NDT/Bobath Certificate Course in the Management and Treatment of Adults with Hemiplegia, Pune, India 2015


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

Sancheti is organising  second ADULT NDT course in INDIA.

Seats available – 24 only
Course Dates:
19-01-2015 – 06-02-2015
It will be 5 days/week for three weeks. Saturday & Sunday off.

Course Number: 14A101
Course Status: Approved

Registration Fee: A non-refundable RS 5000/- and $ 100 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 15 days of course (5day/week).

TYPE PERIOD INDIAN DELEGATE INTERNATIONAL DELEGATES.
Registration Fee Up to 31/09/14 RS 5000/- $ 100
Early bird Fee UPTO 30/09/2014 Rs1,00,000/- US  $ 2050/-
Regular Fee 01/10/2014 TO 31/010/2014 Rs1,10,000/- US  $ 2100/-
Late Fee 01/11/2014 TO 31/30/2014 Rs1,20,000/- US  $ 2150/-

 

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.

Banking details for electronic transaction

Bank name:                 Bank of Maharashtra

Branch:                        Pune Main branch, Lokmangal Pune -411005

IFSC code:                  MAHB0001150

Account name:            Sancheti continuous physiotherapy education (CPE) program

Account number:        60130671451

Note: We reserve the right to cancel this course, if necessary. Full tuition reimbursement will be provided on a prorated basis in the event of sponsor or Coordinator-Instructor cancellation.

(NOTE: Application fee is non-refundable.)

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

Faculty

Cathy Hazzard, B.Sc, MBA, PT, C/NDT CI
Ms. Katy Kerris, OT, C/NDT

Course ID no. 15A101

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. (http://www.ndta.org/instructor_detail.php?instructor=768)

Ms. Katy Kerris, OT, C/NDT

She has 25 years of experience working with neurologically impaired and orthopedic patients. She uses an NDT perspective in treating neuro patients. In addition she has  a Certified Hand Therapist and also have a strong background in manual therapy.she is an OT Adult Hemi Instructor. She has taught several introductory level classes and assisted in teaching several 3 week certificate courses.

Course Contact:
Dr. Gajanan Bhalerao
Phone: 9198 22623701
Fax: 9120 25539494
gajanan_bhalerao@yahoo.com
Website

http://www.ndta.org/course_list.php?type=AH

Application of Registration:-

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. (http://www.ndta.org/instructor_detail.php?instructor=768)

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.
(http://www.ndta.org/instructor_detail.php?instructor=1676)

Course Contact:
Dr. Gajanan Bhalerao
Phone: 9198 22623701
Fax: 9120 25539494
gajanan_bhalerao@yahoo.com
Website

http://www.ndta.org/course_list.php?type=AH#course283

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.

http://www.youtube.com/watch?v=bh0Cvh1O-O4

Postponed the course on Basic Neuro-Developmental Treatment (NDT Paeds) workshop in December 2012


Please Note the course is postponed.

New dates are

8th & 9th December and

22nd and 23rd December

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 8th & 9th December and 22nd & 23rd 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 Final Year BPT & BOT , 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

 

Fourth year CBR Project made easy, well planned, organized and fun filled Potential Research questions for a high-quality research project -A trial


All fourth year students  have to do a research project for community health  for partial completion of the exam. Every year, students  are allotted different teachers as guides. topics are provied by the guide or the concerned student,based on need of study and interest.

There are several queries the student faces during project initiation

Selection of topic?

What are the aims and objectives of the study?

What is the method and methodology?

How to go about data collection?

How to make an excel document?

How to find review of literature?

What is the type of analysis?

How to form a questionairre?

How to write the synopsis?

What is to be included in the discussion of the project?

When is the research considered valid?

The guidance obtained by the student may have certain limitations based on time constraints,etc . Fourth year CBR Project  has always  been one of the common problems faced in fourth year.Some students cannot complete the project before prelims so they have to complete the project during their Preparatory leave (PL) time. PL’s period is an extremely valuable time which we cant just utilize for data collection, analysis, editing, printing  and project completion.

So this year I though of  helping all the fourth year students to complete the project by end of December. So that their project will be ready for being presented at the Scientifica 2013,organized by MUHS Nashik!

In the  month of August &  September we  told the students to come with the research topic. Till September end we went  through their topics. By October 15 they had to submit the topic. I had invited every students to come up and present the topic details in front of the whole class and submit a hard copy of the same, i.e. introduction, sample population, sample size criterion, study design and method and methodology, inclusion and exclusion criterion, Review of literature . I helped the students for  the selection of an  appropriate sample size, study design and method whenever  required and added my suggestios when need be. I had taken a lecture on How to design a questionnaire (Thanks to MUHS Nashik, MET cell Pune, where I had attended a workshop Research methodology where they taught us how to design a questionnairre) .  In this process of presentation everybody got a clear idea of the project and everyone learned from each other’s mistakes and good topics came forth.By the end of October eachone had submitted the synopsis of the topic. Now,next two months they will  beworking  on data collection and by 15th of December the plan is to  complete data collection and finish analysis.The results and discussion  will be completed in  the next two weeks, and by 31st December their topics would be submitted for Scientifica 2013

This was a small attempt done by me  to make  the Fourth year CBR Project  easy, well planned, organized and fun filled Potential Research questions for a high-quality research project.Initially there was low compliance by some of the students  because they were asked to do a lot of work within a short period of time and they did not have a clear picture of how to go about it.

       

Fourth year project Gant chart  click here to see the sample of  Gant chart.

But once all the above mentioned sessions were conducted the students got a clearer idea and started  participating more actively and enthusiastically in the reserch project.Now the project work has taken a kick started and is smooth functioning as everything is well planned and organised!

The below mentioned article is an experience shared by one of the 4th year student.

A NEW START …4TH YR PROJECT- LEARNING MADE FUN

Anood Faqih(4th yr B.P.Th)

Project…! Research…! Was something each one of us was apprehensive of when we entered the 4th year …

Starting right from what to choose as the topic to how to go about it was a big question mark to us…and one fine day, we were allotted our guides and then it all began….

There were questions flying into our minds “why are we doing this project?” “What is the need?” and “how are we going to manage it with this hectic schedule of ours!”

So, here we take our 1st step…with our class teacher Dr. Gajanan Bhalerao introducing research methodology to us. No! It wasn’t mandatory for him to take the lecture but out of interest and for our benefit and better understanding, he did it all..

He guided us with every step of ours..from choosing the right topic to writing the synopsis to framing the correct questionnaire.

In the class we were asked to think about our individual topics and put our thoughts forward.  There was a lot of confusion about what sample population & sample size i.e. to be taken in a particular type of population. E.g.: musculoskeletal injuries in rifle shooters. Questions that came up were. What should be the criteria for selection? Age group? Duration for which the individual has been practicing rifle shooting? Etc

Then we were given a period of 15 days to come up with the final synopsis.

We made Gantts charts so that we have a systematic overview about our project process and follow it in an orderly manner.

We were asked to submit the gantts charts and put them up on the notice board so that we have a continuous feedback of the things that we have planned. Hardly a few of us had made the gantts chart in the time allotted to us, rest all of us made it in the class during the lecture. There was a better understanding.

Each one of us had to present the topic in front of the whole class. Suggestions from everyone were invited. This individual discussion of synopsis was equally beneficial as we learnt from the mistakes made by our own batch mates and helped us to improve our own. So we learned from our own as well as others mistakes. Before this we had an idea but it wasn’t very clear. Presentations in front of the class and the following discussions made our idea crystal clear.  This helped us in writing the synopsis very well and discussing our point of view with the guides allotted.

This whole process of research and group discussion made us realize the importance of team effort, time management and definitely exchange of ideas.

Now, gradually all the confusion that was once bothering our minds was resolving.

Now, all of us have our concepts changed … the concept of taking research and project as a burden to a beneficial, knowledgeable and interesting one.

Now “our idea is no more an idea but it has become a potential Research Question for a high-quality research project”.

Learning was definitely made fun.. and now this is just the beginning… !!

We are now working on the project, Questionnaire design assessment form, consent letters, data collection by direct interview/emails/telephonic interviews etc.

We are eagerly waiting for that something which started with confusion, turned into a fun learning process and we are expecting fruitful results. Frankly, I’m loving the process of going through it than the ultimate result.  I am sure each one of my classmates also feel the same & are going through the similar kind of emotion.

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

DURING LOADING RESPONSE DURING MIDSTANCE
DURING TERMINAL STANCE DURING PRESWING

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

  • FORWARD TRUNK LEAN IN STANCE

    during LOADING RESPONSE during 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:

    • QUADRICEPS WEAKNESS

    • PAIN WITH QUADRICEPS ACTIVATION

    • PROPRIOCEPTIVE DEFICIT

    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.

References

1. WHO | Stroke, Cerebrovascular accident [Internet]. [cited 2010 Aug 3]; Available from: http://www.who.int/topics/cerebrovascular 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 http://www.mayoclinic.com/health/hyperextended-knee/AN00283

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

5.  what is genu recurvatum?  http://www.wisegeek.com/what-is-genu-recurvatum.htm.

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. http://www.ijtr.co.uk/cgi-bin/go.pl/library/article.cgi?uid=90240;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. http://www.healio.com/orthotics-prosthetics/orthotics/news/online/%7BBDC02BFE-6C76-42E6-8457-462C3F6EC0B7%7D/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. http://www.asbweb.org/conferences/2005/pdf/0517.pdf

12.Prevalence of knee hyperextension in individuals with hemiplegia. http://www.google.co.in/url?sa=t&rct=j&q=causes%20of%20knee%20hyperextension%20in%20stroke%20patients&source=web&cd=5&cad=rja&ved=0CGMQFjAE&url=http%3A%2F%2Fwww.rguhs.ac.in%2Fcdc%2Fonlinecdc%2Fuploads%2F09_T025_33559.doc&ei=naewUJy4FIKIrAf94oHIAQ&usg=AFQjCNFq_n-B0tDhquU8Wkz6EhE17eWgtQ.

13.Ankara Fizik Tedavi. Assessment of Genu recurvatum in hemiplegic patients. http://www.jpmrs.org/pdf/pdf_PMJ_98.pdf

14. Knee hyeprextention in stance. http://moon.ouhsc.edu/dthompso/gait/kinetics/kneehypr.htm

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