Some key points include:
- Polio is caused by infection with the poliovirus and can lead to paralysis of muscles.
- It spreads via the fecal-oral or respiratory routes and infects the anterior horn cells of the spinal cord.
- Clinical features may include fever, neck rigidity, asymmetric limb paralysis that often affects the legs. Respiratory muscles can be involved.
- Treatment focuses on supportive care, splinting to prevent deformities, physiotherapy to
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
It is a viral infection affecting the Anterior Horn cell of Spinal cord and Brainstem producing a flaccid motor paralysis.
It is also know as Infantile Paralysis.
Highly infectious
Mainly affects young children
First case recorded in late 1700’s with first epidemic in late 1800’s
Cases reported after 1979 were mild and self-limited and did not result into paralysis
Last case in India – 13th Jan, 2011
In greek, polios means grey, myelos – medulla, itis – inflammation
Viral infection localized in the anterior horn cells of the spinal cord & certain brain stem motor nuclei.
The Poliovirus, a human enterovirus, of the family of Picornaviridae has 3 subtypes -(Polio 1, 2, 3)
Composed of RNA genome and a protein capsid. The genome is single stranded positive sense RNA
SYBPO - Orthotics.This presentation consists of all the pathological reasons affecting the lower extremity causing various deformities. it consists of Cerebral Palsy, polio, CDH etc.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. INTRODUCTION
• Poliomyelitis, is an acute infectious disease caused by the
poliovirus. The types of virus responsible for causing
poliomyelitis are: Type I- Brunhilde, Type II- Lansing, Type II-
Leon.
• The infection may manifest as an episode of diarrhoea or may
affect the anterior horn cells of the spinal cord and lead to
extensive paralysis of the muscles.
• In extreme forms, the paralysis may involve respiratory muscles,
and may lead to death.
3. AETIOPATHOLOGY
• The poliovirus enters the body either through the faeco-oral
route or by inhalation of droplets.
• Paralysis may be precipitated after strenuous physical activity,
by an intramuscular injection or in a child on cortisone
therapy.
• A tonsillectomy, adenoidectomy or tooth extraction
predisposes to paralysis during polio epidemics.
• The infection occurs commonly in summer.
4. PATHOGENESIS
• The virus multiplies in the intestine. From here it
travels to enter the blood circulation.
• If the defense mechanism of the body is poor, the
virus reaches the nervous system (anterior horn cells)
via the blood or peripheral nerves.
• The neurons undergo varying degree of damage –
some may permanently die, others may be
temporarily damaged, others may undergo only
functional impairment due to tissue oedema.
5. PATHOGENESIS
• The neurons, which are permanently damaged,
lead to permanent paralysis; while the others may
regenerate, so that partial recovery of the
paralysis may occur.
• It is this residual paralysis (called post-polio
residual paralysis – PPRP) which is responsible
for the host of problems associated with a
paralytic limb (deformities, weakness etc.).
6. CLINICAL FEATURES
• The patient is a child around the age of 9 months. The
mother gives a history that the child developed mild
pyrexia associated with diarrhoea, followed by
inability to move a part or whole of the limb.
• The lower limbs are affected most commonly.
Paralysis is of varying severity and asymmetrical in
distribution.
• In extreme cases, the respiratory muscles may also be
paralyzed.
7. CLINICAL FEATURES
• In the early stages, the child is seen by a paediatrician
and then referred to an orthopaedic surgeon.
• By this time the paralysis may already be on its way
to recovery.
• Recovery of power, if it occurs, may continue for a
period of 2 years. Most of the recovery occurs within
the first 6 months.
• Any residual weakness persisting after 2 years is
permanent, and will not recover.
8. General Pattern of Paralysis and Expected Recovery
Following Acute Episode
Vigorous concentrated physiotherapy from week 3 or as soon as tenderness
subsides up to 6 months is crucial. Maximum advantage can be derived at this
stage.
9. EXAMINATION
• In the early stage, the child is febrile, often with rigidity of
the neck and tender muscles.
• This may be associated with diffuse muscle paralysis. The
following are some of the typical features of a paralysis
resulting from polio:
It is asymmetric i.e., the involvement of the affected
muscles is haphazard.
It occurs commonly in the lower limbs because the anterior
horn cells of the lumbar enlargement of the spinal cord are
affected most often.
The muscle affected most commonly is the quadriceps,
although in most cases it is only partially paralyzed.
10. EXAMINATION
The muscle which most often undergoes complete
paralysis is the tibialis anterior.
The muscle in the hand affected most commonly is the
opponens pollicis.
The motor paralysis is not associated with any sensory
loss.
Bulbar or bulbo-spinal polio: This is a rare but life
threatening polio (the motor neurons of the medulla are
affected). This results in involvement of respiratory and
cardiovascular centres, and may cause death.
11. EXAMINATION
• In late stage (PPRP), the paralysis may result in
wasting, weakness, and deformities of the limbs.
• The deformities result from imbalance between
muscles of opposite groups at a joint, or due to
the action of the gravity on the paralyzed limb.
• The common deformity at the hip is flexion-
abduction-external rotation.
12. EXAMINATION
• At the knee, flexion deformity is common.
• At the foot, equino-varus deformity is the commonest;
others being equino-valgus, calcaneo-valgus and
calcaneocavus.
• In the upper limbs, polio affects shoulder and elbow
muscles.
• Muscles of the hand are usually spared.
• With time, the deformities become permanent due to
contracture of the soft tissues and mal-development of the
bones in the deformed position.
14. PROGNOSIS
• Of the total number of cases infected with the poliovirus, 50
per cent do not develop paralysis at all (non-paralytic
polio).
• 40 per cent develop paralysis of a varying degree (mild,
moderate or severe).
• 10 per cent patients die because of respiratory muscle
paralysis.
• Of the patients with paralytic polio, 33 per cent recover
fully, 33 per cent continue to have moderate paralysis, while
another 33 per cent remain with severe paralysis.
15. PROGNOSIS OF RECOVERY IN RELATION TO THE
INITIAL ASSESSMENT OF MUSCLE POWER
• All the muscle groups of the affected limb should be divided into
two groups:
• Group I – muscles that are partially paralyzed (MMT grade = 1 to
3)
• Group II – muscles that are totally paralyzed (MMT grade = 0)
17. MEDICAL TREATMENT
• Polio can be prevented by immunization.
• It is important to immunize patients even after an attack
of acute poliomyelitis. This is because there are three
strains of the virus, and the patient could still get
paralytic polio by another strain.
• The treatment principles are:
(i) To provide supportive treatment during the stage of
paralysis or recovery
(ii) To prevent the development of deformities during this
period
(iii) To use, in a more efficient way, whatever muscles are
functioning.
18. TREATMENT
Stage of onset: It is generally not possible to diagnose polio at
this stage. In an endemic area, if a child is suspected of having
polio, intramuscular injections and excessive physical activity
should be avoided.
Stage of maximum paralysis: In this stage, the child needs
mainly supportive treatment.
• A close watch is kept for signs suggestive of bulbar polio.
These are signs of paralysis of the vagus nerve, causing
weakness of the soft palate, pharynx and the vocal cords –
hence problem in deglutition, and speech. A respirator may be
necessary to save life if the respiratory muscles are paralyzed.
• Paralytic limbs may have to be supported by splints to prevent
the development of contractures.
• All the joints should be moved through the full range of
motion several times a day.
• Muscle pain may be eased by applying hot packs.
19. Stage of recovery: The principles of treatment
during this stage are as follows:
• Prevention of deformity by proper splintage, and
joint mobilizing exercises.
• Correction of the deformity that may have already
occurred.
• Retraining of muscles that are recovering by
exercises. Progress evaluated by repeated
examination of the motor power of the paralyzed
limb.
• Encourage walking with the help of appliances,
wherever possible.
20. TREATMENT
Stage of residual paralysis: It consists of the following:
• Detailed evaluation of the patient: Most patients with residual polio
(PPRP) walk with a limp, with or without calipers. An assessment is
made whether functional status of the patient can be improved.
• For this, an evaluation of the deformities and muscle weakness is
made.
• Prevention or correction of deformities: The main emphasis is on
prevention of deformity.
• Splinting the paralyzed part in such a way that the effect of muscle
imbalance and gravity is negated.
• An operation may be required to prevent the deformity. For example,
in a foot with severe muscle imbalance between opposite group of
muscles, a tendon transfer operation is done. A ‘balanced’ foot
produces less possibility of deformity
21. TREATMENT
• Tendon transfers: It is not done before 5 years of age, as the child has to be
manageable enough to be taught proper exercises. More commonly
performed tendon transfers are as follows:
• Transfer of extensor hallucis longus (EHL) from the distal phalanx of great
toe to the neck of the first metatarsal. This is done to correct first metatarsal
drop in case of tibialis anterior muscle weakness.
• Transfer of peroneus longus and brevis muscles to the dorsum of the foot.
The transfer is required in a foot with dorsiflexor weakness. Evertors can
be spared for more useful function of dorsiflexion of the foot.
• Hamstring (knee flexors) transfer to the quadriceps muscle to support a
weak knee extensor.
22. Principles of tendon transfers
Donor tendon
• Should be expandable
• Minimum power 4/5
• Amplitude of excursion to match that of the recipient muscle
• Preferably a synergistic muscle
Recipient site
• Range of movements of the joints on which the transferred muscle is expected to work
should be good
• No scarring at the bed of the transferred tendon
Technical considerations
• Transferred tendon should take a straight route
• It should be placed in subcutaneous space
• Fixation must be under adequate tension
Patient considerations
• Age – minimum 5 years*
• The disease should be non-progressive
* Minimum age when a child can be trained in using the transferred muscle.
23. TREATMENT
• Stabilization of flail joints: Joints with severe muscle
paralysis that the body loses control over them are called
flail joints.
• Stabilization of these joints is necessary for walking. This
can be achieved by operative or non-operative methods.
Non-operative methods consist of calipers, shoes etc.
• Operative methods consist of fusion of the joints (e.g., triple
arthrodesis for stabilization of the foot).
• Leg length equalization: In cases where a leg is short by
more than 4 cm, a leg lengthening procedure may be
required.
28. Lower limb: Release of soft tissue contractures
• Hip: The flexion contracture at the hip is corrected by Soutter’s operation in
which the tight structures along the anterior iliac crest are released and the
deformity is corrected. The abduction contracture is corrected by release of
abductors, fascia lata and the iliotibial band. Postoperatively, the patient is given
a POP hip spica, in the corrected position, for about 4–6 weeks. The joints are
then mobilized but the correction is maintained in a caliper.
• Knee: Mild flexion contractures are generally due to tight iliotibial band that is
divided. Moderate degrees of flexion contracture can be treated by lengthening of
the hamstrings. Severe flexion contractures require lengthening of hamstrings and
posterior capsulotomy of the knee (Wilson’s operation). Postoperatively, an
above-knee plaster cast for 4–6 weeks followed by mobilization is the usual
regime. The correction is maintained in a caliper.
29. • Ankle: The commonest deformity is equinus, which results from contracture of
the tendoachilles. Lengthening of the tendoachilles by Z-plasty is undertaken.
An above-knee plaster cast for 3–6 weeks is given after operation. A below-
knee caliper is usually worn for 3–6 months to prevent recurrence.
• Foot: Contracture of the plantar fascia produces a cavus deformity of the foot.
The tight plantar fascia is stripped from its attachment to the calcaneus
(Steindler’s operation). In the postoperative period, a below-knee plaster is
given for 2–4 weeks, after which a night splint is used for 2–4 months.
Lower limb: Release of soft tissue
contractures
31. PHYSIOTHERAPY FOLLOWING SURGERY
• The basic approach of physiotherapy varies according to the type of the
surgical procedure:
1. After release of the soft tissue contractures, measures should be taken to
avoid recurrence of contracture.
2. Following tendon transplants, the emphasis should be on re-education of
the transplanted muscle to its new role.
3. Following the joint arthrodesis, the emphasis should be on educating the
functional use of the limb in which the joint is arthrodesed.
32. RELEASE OF THE SOFT TISSUE CONTRACTURES
• 1. Positioning: Proper Positioning of the operated limb and of the body will not
facilitate recurrence of the contracture.
• Long periods of prone lying are important to prevent recurrence of hip flexion
contracture following Soutter’s release.
• Maintaining optimal extension at the knee after release of the iliotibial band and the
hamstrings are important.
• Maintaining neutral dorsiflexion is mandatory in the release of tendoachilles.
• The shell of POP or suitable orthoses is necessary to retain till the position of
correction is maintained with active efforts by the patient.
• 2. Mobilization: Graded mobilizing procedures are used to regain early full ROM at
the joint related to the soft tissue release.
• Relaxed passive movements following soothing heat is also ideal.
33. • 3. Muscle strengthening and endurance exercises: Exercises should be given to improve
strength and endurance of the muscle groups antagonistic to the ones that were
released surgically, to maintain the corrected position of the joint concerned.
Therefore, gluteus maximus in the release of hip flexion contracture and quadriceps in
the release of knee flexion contracture needs attention.
• Agonistic control as well as overall strengthening of the other muscle groups of the limb
should not be neglected.
• Surgical scar should be mobilized by friction massage or ultrasound to avoid it getting
adherent.
• 4. Re-education: Re-education of the proper use of the joint, weight bearing and gait is
done to avoid recurrence of soft tissue contractures.
• 5. Home treatment program: Simple regular regime of correct positioning and exercises
need to be continued at home.
RELEASE OF THE SOFT TISSUE CONTRACTURES
34. TENDON TRANSFERS
• In Preoperative management and training, four factors need special
consideration:
• 1. Due to imbalanced muscular action, the concerned joint is most likely to
get stiff in the direction of the weaker muscle, e.g., limitation of inversion in
dorsiflexion when anterior tibial group is paralysed and peronei are strong.
The transplant can never be effective unless full ROM is achieved at the
concerned joint in the direction of the proposed action of the transplant.
• 2. The muscle to be transplanted is bound to get weak after the
transposition and therefore it should be stronger before surgery.
• Therefore, concentrated sessions of preoperative training of strengthening
and isometric holding of the muscle to be transplanted is a must.
35. • 3. There is a tendency for the transplanted muscle to continue its previous
action even after transposition. This is avoided by adequate training of the
patient on the contralateral limb, e.g., correct groove of dorsiflexion with
inversion is repeatedly practiced on the contralateral limb before
undertaking peroneal transplant for the paralysed anterior tibial group.
• 4. Specific strengthening procedures are given to the associated muscle
groups of the movement for which the transplant is planned.
• These muscle groups are instrumental in assisting the performance of the
transplanted muscle. For example, extensor digitorum and hallucis longus
are strengthened when the peroneal transplant to the dorsum of the foot is
planned to assist dorsiflexion.
TENDON TRANSFERS
37. • Postoperatively: Re-education of the transplanted muscle is important.
• Begin with guided passive full-range movement in the exact groove of the expected arc of
movement.
• Gradually progress to assisted movement by encouraging the patient to actively contract
the transplanted muscle.
• Electrical stimulation synchronized with the patient’s effort is extremely useful in re-
education. Biofeedback also provides an excellent means of re-education.
• The sessions of muscle re-education and strengthening should be continued and
progressed till strong and controlled movements by the transplanted muscle are
achieved.
• Guided functional training hastens the recovery.
• Dynamic orthosis may sometimes become necessary to provide assistance and to avoid
unwanted movements.
TENDON TRANSFERS
38. ARTHRODESIS
• This is a joint stabilizing procedure where immobilization is usually done for a long
period.
Preoperative training
• The patient is taught the procedures of functionally using the limb effectively, e.g., non–
weight-bearing crutch walking.
• Exercises are given to strengthen the movements of the joints adjacent to the joint to be
arthrodesed.
• Mobilization of the shoulder girdle and pelvic girdle are given when the arthrodesis is
planned for shoulder and hip, respectively. It helps in the functional use of the limb
following stabilization.
During immobilization:
• Vigorous exercises are given to the joints free from immobilization.
• Gait training is started as soon as the pain recedes.
39. Mobilization:
• As the initial weight bearing is painful, weight transfers to the limb; single leg balance and
ambulation are done in a graduated manner.
• Adequate walking aid may be necessary initially, but it should be waned gradually.
• Functional use of the operated joint is emphasized by teaching compensatory mechanisms
by using adjacent joints.
• The exercise program is then made vigorous, emphasizing endurance training.
CORRECTION OF THE LIMB LENGTH DISPARITY
• The period of immobilization is long and therefore strengthening and endurance exercises
are emphasized to all the free joints.
• Proper positioning of the limb is ensured in the external fixator.
• Isometrics to the glutei and quadriceps are given on removal of the external fixator or POP.
• Gradual training in weight bearing, weight transfers, balance and gait is initiated and
progressed to normal use.
ARTHRODESIS
40. Thanks
Dr. Sanjib Kumar Das, MPT(Musculoskeletal)
Fellow PhD (Ergonomics & Human Factors)
Contact No. +918879485847 / 8169951520
Email: sanjib_bpt@yahoo.co.in / skdas@amity.edu
Google Scholar:https://scholar.google.com/citations?user=rdOq9r8AAAAJ&hl=en&oi=ao
Linkedin: https://www.linkedin.com/in/dr-sanjib-kumar-das-75950936/