Physiotherapy management of Head Injury
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This document discusses head injuries and their classification, as well as scales used to measure head injuries. It describes physical therapy management for mild, moderate, and severe head injuries. For severe injuries, PT focuses on preventing secondary complications like contractures and bed sores through positioning, splinting, and early mobility. For moderate injuries, interventions include motor relearning programs and task-oriented approaches. PT for mild injuries includes vestibular rehabilitation and balance training.
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Muscle Weakness
Spasticity
Hyperreflexia
Pathological reflexes
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Muscle Weakness
Muscle Atrophy
Hypotonicity
Hyporeflexia
Fasciculation
Muscle Cramp
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Diagnostic Criteria
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EMG-
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Signs of chronic denervation, such as large motor unit potentials (increased duration, increased proportion of polyphasic potentials, increased amplitude)
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Muscle tone and reflexes
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Physiotherapy goals in MND treatment.
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Prevention for contractures
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Management of Sialorrhea and Pseudobulbar Affect
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Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
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Content
Introduction
History of CIMT
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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 .
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Overall greater improvement in function than traditional treatment.
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There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
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Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
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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.
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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.
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This document discusses neurological gait and gait rehabilitation. It begins by defining normal gait and describing common pathological gaits that can result from neurological conditions, including hemiplegic, spastic diplegic, Parkinsonian, myopathic, and ataxic gaits. Specific characteristics and management approaches are described for each type. Rehabilitation approaches covered include traditional gait training exercises, use of assistive devices, high-tech options like body-weight supported treadmill training and electrical stimulation, as well as strength and balance training. Surgical management is also briefly discussed for some conditions.
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Spasticity is defined as a velocity-dependent increase in muscle tone and exaggerated tendon reflexes caused by hyperexcitability of the stretch reflex. It results from an upper motor neuron lesion and can occur in conditions like spinal cord injury, multiple sclerosis, and cerebral palsy. Spasticity is classified based on severity from mild to severe and causes increasing tightness, spasms, and loss of functional abilities. Treatment involves pharmacological management with drugs like baclofen, physical therapy including stretching and range of motion exercises, and in severe cases surgery such as baclofen pump implantation or tendon lengthening.
Disability evaluation
evaluation of type of disability and percentage of disability of the subjects with upper limb, lower limb and spine seperately.
Tone
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
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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.
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Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
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Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
Types of MND
Clinical Features of MND
Diagnostic Procedure
Management: 1) Pharmaceutical
2) Physiotherapy
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Motor Neuron Disease are a group of neurodegenerative disorders that affects the nerves in the spine and brain to progressively lose its function.
Motor neuron diseases (MND) include a heterogeneous spectrum of inherited and sporadic (no family history) clinical disorders of the upper motor neurons (UMNs), lower motor neurons (LMNs), or a combination of both.
Types of MND
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Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by progressive degeneration of motor neurons in the spinal cord, brain stem, and motor cortex, leading to progressive muscle atrophy and weakness.
Clinical Features
UPPER MOTOR NEURON
Loss of Dexterity
Muscle Weakness
Spasticity
Hyperreflexia
Pathological reflexes
LOWER MOTOR NEURON
Muscle Weakness
Muscle Atrophy
Hypotonicity
Hyporeflexia
Fasciculation
Muscle Cramp
Impairment related to LMN
Other clinical features
Diagnostic Criteria
Diagnostic Procedure
EMG-
It include signs of active denervation, such as fibrillation potentials and positive sharp waves;
Signs of chronic denervation, such as large motor unit potentials (increased duration, increased proportion of polyphasic potentials, increased amplitude)
Unstable motor unit potential
Nerve Conduction Velocity Studies,
Muscle And Nerve Biopsies,
Neuroimaging Studies - MRI
Management- Multidisciplinary Approach
Physical Therapy Examination
Cognition
Pain
Psychosocial Function
Joint integrity, ROM and Muscle strength.
Motor Function: Gross motor and Fine motor
Muscle tone and reflexes
Cranial nerve integrity
Sensations
Gait
Respiratory Function
Physiotherapy goals in MND treatment.
Pain reduction
Prevention for contractures
Maintenance of joint mobility
Regular review of posture
Positioning to relieve discomfort
House Modification and ergonomic advice.
Management of Sialorrhea and Pseudobulbar Affect
Management for Dysphagia
PEG procedure.
A PEG may be recommended as the disease progresses.
A PEG is a type of gastrostomy tube inserted via endoscopic surgery that creates a permanent opening into the stomach for the introduction of food.
Studies have found that PEG insertion may prolong survival. Patients with PEG were found to live 1 to 4 months longer than those individuals who refused it.
Management of Dysphagia
A palatal lift prosthesis may be prescribed for individuals with good articulation but who have a breathy voice quality or decreased loudness because of excessive air loss through the nose.
The device, a dental appliance designed to attach to the existing teeth and to elevate the soft palate, is custom-made by a prosthodontist.
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The document discusses mechanisms of therapeutic exercise progression based on scientific evidence from cellular physiology research. It identifies three components of recovery-centered training: mechanical, neuro-musculoskeletal, and cardiovascular systems. Optimal therapeutic exercise requires applying principles of mechanical loading strategies and tissue-specific progressions based on symptomatic, mechanical, and functional responses to achieve desired cellular and tissue adaptations.
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Parkinson's disease is a progressive neurodegenerative disorder characterized by loss of dopaminergic neurons. Its primary symptoms include tremor, rigidity, slow movement, and impaired balance. While medications can provide symptomatic relief, there is no cure. Physical therapy focuses on improving mobility, balance, strength, and fall prevention through exercises like treadmill training, Tai Chi, stretching, and cueing strategies. Surgery such as deep brain stimulation may also help manage severe symptoms.
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
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Emd rreferal2016
EMDR is a trauma-focused psychotherapy recommended for treating PTSD. It involves having patients focus on traumatic memories while performing eye movements or other bilateral stimulation. This is thought to help reprocess the traumatic memories so they are no longer linked to distressing emotions and beliefs. EMDR uses an 8-phase protocol to access and process traumatic memories in order to reduce PTSD, depression, and anxiety symptoms. It has been shown to be an effective evidence-based treatment for PTSD according to various health organizations.
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Roods Approach neuro approaches study notes
In this note included Roods Approach
Definition
Principles
Basic concepts
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Technique
SPASTICITY.docx
The document discusses spasticity, its causes, and various treatment approaches. It defines spasticity as increased muscle tone caused by damage to upper motor neurons. Two treatment approaches are described - the Bobath technique which facilitates normal movement patterns to reduce excessive muscle activity, and the Rood approach which uses sensory stimulation and motor patterns to influence muscle tone. Finally, common inhibition techniques are outlined which apply sensory input to muscles to reduce hyperactivity and promote relaxation.
MOTOR NEURON DISEASES
This document summarizes motor neuron diseases, including amyotrophic lateral sclerosis (ALS). It describes the clinical manifestations and progression of weakness, atrophy and spasticity. It outlines different types of motor neuron diseases and details the clinical features of ALS, progressive muscular atrophy, progressive bulbar palsy and primary lateral sclerosis. Laboratory and pathology findings are summarized. Treatment focuses on supportive measures as the disease progresses through different stages from independent to dependent. Exercise and rehabilitation programs aim to maintain function and prevent complications according to the stage of disease.
Concussion and return to play
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Prep family lecture_shepherd
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Concussion treatment
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Physiotherapy management of perceptual disorders
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PT MANAGEMENT OF INFECTIONS OF BRAIN
Inflammation of the protective membranes surrounding the brain and spinal cord (meninges) can cause meningitis. Common symptoms include vomiting, seizures, stiff neck, rash, and altered consciousness. Assessment involves evaluating neurological, vascular, musculoskeletal and other systems. Management aims to provide psychological support, prevent complications like chest issues and blood clots, correct deformities, improve strength and balance, and train gait. Techniques include stretching, positioning, exercises and assisted walking.
Cerebellar Ataxia
This document discusses cerebellar ataxia, which is a lack of muscle coordination caused by dysfunction of the cerebellum. It classifies ataxia into hereditary, non-hereditary degenerative, and acquired types. Hereditary ataxia includes autosomal dominant, autosomal recessive, and X-linked forms. Common symptoms are gait instability, limb incoordination, slurred speech, and eye movement abnormalities. Diagnosis involves testing for genetic mutations, imaging the brain, and checking for metabolic deficiencies. Treatment aims to reduce symptoms and improve coordination through medications, physical therapy, and assistive devices.
Tabes dorsalis
Tabes dorsalis is a progressive degeneration of nerve cells and fibers in the spinal cord that carry sensory information to the brain, caused by untreated syphilis. It is characterized by sensory deficits, loss of coordination, and diminished reflexes. The disease progresses through preataxic, ataxic, and paralysis stages. Clinical features include loss of sensation, Argyll Robertson pupils, dementia, hypotonicity, loss of coordination, and trophic ulcers. Treatment involves antibiotics, steroids, pain medications, exercises, and splinting to manage symptoms.
Neuro syphilis
This document discusses syphilis, a multi-system disease caused by the bacteria Treponema pallidum that can involve the nervous system. It has various stages and presentations depending on whether it was acquired or congenital. Neurosyphilis can occur in early or late stages and manifest as asymptomatic neurosyphilis, meningitis, meningovascular symptoms, general paresis, or tabes dorsalis. Diagnosis involves serology and CSF tests. Treatment is with penicillin or other antibiotics. Complications can include hydrocephalus, myelitis, and Jarisch-Herxheimer reaction.
Evoked potentials
This document discusses evoked potentials, which are electrical activities in the neural pathway generated in response to external stimuli. It focuses on three types of sensory evoked potentials: visual evoked potentials (VEP), somatosensory evoked potentials, and brainstem auditory evoked potentials (BEAP). VEP assess the visual pathway and look for abnormalities in P100 latency and amplitude. BEAP assess the auditory pathway by analyzing wave latencies and amplitudes, with abnormalities indicating lesions in the auditory nerve, brainstem, or cranial nerves. Evoked potentials are used to detect disturbances in the central nervous system.
CT SCAN
A CT scan is a fast, easily accessible, cost efficient, non-invasive imaging technique used to detect fractures, bleeds, degenerative changes, abnormalities, and the extent of damage in the brain. A CT scan provides information about attenuation levels that can indicate hemorrhage, contrast, calcium, metal, ischemia, infection, or edema. When reading a CT scan, one examines the patient details, type of scan, purpose, cranial and extracranial structures, ventricles, cistern, sulci, and brain parenchyma for lesions characterized by their location, color, and margin.
Craniotomy
Craniotomy is a surgical procedure where a section of the skull is removed to access and expose the brain and intracranial structures. It is commonly used to clip aneurysms, remove tumors, abscesses or other lesions, decompress blood vessels, implant devices, biopsy tissue, or evacuate hematomas. Complications can include hemorrhage, seizures, cerebrospinal fluid leaks, infections, and neurological deficits. Craniotomies are classified based on location such as frontal, temporal, parietal or occipital, and may also be keyhole, stereotactic, or awake procedures. The case discussion involves an 11-year old girl who suffered head trauma in a car accident and showed signs of
Skull x ray
This document discusses an x-ray of the skull, including its anatomy, bones, sutures, fontanelles, and sinuses. It notes there are 22 total bones in the skull, with 8 in the cranium and 14 in the facial skeleton. It describes different views of skull x-rays and indications for skull x-rays such as shape, size, density, tumors, infections, and fractures. It outlines some abnormalities seen on skull x-rays related to density, contour, intracranial contents, and lytic or sclerotic lesions.
CSF Analysis
A lumbar puncture, or spinal tap, is a diagnostic procedure used to collect and analyze cerebrospinal fluid (CSF) from the spinal canal. It can help diagnose infectious and non-infectious neurological conditions. The document outlines the steps of a lumbar puncture procedure, including positioning the patient and inserting a needle between two vertebrae in the lower back to withdraw CSF. Complications are minor in most cases but can include back pain, headache, or nerve damage. Analysis of CSF properties and biochemical components can provide information about conditions affecting the central nervous system.
TBI
This document discusses traumatic brain injury (TBI). TBI is defined as damage to the brain caused by an external force and can be either open or closed injuries. It affects about 1.5-2 million people annually. Common causes include motor vehicle accidents (60%), falls (20-25%), and violence (15%). TBI can cause impairments in cognitive, physical, and behavioral/emotional functioning. Diagnosis involves imaging tests like CT scans and MRI to evaluate the severity and location of the brain damage. Management may include medications to reduce secondary brain damage, surgery to repair skull fractures or drain blood clots, and rehabilitation.
SWD
Short wave diathermy uses electromagnetic waves between 107-108 Hz to induce heating in tissues. It has both thermal and non-thermal physiological effects and can be used to treat inflammatory conditions, infections, muscle injuries and more. The document describes the production of short wave diathermy through an oscillating circuit, and discusses methods of application including capacitor and cable techniques which create electric and magnetic fields. Precautions are outlined to avoid risks like burns. In summary, it provides an overview of short wave diathermy including its mechanisms, effects, indications and application methods.
PEME
This document discusses pulsed electromagnetic energy (PEME) therapy. PEME uses non-thermal pulses of electromagnetic energy to stimulate tissues for therapeutic purposes. It can increase ATP production, alter cell membranes, decrease inflammation, and increase healing. PEME is used to treat neurological conditions like radiculopathies and neuropathies, musculoskeletal issues like fractures and strains, psychological disorders, and general wounds and sores. Contraindications include pregnancy, menstruation, metal implants and recent radiation therapy.
LASER
This document discusses laser therapy, including its production, types, effects, applications, and techniques. It begins by defining laser as light amplified by stimulated emission of radiation. It then describes the key properties of lasers as monochromaticity, coherence, and collimation. It discusses the different types of lasers based on lasing medium (ruby, HeNe, diode) and intensity (high power, low power). The physiological and therapeutic effects of lasers are outlined, including effects on wound healing, pain relief, and inflammation. Applications such as wound healing and reducing pain and inflammation are indicated. The document concludes by describing techniques for laser application and important parameters like wavelength, energy density, and dosage.
UVR
Ultraviolet radiation can be used therapeutically to treat various skin conditions. It has both immediate physiological effects like erythema, tanning, and long term effects like aging and cancer. There are different types of UV generators that produce UVA, UVB or UVC. Dosage is carefully determined based on skin type and response. PUVA treatment uses oral photosensitizing drugs before UVA exposure to treat conditions like psoriasis. Precautions must be taken with UV therapy due to risks of overexposure like burns, aging and skin cancer.
Movemet disorders
This document provides an overview of various movement disorders including dystonia, chorea, ballismus, athetosis, tics, myoclonus, and Wilson's disease. It discusses the epidemiology, classification, etiology, clinical features, pathophysiology, investigations and treatment of each disorder. The classifications are based on factors like age of onset, distribution of symptoms, underlying etiology. Primary and secondary dystonias are described. Common types of chorea like Huntington's chorea are outlined. The document provides detailed information on different types of these movement disorders for healthcare professionals.
Infra red rays
Keerthi Priya MPT Neuro is an assistant professor discussing infrared rays. Infrared rays have wavelengths between 750 nm to 1 mm. They are produced through molecular vibration and can be generated through non-luminous electric wires or luminous generators. Infrared rays are absorbed by the skin where they cause vasodilation, sweating, and increased metabolism. Their therapeutic effects include relief of pain, reduction of muscle spasm, and acceleration of healing. Proper technique of application and precautions against dangers like burns are important.
Electro magnetic spectrum
The document discusses the electromagnetic spectrum. It defines key terms like wavelength and frequency. The electromagnetic spectrum includes all types of electromagnetic radiation organized based on their wavelength and frequency. Radiation is produced through the interaction of electric and magnetic fields and can be classified as luminous or nonluminous. Laws governing radiation include reflection, refraction, absorption, transmission, penetration, and scattering. Specific laws of radiation discussed are the Arndt-Schultz principle, the law of Grotthus-Draper, the cosine law, and the inverse square law. The document also briefly mentions uses of electromagnetic radiation but does not provide details.
Parkinsons disease
Parkinson's disease is a neurodegenerative disorder that results from the loss of dopamine-producing neurons in the basal ganglia. The four primary symptoms are tremors, rigidity, bradykinesia, and postural instability. It typically presents after age 50 and treatment involves dopamine replacement therapy with levodopa/carbidopa or dopamine agonists to manage the motor symptoms. Deep brain stimulation may also be used in advanced cases that do not respond well to medication.
Multiple sclerosis
Multiple sclerosis is an autoimmune demyelinating disease of the central nervous system characterized by inflammation, demyelination and scarring of nerve tissue. It typically affects people in their 20s-40s and is more common in women. Symptoms vary depending on the location of lesions but may include visual problems, numbness, weakness, fatigue and cognitive issues. Diagnosis involves MRI of the brain and spine, lumbar puncture and evoked potential tests. Treatment focuses on reducing relapses and managing symptoms, and may include medications like beta interferons, steroids, and disease-modifying drugs.
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- 1. PT MX HEAD INJURY KEERTHI PRIYA MPT NEURO, ASSISTANT PROFESSOR
- 2. What is Head Injury?
- 5. Scales Used In Head Injury Glasgow Coma Scale Galveston Orientation & Amnesia Test Ranchos Los Amigo Scale Glasgow Outcome Scale
- 6. Scales Used In Head Injury Disability Rating Scale Functional Independence Measure Functional Assessment Measure
- 7. Classification of Head Injury 1. Mild 2. Moderate 3. Severe
- 8. Severe Head Injury Scales used in severe head injury: Coma recovery scale Disorders of consciousness scale
- 10. PT MX for Severe Head Injury Prevent secondary complications: Positioning Serial casting Turning Splinting Prevent Contractures, Heterotopic Ossification & Maintain Muscle Properties Prevent Bed Sores
- 15. PT MX for Severe Head Injury Prevent secondary complications: Postural Drainage Chest Physiotherapy Early Mobility ( prevent DVT) Sensory Stimulation ( Arousal & Elicit Movement) To Maintain Pulmonary Function
- 16. Moderate Head Injury Scales used in moderate head injury: Moss attention rating scale Galveston orientation & amnesia test BBS FIM & FAM
- 17. PT MX for Moderate Head Injury Interventions: Motor Relearning Program Compensatory & Restorative Approach Task Oriented Approach CIMT
- 18. PT MX for Moderate Head Injury Interventions: Endurance Training Resistance Training FES Dual Tasking
- 19. Mild Head Injury
- 20. PT MX for Mild Head Injury Interventions: vestibular rehabilitation Dual tasking Graded rehabilitation Balance training
- 22. Any query