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  1. 1. STROKEStroke rehabilitation is sometimes an uphill climb.the aim of regaining function as quickly as possible at the expense of the affected limbPhysiotherapists begin stroke rehabilitation very soon after the stroke has occurred, while the patient is still in acute care.The physiotherapist will first do an evaluation to determine what disabilities must be dealt with during stroke rehabilitation.
  2. 2. Rehabilitation begins on the day of the stroke. This initially consists of positioning and passive stretches to maintain muscle and joint range, together with a close liaison with medical staff. Early mobilisation of the patient is encouraged as soon as possible when the medical condition allows.possible problems are: lack of strength and endurance, limited range of motion, problems with sensation in the limbs, and troubles walking. Stroke rehabilitation will focus on the problems that the patient displays.One problem of stroke rehabilitation is called learned nonuse. This is when stroke patients do everything in their power to avoid using limbs that have been affected by the stroke. If left to their own devices, they will cripple the limb further by letting it atrophy through nonuse.
  3. 3. Patients will learn to use limbs that the stroke has made temporarily useless.During stroke rehabilitation, it will be determined whether these limbs will reach their previous potential.If not, the physiotherapist will teach the patients ways to manage without their full use of the limbs.
  4. 4. It can be a difficult task of stroke rehabilitation to help victims relearn switching from one task to another- Perceptual problemsThis is partly because of problems in the brain.This is why practice is so important. The more times physiotherapists help a patient with this, the easier it becomes.
  5. 5. Recent studies have revealed that stroke rehabilitation can continue long after the hospital stay. In the past, stroke victims were given a short round of physiotherapy during the time they were in the hospital and for a few weeks shortly afterwards. New research shows that physiotherapy can promote more advanced stroke rehabilitation if it is continued progressively at home.Patients will learn to walk better. They will gain strength to do daily chores. They will also achieve better posture and more balance, which can prevent falls.
  6. 6. • Exercises to improve strength, flexibility and cardio-vascular fitness.• Retraining movement to achieve improve coordination, balance and control.• Spasticity management.• Contracture management.• Management of shoulder subluxation and shoulder pain.• Mobility retraining to improve independence and provide access to social, leisure and community-based activities.• Education and support for the person, their family and carers in managing physical impairments.• Assessment for aids and appliances such as splints, braces
  8. 8. SCISports injuries and car accidents, among other injuries, can cause spinal cord injury.As always with physiotherapy, the first step is evaluation.An important issue in spinal cord injury is the level of the damage.
  9. 9. If a physiotherapy program is not followed faithfully, the spine will begin to atrophy below the level of the spinal cord injury. The spine will shrink and the whole body below that point will become weaker as time goes by.Physiotherapy for spinal cord injury involves exercising and stimulating the nerves and muscles below the level of the damage.The physiotherapist will give exercises where the patient lies on the side, back, or stomach and works out or sits up and works out.
  10. 10. • Prevention and management of muscle contractures• Establishment and monitoring of a daily standing programme• Balance work in sitting and/or standing• Strengthening of all remaining active muscle groups• Cardiovascular fitness• Wheelchair skills and leisure activities
  11. 11. Mat Exercises• Rolling practise• Performing lie to sit• Sitting balance training• Practising sit to stand• Gait re-education• Stepping and stairs practise• Outdoor mobility• Transfer practise• Hand and arm exercises• Wheelchair skills
  13. 13. With all these therapies, spinal cord injury patients can sometimes restore themselves to earlier functioning.Spinal cord injury research is being conducted constantly. Physiotherapy is one of the fields that are being explored. One study is putting spinal cord injury patients in harnesses over treadmills stimulating walking.Physiotherapy gives hope for spinal cord injury patients. It allows them to have the most normal functioning that they are currently able to have.
  14. 14. Physiotherapy and Traumatic Brain InjuryPeople with traumatic brain injury (TBI) oftenexperience a diverse range of physicalproblems. These problems may be related to the injury tothe brain itself, other orthopaedic injuriessustained at the time of the injury, or the effects of disuse and immobilizationthat occur following the extended time when aperson is confined to bed or a wheel-chair
  15. 15. The injuries sustained are usually more severe and take longer to recover from than other types of neurological problems.Although the majority of a person’s recovery is achieved in the first 12 months following the injury, recent research has demonstrated that significant improvements can be made for up to 5-10 years
  16. 16. Physiotherapy treatment may include:• Exercises to improve strength, posture, flexibility and fitness.• Retraining movement to improve coordination, balance and control.• Mobility retraining to improve independence and provide access to social, leisure and sporting activities.• Education and support for the person, their family and carers in managing physical impairments.• Assessment for aids and appliances such as splints and wheelchairs.
  18. 18. Multiple Sclerosis• Symptoms of MS can include:• Loss of motor (muscular) control• Fatigue• Visual disturbances and vertigo• Continence problems• Cognitive difficulties such as memory loss and depressionThere is currently no cure for MS however there are a range of treatment options to assist the person to manage their condition.
  19. 19. Physiotherapy and Nerve Injuries and Neuropathies• Nerve Injuries Depending on the nerve or nerves injured, impairment or loss of sensation and or movement may be experienced. Recovery of function is determined by the severity, location and type of injury, as well as the age of the patient and the presence of associated injury. Function may return within days, weeks, months or not at all. Some injuries may require surgical repair with varied prognosis.
  20. 20. NeuropathiesGuillain-Barré SyndromePhysiotherapy treatment will accelerate your recovery and lessen the severity of your condition. Physiotherapy treatment will also help you make significant improvements by promoting your maximum functional potential.
  21. 21. • Treatment of Nerve Injuries and Neuropathies is established on an individual basis but often include:• Stretching and mobilisation• Assisted movement• Graded exercise• Sensory stimulation• Pain management• Education and support• Prevention of secondary complications• Assessment for aids and appliances such as splints and braces
  22. 22. STRECHING
  23. 23. Motor Neurone Disease• Exercises to maintain muscle strength for as long as possible and improve energy levels.• Stretching to lengthen tight muscles and joints and improve range of movement.• Minimising abnormalities of muscle tone.• Advice on postural management to increase comfort and reduce pain when sitting, standing or sleeping.• Facilitating the use of efficient functional movement patterns including the quality of walking.• Activities to improve balance to help improve confidence and reduce the risk of falling.• Education and advice about MND• Gentle massage to help reduce your anxiety.• Hydrotherapy treatment will also help relax and stretch tight muscles and help with mobility.
  24. 24. Parkinsons DiseasePhysiotherapy treatment will promote your physical function and your independence in everyday life.Physiotherapy will also focus on managing the risk of falling. Physiotherapy treatment will increase muscle strength, joint flexibility and balance.
  25. 25. Physiotherapy treatment may include:• Exercises to improve strength, movement, posture, balance, co-ordination and fitness.• Rehearsal of tasks found difficult. The physiotherapist can assist with breaking these activities into parts and provide strategies to simplify the movement.• Gait practice to enhance safety when walking.• Education and support for the person with Parkinson’s, their family and carers.
  26. 26. Cues• Visual cues – flashing lights, triangles, black stripes, light device and taped step length.• Auditory cues – rhythmic auditory stimulation (RAS) using a metronome and music with a known rhythm.• Attentional cues – dual tasks and use of internal cues.
  27. 27. • Education and use of cues can improve intrinsic falls risks.• Large number of falls due to loss of balance therefore balance exercises.• AS common fall area’s e.g. bathroom where turns occur, add cues.• Encourage safe activity and regular medication reviews
  28. 28. Muscular DystrophyPhysiotherapy treatment will help make activities easier to achieve by reducing pain and improving joint flexibility and muscle strength. Physiotherapy treatment will also promote independence and maximise your potential.
  29. 29. • Stretching to reduce muscle tension and joint stiffness.• Exercises to increase muscle strength and energy levels. This will also increase self-esteem and confidence with daily tasks.• Passive and active movement of joints to improve flexibility and circulation.• Postural advice to increase comfort and prevent pressure sores when lying and sitting• Activities to improve balance and coordination• Promote functional activities important to you• Regular standing if necessary.• Advice on mechanical support such as wheelchairs walking aids and orthotic devices in order to maintain functional ability.• Hydrotherapy and massage to relax sore muscles.• Breathing control and assisted coughing if appropriate to maintain a clear chest.
  30. 30. Vestibular Rehabilitation• Vestibular Rehabilitation is a simple exercise based treatment and was first introduced by Cawthorne & Cooksey in 1946 – Noticed patients with balance problems often refrain from moving their heads – Developed a simple series exercises known as Cawthorne-Cooksey exercises or Vestibular Rehabilitation (VR) – BPPV
  31. 31. Secondary symptoms may include:• fatigue• reduced concentration• emotional factors such as fear of falling and/or depression• functional restrictions within the home or workplace• neck stiffness associated with avoidance of head movement to prevent dizziness and• headaches.
  32. 32. Exercises are tailored to theindividual’s needs and are designed to:• Improve balance• Improve walking pattern• Reduce falls• Increase independence• Increase confidence• Reduce disability• Habituation & Repositioning
  33. 33. Physiotherapy following neuro- surgeryNeuro-surgery may be performed for a variety of reasons, such as excision of a tumor or clipping of an aneurysm, Evacuations surgeries. Often a period of rehabilitation is required following neuro-surgery to help restore function.Problems following neuro-surgery are specifically related to the location of the surgery and may vary considerably.
  34. 34. Exercises for Neuro Surgery• Acute care PT• Comma Stimulation• Retraining movement to achieve improve coordination, balance and control.• Mobility retraining to improve independence and provide access to social, leisure and community- based activities.• Education and support for the person, their family and carers in managing physical impairments
  35. 35. Geriatric PhysiotherapyGeriatric physiotherapy became a specialty of physical therapy study in 1989. Since then, physiotherapists have worked to understand the problems of the aging.There is a long list of problems dealt with in geriatric physiotherapy.
  36. 36. The types of problems faced in geriatric physiotherapy are grouped into three different categories.One category is the problems that happen because the patient simply does not use their limbs or does not exercise.These problems can be addressed by reconditioning through range-of-motion exercises and other exercises.
  37. 37. Another category geriatric physiotherapy deals with is cardiovascular disease, like heart disease and stroke.The third category is skeletal problems.Eg: OA, knee or hip replacement surgeriesBecause falls are such a problem, geriatric physiotherapy is responsible for preventing many falls because of work with balance and gait. Some clinics focus entirely on balance issues for the elderly.
  38. 38. PT IN FALLSIndividuals with neurological conditions & Geriatric are often at an increased risk of falls. Individuals with other conditions can also be at risk of falling. It is estimated that one third of over 65’s are at risk of falling each year. Falls are a major cause of ill health for older people and account for 62% of all fatal injuries in people aged 65 and above.
  39. 39. Practices Proven to Prevent Falls1. Evidence Based Exercise Programs: These will include the following components3: • Balance • Muscle Strength • Flexibility Tai Chi is an example of a discipline which includes all of these components.
  40. 40. 2. Environmental modification • Removing risks from the home and the community3. Education • Presentations, handouts, demonstrations and discussions4. Assistive devices/protective devices • Correct use of walkers, canes, scooters5. Multifactorial Intervention • Combining a number of the above interventions
  41. 41. Exercises• Tai Chi• Center of Gravity (COG) Control Training – Seated Balance Activities – Standing Balance Activities – Floor-to-Standing Transfers
  42. 42. • Multi-sensory Training – Forcing use of Somatosensory System • On solid ground, eyes open – Forcing use of Visual System • On compliant surface, eyes open – Forcing use of Vestibular System • On compliant surface, eyes closed – Eye-Head coordination exercises
  43. 43. • Postural Strategy Training – Ankle, Hip, Step• Flexibility Training – Neck and upper body flexibility exercises – Lower body flexibility exercises• Kitchen Sink Exercises• Gain muscle strength and flexibility• Improve balance reactions and postural control• Use walking aids more effectively• Assist walking on uneven ground and around obstacles
  45. 45. GAIT TRAININGMany neurological gaitFacilitation of MuscleInhibition of MusclesExternal supportWalking Sideways to the Left, Walking Sidewaysto the Right.Exercises to StrengthenExercises to Abnormal Tone
  46. 46. Traditional
  47. 47. Current Trends
  48. 48. Aids & AdaptionsMany of the patients with neurological conditions cannot carry on daily functions such as caring for themselves and their homes.physiotherapist can show you how to use recommended equipment and will often teach you how to do things in easier, safer, new ways to enable you to remain as independent as possible.The aids and adaptations that may benefit from depend on current diagnosis / symptoms, individual housing circumstances, lifestyle, and goals.
  49. 49. Aids & Adaptions• Walking sticks• Crutches Gutter frames• Three wheeled walkers• Four wheeled walkers• Wheelchairs• Seating systems• Pressure relief cushions• Access ramps• Bath seats• equipment /accessories to improve hand function• slings• Transfer boards / belts• Leg lifters• Adapted toilets
  51. 51. ADL TrainingMany people with neurological disorders experience difficulties with everyday tasks, such as; getting in and out of bed, on and off chairs, on and off the toilet, washing / bathing yourself, getting dressed, getting around your home, going up and down the stairs, getting in and out of homeMedications or surgeries can help with some of their problems, but many problems are ones they will have to abide.Physiotherapy can offer solutions that other branches of medicine cannot.
  52. 52. ADL continue..Exercises, as in most physiotherapy, include Hand exercises and functional oriented exercisesPhysiotherapists may be able to make a plan so that this is possible.
  53. 53. Thank You