physiotherapy
TRANSCRIPT
demonstration class taken on 19/11/07
physiotherapydr. ashish gohiya assistant professor department of orthopaedics gandhi medical college bhopal d
*the responsibility of the doctor does not end when the temperature touches normal and stitches are removed *the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability. *medical rehabilitation *vocational rehabilitation *social rehabilitation *psychological rehabilitation
rehabilitation
*(who (1969) techn. rep. ser. , no. 419)
rehabilitation
physical medicine and rehabilitation *its not after care, it is a part of care. *it includes*assessment of the patient *planning the intervention *implementing the treatment *evaluation
physiotherapy
*altering the treatment if required.
*physiotherapy during immobilization *physiotherapy after removal of immobilization. *to reduce edema limb elevation, static contraction of the muscles reduce adhesions. *maintenance of circulation *maintain muscle function *maintain joint range *maintain optimal function
trauma
during immobilization
*to reduce swelling *to regain full range of movement pain, edema, adhesion, muscle weakness. *to regain full muscle power *to re educate full function *passive movement *assisted active movement *free active movement *resisted movement
after removal of immobilization
movement technique
*indicated when patient can not perform the movements on his own*muscle paralysis / weakness *patient not conscious *range of joint movement *muscle length
passive movement
*passive movements regain
*starting position *grasp *position of therapist *traction *movement *indicated when
passive movement
assisted active movement
*muscles are weak *free movement is painful
*patient is encouraged to do most of the movement with the physiotherapist assisting when necessary. *suspension slings may be used for assistance *movements performed by the patients without external assistance or resistance. *indicated to*increase the range of joint movement *increase the muscle strength *retrain balance and coordination *regain independence
active movement
*pain
range of movement
*swelling
*protective mechanism - may be a contraindication to active exercise. *medical treatment , electrical , thermal t/t. *limb elevation *static contraction of muscles *free exercise of other joints *stretches the adhesions *improve the blood supply
*adhesions
to strengthen the muscles
*technique will depend on the grade of the muscle.*grade 0, 1 *grade 2 (gravity counterbalanced ) *grade 3 (against the gravity ) *grade 4 (against mild resistance ) *grade 5 (normal power)
*increasing the no. of times the movement is made. *gradually increasing the resistance. *this is problem with muscle weakness and neurological deficit. *started with forearm supported prone lying, progressing to prone kneeling, half kneeling, sitting and standing. *in coordination due to muscle weakness improves on improving the muscle power. *to facilitate activity and strengthen muscles. *resistance to the movement can be given by*physiotherapist *patient himself *mechanical resistance
retrain balance & coordination
resisted exercises
*weights *springs *electronic operated machines.
*this modality includes use of various methods of heating or cooling the tissues. *heating the tissues*paraffin wax *ir radiation *heat pads *hot moist packs *short wave diathermy *ice therapy
electrotherapy
*cooling the tissues
paraffin wax
*low melting point 40 oc 44 oc *heats slowly but retains heat for long *wax solidifies on the skin - energy released by the latent heat of fusion results in - heating of tissues. *only for distal part of extremities
*radiation are absorbed radiant heat is converted to heat. *two type of generators *rays should strike the part at 90o*luminous penetrates epidermis and dermis *non luminous penetrates only sup. epiderm
infra-red radiation
*effects
infra-red radiation
*vasodilatation in tissues *improves nutrition *removes waste products *sedative effect on sensory nerve endings *relaxes muscles
*plastic covered pads *pad has three level of heating *used for treating neck & back *pt. lies on it, heat passes by conduction *canvas bags filled with hydrophillic substance *part covered by towels packs applied and moulded to part heat passes by conduction *moist heat is conducted more uniformly than dry heat.
heat pads
hot moist packs
*application to tissues an electric field which oscillates at a frequency of 27.12mhz& have a wave length of 11.06 m. *the oscillating field produces distortion of molecules which generates heat. *the amount of heat depends on the arrangement of field and electrical impedance of tissues*can be used to treat both superficial and deep lesions *rapid and greater rise in temperature than conductive methods. *swd can be pulsed, during resting period the heat is dispersed in to tissues through circulation and the treatment is non thermal
short wave diathermy (swd)
*when ice applied to skin it melts and removes the heat from the tissues (the latent heat of fusion) *application of cold leads to alternate vasoconstriction and vasodilation, reduced nerve conductivity and reduction of muscle spasm and spasticity. *used
ice therapy
ice therapy
*to relieve pain *reduce muscle spasm *reduce swelling *reduce spasticity *facilitate muscle contraction *increase muscle endurance *reduce hematoma formation *prevent pressure sore *promote healing of wounds
*production of longitudinal mechanical waves above the
ultrasound
audible range (20khz) *produced by distortion of quartz crystal by a high frequency alternating currents. *longitudinal sound waves cause to-and-fro movement of particles giving alternate areas of compression and rarefaction.
*treatment head is applied perpendicular to the surface. *head continuously moved to prevent concentration to one tissue site. *higher the frequency greater the absorption and smaller the depth of penetration. *lower frequency deeper penetration
ultrasound
*effects
ultrasound
*release of chemical mediators *proliferation of granulation tissue *stimulation of fibroblast *increased circulation *increased activity of phagocytes & macrophages *this results in healing and reduced pain.