Neuro therapeutic approaches in neuro rehabilitation : Workshops Details

neuro rehab

We have to study all the Neuro therapeutic approaches in  Neuro rehabilitation from BPT third year class, to fourth year and MPT.  In these Approaches there are similarities and differences, advantages and limitations of each approaches need to be understood and studied during our graduation.

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In third year and fourth year we need to discuss about it and show at least few techniques and do the demonstration on patients. It was very  difficult for me to understand all these components  and its was more difficult to apply these approaches in clinical practice.

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Even though i was exposed to these approaches/technique it was very difficult to practice it. There was not enough opportunity to attend these kind of workshops or training. this thought process regarding this issue has been continuously thought-provoking in my mind. And i have experienced my students coming to me with the similar problem. they have been facing the similar problem like i use to.

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There are so many approaches, What approach i suitable for my patient? This always a question with us all the time.

pt_2068_3236_o MiniToy on Crossroads what-to-do

What is the technique i use for improving the desired control? The more try to answer this question we get more confused and we reach no where.

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So i  am planning to conduct a series of workshop on different approaches in neuro rehabilitation. These workshop will include practical demos on patients, clinical application of these approaches.  These workshop  will emphasis on similarities and differences, advantages and limitations approaches.

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Date Topic Participant Criterion Participant fee INR Resource No. of days
13/09/2014 Neuro therapeutic approaches in  neuro   rehabilitation :part I-  Proprioceptive neuro Muscular facilitation.


4th year +, BPT, MPT30 students MAX Indian –RS 1000/-International US $25/- Dr. GAJANAN BHALERAO (PT) 1 DAY
18th & 19th October 2014  Neuro therapeutic approaches in  neuro   rehabilitation : Part II-  NDT /Bobath approach in Adult hemiplegia  4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/-/ Dr. GAJANAN BHALERAO (PT) 2 DAYS
27th December 2014 Neuro therapeutic approaches in  neuro   rehabilitation  : part III-  Brainstorm & Roods approach 4th year +, BPT, MPT30 students MAX Indian –RS 1000/-International US $25/- Dr. GAJANAN BHALERAO (PT) 1 DAY
3rd & 4th January 2015 Neuro therapeutic approaches in  neuro   rehabilitation : part IV-  Motor relearning program 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/- Dr. GAJANAN BHALERAO (PT) 2 DAYS
28th February 2015 Neuro therapeutic approaches in  neuro   rehabilitation : part V-  Recent advances with evidences.(CIMT, Mirror therapy, FES, BWSTT, mental imaginary training, strength training, robotic therapy etc) 4th year +, BPT, MPT30 students MAX Indian –RS 1000/-International US $25/-




Other Workshops

November2014 Spinal cord injury rehab 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/-/ Dr. GAJANAN BHALERAO (PT) 2 DAY
13th & 14th December2014 2D and 3D gait analysis and management of gait deviation 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/- Dr. GAJANAN BHALERAO (PT) 2 DAYS
14th & 15th March 2015 Neuro therapeutic approaches in stroke   rehabilitation:  part VI-  Motor control & Strategies to improve motor control 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/- Dr. GAJANAN BHALERAO (PT) 2 DAYS

Please give your suggestions 1akuzic3mu6ujpl6tedtew

Workshop on ” Neuro therapeutic approaches in neuro rehabilitation : part I- Proprioceptive neuro Muscular facilitation” on 13th Sept 2014 ​

On the occasion of word physiotherapy Day on  in month of September

Sancheti Institute College of physiotherapy, Sancheti healthcare academy

  ​organizing​ a one  days work shop on​

Neuro therapeutic approaches in  neuro   rehabilitation : Part I-  Proprioceptive neuro Muscular facilitation

Date :- 13th Sept 2014

Contact hours – 8hrs

Eligibility – Clinical Therapist, Post Graduate, 3rd & 4th year students and Intern

Registration fees: - Rs 1000 per candidate.

Venue: – Sancheti Institute College of Physiotherapy Shivajinagar, Pune.

Limited Entries: 30 Only

Course instructor

Dr. Gajanan Bhalerao (PT)

Master of Physiotherapy (Neurosciences)

Certified Adult NDT (C/NDT) Therapist

Associate professor Sancheti Institute College of Physiotherapy

HOD Physiotherapy Dept Sancheti Hospital

Shivajinagar, Pune.

Kindly send registration on


  1. Definition and neurophysiologic bases of PNF
  2. Principals of PNF
  3. Pattern of movement –D1 and D2
  4. Pattern of movement in upper limb – unilateral pattern, bilateral pattern, symmetrical, asymmetric and reciprocal pattern of UL.
  5. Pattern of movement in lower limb – unilateral pattern, bilateral pattern, symmetrical, asymmetric and reciprocal pattern of LL.
  6. Training of use these patterns in patient treatment.
  7. The approached PNF techniques will be: Slow Reversals (SR), Slow Reversal Hold (SRH), Repeated Contraction (RC), Timing for Emphasis (TE), Agnostic Reversals (AR), Hold-relax Active Movement (HRAM), Resisted Progression (RP), Rhythmic Rotation (RR), Hold-Relax (HR), Contract-Relax (CR), Rhythmic Stabilization (RS), Rhythmic Initiation (RI), Alternating Isometrics (AI),
  8. Use of PNF for facilitation, inhibition or stability
  9. Exercises for stability, mobility and coordination.
  10. Training of activities of daily living, ambulation and transfers training using PNF.



Associate Professor

Masters in physiotherapy, Neurosciences,

Certified Adult NDT (C/NDT) Therapist

Sancheti Institute College of physiotherapy,

HOD Physiotherapy Dept Sancheti Hospital

Shivajinagar, Pune.

Credits : University Topper in Master of Physiotherapy 2007 Pune university


Work Shops Conducted (Continued Medical Education)

  1. Workshop on Motor Relearning program for stroke

Rehabilitation at Youth Men Christian Association (YMCA), Pune, on 29th & 30th of March 2007.

  1. A 2 day workshop under Indian Association of Physiotherapy Pune branch, on “Spinal Cord Injury Rehabilitation” in 2008
  2. Resource person for the pre conference workshop and lecture during National Seminar On Multidisciplinary Approach To The Management Of Paediatric Disabilities organized by Faculty of Disability Management and Special Education Ramakrishna Mission Vivekananda University SRKV, Coimbatore, Tamil Nadu 641 020, INDIA. June 2010
  3. A workshop on 2D & 3D Gait Analysis And Management Of Gait Deviations organized by Indian Association Of Physiotherapy Pune & Pimpri Chinchwad Branch on 27th &28th November 2010, at Sancheti institute college of physiotherapy.
  1. A workshop Motor Relearning program for stroke Rehabilitation on October 2010, organized by Indian Association of Physiotherapy Pune & Pimpri Chinchwad Branch on 27th &28th November 2010, at Sancheti Institute College of physiotherapy.
  2. A workshop on 2D & 3D Gait Analysis And Management Of Gait Deviations organized by Indian Association Of Physiotherapy Pune & Pimpri Chinchwad Branch on 27th &28th November 2010, at Sancheti institute college of physiotherapy.
  3. A workshop Spinal cord injury Rehabilitation, organized by Indian Association of Physiotherapy Pune & Pimpri Chinchwad Branch on December 2010, at Sancheti Institute College of physiotherapy.
  4. A workshop Spinal cord injury Rehabilitation, organized by Sancheti healthcare academy on December 2012, at Sancheti Institute College of physiotherapy.
  5. A 2 day Workshop on Task specific training in neuro rehabilitation, on 30 -31sept 2013, at Mission health physiotherapy centre Ahmadabad, Gujarat.
    Hurry up! limited sits only.

    For eligibility  program & Registration from details click attachment.

    Please forward this information to the interested therapist and students​.​




…..A Practical Approach

On 16th and 17th August 2014
Course instructor
Dr. Gajanan Bhalerao (PT)
Master of Physiotherapy (Neurosciences) Associate professor
Sancheti Institute College of Physiotherapy Shivajinagar  Pune.

Contact hours – 16

Eligibility – Clinical Therapist,

Registration fees: - Rs 2000 per candidate.


In this course 44 students, clinical therapist and teachers   attended the work shop. The workshop included the motor control theories, different introduction approaches fours steps of MRP Assessment . Different  activities of daily living and assessment and treatment in these activities is taught. activities such as Training of Supine to sit, Training of Sitting Balance, Training of Standing Balance,Training Of Standing Up & Sitting Down, Training of Upper Limb control, Shoulder hand syndrome,  Gait Training, Orthotic prescription and management of Genu recurvatum.

Participant were taught how to set the goals according to task analysis and lifestyle, contextual and environmental factors in his own home/village/town/city.

Practical demos of treatment on patients  was shown.

Workshop schedule 

DAY ONE 16/08/14



9.30 -1.00 am INTRODUCTION  
Stroke anatomy and physiology
Localization of lesion
Theories of motor control
Neurophysiological approaches(their differences and limitations)

  1. Muscle Re-Education Approach
  2. Neurotherapeutic approach

Sensorimotor approach

Movement therapy approach (Brunnstrom,)

Bobath approach

PNF approach (Knot and Voss)

  1. Task- specific approach system model of motor control

Motor relearning program for stroke (1980s)

Contemporary task-oriented approach (1990s)


What is importance of the task specific approach? (Carry over, Neuroplasticity)
  General Assessment of stroke & common problems
1-2pm LUNCH
1.00 – 5.00 PM MRP Assessment
Step 1 Analysis of task
Step 2 Practice of missing component
Step 3 Practice of task
Step 4 Transfer of training
Training of Supine to sit
Training of Sitting Balance
Training of Upper Limb control




Day Two 17 /08/ 14

Time Topic
9AMTo1.00 PM Training Of Standing Up & Sitting Down
Training Of Standing Balance
Orthotic prescription
Gait Training
1.00 pm to 2.00 pm LUNCH
2-3.30pm Complications and its management
Shoulder hand syndrome
Genu recurvatum
3.30 pm – 5.00 pm  Pool of Evidences of Stroke Rehab
Case discussions

The workshop focuses on practical demonstration & handling techniques in the Neuro rehabilitation. The workshop also aims at enhancing the skills of the participants & better understanding of problems commonly encountered in the management of stroke patients. Besides the workshop will emphasis on insight into unique case studies as well.



 on 16th & 17th Aug 2014


  1. The PPTS were short and precise, clinical assessment was long and required.
  2. Excellent workshop; it was more beneficial because we had learnt things on the patients.
  3. Food was good too.
  4. Great workshop, teacher was good , and friendly workshop.
  5. Preparations made by college were systemic.
  6. Was the first workshop ever attended and really liked it, enjoyed a lot, got to know my mistakes while treating patients.
  7. Explanation of theory was simplified.
  8. Optimally arousing workshop.
  9. Teaching methods and practical sessions.
  10. Demo on patients was good.
  11. Understood MRP for the first time.
  12. Will help patients in Nanavati hospital .
  13. Practical approach to treat hemiplegics.
  14. Knowledge with fun workshop.
  15. Regular attitude with patients of Sir.
  16. More task-specific.
  17. Excellent environment.
  18. Motor control theories were made easier.
  19. Interaction with students was good.
  20. Not sleepy at all.
  21. Learnt the importance of BOS in every movement.
  22. Basic concepts got cleared today.
  23. Totally new concept of rehab.
  24. Biomechanics concept was taught again.


  1. The teaching speed bacem fast sometimes.
  2. Got heavy post-lunch.
  3. Include all participants in the activities.
  4. More explanation of every specific activity, assessment.
  5. Vast topics so slow bombardment of topics is advised.



  1. Behavioral sciences.
  2. The body follows the biomechanics and so should we while treating the patient.
  3. Learnt to give task specific activities.
  4. Assess functional activity directly without checking MMT, tone, reflexes.
  5. How the treat the lateral slouch
  6. Use of heel raise – sit to stand.
  7. Without touching perform the activity.
  8. Theories of motor control.
  9. Constraint is not only resisting but preventing an abnormal, unnecessary movement.
  10. Self confidence is important.
  11. Communication with the patient
  12. Task-specific
  13. Postural components are important to target.
  14. Analyse the function and treat.
  15. Learnt how to treat patients without much energy expenditure.
  16. ‘What not to do’ in treatment.
  17. Command to patients is important.
  18. Line of gravity and centre of mass importance.
  19. Tangent- bridge concept.
  20. Analyse demand of task.
  21. New phrases- invite muscles, create opportunities.




Workshop Standard

Knowledge of the Course Instructor

Presentation of the Course instructor

The manner in which your queries and doubts were handled -answered

Relevance of the Workshop contents to your Professional practice

Value for your money

Venue arrangeme

Food quality




Participant 1.


  • The behavioral sciences was something new.
  • Each component of sit to stand , supine to sit was practically amazing .
  • In neurosciences not necessary that neural involvement makes an activity difficult but other system involvement should be considered also .
  • Doubts were cleared.


  • Theories of motor control
  • Alignment
  • Assessment
  • Biomechanics


Participant 2

Good points –

  • Understood well
  • Simple language
  • Functional assessment was taught well


What did I learn today ?

  • How to change behavior of the patient ?
  • Task specific activities



Participant 3.

Good points –

  • biomechanics
  • how to approach the patient


What I have learnt today ?

  • the bioemchanics and its use in treatment



Participant 4

Good points –

  • good food and tea
  • nice way of diverting from topic and keeping us awake in lecture


Bad points –

  • please explain basic terms
  • teach simple things after lunch


what I have learnt today ?

  • assessing functional activity and then treating like wise
  • lateral slouch technique
  • to give heel raise


Participant 5

Good points – ppts were good


Bad points –

  • practicals would’ve been more beneficial


What ive learnt today ?

  • Proper handling and commands beneficial
  • Theories of motor control
  • Practical sessions were good


Participant 6

Good points –



Bad points –

  • 2days is less duration


What ive learnt today ?

  • Motor control
  • Reflex theory was taught well
  • I learnt how to make others happy during therapy



Participant 7

Good points –

  • Misconceptions were cleared
  • Correlation with patients imeediately helped


What ive learnt today ?

  • Simple and easy techniques were taught
  • Energy expenditure was less


Participant 8 –

Good points –

  • Learnt new words
  • Concepts were cleared

What ive learnt today ?

  • Good rapo with patients
  • Behavioral attitudes of patients


Participant 9 –

Good points – handling was well taught

What ive learnt today ?

  • Communication with patient was well explained
  • Minimize therapist’s work by using proper biomechanics


Participant 10 –

Good points –

Understood what was taught and environment was good enough

Bad points –

Break of 5-5 mins in between

What ive learnt today ?

  • View of treating the patients changed
  • Functional tasks help patient
  • Patterns of activities


Participant 10-

Good points – nice and interesting seminar

Bad points – Food was ok

What ive learnt today ?

Treating the patient in a better way


Participant 11 –

Good points – interesting lecture and learnt many things


Participant 12 –

Good points –

  • liked the teaching method
  • question answer session

Bad points – Breakfast

What i have  Learnt today ?

  • commands to the patients
  • how to emotionally handle the patients?


Participant 13 –

Good points-


Bad things –

  • food

What ive learnt today ?

  • totally new concept of treating patient
  • biomechanics
  • theories



Participant 14-

Good points –

Great workshop and it has helped a lot

What ive learnt today ?

Theories of motor control was taught really well


Participant 15 –

Good points –

  • Task specificity
  • BOS importance
  • Anatomy and physiology of nerve conduction

What ive learnt today ?

Satisfied with all the knowledge gained.


Participant 16 –

Good points –

Easy an inspiring workshop and great environment

Bad points –

Saturation after lunch .

What ive learnt today ?

Motor control theories


Participant 17-

Good points –

Practical sessions were great.

Bad points – Nothing as such .

What ive learnt today ?

Rehab of patient can be done with commands


Participant 18 –

Good points –

Practical sessions and food were great .

What ive learnt today ?

Assessment and treatment should be the same


Participant 19 –

Good points –

Interaction with students and question answer session wee good

Bad Points – time constraint

What ive learnt today ?

New words like constraint, alignment , postural adjustments .


Participant 20-

Good points –

  • Workshop content
  • Hand on training
  • Motor control theory
  • Mrp in daily tasks


What ive learnt today ?

  • Task oriented activities
  • Analysation of patient
  • Allowing patient to the prep phase and correcting it.



Participant 21

Good points –

Workshop was great


What ive learnt today ?

Approach is task oriented


Participant 22 –

Good points –

Workshop is excellent

Good interaction

Good food


Bad points –



What ive learnt today ?

Informative session ,

Invite the muscle

Simple ways




Participant 23-

Good points-

Practical sessions

Cleared common myths regarding stroke rehab.


Bad points –

Gets boring after lunch


What Ive learnt today ?

Old techniques were corrected.

Confidence was increased.

Create opportunities.


Participant 24-


Good points –

Great workshop.

New things .

Interaction was good.


Bad points- food

What ive learnt today ?

Task specific assessment .

Interaction with patient.

Commands to be given to patient.

Behavioral changes.


Participant 25 –

Good points –

Teaching method .

Good interaction.

On patient handling.


Bad points – more explanation on basics.


What ive learnt today ?

New concept of mrp.


Participant 26-

Good things-

Demo on patient


Bad things – food


What ive learnt today ?

Patient’s cooperation required in mrp.



Participant 27-

Good points-

Practical and handling of patient.

Keeping me focused on the lecture.


Bad points –

Slow bombarding about the topic.


What ive learnt today ?

New dimensions in patient – therapist sessions.

Behavior about learning and understanding problem-solving.



Participant 28 -


Good points-

Great understanding of the topic.

Interactive sessions.


Bad points –



What ive learnt today ?

Completely new dimension of neuro- assessment and treatment.



Participant 29 –


Good points –

Great interactive session.

Functional assessment .


Bad points –



What ive learnt today ?

Treatment is task – specific always which will help the patient .



Participant 30 –


Good points –

Practical approach to treat hemiplegics.

Simple approach to treat and assess too.


Bad points-



What ive learnt today ?

Excellent content about functional assessment and treatment.


Participant 31 –


Good points-

Assessment was great .

Analysis of the task was taught well.


Bad points –



What ive learnt today ?

Motor control theories .

Step wise analysis of the task.

Deep well and shallow well phenomenon.

Task specific approach.



Participant 32 –


Good points –

Knowledge with fun.

Attitude to talk to the patients.


Bad points –



What ive learnt today ?

Deeper knowledge of stroke and mrp.



Participant 33-


Good points –



What ive learnt today ?

Practical application which is usually required in day to day activities.



Participant 34-


Good points –

Presentation was great .



What ive learnt today ?

New approach towards rehab .

Participant 35-


Good points –

Practical- oriented .

Content was great.


What ive learnt today ?

My behavior with the patients was changed.



Participant 36-


Good points-

Good ppts.

Practical was better.


What ive learnt today ?

Totally new concepts and technique .



Participant 37 –


Good points –

Great way of teaching.


What ive learnt today ?

Lesser energy consumption techniques for the therapist .


Participant 38 –


Good points –

Friendly way of teaching .

On patient learning was great .

Good arrangement by the college.


What ive learnt today ?

Constraint and BOS topics were discussed.





Participant 39-

Good points-

Corrected my wrong ways of treating the patients.


What ive learnt today ?

Amazing experience.

Learnt how to develop rapport with the patient .


Participant 40 –

Good points-

I was optimally aroused.

Great on patient demo.

Less ppt.


Bad points-

Small batch of students should be there while treating and assessing the patient.


What ive learnt today ?

Analyse the demand of task of patient and then treat accordingly.



Participant 41-

Good points –

Learnt many things which ive not learnt in my ug .


Bad points-

Afternoon session went tangent.

What ive learnt today ?

Most of the basic concepts.


Pariticipant 42-

Good points –

Gait observation was great.

Assessment .

Great food.

Bad points-

Just go little slow.


What ive learnt today ?

Tangent – bridge concept.

Behavioral problems.



Participant 43 –


Good points –

Excellent environment.

On patient learning better.

Allowance to directly analyse patients by assessment.


Bad points –


Time constraint of only 2 days .


What ive learnt today ?

Basic approaches .

Handling of patients.

Task-oriented management .





Name-Shradhha Kodilkar

What I learnt-

-I liked the sentence ‘’Do not work on mobility if stability is not there… ’’Routinely we work on mobility first, so this will help me to see and prevent shoulder hand syndrome in stroke patients.

-WHAT WORKS FOR THE PATIENT IS TREATMENT, AND WHAT DOES NOT WORK IS ASSESSMENT! So I won’t force the patient to perform any activity which he is finding difficult.

-Hence forth my commands will change while treating patients. Also we should understand what patient wants him/her to improve and what we want him/her to do.

Good points-

. It was a great workshop




What I learnt-

-I learned how to mobilise adult with grade 0 control.

Good points-

-Good practical demo

-appreciate the efforts of calling patients on Sunday/holiday weekend.

-Custom made fast food provided.

Bad points-

-The calibre of participants should be at least graduates as the session becomes less interactive.



Name-Rashmi Kulkarni

What I learnt-

-Being neuro physiotherapist I used to think that I don’t have to read biomechanics to know dynamics. But it is very important.

Good points-

-I really liked the workshop and will definitely attend all the workshops in future.

Bad points-






What I learnt-

-Traditional approach of assessment is good to follow, but the new way task oriented approach of assessing range, function, strength, voluntary control is very interesting.

-Small biomechanical mal alignments result in major deviations.

-Eccentric lengthening is more appropriate to deal with spasticity.

-Weight bearing affects the moment arm of long finger flexors of hand and thus results in increase in flexor spasticity, so stretch the muscle to its optimal length.

-First to change the ‘’BEHAVIOUR OF THE PATIENT ‘’ we need to change ‘’BEHAVIOUR OF OURSELVES’’

Good points-

-Learnt about of the importance of knowledge of result and how observation is necessary before formulating any treatment protocol.

Bad points-

-Duration of workshop was less so practical session was for shorter duration.



Name-Pratibha Salkar

What I learnt-

-I found out the missing component in our practice. I will start applying it into my practice and make my skill stronger to improve functional ability.

-Transfer of learning-using this into various activities and treatment.

-It started the motor relearning in me!

Good points-

-Wonderful workshop

-Great work sir. Thanks for arranging this workshop.

Bad points-




Name-Sabah Jhaver

What I learnt-

-It has cleared a lot of concepts which were previously not well understood.

-I am very eager to go back and apply all the new things that I have learned.

-The workshop has broadened my view and has helped change my views about stroke management.

Good points-

-The entire workshop was very interesting

-It was conducted in a very student friendly manner.

-It has been a very nice experience overall and I am looking forward to attend more workshops conducted by sir.


Bad points-

-It was very long.



Name-Dhara Mehta

What I learnt-

-There is nothing like wrong treatment.’’ WHAT WORKS IS TREATMENT WHAT DOES NOT IS ASSESSMENT’’Dr.Gajanan.

Good points-

-I learnt how to able the patient functionally

-Correction of certain commonly made mistakes.

-It was not only motor relearning, but also how it can be used with other approaches.

Bad points-




Name-Rupa Gulani

Thanks for everything and sharing your ideas with us.




What I learnt-

-Dual task training

-Bilingual task training

-Using tenodesis eccentric lengthening mfr to reduce spasticity.

-Gait training-Stance phase: Stability important, Swing phase: Initiation.

-Hand and upper limb task training.

-Hand grasp- Task training for fine motor skills.

-Path mechanics of hemiplegic shoulder and hand, and how to correct this alignment.

-Hurdle walking, Pelvic rotation, shifting of centre of mass.

Good points-

-More on patient explanation especially regarding preparatory postural adjustments, and going on postural adjustments during tasks.

Bad points-




Name-Shalmali Sulakar

What I learnt-

-I learnt that there is no fixed protocol. We can mix anything that can work on a patient.


Good points-

-This 2 day workshop was very knowledgeable and got to know how to use tenodesis and active insufficiency in regular treatment.

-The videos shown are very useful.

-Sir taught how to get along with patients and how to make a friendly atmosphere in the opd.

-Thank you so much sir for sharing your knowledge.

Bad points-




Name-Radha Joshi

What I learnt-

-I learnt many new things and will surely apply it on our college’s patients

-I am sure I am going back with lots of new and interesting knowledge

Good points-

-today’s workshop was excellent and I had written yesterday on feedback paper that I used to treat in a wrong manner but when sir explained it, I realised and now I will also be optimistic.

-I really enjoyed the workshop and looking forward to attend more workshops in future. Everything was just PERFECT

Bad points-




Name- Priya bang

What I learnt-

-I learnt so many new things like on the first day I came with lots of questions about approaches and neurosciences but after this workshop I think I can treat stroke patients not as good as you but I will try my best

-One more thing I like which you tell us


-I like the word “ZIKZAK” which explains that ZIK is an output of patient (which can be normal or abnormal), where ZAK is a cause which is responsible for zik. If u beat the zak automatically zik is corrected

Good points-

-Thank you for teaching us.

Bad points-





What I learnt-

About mrp and other neuro techniques

Good points-

-This workshop on mrp  was very knowledgeable and interesting.

-The environment he creates is simply mind awakening, actually it does not let you sleep at all, even for a second.

Bad points-NONE


Participant -14


What I learnt-

-Good tapping techniques and videos

Good points-

-Workshop was very good, understanding the basic corrective treatment for walking.

-Hands on patient was outstanding, especially technique for releasing of hand of patient stephon

Bad points-





What I learnt-

-About MRP, its benefits and limitations.

-MRP is useful in missing components like alignment, postural adjustments etc.


Good points-

-Since yesterday we are very attentive for lecture. I couldn’t distract my attention in fear of missing some important line which you have spoken… very interesting.

-Practical sessions were very good


Bad points-

-Though there were enough practical sessions, hands on for every person could have been improved.

-Some more instructors could have been there to help sir for practical sessions.




What I learnt-

-Many and various new concepts were learned

-Patient handling, communication, treating was taught

-Various exercises using different techniques

-Gait training, by actually doing it on each other was a good experience.

-Meaning of particular words/terms was understood

-Videos helped in tapping and exercises

Good points-

-The way of teaching was excellent

-All experience we got actually on patients

Bad points-





What I learnt-

-I have learned a lot of new things.

-The best thing u taught “what works is treatment and what does not work is assessment”

-I learned that correct the biomechanics the problem will automatically get solved

Good points-

-They provided good food

Bad points-




Name- Rasika athawale

What I learnt-

-Got to learn new concepts of treating stroke patients. Will surely help in the assessment and treatment of CVA patients.

-Learnt how to interact with patients very well

-Got to learn new meanings of words like postural control and alignment

- Frankly learnt biomechanics today in true sense. Will correct biomechanics henceforth


Good points-

-Good experience

-Thank you for such a great workshop

Bad points-





What I learnt-

-Taught us many new ways of treating the patient

-The sentences used by you are encouraging “whatever works is treatment and whatever does not work is assessment”

Good points-

-The time we spend was very valuable

-It was fun learning new things

Bad points-




Name-Ankita singh

What I learnt-

-right use of words at the right time was nicely taught by you.

Good points-

-Today’s session was again really new, innovative as well as creative.

-the friendly environment was created for the patient so that she/he becomes comfortable

-I didn’t feel “sleepy” even for a single minute.

Bad points-




Name-Sachin Pandey

What I learnt-

-One of the best experiences till now in neurology.

-Learn a lot from Dr Gaju Sir.

-One of the best things I got to know is how to treat a stroke or hemiplegic patient.

-Now I can treat the patient without using much support.

-It was the first time in the past year that I learned so many things about neurology in a day. That’s because of you sir.

-Today I learned how to manipulate in exercise via using environment things which is very important because all time provide all things.




What I learnt-

-The workshop gave mr an aim towards studying and taught me ways how to study…

-Learnt an important thing-When things can be done in a simple way, no need to complicate them.

-Would definitely like to attend more workshops and grasp knowledge from you sir.

-Thanks to Sancheti Healthcare Academy.

Good points-

-It was an excellent experience and surely got to know new things for handling patients which definitely added up in my learning.

-Great arrangements were made and I was mentally present throughout the session.




Name-Mehvish Mansuri

What I learnt-

-I was really tensed as I thought workshop would be as same as those lecture but this workshop was all worth it.

-I learnt not only MOTOR RELEARNING PROGRAMME but also the neuroscience behaviour, communication with the patient and how to assess and treat simultaneously.

-The gait pattern was well understood.

-Every minute details were explained practically well.


-Last but not the least what I learnt was ‘’THE BODY FOLLOWS BIOMECHANICS AND SO THE TREATMENT’’





Name-Sunil Soni


What I learnt–

- I learnt a new approach to treat stroke patients. Numbers of new words were learnt like constrain, postural adjustments, anticipatory postural adjustments, on going postural adjustments.

Good points-

  • My overall experience of this workshop was good.
  • Presentation and arrangement were good
  • Thanks gajanan sir and thanks to Sancheti healthcare
  • Please inform about upcoming workshop

Bad points-




Name- Jui Bane

What I learnt-

  • Today’s PPT taught us that we have an integrated approach towards patient and include all approaches for the benefit of patient.

Good points-

-Sir you are my inspiration.

  • Entire MRP workshop was very informative and a wonderfull experience for me.
  • All the practical as well as ppt sessions were nice

Bad points-



Participant- 26

Name – Rochelle Rego

What I learnt-

-motor leaning with re education

- I learnt to how to approach any patient


Good points-

-today’s session was very excellent and motivating.

-The practical session was very good.

- I liked the fact that practical sessions were taken on the patients.

- I have understood the topic well

- Thank you for explaining so well and making the workshop light and funlearning.

-the lecture was very interactive

-good food

Bad points –



Participant- 27

Name – AaditiPanchwadkar

What I learnt-

-I got to learn newer ways of mobilisation also which can be used in ortho and neuro.

-I will definitely inculcate them.


Good points-

  • Today’s workshop was excellent.
  • There was more importance to practical session so I enjoyed it.
  • Overall workshop was very interactive and was a source of knowledge.
  • Thank you sir for sharing such knowledge with us.

Bad points-



Participant – 28

Name- RuchitaHajare

What I learnt-

  • I learned many new concepts.
  • I learned how to handle, communicate, re-educate the stroke patient
  • I learned new words like postural adjustments, constrain, “invite the muscle”


Good points-

  • Workshop was excellent
  • The practical session was good.
  • You are so jolly that we don’t get bored in the workshop.
  • The way you teach is outstanding.
  • This made a behavioural change in me.
  • Thank you sir

Bad points-






What I learnt-

-The best thing I learned is that nothing or no treatment is wrong whenever or whatever we use becomes assessment, and the thing which is affective becomes treatment.

-As our patient always wants task accomplishment and MRP delay with the specific need of the patient mainly daily activities of life.

Good points-

-It was the best workshop I have ever been to.

Bad points-






What I learnt-

-I got to learn very difficult hand rehabilitation which was very task specific.

-Learnt the eccentric lengthening technique to reduce spasticity.

Good points-

-I loved the way hand grips were taught.

-I loved every moment of the workshop

-gait training was taught awesomely.

Bad points-





What I learnt-

-I got to know about a very difficult approach towards stroke patients.

-I understood how to communicate with them.


Good points-

-The seminar was outstanding.

Bad points-




Name-Prajakta Dingle

What I learnt-

-I got to learn many things and many concepts got cleared.

-I got to know about techniques that can also be used on orthopaedic patients and not only on stroke, in fact how to correct one’s posture and how to learn and correct  one’s biomechanics.

-And main thing I learnt is whatever we do if it is beneficial to the patient than it becomes treatment and what we do is not beneficial becomes our assessment. So from next time whenever I deal with the patient, I won’t be afraid because I would be assessing him or treating him.

-Next was stability. I will concentrate more on stability then on mobility.

-Postural alignment, eccentric contraction of muscles proves to be very useful and powerful aspects while treating patients.

-Even with minimal assistance we can do wonders with the postures of patients which can help in postural correction.

Good points-

-I would love to attend more workshops of yours sir.

-Food was very nice.

Bad points-





What I learnt-

-Thank you sir, for giving this opportunity to learn so many good things about neurology and treatment of such patients.

-With this workshop I have learnt how to attend our patient, how to change the behaviour and make the environment so that we can make the patient to be more co-operative with us.

-I have also learnt about the neurological approaches, how they come into picture and how the biomechanics are important for every movement to take place and with the help of normal biomechanics, we form the treatment for patient.

-I also have learnt how the task specific activities help the patient to become functionally independent in their life.

-‘’If you can do a good analysis of the patient and can find out the missing component in them and correct it , you can a  good therapist.’’

Good points-

-Thank you sir for sharing your great knowledge and exploring it.

Bad points-





What I learnt-

-I got to know more about the gait patterns.

-I also learned how to communicate and handle the patient.

Good points-

-The workshop was very good

-My thinking towards neurology has changed a lot.

-The best part about this workshop was the instructor was friendly, he was not teaching like a typical professor where most of the time we get bored and sleep.

-The college management was very systemic.

Bad points-

-The only boring part was the power point presentations, it was good that more of practical was demonstrated on patient itself so we get to know more easily.





What I learnt-

-Through this workshop I could learn new therapy of treating patients. And by this therapy we could improve quality of life of the patients as our main focus is to make patient functional. Due to which we are ultimately serving the society.

-So I am definitely going to use protocol and get fruitful results for my patients.





What I learnt-

-Today we have learnt about different phases of gait and its importance.

-I liked the practical session in the classroom about the gait initiation.

-Today we got to know about zigzag what it is actually.

-The practical session about hand treatment and shoulder treatment with the task specific treatment we learn and this will help us a lot.

-We got to know new idea of taping patient in hemiplegic patient.

-Behaviour changes are necessary that we know from you sir.

-We got to know about orthotics used in hemiplegic patients.

Good points-

-I liked the videos, practical sessions

-New techniques of giving bridging in hypotonic patients.

-We will apply the techniques of assessment and treatment in our daily clinical posting.







What I learnt-

-I had many doubts regarding the various phases of gait cycle, but after today’s workshop the gait biomechanics is very much clear to me.

Good points-

-Excellent practical knowledge was provided.

-I would like to learn the hand biomechanics more in detail.

Bad points-






What I learnt-






What I learnt-

-Many things.

Good points-

-It was very good workshop.

-The best thing was practical sessions which cleared many doubts.





What I learnt-


-I feel myself very lucky to be part of this workshop.

-I will surely practice what techniques I have learnt today. I was never aware of such techniques.


You are a rally good teacher sir. You explain so well. I have become your teaching fan.

Thank you sir. Please conduct more workshops on other approaches.

Good points-

-The workshop was well organised including food.

-You are doing an excellent job sir. Please don’t stop it. You are one of my idols now. I am a neuroscience post graduate student and I would try to do my best the way you are doing.

Bad points-

-PPT was boring.

-Specially today in the morning session it was boring. Sorry I was sleeping.





What I learnt-

-I got to know taping technique. I used to know it but i

Now I know how exactly to do it.

-Biomechanics, lengthening, MFR, hand mobilisation and the way sir you make the environment useful for learning new techniques.

Good points-

-I like the task performance, before I was doing it very superficially but now I know assessing and treating too.

Bad points-

-PPT was a little boring and food was not good today.



I loved all the techniques you taught.

The workshop was all worth the efforts of coming to pune.



On 16th and 17th August 2014
Course instructor
Dr. Gajanan Bhalerao (PT)
Master of Physiotherapy (Neurosciences)
Associate professor
Sancheti Institute
College of Physiotherapy
Shivajinagar, Pune.
Kindly send registration on

Hurry up! limited sits only.

For eligibility & programme details click attachment.

 Please forward this information to the interested therapist and students​.​
Please click here for details.

NDTA Advanced Handling and Problem Solving Course Pune, Maharashtra, India 2015

NDTA Advanced Handling and Problem Solving Course

Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India

Course Description

This five-day course is designed to broaden one’s knowledge base and enhance skills learned in the certificate course.  An emphasis will be placed on enhancing participants’ assessment and handling skills. The patient practicum of the course will involve patients with a variety of acquired CNS lesions (stroke, traumatic brain injury, and ataxia if possible). The registration form asks you to state specific questions you would like addressed during the course.  As much as possible, we will try to address your clinical questions.   Participants must have completed an NDT/Bobath Certificate Course in the Treatment and Management of Adults with Hemiplegia or a Certificate Course in the Treatment and Management of Individuals with Cerebral Palsy as a prerequisite to this course.


Course content will include:

  • ICF Enablement Model (from the WHO) for assessment and intervention planning
  • Current concepts of postural control and movement
  • Analysis of complex movement patterns related to function
  • Analysis of atypical movement patterns
  • Problem-solving and Intervention principles and strategies

Course will include lab, lecture and patient demonstrations.  Participants will treat patients at least four of the five days of this course.


Course Objectives

Upon completion of the course, the participant will be able to:

  • Utilize the ICF Enablement Model for patient evaluation and intervention planning
  • Identify current concepts of postural control and movement
  • Analyze factors which interfere with the performance of functional activities
  • Identify impairments contributing to these ineffective posture and movement strategies
  • Synthesize information to develop appropriate intervention strategies for persons with neurological dysfunction
  • Demonstrate ability to implement appropriate intervention strategies during treatment practicum

Course Dates:

  • 01-12-2015 – 01-16-2015

Course Number: 15H101
Course Status: Approved
Prerequisite: NDT/Bobath Certificate Course
Location: Sancheti Institute College of Physiotherapy
Sancheti Health Academy, Shivajinagar, Thube Park 11/12
Pune, Maharashtra, India, 41105

Course Instructors:
Cathy Hazzard, B.Sc, MBA, PT, C/NDT CI

Course Contact:
Dr. Gajanan Bhalerao
Phone: 9198 22623701
Fax: 9120 25539494

Advance NDT course
Registration Fee: A non-refundable RS 3000/- and $ 50 for international delegates (No application will be processed without it).
Course Fees: These include course tuition fees, course material, daily breakfast, lunch and high tea on all 5 days of course (5day/week).
Registration Fee
Up to 31/09/14
Rs 3000/-
$ 50
Early bird Fee
Up to 30/09/2014
Rs 35,000/-
US  $ 650/-
Regular Fee
01/10/2014 TO 31/10/2014
Rs 40,000/-
US  $ 700/-
Late Fee
01/11/2014 TO 30/11/2014
Rs 45,000/-
US  $ 750/-
After November 31st registration is closed.
Please register early to get benefit.
Please Send DD/ Multi city Cheque in favor of “Sancheti Continuous Physiotherapy Education (CPE) Program” payable at Pune.

Please click here for application

advance course Application for NDTA Adult Certificate course 2015 India -


NDT/Bobath Certificate Course in the Management and Treatment of Adults with Hemiplegia in Pune, India

NDT/Bobath Certificate Course in the Management and Treatment of Adults with Hemiplegia
Sancheti Institute College of Physiotherapy, Sancheti Health Academy, Shivajinagar, Pune, Maharashtra, India

This is the first time NDTA is conducting a ADULT NDT course in INDIA. We want maximum people to benefit from this course. But there a seats limit of 24 only. Everyone will need to apply for the course and the NDTA/course instructors will select the delegates for the course depending on their experience and accreditation in the field of adult neuro.
Course Dates:
27-01-2014 – 14-02-2014
It will be 5 days/week for three weeks. Saturday & Sunday off.

Course Number: 14A101
Course Status: Approved

Course fee- Rs-90,000/- for Indian
and $ 2000/- for International delegates

Registration fee (Non Refundable) Rs 2500/- and $ 50/- for International delegates
All the people has first aplly for registration out of which 24 will be selected.
Please send me your mail so that i can send you the registration form.

Location: Sancheti Institute College of Physiotherapy, Sancheti Health Academy
Thube Park 11/12
Shivajinagar, Pune, Maharashtra, India, 41105

Course Instructors:
Cathy Hazzard, B.Sc, MBA, PT, C/NDT CI
Nicky V. Schmidt, PT, C/NDT CI

Cathy Hazzard, B. Sc. P.T., MBA is a Physiotherapist with over 25 years experience working with adults with varied neurological diagnoses. Her clinical background also includes experience and continuing education courses in manual therapy and orthopedics. She obtained an MBA in 1993 while continuing to work as a PT. She has been an NDTA™ Coordinator Instructor in Adult Hemiplegia since 1998 and has taught introductory, certificate and advanced level NDT courses extensively throughout North America (Canada, United States, and Mexico) and internationally in such countries as Ireland, Hong Kong, Singapore, Estonia, Colombia, and Peru. Cathy practiced in Calgary, Alberta, Canada for over 20 years in the acute, rehabilitation and outpatient phases of care. She is now working in private practice and Home Health on Vancouver Island, British Columbia. Cathy served as the Chair of the NDTA™’s Instructor Group from 2002 – 2005 and a member of the Board of Directors of NDTA™ from 2003 – 2007. (

Nicky Schmidt, PT, received her bachelor’s of science degree in Physical Therapy from Louisiana State University Medical Center in 1978. She is NDT trained in both pediatrics and adult hemiplegia and has been an active NDTA Coordinator-Instructor since 1985. Ms. Schmidt has taught NDTA introductory, basic, and advanced courses throughout the United States and Canada for 28 years. During her 33 years of clinical practice she has worked as a clinical neuro specialist in a broad spectrum of healthcare settings including acute care hospitals, short-term rehabilitation, outpatient rehabilitation clinics, home health and private practice. Nicky was an Associate Clinical Professor at LSU Medical Center in the 1980’s, is a past member of the NDTA Curriculum Committee, and past board member and Instructor Group Chair of NDTA. Currently, Ms. Schmidt is in private practice in the New Orleans area where she specializes in consultation for and treatment of adult and pediatric clients with diagnoses of stroke, brain injury and cerebral palsy.

Course Contact:
Dr. Gajanan Bhalerao
Phone: 9198 22623701
Fax: 9120 25539494

The course details about the fee structure, eligibility, and course details will be published soon on facebook page.
Those who are interested please accept the invitation or show your interest so i will get your contact details. Then i can send you the course details as soon as it is finalized.

Thanks for showing interest.

Application for NDTA Adult Certificate course

Hydrotherapy for traumatic brain injury with hemiplegia – our challenges and solutions

Swimming pool

Swimming pool (Photo credit: Wikipedia)

This is the case of a 16 yr old boy who met with an accident leading to a traumatic head injury in August 2011. He was in a coma for 1 month after which he gradually started showing improvement. I started treating him in January 2011. He had suffered a diffuse axonal injury due to which both the sides of his body were involved.  Initially he was hypotonic on both sides and trunk . He could move his left side voluntary control grade III in upper and lower limb but no control on right side. Within next 2 months he started sitting without support, supine to sit with support and required minimum to moderate assistance for sit to stand from high bed. He could stand with weight bearing on both legs with moderate assistance. His left side improved up to grade VI. His tone in trunk &  RT upper & lower  limb started improving (grade II).

Assisted walking training on the ground

In March and April 2012 he was showing a picture of RT hemiplegia with grade II in UL & LL with developing spasticity. We used to make him walk with FRO and push knee brace on Rt (hemiplegic side). Initially with back forearm support walker then without walker. Assisted walking training was started ( we have to passively step forward the hemiplegic leg ).

English: bathing hall, Carolus Thermen, Aachen...

commercial pool training

He could move the limb in supine but could not take a step forward while walking on ground.  So we have decided to take him for hydrotherapy to improve his control of lower limb and active walking. Taking a Patient to hydrotherapy was a good idea but we do not have hydrotherapy centre/ swimming pool for patients in Pune (Except in Aditya Birla hospital). So we contacted one of the commercial pool in Kalyaninagar. We explained them the condition of the patient & our objective. Then they gave us the permission. They have given us two lifeguards to help us during training session in the pool.

We were alloted a time of 7 pm to 8pm as the pool was occupied at other times. So, the patients had to adjust accordingly as they were not allowed to come along with regular batches.

Getting in Pool (Transfer)

While going for swimming we had one more challenge of  how to take the patient in the pool (transfer)? So for that I used my Ganpati Transfer method. We made the patient to sit on the thick towel, the towel acted like a sling where the patient was sitting in the centre of the sling. Then two people were holding the towel from the sides, this helped to lift the patient easily.  After lifting the patient we made him sit at the edge of the swimming pool with his legs dangling in the pool. Then he was assisted to slide down in the pool so that he can stand in the pool. This was a very easy and safe transfer.

Swimming with help of raft

Because patient had a poor balance he could not stand in the pool and poor control of Rt (hemiplegic side) he could not swim independently. So we made him lie-down on the Raft with his trunk on the raft. Which helped to control weight of the body and arms & legs were free to move.

As he was able to move the normal upper and lower limb he started to stroking/swing them in the water which helped him to propel his body forward in water. We were assisting the hemiplegic upper and lower limb for stroking/swinging.

This is how we started swimming a patient with head injury with Hemiplegia in the water with help of Raft. We continued this Practice daily evening for about two months (6days/week)

Assisted Walking Training in Water

He was having lot of difficulty in walking  steeping forward on ground, while doing assisted walking with AFO and Long knee Brace on Hemiplegic side. so we started training of assisted walking in water, with hand support. Because of the bouyancy his body weigth was reduced and he could stand in water with minimum assistance, this also helped in stepping forward the hemiplegic leg. It was very easy for him to walk in water with less support.

We were Training him Assisted Walking on ground since 2 months but he could not step forward actively, but after training of walking in water for 1 months he could step forward on ground also with walker without assistance.

Causes and management of hyperextension of knee in hemiplegic and Paraplegic

English: Right knee.
English: Right knee. (Photo credit: Wikipedia)
Capsule of right knee-joint (distended). Later...
Capsule of right knee-joint (distended). Lateral aspect. (Photo credit: Wikipedia)

Genu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee. This deformity is more common in women and people with familial ligamentous laxity.

Hyperextension of the knee may be mild, moderate, or severe.

Normal range of motion (ROM) of the knee joint is from 0 to 135 degrees in an adult. Full knee extension should be no more than 10 degrees. In genu recurvatum (back knee), normal extension is increased. The development of genu recurvatum, may lead to knee pain and knee osteoarthritis.

knee hyperextension in stance

This common gait deficit occurs when the quadriceps fail to perform their customary role during loading responseand the first part of midstance.


normal grf, sagittal plane, loading response LOADING RESPONSEOrientation of ground reaction force vector (GRFV) in sagittal planeNormal GRF is located
  • posterior to ankle joint
  • posterior to knee joint
  • anterior to hip joint

What effect will this have on joint motion and muscle activation?

normal grf, frontal plane, loading response LOADING RESPONSEOrientation of ground reaction force vector (GRFV) in frontal planeNormal GRF is located
  • lateral to subtalar axis
  • medial to knee joint
  • medial to hip joint

What effect will this have on joint motion and muscle activation?

normal grf, sagittal plane, loading response During loading response, ground reaction force produces
  • a plantar flexion moment at the ankle joint
  • a flexion moment at the knee
  • a flexion moment at the hip

The body controls these moments with

  • eccentric activity in the ankle dorsiflexors
  • eccentric activity in the knee extensors
  • isometric activity in the hip extensors

compare to frontal plane

normal grf, frontal plane, loading response During loading response, ground reaction forces produce:
  • a pronation moment at the subtalar joint
  • a varus moment at the knee
  • an adduction moment at the hip

The body reponds to these moments with

  • eccentric activity in the intrinsic foot muscles and other supinator muscles to control subtalar pronation.
  • passive tension in the lateral knee structures. Active force in the tensor fascia lata could contribute to knee stability in the frontal plane
  • activity in hip abductor muscles

return to using ground reaction forces…

Visualizing ground reaction force vectors (GRFV) to understand typical gait patterns


The quadriceps may not act appropriately in the event of:

  • Quadriceps weakness

  • Pain with quadriceps activation

  • Proprioceptive deficit

When the knee extensors fail to control the ground reaction force’s knee flexor moment, the person must compensate to preserve knee stability.

These compensations will likely hyperextend the knee during stance. The compensations might include one or more of the following:

  1. Substitution of another muscle in a closed chain

For example,

  • Increased hip extensor force

  • Increased ankle plantar flexor force

  1. Motions that relocate the GRF vector, changing the moment the GRF produces at a joint.

For example,

  • Forward trunk lean during loading response and midstance



    This common gait deficit occurs when the quadriceps fail to perform their customary role during LOADING RESPONSEand the first part of midstance. This might occur in the event of:




    During loading response, a forward leaning of the trunk produces an anterior inclination in the ground reaction force vector. Because this relocated vector passes closer to the knee joint, it produces a smaller flexor moment at the knee.

    If the GRF vector passes in front of the knee joint, it can hyperextend the knee during loading response.

    forward trunk lean during stance

    When the person leans forward with the trunk DURING MIDSTANCE, but not during loading response, quadriceps weakness or knee pain are less likely causes. Instead, it may be a compensation that helps move the body’s center of gravity forward over the stance foot. This compensation is necessary when:

    • the ankle has limited range of motion in dorsiflexion

    • plantar flexor strength is inadequate to control midstance dorsiflexion.

  • Flat Footed Initial Contact

  • Foot flat at initial contact

    typical ground reaction force during initial contact

    At initial contact, the ground reaction force vector’s point of application is ordinarily near the heel.

    typical ground reaction force during loading response

    As loading response progresses, the ground reaction force vector moves posterior to the knee, producing a flexor moment.

    flat footed initial contact

    By contacting the ground initially on a flat foot, the person moves the ground reaction force vector’s point of application anteriorly…

    so that the more anteriorly situated force vector is closer to the knee joint throughout loading response, and so produces a smaller knee flexor moment during that period.

    If the ground reaction force moves anterior to the knee joint’s lateral axis, it produces a knee extensor moment. Therefore, people may compensate for knee extensor weakness by contacting the floor with a relatively flat foot.


  1. Motions that relocate the joint axis, changing the moment the GRF produces at a joint

For example,

  • Decreased forward pelvic rotation

Hemiplegic patient have a common gait deviation during their gait training is hyper-extension of knee or  genu recurvatum.

Cause of  genu recurvatum are

1. Weakness of plantar flexors:

2. Flail foot i.e. polio, cerebral palsy etc

3. Tightness of plantar flexors (TA tendon)

Becouse of above factors patient shows a poor loading responce in gait.

In normals loading responce ankle goes from 10 degree of plantar flexon to 10 degree of relative dorsiflexion and knee in 10-20 degree of lexion. There is anterior translation of tibia over the fixed foot.

This anterior translation of tibia over the fied foot is affected due to TA tigthness.

In weakness of  plantar flexors & flail foot  if tibia moves over the fixed foot and goes in to relative dorsiflexion then this may lead to buckling of knee and lead to poor stability during loading responce to mid stance. to avoid this patient does the compansotory movement of, avoiding the anterior translation of tibia and forward lurching gait, with locking of knee. frequent use of this pattern of locking mechanism of knee during walk leads to hyperextension of knee.

Gait of RT hemiplegic Patient with genu Recurvatum

1. in case of weakness of platar flexors , . flail foot & weakness in whole limb use HIGH AFO. That is the posterior strap of the AFO is hiogh enough up the lower margine of popliteal fossa.this long leverage prevents it from going backward.

2.But this will not work in patients who walk with forward lurch posture or those who take bigger step length of opposite unaffected leg.the solution for this is very simple reduce the step length of opposite leg and allow him to step by the affected leg instead of going ahead. this will pull back the line of gravity which was falling forward to knee and reduce hyper extension.

3. In the patients having sever hyeperextension and can’t be corrected by all these measures then the last solution is use KAFO for walking.

4. knee surgery are not successful for preventing hyperextesnion.

5. In TA tightness -do stretching but the effect doesn’t last longer in the functional activity of walking. so we should give functional stretching.  for this  use modified AFO{FRO} : shift the calf bad of AFO anteriorly this produces good three point pressure phenomenon and helps in stretching the TA in functional activity of walking and helps in  reducing  recurvatum.


6. In cases  Poor trunk control and imbalance  or low postural tone ( Down & hypotonic CP. wok on postural tone , trunk control in addition give AFO & walker with forearm support this reduces the forward flexion of trunk.


1. WHO | Stroke, Cerebrovascular accident [Internet]. [cited 2010 Aug 3]; Available from: accident/en

2. Tapas kumar banerjee et al. Epidemiology of stroke in India. Journal of Neurology Asia.2006;11:1-4.

3. Edward R. Laskowski, M.D. Hyperextended knee: Cause of serious injury

4.Jennifer Kirkman, Yahoo! Contributor Network. Hyperextended Knee-Causes, Symptoms, Diagnosis, and Treatments

5.  what is genu recurvatum?

6. Allison Cooper et al. The Relationship of Lower Limb Muscle Strength and Knee Joint hyperextension during the Stance Phase of Gait in Hemiparetic Stroke Patients. Journal of Physiotherapy research international.2011;(17)1.

7. Lucarli P et al. Alteration of load response mechanism of knee joint during hemiparetic gait following stroke. Journal of clinics.2007;22:813-820.

8. Susan Richardson. Assessing knee hyperextension in patients after stroke: comparing clinical observation and Siliconcoach software. International Journal of Therapy and Rehabilitation, Vol. 19, Iss. 3, 07 Mar 2012, pp 163 – 168.;article=IJTR_19_3_163_168.

9. Bleyenheuft et al. Treatment of genu recurvatum in hemiparetic adult patients: A systematic literature review. Journal annals of physical and rehabilitation medicine.2010;53(3):189-199.

10. Rehabilitation, Treatment and Orthotic Management of the Stroke Patient.

11. D. Beckers. Effects of AFO-assisted ankle angle position on dynamic knee stability in brain injured and spinal cord injured patients.ISB XXth Congress – ASB 29th Annual Meeting, July 31 – August 5, Cleveland, Ohio.

12.Prevalence of knee hyperextension in individuals with hemiplegia.

13.Ankara Fizik Tedavi. Assessment of Genu recurvatum in hemiplegic patients.

14. Knee hyeprextention in stance.

Taping in hemiplegic shoulder subluxation

dislocated shoulder - study b

dislocated shoulder – study b (Photo credit: Jon Winters)

The left shoulder and acromioclavicular joints...

The left shoulder and acromioclavicular joints, and the proper ligaments of the scapula. (Photo credit: Wikipedia)

The shoulder complex consists of four separate joints, which afford it incredible mobility in all planes of motion, but at the expense of its stability.

The human shoulder joint

The glenohumeral joint (GHJ) relies on the integrity of muscular and capsuloligamentous structures rather than bony conformation for its
stability. Injury or paralysis of muscles around the shoulder complex may lead to GHJ subluxation.

Glenohumeral subluxation is a secondary complication to hemiplegia caused by a CVA, in which the head of the humerus drops out of the joint. Across the literature, anywhere from 17 to 66 percent of patients experience a shoulder subluxation after a CVA (Peters & Lee, 2003).

Patients with such a subluxation experience pain and decreased ability to perform activities of daily living. In fact, the pain caused by a glenohumeral subluxation has not been isolated. Some research even claims that shoulder subluxation is not the etiology for shoulder pain experienced post-CVA.

procedure of  taping

step 1. check the sulcus sign, and measure it. (no of finger)

step 2. check the range of movement, pain severity, end feel, capsular   tightness. record for pre and post checking for comparison.

step 3. shave the area of shoulder, scapular region up to inferior angle of scapula.

step 4. Take sticking plaster dynaplast of 4″ width. Measurement of para spinaltaping length. Measure from superior border of trapezius muscle till the inferior angle of scapula and cut the tape. Remove the polythene from the tape and stretch the tape to full length.

step 5. Postural alignment &  positioning:  make the patient stand erect so he/she gets a upright posture. correct the abducted scapula to neutral position

step 6. Stick the tape paraspinally starting from superior border of trapezius muscle up to lower sub costal area. take a note while taping that the black center line on the tape should align with the medial border of scapula. take care that there should not be any creases while taping the tape.

step 7. Preparation of second strapping of the tape. Measure from the medial tip of spine of scapula up to deltoids tuberosity level(insertion of deltoids).  cut the tape from middle up to one inch in line with black line in the middle of tape. then split it in the form of “Y” shape. then stretch it to full length.

Step 8. stick base of Y at deltoids tuberosity level. stick it in such a that the middle line of tape come over the anterior tip of acromian process. so that the half of tape  is anteriarly and half laterally  covering the shoulder for proving a better stability. out of the two strip of Y end, upper end in line of the spine of scapula and other strip towards inferior angle of scapula.

check the reduction in sulcus size

To view a video of the procedure please click on the link

  1. Griffin A, Bernhardt J. Strapping the hemiplegic shoulder prevents development
    of pain during rehabilitation: a randomized controlled trial. Clin Rehabil. 2006
    Apr;20(4):287-95. PubMed PMID: 16719027.
  2. Painful Hemiplegic Shoulder.Robert Teasell MD, Norine Foley MSc, Sanjit K. Bhogal MSc
  3. S. Beth Peters1 and Gregory P. LeeProfessor2. Functional Impact of Shoulder Taping in the Hemiplegic Upper Extremity. Occupational Therapy in Health Care. 2003, Vol. 17, No. 2 , Pages 35-46
  4. Kinesiology Tape: The Little Miracle Worker (
  5. Exercises for a Loose Shoulder – Orthopedics Doctor Houston TX (
  6. Shoulder Pain (
  7. Shoulder Pain: Multi-factorial, confusing, and tiring to treat (My Rant) (
  8. Build Big Strong Shoulder Muscles For V Shape Upper Body Build Big Deltoids (
  9. How Are You Healing Today? (
  10. Shoulder Girdle: A Delicate Balance (
  11. Hemiplegic shoulder pain: defining the problem and its
    management. Bender L, McKenna K. Disabil Rehabil. 2001 Nov 10;23(16):698-705. Review. PubMed PMID:11732559.
  12.  Therapeutic Taping for the Shoulder. Dr. Dyanna Haley-Rezac, PT,DPT, OCS, CSCS, CKTP. Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

    13. Kinesio@Taping in Stroke:Improving Functional Use of the Upper in hemiplegic. Eva Jaraczeweska.

    14. Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial.Griffin A, Bernhardt J. Clin Rehabil. 2006 Apr;20(4):287-95.

    15. Hemiplegic shoulder pain: defining the problem and its management. Bender L, McKenna K. Disabil Rehabil. 2001 Nov 10;23(16):698-705.

    16. Arthrographic distension for adhesive capsulitis (frozen shoulder). Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD007005.

    17. Functional Impact of Shoulder Taping in the Hemiplegic Upper Extremity. S. Beth Peters1 and Gregory P. LeeProfessor2



Spastic muscles cant do eccentric lengthening

Spastic muscles are in the state of concentric contractions can’t do eccentric lengthening. Spastic muscles are in shortened state and active eccentric contraction in difficult. This can be due to

a. Weakness of antagonistic muscle

b. Due to reciprocal inhibition causes relaxation of antagonistic muscle

Spastic muscles act like spring that work in concentric contraction and remains in contraction mostly (flexed position) which creates motor imbalance between them and antagonist to them. Therefore strengthening antagonist assists in reducing tone of spastic muscles as this allows lengthening of spastic muscle!!

So in the initial phase of neuro rehabilitation of hemiplegic patients we should concentrate more on eccentric and static (placing reaction) contraction.

Avoid strengthening the concentric contraction. Because if the spastic muscle becomes strong then it is difficult to initiate the eccentric contraction.

During training of upper limb control we train the elbow flexion and shoulder flexion. The common mode is to train concentric contraction. We tell the patient to lift upper limb against gravity. This indirectly trains the flexor synergy make it strong then it becomes difficult to break the synergy.

So what to do? Work on placing reaction in upper limb. Place the shoulder in flexion above 90 degree and let him hold it and followed by slow lowering the upper limb (eccentric contraction).

What is the advantage of eccentric contraction? Eccentric contraction helps early and better in recruitments of motor units than concentric contractions. Eccentric contraction can generate more force with less motor unit recruitment. Concentric contraction requires more motor unit recruitment for even generation minimum muscle contraction. So it becomes difficult to initiate concentric contraction than eccentric contraction.

So in the spastic muscles we should concentrate more on eccentric lengthening. Increase in eccentric lengthening of muscles indirectly helps in reducing spasticity.