NEURO PHYSIOTHERAPY ASSESSMENT
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NEURO PHYSIOTHERAPY ASSESSMENT
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Recommended
Roods approach
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
Physiotherapy management of Multiple sclerosis
This document provides an overview of the physical therapy management of multiple sclerosis. It discusses assessing patients through examinations of vital signs, cognition, sensation, motor function, posture, balance, gait, locomotion, aerobic capacity, and functional independence. Short term goals include minimizing progression, preventing complications, and maintaining respiratory and functional abilities while long term goals focus on decreasing spasticity and improving strength, range of motion, balance, and activities of daily living. Management techniques for weaknesses, spasticity, ataxia, fatigue, locomotion, and swallowing are outlined, including exercises, stretches, electrical stimulation, and energy conservation methods.
Berg balance scale. By Philans Cosmos Ankrah
The document discusses the Berg Balance Scale (BBS), which is a 14-item clinical test used to assess static and dynamic balance abilities. It involves tasks of increasing difficulty ranging from sitting to standing to walking. Scores are interpreted on a scale of 0 to 4 for each item, with a maximum total of 56 indicating low fall risk. The BBS has been validated as a reliable tool for measuring balance impairment, especially in elderly patients and those with conditions like stroke. However, it may lack sensitivity for early-stage stroke patients and not adequately challenge very high-functioning individuals.
Bobath approaches
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Mckenzie approach, Mechanical Diagnosis Therapy, Directional preference
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brunnstrom Approach
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
Brunnstrom approach
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Assessment of shoulder
This document provides an overview of performing an examination of the shoulder, including assessing functional anatomy, subjective factors, and objective tests. It describes the resting and closed pack positions of the glenohumeral, acromioclavicular, and sternoclavicular joints. Subjective factors covered include symptoms, aggravating/relieving factors, and past history. The objective examination involves observation, palpation, range of motion testing, strength testing, and multiple special tests to assess various structures like the labrum, biceps, rotator cuff, nerves. The goal is a thorough subjective and physical assessment of the shoulder.
Recommended
Roods approach
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
Physiotherapy management of Multiple sclerosis
This document provides an overview of the physical therapy management of multiple sclerosis. It discusses assessing patients through examinations of vital signs, cognition, sensation, motor function, posture, balance, gait, locomotion, aerobic capacity, and functional independence. Short term goals include minimizing progression, preventing complications, and maintaining respiratory and functional abilities while long term goals focus on decreasing spasticity and improving strength, range of motion, balance, and activities of daily living. Management techniques for weaknesses, spasticity, ataxia, fatigue, locomotion, and swallowing are outlined, including exercises, stretches, electrical stimulation, and energy conservation methods.
Berg balance scale. By Philans Cosmos Ankrah
The document discusses the Berg Balance Scale (BBS), which is a 14-item clinical test used to assess static and dynamic balance abilities. It involves tasks of increasing difficulty ranging from sitting to standing to walking. Scores are interpreted on a scale of 0 to 4 for each item, with a maximum total of 56 indicating low fall risk. The BBS has been validated as a reliable tool for measuring balance impairment, especially in elderly patients and those with conditions like stroke. However, it may lack sensitivity for early-stage stroke patients and not adequately challenge very high-functioning individuals.
Bobath approaches
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Mckenzie approach, Mechanical Diagnosis Therapy, Directional preference
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brunnstrom Approach
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
Brunnstrom approach
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Assessment of shoulder
This document provides an overview of performing an examination of the shoulder, including assessing functional anatomy, subjective factors, and objective tests. It describes the resting and closed pack positions of the glenohumeral, acromioclavicular, and sternoclavicular joints. Subjective factors covered include symptoms, aggravating/relieving factors, and past history. The objective examination involves observation, palpation, range of motion testing, strength testing, and multiple special tests to assess various structures like the labrum, biceps, rotator cuff, nerves. The goal is a thorough subjective and physical assessment of the shoulder.
Tone
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Work conditioning and Work hardening
A highly structured, goal-oriented, individualized intervention program designed to return the employee to work. Our Work Hardening programs are multidisciplinary in nature and utilize real or simulated work activities designed to restore physical, behavioral and vocational functions.
Neuro developmental therapy
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Modified ashworth scale application
The Modified Ashworth Scale is a clinical measure of muscle spasticity in patients with neurological conditions. It is a 6-point scale ranging from 0-4 where lower scores represent normal muscle tone and higher scores represent increased spasticity or resistance to passive movement. The document provides detailed instructions on administering the Modified Ashworth Scale for assessing spasticity in the ankle plantar flexors, knee flexors, elbow flexors, and wrist flexors by standardizing limb positioning, stabilization, and movement during testing.
Hemiplegic Gait Rehabilitation
key words : Stroke, Hemiplegic Gait, Circumductory gait, Post stroke gait rehab, post stroke recovery, benefits of gait training, rehabilitation, Gait Rehabilitation, Parallel bars, balance board, core strength, balance, functional training, treadmill training, body weight support treadmill training, strength training, Hi tech gait rehabilitation, functional electrical stimulation, virtual reality gait training, orthosis, AFO, Assistive devices, exercises, heel raises, toe raises, Physiotherapy, physical therapy, recent advances in gait training, learning, education, functional independence, functional training, task specific training, physiotherapist, physical therapist, neuromuscular gait deviation, pathological gait, gait deviation, central nervous system, exercise, ambulation.
Hemiplegic Gait Rehabilitation is a vast area of therapeutic intervention in post stroke patients. various components of hemiplegic gait rehabilitation is discussed in this slide.
constraint induced movement therapy.pptx
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
Motor relearning programme
Motor relearning programmeDr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Motor relearning program
The document describes the Motor Re-Learning Program (MRP), an approach to improving motor control after stroke. The MRP focuses on relearning daily activities through task-oriented practice and is based on theories of distributed motor control. The summary is:
1. The MRP involves analyzing tasks, practicing missing components, practicing whole tasks, and transferring learning to other contexts.
2. Intervention follows four steps - analyzing the task, practicing missing components, practicing the whole task, and transferring learning.
3. The program evaluates and improves functions like upper limb use, sitting, and walking through identifying normal movement and compensatory strategies.
Physiotherapy in Myasthenia Gravis.pdf
Myasthenia Gravis is an autoimmune disorder affecting the neuromuscular junction. Physiotherapy can help patient not only in teaching the patients learn muscle energy conservation technique but also improve the overall functional status of the patient.
Myasthenia gravis rehabilitation
Myasthenia Gravis is a neuromuscular disease causing fluctuating muscle weakness and fatigue due to a breakdown in communication between nerves and muscles. There is no cure, but treatment can relieve symptoms. Signs include weakness of specific muscles like eyes and throat, as well as limbs, worsened by exertion and stress. Physical therapy focuses on aerobic exercise, strength training, swimming, posture, and breathing to build functional capacity and decrease fatigue while avoiding overexertion that worsens symptoms. The goal is improved mobility, balance, and ability to perform daily activities.
PT MANAGEMENT OF GBS
This document discusses Guillain-Barré syndrome (GBS), including its definition, clinical features, assessment scales, and phases. It defines GBS as an acute/subacute symmetrical motor neuropathy involving more than one peripheral nerve. The phases of GBS are described as the acute, plateau, and recovery phases. For each phase, goals of physical therapy and examples of interventions are provided, such as chest physiotherapy, positioning, stretching, and strengthening exercises to address weaknesses and functional limitations during the different stages of GBS.
Hemiplegic Gait
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.
Roods approach
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Neural tissue mobilization
Neural tissue mobilizationDr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar
A 3 part system –
- Mechanical interface – a/k/s – nerve bed – consist of bone, tendon, muscle, Ivdisc, ligaments, fascia, blood vessels.
- Neural structures – brain, nerve roots, C.N, peripheral nerves, spinal cord
- Innervated tissues – all tissues which are innervated by nervous system.
Bobath therapy.ppt
The Bobath concept is an approach to treating mobility difficulties caused by neurological conditions like cerebral palsy and strokes. It was developed over 50 years ago by Bertha and Karel Bobath based on clinical experience and the neuroscience of the time. The Bobath approach uses specialized handling techniques to reduce abnormal tone and facilitate normal movements. Through positioning and handling, stiffness can be reduced and muscle control and movement improved. The overall aim is to enable better functioning in daily life.
Physiotherapy management of Head Injury
This document discusses head injuries and their classification, as well as scales used to measure head injuries. It describes physical therapy management for mild, moderate, and severe head injuries. For severe injuries, PT focuses on preventing secondary complications like contractures and bed sores through positioning, splinting, and early mobility. For moderate injuries, interventions include motor relearning programs and task-oriented approaches. PT for mild injuries includes vestibular rehabilitation and balance training.
Late Responses (F-wave and H.Reflex)
This document provides information about late responses in nerve conduction studies, including F-waves, H-reflexes, and axon reflexes. It discusses the mechanisms, characteristics, and clinical applications of each response. The F-wave results from antidromic stimulation of motor neurons and evaluates more proximal nerve segments. The H-reflex is a monosynaptic stretch reflex that is reliably measured in the lower limbs. Axon reflexes occur due to terminal nerve branching and suggest reinnervation. Late responses provide valuable information about radiculopathies and plexopathies that cannot be observed with distal nerve studies alone.
Ataxia Management
1. The document outlines the general management of ataxia through relaxation techniques, strengthening exercises, and fatigue reduction measures.
2. The goals of general physical therapy for ataxia are to prevent complications, treat symptoms like hypotonicity and dysmetria, improve muscle strength and range of motion, and provide education to patients.
3. Specific techniques discussed include relaxation, strength and cardiovascular conditioning, pain management, functional training, and flexibility exercises. Patient education is also emphasized.
Voluntary Control and Assessment Physiotherapy Perspective.pptx
This document discusses voluntary control of movements and assessment methods. Voluntary control is the ability to produce and control movements volitionally and adapt to tasks and the environment. Normal synergy involves linked muscles acting cooperatively, while abnormal synergy is stereotypical and non-adaptable. Assessment can be qualitative using grading scales or quantitative using tools like the Fugl-Meyer Assessment which evaluates motor function, sensation, balance, and range of motion. The Trunk Impairment Scale assesses trunk control in sitting and coordination. Good assessment informs effective treatment.
CYRIAX TECHNIQUES.pptx
Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.
Chapter wise All Notes of First year Basic Civil Engineering.pptx
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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What's hot
Tone
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Work conditioning and Work hardening
A highly structured, goal-oriented, individualized intervention program designed to return the employee to work. Our Work Hardening programs are multidisciplinary in nature and utilize real or simulated work activities designed to restore physical, behavioral and vocational functions.
Neuro developmental therapy
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Modified ashworth scale application
The Modified Ashworth Scale is a clinical measure of muscle spasticity in patients with neurological conditions. It is a 6-point scale ranging from 0-4 where lower scores represent normal muscle tone and higher scores represent increased spasticity or resistance to passive movement. The document provides detailed instructions on administering the Modified Ashworth Scale for assessing spasticity in the ankle plantar flexors, knee flexors, elbow flexors, and wrist flexors by standardizing limb positioning, stabilization, and movement during testing.
Hemiplegic Gait Rehabilitation
key words : Stroke, Hemiplegic Gait, Circumductory gait, Post stroke gait rehab, post stroke recovery, benefits of gait training, rehabilitation, Gait Rehabilitation, Parallel bars, balance board, core strength, balance, functional training, treadmill training, body weight support treadmill training, strength training, Hi tech gait rehabilitation, functional electrical stimulation, virtual reality gait training, orthosis, AFO, Assistive devices, exercises, heel raises, toe raises, Physiotherapy, physical therapy, recent advances in gait training, learning, education, functional independence, functional training, task specific training, physiotherapist, physical therapist, neuromuscular gait deviation, pathological gait, gait deviation, central nervous system, exercise, ambulation.
Hemiplegic Gait Rehabilitation is a vast area of therapeutic intervention in post stroke patients. various components of hemiplegic gait rehabilitation is discussed in this slide.
constraint induced movement therapy.pptx
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
Motor relearning programme
Motor relearning programmeDr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Motor relearning program
The document describes the Motor Re-Learning Program (MRP), an approach to improving motor control after stroke. The MRP focuses on relearning daily activities through task-oriented practice and is based on theories of distributed motor control. The summary is:
1. The MRP involves analyzing tasks, practicing missing components, practicing whole tasks, and transferring learning to other contexts.
2. Intervention follows four steps - analyzing the task, practicing missing components, practicing the whole task, and transferring learning.
3. The program evaluates and improves functions like upper limb use, sitting, and walking through identifying normal movement and compensatory strategies.
Physiotherapy in Myasthenia Gravis.pdf
Myasthenia Gravis is an autoimmune disorder affecting the neuromuscular junction. Physiotherapy can help patient not only in teaching the patients learn muscle energy conservation technique but also improve the overall functional status of the patient.
Myasthenia gravis rehabilitation
Myasthenia Gravis is a neuromuscular disease causing fluctuating muscle weakness and fatigue due to a breakdown in communication between nerves and muscles. There is no cure, but treatment can relieve symptoms. Signs include weakness of specific muscles like eyes and throat, as well as limbs, worsened by exertion and stress. Physical therapy focuses on aerobic exercise, strength training, swimming, posture, and breathing to build functional capacity and decrease fatigue while avoiding overexertion that worsens symptoms. The goal is improved mobility, balance, and ability to perform daily activities.
PT MANAGEMENT OF GBS
This document discusses Guillain-Barré syndrome (GBS), including its definition, clinical features, assessment scales, and phases. It defines GBS as an acute/subacute symmetrical motor neuropathy involving more than one peripheral nerve. The phases of GBS are described as the acute, plateau, and recovery phases. For each phase, goals of physical therapy and examples of interventions are provided, such as chest physiotherapy, positioning, stretching, and strengthening exercises to address weaknesses and functional limitations during the different stages of GBS.
Hemiplegic Gait
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.
Roods approach
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Neural tissue mobilization
Neural tissue mobilizationDr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar
A 3 part system –
- Mechanical interface – a/k/s – nerve bed – consist of bone, tendon, muscle, Ivdisc, ligaments, fascia, blood vessels.
- Neural structures – brain, nerve roots, C.N, peripheral nerves, spinal cord
- Innervated tissues – all tissues which are innervated by nervous system.
Bobath therapy.ppt
The Bobath concept is an approach to treating mobility difficulties caused by neurological conditions like cerebral palsy and strokes. It was developed over 50 years ago by Bertha and Karel Bobath based on clinical experience and the neuroscience of the time. The Bobath approach uses specialized handling techniques to reduce abnormal tone and facilitate normal movements. Through positioning and handling, stiffness can be reduced and muscle control and movement improved. The overall aim is to enable better functioning in daily life.
Physiotherapy management of Head Injury
This document discusses head injuries and their classification, as well as scales used to measure head injuries. It describes physical therapy management for mild, moderate, and severe head injuries. For severe injuries, PT focuses on preventing secondary complications like contractures and bed sores through positioning, splinting, and early mobility. For moderate injuries, interventions include motor relearning programs and task-oriented approaches. PT for mild injuries includes vestibular rehabilitation and balance training.
Late Responses (F-wave and H.Reflex)
This document provides information about late responses in nerve conduction studies, including F-waves, H-reflexes, and axon reflexes. It discusses the mechanisms, characteristics, and clinical applications of each response. The F-wave results from antidromic stimulation of motor neurons and evaluates more proximal nerve segments. The H-reflex is a monosynaptic stretch reflex that is reliably measured in the lower limbs. Axon reflexes occur due to terminal nerve branching and suggest reinnervation. Late responses provide valuable information about radiculopathies and plexopathies that cannot be observed with distal nerve studies alone.
Ataxia Management
1. The document outlines the general management of ataxia through relaxation techniques, strengthening exercises, and fatigue reduction measures.
2. The goals of general physical therapy for ataxia are to prevent complications, treat symptoms like hypotonicity and dysmetria, improve muscle strength and range of motion, and provide education to patients.
3. Specific techniques discussed include relaxation, strength and cardiovascular conditioning, pain management, functional training, and flexibility exercises. Patient education is also emphasized.
Voluntary Control and Assessment Physiotherapy Perspective.pptx
This document discusses voluntary control of movements and assessment methods. Voluntary control is the ability to produce and control movements volitionally and adapt to tasks and the environment. Normal synergy involves linked muscles acting cooperatively, while abnormal synergy is stereotypical and non-adaptable. Assessment can be qualitative using grading scales or quantitative using tools like the Fugl-Meyer Assessment which evaluates motor function, sensation, balance, and range of motion. The Trunk Impairment Scale assesses trunk control in sitting and coordination. Good assessment informs effective treatment.
CYRIAX TECHNIQUES.pptx
Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.
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Introduction to objective, scope and outcome the subject
Chapter 2
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Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
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