BIOMECHANICS- Gait.pptx
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BIOMECHANICS : GAIT - Dr. Quazi Huma MPT Neurosciences Asst. Professor OBJECTIVES WHAT IS GAIT? GAIT CYCLE GAIT TERMINOLOGY KINEMATICS:PHASES OF GAIT KINETICS GAIT Alternating movements of the lower extremities essentially support and carry along the head, arms, and trunk Translatory progression of the body as a whole, produced by coordinated, rotatory movements of body segments. GAIT CYCLE A gait cycle spans two successive events of the same limb KINEMATICS Phases of Gait Cycle: Stance Phase EVENTS OF STANCE PHASE Heel strike Foot flat Midstance Heel off Toe off SUB PHASES Heel strike phase Loading response Midstance Swing Phase: Gait Terminology: Temporal Variable Gait Terminology: Distance Variable KINETICS GROUND REACTION FORCES KINETICS COP (Centre of Pressure) Reference Pamela K. Levangie, Cynthia C. Norkin; Joint Structure and Function: A Comprehensive Analysis 4th Edition.
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What is SOAP?
Introduction
Aims
Structure
Its application in the field of Physiotherapy
What is SOAP??
S- Subjective
O- Objective
A- Assessment
P- Plan of care
Developed in the 1960s at the University of Vermont by Dr. Lawrence Weed as part of the Problem-oriented medical record (POMR)
Method of documentation for healthcare providers.
To document in a structured and organized way.
Structure- Subjective (First heading of the SOAP note)
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CHIEF COMPLAINT
The CC or presenting problem is reported by the patient.
This can be a symptom, condition, previous diagnosis or another short statement that describes why the patient is presenting today.
The CC is similar to the title of a paper, allowing the reader to get a sense of what the rest of the document will entail.
CHIEF COMPLAINT- Cont’d
Examples: chest pain, decreased appetite, shortness of breath.
However, a patient may have multiple CC’s, and their first complaint may not be the most significant one.
Thus, physicians should encourage patients to state all of their problems, while paying attention to detail to discover the most compelling problem.
Identifying the main problem must occur to perform effective and efficient diagnosis.
HISTORY OF PRESENT ILLNESS (HOPI)
The HOPI begins with a simple one line opening statement including the patient's age, sex and reason for the visit.
Example: 47-year old female presenting with PAIN AT RIGHT SHOULDER .
This is the section where the patient can elaborate on their chief complaint. An acronym often used to organize the HOPI is termed “OLDCARTS”:
“OLDCARTS”
ONSET: When did the CC begin?
LOCATION: Where is the CC located?
DURATION: How long has the CC been going on for?
CHARACTERIZATION: How does the patient describe the CC?
ALLEVIATING AND AGGRAVATING FACTORS: What makes the CC better? Worse?
RADIATION: Does the CC move or stay in one location?
TEMPORAL FACTOR: Is the CC worse (or better) at a certain time of the day?
SEVERITY: Using a scale of 1 to 10, 1 being the least, 10 being the worst, how does the patient rate the CC?
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Social History: An acronym that may be used here is HEADSS which stands for Home and Environment; Education, Employment, Eating; Activities; Drugs; Sexuality; and Suicide/Depression.
REVIEW OF SYSTEM
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Physiotherapy in MND
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
Types of MND
Clinical Features of MND
Diagnostic Procedure
Management: 1) Pharmaceutical
2) Physiotherapy
Motor Neuron Disease
Motor Neuron Disease are a group of neurodegenerative disorders that affects the nerves in the spine and brain to progressively lose its function.
Motor neuron diseases (MND) include a heterogeneous spectrum of inherited and sporadic (no family history) clinical disorders of the upper motor neurons (UMNs), lower motor neurons (LMNs), or a combination of both.
Types of MND
Amyotrophic Lateral Sclerosis
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by progressive degeneration of motor neurons in the spinal cord, brain stem, and motor cortex, leading to progressive muscle atrophy and weakness.
Clinical Features
UPPER MOTOR NEURON
Loss of Dexterity
Muscle Weakness
Spasticity
Hyperreflexia
Pathological reflexes
LOWER MOTOR NEURON
Muscle Weakness
Muscle Atrophy
Hypotonicity
Hyporeflexia
Fasciculation
Muscle Cramp
Impairment related to LMN
Other clinical features
Diagnostic Criteria
Diagnostic Procedure
EMG-
It include signs of active denervation, such as fibrillation potentials and positive sharp waves;
Signs of chronic denervation, such as large motor unit potentials (increased duration, increased proportion of polyphasic potentials, increased amplitude)
Unstable motor unit potential
Nerve Conduction Velocity Studies,
Muscle And Nerve Biopsies,
Neuroimaging Studies - MRI
Management- Multidisciplinary Approach
Physical Therapy Examination
Cognition
Pain
Psychosocial Function
Joint integrity, ROM and Muscle strength.
Motor Function: Gross motor and Fine motor
Muscle tone and reflexes
Cranial nerve integrity
Sensations
Gait
Respiratory Function
Physiotherapy goals in MND treatment.
Pain reduction
Prevention for contractures
Maintenance of joint mobility
Regular review of posture
Positioning to relieve discomfort
House Modification and ergonomic advice.
Management of Sialorrhea and Pseudobulbar Affect
Management for Dysphagia
PEG procedure.
A PEG may be recommended as the disease progresses.
A PEG is a type of gastrostomy tube inserted via endoscopic surgery that creates a permanent opening into the stomach for the introduction of food.
Studies have found that PEG insertion may prolong survival. Patients with PEG were found to live 1 to 4 months longer than those individuals who refused it.
Management of Dysphagia
A palatal lift prosthesis may be prescribed for individuals with good articulation but who have a breathy voice quality or decreased loudness because of excessive air loss through the nose.
The device, a dental appliance designed to attach to the existing teeth and to elevate the soft palate, is custom-made by a prosthodontist.
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Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
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Early Intervention in High Risk Infants
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Objectives
By the end of the seminar one would know
What is high risk infants?
Determinants of high risk infants
Monthwise neurodevelopment of infants in gestational age
Early intervention
General NICU guidelines for high risk infants
Recent advances
What is High Risk Infant?
A High risk infant is broadly defined as one who requires more than the standard monitoring and care offered to a healthy term newborn infant.
According to American Academy of Pediatrics, High risk infant may be defined as
Preterm Infant
Infant with special healthcare needs or dependence on technology
Infant at risk because of family issues.
Infant with anticipated early death.
High-Risk Clinical Signs
At 4 months of age, hypertonicity of the trunk or extremities is recognized as a high-risk clinical sign.
Less alternate kicking movement compared with typically developing LBW infant.
Abnormalities of kicking described by Prechtl as “cramped-synchronized,” that is, limited in variety and characterized by “rigid movement with all limbs and the trunk contracting and relaxing almost simultaneously,”
Preterm Infant
Preterm infant is the infant which is born before 36 weeks of gestation
Usually preterm infant have low birth weight i.e. less than 2.5 kgs
Determinants of High Risk Infant
Biological Risk
Attributed to medical/physical condition presence of
Asphyxia
Neonatal seizures
Prenatal exposure to drugs or alcohol
Brain-lesions
Low birth weight
Established Risk
Associated with diagnosis that is clearly established like,
Congenital malformation
Chromosomal abnormalities
CNS disorders
Metabolic disease.
Environmental & social risk
Refers to competency in parenting roles and factors in family dynamics
Suboptimal levels of stimulation and interaction in NICU
Inadequate parent-infant attachment
Insufficient educational preparation for caregiver roles
Meager financial resources of parents
Limited or absent family support to assist in taking care of and nurturing the infants in home environment.
The systems of infants develop in their stipulated time during gestational period prenatal or preterm results in specific injury
Commonest condition which requires early intervention
Newborn Maturity Rating—Ballard Score
Widely adopted because of the time efficiency
Ballard instrument involves only six physical and six neurological criteria, with a 0 to 5 scale and a maturity rating
designed to be used for neonates (20 to 44 weeks gestation) from birth through 3 days of age and has demonstrated concurrent validity with the Dubowitz gestational age calculation tool.
Neonatal Behavioral Assessment Scale
30- to 45-minute examination consists of observing, eliciting, and scoring 28 behavioral items on a 9-point scale and 18 reflex items on a 4-point scale
Six behavioral state categories are outlined in the NBAS: deep sleep,
Designing a neurophysiotherapy department.pptx
Designing a neurophysiotherapy department
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (PhD, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Objectives
At the end of the seminar one should understand
Architecture programming.
Planning the neurophysiotherapy department.
introduction
Architecture programming
Architectural programming is a decision-making process leading to the definition of a building project in terms of purpose and function. It precedes and feeds into the design stage and is carried out at the very beginning of the construction project.
Our neurophysiotherapy dept
reference
Samuel Bonnet ,Physical Rehabilitation Centres Architectural Programming Handbook by International Committee of the Red Cross.
Questions???
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Orthotics used in Neurological dysfunction
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (PhD, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Orthotics used in Neurological dysfunction
objectives
At the end of this seminar the students would have understood
Principle of orthosis and its function
Types of orthosis
Different types of orthosis used in neurological disorder.
Recent advances.
Principle of orthosis
Three point pressure principle:
1) forms the mechanical basis for orthosis correction
2) single force is applied at the area of deformity or angulation
3) two additional counter forces act in the opposing direction.
Functions of orthosis
Prevent deformity
Assist function of a weak limb
Maintain proper alignment of the joints
Inhibit tone
Protect against injury of a weak joint
Allow for maximal functional independence
Facilitates motion
Lower limb orthosis
ANKLE FOOT ORTHOSIS (AFO)
It consist of shoe attachment, ankle control, uprights and a proximal leg band.
Ankle Control
Ankle control – 1) by assisting motion
2) by limiting motion
Weak dorsiflexor dorsiflexion assistance Posterior leaf spring
Ankle control
Limited motion ankle control
Anterior Stop (dorsiflexion stop): determines the limits of ankle dorsiflexion.
Posterior Stop (plantarflexion stop): determines the limits of ankle plantarflexion.
Robinson et al (2008) carried out a randomised controlled trial (RCT) to compare the effectiveness of a temporary night splint with prolonged standing on a tilt table to prevent loss of ankle movement early after stroke in 30 people. Results suggest that a night splint in this cohort of people was as effective as the tilt table in maintaining range of movement. Compliance was 87% in the people who used the tilt table and 73% in the people who wore splints. It is suggested that an ankle splint can be used for preventing the loss of range of movement at the ankle joint (in people with stroke) when positioned at plantar grade.
Knee-Ankle-Foot Orthoses
Individuals with more extensive paralysis or limb deformity may benefit from KAFOs, which consist of a shoe attachment, foundation, ankle control, knee control, and superstructure.
Recent advances
An active knee orthosis for the physical therapy of neurological disorders
-Elena Garcia, Daniel Sanz-Merodio et al
This paper presents the design of a new robotic orthotic solution aimed at improving the rehabilitation of a number of neurological disorders (Multiple Sclerosis, Post-Polio Stroke and Spinal cord injury)
A KAFO with electronic knee control enables some patients with stroke
and other neuropathies to walk.
Hip knee ankle foot orthosis
Specialized thkafo
Contains a trunk band added to a HKAFO
Reciprocating gait orthosis:
The hips are connected by steel cables
which allow for reciprocal gait pattern.
When the patient leans on the supporting
BIOMECHANICS - Tmj.pptx
BIOMECHANICS: TMJ
Dr.Quazi Huma
MPT(Neurosciences)
Asst professor
Objectives
Introduction
Structures: Articular Surfaces
Articular Disk Capsule and Ligaments
Upper and Lower Temporomandibular Joints
Function
Dysfunction
Introduction
Complex joint and unique
Condylar hinge-type of joint
Moves in all direction
Synovial type with no articular cartilage
Structure: Articular Surfaces
Proximal segment: Temporal bone
Distal segment; Condyles of Mandible
Trabecular bone with no articular cartilage
Fibrocartilage: dense, avascular collagenous tissue that contains some cartilaginous cells.
Fibrocartilage - present in areas, intended to withstand repeated and high-level stress.
For example – biting, chewing
In closed mouth position, the coronoid process sits under the zygomatic arch, but it can be palpated below the arch when the mouth is open.
Articular Disc
Biconcave
Thickness- 2 mm anteriorly -3 mm posteriorly-1 mm
Anterior & posterior portions- vascular and innervated
Middle part- Fibrocartilaginous, force-accepting segment
Attachment - medial and lateral poles of the condyle of the mandible
Bilaminar retrodiskal pad-
Superior lamina – elastic in nature
Inferior lamina – inelastic
The superior lamina allows the disk to translate anteriorly along the articular eminence during mouth opening ,its elastic properties assist in repositioning the disk posteriorly during mouth closing.
The inferior lamina simply serves as a tether on the disk, limiting forward translation
Capsule
TM joint capsule is not as well defined
Anterior, medial, and posterior capsule - quite thin and loose
Lateral aspect - stronger and is reinforced with long fibers
Ligaments
Primary ligament:
TEMPOROMANDIBULAR LIGAMENT: (suspensory ligament)
Outer portion: limits downward and posterior motion of the mandible,
limits rotation of the condyle during mouth opening.
Inner portion: Limitation of posterior translation of the condyle pro
b. STYLOMANDIBULAR LIGAMENT:
band of deep cervical fascia
limitation to protrusion of the jaw
c.SPHENOMANDIBULAR LIGAMENT:
that it serves to suspend the mandible
to check the mandible from excessive forward translation.
Functions of Temporomandibular Joint.
Most frequently used joints
Talking, chewing, and swallowing
Cartilage covering the articular surfaces is designed to tolerate repeated and high-level stress.
Musculature is designed to provide both power and intricate control.
Speech requires fine control of the jaw, and the ability to chew requires great strength.
Mandibular Movements
Depression (mouth opening)
Elevation (mouth closing)
Protrusion (jutting the chin forward)
Retrusion (sliding the teeth backward)
Lateral deviation (sliding the teeth to either side)
Muscles
Mandibular depression – Digastric muscle
Mandibular elevation – Temporalis, Masseter
Protrusion -- bilateral action of the masseter, medial pterygoid and lateral pterygoid muscles
Retrusion -- bilateral action of the pos
POSTURE.pptx
POSTURE
Dr. Quazi Huma
MPT Neurosciences
Asst Professor
Objectives
Definition
Human posture – quadruped to bipedal
Postural Control
Analysis of all views
Physiological Deviations
Factors affecting posture
Definition
Good posture is the attitude which, is assumed by body parts to maintain stability and balance with minimum effort and least strain during supportive and non supportive positions.
CHARACTERISTICS OF GOOD POSTURE (Prerequisites of good posture)
For good posture to be maintained the following must be obtained:
The ability to maintain 'the body upright in good and erect position with less energy.
The ability to maintain balance in upright position via keeping the line of gravity near the center of the base of support.
Quadruped Vs Bipedal
Quadruped posture
Body weight is distributed between the upper and lower extremities
Good stability
Bipedal posture
Unique found in human
Small BOS
Use of upper extremities
Instability caused by a small BoS and a high CoM
BASE OF SUPPORT
BOS is defined by an area bounded posteriorly by the tips of the heels and anteriorly by a line joining the tips of the toes
CENTER OF MASS
It is the point where the mass of the body is centered
Position of the CoM is not fixed
CoM moves lower to a location in the standing adult at about the level of the second sacral segment in the midsagittal plane.
POSTURAL CONTROL
refers to a person’s ability to maintain stability of the body and body segments in response to forces that threaten to disturb the body’s equilibrium
POSTURAL CONTROL
STATIC POSTURE The body and its segments are aligned and maintained in certain position
DYNAMIC POSTURE Postures in which the body or its segments are moving
PLUMB LINE
ANALYSIS OF POSTURE IN SAGITTAL VIEW
DEVIATION IN SAGITTAL VIEW
FLEXED KNEE POSTURE
GENU RECURVATUM
KYPHOTIC AND LORDOTIC CURVES
DOWAGERS HUMP AND GIBBUS DEFORMITY
ANALYSIS OF POSTURE IN FRONTAL VIEW
A. NORMAL FOOT B. PES PLANUS
C. PES CAVUS
ANALYSIS OF POSTURE IN CORONAL VIEW
FACTORS AFFECTING POSTURE
THANK YOU!!!!
Pamela K. Levangie, Cynthia C. Norkin; Joint Structure and Function: A Comprehensive Analysis 4th Edition.
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According to the TechSci Research report titled “India Diagnostic Labs Market Industry Size, Share, Trends, Competition, Opportunity, and Forecast, 2019-2029,” the India Diagnostic Labs Market was valued at USD 16,471.21 million in 2023 and is projected to grow at an impressive compound annual growth rate (CAGR) of 11.55% through 2029. This significant growth can be attributed to various factors, including collaborations and partnerships among leading companies, the expansion of diagnostic chains, and increasing accessibility to diagnostic services across the country. This comprehensive report delves into the market dynamics, recent trends, drivers, competitive landscape, and benefits of the research report, providing a detailed analysis of the India Diagnostic Labs Market.
Collaborations and Partnerships
Collaborations and partnerships among leading companies play a pivotal role in driving the growth of the India Diagnostic Labs Market. These strategic alliances allow companies to merge their expertise, strengthen their market positions, and offer innovative solutions. By combining resources, companies can enhance their research and development capabilities, expand their product portfolios, and improve their distribution networks. These collaborations also facilitate the sharing of technological advancements and best practices, contributing to the overall growth of the market.
Expansion of Diagnostic Chains
The expansion of diagnostic chains is a driving force behind the growing demand for diagnostic lab services. Diagnostic chains often establish multiple laboratories and diagnostic centers in various cities and regions, including urban and rural areas. This expanded network makes diagnostic services more accessible to a larger portion of the population, addressing healthcare disparities and reaching underserved populations. The presence of diagnostic chain facilities in multiple locations within a city or region provides convenience for patients, reducing travel time and effort. A broader network of labs often leads to reduced waiting times for appointments and sample collection, ensuring that patients receive timely and efficient diagnostic services.
Rising Prevalence of Chronic Diseases
The increasing prevalence of chronic diseases is a significant driver for the demand for diagnostic lab services. Chronic conditions such as diabetes, cardiovascular diseases, and cancer require regular monitoring and diagnostic testing for effective management. The rise in chronic diseases necessitates the use of advanced diagnostic tools and technologies, driving the growth of the diagnostic labs market. Additionally, early diagnosis and timely intervention are crucial for managing chronic diseases, further boosting the demand for diagnostic lab services.
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M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
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The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
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- 4. z GAIT CYCLE A gait cycle spans two successive events of the same limb Stance (60%) Swing (40%) Gait Cycle
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- 6. z
- 7. z
- 8. z
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