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 .