comprises of various articles

1. PHYSIOTHERAPY
MANAGEMENT OF AIDS
SAYALI GUJJEWAR
MPT II

2. QUESTIONS
 Not asked yet.

3. GOALS
 Pain relief
 Increase muscle strength
 Increase endurance
 Improve cardiovascular function
 Improve pulmonary function
 Prevention of respiratory infections
 Enhance immune function (by increasing T helper/ inducer CD4 cells and activating CD8 cells)
 Reduce anxiety and improve mood

4. INTERVENTION
 Progressive resistance exercise
 Aerobic exercise
 Stretching
 Soft Tissue and Joint Mobilization
 Gait and Balance Training
 Functional Electrical Stimulation/Neuromuscular Electrical Stimulation
 Proprioceptive Neuromuscular Facilitation
 Desensitisation Techniques

5. COMBINATION OF MANUAL THERAPY
AND AEROBIC AND RESISTIVE EXERCISE
 After initial evaluation, the patient has to participate in a 12-week physiotherapy intervention consisting of
manual therapy and aerobic and resistive exercise components.
 The patient exercises three times weekly for 30 minutes on nonconsecutive days.
 Two training sessions per week are supervised in the clinic by a physiotherapist, while the third session is home-
based and confirmed by telephone on that day.
 The patient is allowed to progress at his/her own pace.
 Physiotherapist performs soft tissue mobilization/ massage to the patient’s upper and lower back to address
the pain. Specific muscles targeted are the mid trapezius, erector spinae, and latissimus dorsi, because they were
tender to palpation on evaluation and appeared to be the source of the patient’s muscle pain.
 Massage was performed for the initial 2 weeks of the intervention.

6.  Aerobic exercise is performed at 50%–60% of the patient’s heart rate reserve and the aerobic component of the
intervention comprises of 30–40 minutes of walking on the treadmill at the patient’s own pace.
 The patient’s heart rate is monitored during exercise sessions to ensure that the patient is exercising at the desired
intensity.
 Oxygen saturation is measured at regular intervals using a hand-held pulse oximeter.
 For the strength training component of the intervention, five “multigym” training stations in the clinic is used to
target large muscle groups: biceps curls (biceps), pull-downs (latissimus dorsi), chest press (pectorals), leg
extension (quadriceps), and leg curls (hamstrings and gluteus maximus).
 The amount of weight can be adjusted in increments of 0.25 kg for each station.
 Resistance is increased throughout the program.
 Throughout the 12 weeks, the patient gradually progressed at own pace.
 With each increase in weight, the number of sets is reduced.
 The patient is allowed to perform repetitions as the patient’s energy allowed for the different work stations.

7.  Both aerobic and resistive exercises are performed after adequate warm-up and are followed by cool-down.
 For the aerobic component, warm-up and cool-down involved progressive walking on the treadmill for 3–5
minutes below the target heart rate.
 For the resistive component, warm-up and cool-down involves performing all joint movements without
weights for 10 repetitions.
 At each session, the patient is asked to report pain level and to report if the patient experienced any adverse
effects after the previous session.
 At the halfway point (6 weeks of intervention), the patient will undergo repeat laboratory tests to ensure that
there are no adverse changes.

8. COMBINATION OF AEROBIC EXERCISES
AND RESISTED EXERCISES
Aerobic exercise intervention
 Exercise intervention subjects completed 30 minutes of aerobic exercise treadmill training in the intensity
range of 50-70% of their age-predicted maximum HR (220-age in years) twice weekly, for six weeks.
 Heart rate was monitored.
 Each treadmill session consisted of a 5-minute warm-up period, followed by 30 minutes of training within
the intensity range and then a 35 minute cool-down.
 Treadmill speed and grade were adjusted during each session to keep subjects within their prescribed intensity
range.

9. Resistance exercise intervention
 Following the aerobic training session, EX subjects completed upper-body and lower-body resistance training
approximately 20 minutes.
 Movements targeting the chest, upper back and triceps muscles were performed on plate-loaded Hammer
Strength machines, the upper anterior and posterior legs on Life Circuit machines and the biceps brachii and
deltoids using free weights.
 Subjects were given approximately one minute recovery time between exercises.
 Resistance was adjusted so that each subject could complete one set of 12 repetitions for each exercise while
maintaining proper form.
 As strength increased, resistance was changed to keep the subjects at their prescribed training intensity.
 Sessions were separated by at least 48 hours of recovery and lasted one hour in total duration.

11. COMBINATION OF JOINT MOBILIZATION, SOFT
TISSUE MOBILIZATION, MICROCURRENT,
STRETCHING AND HOME PROGRAMME
Joint mobilization
 To promote normal gait and decrease pain related to stiffness, joint mobilization or passive accessory movement,
as defined by Maitland, was used.
 Specific techniques were grade III and grade IV postero-anterior and antero-posterior movements of tarsal on
tarsal, tarsal on metatarsal, metatarsal on metatarsal, metatarsal on proximal phalanx and phalanx on phalanx.
 Longitudinal distraction of the proximal phalanx on metatarsal was also used.
Soft tissue mobilization
 Soft tissue mobilization was used to decrease sensitivity, improve soft tissue pliability and promote circulation.
 Both petrissage and effleurage were applied to the limit of patient tolerance, working from distal to proximal.
 Firm touch was best tolerated.

12. Stretching
 The toe extensor musculature was tight and the subject lacked heel strike during ambulation.
 Because of these findings, two muscle groups, the toe extensors and the triceps surae, were passively
 The toe extensor musculature was stretched beginning with the ankle in neutral and progressing to plantar
flexion.
 The triceps surae musculature was stretched with the knee in extension and the ankle in maximum dorsiflexion.
 The elongated positions were held for 30 s.
 Following a brief rest, the stretch was repeated.
 Passive range of motion with overpressure was used to regain mobility in the joints of the feet.

13. Microcurrent
 Electrodes were placed over the acupuncture points for chronic pain in the lower extremity.
 These points are: anterior and inferior to the fibular head; at the centre of the popliteal crease; anterior and
inferior to the medial malleolus; and posterior to the lateral malleolus.
 The microcurrent unit was set at a frequency of 0.5 Hz and intensity was sub-threshold for sensation.
 At each treatment session, microcurrent was applied for 15 min to each lower extremity concurrent with the
and soft tissue mobilization.

14. Home programme
 To be performed once daily.
 This included stretching of the toe extensor and triceps surae musculature for two bouts of 30 s for each
group.
 The toe extensors were stretched with the foot in plantar flexion, moving the toes into flexion.
 The triceps surae musculature was stretched in standing, legs astride, with the knee of the posterior leg
extended; the patient leaned forward, keeping the heel on the floor.
 Desensitization techniques for the feet using a terry towel after a warm shower or bath were also to be
performed daily.

15. BALANCE AND GAIT TRAINING
 Conduct Training Exercises for 3 -60 min Over a 6-week Period

16. PROPRIOCEPTIVE NEUROMUSCULAR
FACILITATION
 4 months
 daily 40–50
minutes
 rest 2
minutes
between the
movements
 stretching
before and
after the
activities

17. DESENSITISATION TECHNIQUES
 It involves application of "unpleasant" stimuli.
 The items used for desensitization consist of different textures/fabrics, light or deep pressure, vibration,
tapping, heat or cold.
 Progress from a very soft material stimulus (i.e. silk) to a rougher material (i.e. wool) or textured fabric (i.e.
Velcro).

18. PRECAUTIONS
 Use protective barriers (gloves, glasses, gowns) when handling blood, body fluids, and infectious fluids.
 Wash hands
 Prevent needle/scalpel sticks
 Use ventilation devices for resuscitation
 Don't treat a patient with HIV/AIDS if you have open wounds or skin lesions until lesions have healed.

19. REFERENCES
 Gale J. Physiotherapy intervention in two people with HIV or AIDS-related peripheral neuropathy. Physiotherapy
Research International, 8(4) 200–209, 2003 © Whurr Publishers Ltd.
 Orsini M et al. Rehabilitation in Inclusion Body Myositis associated with human immunodeficiency virus (HIV)
infection. Rev Neurocienc 2009; (17)4 376-380.
 Gregory A et al. (2008) Moderate intensity exercise training reverses functional aerobic impairment in HIV-
infected individuals, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 20:9, 1066-1074.
 Pullen et al. Physiotherapy intervention as a complementary treatment for people living with HIV/AIDS. HIV/AIDS
– Research and Palliative Care 2014:6.
 Veeravelli, S. et al. Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some
Aspects of Frailty. J. Vis. Exp. (116), e54275, doi:10.3791/54275 (2016).