Physiotherapy

demonstration class taken on 19/11/07

physiotherapy dr. ashish gohiya assistant professor department of orthopaedics gandhi medical college bhopal d

*the responsibility of the doctor does not end when the “temperature touches normal and stitches are removed”

rehabilitation

*the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability.

*(who (1969) techn. rep. ser. , no. 419)

rehabilitation

*medical rehabilitation *vocational rehabilitation *social rehabilitation *psychological rehabilitation

physical medicine and rehabilitation

physiotherapy

*it’s not after care, it is a part of care. *it includes *assessment of the patient *planning the intervention *implementing the treatment *evaluation

*altering the treatment if required.

trauma

*physiotherapy during immobilization *physiotherapy after removal of immobilization.

during immobilization

*to reduce edema – limb elevation, static contraction of the muscles reduce adhesions. *maintenance of circulation *maintain muscle function *maintain joint range *maintain optimal function

after removal of immobilization

*to reduce swelling *to regain full range of movement – pain, edema, adhesion, muscle weakness. *to regain full muscle power *to re educate full function

movement technique

*passive movement *assisted active movement *free active movement *resisted movement

passive movement

*indicated when patient can not perform the movements on his own *muscle paralysis / weakness *patient not conscious

*passive movements regain *range of joint movement *muscle length

passive movement

*starting position *grasp *position of therapist *traction *movement

assisted active movement

*indicated when

*muscles are weak *free movement is painful

*patient is encouraged to do most of the movement with the physiotherapist assisting when necessary. *suspension slings may be used for assistance

active movement

*movements performed by the patients without external assistance or resistance. *indicated to *increase the range of joint movement *increase the muscle strength *retrain balance and coordination *regain independence

*pain

range of movement

*protective mechanism - may be a contraindication to active exercise. *medical treatment , electrical , thermal t/t.

*swelling

*limb elevation *static contraction of muscles *free exercise of other joints

*adhesions

*stretches the adhesions *improve the blood supply

to strengthen the muscles

*technique will depend on the grade of the muscle. *grade 0, 1 *grade 2 (gravity counterbalanced ) *grade 3 (against the gravity ) *grade 4 (against mild resistance ) *grade 5 (normal power)

*increasing the no. of times the movement is made. *gradually increasing the resistance.

retrain balance & coordination

*this is problem with muscle weakness and neurological deficit. *started with forearm supported prone lying, progressing to prone kneeling, half kneeling, sitting and standing. *in coordination due to muscle weakness improves on improving the muscle power.

resisted exercises

*to facilitate activity and strengthen muscles. *resistance to the movement can be given by *physiotherapist *patient himself *mechanical resistance

*weights *springs *electronic operated machines.

electrotherapy

*this modality includes use of various methods of heating or cooling the tissues. *heating the tissues *paraffin wax *ir radiation *heat pads *hot moist packs *short wave diathermy

*cooling the tissues *ice therapy

paraffin wax

*low melting point 40 oc – 44 oc *heats slowly but retains heat for long *wax solidifies on the skin - energy released by the latent heat of fusion results in - heating of tissues. *only for distal part of extremities

infra-red radiation

*radiation are absorbed – radiant heat is converted to heat. *two type of generators *luminous – penetrates epidermis and dermis *non luminous – penetrates only sup. epiderm

*rays should strike the part at 90o

*effects

infra-red radiation

*vasodilatation in tissues *improves nutrition *removes waste products *sedative effect on sensory nerve endings *relaxes muscles

heat pads

*plastic covered pads *pad has three level of heating *used for treating neck & back *pt. lies on it, heat passes by conduction

hot moist packs

*canvas bags filled with hydrophillic substance *part covered by towels packs applied and moulded to part heat passes by conduction *moist heat is conducted more uniformly than dry heat.

short wave diathermy (swd)

*application to tissues an electric field which oscillates at a frequency of 27.12mhz& have a wave length of 11.06 m. *the oscillating field produces distortion of molecules which generates heat. *the amount of heat depends on the arrangement of field and electrical impedance of tissues *can be used to treat both superficial and deep lesions *rapid and greater rise in temperature than conductive methods. *swd can be pulsed, during resting period the heat is dispersed in to tissues through circulation and the treatment is non thermal

ice therapy

*when ice applied to skin it melts and removes the heat from the tissues (the latent heat of fusion) *application of cold leads to alternate vasoconstriction and vasodilation, reduced nerve conductivity and reduction of muscle spasm and spasticity. *used

ice therapy

*to relieve pain *reduce muscle spasm *reduce swelling *reduce spasticity *facilitate muscle contraction *increase muscle endurance *reduce hematoma formation *prevent pressure sore *promote healing of wounds

ultrasound

*production of longitudinal mechanical waves above the

audible range (20khz) *produced by distortion of quartz crystal by a high frequency alternating currents. *longitudinal sound waves cause to-and-fro movement of particles giving alternate areas of compression and rarefaction.

ultrasound

*treatment head is applied perpendicular to the surface. *head continuously moved to prevent concentration to one tissue site. *higher the frequency greater the absorption and smaller the depth of penetration. *lower frequency deeper penetration

*effects

ultrasound

*release of chemical mediators *proliferation of granulation tissue *stimulation of fibroblast *increased circulation *increased activity of phagocytes & macrophages *this results in healing and reduced pain.