WHAT IS PHYSIOTHERAPY?

By Dr Norazlina bt Abdul Aziz Rehabilitation Physician Rehab Medicine Dept HTJ, Seremban
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Rehabilitation Definition
The development of a person to his or her fullest physical, psychological, social, vocational and educational potential consistent with his or her physiologic or anatomic impairment and environmental limitation (holistic)

Interdisiplinary team approach

What are the benefits of Physiotherapy ?

Physiotherapy
The treatment of physical dysfunction or injury : by the i) use of therapeutic exercise ii) the application of modalities intended to restore or facilitate normal function or development.

Physiotherapist
Health profession whose primary purpose is the promotion of human health and function through the application of scientific principles to prevent, identify, assess, correct or alleviate acute or prolonged movement dysfunction
The American Physical Therapy Association

PHYSIOTHERAPY SERVICES
General Specialized area
       

Spinal cord injury Amputee Paediatric Cardiac Neuro Musculoskeletal Women Health Lymphedema

PRESCRIPTIONS
Therapeutic exercises Chest Physiotherapy Physical modalities Mobility and Ambulation aids Gait training

1. Therapeutic exercises
Mobility exercises Resistance exercises Cardiopulmonary endurance exercises Motor coordination and skill exercises Aquatic exercises Relaxation exercises

Therapeutic exercises
Mobility exercises
 Range Of Motion maintain ROM within available range  Stretching increases ROM by lengthening shorthened structure

Resistance exercises
 Isometric training - generation of muscular force with no visible joint movement  Isokinetic training - generation of muscular force with visible joint movement at constant speed  Isotonic training - generation of muscular force with visible joint movement at variable speed but with constant external resistance

Cardiopulmonary endurance exercises

 Aerobic  Anaerobic

Motor coordination and skill exercises

 Traditional approach - Proprioceptive neuromuscular approach - Brunnstrom - Bobath - Rood  Co-temporary Carr and Shepherd approach Co-

2. Chest physiotherapy
Modalities
       1. Secretion removal techniques 2. Controlled breathing techniques 3. Abdominal exercise & support 4. Postural relief technique 5. General reconditioning exercise 6. Relaxation technique 7. Energy conservation technique

Secretion removal techniques

1. Secretion mobilization techniques involve the use of percussion, shaking & vibration to loosen & mobilize secretion in a patient placed in a specific position for postural drainage 2. Airways clearance technique - cough maneuver - huffing - mechanical insufflations & ex-sufflation ex- suction

Controlled breathing techniques

Diaphragmatic breathing Segmental breathing Incentive spirometer technique Glossopharyngeal breathing Pursed lip breathing Paced breathing

Chest physiotherapy
Clearance of secretions is mandatory
 To reduce the work of breathing  To limit infection  Atelectasis

To optimize the effect of chest physiotherapy ,mucoactive medications is given :

    Expectorants Mucolytics agent Bronchodilators Surfactants

3. Physical Modalities
Thermal modalities
 Cryotherapy  Superficial heat modalities  Deep heat modalities

Nonthermal modalities
Electrotherapy Light therapy Hydrotherapy Manipulation, traction & massage

Cryotherapy
Therapeutic application of cold substance to body results in withdrawal of heat form the body & lowering tissue temperature Eg: ice packs, cold gel packs, ice immersion Initial respond constriction of arterioles and venules (within 15 minutes or less) blood flow to the area decreased and body attempts to conserve temp. ,later vasodilatation Decreased conductivity of pain receptors and nerves

Cryotherapy
 Indications
Rational for application of cold 24-48 hours after acute injury 24 Decreases fluid filtration into interstitium by vasoconstriction  Decreases inflammation  Decreases pain and muscle spasm

 Contraindications
Impaired sensation Impaired circulation Hypersensitivity to cold Angina Pectoris Open wound

Superficial heat modalities

Physiologic effect
Causes rise in temperature at skin and subcutaneous tissue to depth 1-2cm 1Oxygen uptake increases, making more nutrients available to promote tissue healing Decreases in pain results from elevation of pain threshold, alteration of nerve conduction velocity, decreses firing rate of muscle spindles

Superficial heat modalities

 Moist heat
Moist hot packs Paraffin wax

 Dry heat

Superficial heat modalities

Indications
     Promotes decrease in musculoskeletal pain Helps decrease joint stiffness and increase ROM Alleviates muscle spasm and contracture Improves tissue healing by increase blood flow and nutrients Paraffin wax treats joint stiffness in extremities

Contraindication
    Acute inflammatory conditions Prone to bleeding eg hemophilia Malignant tumors Cardiac insufficiency

Deep heat modalities

 Causes rise in temperature at skin and subcutaneous tissue to depth 3-2cm 3Ultrasound Short wave diathermy

Ultrasound
Uses sound wave >20,000Hz Therapeutic - 0.8 to 3 MHz Physiologic effects  Increases tissue extensibility  Increases local metabolism  Increases blood flow  Increases pain threshold  Increases nerve conduction velocity  Denaturing of scar tissue

Ultrasound
Indications
    Soft tissue injury Joint contracture Scar tissue Muscle spasms

4. Electrotherapy
Therapeutic use of electricity to transcutaneously stimulate the nerve or muscle using surface electrodes General Clinical indication:
      

Pain management (acute & chronic msk pain) Neuropathic pain Joint effusion Muscle spasm Muscle atrophy Dermal ulcers and wounds Circulatory disorder

Electrotherapy
Types :
 Microcurrent electrical neuromuscular stimulation (MENS)  Trancutaneuous electrical nerve stimulation (TENS)  Percutaneous electrical nerve stimulation (PENS)  Neuromuscular electrical stimulators (NMES)

5. Mobility
Ambulation aids
 Adults  Paediatrics

Mobility system
 Manual wheelchair  Motorized wheelchair

Ambulation aids
Straight cane
 Cane with one point of support  For patient with mild to moderate weakness or balance  Used on the opposite side of weakness

Ambulation aids
Quad cane
   

Four point of support Moderate weakness or balance Small or large base (the larger the base ,more stability Used on the opposite side of weakness

Ambulation aids
Axillary crutch
 Top portion extends upward to axillae but not touch the axillae_2 inch below the axilla  Proper fit is important to prevent
Radial nerve mononeuropathy due to leaning to axillary pad Usually use in patient with temporary limitations in weight bearing status eg patients with fracture May be used on permanent basis for patients with mild to moderate weakness or balance impairment

Ambulation aids
Forearm crutch
 Top portion extends upward to forearm  Cuffs wrap around forearm ,thus freeing hand for other activities

Ambulation aids
Walker/Walking frame
 4 point of support  Used in patient :moderate to severe weakness, balance or decreased endurance

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6. Gait training
Should be individualized based on pt s d(x), contraindication & goals. PrePre-ambulation programmes
 To improve strength, coordination, ROM, postural stability, balance & transfer.  Standing aids: tilt tables, standing frames.  Basic mat actvities

Parallel bars activities progression Indoor progression Outdoor progression

THE END