Establishing the need for a surgical intervention
Confirmation of relevant physical findings and review of the clinical history and laboratory investigations that support the need of surgical intervention
Type of approach- Benefits & Risks of surgical procedure
The incision site- ease of surgery as well as cosmetic considerations
Type of anesthesia
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Prostatectomy Surgery abroad in India info on cost Prostatectomy Surgery India,Prostatectomy male Surgery hospitals India,Prostatectomy surgeons India.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Prostatectomy Surgery abroad in India info on cost Prostatectomy Surgery India,Prostatectomy male Surgery hospitals India,Prostatectomy surgeons India.
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal
Approach to the hip and knee joint for various procedures including the drainage of septic joint, arthroplasty, soft tissue relase and and various osteotomies around hip and knee e joints.
\It is a condition of the lung characterized by permanent dilatation of the air spaces distal to the terminal bronchioles with destruction of the walls of these airways.
Chronic Bronchitis
It is a disease characterized by daily cough with sputum for at least 3 months of the year for at least 2 consecutive years and airway obstruction which is irreversible.
These are cardiac anomalies arising as a result of a defect in the structure or function of the heart and great vessels which is present at birth
These lesions either obstruct blood flow in the heart or vessels near it, or alter the pathway of blood circulating through the heart
Burn is coagulative necrosis of the skin’s tissues, usually caused by excessive heat
Excess heat causes rapid protein denaturation and cell damage
Wet heat (scald) travels more rapidly into tissue than dry heat (flame)
A surface temperature of over 60˚C produces immediate cell death as well as vessel thrombosis
The dead skin tissue is known as Eschar
Modified Sweat gland
Lies in the deep pectoral
fascia
Boundaries:
clavicle superiorly,
the lateral border of the latissimus muscle laterally,
the sternum medially
inframammary fold inferiorly
Pre- Operative Assessment
Detailed History (Obsteritic & Gynecological h/o)
Chest assessment
Lung function tests (PFT)
Stage of cancer, extent of the disease
Surgical plan should be documented -length & duration of surgery, type of incision & details of the flap used for reconstruction
Assess the involvement of lymph nodes, posture, mobility
Checking of the Exercise capacity considering the patient’s tolerance
AMPUTATION:
“Surgical removal of limb or part of the limb through a bone or multiple bones”
DISARTICULATION:
“Surgical removal of hole limb or part of the limb through a joint”
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Pulmonary function testing is the process of having the patient perform specific inspiratory and expiratory maneuvers while breathing in and out of tubing attached to the equipment that measure a variety of variables
More from Dr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar (20)
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. General Surgery
Principles of Physiotherapy Management
Dr.Nidhi Ahya (Assistant Professor)
Cardio-Vascular And Respiratory
PT
DVVPF College Of Physiotherapy,
Ahmednagar 414111
2. Contents
• General Surgical Principles
• Type of Anesthesia and effect on
Cardio-pulmonary system
• Ideal incision
• Types of incision
• Common Post-operative
Complications
• Role of Physiotherapy
• Pre and Post-operative Assessment
& PT Management
3. Principles of General Surgery
Establishing the need for a surgical
intervention
• Confirmation of relevant physical findings and
review of the clinical history and laboratory
investigations that support the need of surgical
intervention
Type of approach- Benefits & Risks of
surgical procedure
• The incision site- ease of surgery as well as
cosmetic considerations
• Type of anesthesia
4. Pre-operative Work-up
• Consent for surgery, Pre-anesthetic Check-up
Peri-operative Considerations
• Length of the surgical procedure, volume of blood
lost during surgery, monitoring of vitals, risk
assessment and management uptill 72 hrs post-
surgery
Post-operative Management
• From 72 hrs post-opoeratively to uptill 30 days
• Incisional care and healing , management of risk
factors, evaluation for success of surgical
intervention for primary problem ,risk management
5. Types of Anesthesia
General Anesthesia
• Refers to the suppression of activity in
the central nervous system by inhalation
of anesthetic agent causing lack of
movement (paralysis), unconsciousness,
and blunting of the stress response
Regional Anesthesia
• Types- Infiltrative, Intravenous,
peripheral nerve blockade, topical,local
anesthesia,central nerve blockade
(spinal,epidural,caudal)
6. Ideal Incision
The ideal incision characteristics:
• Easy to open
• Minimise damage to tissues
– Avoid cutting nerves
– Split rather than transect muscles
– Limit damage to fascia
• Easy to close
• Allow sufficiently strong closure
• Allow sufficient access
• Extendable if necessary
• Target organ
• Body habitus
• Previous operations
7. Classification of incisions
Vertical incision
Midline incisions
Paramedian incisions
Transverse and oblique incisions
Kocher's subcostal Incision
Mc Burney’s grid iron or muscle
splitting incision.
Pfannenstiel incision
Maylard Transverse Muscle cutting
Incision
Oblique Muscle cutting incision
Thoracoabdominal incisions.
8. Midline incision
Upper Midline Incision
From xiphoid to above umbilicus.
Skin superficial and deep fascia
linea alba extraperitoneal fat
peritonium.
Division of the peritoneum is best
performed at the lower end of the
incision, just above the umbilicus so
that falciform ligament can be seen
and avoided.
9. . Lower Midline Incision
From the umbilicus superiorly to
the pubic symphysis inferiorly.
Allow access to pelvic organs.
The peritoneum should be
opened in the uppermost area
to avoid possible injury to the
bladder.
Full Midline Incision
From xiphoid to pubic
symphysis inferiorly.
Great exposure is needed.
10. Paramedian incision
2 to 5 cm lateral to the midline.
Over the medial aspect of the
rectus muscle.
skin fascia anterior rectus
sheath The anterior rectus
muscle is freed from the anterior
sheath and retracted laterally
The posterior rectus sheath
or transversalis fascia
extraperitoneal fat ,peritoneum
excised allowing entry to the
abdominal cavity.
11. Kocher’s incision
Incision parallel to the right costal
margin
Starts at the midline, 2 to 5 cm
below the xiphoid and extends
downwards, outwards and
parallel to and about 2.5 cm
below the costal margin
It shows excellent exposure to
the gallbladder, biliary tract and
can be made on the left side to
show access to the spleen..
12. Chevron (Roof Top) Modification
The incision may be continued across the
midline into a double Kocher incision or roof
top approach which provide excellent access
to the upper abdomen
Used for:
Total Gastrectomy.
Total oesophagectomy.
Extensive hepatic resections
Bilateral adrenalectomy
.
13. The Mercedes Benz Modification
Consists of bilateral low
Kocher’s incision with an
upper midline incision up
to the xiphisternum.
Excellent access to the
upper abdominal
viscera. (mainly the
diaphragmatic hiatuses)
.
14. McBurney Grid -Iron Incision
First described in 1894 by Charles
McBurney
Is the incision of choice For most
Appendectomies.
It is a muscle splitting incision
Made at the junction of the middle
third and outer thirds of a line
running from the umbilicus to the
anterior superior iliac spine
.
15. P - fannenstiel incision
Used frequently by gynecologists
and urologists for access to the
pelvic organs, bladder, prostate
and for caesarean section.
Usually 12 cm long and made in
a skin fold approximately 5 cm
above symphysis pubis.
skin fascia anterior rectus
sheath rectus muscle
transversalis fascia
extraperitoneal fat perineum.
.
16. Maylard’s Incision
It is a transverse muscle
cutting incision
It is placed above but
parallel to the traditional
placement of
Pfannenstiel incision.
Gives excellent exposure
of the pelvic organs.
.
17. Thoracoabdominal Incision
Converts the pleural and
peritoneal cavities into one
common cavity excellent
exposure.
Left incision Resection of the
lower end of the esophagus and
proximal portion of the stomach.
Right incision elective and
emergency hepatic resections.
.
19. Vascular Complications
• Thrombosis or embolism
• Can occur at any time between the 3rd to
the 21st post-operative day
• Thrombosis are mainly of toe types
Thrombo-phlebitis
Phlebothrombosis
• Phlebothrombosis is by far the most
serious complication of operations on the
pelvis
20. Thrombo-Phelbitis
• Damage to the vein wall
caused by insertion of an
interavenous drip
• Vein becomes irritant,inflamed
and blood clots becomes
adherent to vein wall
• If inflammation spreads to the
surrounding tissue it may lead
to cellulitis.
• Condition is self limiting, and
resolves if irritant is removed
21. Phlebo-Thrombosis
• Formation of blood clot in the
depper viens
• It is non-inflamatory, so rarely
produces symptoms
• Lifethreating condition
• Common causes-
slow blood flow
in no.of platelets and their
cohesiveness
more fibrinogen
reduced movement
22. Embolism
• A thrombus formed in a vessel
wall,is attached to it only at the
point of origin
• Fragments from this thrombus
can become disloged, travel
within the circulation and block
the blood supply to vital organs
• Common sites- cerebral,
pulmonary
24. Haemorrhage
• It can be Internal or External
• What to look out for?
Soakage of dressing
Low blood Pressure
Feeble Pulse
Incresed RR
Restlessness
Fainting
25. Muscle Atrophy and Imbalance
• Muscles are retracted,cut,split
during surgery.
• Incision of the muscle reduces it
bulk as well as power
• Damage to the nerve supply of the
muscle can occur during surgery
• Reflex inhibition due to pain
• Protective inactivity of a muscle
lead to atrophy
• Addhesion formation can restrict
range of motion
26. Incisional Hernia
• Incision weakens the
abdominal wall
• Inadequately placed
sutures, poor apposition
of the tissues during
closure, excessive strain
from coughing, lifting
heavy weight can put
strain on the weakened
wall.
27. Delayed Healing
• Infection
Surgical site
Away from the site
• Sepsis
• Systemic Illness
• Poor post-surgical care
29. Need for Pre-operative Assessment
• Acquaintance with the patient and patient’s
family
• To list out pre-operative complains and a
brief history of presenting illness
• Known systemic illness and its impact on
post-operative management
• To assess the risk of post-operative
complications and take steps to limit the
same
• To explain the post-operative physiotherapy
regime
• To assure the patient of total support during
post-operative period
30. Pre-Operative Management
• Teach the patient Ankle toe pumps and
general mobility exercises
• Appropriate airway clearance
techniques
• Incision Splinting, Huff-cuff
• Breathing Exercises
• Incentive Spirometry
• Bed Mobility
• Explain the benefits of early ambulation
31. Post-Operative Assessment
• Review of patients file- Anesthesia and
Surgical notes
Type of surgery
Incision- area, muscles cut, split or retracted,
length of incision, drain sites, closure (staples,
clips, sutures),dressing type
Duration of surgery
Complications during surgery
Post-operative recovery till day of reference
• Review of Nursing Care Chart Monitored
vitals over time, Input-Output charting,
Medications
• Investigations- Chest X-ray, ABG
34. Post-operative Treatment
• DAY 1
Ankle toe Pumps 10 reps per hour
Active/assisted Mobility exercises
Supported long sitting in bed
Breathing Exercises
Airway clearance techniques
Splinting Incision and huff-cuffs
Incentive Spirometry
* *Note: Only Inspiratory
35. • DAY 2
Ankle toe Pumps 10 reps per hour
Active Mobility exercises
Sitting on edge of bed
Breathing Exercises
Airway clearance techniques
Splinting Incision and huff-cuffs
Supported Ambulation 20 meters
Progression of Spirometry
* *Note: Only Inspiratory
36. • DAY 3
Ankle toe Pumps 10x 2 times daily
Active Mobility exercises in sitting
Breathing Exercises
Airway clearance techniques
Splinting Incision and huff-cuffs
Ambulation upto 30 meters
3-4 times in a day
Incentive Spirometry
* *Note: Only Inspiratory
37. • DAY 4 to 7
Independent bed mobility
Active Mobility exercises in sitting
Breathing Exercises
Airway clearance techniques
Splinting Incision in daily activities
Independent Ambulation
3-4 times in a day, increase distance
gradually
Incentive Spirometry
* *Note: Only Inspiratory
38. • Home Exercise Program
Independent Ambulation
Active Mobility exercises
Breathing Exercises
Incentive Spirometry
Inspiratory+ Expiratory beyond 4
weeks
• Precautions: DON’T DO
Forward bending
Lifting heavy weight
Vigorous coughing
Side-lying on operated side
39. Summary
• General Surgical Principles
• Type of Anesthesia
• Ideal incision
• Types of incision
• Post-operative Complications
• Role of Physiotherapy
40. QUESTIONS
1. WRITE THE GENERAL
SURGICAL PRINCIPALS.
5MARKS
2. WRITE ABOUT THE POST
OPRATIVE
COMPLICATIONS.7MARKS
3. WRITE THE ROLE OF
PHYSIOTHERAPIST. 7MARKS