Post on 14-Jan-2015
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PHYSIOTHERAPY DEPARTMENT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centre
, ww
w.b
urn
s-india
.com
, nbca
iroli@
gm
ail.co
m
WHAT IS PHYSIOTHERAPY???
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
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Physiotherapy is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by physical therapists. The specialty areas include:•Cardiovascular and Pulmonary•Clinical electrophysiology•Integumentary •Neurological•Orthopedic•Pediatric•Geriatric
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
WHY IN BURNS???
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
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Burn injuries are for a lifetime and require specialized care. Managing burn injuries properly is essential as it may cause disfiguring and disabling scarring. Physiotherapy is necessary for both in and out patients. The physiotherapist together with other team members must recognize the devastating effect a bad case of burning can have on the family. AIMS: •Achieve a clear airway and prevent respiratory complications•Maintain joint range of movements and prevent contractures or deformities•Maintain muscle strength•Regain maximum function•Minimize scarring•Help the patient to gain independence and return to an active lifestyle.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centre
, ww
w.b
urn
s-india
.com
, nbca
iroli@
gm
ail.co
m
MODALITIES REQUIRED FOR PHYSIOTHERAPY DEPARTMENT
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
Following equipments are necessary in the department:1. Chest percussor2. Cervical and Lumbar Traction
machine3. Short wave Diathermy4. Interferential therapy5. Muscle Stimulator6. Transcutaneous electrical nerve
stimulation7. Ultrasound 8. Continuous passive motion 9. Cryotherapy10.Heat Therapy11.Laser therapy12.Table for Diagnosis and treatment
purpose13.Traction table14.Evaluation sets• Dynamometer• Goniometer
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mCHEST PERCUSSOR
Chest Physiotherapy is a technique used to mobilize or loosen secretions in the lungs and the respiratory tract.
A chest percussor is used to administer percussion over the chest wall mechanically.
It is a high speed hand held hammer that when held against the chest replaces manual percussion. It's more effective, less tiring and easy to self administer.
It results in breaking up thick secretions in the lungs so that they can be more easily removed.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mTRACTION MACHINE: Spinal traction is a therapeutic technique
in which manual or mechanical forces are applied to the body in an attempt to stretch the spine.
Therapeutic spinal traction is most often used to address compressive pain in conditions like sciatica, herniated discs, degenerative disc disease, and pinched nerves.
The goal of traction is to reduce compression in the spinal column, release trapped nerves in turn relieving pain, joint distraction, soft tissue stretching and reduction of disk protrusion.
The ultimate goal is to decrease pain, tingling, weakness, and other symptoms caused by compressive spinal conditions.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mSHORT WAVE DIATHERMY:
Shortwave Diathermy (SWD) is a non invasive physiotherapy technique in which radio frequency electromagnetic energy of sufficient high intensity is directed at biological tissues which causes heating.
It is generally used to provide relief from pain and inflammation in the joints and muscles.
It increases blood flow and elasticity of connective tissue.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mINTERFERENTIAL THERAPY: Interferential therapy is an electrical
modality that applies currents at around 4000 Hz through the affected area of a patient.
Four electrodes are placed in such a way that allows two currents to cross each other and penetrate deep within a joint or body area.
Indications : Pain relief Increase in blood flow to promote tissue
healing reduce swelling/ inflammation Muscle stimulation to activate weak
muscles and overcome muscle inhibition caused by the injury
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mMUSCLE STIMULATOR: Electrical stimulation uses an electrical current to
cause a single muscle or a group of muscles to contract.
Contracting the muscle via electrical stimulation helps strengthen the affected muscle.
It also promotes blood supply to the area that assists in healing.
It is applied to stimulate sensory and motor nerves, facilitate muscle contraction, re-educate muscle, improve circulation and prevent contractures.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS):
TENS is a method of electrical stimulation. It primarily aims to provide a degree of
symptomatic pain relief by exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system.
The different methods of applying TENS relate to these different physiological mechanisms.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mULTRASOUND: Therapeutic Ultrasound is a treatment method that
uses a transducer transmitting sound waves to treat pain, inflammation and muscle spasms by stimulating the body with high-frequency micro vibrations.
Primary benefits are: speeding up of the healing process by increased blood
flow decrease in pain from the reduction of swelling and
edema. gentle massage of muscles tendons and/ or ligaments
and any scar tissue is softened. It also helps in softening of scar tissues.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mCONTINUOUS PASSIVE MOTION: C.P.M. is a proven modality used to reduce
pain, edema, increase/maintain range of motion, and help prevent adhesions, contractures (muscle/joint stiffness).
It provides hours of passive range of motion which allows the patient to focus on more effective Active range of motion and strengthening exercises during their limited visit.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mCRYOTHERAPY: Ice packs or cryotherapy are generally more
effective in terms of depth of penetration than other superficial thermal modalities.
Intramuscular temperatures can actually be reduced by 3-7 degrees C.
This is helpful in reducing local metabolism, inflammation, and pain.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mHEAT THERAPY:Heat packs are thermal
modalities used for relief of pain. This is also helpful in improving
circulation.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
TRACTION TABLE:
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mTABLE FOR DIAGNOSIS AND TREATMENT:
"A VISION WITHOUT A CLEARLY ARTICULATED PLAN IS SIMPLY A HALLUCINATION"
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centre
, ww
w.b
urn
s-india
.com
, nbca
iroli@
gm
ail.co
m
MODALITIES REQUIRED FOR REHABILITATION UNIT
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
Following equipments are necessary in the rehabilitation unit:1. Parallel Bar2. Exercise mat3. Exercise staircase4. Exercise balls5. Treadmill6. Shoulder wheel7. Shoulder ladder8. Wobble board9. Walker10. Crutches11. Ankle exerciser12. Exercise bands13. Hand grip exerciser14. Finger exercise springs15. Hand exercise balls16. Resistance putty17. Dumbbells18. Weight cuffs19. Stability trainer20. Peg boards21. Recreational activities
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
PARALLEL BAR: Physical therapy parallel bars are devices used in
rehabilitation facilities to assist patients in learning to walk after injury or disability.
They are used to help patients regain strength, balance, range of motion and independence.
They are used for coordination exercises and concise movements that work more than one joint and muscle.
This type of training progresses to walking with mobility aids such as walkers, crutches, or walking canes.
Gait training can help patients regain their normal ambulatory motion.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mEXERCISE MAT:
Exercise mats encourage the development of motor skills at all levels – a must for therapeutic, early childhood, and gross motor play.
Each mat is impervious to fluids and easy to clean.
Therapy mats are versatile.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
EXERCISE STAIRCASE:
Stair climbing is very essential in the rehabilitation of a burn patient.
It helps to improve aerobic and anaerobic conditioning and lower body strength.
It also increases independence of the patient and restores the functional ability of the individual.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
m
EXERCISE BALLS: Exercise balls are inflatable balls made of soft elastic
with a diameter of approximately 35 to 85 centimeters filled with air.
These are equipments effective at targeting core muscles, which are essential for stability and good posture.
The benefits are: Posture re-education Increase lumbar (low back) mobility Increase balance and stability Develop overall control and strength of the core body
muscles
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mTREADMILL: Treadmill provides a straightforward and
efficient aerobic workout. Advantages: Improves strength and endurance Incline setting can allow for consistent
"uphill" training Rate settings force a consistent pace Improves cardiovascular endurance
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mSHOULDER WHEEL:
Shoulder wheel is a therapeutic device used for rehabilitation of upper limb.
The benefits are: increase strength of upper limb muscles increases joint range of motion
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mSHOULDER LADDER:
Ideal for progressive range for shoulder motion
Improves strength of upper limb muscles Increases flexibility of joints
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mWOBBLE BOARD:
Wobble boards are designed for balance and proprioception training.
These are also called as Balance Training Boards.
It features as a sensory stimulation surface. It provides a multi-planar challenge.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mWALKING AIDS:
WALKERS CRUTCHES
These are used as assistive devices for walking.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mANKLE EXERCISER:
Ankle exerciser is a therapeutic device used for
Strengthening dorsiflexors and plantar flexors of ankle
Increasing ankle joint range of motion Improving joint flexibility
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mEXERCISE BANDS:
Therapeutic exercise bands are used for strengthening of the muscles.
The varied colored bands are of different resistances which can be used for progressive resisted exercises.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mHAND GRIP EXERCISER: Hand exerciser is used for hand
rehabilitation. It helps in increasing range of motion of all
the fingers. It increases the strength of the muscles of
the hand. It is used as a progressive resisted exercise
for hand.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mFINGER EXERCISE SPRINGS:
Finger exercise springs are used for strengthening of fingers.
The varied resistances help in providing feedback to the patients of increasing strength of the muscles.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mEXERCISE BALLS: Exercise balls are specially designed for the
improvement of motor skills of the hands. The benefits are: Improves strength Improves gripping activities Helps in prehension and precision training
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mRESISTANCE PUTTY:
Used commonly for hand therapy. They are often used in
physiotherapy/rehabilitation exercises and can help prevent future hand and wrist problems.
The goal is to increase the strength of muscles tendons and joints of the hand.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mDUMBBELLS:
Dumbbells are able to target specific muscles and ligaments in the arms, chest, shoulder, back, abdomen, and the legs.
Dumbbells are used for rehabilitation purpose.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mWEIGHT CUFFS:
Weight Cuff set strengthens the weak muscles through load resisting exercises of both upper and lower limbs.
These are iron pellets filled cuff which are double sewn & has long wrap around straps to hold it securely.
These weights come in 1/2kg, 1kg, 1.5kg, 2kg, 2.5kg and 3kg weights.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mSTABILITY TRAINER: Stability forms a large part of the
rehabilitation. It is the training of specific muscles that
stabilize the trunk to provide balance and control.
The reformer provides finely tuned exercise resistance that allows individuals to work very precisely to develop good alignment, core strength, and flexibility.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centr
e, w
ww
.burn
s-india
.com
, nbca
iroli@
gm
ail.co
mPEG BOARDS:
Peg Board is used to rehabilitate the patients with neuromuscular disorder.
It helps in improving fine motor skills.
Dr. S
unil K
esw
ani, N
atio
nal B
urn
s Centre
, ww
w.b
urn
s-india
.com
, nbca
iroli@
gm
ail.co
m