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

Never plan the therapeutic management based on the medical diagnosis or cause of stroke


All students and the therapists who are treating patients with stroke must have thought or heard this kind of question in their practice.

What is the therapeutic management of frontal lobe bleed/infarction?

What is the therapeutic management of occipital bleed /infarction?

What is the therapeutic management of parietal bleed /infarction?

What is the therapeutic management of thalamic bleed?

Instead of answering these questions, we need to ask different questions

What are the sign & symptoms of these patients? What are the physical & perceptual impairments of patients?

What are the activity the patient is able to do and not able to do?

What impairments are limiting the activity? What are the contextual factors & personal and environmental factors are restricting his participation?

 Neurologist does the medical or neurological diagnosis of patient’s i. e. Stroke due to infarction or bleed. Bleed or infraction internal capsule, thalamus, basal ganglion, MCA territory etc. This different level of injury and severity will helps us in finding out the prognosis and planning of treatment according to level of lesion and severity of it.

 But for us as a physiotherapist we need to look at the movement dysfunction. We need to find the physiotherapeutic diagnosis of movement dysfunction. Such as hemiplegia, henianesthesia, cognitive and perceptual disorders, unilateral neglect, heminomus hemianopia, shoulder dislocation, genu recurvatum, hemiplegic hand, claw hand, fixed flexion deformity,

 “Stoke is Medical diagnosis, Hemilplegia is a Physical diagnosis ….!”

 We treat hemiplegia neurologist treats stroke.

We need to keep in mind that we as therapists don’t treat the cause of the stroke like the medical management. We don’t plan treatment directly with the causative factors of the stroke.

We treat physical & functional dysfunction –  “MOVEMENT DYSFUNCTION”.

We plan our management according to:-

  • What are activities limitations?
  • What impairments (signs and symptoms) of patients causing activity limitation
  • What is the need of the patients according to their lifestyle, age and occupational demands (personal & environmental factors, contextual factors)?

Any patient of stroke with any medical diagnosis the physical functional demands from life are same. These demands doesn’t change with diagnosis ( the prognosis & the ability to achieve these target might be affected due to level of lesion and severity of lesion).

Every patient basic physical functional demands from life are: -

  1. Bed mobility- rolling supine to sit, bed side sitting etc
  2. Toilet training
  3. Transfers from bed to chair or toilet transfers
  4. Sit to stand
  5. Standing with or without assistive devices
  6. Walking with or without assistive devices
  7. Upper limb function for hands skills & manipulations
  8. Activities of daily living (ADL) & Instrumental Activities of daily living (IADL)- dressing, feeding, brushing, combing, reading writing & bathing etc
  9. Indoor and outdoor ambulation with or without assistive devices
  10. Stair climbing

 These activities will be required to train in patients. We need to ask questions how to achieve these activities with current level of impairments and contextual, personal & environmental factors. Plan the gaol according to the activity & participation restrictions. Train the patient for his desired activity. Involve him in planning the treatment program. Ask him which activity he wants to learn first. Take his view point in account and set realistic, challenging but achievable goals. And plan the management according to it & try to accomplice that activity. Treat those impairments which are limiting the activity and his participation in community. He may have multiple impairments but not all the impairment limits the desired activity of the patients and his physical and functional demands in his lifestyle.

 To get the right answer for the management you need to ask the right question….!

If you ask a right question you will get the right answer for it.

Your main objective should be changing the participation and activity limitation in community (based on ICF model).

 “Our treatment should bring some change in his life and not in the impairment…!”

 

Every patient of thalamic bleed doesn’t show symptoms of thalamic syndrome…!


 Most of the patients with thalamic bleed don’t show the typical symptoms of thalamic syndrome or thalamic pain. These bleeds are around the basal ganglion and internal capsule so they do show signs of hemiplegia and some will show signs of hemianesthesia on opposite side of body. We assume that every patient of thalamic bleed will show signs and symptoms of thalamic pain but that’s not always true. We need to look at bleeding near thalamus or around basal ganglion with broader view.

What is the therapeutic management of thalamic bleed?


What is the therapeutic management of thalamic bleed? This is the question I have been commonly asked by most of the students and therapists.
Instead of answering their question I ask them a question. What are the signs & symptoms of the patients?
I always keep in mind that we as therapists don’t treat the cause of the stroke like the medical management. We plan our management according to the signs and symptoms of the patients and the needs of the patients according to their lifestyle, age and occupational demand. We don’t plan treatment directly with the causative factors of the stroke. In the end, we have to treat the hemiplegia or hemianesthesia. In thalamic bleed we see the loss of sensation on the side of hemiplegia that will affect the rehabilitation & sensory feedback. This in turn will directly affect the motor learning.

HOW TO DO WALKING TRAINING WITH WALKER IN PATIENTS WITH ASIS TYPE C QUADRIPLEGIA WHO DO NOT HAVE HAND CONTROL TO HOLD THE WALKER DUE TO LMN LESION AT C7, C8 & T1.


Quadriplegic patients who have LMN lesion at C7, C8 & T1 do not have hand control and are unable to hold the walker.  In spite of improvement in lower limb and trunk strength these patients are unable to walk with walker because they can’t hold the walker.
So what is the solution?
The solution is very simple. When they are not able hold the walker due to hand weakness we can use forearm support walker for gait training.

DO NOT WORK ON MOBILIZATION & INCREASING THE RANGE OF MOTION IF MUSCLES DON’T GOOD STRENGTH THROUGHOUT THE RANGE.


Patients with Chronic hemiplega have shoulder stiffness and pain. To reduce the stiffness and to improve the range of motion we perform mobilization of shoulder and try to get the full range of motion. We can get the full range of motion of shoulder but they typically don’t have strength throughout the range. Higher degree of mobility without good stability leads to multidirectional instability of shoulder. This instability will further increase complications of shoulder pain which leads to shoulder hand syndrome.