Spinal Cord Injury Rehabilitation workshop organized by Indian Association of Physiotherapist Pune Branch and Sancheti Institute college of Physiotherapy, Pune


Indian Association Of Physiotherapy Pune Branch & Sancheti institute College Of Physiotherapy organized a workshop on SPINAL-CORD INJURY REHABILITATION  on 27th and 28st October  2012 . Course instructor was Dr. Gajanan Bhalerao (PT) MPTH Neuro, Associate professor, Sancheti College of Physiotherapy & Inchargeof Department of Neuro and Spine Rehabilitation Sancheti Hospital, Pune.

In this course 32 students from all over Maharashtra Physiotherapy colleges & clinical therapist attended the work shop. The workshop was inaugurated By Dr. Meenakshi Pandit, Convener IAP Pune branch, along with Dr. Apurv Shimpi Treasure Executive Committee   Member Dr. Anushree Phansalkar IAP Pune branch.

We had Invited Major Bist, administrator director Paraplegic Rehabilitation Centre Kharaki, Pune to give information the functioning and activities of paraplegic at their centre.  Pararaplegic are living at the centre and all of them are independent in their lifestyle and earning livelihood through vocational rehab.

Dr. Vijay Gupta MPT neuro (USA) was also helped during the practical session for supervising the particiapnt practice of practical demos done in the workshop.

           

The workshop included the neuro anatomy, mat exercises, transfer training, ambulation training etc. Participant were taught how to set the goals according to level, severity and available period of admission, OPD bases taking into account his lifestyle, contextual and environmental factors in his own home/village/town/city.

Practical demos of treatment on patients  was shown. Different techniques of facilitation voluntary control/strengthening was demonstrated on patients with incomplete cord injury TYPE B/C/D/E. Two quadriplegic who were showing type A in first few months were called in the workshop who are now high functioning walking independently, driving two wheelers with added two wheels independently .  Car transfers’ training of patients was shown. Indications and contraindication of different orthotics and prescription of orthosis taught .   

                                                                                                         Modified bike for para

car transfers

Car modifications

Workshop details

Day 1 Saturday -27th /10/12

Registration and breakfast
Introduction

  • Overview of anatomy of spinal cord
  • Incidences of SCI
  • Classification of  SCI
  • Clinical syndromes
  • Physical effect of spinal cord injury
  • Levels of injury & functional abilities
Physical therapy evaluation and goal setting; ASIA scale
Functional goals & Strategies for functional rehabilitation
Case Studies
Evaluation
Day two Sunday – 28th/10/12
Assessment, prescription & Wheel chair ambulation training
PWB Treadmill Training role of Central pattern generators(CPG)
Orthotic prescription
Stair case climbing training
Gait training.
Bladder and Bowel training
Bed sore prevention
Role Of Stem Cell Therapy

Participant’s Feedback on course content and training was taken at the end of both day. All the students like the detailed anatomy and its clinical apllication, differential diagnosis & classfication of different spinal cord injury. Every learned a lot from the lab session of ASIA assessment on patients.  On post workshop feedback all the participaants reported that, they leanred lot of new techniques of faciltation, multiple alterantive methods for bed mobility, transfers and ambulation training, wheechair modification, Orthotic fixation, and Role of steam cell in SCI rehabilitation. Everone extreamely satisfied.

STUDENTS PARTICIPATED IN WORKSHOP

S. NO. NAME STATUS PLACE
1 RADHA AJAY MEHTA PRACTICE MUMBAI
2 NEHA MANJUNATH PRACTICE MUMBAI
3 JUIE MESVANI PRACTICE MUMBAI
4 HETAL JITENDRA SHAH PRACTICE MUMBAI
5 HIRAL PRASHANY SAMPAT PRACTICE MUMBAI
6 DEEPMALA DINESH SHARMA PRACTICE MUMBAI
7 DARSHINI VIJAY DESAI PRACTICE MUMBAI
8 SNEHA JADHAV INTERN PUNE
9 MANALI DEVANE MPT PUNE
10 RUCHITA KOTEWAR MPT PUNE
11 SURYAKANT GADGERAO MPT PUNE
12 TUSHAR DHAWALE MPT PUNE
13 MRUNAL HARLE MPT PUNE
14  PRATIBHA SALKAR MPT PUNE
15 ARCHANA GIDWANI PRACTICE PUNE
16 SADHANA MPT PUNE
17 PURTI MPT PUNE
18 RASHMI MPT PUNE
19 NIMISHA MISHRA MPT PUNE
20 SANNA SAYED PRACTICE MUMBAI
21 SHARDA BHALERAO INTERN PUNE
22 CHETANA AHER INTERN PUNE
23 JAY PAWAR PRACTICE PUNE
24 ABHA BHUTADA PRACTICE PUNE
25 RAJASHREE FADNAVIS MPT PUNE
26 APOORVA PHADKE PRACTICE PUNE
27 ASHWINI KAMBLE PRACTICE PUNE
28 NITIN CHOUKE MPT PUNE
29 CHANDALI DOSHI MPT PUNE
30 HARSHIKA BHANUSHALI INTERN PUNE
31 SNEHA MULE PRACTICE PUNE
32 DENZIL FERNANDES PRACTICE PUNE
       

Basic Neuro-Developmental Treatment (NDT Paeds) workshop in November -December 2012


Indian Association Of Physiotherapy Pune Branch &  Sancheti College Of Physiotherapy Pune

Organizing a workshop on

Basic Neuro-Developmental Treatment (NDT Paeds)

Course Instructor- DR. ASHA CHITNIS MPT, NDT paeds

This is an exciting and intensive training course for physical therapists, occupational therapists, and speech and language pathologists comprised of both theoretical and practical work. The material presented in the course is based upon the theoretical and practical concepts developed by Dr. Karel and Mrs. Berta Bobath and conforms to the standards established by the NDTA, Inc.

This course will be held at Sancheti Institute College of physiotherapy,Shivajinagar, Pune & Sancheti hospital Shivajinagar, Pune. Please note that this is an intensive weekend format (Saturday  & sunday) on 24th & 25th November and 8th & 9th December 2012. The number of days in class will total 4 days with class running between the hours of 8:30 am and 5:00 pm. This course curriculum is outlined to include a minimum of 24 hours, inclusive of lectures, group work and presentations, discussions, demonstrations, and patient treatment.

The course will cover: fundamentals of NDT philosophy; neurophysiology as it relates to NDT; typical and atypical movement development; fine motor development and sensorimotor aspects of development of functional skills, typical and atypical development of upper and lower extremity  and the progression through space, including gait; and treatment principles and application.

The course is limited to a total of 30 therapists, including physical therapists, occupational therapists,

The course contents 
(1) Motor control & it’s clinical Reasoning
(2) Normal & Abnormal Development
(3) Evaluation of child with CP
(4) Guiding Principles of treatment
(5) sensory Processing & NDT
(6) handling treatment Principles & Demo

Who can attend?

1. All the clinical therapist interested in peads (PT &OT)

2. Interns BPT

3. Master of physiotherapy

4. Master of occupational therapy

Why to attend this course?

1. NDT bsci course will help the therapist interested in Neuro & peads in understanding motor control, normal and abnormal development, Evaluation of children with Cerebral Palsy.

2. This course helpfull for all the MPT/MOT students in the masters programe because each master has to study motor control, normal development and neurotherapeutic approches. This course will help them in better understanding.

3. The course in Pune is organised in a educational institute who has very good infrastucture with AC rooms which helps us in keeping the course cunduction cost less compared to the course organized in 3-5 star Hotel in Mumbai (cost of event and food is very high in Mumbai).

Numbar of seats awailable =30

Course fees = Rs 5000/-

Venue = Sancheti College Of Physiotherapy Pune

Contact : Apurv Shimpi (Treasure of IAP Pune branch) 9890183195,apurv008@gmail.com

Or Gajanan Bhalerao -9822623701gajanan_bhalerao@yahoo.com

 

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.http://www.ncbi.nlm.nih.gov/pubmed/16719027
  2. Painful Hemiplegic Shoulder.Robert Teasell MD, Norine Foley MSc, Sanjit K. Bhogal MSc http://www.ebrsr.com/uploads/Module-11_hemiplegic-shoulder.pdf
  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 http://informahealthcare.com/doi/abs/10.1080/J003v17n02_03?journalCode=ohc
  4. Kinesiology Tape: The Little Miracle Worker (drkristakip.wordpress.com)
  5. Exercises for a Loose Shoulder – Orthopedics Doctor Houston TX (orthopedicsportsdoctor.com)
  6. Shoulder Pain (mycerebellarstrokerecovery.com)
  7. Shoulder Pain: Multi-factorial, confusing, and tiring to treat (My Rant) (jessephysio.wordpress.com)
  8. Build Big Strong Shoulder Muscles For V Shape Upper Body Build Big Deltoids (extrememuscles4u.wordpress.com)
  9. How Are You Healing Today? (ofekfamilychiropractic.wordpress.com)
  10. Shoulder Girdle: A Delicate Balance (theverticalworkshop.wordpress.com)
  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. http://www.ncbi.nlm.nih.gov/pubmed/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. http://www.kinesiotaping.com/images/kinesio-association/pdf/research/2006-1.pdf

    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. http://www.ncbi.nlm.nih.gov/pubmed/16719027

    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

     

     

Outcome Measures used in Cerebral Palsy; Types of scales & Validity, reliability & sensitivity of scales


Outcome Measures used in Cerebral Palsy; Types of scales & Validity, reliability & sensitivity of scales

  • What is outcome measure?
  • Why do we have to measure the outcome?
  • How to choose the outcome measures?
  • Which scale will be able to pick up the change?
  • What is validity, reliability and sensitivity of a scale?
  • What level of ICF model do you want to target? (Body structure and function/ Activity/Participation)?

please go through the link: – OUTCOME MEASURES USED IN CEREBRAL PALSY

Evidences of cerebral palsy management


management of cerebral palsy is always a challenge. What should be plan of treatment?

What is effective what is not? what is the evidences of cerebral palsy management?

These are the common questions in the therapist and students mind.

Hear i have given an  overview of it. please click on the link.

link: EVIDENCE BASED MANAGEMENT OF CP

TILT TABLE STANDING: early weight bearing and standing in patient with Total Hip Replacement with complications.


TILT TABLE STANDING:  early weight bearing and standing in patient with Total Hip Replacement with complications- para paresis, diabetic, high BP and cardiac problems.

This is patient with Total Hip Replacement rt side with bilateral lower limb weakness and trunk weakness. she was unable to stand on her even with walker. so we have to make her stand with help of tilt table. give her feedback of upright standing and weight bearing through legs. to improve the postural reactions and  to keep her engage in active participation patient is given a activity of ball catch and through. after few days of standing we made her stand with bilateral knee brace and walk with forearm support walker. initially we have passively start stepping forward for her. slowly she learned to take steps with help of walker with minimum assistance.

please click here for details of video

video will be live at: http://youtu.be/TbrKFsORYd0

SCI REHAB: Modified prone push up in high Paraplegics & Quadriplegics with weak triceps


Modified prone push up in high  paraplegics – who have weakness in trunk and unable to do push up for upper limb strengthening. in that case we can put a big bolster under the chest and  raise and support the upper trunk on the bolster that will help him balance and control the upper trunk and could put more efforts in prone push ups and help in strengthening of upper limb.

Quadriplegics with weak triceps also have difficulty in prone push up also can be benefited by this technique.

please check the link of video
http://youtu.be/uNeEBhyyHUI

 

I HAVE COMPLETED FIVE YEARS IN SANCHETI COLLEGE OF PHYSIOTHERAPY AS A ASSISTANT PROFESSOR/ LECTURER.


Dear friends,
at the end of marc 2012 i have completed my
FIVE YEARS IN SANCHETI COLLEGE OF PHYSIOTHERAPY PUNE, INDIA
AS A ASSISTANT PROFESSOR/ LECTURER.
It unbelievable that i complete five years. what a journey….! i was a great experience. when i look back there are many more milestones and achievements i could do in and due to sancheti college of physiotherapy.

1. PUBLICATION:- i could done two publication (1 international -NDTA NETWORK and 1 national Journal of orthopedics and rehabilitation). Preparing for next 4-5 publications this year

2. RESEARCH PAPER PRESENTATIONS & AWARDS:- INTERNATIONAL
a.Winner Of Young Presenters Scholarship From Epilepsy Foundation India, in the conference of“International congress on neurology and rehabilitation Goa April 2010”,
STATE LEVEL:
a. Winner of best paper award in engeering and technology category In Avishkar 2010 of Maharashtra university of health sciences (MUHS), Nashik India.
b.WINNER OF BEST PAPER FOR scientific paper presentation in AVISHKAR 2010 of Maharashtra University of Health Sciences (MUHS), AURANGABAD, India.

3.REESOURCE PERSON/COURSE INSTRUCTOR:- I have conducted Conducted workshop on
a. 2D & 3D Gait Analysis and its Management
b. two workshops of MOTOR RELEARNING PROGRAM- for stroke rehab
c. two workshops of Spinal Cord Injury Rehabilitation

4. Development of new NEURO DEPT thanks so sancheti hospital and sancheti healthcare academy

5. SUPPORT GROUP: we have started with Spinal Cord Injury Rehabilitation, and very soon we will start stroke, Parkinson and brain injury.

6. i got opportunity to treat DADA J. P. VASVANI.

7. May be this academic year i will be a post graduate teacher and i will get opportunity to guide 2 PG students and be a READER.

8. Be a imp part of scientica- students conference.

I am very thankful for support of
Dr. K. H SANCHETI, MS ORTHO, founder chairman, Sancheti hospital.
DR. PARAG SANCHETI, MS ORTHO,  chairman, Sancheti hospital.
MRS. MANISHA SANGHAVI, executive director, Sancheti healthcare Academy
DR. S. M. SABNIS, EX PRINCIPAL, Sancheti college of physiotherapy,

DR. S. A. RAIRIKAR, PRINCIPAL, Sancheti college of physiotherapy,
DR. NILIMA BEDEKAR
DR. VASANTI JOSHI,
DR. VIVEK KULKARNI,
DR. RAZIA NAGARWALA,
DR. APURV SHIMPI,
DR. SEEMI RETHAREKARDR.
and all the consultant and staff of
Sancheti college of physiotherapy,
Sancheti healthcare academy and
Sancheti hospital.

Thankful to all students for giving me opportunity to teach them and making me COMPLETE TEACHER.

THANKS TO MY FAMILY

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.

My first International publication as Co Author in NDTA Network on the net, NOVEMBER/DECEMBER 2011, VOLUME 18, ISSUE 6: Thanks to Dr. Asha Chitnis, C/NDT


Thanks to Dr. Asha Chitnis, C/NDT for help and guidance in publishing the paper in NDTA NETWORK.

Participation and Participation Restrictions in a Teenager with Down Syndrome: an Indian Scenario
By by Reena Mody, PT, C/NDT, Gajanan Vithalrao Bhalerao, MPT, Sujata Noronha, PT, C/NDT Madhavi Kelapure, PT, C/NDT, Asha Chitnis, PT, C/NDT

NDTA Network  on the net November – December 2011 • Adults with Congenital Disabilities. Volume 18, Issue 6

link:

https://www.ndta.org/network/article.php?article_id=575