice from your physiotherapist. ·         If any exercises cause pain, discontinue and seek advice from your physiotherapist. ·         Your consultant may also wish you to practise pelvic floor exercises. If so, a separate exercise sheet is available. Before you go home The need for continued pain relief at home is very individual. Please discuss this with your nurse. If you have any worries or concerns, please talk to the physiotherapist or nursing staff . Advice on discharge Exercises Continue with exercises taught for at least six weeks, preferably three months. Rest Take a daily rest on your bed for about an hour. Continue for as long as necessary. Walking This is a very valuable exercise. Try to walk for about 20 minutes at least once a day. Hills and stairs are quite safe, but build up speed and distance gradually. Driving Check with your consultant but do not expect to drive for about four or six weeks, depending on your surgery. Make sure you can wear a seatbelt comfortably and perform manoeuvres and an emergency stop without undue pain. Work You should not expect to return to full-time work until after your post-op appointment with your consultant (six weeks). Always get approval from your doctor to return to work. Sports Also get approval at this appointment to return to sports, swimming, aerobics etc. Gardening Avoid gardening for a few weeks. Start slowly. Sexual Intercourse You should refrain from sexual intercourse for about six weeks. Household Activities 'Dos and don'ts' DOS: Independent personal hygiene; light housework, such as dusting, ironing, making drinks; washing and drying dishes; preparing light meals. Don’ts: Decorating; heavy lifting; shaking the duvet or heavy bedding; cooking a large meal using the oven; heavy housework. Take things slowly. Be very careful for the first six weeks after your operation. Gradually build up activity over the next six weeks until you feel able to resume your normal lifestyle.

Theoretical Approach “Living concept”

Where Bobath Began

·         Problem-solving approach based on reflex/hierarchical models.

·         Hierarchical model of CNS structure and function.

·         CNS viewed as the “controller”. Automatic postural control mechanism simplified the responsibility of the CNS in control of movement.

·         Sensory feedback is important for the correction of movement errors.

·         “Positive signs” including spasticity and abnormal coordination of movement are the most important aspects of sensorimotor impairments.

·         Muscle and postural tone determine the quality of the patterns of posture and movement used in functional activities.

Where NDT Is Now

·       Problem-solving approach based on a system/selectionist model.

·       Distributed model of CNS structure and function.

·       The CNS determines the pattern of neural activity based on input from multiple intrinsic systems and extrinsic variables that establish the context for movement initiation and execution.

·       Sensory feed-forward and feedback are equally important for different aspects of movement control.

·       The “negative signs’, including weakness, impaired postural control and paucity of movement are recognized as equally important as the “positive signs” in limitations of function limitations of function.

·       Task goals, experience, individual learning strategies, movement synergies, energy and interests all affect the quality of the final action.

JALGAON DISTRICT OT-PT ASSOCIATION

A golden day in the history of jalgaon physiotherapists-
FINALLY SET 
"JALGAON DISTRICT OT-PT ASSOCIATION" on september 2012 with Dr.Jaywant Nagulkar(PT) as "PRESIDENT"
and Dr.NEHA INGALE(PT) elected as a "VICE PRESIDENT" of the association.

This association will work  best for the awareness and upliftment of the physiotherapist profession in india and focussing on the rural areas of maharashtra .

UPPER AND LOWER CROSS SYNDROME

IT OCCURS DUE TO FAULTY POSTURES.AS NOW A DAYS WE ARE LIVING A SEDENTARY LIFESTYLE AND LACK OF EXERCISE CAUSES DECREASE IN MUSCLE STRENGTH,WEAKENING AND LENGTHENING PHENOMENON OF MUSCLES.
EXAMPLES TO DECREASE THIS SYNDROME ARE AS FOLLOWS:-

• Perform the hip flexor stretch for 30 seconds on each side
• Strengthen the glute muscles by tying a theraband just above the knee and walk side ways across the room
• Stretch the pectoral muscles for 30 seconds by putting your hand and elbow against the corner of a wall and pushing forward until you feel a stretch in the pectoral/chest area.
• Strengthen your lower trapezius and seratus anterior by lying down on your stomach. Turn your thumps to the ceiling and raise your chest off of the floor. Push your shoulder blades back and down, engaging the mid back and glutes, and hold for at least 30 seconds.

myotomes and dermatomes used for testing various signs and symtoms and diagnosis.

PT CAREER IN INDIA

PHYSIOTHERAPY                CAREER INFORMATION

SECTION I:     QUESTIONS AND ANSWERS

PHYSIOTHERAPY:   THE PROFESSION

1.         What is physiotherapy?

Physiotherapy is a first-contact, autonomous, health profession primarily directed towards the prevention or alleviation of movement dysfunction in people.  Movement is an essential component of life and health.  Physiotherapy helps keep people in motion throughout all ages of life.

The practice of physiotherapy is anchored in the movement sciences and concerned with the function of multiple body systems.  The profession is dedicated to:

Ø  restoring, improving or prolonging physical performance and functional independence

Ø  preventing and managing pain, physical impairment and disability

Ø  promoting fitness, health and wellness

2.         What do physiotherapists do?

Physiotherapists work with individuals with temporary, or permanent, mobility problems caused by injury, disease, aging or birth abnormalities.

They assess clients to determine their physical status and the potential for change.  Therapy, when indicated, often focuses on:

Ø  decreasing pain

Ø  increasing joint movement and flexibility

Ø  building muscle strength and endurance

Ø  improving balance and co-ordination

Ø  enhancing tolerance in exercise and daily activities, and

Ø  educating about the condition and therapy program.

Physiotherapists use a variety of techniques and modalities in their practice, including:

Ø  therapeutic exercise and specific techniques of mobilization, manipulation and facilitation

Ø  physical agents such as heat, cold, water, electrical energy, acupuncture

Ø  functional activity training and reconditioning

Ø  assistive devices such as canes, crutches, walkers, braces and artificial limbs.

An important part of the therapy program is providing advice on ways to prevent further injury or deterioration.

3.         With whom do physiotherapists work?

Physiotherapists work with members of the health care "team" including physicians, occupational therapists, nurses, social workers, speech language pathologists, pharmacists, teachers, etc.  The physiotherapist may work with one or many of the team members in order to meet a client's needs.

4.            Where do physiotherapists work?

Physiotherapists work predominantly in hospitals, rehabilitation centres, and private practices.  They also work in nursing homes, home care and community agencies, industrial health units, schools, sports clubs or clinics, the armed forces and universities.

5.         What are the working hours / salary scales / fringe benefits / job possibilities?

           6-8 HOURS IN HOSPITALS AND CLINICS,IN SLIMMING CENTRES AND GYM PART            TIME 4 HOUR JOBS AVAILABLE.PRIVATE HOME VISITS.

6.         Where can the profession lead?

It can lead to a variety of interesting and challenging jobs in the health care system.  Many physiotherapists today develop a specialized area of interest such as paediatrics, geriatrics, neurology (stroke, spinal cord injuries, brain injuries) cardiorespiratory (heart and lung problems) and orthopaedics (broken bones, back problems, arthritic conditions, sports injuries, etc.).  Some physiotherapists pursue a doctorate degree and become involved in research and/or physiotherapy education.

7.         Is there a professional body?

Yes,IAP INDIAN ASSOCIATION OF PHYSIOTHERAPY.

8.         Must physiotherapists be licensed to practise?

Yes, Physiotherapists must be licensed in order to practice in IAP.  It is a legal requirement. Each province has a licensing board.MAHARASHTRA ALSO FORMED COUNCIL OF OT/PT. 

Maharastra council of ot/pt provides you registration number with also a personel identity card.Only those who studied from Maharashtra state from recognised college can get registered through the process.

PHYSIOTHERAPY:   THE EDUCATION

1.         What are the educational requirements?  How long will it take?

Currently in India, the basic educational requirement is a bachular degree in Physiotherapy (i.e. B.P.Th.).  Following high school, it will take a minimum of four years +intership of university study. 

Within the next several years, the basic requirement for Physiotherapy entry-to-practice will change from a Bachular degree to a Masters degree.   Many universities in India are currently offering Masters Entry-Level Physiotherapy Programs.  The other universities are moving in this direction.   It is important to keep current on the admission requirements for the individual institutes.

2.         What are the academic pre-requisites?

The requirements for admission into a Physiotherapy career vary from university to university.  Generally, students benefit from a strong science background.  Specific pre-requisites for each university program are outlined in the respective university calendars and websites.

3.         Where can one study?

          1.AIIMS UNIVERSITY

          2.MUHS UNIVERSITY

          3.ALGAPPE UNIVERSITY

          4.DEEMED UNIVERSITY

4.         What can I expect while studying physiotherapy?

You will be very busy.  Academic loads are heavy.  Subjects include anatomy, neuroanatomy, kinesiology, exercise physiology, neurophysiology, electrotherapy, orthopaedics, neurology, cardiorespirology, etc.  Clinical skills labs are also part of the curriculum.

Workplace experience is gained through fieldwork placements in a variety of health care settings (hospitals, rehabilitation centres, home care/community agencies, nursing homes and private clinics). Students work under the guidance of qualified therapists to develop and enhance their clinical knowledge and skills. Clinical placements are interspersed throughout the academic program.

5.         How much will the course cost?

Costs vary from university to university.  Tuition fees currently range from 40,000 -75000per year, while residence fees (room and board) range from approximately  25000/-per year for a single room.  Books, uniforms and other incidentals are additional expenses.

PHYSIOTHERAPY:  THE APPLICANT

1.         What are the personal pre-requisites?

Desirable personal traits include:  (1) a strong interest in how the human body functions and moves,

(2) a desire to work with persons with physical disabilities, (3) an ability to work collaboratively with others, (4) good communication and interpersonal skills, (5) physical fitness and emotional stability, and (6) an enthusiastic and caring personality.

2.         Should I have alternate career choices?

Acceptance into a Physiotherapy Program is highly competitive.  Selection is usually based on a combination of marks, personal qualities, and non-academic achievements.  Application to more than one university is strongly advised, as are alternate career options.

3.         How can I best learn about physiotherapy?

Visit at least two physiotherapy departments to see physiotherapy in action.  Ask lots of questions of physiotherapists, physiotherapy students, or physiotherapy patients/clients.  Explore the scope of practice and the different work settings. Summer employment or volunteer work with children, seniors, or adults with physical disabilities is an asset.