Physiotherapy and rehabilation (2)
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PHYSIOTHERAPY AND REHABILITATION
Presenter : Dr. S.V.Hari krishnan(PGT ORTHO)
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LEARNING OBJECTIVES
INTRODUCTIONELECTROTHERAPYCRYOTHERAPYEXERCISE THERAPYHYDROTHERAPYREHABILITATIONCONCLUSION
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DEFINITION
PHYSICAL THERAPY - evaluating, diagnosing, and treating a range of diseases, disorders, and disabilities by physical means.
Diagnosis and treatment of physical source of the problem; the injured tissues and structures
He must cure himself is the doctrine of physiotherapy.
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HISTORY• Hippocrates & later Galenus first
practitioner of physiotherapy (460 BC)
• Per hendrik ling – “father of swedish gymnastics”
• Modern Physiotherapy was established in Great Britain
• Emergence of physiotherapy : World Wars
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PHYSIOTHERAPY SPECIALTIES
CARDIO PHYSIOTHERAPY
PAEDIATRIC PHYSIOTHERAPY
GERIATRIC PHYSIOTHERAPY
ORTHOPAEDIC SPORTS NEUROLOGY
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ROLE OF PHYSIOTHERAPIST• Assess ,manage & treat a broad range of medical conditions
• Relieve physical pain & heal injuries.
• Increase mobility, build strength, improve balance & enhance Cardiopulmonary performance.
• Use a variety of techniques to strengthen the muscles & joints.
• Make individual independent for his/ her activity of daily living.
• Provides gait training & Posture correction.
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• Thus rehabilitation includes prevention of avoidable disabilities Bed-soresVenous thrombosis Urinary infectionRenal stones Muscle wastingJoint stiffness and Contractures early mobilization
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ELECTROTHERAPY
Shortwave Diathermy
Microwave Diathermy
Ultra sound
Interferential Current Therapy
( IFT)
Transcutaneous Electrical Nerve
Stimulation ( TENS).
Faradic & galvanic muscle
stimulator
Cervical/ Lumbar Traction Wax bath Infrared
rays
LASER
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SHORTWAVE DIATHERMY
• Frequency - 27.12 MHz
• wavelength -11 meters.
• Treatment of deep muscles and joints that are covered with a heavy soft-tissue mass.
• Utilizes two condenser plates that are placed on either side of the body part to be treated.
• Types:– Continous– pulsed
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Microwave Diathermy Frequency – 300 – 30,000mhz
Wavelength – 10-12cm(shorter than short wave diathermy)
Strongly absorbed by tissues of high water content(all joints)
Selective heat application
Not suitable for deeper tissues
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ULTRASOUND Uses high frequency sound
waves, greater than 20,000 Hz.
Frequency range of 1- 3 MHz
It has both thermal & mechanical effect.
Used to heal soft tissue and ligaments injury , scar mobilization & edema reduction.
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INTERFERENTIAL CURRENT THERAPY ( IFT)
Placement of electrodes
two currents produced cross each other in the affected area
Two currents 'interfere' with each other
“INTERFERENTIAL”
This modality addresses the issues of pain, spasm, and inflammation
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TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
Most commonly used forms of electro analgesia
Goal - block pain signals and to stimulate the release of naturally produced pain killers such as endorphin
Uses: Low Back Pain (LBP) Myofascial And Arthritic Pain Sympathetically Mediated Pain Bladder Incontinence Neurogenic Pain Visceral Pain Postsurgical Pain
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FARADIC & GALVANIC MUSCLE STIMULATOR
Generation of impulse by a electic device
Delivered through electrodes on the skin in direct proximity to the muscles
elicitation of muscle contraction using electric impulse
stimulation of blood flow and pain reduction, as well as ionization
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CERVICAL/ LUMBAR TRACTION
short term relief of neck pain and low back ache
relieve muscle spasm and nerve root compression by stretching soft tissues
Increases the spaces between vertebrae reducing pressure on intervertebral discs and nerve root
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WAX BATH
Application of the molten paraffin wax on the body part(40 – 44˚c)
Methods: Dipping and Wrap, Direct pouring method Toweling or bandaging method
Reduces pain,inflammation,edema and muscle spasm
C/i in ischaemia,haemoorhage,spinal cord injuries, acute trauma
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INFRARED RAYS A band of light that we perceive as heat
Decreases muscle spasm and promote relaxation
Promoting healing of superficial wounds
Faster ability to heal from soft tissue
injuries such as tears, pulls, and sprains May cause burns and electric shock
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CRYOTHERAPY
Pain and muscle spasm
Stretching of collagen due to tension(tear)
Blood vessels are torn,invagination of fluid in to muscle fibres
Bruises in skin
Application of cold
Reduction in flow of fluid in to fibres
Reduces transmission of pain impulses
Reduces spasm (reduces ability of muscle to maintain contraction)
Swelling and internal bleeding is reduced
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Advantages
Usually inexpensive. Quick application with little
preparation. Faster muscle recovery Promotes healthier skin
complexion Effective with chronic pain
management Reduces stress & anxiety
Disadvantages
It is difficult to keep the ice in place
Quickly melts No compression is applied. Can only be applied for short
periods of time (10-20 minutes).
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ICE BAGS: simple plastic bags, chemical cold packs or
frozen vegetables. The skin will pass through four stages of
sensation in 10-15 minutes. These sensations in order are:
Cold BurningNumbness
ICE MASSAGE DO NOT hold the ice in one area for more
than 3 minutes since this may cause frostbite.
• Cold therapy should be stopped once the skin feels numb
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LASER Light Amplification from the Stimulated
Emission of Radiation (LASER) Increases
healing rate in wounds and burns healing response of fractures regeneration of damaged nerve by
stimulating axon sprouting Decrease inflammatory edema Uses :
Osteoarthritis Rheumatoid arthritis Ankle sprain Chronic Low back pain Chronic ulcers and wounds
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EXERCISE THERAPY
Active & Passive Exercises
Resisted exercises
Joint Mobilization techniques.
Suspension therapy
Hydrotherapy
Relaxation techniques Stretching
Proprioceptive Neuromuscular
Facilitation. ( PNF)
Myo Fascial Release
Technique
Muscle Energy Technique
Gait & Balance Training
Posture Correction.
Breathing Exercise
Postural training
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ACTIVE AND PASSIVE EXERCISES
• Regain muscle power and then increase the range of joint movement under muscle control
• Active exercise is the keynote of treatment• It strengthen muscles and mobilize joints• prevents bone atrophy, stimulate circulation,
improve co-ordination and restore function
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SHOULDER WHEEL EXERCISES
To improve the Range of motion of shoulder joint
FINGER LADDER EXERCISES
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PARALLEL BARS
For gait training & posture correction
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STAIRS & RAMP
Stair climbing training
WOBBLE BOARD
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SUSPENSION THERAPY form of Assisted Exercises(continuous passive motion)
to increase ROM, increase muscle power and support body parts by using ropes and slings.
Aim : Muscle Strengthening Neuro-Muscular Co-ordination
Types :Axial Pendularvertical
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SUSPENSION THERAPY
To improve range of movements
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QUADRICEPS CHAIR AND STATIC BICYCLE
For Quadriceps Strengthening
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GYM BALL EXERCISEFor Back exercise , Neck & trunk control in Baby
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OVERHEAD PULLEY & SUPINATOR/ PRONATOR EXERCISE
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FINGER EXERCISER
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WALKING AIDS• A device designed to assist walking• Improve the mobility of people • Redistribute weight-bearing area
(decreasing force on injured or inflamed part or limb)
• Can compensate weak muscles• Decrease pain• Improve balance
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TYPESRIGID FRAMES
FOLDING FRAMES
RECIPROCAL
FRAMES
FOREARM
SUPPORTING FRAMES
WHEELED FRAMES
ROLLATORs
AXILLARY / UNDER ARM CRUTCHES
ELBOW CRUTCHES
(LOFSTRANDS )
FOREARM (GUTTER CRUTCHES)
WALKING STICKS(TETRAPOD
AND TRIPOD)
TYPES
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AXILLARY CRUTCHES
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ADVANTAGES: Convenience from temporary injuries A large degree of support for the lower
body Available at low cost. perform a greater variety of gait
patterns , ambulate at a faster pace
DISADVANTAGES: Limited upper body freedom crutch paralysis(Radial N.and brachial
plexus injury)
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Gutter crutches
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PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION
Proprioceptive: sensory receptors that give information concerning movement and position of the body
Neuromuscular: involving the nerves and muscles
Facilitation: making easier
vital element in rehabilitation process of sports related injuries
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USES• To increase strength, flexibility,
coordination and functional mobility.
• The main goal of treatment is to facilitate the patient in achieving a movement or posture.
• used in orthopedic rehabilitation for musculoskeletal injuries and in neurological rehababilitation
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MYO FASCIAL RELEASE THERAPY Scarring or injury to network of
connective tissues produce pain and impede motion
Gentle blend of streching and massage
Uses hands on manipulation of entire body
Technique to ease pressure in the fibrous band of connective tissue in the body
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USES
• Long standing back ache• Fibromyalgia• Sports injuries• Rotator cuff injuries• Sciatica
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HYDROTHERAPY
• Hydrotherapy, or water therapy, is the use of water (hot, cold, steam, or ice) to relieve discomfort and promote physical well-being– Hot Water: relaxing, stimulate immune system.– Tepid Water: stress reduction.– Cold Water: reduce inflammation
• Alternating hot and cold water can stimulate the circulatory system and improve the immune system
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External Hydrotherapy – involves the immersion of the
body in water
Motion-based treatments– uses water under pressure in the
form of jets, whirlpools or aerated bubbles
– It is used to treat joint and muscle injuries ,stress and anxiety disorders.
Uses:osteoarthritis
rheumatoid arthritisfibro myalgiasciatica
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REHABILITATION
• Co ordinated usage of medical ,social ,educational and professional activities for training(retraining) of individual for optimum working ability
• Kinds of rehabilitationMedicalPsychologicalHomeProfessionalSocial
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MEDICAL REHABILITATION
OBJECTIVE:The restoration of health of the affected person in optimal
timeIt starts from the place of accident, emergency room of
hospital,specialised rehabilitation centers
EARLY • From moment of trauma and continued during outpatient and in patient department
LATE •Aims at adaption to new environment of persons with disabilities and employment
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STAGES OF REHABILATION
• Immobilisation• Medications/
surgeryACUTE
• Specific exercises
• Neuromuscular control
RECOVERY
• Specific functional programes
• Exercises
FUNCTIONAL
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SOCIAL REHABILITATION
• Goal:– Recovery of skills in the affected for self catering
and living conditions
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PROFESSIONAL REHABILITATION
• Goal :– Restoration (full /partial) or nursing of new
professional skills allowing the sick and disabled patients to return to work
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PRINCIPLES OF REHABILITATIONEarly beginning(hospital)Succession(out patient basis)Continuity
PERIODS OF REHABILITATIONHOSPITAL OUTPATIENT POLYCLINICS
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CONCLUSION• Orthopaedic surgeon and a doctor of physiotherapy should
be “guides” for the patient during the rehabilitation period
• Rehabilitation of patients rests on accurate diagnosis, proper identification of roles, cooperation among the different disciplines and a potent but practical goal setting
• The patient is always the focus of treatment, and should have a quality of life that is deemed most acceptable
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BIBLIOGRAPHY
• Clayton's Electrotherapy - Theory and Practice(8th edition)
• Principles of exercise therapy (M.Dena gardiner)
• Watson – jones fractures and joint injuries (7th edition)
• Orthopaedic physical therapy secrets(jeffrey D.placzek)
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THANK YOU
“Happiness is a state of mental,physical and spiritual well-being. Think pleasantly,engaged sport and read
daily to enhance your well-being.”