Spinal cord injury (SCI) is a debilitating neurological condition with tremendous socioeconomic impact on affected individuals and the health care system. Today, the estimated lifetime cost of an SCI patient is $2.35 million per patient. According to the National Spinal Cord Injury Statistical Center, there are 12,500 new cases of SCI each year in North America. More than 90% of SCI cases are traumatic and caused by incidences such as traffic accidents, violence, sports, or falls. The Male-to-female ratio of 2:1 for SCI, which happens more frequently in adults compared to children. Demographically, men are mostly affected during their early and late adulthood (3rd and 8th decades of life) while women are at higher risk during their adolescence (15–19 years) and 7th decade of their lives i.e. age distribution is bimodal, with a first peak involving young adults and a second peak involving adults over the age of 60. Those over 60 years of age who suffer SCI have considerably worse outcomes than younger patients their injuries usually result from falls and age-related bony changes.
Adhesive capsulitis case presentation physiotherapymanisha thakur
Satisfactory presentation on adhesive capsulitis because of satisfactory results in 2 weeks.
Can do these exercises to increase range
Muscle strength and overall well being.
Case of Prolapse intervertebral Disc, lumbar disc prolapse, case, physiotherapy management, Assessment, recent Advance, orthopaedic case presentation, musculoskeletal physiotherapy case presentation, orthopaedic physiotherapy, case of a low back pain patient, lumbar radiculopathy, final year,
Adhesive capsulitis case presentation physiotherapymanisha thakur
Satisfactory presentation on adhesive capsulitis because of satisfactory results in 2 weeks.
Can do these exercises to increase range
Muscle strength and overall well being.
Case of Prolapse intervertebral Disc, lumbar disc prolapse, case, physiotherapy management, Assessment, recent Advance, orthopaedic case presentation, musculoskeletal physiotherapy case presentation, orthopaedic physiotherapy, case of a low back pain patient, lumbar radiculopathy, final year,
Hemiparesis is a condition characterized by weakness or paralysis on one side of the body, typically resulting from damage to the brain or spinal cord. In a case presentation, it is essential to provide a comprehensive overview of the patient's history, including any relevant medical conditions or events such as stroke, traumatic brain injury, or tumor. Additionally, outlining the physical examination findings, such as decreased strength, altered reflexes, and possible sensory deficits on the affected side, aids in diagnosing and assessing the severity of hemiparesis. Diagnostic tests like brain imaging studies (CT or MRI) and electrophysiological evaluations may also be included to confirm the underlying cause and guide treatment strategies, which often involve a multidisciplinary approach focusing on rehabilitation, medication, and supportive care to improve functionality and quality of life for the patient.
Hemiparesis is a condition characterized by weakness or paralysis on one side of the body, typically resulting from damage to the brain or spinal cord. In a case presentation, it is essential to provide a comprehensive overview of the patient's history, including any relevant medical conditions or events such as stroke, traumatic brain injury, or tumor. Additionally, outlining the physical examination findings, such as decreased strength, altered reflexes, and possible sensory deficits on the affected side, aids in diagnosing and assessing the severity of hemiparesis. Diagnostic tests like brain imaging studies (CT or MRI) and electrophysiological evaluations may also be included to confirm the underlying cause and guide treatment strategies, which often involve a multidisciplinary approach focusing on rehabilitation, medication, and supportive care to improve functionality and quality of life for the patient.
Peripheral Vascular Disease (PVD): Physiotherapy assessment and managementTushar Sharma
The presentation discusses the realm of peripheral vascular disease (PVD) and the importance of physical therapy for effectively managing the condition. A collection of conditions known as peripheral vascular disease mostly affects the arteries and veins in the extremities and blood vessels that are not part of the heart or brain.
The presentation will highlight the importance of physiotherapy in the overall care of PVD. To improve blood flow, manage symptoms, and increase a person with PVD’s total functional capacity, physiotherapy therapies are essential. To maximize patient outcomes, this presentation will cover evidence-based physiotherapy techniques such as exercise regimens, vascular rehabilitation, and lifestyle changes.
Key Topics Covered:
1. Case study
2. Assessment of PVD patients
3. Exercise prescription for PVD patients
Case Presentation of a patient presented with polyradiculoneuropathy and bilateral bulbar palsy. Detailed evaluation finally pinpoints to Guillian barre syndrome.
What is a PowerPoint presentation or PPT? Answer: A combination of various slides depicting a graphical and visual interpretation of data, to present information in a more creative and interactive manner is called a PowerPoint presentation or PPT.
Sample Medical Chronology - Medical Chronology Services for AttorneysMedLegal Services
When creating a medical chronology, it is important to maintain accuracy and objectivity. The information should be presented in a clear and concise manner, using standardized medical terminology. https://www.mlr-medicalrecordsreview.com/medical-record-chronologies
The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system.
It is named after Berta Bobath, a physiotherapist, and her husband Karel Bobath, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.
Procedure: in a “trial & error” fashion in 1948.
Concept of compensatory training.
Neglects the potential of hemiplegic side.
It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans, and relevant objective measures to evaluate interventions.
Therapist should have:
Good posture & movement analysis skills.
PRINCIPLES
NDT THERAPY WORKS
ALWAYS TREAT THE PATIENT AS A WHOLE
WORK SIMULTANEOUSLY ON PATIENTS STRENGTHS & WEAKNESSES
INDIVIDUALIZED FOR EVERY PATIENT BASED ON ICF MODEL
GAIN THE INFORMATION FROM PAST, PRESENT & FUTURE
TEAMWORK IS CRITICAL FOR REHAB PURPOSES
UNDERSTANDING THE CONCEPT OF TYPICAL DEVELOPMENT (MOTOR CONTROL)
TRANSFERENCE OF TRAINING IN DAILY LIFE
HANDS ON INTERVENTION TO ENHANCE MOTOR LEARNING & FUNCTIONS
OBJECTIVES
Identify the anatomical structures, indications, and contraindications of therapeutic exercise.
Describe the equipment, personnel, preparation, and technique in regard to therapeutic exercise.
Review the appropriate evaluation of the potential complications and clinical significance of therapeutic exercise.
Summarize inter-professional team strategies for improving care coordination and communication to advance therapeutic exercise and improve outcomes.
BRAINSTEM
The Brainstem lies at the base of the brain and the top of the spinal cord.
The brainstem is located in the posterior cranial fossa.
The brainstem is the structure that connects the cerebrum of the brain to the spinal cord and cerebellum.
Provides a pathway for tracts running between higher and lower neural centers.
Divided into 3 major divisions:
midbrain,
pons, and
medulla oblongata.
It is responsible for many vital functions of life, such as breathing, consciousness, blood pressure, heart rate, and sleep.
It contains many critical collections of white and grey matter.
The grey matter within the brainstem consists of nerve cell bodies and form many important brainstem nuclei. Ten of the twelve cranial nerves arise from their cranial nerve nuclei in the brainstem.
The white matter tracts of the brainstem include axons of nerves traversing their course to different structures. These tracts travel both to the brain (afferent) and from the brain (efferent) such as the somatosensory pathways and the corticospinal tracts, respectively.
Mid Brain
The midbrain is continuous with the cerebral hemisphere.
The upper posterior (i.e. rear) portion of the midbrain is called the tectum, which means "roof."
The surface of the tectum is covered with four bumps representing two paired structures: the superior and inferior colliculi.
The superior colliculi are involved in eye movements and visual processing, while the inferior colliculi are involved in auditory processing.
Another important nucleus, the substantia nigra, is located here.
The substantia nigra is rich in dopamine neurons and is considered part of the basal ganglia.
Pons
An important pathway for tracts that run from the cerebrum down to the medulla and spinal cord, as well as for tracts that travel up into the brain.
It also forms important connections with the cerebellum via fibre bundles known as the cerebellar peduncles.
Posteriorly, the pons and medulla are separated from the cerebellum by the fourth ventricle.
Home to several nuclei for cranial nerves.
Medulla
The point where the brainstem connects to the spinal cord.
Contains a nucleus called the nucleus of the solitary tract that is crucial for our survival (receives information about blood flow, along with information about levels of oxygen and carbon dioxide in the blood, from the heart and major blood vessels).
When this information suggests a discordance with bodily needs (e.g. blood pressure is too low), there are reflexive actions initiated in the nucleus of the solitary tract to bring things back to within the desired range.
Blood Supply
The brain stem receives its blood supply exclusively from the posterior circulation, including the vertebrae and basilar artery.
The medulla receives its blood supply from the vertebral via medial and lateral perforating arteries.
The pons and midbrain receive their blood from the basilar via the medial and lateral perforating arteries.
Genomes and genetic_syndromes_affecting_movementsHimani Kaushik
Genomes and genetic syndromes affecting movements
Mendel’s work on inheritance in Pisum sativum was first published in 1866 and gave the law of inheritance. He described the concept of Modern Genetics. While Mendel’s research was with pisum sativum, the same principle of heredity that was discovered by Mendelian also apply to human and other animals because of the mechanism of heredity same for all complex forms of life.
Rosalind Franklin and Maurice Wilkins contribute to the discovery of the double-helix structure of DNA and James Watson and Francis Crick solved the structure of DNA, starting the new branch of molecular biology.
This project is completed in 2003 and expanded knowledge about the genetic basis for diseases and congenital malformation.
The impact of this project is just being realized, with new research into diagnostic and treatment techniques for genetic disorders.
According to WHO it occurs due to a defect in a single gene or set of genes.
Brunnstrom Approach
Brunnstrom's Approach (SIGNE BRUNNSTROM)
Objectives: ➢ Discuss the concepts and principles underlying Brunnstrom’s approach ➢ Brunnstrom recovery stages ➢ Treatment principles & techniques
★ Brunnstrom’s approach was developed by the physical therapist from Sweden in the early 1950’s
★ Brunnstrom used motor control theory and observations of the patients'
★ Procedure: In a “trial & error” fashion ★ Later modified: in light of neurophysiological knowledge
Introduction: Reflex Theory Movement is controlled by stimulus-response. Reflexes are the basis for movement: reflexes are combined into actions that create behavior. Hierarchical Theory Characterized by a top-down structure, in which higher centers are always in charge of lower centers.
● When the CNS is injured, as, in a cerebrovascular accident, an individual goes through an “evolution in reverse”. Movement becomes primitive, reflexive, and automatic.
● Changes in tone and the presence of reflexes are considered a normal process of recovery.
● Movement recovery tends to be stereotypic.
● Patients exhibit only a few stereotypic movement patterns: Basic Limb Synergies.
● Based on observations of recovery following a stroke, this approach makes use of associated reactions, tonic reflexes, and the development of basic limb synergies to facilitate movements.
● The use of such a procedure is temporary.
Basic Limb Synergies:
● Normal synergistic movements are purposeful movements with maximum precision and minimum waste of energy.
● Basic limb synergy (BLS) does not permit the different combinations of muscles.
● BLS is considered primitive, automatic, and reflexive due to loss of inhibitory control from higher centers.
● Mass movement patterns in response to a stimulus or voluntary effort both Gross flexor movement (Flexor Synergy) Gross extensor movement (Extensor Synergy) Combination of the strongest component of the synergies (Mixed Synergy)
● Appear during the early spastic period of recovery
Upper Limb Flexor Synergy: Scapula: Retraction / Elevation Shoulder: Abduction and External rotation Elbow: Flexion Forearm: Supination Wrist and Finger: Flexion Lower Limb Extensor Synergy: Pelvis: posterior tilt Hip: Extension, Adduction & Internal rotation Knee: Extension Ankle: Plantarflexion Toes: Flexion Upper Limb Extensor Synergy: Scapula: Protraction / Depression Shoulder: Adduction and Internal rotation Elbow: Extension Forearm: Pronation Wrist: Extension Finger: Flexion Lower Limb Flexor Synergy: Pelvis: anterior tilt Hip: Flexion, Abduction & External rotation Knee: Flexion Ankle: Dorsiflexion Toes: Extension
Upper Limb Mixed Synergy: Scapula retraction Shoulder add.+IR Elbow flexion Forearm pronation Wrist & fingers flexion Lower Limb Mixed Synergy: Pelvis post tilt hip add.+IR Knee extension Ankle & toes plantarflexion
Rubrospinal tract Vestibulospinal tract
Associated Reactions
Primitive Reflexes
Stroke is also known as Cerebrovascular Accident. This results in the sudden death of the brain cells due to the O2 deficiency when the blood flow to the brain is lost by obstruction/rupture of cerebral arteries which supplies to the brain. Stroke prevention requires the management of the many risk factors important to stroke development. It is important to diagnose stroke as early as possible to reduce the risk of more damage and functional loss. Stroke recovery is an inhomogeneous process, therefore, it is challenging to predict the actual post-stroke outcomes which assure a holistic approach. Rehabilitation can be provided in inpatient or outpatient departments to stroke survivors.
Walking is a phenomenon that is taken for granted by healthy individuals, but requires a complex control of the neuromusculoskeletal system. Walking is mainly a result of an automatic process, involving the spinal cord and brainstem mechanisms. Hemiplegic type of gait of a person who has had a brain insult and depends on which area of the brain is affected. Hemiplegic gait usually has:
Decreased stance phase and prolonged swing phase of the paretic side.
Decreased walking speed and shorter stride length.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
3. ASSESSMENT
DEMOGRAPHIC DATA:
NAME: XYZ
AGE / SEX: 43 Yrs. / M
WEIGHT: 77 Kgs
HEIGHT: 173.73cms
BMI: 26.2Kg/m2
DOMINANCE: Right hand
OCCUPATION: Police Sub-inspector
ADDRESS: Mujafarpur, Bihar (Temporarily: Sahin
Bagh, Okhla, Delhi)
MOB. NO. xxxxxxx
SOCIOECONOMIC STATUS: Middle class family
DATE OF ASSESSSMENT: 18th October; 2019
4. Chief Complaints:
Inability to move both the lower limbs.
Loss of sensation in both the lower limbs and inability to control urine.
Inability to sit properly, stand and walk.
Feeling of lower back stiffness and left shoulder pain. .
5. History of present illness:
Patient was apparently well 10 days back when he had an alleged history of RTA.
On 10th June, 2019, 7:30 am patient had a RTA his 2 wheeler hit by the 4 wheeler.
Initially patient was taken to the xxx Hospital in Bihar for the primary care of treatment
and from where he was referred to the yyyHospital, Delhi for the further management
and he was admitted in the ICU on 18th June, 2019.
After that patient was coming into the department of Rehabilitation at zzz, Delhi on 16th
October, 2019 with the history of RTA.
FUC of T11-T12 translational SCI with AIS-A, right femur fracture, right tibia fracture
and left tibia fracture.
6. Surgical history:
He had a surgery for posterior stabilization of T11-L1 and T11-T12 transforaminal
(interbody) fusion was done under GA on 19th June, 2019.
After that he had surgery for fracture of left proximal tibia ORIF was done and
extension tibia nail done for right leg and debridement of right knee was done under
GA on 26th June, 2019.
After sometime patient was advice for removal of cement beads from right distal
femur and bone grafting and was done on 14th August, 2019 under GA.
7. Medical treatment history: Patient discharged with some medications:
Inj. Clexane 60 mg once in a month
Tab ultracet 100 mg 1 tab X2 daily for 7 days
Cap Razo-D 40 mg 1 cap once daily for 7 days
Tab Dulane 20 mg 1 tab X2 daily for 6 weeks
Tab Emset 4 mg and Crocin 650 mg 1 tab X3 daily for 7 days
Syrup Looz 45 ml at bed time
Syrup Aristozyme and Mucaine gel 2 tsf X3 daily
Dulcolax suppository 2 tsf once daily
8. Previously patient was taking physiotherapy management in yyy Hospital.
History of past illness and medications: No any relevant past medical history is
present.
Personal history: No any relevant personal history is present.
Family history: Father : Asthmatic but this history is not relevant to the case.
Social history: Patient family, relatives and colleagues are supported.
9. ON OBSERVATION:
Body built: Endomorphic.
Posture (sitting): Chin poked, shoulders protracted, elbows flexed, wrists
and arms rested on the armrests, thoracic spine kyphotic,
hips and knees flexed and foots rested on the foot rest in
the sitting posture.
Attitude of limbs: B/L UL: shoulders adducted, externally rotated,
elbows extended, forearms supinated, wrists neutral
and fingers extended.
B/L LL: hips adducted, externally rotated, knees
hyperextended and ankles plantarflexed.
Swelling: Present over the dorsum of the B/L ankles.
10. Skin color: No any skin discoloration is present.
Pressure sores: Not present.
Scar: Present over the thoracic spine, anteriorly above the
knee on the right side, on the medial malleolus of
the right leg and anteriorly below the knee on the
left side.
External aids: KAFO and walker is used B/L for the assisted standing.
Gait: Patient is coming into the department with the
wheelchair.
11. ON EXAMINATION:
Higher Mental Functions: Patient is alert, oriented to person, place and time and
follow all the commands properly.
Pain:
Dull ache pain: VAS: On occasion: during left shoulder movements: 4.
At rest: 2.
Diffuse pain on the lower-back: VAS: On occasion: prolonged sitting on the wheel-
chair: 2.
At rest: 2.
Tenderness : Not present.
Skin temperature: Normal.
12. MINI-MENTAL STATE EXAMINATION (MMSE)
Maximum Score Score
Orientation
5 (5) What is the (year) (season) (day) (date) (month)?
5 (5) Where are we: (state) (county) (town) (hospital)
(floor)?
Registration
3 (2) Name three unrelated objects. Allow one second to
say each. Then ask the patient to repeat all three
after you have said them. Give one point for each
correct answer. Repeat them until he or she learns all
three. Count trials and record. Trials: __2__ .
Attention and Calculation
5 (4) Ask patient to count backwards from 100 by sevens.
Give one point for each correct answer. Stop after
five answers. Alternatively, spell world backwards.
Recall
3 (3) Ask patient to recall the three objects previously
stated. Give one point for each correct answer.
13. Maximum Score Score
Language
9 (2) • Show patient a wrist watch; ask patient what it is.
Repeat for a pencil. (2 points)
(1) • Ask patient to repeat the following: "No ifs, ands,
or buts." (1 point)
(3) • Ask patient to follow a three-stage command:
"Take a paper in your right hand, fold it in half, and
put it on the floor." (3 points)
(1) • Ask patient to read and obey the following
sentence which you have written on a piece of
paper: "Close your eyes." (1 point)
(1) • Ask patient to write a sentence. (1 point)
Total Score: _28_ Assess level of consciousness along a continuum: Alert,
Drowsy, Stupor, Coma
14. Scoring:
24-30 Uncertain Cognitive Impairment
18-23 Mild to Moderate Cognitive Impairment
0-17 Severe Cognitive Impairment
The score ranges listed here are widely used, but it should be noted that an
MMSE score is only an initial indicator of cognitive status, and norms for the
MMSE vary greatly depending on a person's age, education level, and race.
16. INTERNATIONAL SPINAL CORD INJURY PAIN BASIC DATA SET
Date of data collection: 2019/10/22
Have you had any pain during the last seven days including today: Y N
If yes:
Please note that the time period during the last week applies to all pain
interference questions.
In general, how much has pain interfered with your day-to-day activities in the
last week?
No interference 0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 Extreme interference
In general, how much has pain interfered with your overall mood in the last week?
No interference 0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 Extreme interference
In general, how much has pain interfered with your ability to get a good night's
sleep?
No interference 0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 Extreme interference
How many different pain problems do you have? 1; 2; 3; 4; >5
Please describe your three worst pain problems:
24. Manual muscle testing: Done according to the ASIA scale used for the SCI
patients.
Range of motion: AROM of B/L LL is not documented because of patient is unable
to initiate the movement and flaccidity.
25. SENSORY SCORING:
0 = absent
1 = altered
2 = normal
NT = non-testable
MOTOR SCORING:
0 = No flicker or visible contraction
1 = Palpable or visible contraction
2 = Active movement in gravity eliminated plane
3 = Active movement in gravity against plane
4 = Active movement in gravity against plane with min. resistance
5 = Active movement in gravity against plane with max. resistance
31. DTR SCORING:
0 = Absent, no response
1+= Slight reflex, low response
2+= Normal response, typical reflex
3+= Brisk reflex
4+= Very brisk reflex with clonus abnormally
MUSCLE TONE SCORING:
0= No response (Flaccid)
1+= Decreased response (Hypotonia)
2+= Normal response
3+= Exaggerated response (Mild to Moderate Hypertonia)
4+= Sustained response (Severe Hypertonia)
32. End-feel: Right knee end-feel : Bony end-feel
Limb girth:
Limb length discrepancy : From ASIS to medial malleolus:
RT. 86.5cms ; LT. 87cms
Right UL: 4inches:
Above olecranon process: 29cms
Below olecranon process: 24cms
Left UL: 4inches:
Above olecranon process: 29.5cms
Below olecranon process: 24.5cms
Right LL: 6inches:
Above mid-patella: 44.5cms
Below mid-patella: 32.5cms
Left LL: 6inches:
Above mid-patella: 42.5cms
Below mid-patella: 32cms
33. Deformity / contractures: B/L ankle P/F (deformity)
Scar Examination:
Thoracic scar: 10.5 cm
Right femur: Anteriorly above the knee: 24 cm
Right medial malleolus: Medially: 6 cm
Left tibia: Anteriorly below the knee: 16.5 cm
38. Balance and Coordination tests:
Non-equilibrium test Equilibrium test
Finger to nose
Finger to finger
Alternate finger to nose
Pronation/supination
Heel-on-shin
Drawing circle foot
Foot tapping
Sitting independently
Standing
Tandem stance
Rombergs test
normal
Activity
impossible
fair
NT,
Poor
Functional Skills: SCIM Scale is used.
Bed mobility and Wheelchair skills:
Independently roll left and right.
Mild assistance to supine to prone and prone to supine.
Mild assistance for supine to long-sitting.
Moderate assistance for supine to bed-side sitting.
Maximal assistance requires for shifting the patient from wheelchair to bed and
bed to wheelchair
43. Gait Assessment: Patient is wheel-chair bound gait assessment is not possible.
Scales:
MMSE: 28/30
International Spinal Cord Injury Pain Basic Data Set
ASIA: AIS-A
SCIM: 48/100
Investigations:
MRI
X-RAYS
Diagnosis: FUC of post-surgical T11-T12 translational SCI with AIS-A, right femur
fracture, right tibia fracture and left tibia fracture
47. PHYSIOYHERAPY MANAGEMENT:
Goals:
Precautions:
Stress at fracture sites and overuse
Skin integrity and risk of falls
SHORT TERM GOALS LONG TERM GOALS
To relief pain
To maintain the upper limb ROM &
activities within normal limits
To improve UL strength
Risk of secondary impairment is
reduced
Patient and caregivers counseling
Sensory and Motor re-education
Muscle performance is increased
Independence pressure relief
Improve balance
Independence in wheel-chair transfers
Independence self-directing care
Independence in ADL’S
Tolerates upright position
Patient and caregivers counseling
48. Plan of care:
For sensory and motor
reeducation and
psychological
motivation
For preservation of spared
activity and prevent
secondary impairments
For balance and coordination control and
make patient functionally independent as
much as possible
Patient and
caregiver
counseling
during each
phase of
rehabilitati
on about
the
prognosis of
the patient
49. TREATMENT
Active range of motion exercises for the bilateral upper limb.
TENS for left shoulder pain X 10 minutes.
Hot-pack for left shoulder pain X 10 minutes.
Strengthening exercises for the bilateral upper limb.
Passive range of motion for the bilateral lower limb.
Sensory re-education protocol:
Tapping
Brushing
Pro-prioceptive neuromuscular facilitation for the bilateral lower limb.
Static abdominal exercise.
Long-sitting balance exercise.
Wheel chair push-ups
50. AROM exs of
the B/L UL -
to preserve
and maintain
ROM.
TENS and
Hot-pack for
the pain
relief.
Strengthening
of B/L UL –
to maintain
and improve
the strength
of UL.
PROM exs of
the B/L LL to
prevent DVT,
Pressure
sores,
spasticity and
contractures.
Sensory re-
education :
tapping and
brushing
helps to
return sensory
function.
PNF for the
B/L LL to re-
educate and
facilitate the
movements.
Static
abdominal ex.
and long-
sitting
balance
exercise to
improve trunk
control.
Wheel-chair
push-ups to
prevent
Pressure sores
and improve
UL strength.
51. Bridging exercises with assistance.
Crunches exercise with assistance.
Mat activities:
Prone on elbows.
Prone on hands.
Assisted prone to quadruped position.
Bed-side sitting balance exercise.
Sitting reaching activities.
Transfer activities:
From bed to wheelchair.
From wheelchair to bed.
From mat to wheelchair.
Hitching and hiking exercises.
Standing exercises for 5 minutes (7 Nov; 2019)
52. Crunches and
bridging exs
for
strengthening
of
abdominals,
and weight-
bearing on
B/L LL.
MAT
ACTIVITIES
AND
TRANSFERS
ACTIVITIES
Bed-side
sitting and
sitting
reaching
activities – to
improve
sitting
balance.
Standing (to
improve
circulation)
for 5min/day
to hold &
regain the
correct
posture and to
improve
balance.
53. MAT ACTIVITIES
SUPINE LYING SUPINE ON ELBOWS
PRONE LYING LONG SITTING
PRONE ON ELBOWS
PRONE ON HANDS
QUARUPED POSITION
KNEELING
STANDING
55. Mat activities: Improves ROM, strength, restoration of functions and awareness
of COG.
Prone on elbows : Improving bed mobility, helps in strengthening of scapular
muscles and improves stability by joint approximation.
Prone on hands: Improves postural alignment includes development of
hyperextension of hip and low-back extension which required later on in standing
from wheelchair and ambulation. It facilitate tonic holding of proximal joints and
utilize as strengthening exercise for e.g. push-ups.
Prone to quadruped position: It is useful for facilitating initial control of available
musculature of lower trunk and hips, helps to hold position, develop dynamic
balance, improve strength, coordination and timing e.g. creeping activity.