The document outlines the components of a thorough subjective examination, including gathering a patient's medical history, symptoms, and how they are impacted by daily activities. A quality subjective examination involves clear communication and focused questions to understand the source of symptoms, contributing factors, and prognosis. Details should be collected on location and characteristics of pain, aggravating/easing factors, and how symptoms vary over 24 hours and with different motions. Special questions target specific areas like the lumbar spine, cervical spine, general health history, medications, and lifestyle.
The document outlines strategies for physical therapy management in the acute stage after a stroke. It discusses positioning strategies, improving respiratory and circulatory function, preventing pressure sores and deconditioning. It then outlines various physical therapy interventions to improve sensory function, flexibility, strength, movement control, functional mobility, upper and lower limb function, balance, locomotion, aerobic function, swallowing, motor learning, and provides education to patients and families.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
This document provides information on lateral epicondylitis (tennis elbow), including its anatomy, causes, symptoms, diagnosis, and treatment options. It describes how lateral epicondylitis is an overuse injury caused by repetitive microtrauma to the common extensor tendon at the lateral epicondyle. The diagnosis is typically made based on physical examination findings of tenderness over the lateral epicondyle with resisted wrist and finger extension. Both non-operative treatments like physiotherapy, bracing, and steroid injections and surgical options are discussed for managing lateral epicondylitis.
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.
Dr. Satyendra Bhattacharyya's document discusses the history and procedure of shoulder arthroplasty. It begins with the first documented shoulder replacement in 1894, but focuses on developments starting in 1951 by Dr. Charles Neer, who created the first hemi-arthroplasty and total shoulder replacement. The document then discusses factors that influence arthroplasty outcomes, indications for the procedure for conditions like osteoarthritis and rheumatoid arthritis, and details each step of the surgical procedure. It concludes by describing postoperative rehabilitation protocols.
The document describes various techniques used in physical therapy for neuromuscular re-education and facilitation including proprioceptive neuromuscular facilitation, neurodevelopmental technique, sensory integration, Brunnstrom movement therapy, and Rood's technique. It provides details on how each technique is applied and the receptors and responses targeted through different stimuli like stretching, traction, touch, and movement.
low back pain is very common in population occurring at least once a lifetime in nearly 60-80% of population.
This presentation was presented as a webinar in coordination with ypta and serving hands on 12-8-2021.
PHYSIOTHERAPY MANAGEMENT OF POST STROKE PATIENT.Jonasbrother2013
This document provides an overview of physiotherapy management for stroke. It begins with definitions of stroke and transient ischemic attack. It then discusses risk factors, types, signs and symptoms, diagnosis, and medical management of stroke. The remainder of the document focuses on the physiotherapy assessment and treatment approaches in both the acute and post-acute stages. The assessment covers various body functions and structures, while the treatment approaches aim to improve motor function, mobility, balance, sensation, flexibility, strength, and reduce spasticity to achieve functional independence.
The document outlines strategies for physical therapy management in the acute stage after a stroke. It discusses positioning strategies, improving respiratory and circulatory function, preventing pressure sores and deconditioning. It then outlines various physical therapy interventions to improve sensory function, flexibility, strength, movement control, functional mobility, upper and lower limb function, balance, locomotion, aerobic function, swallowing, motor learning, and provides education to patients and families.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
This document provides information on lateral epicondylitis (tennis elbow), including its anatomy, causes, symptoms, diagnosis, and treatment options. It describes how lateral epicondylitis is an overuse injury caused by repetitive microtrauma to the common extensor tendon at the lateral epicondyle. The diagnosis is typically made based on physical examination findings of tenderness over the lateral epicondyle with resisted wrist and finger extension. Both non-operative treatments like physiotherapy, bracing, and steroid injections and surgical options are discussed for managing lateral epicondylitis.
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.
Dr. Satyendra Bhattacharyya's document discusses the history and procedure of shoulder arthroplasty. It begins with the first documented shoulder replacement in 1894, but focuses on developments starting in 1951 by Dr. Charles Neer, who created the first hemi-arthroplasty and total shoulder replacement. The document then discusses factors that influence arthroplasty outcomes, indications for the procedure for conditions like osteoarthritis and rheumatoid arthritis, and details each step of the surgical procedure. It concludes by describing postoperative rehabilitation protocols.
The document describes various techniques used in physical therapy for neuromuscular re-education and facilitation including proprioceptive neuromuscular facilitation, neurodevelopmental technique, sensory integration, Brunnstrom movement therapy, and Rood's technique. It provides details on how each technique is applied and the receptors and responses targeted through different stimuli like stretching, traction, touch, and movement.
low back pain is very common in population occurring at least once a lifetime in nearly 60-80% of population.
This presentation was presented as a webinar in coordination with ypta and serving hands on 12-8-2021.
PHYSIOTHERAPY MANAGEMENT OF POST STROKE PATIENT.Jonasbrother2013
This document provides an overview of physiotherapy management for stroke. It begins with definitions of stroke and transient ischemic attack. It then discusses risk factors, types, signs and symptoms, diagnosis, and medical management of stroke. The remainder of the document focuses on the physiotherapy assessment and treatment approaches in both the acute and post-acute stages. The assessment covers various body functions and structures, while the treatment approaches aim to improve motor function, mobility, balance, sensation, flexibility, strength, and reduce spasticity to achieve functional independence.
The McKenzie Method is a classification system and treatment approach developed by Robin McKenzie for back, neck, and extremity pain. It involves assessing a patient's response to various movements and positions to determine the cause of their pain and develop an individualized exercise plan. The goals are to centralize or reduce pain. There are three main syndromes - postural, dysfunction, and derangement - each with different treatments like posture correction, mobilizing exercises, or movements to induce a directional preference. The McKenzie Method aims to actively involve patients to self-manage their pain.
This document discusses rehabilitation principles for multiple sclerosis (MS). It begins by defining MS as a chronic, progressive disease of the central nervous system characterized by demyelination of the brain and spinal cord. It then covers the epidemiology, pathogenesis, subtypes, common symptoms and signs, diagnosis using the McDonald criteria, disease severity as measured by EDSS, disease-modifying therapies, and approaches to managing common issues like gait impairment and fatigue through rehabilitation and exercise.
Piriformis syndrome is an underdiagnosed cause of buttock and leg pain that can result from myofascial pain or sciatic nerve compression by the piriformis muscle. It most commonly affects middle-aged females and accounts for 5-6% of sciatica cases. Diagnosis is challenging as symptoms can mimic other conditions, but involves physical exams like the Freiberg test and imaging. Treatment includes physical therapy, medications, piriformis muscle injections, or rarely surgery.
Therapeutic management of knee osteoarthritis; physiotherap case studyenweluntaobed
The document discusses the therapeutic management of knee osteoarthritis. It provides background on the epidemiology and economic burden of the condition. Key points include that knee OA prevalence is rising with population aging and affects nearly 10% of those over 55 years old. Treatment involves a multidisciplinary approach including pharmacological interventions, physiotherapy, and sometimes surgery, with the overall goals of reducing pain and improving joint function and quality of life. Assessment involves evaluating pain levels, range of motion, muscle strength, and radiological imaging to determine the severity and appropriate treatment.
The document discusses neuropathodynamics and neuromobilization techniques. It covers:
- Flexion and extension of the spine and their effects on neural tissues, producing tension and sliding.
- Lateral flexion and its effects of increasing tension on the convex side and reducing tension on the concave side.
- Various mechanical interface and neural dysfunctions that can occur.
- Objectives, clinical tests, and techniques used in neuromobilization to restore normal neuromechanical function.
- Contraindications for neuromobilization include acute injuries or infections of the nervous system.
- Different levels of neurodynamic testing based on symptoms and neurological status.
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.
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 document discusses joint mobility assessment in physical therapy. It begins by stating the learning objectives, which are to explain concepts of joint mobility assessment, state principles and guidelines, identify indications and precautions, demonstrate techniques, and communicate results. It then reviews relevant concepts such as range of motion, limitation of motion, and hypermobility versus instability. The document outlines the assessment procedures including pain assessment, active and passive motion tests, and accessory mobility tests. It provides guidance on patient positioning, use of glides and distraction/compression. The document concludes by describing how to interpret test findings and documenting the results.
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.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
The document provides an overview of the McKenzie method for assessing and treating musculoskeletal pain. It describes the key concepts of centralization and peripheralization and how patients' pain responses to specific movements can help classify their condition as a postural syndrome, dysfunction syndrome, or derangement syndrome. Treatment generally involves repeated movements and positioning to encourage centralization of pain. Precautions are taken to avoid worsening a patient's pain. The McKenzie method examines both spinal and extremity issues through detailed mechanical diagnosis and management.
Guillain-Barré syndrome (GBS) is an acquired autoimmune disorder that causes inflammation of the peripheral nervous system. It can cause muscle weakness or paralysis. Physiotherapy management focuses on preventing complications like respiratory issues, contractures, and deep vein thrombosis during the acute phase. In subsequent phases, treatment includes stretching, strengthening, aerobic exercise, and balance training to aid recovery. Speech therapy may also be used to address swallowing difficulties that can occur with GBS.
Physiotherapy management for rheumatoid arthritissenphysio
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It most commonly affects women and can lead to joint damage, deformity, and disability over time. Physiotherapy plays an important role in managing rheumatoid arthritis by providing pain relief, preventing deformities, improving flexibility and strength, and maintaining functional ability. Treatment involves heat/cold therapy, exercises, joint protection techniques, and alternative therapies to help reduce inflammation and preserve joint function. The goals of physiotherapy are to protect joints, relieve pain, and prevent disability through regular exercise and mobility work.
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
A 35-year-old male suffered a right CVA 1 month prior, resulting in decreased higher mental function, facial weakness, loss of sensation in his left upper and lower limbs, and involvement of the 7th and 8th cranial nerves. He has grade II spasticity in his left elbow flexors and requires assistance to sit up. Using the ICF framework, the summary describes his structural impairments affecting areas of his brain, functional impairments including decreased attention and memory, activity limitations such as difficulty transferring and walking, and environmental factors like assistive products and health services that can facilitate or be barriers to his rehabilitation.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
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.
Case of Prolapse intervertebral Disc, lumbar disc prolapse, case, physiotherapy management, Assessment, recent Advance, orthopaedic case presentation, musculoskeletal physiotherapy case presentation, orthopaedic physiotherapy, case of a low back pain patient, lumbar radiculopathy, final year,
Spinal cord injuries can be either traumatic, from events like car accidents or falls, or non-traumatic, from conditions that damage the spinal cord. They are classified as either tetraplegia or paraplegia depending on whether the arms or legs are affected. Physiotherapy focuses on managing symptoms, preventing complications, and improving function through exercises for mobility, transfers, wheelchair skills, and more. The goal is to maximize independence and allow patients to safely perform daily living activities. Prognosis depends on the completeness of the injury and potential for recovery decreases over time as improvement plateaus.
The document provides guidance on how to conduct a thorough patient history, including how to structure the history taking session and how to approach each component of the history. It discusses taking the chief complaint, history of present illness, past medical history, drug history, family history, and social history. For each component, it provides tips on what information to obtain and how to record it in the patient's own words. It also describes doing a review of all body systems to check for any associated symptoms.
The McKenzie Method is a classification system and treatment approach developed by Robin McKenzie for back, neck, and extremity pain. It involves assessing a patient's response to various movements and positions to determine the cause of their pain and develop an individualized exercise plan. The goals are to centralize or reduce pain. There are three main syndromes - postural, dysfunction, and derangement - each with different treatments like posture correction, mobilizing exercises, or movements to induce a directional preference. The McKenzie Method aims to actively involve patients to self-manage their pain.
This document discusses rehabilitation principles for multiple sclerosis (MS). It begins by defining MS as a chronic, progressive disease of the central nervous system characterized by demyelination of the brain and spinal cord. It then covers the epidemiology, pathogenesis, subtypes, common symptoms and signs, diagnosis using the McDonald criteria, disease severity as measured by EDSS, disease-modifying therapies, and approaches to managing common issues like gait impairment and fatigue through rehabilitation and exercise.
Piriformis syndrome is an underdiagnosed cause of buttock and leg pain that can result from myofascial pain or sciatic nerve compression by the piriformis muscle. It most commonly affects middle-aged females and accounts for 5-6% of sciatica cases. Diagnosis is challenging as symptoms can mimic other conditions, but involves physical exams like the Freiberg test and imaging. Treatment includes physical therapy, medications, piriformis muscle injections, or rarely surgery.
Therapeutic management of knee osteoarthritis; physiotherap case studyenweluntaobed
The document discusses the therapeutic management of knee osteoarthritis. It provides background on the epidemiology and economic burden of the condition. Key points include that knee OA prevalence is rising with population aging and affects nearly 10% of those over 55 years old. Treatment involves a multidisciplinary approach including pharmacological interventions, physiotherapy, and sometimes surgery, with the overall goals of reducing pain and improving joint function and quality of life. Assessment involves evaluating pain levels, range of motion, muscle strength, and radiological imaging to determine the severity and appropriate treatment.
The document discusses neuropathodynamics and neuromobilization techniques. It covers:
- Flexion and extension of the spine and their effects on neural tissues, producing tension and sliding.
- Lateral flexion and its effects of increasing tension on the convex side and reducing tension on the concave side.
- Various mechanical interface and neural dysfunctions that can occur.
- Objectives, clinical tests, and techniques used in neuromobilization to restore normal neuromechanical function.
- Contraindications for neuromobilization include acute injuries or infections of the nervous system.
- Different levels of neurodynamic testing based on symptoms and neurological status.
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.
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 document discusses joint mobility assessment in physical therapy. It begins by stating the learning objectives, which are to explain concepts of joint mobility assessment, state principles and guidelines, identify indications and precautions, demonstrate techniques, and communicate results. It then reviews relevant concepts such as range of motion, limitation of motion, and hypermobility versus instability. The document outlines the assessment procedures including pain assessment, active and passive motion tests, and accessory mobility tests. It provides guidance on patient positioning, use of glides and distraction/compression. The document concludes by describing how to interpret test findings and documenting the results.
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.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
The document provides an overview of the McKenzie method for assessing and treating musculoskeletal pain. It describes the key concepts of centralization and peripheralization and how patients' pain responses to specific movements can help classify their condition as a postural syndrome, dysfunction syndrome, or derangement syndrome. Treatment generally involves repeated movements and positioning to encourage centralization of pain. Precautions are taken to avoid worsening a patient's pain. The McKenzie method examines both spinal and extremity issues through detailed mechanical diagnosis and management.
Guillain-Barré syndrome (GBS) is an acquired autoimmune disorder that causes inflammation of the peripheral nervous system. It can cause muscle weakness or paralysis. Physiotherapy management focuses on preventing complications like respiratory issues, contractures, and deep vein thrombosis during the acute phase. In subsequent phases, treatment includes stretching, strengthening, aerobic exercise, and balance training to aid recovery. Speech therapy may also be used to address swallowing difficulties that can occur with GBS.
Physiotherapy management for rheumatoid arthritissenphysio
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It most commonly affects women and can lead to joint damage, deformity, and disability over time. Physiotherapy plays an important role in managing rheumatoid arthritis by providing pain relief, preventing deformities, improving flexibility and strength, and maintaining functional ability. Treatment involves heat/cold therapy, exercises, joint protection techniques, and alternative therapies to help reduce inflammation and preserve joint function. The goals of physiotherapy are to protect joints, relieve pain, and prevent disability through regular exercise and mobility work.
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
A 35-year-old male suffered a right CVA 1 month prior, resulting in decreased higher mental function, facial weakness, loss of sensation in his left upper and lower limbs, and involvement of the 7th and 8th cranial nerves. He has grade II spasticity in his left elbow flexors and requires assistance to sit up. Using the ICF framework, the summary describes his structural impairments affecting areas of his brain, functional impairments including decreased attention and memory, activity limitations such as difficulty transferring and walking, and environmental factors like assistive products and health services that can facilitate or be barriers to his rehabilitation.
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
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.
Case of Prolapse intervertebral Disc, lumbar disc prolapse, case, physiotherapy management, Assessment, recent Advance, orthopaedic case presentation, musculoskeletal physiotherapy case presentation, orthopaedic physiotherapy, case of a low back pain patient, lumbar radiculopathy, final year,
Spinal cord injuries can be either traumatic, from events like car accidents or falls, or non-traumatic, from conditions that damage the spinal cord. They are classified as either tetraplegia or paraplegia depending on whether the arms or legs are affected. Physiotherapy focuses on managing symptoms, preventing complications, and improving function through exercises for mobility, transfers, wheelchair skills, and more. The goal is to maximize independence and allow patients to safely perform daily living activities. Prognosis depends on the completeness of the injury and potential for recovery decreases over time as improvement plateaus.
The document provides guidance on how to conduct a thorough patient history, including how to structure the history taking session and how to approach each component of the history. It discusses taking the chief complaint, history of present illness, past medical history, drug history, family history, and social history. For each component, it provides tips on what information to obtain and how to record it in the patient's own words. It also describes doing a review of all body systems to check for any associated symptoms.
This document outlines the topics and contents to be covered in a course on patient assessment and history taking for the respiratory system. The course will cover topics like introduction and history taking, cardiopulmonary symptoms, vital signs, respiratory examinations, neurological assessments, and more. It will teach principles of communication, techniques for interviewing patients, and the structure of a medical history, including collecting information on the chief complaint, present illness, past medical history, and social history. The goal is to train participants to properly assess patients and obtain an organized medical history focused on the respiratory system.
The document discusses the importance of history taking skills in medical education. It outlines the key elements of an effective history, including introducing oneself, using open and closed-ended questions, actively listening, and tailoring the history to the presenting complaint. The standard history taking format is also described, covering identifying data, chief complaint, history of present illness, past medical history, medications, allergies, and family/social histories. Special challenges in history taking and common pitfalls are also addressed.
This document outlines the process and components of taking a patient's medical history. It discusses introducing oneself to the patient, obtaining their chief complaint, history of present illness, past medical history, family history, drug history, and social history. It emphasizes listening to the patient, asking open-ended questions, avoiding medical terminology, and recording all information in the patient's own words. The goal is to accurately determine the etiology of the patient's illness based on their history.
1. History taking provides vital information to arrive at a diagnosis in over 70% of cases by allowing the patient to describe their illness and systematically inquiring about their medical history, presenting complaints, past illnesses, habits, and family history.
2. It is important to build rapport with the patient, have them describe their illness chronologically without interruption, then prompt them for details in key areas before making a systematic inquiry about each body system.
3. A thorough history should explore the patient's presenting complaints, history of present illness, investigation and treatment details, past medical history, personal history, and family history in order to understand how their illness started and progressed and arrive at the most likely diagnostic possibilities based on
The document provides an overview of the speech and audiology department at Themba Hospital. It discusses the scope of practice in audiology, including electrophysiological testing, geriatric audiology, pediatric audiology, educational audiology, and vestibular audiology. It then focuses on vestibular audiology, describing the vestibular system and how it maintains balance. Several common vestibular disorders are explained in detail, including benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, bilateral vestibular hypofunction, and persistent postural-perceptual dizziness. Diagnostic techniques and treatment approaches are outlined for each condition.
This document provides guidance on performing a thorough patient history. It outlines the key components of a patient history, including chief complaint, history of present illness, past medical history, drug history, family history, and social history. The importance of obtaining an accurate history is emphasized as it allows the healthcare provider to determine the etiology of the patient's problem. Guidelines are provided on how to conduct each part of the history respectfully and obtain relevant information through active listening and open-ended questioning.
Pediatrics History Taking and Physical Examination.pptxAJAY MANDAL
This document outlines the components and steps for taking a pediatric history and conducting a physical examination for newborns, infants, children, and adolescents. It discusses obtaining a thorough history, including chief complaint, history of present illness, review of systems, past medical history, family history, and social history. The document also provides guidance on performing a complete physical exam for newborns, assessing vital signs, appearance, and examining each body system.
1) History taking is an essential nursing skill that provides information to make an accurate diagnosis. It involves obtaining a patient narrative through structured questioning.
2) Key principles of history taking include actively listening to the patient, maintaining privacy and confidentiality, using a systematic approach, and ensuring patient comfort.
3) The standard format includes collecting biographical data, chief complaint, history of present complaint, past medical history, medication history, family history, and reviewing all body systems. Summarizing each section ensures clear understanding before moving forward.
This document discusses the importance of pre-anaesthetic evaluation. It outlines that the evaluation includes obtaining a medical history, physical examination, and relevant tests to evaluate a patient's medical condition, optimize their health for anesthesia, identify risks, plan anesthesia technique and care, develop rapport with the patient, obtain consent, and follow ERAS guidelines. Benefits include reduced costs, improved acceptance of regional anesthesia, shorter hospital stays, and avoidance of delays or complications. The evaluation process, components of history and physical exam, relevant tests, documentation, and preparation for anesthesia are described in detail.
This document discusses pediatric palliative care, including:
- Defining pediatric palliative care as relieving suffering and improving quality of life for children with life-threatening conditions and their families.
- Common pediatric conditions that require palliative care like cancer, heart disease, prematurity, and neurological disorders.
- Key aspects of care include managing pain, other symptoms, psychological distress, and end-of-life care while communicating effectively with children and families.
- The importance of an interdisciplinary approach to provide holistic care from diagnosis through the end of life.
Taking history in any medical cases in clenicsz2mtqw4gq9
The document provides guidance on taking a patient's medical history. It explains that taking a thorough patient history is important for systematically recording all relevant medical information. It outlines the key components of a patient history, including personal details, chief complaint, present illness history, review of systems, past medical history, family history, medication history, social history, and other relevant details. The document provides examples of questions to ask within each section and notes important points such as using open-ended questions and avoiding leading questions. It also provides tips for handling special situations and challenges that may arise during a patient interview.
The document discusses a seminar presentation about history collection and physical assessment. It covers key terminology, the importance and components of collecting a patient history, and the definition, principles, preparation, techniques, and components involved in performing a physical assessment. The presentation provides an overview of best practices for nurses to obtain comprehensive information about a patient's health status through thorough history collection and physical examination.
The document provides guidance on taking a patient's medical history. It outlines the 10 components of a history that should be covered which include the present complaint, history of the complaint, review of major body systems, past medical history, and social history. Taking a thorough history is important for making an accurate diagnosis and treatment plan. The history should be taken in a respectful manner and all relevant details about the patient and their condition should be documented.
This document provides guidance for conducting a comprehensive physical assessment. It outlines the components and order of a nursing history and physical exam, including subjective and objective data collection. Key areas like vital signs, body systems, documentation and specific assessment techniques are reviewed in detail with an emphasis on being thorough yet efficient. The goal is to obtain relevant health information to inform the nursing care process.
This document discusses the identification and management of critically ill patients deteriorating on general wards. It emphasizes the importance of early recognition to prevent further physiologic decline and optimize outcomes. A structured approach is recommended, remembering ABCDE - Airway, Breathing, Circulation, Disability, Exposure. Vital signs can predict deterioration and scoring systems like MEWS are used. A focused history and exam should assess organ dysfunction. Rapid treatment of life-threatening issues and calling for help early maximizes chances of recovery.
Multiple sclerosis: Medical and Nursing ManagementsReynel Dan
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This document outlines the components of a patient profile and case history for an optometry examination. It describes collecting information on a patient's personal details, chief complaint, ocular and medical history, medications, and visual requirements. The case history aims to understand the patient's reasons for visiting and acquire relevant background to determine appropriate tests and form a tentative diagnosis. Key elements include communication skills, exploring the chief complaint and symptoms, and using common abbreviations in documentation.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
4. QUALITY SUBJECTIVE EXAMINATION
Clear communication
Speak slowly and deliberately
Keep questions short
Ask only one question at a time
5. RESULTS OF SUBJECTIVE EXAMINATION
Source of the symptoms and/ or dysfunction, i.e. the structure(s) at fault
Factors contributing to the condition, e.g. environmental, behavioral,
emotional, physical or biomechanical
Alerts the clinician about further examination
Precautions or contraindications to the physical examination
Prognosis of the condition
How best to manage the patient's condition
9. FUNCTION
How the symptoms vary according to various daily activities
Detailed information on each of the daily life activities is useful in
order to determine
Structure(s) at fault
Identify clearly the functional restrictions
10. STAGE OF THE CONDITION
Knowing whether the symptoms are getting
Better
Worse
Remaining static
11. GENERAL QUESTIONS
Special questions
General health
Weight loss
RA
Drugs
Steroids
Anticoagulants
X-ray
Cord symptoms
Dizziness
13. SPECIAL QUESTIONS FOR LUMBAR SPINE
Cauda Equina (compression of the spinal cord that could lead to serious long
term damage to the cord unless treated immediately)
Any bladder or bowel dysfunction
Bilateral neural symptoms in both legs
Perineum numbness/pins and needles
Unremitting pain
14. SPECIAL QUESTIONS FOR CERVICAL SPINE
Signs of some Cervical Arterial Dysfunction, upper cervical instability, disease
of inner ear
5 D’s
Dizziness
Drop attacks
Dysphagia (swallowing problems)
Dysarthria (speech problems)
Diplopia ( Double vision)
15. HISTORIES
History of the present condition (HPC)
How long the symptom has been present
Whether there was a sudden or slow onset of the symptom
Past medical history (PMH)
Details of any medical history(THREADS)
History of any previous attacks
Results of any past treatments
Social and family history (SH,FH)
Age of the patient
Employment
Home situation
Dependents
16. Subjective
Examination
Body Chart
Type & area of
symptom
Depth
Quality
Intensity
Abnormal
Sensation
Relationship of
Symptoms
Behavior of
Symptoms
Aggravating
factors
Easing Factors
Severity &
Irritability
24 hrs behavior
Daily Activity
Stage of Condition
Special
Questions
General Health Drugs
Steroids
Anticoagulants
Weight loss –
recurrent
unexpected
Rheumatoid
Arthritis
Spinal Cord
Cauda equina
symptoms
Dizziness X-ray (recent)
History of Present
Illness
How it started?
Past Medical
History
Relevant Medical
History
Previous Attacks
Effects of previous
treatments
Social & Family
History
Age
Gender
Home of work
situation
Dependents
Leisure Activities
Subjective Examination in Physiotherapy
This article will discuss the subjective examination for physiotherapists in terms of what to ask and why we ask these questions in the clinical reasoning process. We use the subjective assessment in order to assess the biopsychosocial context of the patients current pain state. What this means, is that when we gather our subjective information, we are not just thinking about the source of pain in terms of a pathological process, but also how the persons social and psychological state is affecting there pain.This leads us into our objective examination with a working hypothesis of what factors may be contributing to the persons pain and therefore what tests are more of a priority when physically assessing along with helping us clinically reason what we are doing with the patient and why.It is very important to asterisk your main subjective findings so that you can use these subjective markers as you treat the patient on following visits in order to measure progress.What follows is a list of a subjective exam which is by no means an exhaustive list but covers the main areas you need to discuss and more importantly why you are asking questions in each section.Before we start i will give a list of red flags for serious pathology. These are discussed throughout the article but i think its important to be aware of these things as you go through the assessment. This enables you to have your radar raised for serious pathology that may need an onward referral. You are looking for an abnormal pattern which includes some of the red flags and doesn’t seem like something that physio is appropriate for. Obviously a lot of patients will have some of the red flags and the findings should be taken in the context of the complete clinical picture before an onward referral is made.RED FLAGSUnexplained weight lossConstant unremitting painOver 55 years old or under 20Widespread neurologyPast history of cancerTraumaThoracic pain without obvious causeCauda equina symptoms (see bottom of article)CAD symptoms (see bottom of article)The following is a general guide as to how i flow through my exam but as long as you get all the info, do it in any order that suits you.HPC (history of present condition) – Firstly you want to find out the history of the present condition1. How long have they had the pain for?This gives you an idea of whether they are in an acute phase or a chronic state and what stage of healing they may be in if you are hypothesising a soft tissue/bone injury (obviously these stages overlap)2. When did it start? MOI (mechanism of injury)/ insidious?This will tell you if there was a form of trauma which should always give you suspicion of a fracture if they have not had any scans. It will also give you an idea of possible tissues that may have been stressed during the trauma based on the direction of trauma and force/speed of trauma.3. Did your life circumstances or activity levels change at this time?This gives an indication of any stress at this time or possible overload due to increasing training etc4. Is the pain getting better, worse, static or episodic since it started?This will indicate the state of the pain state and pain that is getting worse will generally take longer to recover from than pain that is progressively improving. Also if the pain is episodic you can try to establish patterns of movement or behaviour around these times to see if certain situations increase and reduce the pain5. Have they seen anyone about the current episode of pain?This will indicate whether they have seen there GP and give you info as to whether any scans have been taken which can be very useful in situations of trauma to rule out fractures and/or soft tissue ruptures/tears. It will also tell you if they are under the care of any consultants and give you insight into there current direction of treatment. It is also useful in talking about what they have been told by other professionals as this can have a big impact on there psychological/emotional state with regards to the pain.6. Have they had the same problem before and if so how was it treated?This gives valuable info into whether their problem keeps repeating itself which gives an indication that they are not getting to the bottom of their problem with previous treatment. It also gives an indication of treatments that may have worked for the patient recently and also ones that have not worked and gives you an insight as to what sort of treatment the patient expects and whether some education may be necessary as part of the patients treatment plan.PC (presenting condition) – Discuss the symptoms as they present now 1. Body chart/location of pain?The location of the pain will give an indication of the possible sources of pain through structures directly beneath the site of pain and also structures that refer into that area of pain. If you have multiple areas of pain you will also gain info on how each area interacts with the other which will either implicate one structure causing the pain or multiple structures causing the different areas of pain. Asking which pain is the worst can direct your assessment in situations where a patient has multiple sites of pain.2. What is the Quality of pain?This can give you some indication of the nature of pain but you must be mindful that this is very subjective and can be misleading. Some proposed areas relating to quality of pain is below:Bone = Deep, nagging, dullMuscle= Dull acheNerve root= sharp shooting, electric shockSympathetic= Burning, pressure, stingingVascular= Throbbing diffuse pain3. What is the intensity of pain? (use VAS or NRS)You can use the VAS for this but i generally use the NRS (numerical rating score from 1-10). This will give you an idea how severe the pain is at present which will guide your objective assessment. It gives you a good subjective marker that you can return to in future sessions in order to chart progress.4. Is it constant or intermittent?Constant pain which does not change must be viewed with caution as this is a red flag for malignancy and/or metabolic disease. Pain which is constant but varies in intensity and allows sleep although possibly disturbed is a sign of inflammation. Pain which is intermittent in nature in that it is only there on certain movements suggests a mechanical source of pain and pain that is intermittent which increases as an activity is carried out is indicative of ischaemic postural type pain.5. Is there reffered pain or any Pins and needles/numbness?Pain which refers a long way from the site of pain does suggest some nerve root irritation, Pins and needles and/or numbness is a definite sign that the nerve root and/or peripheral nerve is involved although this could also be caused by vascular disorders like diabetes so this must be taken into acount. Pain that is reffered a long way from the source of pain suggests more severity than pain which is quite local to the source of pain.6. What are the Aggravating factors?This gives you insight into what positions/movements/behaviours/feelings make the pain better and worse and will then indicate certain structures that may be at fault for the pain. This is a great time to determine the irritability of a pain state. If the pain is brought on quickly and takes a while to settle this would indicate an irritable condition. One which comes on and then goes immediately on cessation of an activity would generally be said to be low irritability. Obviously there can be different combinations of this and also different movements may be more or less irritable. This will guide your physical exam as for a condition that is highly irritable you may want to do the test in a specific order as once the pain has been aggravated you are more likely to get a lot of false positives with certain tests. It also gives you an indication of the relationship between symptoms as you can determine if painful sites come on together or separately with the same activities. You can also ask about commonly known positions of aggravating positions such as below:TMJ – Yawning, chewing, talkingC-spx- Reversing car, sitting, readingT-spx- Deep breathL-spx- Sitting, standing, bendingSIJ- Standing on one leg, turning in bed, getting out of bed, walkingHip- Squat, walking, stairsFoot/ankle- Walking, running* Make a note of how symptoms affect functional activities.7. What eases the pain?Gives you an indication on irritability and confirms relationship between pain. Does painkillers reduce the pain if so what type? This may give you an indication as to the type of pathology going on.8. What is the 24 hour pattern of pain?Night symptoms – joints have less force in lying so should be less painful in such conditions. Ask what position is most comfortable. It is common to be woken with pain as turning in sleep may aggravate symptoms but constant night pain that gives no ability to sleep should be viewed with caution of malignancy. Ask about pillows if a C-spx problem plus firmness of mattress in spinal patients can be useful information.Morning symptoms – Morning pain with minimal improvement suggests inflammation. Pain in AM which gets slightly better with movement but worse as the day goes on is linked to OA.Increasing through day suggests some postural type pain so need to find out what they are doing during the day that seems to be causing the increasePMH (Past Medical History/Screening questions)1. Is your general health at present good? No unexplained weight loss? Constant night Pain? Gait disturbance?Gives you an idea of if they feel unwell which could indicate systemic or metabolic problems. Unexplained weight loss, constant night pain and gait disturbance/coordination issues are all signs of possible malignancy or serious pathology that would require referral.2. Ask about THREADS (Thyroid, Heart, Rheumatoid, Epilepsy, Asthma/Respiratory, Diabetes, Steroids)Thyroid problems are assosaited with increased neuromuscular issues such as frozen shoulder and dupytrens plus carpal tunnel. You also want to know if this is controlled.Heart problems may give you an indication of how good the circulatory system is so may flag up vascular issues that could contribute to the pain plus if a pacemaker is fitted this will limit some treatments that you can do as it is a contraindication so is important info to obtain.Rheumatoid or inflammatory joint disease may be a causative factor in the pain but may not. Avoiding accessory motions to the C-spx and care with other joints is indicated in these patients as this can flare up symptoms.Epilepsy is something you want to be aware of in case of a fit and find out if it is controlled plus what type of epilepsy so you know if there is a likeliness of a fit or not.Asthma you want to find out if it is controlled plus if problems are around thorax some breathing strategies may be helpful in terms of not aggregating the symptomsDiabetes is associated with poor healing and peripheral neuropathiesLong term oral steroid use has been associated with osteoporosis, skin quality is often reduced so taping need to be careful and handling needs to be done with care.3. Any history of Cancer?Pain associated with current malignancy might not be relevant for physiotherapy, history in the family or with the individual may raise your suspicion levels if other red flags are present.4. Previous surgery?This gives you an idea of previous medical issues they may have forgot about (you would be surprised how often this happens) also gives an indication of previous injuries. Hysterectomies have also been linked with osteoporosis.5. Previous fractures?Gives an indication of possible weak points in the patients system plus previous injuries6. Osteoperosis/bone disease?This gives you info on bone strength which is important in treatment as you may want to avoid manipulations and handle with more care when/if doing manual therapy7. Pregnancy?If the patient is getting pelvic girdle pain this could be due to pregnancy. You also want to be careful as in the first trimeter there is increased risk of miscarriage so certain treatments may be contraindicated at this stage.Special Questions for Lumbar spine and C-spxL-spx Cauda Equina (compression of the spinal cord that could lead to serious long term damage to the cord unless treated immediately)Any bladder or bowell dysfunctionBilateral neural symptoms in both legsPerineum numbness/pins and needles/strnage sensationsUnremitting painC-spx signs of some Cervical Arterial Dysfunction, upper cervical instability, disease of inner ear (possibly cranial nerves – Look up my cranial nerve testing article)DizzinessDrop attacks (feinting feeling like your going to faint)Dysphagia (swallowing problems)Dysarthria (speech problems)Diplopia ( Double vision)DH (Drug history)Are they on any medication?Gives you an indication of health issues, Anticoagulant therapy patients need to be handled with care. If they have been prescribed pain meds then its important to know what type and if they are helping. Long term pain meds can cause addiction and need to be aware of the psychological aspect that this causes in a pain state.SH (social history)1. What do you do work wise?This will give an indication of general postures adopted during the day and the affect this has on the pain2. What activities/sports/hobbies do you do outside of work?Gives an indication of activity levels, can determine if is able to do current levels outside of work or if unable.Couple of important questionsWhat do they think is going on?We are often quite perceptive about what is going on in our bodies and its sometimes useful to get the patients perspective on whats happening. Also gives you an insight to their state of mind about the issue.What are you expectations?Its often helpful to get the persons expectations of physio treatment and also about the treatment. Some patients will need more education than others and some expectations will need to be revised at times when these expectations are not helpful to their pain state e.g. when a patients perception is they need to stay still to prevent their back pain, we know this is not true so need to educate them.
Peripheral joint questionsYou can also ask about swelling, clicking, grinding, giving way and locking which is especially important in the knee where true locking where the patient cannot move the leg is a sign of a bucket handle meniscal tear which needs onward referral.So there you have it, a pretty comprehensive look at the subjective assessment and how to interpret the questions you are asking so you don’t just ask the questions, you actually know why you are asking them and what to do with the answers. Obviously there are other questions that can be asked but if you go through the list here and get confident and comfortable you won’t go far wrong.
By the end of the subjective examination the
clinician needs to decide Oones 1 994):
• the source of the symptoms and/ or
dysfunction, i.e. the structure(s) at fault
• what factors are contributing to the condition,
e.g. environmental, behavioural, emotional,
physical or biomechanical
• whether there are any precautions or
contraindications to the physical examjnation
• the prognosis of the condition - this can be
affected by factors such as the stage and extent
of the injury as well as the patient's
expectation, personality and life-style
• how best to manage the patient's condition