CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
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.
This document discusses sensory integration techniques. It defines sensory integration as the process by which the brain organizes sensory input to produce useful responses. It describes the seven senses and the three main sensory systems - tactile, proprioceptive, and vestibular. For each system, it provides examples of how it works and suggestions for activities to improve sensory integration. Implementing these techniques may help children improve attention, processing, flexibility, balance, motor skills and handwriting.
The Brunnstrom concept is a theoretical model of motor recovery following central nervous system injury developed by physical therapist Signe Brunnstrom. It is based on the hierarchical reflex theory and assumes that lower level reflexes get incorporated into purposeful movements through higher centers. Recovery proceeds from primitive reflexive movement to voluntary isolated movements. Treatment involves facilitating this progression using reflexes, associated reactions, proprioceptive and exteroceptive stimuli, and resistance. Motor and sensory function is evaluated using Brunnstrom's staging which characterizes recovery in a sequential progression.
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.
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.
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
constraint induced movement therapy.pptxibtesaam huma
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
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
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.
This document discusses sensory integration techniques. It defines sensory integration as the process by which the brain organizes sensory input to produce useful responses. It describes the seven senses and the three main sensory systems - tactile, proprioceptive, and vestibular. For each system, it provides examples of how it works and suggestions for activities to improve sensory integration. Implementing these techniques may help children improve attention, processing, flexibility, balance, motor skills and handwriting.
The Brunnstrom concept is a theoretical model of motor recovery following central nervous system injury developed by physical therapist Signe Brunnstrom. It is based on the hierarchical reflex theory and assumes that lower level reflexes get incorporated into purposeful movements through higher centers. Recovery proceeds from primitive reflexive movement to voluntary isolated movements. Treatment involves facilitating this progression using reflexes, associated reactions, proprioceptive and exteroceptive stimuli, and resistance. Motor and sensory function is evaluated using Brunnstrom's staging which characterizes recovery in a sequential progression.
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.
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.
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
constraint induced movement therapy.pptxibtesaam huma
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
Neurodevelopmental Therapy
Neurodevelopmental treatment (NDT) is a hands-on treatment approach used by physical therapists, occupational therapists, and speech-language pathologists
Without NDT interventions, the patient likely will develop a limited set of movement patterns that he or she will apply to nearly all tasks.
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
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.
The Brunnstrom approach is a physical therapy technique developed by Signe Brunnstrom for patients with hemiplegia. It uses reflexes and primitive movements to facilitate voluntary movement by progressing through normal developmental stages. The approach assesses tonic reflexes, associated reactions, sensory function, and classifies motor recovery into 6 stages. Exercises aim to elicit synergies and facilitate movement using proprioceptive and exteroceptive cues.
This document discusses perceptual and cognitive dysfunction. It begins by defining perception as the process of integrating sensory stimuli into meaningful information. Cognition is defined as the act of knowing, including awareness, reasoning, judgment, intuition and memory.
The document then discusses assessment of perceptual and cognitive deficits. It notes that perception is positively correlated with ability to perform activities of daily living and is a prerequisite for learning and rehabilitation. Clinical indicators of perception deficits include functional loss unexplained by motor or sensory deficits and deficient comprehension. Assessment aims to determine intact and affected perceptual abilities and how task performance is affected by deficits.
For management, the document discusses five approaches: transfer of training, sensory integrative, neurodevelopmental, functional, and cognitive
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Sensory integration is a neurological process that allows individuals to make sense of sensations from their body and environment. Sensory integration disorder occurs when this process is not functioning properly, making it difficult for individuals to respond appropriately. Sensory integration therapy aims to stimulate the senses through activities involving movement, touch, sound, and vision to help brains better process sensory information. Research suggests this therapy can help brains of children with sensory integration disorder change and develop through rich sensory experiences.
This document provides an introduction to community-based rehabilitation (CBR). It discusses that CBR is a strategy that aims to rehabilitate, equalize opportunities, and socially integrate people with disabilities within their communities. The document outlines the aims of CBR, including prevention of disabilities, early detection and management, and empowering communities. It discusses aspects of CBR including medical, social, educational, and economic aspects. Finally, it notes some challenges of implementing CBR programs, such as lack of funds, cooperation among team members, and non-participation from communities.
این ارائه توسط دکتر خیاط زاده در کارگاه رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه گردیده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه نمایید.
https://www.farvardin-group.com
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
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
Physiotherapy management of Multiple sclerosisKeerthi Priya
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.
Vojta technique is a treatment method developed by Dr. Vaclav Vojta based on reflex locomotion and developmental kinesiology. It stimulates specific zones of the body to elicit involuntary motor responses and movement patterns. The zones activate rolling, creeping, and other movements to improve musculoskeletal issues and central nervous system disorders. Vojta therapy is used for various conditions like cerebral palsy, stroke, hip dysplasia, and aims to enhance motor skills, posture, respiration and autonomic function through reflex-based exercises in supine, prone, and side-lying positions.
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.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceSusan Jose
Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice.
does it really have that evidance base?
Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.
Sensory integration therapy is used to help children to learn to use all their senses together. That is touch,smell,taste,sight and hearing can improve difficulties/problems in children with special need.
This document defines and describes different types of muscle tone abnormalities. Muscle tone is the resistance offered by muscles to passive stretch. Hypertonia includes spasticity and rigidity, where there is increased resistance to stretch. Spasticity is velocity-dependent and involves exaggerated reflexes. Rigidity is resistance throughout range of motion. Hypotonia involves decreased or absent resistance and flaccidity. Specific types of hypertonia and hypotonia are further described based on their neurological causes and clinical presentations.
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.
Communication disorders with it's implications and it's management
Defined communication processes.
Have any doubt any lacking please drop in comment box
This document provides an overview of speech therapy and communication disorders. It discusses that communication involves the exchange of information verbally and non-verbally. Speech disorders are classified as aphasia, dysarthria, or dysphonia. Aphasia is caused by brain damage and impairs language comprehension and use. Types of aphasia include Broca's, Wernicke's, and conduction aphasia. Dysarthria refers to motor speech defects from trauma or disease that affect articulation, loudness, and other speech aspects. Speech therapy treats conditions like cleft palate, cerebral palsy, autism, and Bell's palsy through techniques like imitation, repetition, listening, and sign
Neurodevelopmental Therapy
Neurodevelopmental treatment (NDT) is a hands-on treatment approach used by physical therapists, occupational therapists, and speech-language pathologists
Without NDT interventions, the patient likely will develop a limited set of movement patterns that he or she will apply to nearly all tasks.
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
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.
The Brunnstrom approach is a physical therapy technique developed by Signe Brunnstrom for patients with hemiplegia. It uses reflexes and primitive movements to facilitate voluntary movement by progressing through normal developmental stages. The approach assesses tonic reflexes, associated reactions, sensory function, and classifies motor recovery into 6 stages. Exercises aim to elicit synergies and facilitate movement using proprioceptive and exteroceptive cues.
This document discusses perceptual and cognitive dysfunction. It begins by defining perception as the process of integrating sensory stimuli into meaningful information. Cognition is defined as the act of knowing, including awareness, reasoning, judgment, intuition and memory.
The document then discusses assessment of perceptual and cognitive deficits. It notes that perception is positively correlated with ability to perform activities of daily living and is a prerequisite for learning and rehabilitation. Clinical indicators of perception deficits include functional loss unexplained by motor or sensory deficits and deficient comprehension. Assessment aims to determine intact and affected perceptual abilities and how task performance is affected by deficits.
For management, the document discusses five approaches: transfer of training, sensory integrative, neurodevelopmental, functional, and cognitive
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Sensory integration is a neurological process that allows individuals to make sense of sensations from their body and environment. Sensory integration disorder occurs when this process is not functioning properly, making it difficult for individuals to respond appropriately. Sensory integration therapy aims to stimulate the senses through activities involving movement, touch, sound, and vision to help brains better process sensory information. Research suggests this therapy can help brains of children with sensory integration disorder change and develop through rich sensory experiences.
This document provides an introduction to community-based rehabilitation (CBR). It discusses that CBR is a strategy that aims to rehabilitate, equalize opportunities, and socially integrate people with disabilities within their communities. The document outlines the aims of CBR, including prevention of disabilities, early detection and management, and empowering communities. It discusses aspects of CBR including medical, social, educational, and economic aspects. Finally, it notes some challenges of implementing CBR programs, such as lack of funds, cooperation among team members, and non-participation from communities.
این ارائه توسط دکتر خیاط زاده در کارگاه رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه گردیده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه نمایید.
https://www.farvardin-group.com
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
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
Physiotherapy management of Multiple sclerosisKeerthi Priya
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.
Vojta technique is a treatment method developed by Dr. Vaclav Vojta based on reflex locomotion and developmental kinesiology. It stimulates specific zones of the body to elicit involuntary motor responses and movement patterns. The zones activate rolling, creeping, and other movements to improve musculoskeletal issues and central nervous system disorders. Vojta therapy is used for various conditions like cerebral palsy, stroke, hip dysplasia, and aims to enhance motor skills, posture, respiration and autonomic function through reflex-based exercises in supine, prone, and side-lying positions.
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.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceSusan Jose
Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice.
does it really have that evidance base?
Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.
Sensory integration therapy is used to help children to learn to use all their senses together. That is touch,smell,taste,sight and hearing can improve difficulties/problems in children with special need.
This document defines and describes different types of muscle tone abnormalities. Muscle tone is the resistance offered by muscles to passive stretch. Hypertonia includes spasticity and rigidity, where there is increased resistance to stretch. Spasticity is velocity-dependent and involves exaggerated reflexes. Rigidity is resistance throughout range of motion. Hypotonia involves decreased or absent resistance and flaccidity. Specific types of hypertonia and hypotonia are further described based on their neurological causes and clinical presentations.
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.
Communication disorders with it's implications and it's management
Defined communication processes.
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This document provides an overview of speech therapy and communication disorders. It discusses that communication involves the exchange of information verbally and non-verbally. Speech disorders are classified as aphasia, dysarthria, or dysphonia. Aphasia is caused by brain damage and impairs language comprehension and use. Types of aphasia include Broca's, Wernicke's, and conduction aphasia. Dysarthria refers to motor speech defects from trauma or disease that affect articulation, loudness, and other speech aspects. Speech therapy treats conditions like cleft palate, cerebral palsy, autism, and Bell's palsy through techniques like imitation, repetition, listening, and sign
- Aphasia is an acquired communication disorder that impairs language processing but not intelligence. It can affect speaking, comprehension, reading and writing.
- The brain has specialized language modules that can be impaired by damage to areas like Broca's area in the frontal lobe, affecting expressive language abilities.
- Treatment strategies include impairment-based therapies to repair language skills, compensatory strategies using alternative communication methods, and participation-based therapies engaging family/social support networks.
Speech defect is a type of communication disorder that disrupts normal speech. Speech therapy is a rehabilitative procedure to help people with communication or swallowing problems. Speech defects are classified based on the sounds a patient can produce, whether sounds need demonstration to be stimulated, and sounds that cannot be produced. Major types include aphasia, dysarthria, dysphonia, cluttering, stammering, and apraxia. Diagnostic evaluations include history, physical exams of the head and neck, and tests like laryngoscopy. Management involves correcting underlying conditions, special education, and speech therapy techniques like remediation, language exercises, and swallowing therapy.
This document provides an introduction and overview of speech therapy. It defines key terms like speech therapist and speech therapy. It describes various communication disorders that speech therapists treat, including stuttering, voice disorders, language disorders, aphasia, articulation disorders, dysarthria, and dysphagia. It outlines the roles and therapeutic techniques of speech therapists for each disorder. The document emphasizes that speech therapy aims to help people with communication difficulties reach their maximum communication potential.
This document summarizes intellectual disability and related neurodevelopmental disorders. It defines intellectual disability as significantly subaverage intellectual functioning and deficits in adaptive functioning that onset before age 18. The document outlines diagnostic criteria from the DSM-5 and ICD-11 and describes features of mild, moderate, severe and profound intellectual disability. It lists causes, elements of clinical evaluation, treatment considerations and prevalence statistics. The document also summarizes common communication disorders like language disorder, speech sound disorder, childhood-onset fluency disorder, social communication disorder and aphasia. Related conditions involving sensory impairments, learning disabilities and speech disorders are briefly outlined.
This topic is meant for the study purpose for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
Cerebral palsy is defined as a non-progressive disorder of movement, tone, and posture due to a defect or lesion in the developing brain. It is commonly associated with developmental disabilities like intellectual disability, epilepsy, visual and hearing impairments, and speech and cognitive issues. Cerebral palsy can be classified based on topography, physiology, and functional ability. Treatment involves a multidisciplinary approach including physiotherapy, occupational therapy, assistive devices, medication management, and sometimes surgery to address issues like spasticity, contractures, and orthopedic problems. Prognosis depends on factors like type and severity of cerebral palsy, presence of other disabilities, and home environment support.
Communication problem & its management.Srinivas Nayak
what is communication ? Types of communication problems and how to identify communication problems and their ways of management and multi disciplinary TEAM approach
This document provides information about cerebral palsy (CP), including:
1) CP is defined as a non-progressive disorder of movement, muscle tone, and posture due to a brain injury before age 5. It is often associated with developmental disabilities like intellectual disability, epilepsy, and sensory or speech problems.
2) CP is classified based on affected body parts (topographic), muscle tone physiology), and functional ability. Assessment involves evaluating health, neurological function, movement, cognition, vision/hearing, feeding, speech, orthopedic issues, and home situation.
3) Management is multidisciplinary, involving medical evaluation, physiotherapy to improve movement and prevent deformities, occupational therapy, play
This document presents a case study of a 68-year-old man with aphasia. He had two strokes, in 2010 and 2015, with the second one causing aphasia and a mild phonatory gap. Assessment results showed Broca's aphasia based on limited speech and fair comprehension. On the WAB, he scored 18.9 for aphasia quotient. Voice assessment found hoarseness and a limited pitch range. Therapy was recommended, including speech and language therapy to improve communication and vocal exercises to address the phonatory gap.
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
Fluency disorder (Stuttering also known as stammering)Emmanuel Raj
Introduction, aetiology, Epidemiology, Clinical features, Theories, Scale, Diagnosis, Assessment, management of stuttering.
Fluency: continuity, smoothness, rate, and effort in speech production.
All speakers are disfluent at times. They may hesitate when speaking, use fillers (“like” or “uh”), or repeat a word or phrase. These are called typical disfluencies or non-fluencies (ASHA - American Speech-Language-Hearing Association).
Types of fluency disorders
Stuttering
Cluttering
Normal Non-fluency
Stuttering (Stammering) the most common fluency disorder, is an interruption in the flow of speaking characterised by specific types of disfluencies, including:
Prolongations unnatural stretching of a sound (e.g., “Ssssssssometimes we stay home”);
Repetitions of sounds, syllables, and monosyllabic words (e.g., “Look at the b-b-baby,” “Let’s go out-out-out”);
Hesitations usage of fillers (“like” or “uh”),
Blocks inability to initiate speech sounds/difficulty getting a word/pausing in between words
CLASSIFICATION OF STUTTERING:
DEVELOPMENTAL STUTTERING:
It is initially noted in children between three and eight years of age
Approx. 75 % of pre-schoolers with developmental stuttering spontaneously recover within 4 years.
Normal non fluency:
As children pass through normal language development they will be disfluent in certain period when compared to others.
ACQUIRED STUTTERING:
Neurogenic stuttering: usually follows a neurologic event, such as traumatic brain injury, stroke, or other brain damage.
stuttering occurs at the beginning of the words and the secondary behaviours are more obvious than with acquired stuttering.
Cause:
Cerebrovascular accident (stroke), with or without aphasia, Head trauma, Ischemic attacks (temporary obstruction of blood flow in the Brain)
Signs and symptoms:
Repetitions, Excessive levels of normal disfluencies , Extraneous movements
Psychogenic stuttering: It is rare and usually occurs in adults with a history of psychiatric problems following a psychological event or emotional trauma; there may be no other known aetiology.
Causes:
Depression, Emotional responses to traumatic events, Anxiety
Signs and symptoms:
Rapid repetitions of initial sounds
Epidemiology:
The prevalence of stuttering over the whole population was 0.72%, with higher prevalence rates in younger children (1.4–1.44) and lowest rates in adolescence (0.53).
Male-to-female ratios ranged from 2.3:1 in younger children to 4:1 in adolescence, with a ratio of 2:1 across all ages according to ASHA
In India it is estimated that approx. 10% of cases with communication disorders may have stuttering according to AIISH.
Aetiology:
A variety of factors may influence stuttering events, although the etiology of the condition is unclear
Possible contributing factors include cognitive processing abilities, genetics, gender of the patient, and environmental influences.
American guideline in speech and language pathologyAnam_ Khan
The document discusses the American Speech-Language-Hearing Association (ASHA) and outlines their role in certifying speech-language pathologists and audiologists. It defines speech-language pathology and outlines the services they provide, including assessment, treatment, and referral for communication disorders. The document also discusses clinical documentation requirements and various types of communication disorders and treatments, such as for articulation disorders, aphasia, dysphagia, and more. It provides details on instrumentation, prosthetics, and other tools used in assessment and treatment.
This document discusses speech disorders, including their causes, symptoms, diagnosis, and treatment. It defines different types of speech disorders such as stuttering, cluttering, dysprosody, and articulation disorders. It also outlines assessments used to diagnose speech disorders and treatments including speech therapy, which involves exercises to strengthen oral muscles and techniques to improve communication. Early treatment is emphasized to prevent conditions from worsening and improve outcomes.
This document discusses various types of disabilities and impairments. It defines key terms like impairment, disability, and handicap. It then describes several specific types of disabilities in detail, including physical/orthopedic, intellectual, hearing/visual impairments, autism, behavioral/emotional disorders, and specific learning disabilities. For each type, it discusses characteristics, classifications, causes and levels of support needed. The document provides a comprehensive overview of different disabilities and the factors that influence them.
Communication is the process of expressing and receiving ideas through language, speech, and other means. Typical speech and language development follows predictable patterns through childhood. Speech disorders involve difficulties producing sounds, while language disorders involve challenges with comprehension, expression, or formulation of ideas. Communication disorders can be caused by brain injury, disease, lack of early stimulation, or other factors. Students with communication disorders are evaluated and teachers adapt instruction to support their needs through techniques like repetition, visual aids, and social skills training. Alternative communication systems can also help those unable to communicate verbally.
The cerebral cortex has several association areas that perform different functions. The left hemisphere is specialized for language and analytical abilities in most right-handed individuals, while the right hemisphere is specialized for visuospatial abilities. Damage to different areas can cause different types of aphasias by disrupting language abilities. The hippocampus and medial temporal lobe are important for forming new memories and consolidating them into long-term memory. Alzheimer's disease involves the accumulation of beta-amyloid plaques and neurofibrillary tangles, leading to memory loss and cognitive decline.
Therapies To Break The Chains Of DisabilitiesBrandon Ridley
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This slide(perception) describes perception, types of perception, the parts of the brain which control it, and disorders and remedies. It also explains memory and its types. The language which is another cognitive skill also presented in this slide.
A case presentation was given by Ashik Dhakal and moderated by Mr. Sydney Roshan Rebello regarding Guillain-Barré syndrome. Guillain-Barré syndrome is an autoimmune disorder where the body's immune system attacks the peripheral nervous system, causing muscle weakness and possible paralysis. The presenter discussed the patient's symptoms and medical history related to this neurological condition.
A case presentation was given by Mr. Ashik Dhakal and moderated by Mr. Sydney Roshan Rebello. Investigations were discussed for the case presented. The presentation concluded with thanks expressed.
Physiotherapy plays an important role in treating pediatric patients with conditions that limit mobility or function. Physiotherapists work to improve mobility, restore function, alleviate pain, and promote overall health and wellness in children. They focus on neurological, musculoskeletal, and cardio-respiratory conditions like cerebral palsy, fractures, asthma, and congenital heart disease. Treatment involves coordination, instruction, and procedural interventions such as neurodevelopmental therapy, strength training, electrical stimulation, and balance/gait training.
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCEAshik Dhakal
This document provides an overview of physical and physiological changes during pregnancy and guidelines for exercise during pregnancy and the postnatal period. It discusses the structural, metabolic, and physiological changes that occur in each trimester of pregnancy, as well as contraindications and benefits of antenatal and postnatal exercises. The document also reviews evidence from studies on the effects of aerobic exercise, pelvic floor exercises, acupuncture, and other physiotherapy modalities in treating pain and other issues during pregnancy and the postnatal period.
Motor Imagery in Neuro rehabilitation Ashik Dhakal
This document provides an overview of motor imagery (MI), also known as mental imagery. It discusses the history, theories, types, neurophysiology, frameworks for practice, and supporting evidence of MI. MI involves mentally simulating a motor action without physical movement. It is used in rehabilitation to improve motor skills after injuries. Studies show MI activates similar brain regions as physical practice and can improve motor performance. The document reviews evidence that MI training can benefit recovery from stroke, spinal cord injury, Parkinson's disease, and other conditions. Outcomes used to measure MI ability include movement and imagery questionnaires.
Hemiplegic shoulder pain is a common complication after stroke that can develop within weeks or months. It is caused by changes in shoulder biomechanics due to loss of muscle stability from neurological damage. There are two main types - a hypotonic shoulder with muscle weakness and potential subluxation, and a hypertonic shoulder with spasticity that causes muscle imbalance and contractures. Clinical examination involves assessing range of motion, muscle strength and tone, and specialized tests. Treatment includes pain management, range of motion exercises to prevent contractures, strengthening of antagonist muscles, positioning aids, and prevention strategies like proper handling and posture.
This document discusses hemiplegic gait following a stroke. It describes common gait deviations seen during different phases of gait including increased knee flexion, equinus foot, circumduction, and decreased weight shifting to the affected side. Physical therapy interventions aim to improve balance, coordination, weight shifting, and muscle strength through techniques like neurophysiological approaches, functional electrical stimulation, robotic devices, motor imagery, and mirror therapy. Outcome measures used to assess improvement include the Functional Ambulation Profile, Dynamic Gait Index, Stroke Impact Scale, and various walking tests.
This document summarizes a dissertation presentation comparing the effectiveness of proprioceptive neuromuscular facilitation (PNF) and mirror exercises in improving facial symmetry and function in patients with Bell's palsy. The study used a randomized clinical trial design to compare the outcomes of PNF and mirror exercises, as measured by three facial assessment scales. Both interventions showed highly significant improvements from pre-to-post treatment within each group. However, there was no significant difference found between the two treatment groups. The conclusion is that PNF and mirror exercises are equally beneficial in the early stages of Bell's palsy.
The document discusses motor control and various theories of motor control. It defines motor control as the ability to regulate movement and discusses five main theories: reflex theory, hierarchical theory, motor programming theory, systems theory, and ecological theory. It also discusses the physiology of motor control in the nervous system and how clinical practice has evolved parallel to developments in scientific theories of motor control. Theories provide frameworks to interpret behavior and guide clinical actions, but no single theory can fully explain motor control.
Physiotherapy can help improve both the physical and mental health of patients with mental illnesses. Regular exercise can reduce symptoms of conditions like depression and anxiety while also improving sleep, stress levels, and physical fitness. Physiotherapy aims to enhance psychological well-being through increased self-esteem and reduced social isolation, as well as improve mobility and manage issues like chronic pain. Exercise is prescribed according to individual patient needs and may include activities like relaxation techniques, endurance training, and hydrotherapy.
Dynamic Neuro-Cognitive Imagery Improves Mental Imagery Ability, Disease Severity, and Motor and Cognitive Functions in People with Parkinson’s Disease
PNF VS MIRROR EXERCISE PILOT STUDY .pptxAshik Dhakal
This pilot study compared the effectiveness of proprioceptive neuromuscular facilitation (PNF) and mirror exercises (ME) in improving facial symmetry and function in patients with Bell's palsy. 10 subjects were randomly assigned to receive either 2 weeks of PNF or ME treatment. Outcome measures assessed pre- and post-treatment found significant improvements in facial grading scales within each group, but no significant differences between the groups. Both PNF and ME techniques showed effectiveness in improving facial symmetry and function for Bell's palsy.
Cardiovascular diseases are conditions that affect the heart and blood vessels. Exercise can positively impact CVD by addressing lifestyle factors. Monitoring exercise intensity involves tracking heart rate, metabolic equivalents, and perceived exertion. Common forms of CVD include myocardial infarction, revascularization procedures like bypass surgery and angioplasty, chronic heart failure, and peripheral artery disease. Supervised exercise programs after cardiovascular events and procedures provide benefits like improved cardiac function and quality of life.
A medical case presentation was given by Ashik Dhakal to moderator Sydney Roshan Rebello. The case presentation discussed a patient's medical history and current condition. In 3 sentences or less, the presenter summarized the key details and issues for the patient.
The Brunnstrom Approach is a neurodevelopmental treatment approach for stroke rehabilitation developed in the 1970s. It involves 6 stages of motor recovery: 1) flaccidity, 2) appearance of spastic synergies, 3) semi-voluntary movement, 4) combining movements, 5) complex voluntary movement, 6) restoration of normal movement. Treatment progresses the patient through these stages using reflexes, associated reactions, proprioceptive stimuli and resistance training. Evaluation assesses motor function, sensory loss, and spasticity through tests of range of motion, grasp, and speed of movement. The goal is to facilitate normal motor control and functional use of the affected limb.
Biofeedback is a technique that uses electronic equipment to provide visual or auditory feedback about internal physiological processes to help patients learn to control normally involuntary bodily functions. By monitoring muscle activity or other physiological signals, patients can see or hear the feedback and learn to modify their mental or emotional responses to improve health conditions. Electromyography is commonly used biofeedback that detects muscle activity through electrodes placed on the skin. It provides visual and auditory feedback that patients can use to increase or decrease muscle activity for conditions like stroke, spinal cord injury, spasticity, and more. Biofeedback has advantages of enhancing other therapies, reducing reliance on therapists, and allowing patients to maintain control without equipment.
1. Neurodevelopmental therapy (NDT) was developed in 1948 by Berta and Karel Bobath to treat patients with central nervous system damage like hemiplegia and stroke.
2. NDT uses a problem-solving approach involving examination of posture, movement, functional skills, and systems to develop individualized treatment plans. The goal is to minimize impairments and prevent secondary disabilities.
3. The NDT examination process evaluates clients holistically, incorporates their family/environment, and identifies both limitations and competencies to inform treatment planning.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
2. Learning objectives
• Introduction to oromotor dysfunction and it’s rehabilitation
• Factors affecting oral motor function
• Brief discussion about speech and swallowing dysfunction
• Clinical conditions leading to OMD
• References
3. Introduction
• Oro-motor dysfunction refers to the disturbance in vital functions (drinking,
chewing, sucking, swallowing, speech) that are dependent upon the co-ordinated
interaction of a set of neural structures.
• It also involves language motor articulation and gestural communication by means
of facial expression.
4. • Oral-motor rehabilitation is use of variety of exercises to develop
awareness, strength, coordination and mobility of the oral muscles. e.g,
improve muscle tone of the face or to reduce tongue thrust.
5. Factors affecting oral motor function
• Presence of medical conditions affecting function
• Presence of seizures
• Cognitive level
• Hypersensitivity
• Positioning
• Gagging, coughing.
• Tongue thrust
• Food texture, temperature
• Time alloted for intake.
7. Speech pathology
• Speech is one of our most important human behaviour which sets us apart from
animals like tool making.
• Disruption in the ability to communicate may impact on a person’s daily life in
important way.
• Disruption can be caused by
1. Structural abnormality (e.g., cleft palate)
2. Neurological conditions (e.g., stroke, Parkinson’s disease)
3. Non organic conditions ( non organic articulatory disorder)
8. • The use of speech for communication involves fine motor coordination of
components of the oral-motor system.
• Gestures, pantomime and other non-verbal pragmatic language behaviours, are also
essential elements of communication.
• The common of speech language pathology involves, aphasia, dysarthria.
9. Epidemiology
• Communication disorders exact a large economy costing US economy an estimated
$30 billion a year.
• National institute on deafness and other communication disorders (NIDCD)
estimated, 14 million population with speech and language disorder.
• In population >65 of age, 10.8% have speech and language disorder, <45 of age ,
9.9%.
• The largest population of communication impaired are children with language
disorder (43.7%), and articulation disorder (32.1%), aphasia 15% of adult speech
language impaired population.
11. • Aphasia is an impairment of language, affecting the production or
comprehension of speech and the ability to read or write.
• Aphasia can be severe or very mild depending on the pathology.
• It is estimated that there are more than 1 million individual with aphasia in the
US alone, and approximately 84,000 new patients with aphasia each year.
• The majority are older than 65 years of age and acquired aphasia as a result of a
stroke.
• Smaller number are the consequences of head trauma and neoplasm.
13. 1. Fluent Aphasia : speech output that is facile in articulation, produced at a
normal rate, with preserved flow and melody is referred to as fluent aphasia.
14. 2. Non- fluent Aphasia : speech output that is characterised as hesitant,
awkward, interrupted, and produced with effort.
15. 3. Global aphasia : a severe aphasia with marked dysfunction across all
language modalities and with severely limited residual use of all
communication modes for oral- aural interaction is referred as global
aphasia.
16.
17. Evaluation of recovery
• If complete recovery from aphasia is to occur, it usually happens within a
matter of hours or days following onset.
• Once aphasia has persisted for several weeks or months a complete return to a
premorbid state is usually the exception.
• Two separate recovery dimensions
1. Objective : attempts to quantify the extent to which the patient has regained
language abilities.
2. Humanistic term : measures the recovery of functional communication
18. Treatment
• The primary assumption in treatment of aphasia is that language in the brain is not
“erased”, but that retrieval of its individual units has been impaired.
• Approaches to aphasia therapy have generally followed one of two models : a sub-
stitute skill model or a direct treatment model.
• Substitute skill model can be found in deaf individuals, some of whom use speech
reading, a visual input rather than an auditory input as an aid to comprehend spoken
language .
• In direct treatment model, specific exercise individually designed to ameliorate
specific linguistic deficits are the basis of treatment.
19. • The performance aspect of language — in which repeated practice and teaching
strategies — are assumed to help restore impaired skills through a task oriented
approach (i.e, naming practice.)
• Self-cueing and repetition exercise that manipulate component of grammar and
vocabulary.
• Stimulating the patient to use residual language by — encouraging conversation
— in a permissive setting where a patient’s responses are unconditionally
accepted and — topics are of personal interest.
20. • Visual communication therapy (VIC) is an experimental techniques designed for
global aphasia.
• VIC employs an index card system of arbitrary symbols representing syntactic and
lexical component that patients learn to manipulate so as to
1. Respond to a command
2. Express needs, wishes, or other emotions.
• Weinrich et al demonstrated application of the VIC system called Computer -
Aided Visual Communication system (C-VIC) can lead to improved spoken
language.
21. • Visual Action Therapy (VAT) is designed to train people with global aphasia to use
symbolic gesture representing visually absent objects.
• The task leading to this goal include associating pictured forms with specific
objects, manipulating real object appropriately, and— finally producing symbolic
gesture that represent the objects used (e.g., cup, hammer, razor).
22.
23. Functional communication treatment (FCT):
• This treatment is designed to — improve information processing — in the
activities necessary to conducting ADL, social interactions, and self
expression of both physical and psychological needs.
24. Promoting Aphasics’ Communicative Effectiveness (PACE)
• PACE is a technique — intended to reshape structured interaction — between
clinicians and patients — into more natural communicative changes, includes several
pragmatic components common to natural conversation.
25.
26. • Other interactive approaches
1. Communication partners approach of Lyon : This is a treatment plan designed to
enhance communication and well-being in setting where the — person with aphasia
and the caregiver live.
2. Supported conversation approach by Kagan : In this volunteers are trained as
conversation partners to facilitate conversation by using available modalities.
3. Social model of aphasia approach introduced by Simmons-Mackie : This focuses on
fulfilment of social needs and the encouragement of a greater conversational burden on
the part of communication partners.
27. Dysarthria
• The term dysarthria refers to an impairment of speech production resulting — from
damage to the central or peripheral nervous system, — which causes weakness,
paralysis, or incoordination of the motor-speech system (respiration, phonation,
articulation, resonance and prosody).
• The type and degree of dysarthria depends on the underlying etiology, — degree of
neuropathology,— coexistence of other disabilities, —and the individual responses
of the patient to the condition.
• When patient are totally unintelligent as the result of severe motor-speech system
impairment, they exhibit anarthria.
28. • Dysarthria is generally reflected in deficits occurring in multiple motor-speech
system, but may sometimes occur in a single system (i.e., an impairment of soft
palate movement resulting in cerebral palsy).
• It is notable prevalent in CP, TBI, cerebrovascular accidents, Parkinson’s disease,
ALS, neoplasm and demyelinating disease (e.g., multiple sclerosis).
29. Types of dysarthria :
• Spastic, flaccid, ataxic, hypo-kinetic, and hyperkinetic.
• When two or more types co-exist, it is called mixed dysarthria.
30. • Spastic dysarthria : affects strength, speed, precision, and coordination of
speech musculature movement
31. Treatment
• Treatment must be individually designed.
• Improve the intelligibility of speech, which can be negatively affected if the speaker
is in a dark, noisy place.
• As a patient’s overall physical coordination and precision of movement increases, —
corresponding improvement in the control of the motor-speech system, — hence in
speech intelligibility.
• To rehabilitate speech, use speech.
32. Dysphagia
• Generally refers to any difficulty in swallowing, including asymptomatic
impairments.
• It is a common problem affecting 1/3 to 1/2 of the stroke population and 1/6 of
elderly individual.
• It is common in head and neck cancer, degenerative disorder of the nervous
system, gastroesophageal reflux disease, and inflammatory muscle disease.
33. Types
• According to the location of the problem
1. Oropharyngeal : arises from abnormalities of muscles, nerves or structures of the oral
cavity, pharynx, and upper oesophageal sphincter.
2. Oesophageal : arises from abnormality of the body of the esophagus, lower
oesophageal sphincter, or cardia of the stomach, usually due to mechanical causes or
motility problem.
• According to
1. Mechanical - due to structural lesion of the foodway
2. Functional - by physiologic abnormality of foodway function
34. Symptoms and signs
1. Oral or pharyngeal Dysphasia
• Coughing or chocking with swallowing
• Difficulty initiating swallowing
• Sensation of food sticking in the throat
• Drooling
35. • Unexplained weight loss
• Change in dietary habits
• Recurrent pneumonia
• Change in voice or speech
• Nasal regurgitation
• Dehydration
36. 2. Esophageal dysphasia
• Sensation of food sticking in the chest or throat
• Oral or pharyngeal regurgitation
• Drooling (inability to swallow saliva)
• Unexplained weight loss
• Change is dietary habits
• Recurrent pneumonia
• Dehydration
37. Physical examination
• An examination of oral cavity and neck - structural abnormalities, weakness or
sensory deficits.
• The findings of Dysphonia or dysarthria is often associated with oropharyngeal
dysphasia.
• Changes in voice quality or spontaneous coughing after swallowing suggest the
presence of pharyngeal dysfunction.
• Neurological examination is necessary, as they commonly cause dysphagia.
38. • The findings of atrophy or fasciculation of the tongue or palate suggest LMN
dysfunction of the brainstem motor nuclei.
• Gag reflex is not strongly predictive of the ability to swallow, it may be absent in
normal individual and normal in severe dysphasia and aspiration.
• History and physical examination are limited in their ability to detect and
characterise dysphagia, so instrumental studies are usually necessary.
39. Swallowing trial
• Should be performed by different consistencies, not only by water.
• Always start with very small amount 1/2 of 1 teaspoon;
1. Smooth pudding consistency
2. Sorbet
3. Thickened liquid
4. Carbonated liquid
40. • Correct positioning of the fingers during the clinical or bed-side
swallowing examination
41. Observation during the swallowing
• Observe : avoidance of certain food and liquids
1. Lip closure - any leakage anterior or posterior
2. Tongue movement
3. Mastication
4. Feeding respiratory pattern
53. 2. Fiberoptic laryngoscopy : if vfss cannot be performed.
3. Esophagoscopy : in case of esophagial dysphasia, biopsy for mucosal
abnormality.
4. Manometry : detect motor disorders of the oesophagus.
• EMG : useful in detecting LMN dysfunction of the larynx and pharynx if
neuromuscular disease is suspected
54. Differential diagnosis
• Myocardial ischemia
• Globus sensation
• Heartburn due to gastroesophageal reflux disease.
• Indirect aspiration (aspiration of refluxed gastric contents).
55. Functional limitation
• Depends on nature and severity of dysphasia,
• Many individuals modify their diet, some may require inordinate amount of time
to consume meal.
• In severe cases tube feeding is necessary.
56. • These alterations in the ability to eat a meal may have profound effect on
psychological and social function.
• Difficulty in eating meal may disrupt relationship and result in social isolation.
• Some patient may require supervision during meals or feel unsafe when eating
alone, causing further disruption of social and vocational function
57. Complications
• Aspiration pneumonia
• Airway obstruction
• Dehydration/ starvation.
• Severe dysphasia : social isolation - depression - suicide (reported in severe
cases)
59. Rehabilitation
• Goal of therapy : reducing aspiration, increasing the ability to eat and drink , and
optimising nutritional status.
• Best therapy for activity is activity itself, swallowing (safe and effective) is the
best therapy for swallowing disorder.
• Diet modification - common treatment, behavioural techniques (modification of
posture, head position, and respiration as well as specific swallow manoeuvres).
60. • Exercise therapy : when problem is related to weakness of the muscles of
swallowing,
• Choice of exercise should be individualised according to the physiologic
assessment,
1. Tongue weakness - protrude and lateralise of the tongue are strengthened using
the manual resistance.
2. Upper oesophageal sphincter opens poorly : strengthening of the anterior supra-
hyoid muscle(supine, flex neck against gravity)
61. 1. Active exercise
• Targeted for : weakness and disrupted muscle tone
• Strength training : increases muscle strength and endurance.
2. Passive exercise
• Targeted : hypertonicity and spasticity
• Massage : relaxes muscle and reduce muscle tension
• Stretching : inhibit stretch reflex — decrease muscle tone — increase ROM
63. Surgery
• Cricopharyngeal myotome (effectiveness is controversial)
• Oesophagotomy : in case of oesophageal cancer or obstructive strictures.
• Percutaneous endoscopic gastoctomy (PEG)( feeding gastrotomy) : indicated
when the severity of dysphasia makes it impossible to obtain adequate
alimentation and/or hydration orally, although intravenous hydration or ng tube
feeding may be sufficient on a time-limited basis.
64. Treatment complication
• VFSS is very safe and well tolerated
• Substituting thick for thin fluids — reduce fluid intake — dehydration —
malnutrition
• Failure to re-evaluate in timely manner — unnecessary prolongation of dietary
restriction — increase risk of malnutrition — adverse psychologic effects of
dysphagia.
• PEG : direct sequel-pain, infection, and obstruction of the feeding tube are
common. May promote aspiration pneumonia in individuals with severe
gastroesophageal reflux disease.
66. 1. Stroke
• Symptoms vary with lesion location and size.
• Subcortical as well as right and left hemispheric strokes : pharyngeal and laryngeal
sensory deficits may occur.
• Subcortical stroke (paralytic dysphagia) : mild oral transit delays and a delay in
triggering the swallow.
67. • Right hemispheric stroke (pseudobulbar dysphagia) : mild oral transit delays and
some delay in pharyngeal trigger and laryngeal elevation.
• The pharyngeal stage lasts longer, and there may be penetration of the larynx and
aspiration, there may also be reduced upper esophageal sphincter opening.
68. 2. Traumatic brain injury
• Type and severity depends on the cause of the injury and location and size of
brain lesions.
• Diffuse brain damage, closed head injury — impaired cognition, information
processing, and attention — communication disorder.
• Behavioural and cognitive problems — affect — self-feeding and swallowing,
and abnormal pathological reflexes — can affect — oral and pharyngeal control.
69. • Increased or reduced muscle tone — may cause decreased mouth opening,
decreased lip closure, drooling, decreased tongue control, and pocketing of the
bolus in the cheek.
• Delayed pharyngeal swallow trigger, nasal regurgitation, decreased base of tongue
movement, and decreased laryngeal elevation with resulting pharyngeal residue
may be seen.
• Overall mealtime may be slow.
70. 3. Alzheimer’s Disease : Pseudo-bulbar Dysphagia
• Decreased attention span and apraxia for swallowing and self-feeding may be seen.
• Oral and pharyngeal responses slow — need for physical and verbal cues to self -
feed are needed.
• Difficulty with self-feeding is common, and challenges with initiating the meal
may be present.
71. • Agitation and behavioural challenges can hamper the eating process.
• Patient prefer sweet-flavored and pureed foods.
• Patients are prone to aspiration in later stages of the disease.
72. 4. Developmental disabilities.
• Cerebral palsy and mental retardation — together or in isolation — may present
deficits of bolus formation and transit — delayed swallow reflex, pharyngeal dys-
motility, esophageal disease, and aspiration.
• Abnormal oral reflexes and oral hyposensitivity or hypersensitivity may be
observed.
73. • Poor postural, head, neck, and limb control can affect swallowing.
• Behaviours such as eating too quickly and putting too much food in the
mouth can affect efficiency and safety of swallowing.
74. 5. Multiple sclerosis
• Dysphagia symptoms vary with location of plaques in the central and peripheral
nervous systems.
• Weakness of the oral structures and the neck muscles may be seen.
• Delayed pharyngeal swallow and weakness of pharyngeal contractions may be
seen.
• Dysphagia worsens with disease progression.
75. 6. Parkinson disease
• Impulsiveness and poor judgment can affect swallowing.
• Jaw rigidity, abnormal head and neck posture, impaired coordination of tongue
movements, mastication and orofacial motions are affected along with tongue
control.
• Alterations in the pharyngeal aspect of the swallow occur including pharyngeal
residue and delayed pharyngeal elevation.
76. • Abnormal head, neck, and trunk posture along with difficulty coordinating
upper extremity movements for self-feeding are seen.
• Feeding and swallowing may be too slow and laborious
to allow sufficient nutritional intake.
• Orofacial fatigue may make eating and swallowing more
difficult as a meal progresses.
77. References
• Manual of physical medicine and rehabilitation, Hanley and Balfus
• Susan B. Sullivan
• Occupational therapy for physical Dysfunction, Trombly Latham
• Dysphasia rehab manual, Masami Akai
• Braddom’s Physical Medicine and Rehabilitation