disorders are common among people with neurological conditions such
as stroke, Parkinson’s disease, multiple sclerosis, cerebral
disease or a head injury. Gait disorders can also develop from a
sporting injury or lower limb fracture.
Role of physiotherapy
play an important role in analysing walking patterns in people with
movement disorders and undertake
specialist training to analyse gait problems
all levels of disability.
Gait analysis by a physiotherapist assists in
identifying the underlying cause of the disorder and provides
measures of the severity of the condition that can be used to chart
the effectiveness of treatment. From the analysis, physiotherapists
can advise patients on the appropriate course of treatment.
can analyse gait either in a research laboratory or in a clinic.
Although there are only a small number of gait laboratories,
patients can have a full assessment using computerised motion
analysis and footswitch
devices, force platforms, electromyography and accelerometry and
physiotherapy clinicians analyse the walking pattern at a clinic
using a range of validated clinical assessment procedures to
objectively measure movement disorders,
functional outcome and the effects of
treatment on the walking pattern.
Benefits of physiotherapy
: When treated with physiotherapy, people with gait
disorders can experience improved mobility and independence and
reach their maximum performance levels
whether it be in everyday tasks or high level sporting
analysis assists physiotherapists to determine if the walking
disturbance is due to abnormalities of: muscle tone including spasticity, rigidity, dystonia,
hypotonia; coordination, as occurs in ataxia; muscle strength,
including weakness and paresis; balance, including vestibular,
visual and somatosensory inputs; soft tissue extensibility,
including muscle shortening, joint contractures or hypermobility of
joints; extra movements, such as chorea, athetoid movements,
dystonia, tremor; reduced movement, such as hypokinesia and
akinesia; bony deformities that can occur in disorders such
as scoliosis, kyphosis, talipes equinovarus; sensation, including
proprioception, tactile discrimination,
touch, pressure, pain, temperature and vibration; cognitive and
perceptual problems such as apraxia, depth perception and vertical
perception disorders and neglect.
therapists treat and rehabilitate patients with upper limb injuries,
particularly of the wrist and hand. These injuries include traumatic
injuries, congenital deformities, neurological and arthritic
conditions, and regional pain syndrome arising from RSI of the
Role of physiotherapy :
hand therapist has a range of skills which are
invaluable to the patient’s level and rate of recovery. Hand
surgeons and hand therapists generally work together to ensure the
best possible result for the patient.
Benefits of physiotherapy
of the major skills of the hand therapist is custom-made splinting.
Splinting can be used for rest and immobilisation of fractures and
soft tissue injuries, protection during sport and work, enhanced
function, or for correcting contractures. Other skills include
oedema management, scar management and wound care using modalities
such as massage, compression and appropriate silicon products and
dressings. Return to optimal activity levels is enhanced with the
provision of aids and appliances, e.g. recommendations for car
alterations, work site assessment and return to work plans.
Other treatment techniques include passive joint mobilisation
and soft tissue work such as deep friction
massage. Specific exercise programs are prescribed to
mobilise, strengthen, and desensitise. Electrotherapy modalities
such as ultrasound, laser, wax, TENS, and electrical stimulation are
all frequently employed in treatment.
of the most common forms of arthritis is osteoarthritis. It damages
your joints through wear and tear. It can be painful and depressing.
There is no cure, but there are ways of managing the condition and
making life easier. Physiotherapy is an important part
of that management.
How Does Osteoarthritis Affect People ?
Most people develop some degree of osteoarthritis especially
as they get older. The changes are permanent and will exist even
when there are no symptoms. Osteoarthritis affects people in varying
degrees. Some people may be symptom-free or suffer only mild or
intermittent pain provoked by episodes of increased use or minor
trauma. For some people symptoms can be disabling and, when it
involves the larger joints of the body such as the hip or the knee,
the severity of the problem may require surgical treatment.
Wear and tear of our joints may
occur due to aging, injury, prolonged poor posture, over use
of joints, or excess weight.
is one of 150 different forms of arthritis for which here are
different treatments. Your general medical practitioner can make a
diagnosis. Treatment may include anti-inflammatory medication and/or
How Physiotherapy Can Help ?
Physiotherapists are highly qualified in the assessment and
treatment of the effects of osteoarthritis.
* Reduce pain
* Improve movement and posture
* Strengthen muscles
* Improve independent function
Treatment methods may include gentle passive movement, heat, electrical
treatments, hydrotherapy, splints and
advice on preventing further joint damage.
Symptoms and Signs :
* Recurring pain or tenderness in a joint
* Stiffness, particularly early morning stiffness
* Swelling in a joint
* Obvious redness or heat in a joint
* Inability to move a joint
How You Can Help?
* always respect pain
* avoid overstressing joints
* avoid jerky/sudden movements
* don’t overload joints
* take care with lifting
* watch your weight
* use splints or walking aids as advised
* use labour saving devices
* don’t overdo activity or exercises
Exercises - How Do They Help ?
Exercises for people with osteoarthritis should be
individually prescribed. Your physiotherapist can devise a programme
of exercises to suit your condition. As a general rule remember if
any exercise hurts then DON’T
Exercises help by :
* maintaining or increasing movement
* improving joint lubrication and
* restoring muscle balance
* improving circulation
* improving strength and stability
* improving poor posture
Don’t forget to maintain your GENERAL
FITNESS LEVEL - this helps you feel
better and retain your healthy joints. Gentle regular exercises such
as swimming, exercising in water (hydrotherapy), walking or cycling
REST : Rest
is an important part of managing your
Osteoarthritis. Usually rest is balanced with exercises and
activity. In particular rest is required when joints are HOT,
SWOLLEN OR PAINFUL.
and postural problems are the main causes of neck pain.
Physiotherapists can identify the reasons for your neck pain and
provide effective treatment.
What Causes Neck
head is heavy and balanced on a narrow support made up of seven
bones called vertebrae. The vertebrae are separated from each other
by discs, stabilised by joints and ligaments and moved by muscles.
Because the neck is so mobile, it is easily damaged. Injury and
postural problems are the most common causes of neck pain. Diseases
such as arthritis or degeneration of the discs can also cause pain.
A disorder of the neck joints or muscles can cause referred pain to your
head, shoulders, arms and upper back.
Neck Injuries : Neck injuries
most often result from motor vehicle
accidents, sports or occupational accidents. Damage may occur
to vertebrae, joints and nerves, discs, ligaments and muscles. A
common neck injury is the acceleration/deceleration injury or
‘whiplash’ where the head is thrown forward or back.
Posture : Bad
posture can cause neck pain. Ligaments are overstretched, muscles
become tired and the neck joints and nerves are put under pressure.
shoulders with your head pushed forward, sleeping with your head in
an awkward position, or working with your head down for long
periods, will all tend to cause neck pain.
PREVENTING NECK PAIN
Here is some useful advice to help you prevent neck pain:
Posture: Think tall,
chest lifted, shoulders relaxed, chin tucked in and head level. Your
neck should feel strong, straight and relaxed.
Sleeping : A down pillow or urethane pillow is best for most people.
Avoid sleeping on your stomach.
Relaxation : Recognise when your are tense. You may be hunching your
shoulders or clenching your teeth without realising it.
Work: Avoid working with your head down or to one side for long periods.
Stretch and change position frequently.
Exercise : Keep your neck
joints and muscles flexible and strong with correct neck exercises.
Your physiotherapist can show you how.
How Physiotherapists Can Help
will be able to determine the source of your neck pain and treat it.
They may use:
* remedial exercise
* postural assessment, correction and advice
* relaxation therapy
* laser, ultrasound, electrotherapy and heat
can be an effective treatment for neck problems. In some situations,
it may do more harm than good. Your physiotherapist will carefully
check your neck before manipulating it to see if other methods, such
as mobilisation would be preferable.
Your physiotherapist can also offer you self-help advice on
ways to correct the cause of neck pain, such as practical tips for
work and in the home, adjusting furniture, relaxation and exercise.
Ankle joints and feet are the link between your body
and the ground. If the ankle twists as the foot hits the ground,
particularly during a fall, this may cause a sprain.
Physiotherapists provide advice and treatment to speed up healing
and restore full performance.
What is Ankle Sprain ? The
ankle joint is made up of four bones. The shape of each bone helps
to make the joint stable. Stability around the joint is increased by
the ligaments, which are bands of strong connective tissue that
prevent unwanted movement.
When the ankle twists, the ligaments usually prevent the
joint from moving too much. An ankle sprain occurs when one of the
supporting ligaments is stretched too far or too quickly, causing
the ligament’s fibres to tear and bleed into the surrounding
tissues. This bleeding causes pain then swelling.
What Should I Do After a Sprain ?
In the first 24 to 72 hours after injury, use the
Rest: Take it easy, but move within your limit of pain.
Ice: Apply ice for 15 minutes every
2 hours. This helps control pain and bleeding.
Compression: Firmly bandage the entire ankle, foot and lower leg. This
Elevation: Have your ankle and leg well supported, higher than the
level of your heart. This reduces bleeding and swelling. If there is
still swelling and pain after 24 hours, visit your local
physiotherapist or doctor. Your chances of a full recovery will also
be helped if you avoid the H.A.R.M. factors in the first 48 hours.
Heat : Increases swelling and bleeding.
Alcohol : Increases
swelling and bleeding.
Running or exercise : Aggravates the injury.
Massage : Increases swelling and bleeding.
How Can Physiotherapists Help ?
physiotherapist will examine the sprain to determine the extent of
your injury. Prompt physiotherapy treatment will reduce the
swelling, making it easier to walk after two or three days. To help
you return to normal activity quickly, your physiotherapist can show
you how to tape your ankle and give you exercises to improve
strength and control. If necessary, your physiotherapist can order
an x-ray, or suggest that you see a doctor.
Will I Need a Lot of Treatment ?
Your physiotherapist will discuss the injury with you and
estimate the number of treatments needed. No two injuries are ever
the same. A minor ankle sprain may need between one and four
How Soon Can I Return to Work or Sport ?
will depend on how badly you have damaged the ankle ligament.
Returning to work or sport too early can delay healing and prolong
and taping may allow early return to sport, but normal ankle
ligament strength and muscle control will
take longer to return than the time it takes for pain and
swelling to subside. Your physiotherapist can help you plan ways to
maintain fitness while your ankle is healing.
Can Ankle Sprains be Prevented ?
You can reduce the chance of ankle injury.
Warm up before you exercise. Warm down when you finish.
Avoid activities on slippery, wet or uneven surfaces, or in
areas with poor lighting. Maintain
good general fitness. Wear
well-fitting shoes, boots or ankle braces that give good lateral
ankle joint support.
Dr. Gurdev Chowdhary & Others
Assessment of Sensorium in Children
Infants and young children have a limited repertory (store house) of
behavioural responses, making it difficult to detect and quantify
the states of altered sensorium. A detailed, directed history
and thorough physical
examination is mandatory in arriving at the diagnosis and the
an accurate initial evaluation is critical to the management and the
ultimate outcome in a child with coma, consistent and practical
methods of describing various states of impaired consciousness in
children are needed. The Glasgow Coma Scale (GCS), though effective and widely accepted, has its limitations in
clinical practice because of the varied verbal and motor responses
in children at different ages.
Several modifications of the Glasgow Coma Scale have come into existence,
which are in use for gauging deterioration or improvement in acute
stages of coma in children.
Introduction : Consciousness
is a state of normal cerebral activity in which the patient is able
to respond to internal changes and to changes in the
external environment. Maintenance of consciousness requires
an intact and functioning reticular activating system and an
adequate volume of functional hemispheres. Alterations in
consciousness are apparent
as a decrease in spontaneous activity or in the response to
environmental stimuli. The term “altered sensorium” lacks
precision and is applicable to all states where it is certain that
normal sensorium is not present.
Definition of certain terms used in relation to altered
is a normal variation in consciousness. The sleeping child is easily
aroused and is then responsive to stimuli, questions and directions.
the patient appears to be in normal sleep but can not be
easily awakened. Once awake such patients tend to fall asleep
despite attempts to continue conversation or clinical examination.
There is disorientation and higher intellectual functions are
as a state of impaired consciousness from which a child can be
aroused only by vigorous and repeated stimuli. The child slips back
into unresponsiveness after a few mumbled words. The superficial and
deep tendon reflexes are preserved.
there is an inability to think with customary
speed and clarity. Response to environmental stimuli is
inappropriate and the patient is irritable, excitable and easily
American Psychiatric Association defines delirium as
a. A reduced ability to maintain attention to external stimuli, and to
appropriately shift attention to new external stimuli.
b. Disorganised thinking as evidenced by rambling, irrelevant
and incoherent speech.
c. At least two of the following :
i. Reduced level of consciousness
Disturbances of perception
Disturbed sleep wake cycle
Increased or decreased psychomotor activity
misinterpretations of actual sensory stimuli.
perceptions of sensory stimuli that are not present e.g. hearing
voices, music or sound, seeing objects, animals, people, insects
incorrect beliefs that cannot be changed by evidence or
condition in which a patient is unreasonable and unresponsive to all
mutism or Coma vigile : patient has a blank staring look and appears to be awake but is
unresponsive by way of movement and speech. This state may precede
coma or occur during the course of recovery.
when a patient is in coma for longer than 2 weeks.
vegetative state :
this is the end stage of severe and
extensive brain damage and has the following features :
i. Present for more than one month
ii. No evidence of awareness of self or
iii. All responses are reflex.
iv. There is no meaningful or voluntary
response to stimulation.
v. No evidence of language
vi. Preserved cranial nerve functions.
vii. Intact hypothalamic/autonomic
this is a state of coma in which the brain has ceased to function
completely, but pulmonary and cardiac functions can still be
maintained by artificial means for hours to few days. In children,
systems for describing patients with impaired consciousness are not
consistent. Moreover, infants and young children have a restricted
repertoire of experience and behavioural responses. Therefore, the
detection of and quantitation of
alterations of consciousness are much more difficult.
Clinical Evaluation : A systematic
approach to the initial evaluation of the child with altered
sensorium may mean the difference between survival or death and
permanent neurologic sequelae or full recovery.
A functional airway, adequate ventilation, effective cardiac
output and perfusion pressure must be ensured before any attempt to
reach at the diagnosis is made. A thorough, yet gentle examination
for signs of internal or external haemorrhage must be performed.
Assessment consists of taking a directed history, general
physical examination, neurological examination, neuro-imaging, EEG
and determination of chemical, cytologic and microbiologic content
of the various body fluids. The specific objectives aimed for
assessment of a patient with altered
sensorium are :
To determine the cause of coma.
ii. To delineate the area of the brain which is involved.
iii. To determine further course of management which will
reversing the process and enhance the chances of recovery.
History : The
history must be directed at the following :
Mode of onset of illness.
Presence or absence of preceding warning symptoms.
Temporal course of illness.
Treatment given and the response to the treatment.
addition, factors like age of the child may have a bearing on the
cause of altered sensorium e.g. inborn-errors of metabolism
present during neonatal period or early infancy. Pyogenic meningitis
is more common below 3 years of age, whereas, viral encephalitis
usually occurs after the age of 6 years. Cardio-vascular accidents
take place more commonly in older children as compared to infants.
clinician must be aware of the racial, geographic and seasonal
variations in causes of coma e.g. polio encephalitis is more common
during the monsoons whereas, ARBO viral encephalitides and cerebral
malaria epidemics fall usually in summers.
Mode of onset : The onset of illness may be acute, subacute or
insidious depending on the cause.
Preceding warning symptoms :
Altered sensorium may or may not be preceded by warning
symptoms like fever, headache, jaundice, seizures, vomiting, anuria,
polyuria/polydipsia, diarrhoea and exposure to heat/cold depending
upon the cause.
Nutritional status : Patient may be poorly nourished in
Insulin dependent diabetes
errors of metabolism
Breath odour : Certain distinct odours may be discernable in
the following conditions :
ketoacidosis : fruity smell
Hepatic encephalopathy : mousy odour
Uremic encephalopathy : mousy odour
Aluminium phosphide poisoning : Garlic odour
Kerosene poisoning : Smell of hydrocarbon
Heart Rate :
: alongwith decreased blood pressure may suggest
: increased intracranial tension.
Pattern of breathing :
Cheyne - Stokes breathing (also
called periodic breathing ) :
used for a pattern of breathing in which there is a phase of gradual
deepening of respiration followed by a phase of slowly decreasing
respiratory rate. Respiration gradually becomes quieter and may
cease for a few seconds. The cycle is then repeated. This is a sign
of raised intracranial tension and can occur in coma due to any
breathing : manifests as a deep,
sighing and rapid breathing at a regular rate and is suggestive of
pontine hyperventilation : Term
used for the deep and regular breathing that occurs in rostral
brainstem damage due to reticular pontine infarction or in central
brainstem dysfunction secondary to herniation. Interspersed deep
sighs or yawns may precede the development of this respiratory
conditions associated with hyperventilation are :
Raised intracranial tension
Bacterial meningitis Renal failure Pneumonia Liver
failure Brainstem lesions
Head, Neck and Spine Should be thoroughly examined for any evidence of head
injury and for
any abnormality of the following :
Look for bruits or dysraphisms, transillumination of the skull
must be done in young infants in coma.
Ear : Blue
discoloration of the ear drum : basilar skull fracture Ecchymosis
over the mastoid process : fracture base of skull. (Battle sign)
Epistaxis : head injury, deranged coagulation with intracranial
Laceration of tongue : tonic/clonic seizures
Coated furry tongue : chronic renal failure
Rash : measles, other viral exanthemata, bacterial endocarditis
Pigmentation : pellagra
Changes in turgor: dehydration
Uremic frost : chronic renal failure
Petechiae : meningococcal septicemia
General erythema: atropine poisoning
* Look for size, shape, reaction to
light and accommodation.
* Pontine lesions : pinpoint pupils
* Thalamic lesions : anisocoria
* Transtentorial herniation :
Hutchison’s pupil (ipsilateral constriction followed by
dilatation and subsequently
Fixed and dilated pupils : Sympathomimetic drugs, deep ether
b. Constricted pupils : Narcotics, anticholinergics,
phenothiazines, sodium valproate.
Doll’s eye movements : presence of doll’s eye movements
occulocephalic reflex) in coma denotes that the brain stem is
caloric test :
the fast component of nystagmus occurs towards the side which is
being tested in an unconscious patient. Conjugate lateral deviation
of eyes : In cerebral lesion - towards the side of lesion. In brain
stem lesion : opposite to side of lesion.
haemorrhage : head injury
Papilloedema : raised intracranial tension
Diabetic retinopathy : diabetes mellitus
Hypertensive retinopaty : hypertension
Choroid tubercles : tubercular meningitis
Cherry red spot : Tay Sach’s disease
Decerebrate rigidity : results from brain stem lesion
anywhere between the inter-collicular level and vestibular nucleus
and is characterized by extensor hypertonia and internal rotation of
limbs with opisthotonus.
rigidity : site of lesion is more cephalad at the interface of cerebral hemispheres and diencephalon. There is
in upper limbs. No specificity regarding nature of
lesion, these can occur transiently. Decerebrate rigidity has
a grave prognosis.
Focal Neurological Signs
may be demonstrated in cases of :
Cerebral venous sinus thrombosis
Bacterial meningitis (cortical infarcts)
Sub-arachnoid haemorrhage/intra-cranial haemorrhage
Extra-dural haemorrhage/sub-dural haemorrhage following
of Impaired Consciousness
Glasgow Coma Scale : The Glasgow Coma Scale is an effective method of describing
the various states of impaired consciousness encountered in clinical
practice. It is a practical system, can be used in a wide range of
hospitals and by staff without special training. Three different
aspects of behavioural responses examined are motor response, verbal
response and eye opening, each being evaluated independently of the
other. The responses are clearly defined and accurately graded
according to a rank order that indicates the degree of dysfunction.
The Glasgow Coma Scale was earlier used only for head injury, but it
is now used for all types of altered sensorium.
The Glasgow Coma Scale has several limitations and in the following
circumstances, it is :
Eye Opening Response (E)
Spontaneous : 4
Response to speech : 3
Response to pain : 2
none : 1
Best verbal Response (V)
oriented : 5
confused : 4
inappropriate word :3
incomprehensible sounds : 2
none : 1
Best motor Response (M)
obeys commands : 6
localizes pain : 5
withdraws : 4
flexion to pain : 3
extension to pain : 2
none : 1
Best score is E4 V5 M6 = 15
Worst score is E1 V1 M1 = 3
Glasgow Coma Scale depends upon higher integrative functions
which are not present in the infant or very young child. In children
the verbal and motor response are not readily graded and depend on
the child’s age and development. Hence, in children several
modifications of the Glasgow Coma Scale have become necessary. In
Pediatric practice, the scales used for clinical assessment of
impaired consciousness are the Adelaide Paediatric Coma
Scale, the Children’s Coma Scale and the Modified Children’s
Adelaide Paediatric Coma Scale : Simpson
and Reilly proposed that the best motor response of a child depends
on his age and development status so the score of motor response
should be adjusted according to age. And the verbal response be
graded as follows :
words : 4
vocal sounds : 3
cries : 2
no sounds : 1
The response to eye opening remaining the same as for Glasgow
Coma Scale which is
upto a maximum of 4.
Age Related Motor and Verbal Scores
to 6 Months
Motor response Verbal response
flexes to pain : 3 cries : 2
to pain :2 no sound : 1
no movements : 1
Best score : 9
6 Months to 12 Months
Motor response Verbal response
withdraws : 4 vocal sounds : 3
flexes : 3 cries : 2
: 2 no sound : 1
no movements : 1
Best score : 11
Motor response Verbal response
localizes pain : 5 words : 4
withdraws : 4 vocal sounds : 3
flexes : 3 cries : 2
extends : 2 no sound : 1
none : 1
Best score : 13
Best score 14
> 5 years
Best score : 15
* A rapid and accurate evaluation of a child with altered sensorium
is necessary for appropriate management.
* A detailed history and general physical examination provides vital
pointers towards the underlying diagnosis.
* The Glasgow Coma Scale (GCS) is an effective method of describing
various states of impaired consciousness in a wide range of clinical
* In paediatric practice, the Adelaide Paediatric Coma Scale, the
Children’s Coma Scale and the Modified Children’s Coma Scale
offer clearly defined and accurately graded assessment of the degree
of dysfunction of the central nervous system in children of various
Impairment of consciousness in children may result from a
wide range of aetiological conditions. History taking and a
meticulous physical examination provide important clues to the
underlying diagnosis. An accurate assessment of the cause and extent
of altered sensorium not only helps in the management of coma, but
also helps in focusing attention to a limited number of diagnostic
possibilities, making expensive and exhaustive investigations
The Glasgow Coma Scale, earlier used for assessment of head
injuries is considered to be an effective method of describing and
grading of coma in children. However, since the motor and verbal
responses in children depend upon their age and degree of
development, several modifications of the GCS have come into
existence which provide easy assessment of accurate grading of
central nervous system dysfunction.
Dr. Gurdev Chowdhary, Dr. Praveen C. Sobti, Prof. Daljit
Deptt. of Pediatrics, DMC & Hospital, Ludhiana
The spine has three slight curves - one in the neck, one in
the upper back and another in the lower back. These curves are
normal and can be seen from a side view. From a back view, the spine
should appear straight. If the spine has a side-to-side curve, the
curve is called scoliosis. There are two main types called postural
POSTURAL SCOLIOSIS can be corrected and is caused by some
irregularity of posture such as unequal leg length.
STRUCTURAL SCOLIOSIS can be due to abnormalities or diseases
of bones, muscles or nerves. Between the ages of about 9 and 14,
children’s bones grow rapidly. At this time, the back-bone or
spine may sometimes show signs of developing scoliosis. Early
detection enables early treatment. This may control the condition
and prevent other problems developing in later years.
it Out Regularly
scoliosis is first developing there is almost never any sign of
pain, which is why regular checks are so important. If left
untreated the curve may increase, eventually leading to back pain,
loss of flexibility and the appearance of being bent over. In later
life, severe scoliosis may result in other complications, e.g.
arthritis, respiratory infections and heart problems.
Signs to Check :
Although many students from the age of nine to fourteen are
screened for signs of scoliosis at school, parents could assist
by checking for the early warning signs every six months. Even
if one or more of these signs are present it does not necessarily
mean scoliosis has developed. It may be that one leg is a little
shorter than the other, or it could be a postural problem. By
raising one shoe or undertaking an appropriate exercise and posture
programme it may be corrected.
How Physiotherapy Can Help ?
In the majority of scoliosis cases where it is postural
or the curve is mild, physiotherapy can help.
Physiotherapists can : give an individual posture assessment
assess any muscle imbalance devise an exercise programme to
strengthen weak muscles and stretch tight muscles in some cases use
strapping to control posture advise on posture and back care advise
on ways to alleviate stress on the spine with the use of appropriate
furniture, the correct wearing of back packs, etc. monitor the
condition regularly recommend further assessment by a medical
For a moderate curve or one that is increasing rapidly, the
doctor may advise a back brace or a scoliosis jacket together with
an exercise programme supervised by a physiotherapist.
Bracing does not prevent participation in most sports and
other normal activities. With
a severe curve, surgery may be needed.
is one of the major causes of death and disability in world today.
Physiotherapists have a key role in the rehabilitation of people who
have had a stroke, helping them return to the highest possible level
of physical function.
What is Stroke ? The
brain is supplied by several major blood vessels. These vessels may
become blocked, or less commonly haemorrhage, which results in an
area of damaged brain tissue. This kind of ‘brain attack’ is
called a stroke.
Problems Caused by Stroke?
vary, depending on the area of the brain affected
and how severely it is damaged. Some common problems
* reduced control of movement and/or
loss of feeling in some parts of
body, usually on the opposite side to the stroke
* difficulty walking
* disturbance of balance
* vision problems
* problems with speaking and/or
* confusion, poor memory
* reduced control over bladder or bowel
* difficulty swallowing
* reduced control over emotions
Major Risk Factors : One or a combination of the following factors
may increase the risk of stroke:
* high blood pressure
* hardening and narrowing of the
arteries (this occurs over long periods of time,
to a build up
of fatty deposits inside the artery)
* heart disease
* high cholesterol diet
Warning Signs : Sometimes, one or more of the problems previously described
as caused by stroke may occur for a short
period, then disappear. This is called a transient
ischaemic attack. If this happens, contact your doctor
Reducing the Risk : You
can reduce the risk of stroke by :
* regular medical checkups taking
prescribed tablets as directed by your
giving up smoking keeping
weight within average for height and age
* eating a well balanced diet
* regular exercise
How Physiotherapists Can Help ? Physiotherapists are specially trained to assess movement
difficulties that may occur as a result of a stroke. By re-educating
normal movement, the physiotherapist can retrain functions such as
walking and using the affected arm. Physiotherapists are trained in
rehabilitation and work as an important member of the rehabilitation
team. Physiotherapy rehabilitation may include training in the
A. Standing Up From Sitting
B. Walking Re-Education
C. Arm Re-Education
Early Intervention :
treatment by a physiotherapist assists recovery. Although most
recovery usually occurs in the first three months after a stroke,
improvement in function may continue for several years. Ongoing
physiotherapy maximises the level of recovery achieved.
Treatment Options :
Most people who have had strokes are initially treated in
acute and rehabilitation hospitals. At a later stage, physiotherapy
may be provided through a day hospital. Physiotherapists
skilled in treating stroke patients also work in private practice
and may treat patients in their homes.
active and strong pelvic floor muscles are very important to women
throughout life. Weak and poorly controlled muscles can lead to
prolapse and loss of bladder or bowel control. Physiotherapists
trained in continence management can assess your pelvic floor
muscles and, if necessary, help you strengthen and regain their
What Do Pelvic Floor Muscles Do?
The pelvic floor muscles support the bladder, uterus, vagina
and bowel. They form a muscular and elastic floor across the bottom
of the pelvis. When tightened, the muscles lift the organs and
constrict their openings. The muscles relax to empty the bladder and
bowel. Stretching of these muscles during childbirth and straining
with constipation sometimes causes muscle weakening. As there may be
reasons other than muscle weakness for loss of bladder and bowel
control, professional advice should be sought for all incontinence
Signs of Weak Pelvic Floor Muscles :
* leaking urine when sneezing, coughing, running
(or other sudden actions)
* not getting to the toilet in time
* tampons won’t stay in place
* vaginal or anal flatus (wind) when bending and
* bulging felt at
the vaginal opening (prolapse)
* difficulty emptying the bowel completely
* low pelvic dragging, vaginal heaviness, feeling
everything might fall out
You Need Special Attention If You :
* are pregnant or
a new mother
* are menopausal
* lift heavy objects often
* suffer from constipation
* are overweight
* cough frequently
* have low backache
* go to the toilet often to pass small amounts of
Benefits of Pelvic Floor Control
* active lifestyle without wet or soiled pants
* control of wind (flatus)
* firm vagina
* freedom from pelvic heaviness and dragging
* avoid repair surgery
* a sense of control
You Can Help Yourself By :
drinking two litres of fluid each day
minimising coffee, tea and cola drinks
staying within a healthy weight range
seeking help for a chronic cough which makes
your bladder problems worse
avoiding straining with constipation
How Physiotherapists Can Help ?
Some physiotherapists have special training, skills and
experience in continence management. They can help if you have
incontinence, constipation or prolapse, or simply want to learn how
to use your pelvic floor muscles correctly and safely. Many women
are unable to use their pelvic floor muscles correctly unless they
receive individual pelvic floor muscle testing and training - simply
trying to tighten the muscles is not enough. It is also important to
learn to use your abdominal muscles correctly while exercising the
Physiotherapy teaches you how to :
exercise your pelvic
floor muscles correctly
retrain weak pelvic floor muscles
regain pelvic floor control while sneezing, coughing, laughing and
maintain pelvic floor control
Role of physiotherapy : Physiotherapists can assist patients with asthma in a
number of ways. Strategies to help patients incorporate asthma management
into their daily routine are suggested by the physiotherapist.
Intermittent follow-up is offered to evaluate patient progress and
make any necessary modifications to their program.
Benefits of physiotherapy
: Physiotherapists can help educate patients about asthma by
reinforcing advice about the disease process and the patient’s
individual asthma self management plan, including use of a peak flow
meter if appropriate, and reviewing inhaled medication techniques
and equipment maintenance.
well as promoting the advantages of exercising for fun and fitness,
physiotherapists can design individual exercise programs based on
the patient’s level of disability, current level of fitness,
exercise interests and availability of equipment. This includes
advice regarding intensity, duration and frequency of exercise,
together with the role of asthma medications in exercise.
Control : Techniques
of breathing control and relaxation are utilised in patient
management, and are tailored to the individual patient’s specific
needs and interests.
Clearance : When
necessary, patients are instructed in independent methods of airway
clearance, which may be used if secretions become a problem. A
variety of independent techniques which do not exacerbate
bronchospasm may be utilised. Selection of the appropriate treatment
techniques is based on individual patient assessment.
inactivity is a major risk factor for coronary artery disease. It is
now widely recognised that appropriate exercise can be an effective
disease prevention strategy and is integral to the management of
patients with a variety of cardiovascular conditions.
Role of physiotherapy : Physiotherapists can assess, plan and implement
programs to assist patients with conditions such as :
peripheral vascular disease
post myocardial infarction
cardiac or valve replacement surgery
lung volume reduction surgery and
chronic lung diseases
In cardiac and pulmonary rehabilitation, and in many
other post-operative conditions, physiotherapists play a key role in
enabling patients to successfully manage their own recovery process.
Physiotherapists also play a key role in maximising the patient’s
functional ability and overall quality of life.
Benefits of physiotherapy : Exercise can be tailored to patient needs, modified if
necessary, and graduated according to individual
responses. A physiotherapist
supervised program & can:
* assist with offsetting the deleterious effects
of prolonged bed rest;
* gradually improve fitness;
* give confidence to resume regular activities;
* provide regular review of progress in a safe environment;
* promote the benefits of a healthy lifestyle.
Physiotherapy plays a vital role in rehabilitation after cardiac surgery.
Physiotherapy programs are designed to educate patients and their
relatives on lifestyle changes necessary to achieve optimal post
operative recovery and
minimise the risk of relapse. Patients who
have undergone cardiac surgery are frequently
apprehensive about resuming activities which previously
caused them pain or breathlessness.