multisensory training involves several bodily senses that is combines three learning senses auditory, visual and kinesthetic. In multisensory training exercise are taught using two or more of these modalities simultaneously to receive or express information.
The senses usually employed in multisensory learning are visual, auditory, kinesthetic and tactile – VAKT (i.e. seeing, hearing, doing, and touching). Some studies conclude that the benefits of multisensory learning are greatest if the senses are engaged concurrently and the instruction is direct and systematic.
The document discusses guidelines for functional capacity assessments. It provides details on:
- The components of an assessment including weighted activities, postures, and upper extremity tasks.
- Scheduling and preparing for assessments, including obtaining medical history and addressing potential client issues.
- Greeting the client to make them comfortable and explain the assessment process.
- Using standardized equipment, instructions, methodology, and reporting to ensure objective, reliable results.
- Translating results into recommendations considering client safety and capabilities.
Blood flow restriction therapy uses elastic bands or tourniquets to restrict venous blood flow from leaving exercised muscles during low-intensity exercises, causing the muscles to be exposed to metabolic stress similar to high-intensity training. A case study found that using blood flow restriction during low-intensity bicep curls and triceps extensions led to greater increases in blood lactate, heart rate, and perceived exertion compared to the same exercises without restriction. While blood flow restriction allows for muscle gains with lower exercise loads, it can increase risks of delayed muscle soreness, thrombosis, and elevated blood pressure.
The document provides guidance on safely transferring patients from one surface to another. It describes different types of transfers that vary based on a patient's abilities and needs. Key points include:
1) Assessing a patient's physical, cognitive, and medical status is important for determining the best transfer method.
2) Common transfer techniques include dependent, assisted, and independent transfers using devices like draw sheets, sliders, and boards.
3) Proper body mechanics and communication are essential to avoid injury for both the patient and caregiver. Bend knees, keep back straight, and get help for heavy transfers.
This document provides information on developing a moderate exercise program for managing diabetes, including 7 major components of an exercise routine: warm up, cardiovascular fitness, muscular strength, flexibility, balance, cool down, and body composition. It outlines the benefits of exercise for diabetes, defines moderate intensity, and provides guidance for each component, exercise prescription and safety considerations.
A detailed presentation from our Trigger Point Therapy workshop for sport's and massage therapist's. This event was held at our St John Street clinic on the 30th April 2016.
1) Early management of spinal cord injuries focuses on immobilization, fracture stabilization, and preventing secondary complications. Physical therapy aims to improve respiratory function, prevent skin breakdown, and begin early mobility.
2) During active rehabilitation, the goals are to increase independence and functional mobility. Physical therapy focuses on strengthening, cardiovascular training, and learning mobility skills like transfers, bed mobility, and locomotion.
3) Locomotor training uses body weight support treadmills, orthoses like KAFOs, and assistive devices to retrain walking patterns after spinal cord injury. Training occurs both on the treadmill and overground.
This document provides an overview of craniosacral therapy, including its history, principles, techniques, and applications. It describes how craniosacral therapy involves gentle manual treatment of the cranial bones and spinal column to relieve restrictions and balance the craniosacral rhythm. Key aspects covered include the cranial motion patterns, assessment methods involving palpation of cranial structures, different treatment techniques, indications for its use, and contraindications.
The document discusses guidelines for functional capacity assessments. It provides details on:
- The components of an assessment including weighted activities, postures, and upper extremity tasks.
- Scheduling and preparing for assessments, including obtaining medical history and addressing potential client issues.
- Greeting the client to make them comfortable and explain the assessment process.
- Using standardized equipment, instructions, methodology, and reporting to ensure objective, reliable results.
- Translating results into recommendations considering client safety and capabilities.
Blood flow restriction therapy uses elastic bands or tourniquets to restrict venous blood flow from leaving exercised muscles during low-intensity exercises, causing the muscles to be exposed to metabolic stress similar to high-intensity training. A case study found that using blood flow restriction during low-intensity bicep curls and triceps extensions led to greater increases in blood lactate, heart rate, and perceived exertion compared to the same exercises without restriction. While blood flow restriction allows for muscle gains with lower exercise loads, it can increase risks of delayed muscle soreness, thrombosis, and elevated blood pressure.
The document provides guidance on safely transferring patients from one surface to another. It describes different types of transfers that vary based on a patient's abilities and needs. Key points include:
1) Assessing a patient's physical, cognitive, and medical status is important for determining the best transfer method.
2) Common transfer techniques include dependent, assisted, and independent transfers using devices like draw sheets, sliders, and boards.
3) Proper body mechanics and communication are essential to avoid injury for both the patient and caregiver. Bend knees, keep back straight, and get help for heavy transfers.
This document provides information on developing a moderate exercise program for managing diabetes, including 7 major components of an exercise routine: warm up, cardiovascular fitness, muscular strength, flexibility, balance, cool down, and body composition. It outlines the benefits of exercise for diabetes, defines moderate intensity, and provides guidance for each component, exercise prescription and safety considerations.
A detailed presentation from our Trigger Point Therapy workshop for sport's and massage therapist's. This event was held at our St John Street clinic on the 30th April 2016.
1) Early management of spinal cord injuries focuses on immobilization, fracture stabilization, and preventing secondary complications. Physical therapy aims to improve respiratory function, prevent skin breakdown, and begin early mobility.
2) During active rehabilitation, the goals are to increase independence and functional mobility. Physical therapy focuses on strengthening, cardiovascular training, and learning mobility skills like transfers, bed mobility, and locomotion.
3) Locomotor training uses body weight support treadmills, orthoses like KAFOs, and assistive devices to retrain walking patterns after spinal cord injury. Training occurs both on the treadmill and overground.
This document provides an overview of craniosacral therapy, including its history, principles, techniques, and applications. It describes how craniosacral therapy involves gentle manual treatment of the cranial bones and spinal column to relieve restrictions and balance the craniosacral rhythm. Key aspects covered include the cranial motion patterns, assessment methods involving palpation of cranial structures, different treatment techniques, indications for its use, and contraindications.
The document discusses the neural control of human locomotion. It states that locomotion requires progression, postural control, and adaptation. It is controlled by the coordinated actions of the neurologic, muscular and skeletal systems through various chains including sensorimotor chains. The nervous system generates locomotor patterns and coordinates multi-limb movements while accounting for environmental factors. Both lower motor neurons and supraspinal centers receive convergent input which allows locomotion to be adapted based on context.
This document provides information on assessing a 4-year-old male child with cerebral palsy. It defines cerebral palsy as a group of disorders affecting movement and posture due to brain lesions or anomalies. The child's history notes his mother fell during pregnancy and he was born via C-section blue and did not cry. Physical exam findings include inability to walk, sit, or hold objects independently. The assessment examines developmental milestones, motor skills, reflexes, and provides differential diagnoses for the child's condition.
This document provides an overview of interventions to improve balance in children with cerebral palsy. It defines cerebral palsy and discusses its causes, classifications, common impairments, diagnosis and prognosis. It then summarizes several studies on interventions for improving balance, gait, upper extremity function, muscle strength, and postural control in children with cerebral palsy, including stretching, electrical stimulation, virtual reality, treadmill training, mirror therapy, and balance training. The studies examined the effects of these interventions on outcomes like gross motor function, muscle strength, and balance.
This document provides guidance on performing an objective assessment of the lumbar spine. It outlines steps to plan the examination including identifying relevant anatomical structures and considering the patient's pain. The purpose is to interpret the patient's disability, test hypotheses, and clarify treatment options. Assessment involves observing posture, performing active physiological movements to assess pain and range of motion, and applying techniques like overpressure. Movement patterns are analyzed to identify normal and abnormal responses. Palpation and auxiliary tests complete the examination.
Appropriate Outcome Measures for Lower Level PatientsDaniel Woodward
1) The document discusses outcome measures for assessing balance and mobility in non-ambulatory patients. It recommends the Sitting Balance Scale and Function in Sitting Test as reliable and valid ways to measure progress in patients who may score poorly on measures that require standing or walking.
2) It provides information on how to administer each test and notes they have been shown to effectively measure balance in frail elderly patients and those with conditions limiting mobility.
3) Limitations discussed are the small sample sizes of validation studies to date and need for more research, but both measures are appropriate to use clinically based on current evidence.
Multiple sclerosis a devastating progressive condition cased due to demyelination and gliotic changes in CNS. Physiotherapy managemnet options available for most of the clinical features are enumerated
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
IMPROVING RECOVERY AFTER A STROKE: EVIDENCES FOR CONTEMPORARY APPROACHESAdemola Adeyemo
This document outlines an MSc presentation on improving recovery after stroke through contemporary rehabilitation approaches. It discusses the epidemiology of stroke and common disabilities caused by stroke. Key principles for recovery like neuroplasticity are explained. Contemporary task-specific training approaches and motor learning paradigms are described in detail, including constraint-induced movement therapy, functional electrical stimulation, bodyweight supported treadmill training, robotics therapy, and virtual reality therapy. Evidence for how these approaches can enhance recovery through cortical reorganization is provided.
Proprioceptive neuromuscular facilitation (PNF) is an exercise technique based on principles of neurophysiology and functional anatomy. It uses patterns of diagonal movements combining flexion, extension, abduction, adduction, and rotation. The 9 principles of PNF include resistance, stretch, timing, and verbal commands. PNF techniques like repeated contractions and hold-relax are used to improve areas like strength, flexibility, and motor control by facilitating agonist and antagonist muscle groups. PNF patterns involve multi-joint diagonal movements of the upper and lower extremities.
This is a power point presentation of Lower cross syndrome for medical/physical therapy purpose created by Dr Harshad Morasiya. Including contains are pathophysiology, causes, signs and symptoms, diagnostic and treatment method as well as recent evidences with references.
This document provides guidance on prescribing wheelchairs. It outlines the parts of a wheelchair, important considerations in evaluating patients, and goals of prescription. A proper evaluation involves medical history, physical exam, and functional assessment. Prescriptions are developed using tools like the SEAT checklist to address safety, comfort, and accommodation of needs over time. The goals of prescription include normalization of tone, improved function and mobility, and increased comfort and skin integrity.
This document discusses geriatric management at both the individual and community level. At the individual level, management includes acute care, functional restoration, and prevention. Acute care focuses on education, pain relief, and healing. Functional restoration maintains and improves range of motion, strength, flexibility, and balance. Prevention maintains previous exercises and identifies risk factors. At the community level, a multidisciplinary team provides primary, secondary, and tertiary prevention. This includes health promotion, early diagnosis and treatment, and rehabilitation. The document also outlines exercise recommendations for older adults, including aerobic, strength, flexibility, endurance, and neuromotor exercises.
This is short Presentation on avascular necrosis of femoral head.This presentation gives brief description of introduction, causes investigation and treatment for AVN of hip.
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
This document summarizes the evolution of various neurophysiological approaches in physiotherapy. It describes approaches that were popular prior to the 1940s, which focused on orthopedic interventions and compensation. It then outlines several approaches developed from the 1940s onward that recognized the potential for functional recovery of affected body parts, including Bobath, Peto, Kabbat and Knott, Voss, and Rood approaches. The document proceeds to define neurophysiological approaches and their role in central nervous system plasticity. It provides examples of historical and contemporary approaches, such as muscle re-education, neurodevelopmental approaches, sensory integration, and task-oriented approaches.
Presentation during IFNR 2016.
Brief description with available evidence on various coma arousal therapy with an illustrative study for each therapy and recommendation for future.
Disability Evaluation - Dr Sanjay Wadhwamrinal joshi
The document summarizes the Rights of Persons with Disabilities Act 2016 in India. It outlines the objectives of familiarizing participants with the act and focusing on disability evaluation features. Key points include:
- The act received presidential assent in December 2016 and includes 17 chapters covering rights, entitlements, education, employment and more.
- It expands the definition of disability to include 21 specified disabilities and establishes committees for evaluating autism and developing more objective evaluation criteria.
- Implementing the act faces challenges of low awareness, consensus building, limited resources, and making disability evaluation a higher priority.
Cervical myelopathy is a neurological impairment caused by compression of the cervical spinal cord, most commonly due to degenerative changes like spondylosis. It presents with neck stiffness, leg weakness, gait abnormalities, and clumsy hands. Physiotherapy management includes electrotherapeutic modalities to reduce pain, cervical stabilization exercises, isometric neck exercises, stretching, and progressive resistance exercises. The goals are to relieve pain, improve function, prevent further neurological deficits, and improve existing deficits. Surgery or immobilization may also be considered depending on severity.
The document describes the starting position, range of motion, precautions, and factors limiting range of motion for various neck and trunk motions including flexion, extension, rotation, lateral flexion, and hyperextension. The neck motions include flexion from 0-45 degrees, extension from 45-0 degrees, rotation from 0-60 degrees to each side, and lateral flexion from 0-45-60 degrees to each side. Trunk motions include flexion of approximately 4 inches, hyperextension of 2 inches, and lateral flexion and rotation measuring differences in distances between starting and ending positions using landmarks like spinous processes.
This document provides an overview of physiotherapy for geriatric patients. It discusses assessing patients, setting goals, and therapeutic interventions. The assessment involves a full history, physical exam, and evaluation of functional status. Goals aim to improve mobility, strength, and quality of life. Therapeutic interventions may include range of motion, stretching, strengthening, aerobic exercise, and gait training exercises. Orthotics and reassessment are also discussed.
The document discusses the neural control of human locomotion. It states that locomotion requires progression, postural control, and adaptation. It is controlled by the coordinated actions of the neurologic, muscular and skeletal systems through various chains including sensorimotor chains. The nervous system generates locomotor patterns and coordinates multi-limb movements while accounting for environmental factors. Both lower motor neurons and supraspinal centers receive convergent input which allows locomotion to be adapted based on context.
This document provides information on assessing a 4-year-old male child with cerebral palsy. It defines cerebral palsy as a group of disorders affecting movement and posture due to brain lesions or anomalies. The child's history notes his mother fell during pregnancy and he was born via C-section blue and did not cry. Physical exam findings include inability to walk, sit, or hold objects independently. The assessment examines developmental milestones, motor skills, reflexes, and provides differential diagnoses for the child's condition.
This document provides an overview of interventions to improve balance in children with cerebral palsy. It defines cerebral palsy and discusses its causes, classifications, common impairments, diagnosis and prognosis. It then summarizes several studies on interventions for improving balance, gait, upper extremity function, muscle strength, and postural control in children with cerebral palsy, including stretching, electrical stimulation, virtual reality, treadmill training, mirror therapy, and balance training. The studies examined the effects of these interventions on outcomes like gross motor function, muscle strength, and balance.
This document provides guidance on performing an objective assessment of the lumbar spine. It outlines steps to plan the examination including identifying relevant anatomical structures and considering the patient's pain. The purpose is to interpret the patient's disability, test hypotheses, and clarify treatment options. Assessment involves observing posture, performing active physiological movements to assess pain and range of motion, and applying techniques like overpressure. Movement patterns are analyzed to identify normal and abnormal responses. Palpation and auxiliary tests complete the examination.
Appropriate Outcome Measures for Lower Level PatientsDaniel Woodward
1) The document discusses outcome measures for assessing balance and mobility in non-ambulatory patients. It recommends the Sitting Balance Scale and Function in Sitting Test as reliable and valid ways to measure progress in patients who may score poorly on measures that require standing or walking.
2) It provides information on how to administer each test and notes they have been shown to effectively measure balance in frail elderly patients and those with conditions limiting mobility.
3) Limitations discussed are the small sample sizes of validation studies to date and need for more research, but both measures are appropriate to use clinically based on current evidence.
Multiple sclerosis a devastating progressive condition cased due to demyelination and gliotic changes in CNS. Physiotherapy managemnet options available for most of the clinical features are enumerated
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
IMPROVING RECOVERY AFTER A STROKE: EVIDENCES FOR CONTEMPORARY APPROACHESAdemola Adeyemo
This document outlines an MSc presentation on improving recovery after stroke through contemporary rehabilitation approaches. It discusses the epidemiology of stroke and common disabilities caused by stroke. Key principles for recovery like neuroplasticity are explained. Contemporary task-specific training approaches and motor learning paradigms are described in detail, including constraint-induced movement therapy, functional electrical stimulation, bodyweight supported treadmill training, robotics therapy, and virtual reality therapy. Evidence for how these approaches can enhance recovery through cortical reorganization is provided.
Proprioceptive neuromuscular facilitation (PNF) is an exercise technique based on principles of neurophysiology and functional anatomy. It uses patterns of diagonal movements combining flexion, extension, abduction, adduction, and rotation. The 9 principles of PNF include resistance, stretch, timing, and verbal commands. PNF techniques like repeated contractions and hold-relax are used to improve areas like strength, flexibility, and motor control by facilitating agonist and antagonist muscle groups. PNF patterns involve multi-joint diagonal movements of the upper and lower extremities.
This is a power point presentation of Lower cross syndrome for medical/physical therapy purpose created by Dr Harshad Morasiya. Including contains are pathophysiology, causes, signs and symptoms, diagnostic and treatment method as well as recent evidences with references.
This document provides guidance on prescribing wheelchairs. It outlines the parts of a wheelchair, important considerations in evaluating patients, and goals of prescription. A proper evaluation involves medical history, physical exam, and functional assessment. Prescriptions are developed using tools like the SEAT checklist to address safety, comfort, and accommodation of needs over time. The goals of prescription include normalization of tone, improved function and mobility, and increased comfort and skin integrity.
This document discusses geriatric management at both the individual and community level. At the individual level, management includes acute care, functional restoration, and prevention. Acute care focuses on education, pain relief, and healing. Functional restoration maintains and improves range of motion, strength, flexibility, and balance. Prevention maintains previous exercises and identifies risk factors. At the community level, a multidisciplinary team provides primary, secondary, and tertiary prevention. This includes health promotion, early diagnosis and treatment, and rehabilitation. The document also outlines exercise recommendations for older adults, including aerobic, strength, flexibility, endurance, and neuromotor exercises.
This is short Presentation on avascular necrosis of femoral head.This presentation gives brief description of introduction, causes investigation and treatment for AVN of hip.
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
This document summarizes the evolution of various neurophysiological approaches in physiotherapy. It describes approaches that were popular prior to the 1940s, which focused on orthopedic interventions and compensation. It then outlines several approaches developed from the 1940s onward that recognized the potential for functional recovery of affected body parts, including Bobath, Peto, Kabbat and Knott, Voss, and Rood approaches. The document proceeds to define neurophysiological approaches and their role in central nervous system plasticity. It provides examples of historical and contemporary approaches, such as muscle re-education, neurodevelopmental approaches, sensory integration, and task-oriented approaches.
Presentation during IFNR 2016.
Brief description with available evidence on various coma arousal therapy with an illustrative study for each therapy and recommendation for future.
Disability Evaluation - Dr Sanjay Wadhwamrinal joshi
The document summarizes the Rights of Persons with Disabilities Act 2016 in India. It outlines the objectives of familiarizing participants with the act and focusing on disability evaluation features. Key points include:
- The act received presidential assent in December 2016 and includes 17 chapters covering rights, entitlements, education, employment and more.
- It expands the definition of disability to include 21 specified disabilities and establishes committees for evaluating autism and developing more objective evaluation criteria.
- Implementing the act faces challenges of low awareness, consensus building, limited resources, and making disability evaluation a higher priority.
Cervical myelopathy is a neurological impairment caused by compression of the cervical spinal cord, most commonly due to degenerative changes like spondylosis. It presents with neck stiffness, leg weakness, gait abnormalities, and clumsy hands. Physiotherapy management includes electrotherapeutic modalities to reduce pain, cervical stabilization exercises, isometric neck exercises, stretching, and progressive resistance exercises. The goals are to relieve pain, improve function, prevent further neurological deficits, and improve existing deficits. Surgery or immobilization may also be considered depending on severity.
The document describes the starting position, range of motion, precautions, and factors limiting range of motion for various neck and trunk motions including flexion, extension, rotation, lateral flexion, and hyperextension. The neck motions include flexion from 0-45 degrees, extension from 45-0 degrees, rotation from 0-60 degrees to each side, and lateral flexion from 0-45-60 degrees to each side. Trunk motions include flexion of approximately 4 inches, hyperextension of 2 inches, and lateral flexion and rotation measuring differences in distances between starting and ending positions using landmarks like spinous processes.
This document provides an overview of physiotherapy for geriatric patients. It discusses assessing patients, setting goals, and therapeutic interventions. The assessment involves a full history, physical exam, and evaluation of functional status. Goals aim to improve mobility, strength, and quality of life. Therapeutic interventions may include range of motion, stretching, strengthening, aerobic exercise, and gait training exercises. Orthotics and reassessment are also discussed.
This document provides a care protocol for well elderly individuals. It begins with definitions and an overview of typical age-related changes to body systems. It then outlines the scope, objectives, and components of assessment including history, observation, functional tests, and goal-setting. The main interventions are described as exercise therapy, pain management, patient education, and promoting general fitness. Exercise recommendations include aerobic, strength, balance, and flexibility exercises. Safety guidelines are provided along with fall prevention tips. The protocol concludes with an algorithm outlining the referral, assessment, treatment, re-evaluation, and discharge process for well elderly individuals.
This document provides a summary of a book about fitness for young people between the ages of 8 and 15. The book is divided into three chapters that cover fitness, strength and endurance, and flexibility. It provides guidelines on appropriate exercise frequencies and intensities for children and discusses the importance of warming up, cooling down, and including stretches. Safety is emphasized, and the book aims to provide fun, practical exercises to help children be more active and develop fitness.
This document summarizes four hot topics related to multiple sclerosis: balance, fatigue, spasticity, and headaches. It discusses how balance issues affect over 50% of people with MS and cites a 2008 study that found differences in postural response latencies between the legs of MS subjects. It provides four strengthening and balance exercises to try at home, including heel raises, leg balances, foot exercises, and heel-to-toe walking. It notes that exercising can help balance but to do so safely and be aware of symptoms. The document clarifies that exercise does not cause exacerbations in MS and discusses how Tai Chi is a good approach to improving balance for those with MS.
This document summarizes four hot topics related to multiple sclerosis: balance, fatigue, spasticity, and headaches. It discusses how balance issues affect over 50% of people with MS and cites a 2008 study that found differences in postural response latencies between the legs of MS subjects. It provides four strengthening and balance exercises to try at home, including heel raises, leg balances, foot exercises, and heel-to-toe walking. It notes that exercising can help balance but to do so safely and be aware of symptoms. The document clarifies that exercise does not cause exacerbations in MS and discusses how Tai Chi is a good approach to improving balance for those with MS.
Role of physiotherapy in fall prevention in geriatricRanjeet Singha
Falls are common in the elderly population and can lead to injuries, loss of mobility, and increased healthcare costs. Physiotherapy plays an important role in fall prevention for older adults. A multifactorial approach is most effective, including exercises targeting balance, strength, and risk factors like medications and behaviors. Suitable balance exercises for older adults include reaching, stepping, walking, sit-to-stand, and squats, with progression over time. Physiotherapists should implement well-designed exercise programs individually and in groups to help prevent falls in geriatric patients.
Physical activity and Successful agingSMVDCoN ,J&K
The single most effective means by which older adults can influence their own health and functional abilities and therefore, maintain a high quality in the old age.
I do not have enough context to answer questions about human anatomy or the content of the document. Could you please provide the full document you are referring to?
The document discusses women and exercise throughout history and today. It covers the health benefits of exercise, types of exercise, and challenges women face in exercising. While exercise was previously necessary for work, most women today do not get regular exercise. Exercise can help reduce health risks and improve heart health, mobility, and mental wellbeing. The document provides tips on getting started with exercise and maintaining a routine.
Physical Fitness and Exercise During the COVID-19.pptxpallaviparmar9
More COVID-19 cases continue to rise, and people are requested to be at home and self-quarantine. Aren't we less mobile and more isolated than before the pandemic?
The document outlines components of a physical education course, including basic concepts of fitness and wellness, dimensions of wellness, benefits of exercise, components of physical fitness, tests to measure fitness, exercise program design, and principles for developing movement skills. Key topics covered are the 7 dimensions of wellness, health and skill-related aspects of physical fitness, how to measure components like flexibility, and how to structure an exercise routine following the FITT principle.
The document provides information on various fitness tests that can be used to assess physical fitness levels in key areas such as aerobic fitness, muscular strength and endurance, flexibility, and body composition. It describes how to perform tests like measuring resting heart rate and target heart rate zone, pushups, situps, the sit-and-reach flexibility test, waist circumference measurement, and calculating body mass index. Scoring guidelines are provided for each test to indicate fitness levels based on age and sex.
Multiple sclerosis (MS) is an autoimmune disease that causes demyelination of nerve pathways in the brain and spinal cord, impairing signal transmission. There are four stages of MS: relapsing-remitting, secondary progressive, primary progressive, and progressive-relapsing. Symptoms vary by individual but may include fatigue, tremors, cognitive changes, sensory deficits, weakness, and mobility issues. Occupational therapy can help people with MS through fatigue management, controlling tremors, cognitive compensation strategies, improving sensory function, strength and endurance training, contracture prevention, improving activities of daily living, and use of adaptive equipment.
DONE PE11-Q3-M2-Fitness Enhancement Through Physical Activities.pptxJhonFurio2
Here are 10 benefits of health-related fitness exercises:
1. Improved cardiovascular health - Regular exercise strengthens your heart and lungs.
2. Weight management - Physical activity helps maintain a healthy weight or aids in weight loss.
3. Reduced risk of chronic diseases - Diseases like type 2 diabetes, cancer, and heart disease are less likely with regular exercise.
4. Stronger muscles and bones - Weight-bearing exercise builds bone density and muscle strength.
5. Improved mental health - Exercise releases endorphins that boost mood and reduce stress/anxiety.
6. Increased energy levels - Physical activity gives you more stamina and endurance for daily activities.
7
Physical Activities and Exercise.pptxfffJadeRomorosa
The document discusses the importance of physical activity and exercise for health. It recommends teenagers engage in at least 60 minutes of physical activity per day. However, many Filipino students do not meet these requirements. The document outlines barriers to physical activity and provides strategies to overcome them, such as prioritizing time for exercise. Regular physical activity can improve overall health and reduce the risk of diseases.
This document provides information on physical fitness and exercise. It defines key terms like physical activity, exercise, and physical fitness. It recommends that adults get at least 30 minutes of moderate physical activity most days of the week to promote health. It also discusses the health benefits of exercise and lists the components of physical fitness like cardiorespiratory endurance and muscular strength. Finally, it provides guidelines for developing an effective exercise program and training safely and gradually over time.
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Multisensory training to improve balance to prevent falls
1. MULTISENSORY TRAINING TO IMPROVE
BALANCE TO PREVENT FALLS IN ELDERLY
POPULATIONS
BY DR.POOJA MAHASETH PT
MPT (NEUROLOGY)
poojamahaseth1993@gmail.com
2. MULTISENSORY TRAINING
Multisensory training (MST) has impact on more than one sense at a time. Multisensory training doesn’t
require any specific instruments like ergo metric bicycle, trade mill, and swimming pool. So it is easy to
apply.
multisensory training involves several bodily senses that is combines three learning senses auditory, visual
and kinesthetic. In multisensory training exercise are taught using two or more of these modalities
simultaneously to receive or express information.
The senses usually employed in multisensory learning are visual, auditory, kinesthetic and tactile – VAKT
(i.e. seeing, hearing, doing, and touching). Some studies conclude that the benefits of multisensory learning
are greatest if the senses are engaged concurrently and the instruction is direct and systematic.
poojamahaseth1993@gmail.com
3. Why multisensory training?
Elderly peoples started experience manifestations of imbalance and body instability, they develop impairments in
tactile sensitivity, vibration sense, lower limb proprioception and kinesthesia associated to impaired balance, altered
gait patterns and increased risk of falling, therefore, simple activities like stair climbing, rising up from chair and
standing up may become limited because they are dependent on gait and balance, so to improve the balance and gait
multisensory training is given.
Also multisensory training are effective in Improving Balance in elderly populations and reduce falls rate (by 23%)
and may reduce the risk of fractures (by 27%)
MST exercise programme consist of mainly balance and functional exercises. MST reduce the rate of falls and the
number of people experiencing falls in older people living in the community (high-certainty evidence). Exercise
programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably
reduce falls include multiple exercise categories and also helps to preserve and build muscle, thus reducing the risk of
falling.
poojamahaseth1993@gmail.com
4. FALL
A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or
other lower level.
Falls and fall-related injuries are a common & serious problem for older people. Fall potentially life-
threatening events and may be simply the first signs of single problem.
It lead to hospitalization and increase cost and burden on society and even lead to death
Each year, one out of three adults age 65 and older falls, according to the CDC.
Falls are equally common between men and women, but were more likely to result in injury in women.
poojamahaseth1993@gmail.com
5.
6. CAUSES
Medical Risk factors, Side effects of medications, impaired musculoskeletal function, gait abnormality
and osteoporosis, Arthritis, hip weakness and imbalance, Cardiac arrhythmias (irregular heartbeat), blood
pressure fluctuation, Neurologic conditions, stroke, Parkinson's disease, multiple sclerosis, AND
Depression, Alzheimer's disease and senility and Vision or hearing loss
Personal Risk Factors :
• Age: The risk for a fall increases with age. Normal aging affects our eyesight, balance, strength, ability to
quickly react to our environments.
• Activity: Lack of exercise leads to decreased balance, coordination, bone and muscle strength.
• Habits: Excessive alcohol intake and smoking decrease bone strength. Alcohol use can also cause
unsteadiness and slow reaction times.
• Diet: A poor diet and not getting enough water will deplete strength and energy, and can make it hard to
move and do everyday activities.
Risk Factors at Home (e.g. Slippery floors)
poojamahaseth1993@gmail.com
7. PREVENTION
Falls in older persons occur commonly and are a major factor threatening the independence of older
individuals. Falls often go without clinical attention for a variety of reasons:
1. The patient never mentions the event to a health care provider
2. There is no injury at the time of the fall
3. The provider fails to ask the patient about a history of falls; or either provider or patient erroneously
believes that falls are an inevitable part of the aging process
Control Environmental Hazards: At least one-third of all falls in the elderly involve environmental
hazards in the home. The most common hazard for falls is tripping over objects on the floor.
Other factors include poor lighting, loose rugs, lack of grab bars or poorly located/mounted grab bars,
furniture.
It is useful to conduct a walk-through of the home to identify possible problems that may lead to falling. A
home visit by occupational therapist might also be useful to identify risk factors and recommend
appropriate actions
poojamahaseth1993@gmail.com
8. Exercise: Multiple meta-analyses of randomized trials conducted in various populations find that
general exercise reduces the risk of falls, and that exercise programs that include balance components
are most effective. Exercise interventions can be grouped into six categories:
1. Gait and balance training
2. strength training
3. Flexibility
4. Movement
5. General physical activity
6. Endurance
Exercise classes incorporating multiple categories of exercise reduced the risk of falling . Home-based
exercises that included more than one type of exercise also decreased the fall rate and fall risk.
In one trial, a program that integrated balance and strength training into everyday home activities
resulted in a 31 percent decrease in the rate of falls (RaR 0.69, 95% CI 0.480.99) and was more
effective than a structured exercise program done three times a week.
poojamahaseth1993@gmail.com
9. EXERCISE PROGRAM
A warm-up exercise for 5minutes before the activity are included like short walks with normal speed
and games with medicine balls, using hands and feet.
First with eyes open and then with closed, Participants were asked to walk forwards, backwards, and
sideways at different speeds and for various distances. Also different types of ground surfaces were
included like mattresses and foam rubber, apart from the regular floor. With that participants were also
faced challenges from obstacles such as ropes, cones and sticks.
Again with eyes open and then eyes closed, the participants were asked to remain standing on unipedal
or bipedal support, according to individual ability. As part of the multisensory training, they performed
exercises under the following conditions: (1) Eyes open - firm surface & soft surface (2) Eyes
closed- firm surface & soft surface
The exercises included: performing double-legged stance for 10 seconds, performing tandem stance
for 10 seconds and rising from a chair without the use of arms; walking forwards and backwards with a
tandem walking pattern and performing single legged stance for 10 seconds.
poojamahaseth1993@gmail.com
10. First patients were asked to do warm up for 5minutes like short walking and playing games by throwing
and catching medicine ball.
Than two surfaces was taken firm and soft surface for exercises protocol with obstacles kept during task
like ropes, cones and sticks.
In firm surface: patients was asked for walking forward and backward, then tandem walking, lastly pivot
turning first with eyes open by crossing all obstacles then eyes closed.
In soft surface: same was done as done in firm surface
Lastly patients were asked to take rest and do deep breathing exercises for 15 to 20 times.
poojamahaseth1993@gmail.com
First week:
11. Second week:
Warm up same as first week
Exercise on firm and soft surface was same only distance and speed were increased.
Games were given at last like sitting in Swiss ball passing medicine ball to each other’s by trying to maintain their
balance.
Lastly patients were asked to take rest and do deep breathing exercises 15-20 times.
Third and fourth week:
All previous exercise were repeated.
After that patients were asked first for double-legged stance for 15 sec and then single legged stand for 10 sec
first with eyes open and then eyes closed and these were done first in firm surface and then in soft surface.
Again then patients was asked to walk in foam pad which is kept in straight line with help of therapist.
Games was given lastly with addition to previous week like sitting on Swiss ball and pushing each other’s by trying
to maintain balance. Then patients was asked to stand and try to hold medicine ball doing half squatting with
therapist support.
Lastly patients were asked to cool down and take deep breath 15-20times.
poojamahaseth1993@gmail.com
12. Fifth and sixth week:
Warm up was done as previous.
All previous exercises were repeated at different speeds and for various distances with additional.
While patients was walking in foam pad in straight line therapist was only supervised and obstacles such as
cones were kept in way, which patients should trying crossing it maintain their balance and during playing
games also new challenges were given with previous one.
Lastly patients were asked to take rest and do deep breathing exercises for 15-20 times.
poojamahaseth1993@gmail.com
13.
14. OUTCOME MEASURES: BERG BALANCE SCALE
TIMED UPAND GO TEST
BERG BALANCE TESTS AND RATING SCALE
Patient Name ___________________Date____________ Location _____________
ITEM DESCRIPTION SCORE (0-4)
Sitting to standing _____
Standing unsupported _____
Sitting unsupported _____
Standing to sitting _____
Transfers _____
Standing with eyes closed _____
poojamahaseth1993@gmail.com
15. Standing with feet together _____
Reaching forward with outstretched arm _____
Retrieving object from floor _____
Turning to look behind _____
Turning 360 degrees _____
Placing alternate foot on stool _____
Standing with one foot in front _____
Standing on one foot _____
TOTAL _____
poojamahaseth1993@gmail.com
16. Equipment: arm chair, tape measure, tape, stop watch.
Begin the test with the subject sitting correctly (hips all of the way to the back of the seat) in a chair with arm rests. The
chair should be stable and positioned such that it will not move when the subject moves from sit to stand. The subject is
allowed to use the arm rests during the sit – stand and stand – sit movements.
Place a piece of tape or other marker on the floor 3 meters away from the chair so that it is easily seen by the subject.
Instructions: “On the word GO you will stand up, walk to the line on the floor, turn around and walk back to the chair
and sit down. Walk at your regular pace. Start timing on the word “GO” and stop timing when the subject is seated again
correctly in the chair with their back resting on the back of the chair.
The subject wears their regular footwear, may use any gait aid that they normally use during ambulation, but may not be
assisted by another person. There is no time limit. They may stop and rest (but not sit down) if they need to.
Normal healthy elderly usually complete the task in ten seconds or less. Very frail or weak elderly with poor mobility
may take 2 minutes or more. The subject should be given a practice trial that is not timed before testing. Results
correlate with gait speed, balance, functional level, the ability to go out, and can follow change over time.
poojamahaseth1993@gmail.com
Timed Up and Go (TUG) Test
17. DISCUSSION
According to a study done by Nizar Abdul Majeedkutty, Nishad Abdul Latheefmajida (2013): “effect of
multisensory training on balance and gait in persons with type 2 diabetes” concluded that the multisensory training
can improve the balance of diabetic peripheral neuropathy patients. However, there was no statistically significant
difference in gait speed for those in the experimental group who were given multisensory exercise training.
Further, multisensory exercise is low-cost and can be practiced both indoors and outdoors. The results obtained by
statistical analysis using independent ‘t-test’ to compare the descriptive characteristics (age, height, weight) and no
statistically significant difference was found. The significance level was set at 0.05. The results of unpaired t-test’
with mean showed the homogeneity of two groups. There was no statistically significant difference in the TUG
scores of the control group. The scores obtained from the ‘six- minute walk’ test were analyzed using paired and
unpaired tests wherever necessary. The comparisons of pre- and post-values of 6MWT in the multisensory exercise
group were found to be statistically not significant.
poojamahaseth1993@gmail.com
18. REFERENCES:
1. NICE guideline of falls in elderly, assessment and prevention. July 2013
2. Alfieri FM, Riberto M, Gatz LS, Ribeiro CP, Lopes JA, Santarém JM, Battistella LR. Functional mobility and
balance in community-dwelling elderly submitted to multisensory versus strength exercises. Clinical interventions in
aging. 2010;5:181
3. Rosenberg L. The effects of multisensory, explicit, and systematic instructional practices on elementary school
students with learning impairments in encoding and oral reading.
4. Allet L, Armand S, De Bie RA, Golay A, Monnin D, Aminian K, Staal JB, de Bruin ED. The gait and balance of
patients with diabetes can be improved: a randomised controlled trial. Diabetologia. 2010 Mar 1;53(3):458-66.
5. Chartered society of Physiotherapy Falls prevention exercises - Older People's Day Available
at: https://www.youtube.com/watch?v=n8s-8KtfgFM&t=36s (last accessed 27.11.2019)
6. Hamed A, Bohm S, Mersmann F, Arampatzis A. Follow-up efficacy of physical exercise interventions on fall
incidence and fall risk in healthy older adults: a systematic review and meta-analysis. Sports medicine-open. 2018
Dec;4(1):56.Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292834/ (last accessed 11.1.2020)
poojamahaseth1993@gmail.com