PHYSIO-graphy, KOLKATA (2025)

25/07/2025

🧍‍♂️🚗 𝙋𝙤𝙨𝙩𝙪𝙧𝙚 𝙏𝙞𝙥𝙨 𝙛𝙤𝙧 𝘿𝙧𝙞𝙫𝙚𝙧𝙨

Drive Smart. Sit Right. Stay Pain-Free.

🚨 𝙒𝙝𝙮 𝙄𝙨 𝙂𝙤𝙤𝙙 𝘿𝙧𝙞𝙫𝙞𝙣𝙜 𝙋𝙤𝙨𝙩𝙪𝙧𝙚 𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩?

-Reduces the risk of low back pain, sciatica, and disc issues

-Prevents neck stiffness and upper back strain

-Improves blood circulation, preventing leg numbness and fatigue

-Keeps the spine aligned, reducing wear and tear

-Enhances concentration, comfort, and driving safety

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✅ 𝙃𝙤𝙬 𝙩𝙤 𝙎𝙞𝙩 𝘾𝙤𝙧𝙧𝙚𝙘𝙩𝙡𝙮 𝙒𝙝𝙞𝙡𝙚 𝘿𝙧𝙞𝙫𝙞𝙣𝙜

1. 𝙎𝙚𝙖𝙩 𝘼𝙙𝙟𝙪𝙨𝙩𝙢𝙚𝙣𝙩

-Sit with your back fully supported by the seat

-Adjust the backrest to a slight recline (100°–110°) to support your spine

-Your hips should be at the same level or slightly above your knees

2. 𝙇𝙪𝙢𝙗𝙖𝙧 𝙎𝙪𝙥𝙥𝙤𝙧𝙩

-Use the seat’s lumbar adjustment if available

-If not, place a small cushion or rolled towel in the curve of your lower back

-Avoid over-arching or flattening your lumbar spine

3. 𝘿𝙞𝙨𝙩𝙖𝙣𝙘𝙚 𝙁𝙧𝙤𝙢 𝙋𝙚𝙙𝙖𝙡𝙨

-Sit close enough so your knees are slightly bent when pressing the pedals

-Avoid reaching too far forward or stretching your legs fully

4. 𝙎𝙩𝙚𝙚𝙧𝙞𝙣𝙜 𝙒𝙝𝙚𝙚𝙡 𝙋𝙤𝙨𝙞𝙩𝙞𝙤𝙣

-Keep your elbows slightly bent (~120°) and your hands relaxed

-Hold the wheel at the 9 and 3 o’clock positions

-Avoid locking your arms or hunching over the wheel

5. 𝙃𝙚𝙖𝙙 𝙖𝙣𝙙 𝙉𝙚𝙘𝙠 𝘼𝙡𝙞𝙜𝙣𝙢𝙚𝙣𝙩

-Keep your head upright, resting gently against the headrest

-Avoid the “forward head posture”

-Eyes should naturally align with the road — adjust seat height if needed

6. 𝙈𝙞𝙧𝙧𝙤𝙧 𝘼𝙙𝙟𝙪𝙨𝙩𝙢𝙚𝙣𝙩

-Set your mirrors after achieving correct posture

-This prevents slouching or leaning just to get a better view

7. 𝙁𝙤𝙤𝙩 𝙋𝙤𝙨𝙞𝙩𝙞𝙤𝙣𝙞𝙣𝙜

-Keep your feet flat on the floor when not using the pedals

-Rest your left foot comfortably on the footrest (in manual cars)

-Avoid driving with your heels lifted off the floor — it strains hip flexors

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⏱️ 𝙋𝙤𝙨𝙩𝙪𝙧𝙚 𝙏𝙞𝙥𝙨 𝙛𝙤𝙧 𝙇𝙤𝙣𝙜 𝘿𝙧𝙞𝙫𝙚𝙨

-Take breaks every 60–90 minutes: Get out, stretch, and walk

-Do simple in-seat movements: ankle pumps, shoulder rolls, pelvic tilts

-Use a lumbar support cushion or seat wedge for better spinal alignment

-Stay hydrated to avoid muscle cramps and tension

-Use cruise control on highways to relax your legs briefly

---

❌ 𝘾𝙤𝙢𝙢𝙤𝙣 𝘿𝙧𝙞𝙫𝙞𝙣𝙜 𝙋𝙤𝙨𝙩𝙪𝙧𝙚 𝙈𝙞𝙨𝙩𝙖𝙠𝙚𝙨

-Slouching forward — puts pressure on discs and muscles

-Leaning on one side — leads to uneven spinal loading

-Driving with one hand — strains neck and shoulders

-Wallet in back pocket — tilts the pelvis and can compress the sciatic nerve

-Sitting too far from pedals — overstretches the hamstrings and lower back

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🧘 𝙋𝙝𝙮𝙨𝙞𝙤𝙩𝙝𝙚𝙧𝙖𝙥𝙞𝙨𝙩'𝙨 𝘼𝙙𝙫𝙞𝙘𝙚

> “Your car seat is your workstation. A few ergonomic corrections can save you from years of back and neck issues.”

-Use seat wedges if your pelvis tilts backward

-Place a lumbar roll to maintain natural spine curve

-If you drive for work, consider vehicle-specific ergonomic upgrades

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🙆‍♂️ 𝙎𝙩𝙧𝙚𝙩𝙘𝙝𝙚𝙨 𝘼𝙛𝙩𝙚𝙧 𝘿𝙧𝙞𝙫𝙞𝙣𝙜

-Piriformis stretch (seated or standing)

-Neck side bends and chin tucks

-Standing back extensions (gentle spine stretch)

-Chest opener stretch (against a door frame)

-Hamstring stretch (especially after long hours)

---

✅ 𝙎𝙪𝙢𝙢𝙖𝙧𝙮

-Sit upright, with support and space

-Align your neck, avoid hunching

-Take breaks regularly, stretch often

-Adjust mirrors and seat before every drive

-Drive mindfully to protect your spine, joints, and muscles

25/07/2025

Colle's Fracture Physiotherapy Management

$𝘾𝙤𝙡𝙡𝙚'𝙨 𝙁𝙧𝙖𝙘𝙩𝙪𝙧𝙚 🦴 𝘿𝙚𝙛𝙞𝙣𝙞𝙩𝙞𝙤𝙣A Colles’ fracture is a transverse fracture of the distal radius (within 2.5 cm of the wris...$

24/07/2025

𝘾𝙤𝙡𝙡𝙚'𝙨 𝙁𝙧𝙖𝙘𝙩𝙪𝙧𝙚

🦴 𝘿𝙚𝙛𝙞𝙣𝙞𝙩𝙞𝙤𝙣

A Colles’ fracture is a transverse fracture of the distal radius (within 2.5 cm of the wrist joint) with dorsal displacement and angulation of the distal fragment. It typically results in a characteristic “dinner fork” or “bayonet” deformity of the wrist.

👵 𝘾𝙤𝙢𝙢𝙤𝙣 𝘿𝙚𝙢𝙤𝙜𝙧𝙖𝙥𝙝𝙞𝙘𝙨

•Age Group: Most commonly affects elderly patients (especially >60 years)

•Gender: More frequent in postmenopausal women due to osteoporosis

•Bone quality: Typically occurs in osteoporotic bones

🤕 𝙈𝙚𝙘𝙝𝙖𝙣𝙞𝙨𝙢 𝙤𝙛 𝙄𝙣𝙟𝙪𝙧𝙮

-Fall on an Outstretched Hand (FOOSH) with the wrist in extension

-The force is transmitted through the hand to the distal radius

-Leads to dorsal displacement of the broken fragment

🧠 𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙁𝙚𝙖𝙩𝙪𝙧𝙚𝙨

•Pain and swelling around the distal forearm/wrist

•Obvious deformity – dorsal displacement gives a "dinner fork" appearance

•Restricted wrist and finger motion

•Tenderness over the distal radius

•Possible associated injuries:

•Ulnar styloid fracture (common)

•Median nerve compression (carpal tunnel symptoms)

📷 𝙍𝙖𝙙𝙞𝙤𝙡𝙤𝙜𝙞𝙘𝙖𝙡 𝙁𝙚𝙖𝙩𝙪𝙧𝙚𝙨

✅ X-ray (AP and lateral view of the wrist) shows:

-Extra-articular transverse fracture of distal radius

-Dorsal displacement and angulation

-Radial shortening

-Sometimes an associated ulnar styloid process fracture

🩺 𝘾𝙡𝙖𝙨𝙨𝙞𝙛𝙞𝙘𝙖𝙩𝙞𝙤𝙣 𝙎𝙮𝙨𝙩𝙚𝙢𝙨

🔹 Frykman Classification (based on joint involvement and ulnar styloid fracture)
🔹 Fernandez Classification (mechanism-based)
🔹 AO Classification (used in orthopedic surgical planning)

⚕️ 𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩

🏥 Non-Surgical (Conservative)

For non-displaced or minimally displaced fractures

Closed reduction and immobilization with:

1) Below elbow cast (Colles cast) for 4–6 weeks

2) Frequent X-rays to ensure alignment is maintained

🛠️ Surgical Management

Indicated in:

-Unstable or comminuted fractures

-Intra-articular involvement

-Severe displacement

Options:

1) Open Reduction and Internal Fixation (ORIF) with volar locking plate

2) External fixation in comminuted fractures

3) K-wires in select cases

🧘 𝙋𝙝𝙮𝙨𝙞𝙤𝙩𝙝𝙚𝙧𝙖𝙥𝙮 𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩

🔹 Goals of Rehab:

1) Prevent stiffness and edema

2) Regain ROM and strength

3) Restore hand function

🔹 Phases:

𝙋𝙝𝙖𝙨𝙚-1: 𝙄𝙢𝙢𝙤𝙗𝙞𝙡𝙞𝙯𝙖𝙩𝙞𝙤𝙣 (0–6 𝙬𝙚𝙚𝙠𝙨)

1) Finger, elbow, and shoulder ROM exercises

2) Isometric grip exercises

3) Edema control: elevation, gentle compression

𝙋𝙝𝙖𝙨𝙚-2: 𝙋𝙤𝙨𝙩-𝙞𝙢𝙢𝙤𝙗𝙞𝙡𝙞𝙯𝙖𝙩𝙞𝙤𝙣 (6–12 𝙬𝙚𝙚𝙠𝙨)

1) Gentle wrist ROM: flexion, extension, pronation, supination

2) Scar and soft tissue mobilization

3) Passive stretching (as tolerated)

4) Begin light strengthening exercises

𝙋𝙝𝙖𝙨𝙚-3: 𝘼𝙙𝙫𝙖𝙣𝙘𝙚𝙙 𝙋𝙝𝙖𝙨𝙚 (12+ 𝙬𝙚𝙚𝙠𝙨)

1) Progressive resistance training

2) Functional task training

3) Proprioceptive retraining

4) Return-to-work or ADL retraining

❗𝘾𝙤𝙢𝙥𝙡𝙞𝙘𝙖𝙩𝙞𝙤𝙣𝙨

1) Stiffness of wrist or fingers

2) Malunion (improper healing causing deformity)

3) Median nerve injury → Carpal tunnel syndrome

4) Complex Regional Pain Syndrome (CRPS)

5) Tendon rupture (esp. extensor pollicis longus)

🧠 𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙋𝙚𝙖𝙧𝙡

Even if X-rays show healing, wrist stiffness and functional limitations can persist without proper rehabilitation. Early and progressive physiotherapy is key to full recovery.

24/07/2025

BIOMECHANICS OF GAIT

23/07/2025

“Your Bag Could Be Hurting You!”

Overloaded or one-strapped bags are a recipe for posture disaster—especially in students and office-goers.

🔹 Bag should weigh no more than 10–15% of your body weight
🔹 Use both shoulder straps and ensure even distribution
🔹 Adjust straps so the bag rests in the middle of the back
🔹 Pack heavier items close to your spine

👎 Slinging a bag over one shoulder = tilted spine
👍 Balanced load = happy back!

🔵 PHYSIO-graphy – Protect your back before it packs out!

23/07/2025

🧠 𝙃𝙤𝙬 𝙩𝙤 𝙊𝙥𝙚𝙣 𝙖 𝙎𝙥𝙖𝙨𝙩𝙞𝙘 𝙃𝙖𝙣𝙙 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚

Spastic hand is one of the most common complications following a stroke, especially in hemiplegic patients. Due to damage in the motor cortex or descending pathways, there is increased muscle tone in flexor groups of the upper limb, making the hand tightly clenched, painful, and non-functional.

This article offers a step-by-step, evidence-informed guide to open a spastic hand and promote functional recovery.

🔍 𝙐𝙣𝙙𝙚𝙧𝙨𝙩𝙖𝙣𝙙𝙞𝙣𝙜 𝙩𝙝𝙚 𝙋𝙧𝙤𝙗𝙡𝙚𝙢

After a stroke, upper motor neuron lesions result in:

-Hypertonia (spasticity) in wrist and finger flexors

-Loss of voluntary control

-Altered proprioception

-Pain and contractures due to prolonged flexion

The key goal is to reduce spasticity, improve joint mobility, activate antagonist muscles (extensors), and restore function.

🧤 Before You Begin: 𝙂𝙤𝙡𝙙𝙚𝙣 𝙍𝙪𝙡𝙚𝙨

1. NEVER force open a spastic hand.

2. Always start by relaxing the whole upper limb.

3. Ensure proper scapular alignment and trunk control before working on the hand.

4. Work slowly and rhythmically.

🪢 Phase-Wise Rehabilitation Protocol

🟢 Phase 1: Reduce Tone and Promote Relaxation

🔹 Positioning

-Place the affected hand on a pillow in supination.

-Keep shoulder abducted ~30°, elbow extended.

🔹 Gentle Warm Compress

-Use warm packs on wrist and fingers for 10 minutes to soften tissues.

🔹 Prolonged Stretching

-Hold the fingers and wrist in a stretched (extended) position for 30–60 seconds, repeat 3–5 times.

-Use slow, sustained pressure—avoid sudden jerks.

🔹 Passive Range of Motion (PROM)

-Start from the wrist → MCP joints → PIP → DIP joints.

-Perform 10–15 gentle reps of each joint.

🔹 Weight Bearing

-Use a weight-bearing position on a therapy ball, table, or floor to reduce flexor tone.

🟡 Phase 2: Sensory Stimulation and Neuromotor Activation

🔹 Proprioceptive Input

-Vibration therapy (low frequency) on extensor muscles

-Joint compression techniques to stimulate mechanoreceptors

🔹 Mirror Therapy

-Place a mirror between hands.

-Ask the patient to move the normal hand while watching its reflection, creating the illusion of movement in the spastic hand.

🔹 Tactile Stimulation

-Use different textures (towel, sponge, brush) on the hand

-Helps desensitize and retrain sensory-motor feedback

🔵 Phase 3: Active-Assisted and Voluntary Movements

🔹 Hand-Opening Techniques

-Use the uninvolved hand to assist in opening fingers.

-Cue patient to visualize the hand opening ("motor imagery").

🔹 Facilitation Techniques

-Tapping or brushing on extensor muscles

-Electrical stimulation (FES) for wrist and finger extensors

-PNF patterns (D1, D2) for upper limb may help coordinate movements

🔹 Use of Devices

-Hand splints (resting or functional) to prevent contractures and support joint alignment.

-Therabands and therapy putty for gentle resistance training once movement improves.

🔴 Phase 4: Functional Integration

🔹 Task-Oriented Training

-Practice opening hand during daily tasks:

-Holding a towel

-Picking up soft objects

-Releasing small blocks

-Turning pages, zipping bags

🔹 Constraint-Induced Movement Therapy (CIMT)

-Constrain the non-affected hand to encourage use of the affected hand (only when some voluntary movement is present).

🔹 Bilateral Training

-Perform both-hand tasks: folding clothes, opening a container, clasping fingers.

🧠 Bonus Tips for Better Results

-Repetition is key: Neuroplasticity is driven by consistent practice.

-Stay patient and positive—spastic hand takes time to open.

-Combine mental practice + physical therapy for better cortical remapping.

-Educate caregivers about gentle handling, splinting, and home exercises.

⚠️ Red Flags to Watch

-Pain during stretching—stop and reassess.

-Skin breakdown under splints

-Contractures worsening despite therapy—may need botulinum toxin or orthotic intervention

✅ Conclusion

Rehabilitation of a spastic hand post-stroke requires a multi-modal, phase-wise approach involving:

-Tone inhibition

-Sensory stimulation

-Voluntary motor control

-Functional retraining

With persistence, guided therapy, and patient cooperation, the spastic hand can gradually open and regain functional use.

23/07/2025

Brunnstorm Approach in Neuro Rehabilitation

22/07/2025

🧠 𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜 𝙞𝙣 𝙎𝙩𝙧𝙤𝙠𝙚

Gait dysfunction is one of the most common and disabling consequences after a stroke. Effective gait training plays a crucial role in restoring functional ambulation and improving the quality of life in stroke survivors.

🦵 Why is Gait Affected After Stroke?

Stroke leads to neurological deficits that affect motor control, muscle tone, balance, and coordination. Common gait abnormalities post-stroke include:

-Hemiparetic gait

-Circumduction of the affected leg

-Reduced weight bearing on the affected side

-Foot drop

-Knee hyperextension

-Spastic synergy patterns

🧩 Goals of Gait Training

1. Improve symmetry and stability

2. Enhance weight bearing on the affected limb

3. Promote independent ambulation

4. Increase speed, endurance, and efficiency

5. Improve balance and reduce fall risk

6. Restore normal gait pattern as much as possible

🧠 Principles of Gait Rehabilitation

•Neuroplasticity: Encourage repetitive, task-specific training to promote cortical reorganization.

•Motor learning: Use feedback, cueing, and practice to enhance skill acquisition.

•Proximal to distal control: Restore trunk and pelvic stability before addressing distal function.

•Weight shift training: Essential for symmetry and balance.

•Intensity and frequency: High-repetition training yields better outcomes.

🧰 𝘼𝙨𝙨𝙚𝙨𝙨𝙢𝙚𝙣𝙩 𝘽𝙚𝙛𝙤𝙧𝙚 𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜

•Functional Ambulation Categories (FAC)

•Berg Balance Scale

•Fugl-Meyer Assessment (Lower Limb)

•Timed Up and Go (TUG)

•10-Meter Walk Test

Observation of gait phases (Stance, Swing, Heel Strike, Toe Off)

🚶‍♂️ 𝙋𝙝𝙖𝙨𝙚𝙨 𝙤𝙛 𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜

1. Early Phase (Bed Level to Standing)

-Positioning to prevent contractures

-Bridging exercises

-Sitting balance training

-Sit-to-stand practice

-Weight shifting in standing

-Parallel bar walking

2. Mid Phase (Assisted Walking)

-Walking with support (walker, hemi-walker, cane)

-Step training with affected limb

-Stair climbing initiation

-Theraband resistance gait drills

-Treadmill walking with harness (BWSTT)

3. Advanced Phase (Independent Mobility)

-Dual-task gait training

-Obstacle navigation

-Speed and endurance training

-Uneven terrain and community walking

-Balance-challenging activities (foam surface, dynamic balance)

𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜 𝙏𝙚𝙘𝙝𝙣𝙞𝙦𝙪𝙚𝙨

🔹 Treadmill Training (with or without Body Weight Support - BWSTT)

-Facilitates repetitive gait cycles

-Reduces fear of falling

-Encourages proper foot placement

🔹 Overground Gait Training

-More functional and realistic

-Practice turning, obstacle negotiation, curbs

🔹 Robotic-Assisted Gait Training

-Lokomat, Exoskeletons

-Helps with consistent and repetitive stepping

-Used especially in severe hemiplegia

🔹 Functional Electrical Stimulation (FES)

-Especially for foot drop

-Stimulates dorsiflexors during swing phase

🔹 Mirror Therapy and Mental Imagery

-For motor cortex activation and preparatory training

🔹 Visual and Auditory Cueing

-Improve step length, cadence, and posture

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🧱 Gait Training Exercises

-Marching in place

-Forward, backward, sideways walking

-Heel-toe walking

-Step-ups

-Ladder walking drills

-Obstacle crossing

-Toe clearance drills for foot drop

-Pelvic and trunk dissociation exercises

🧑‍🦽 Assistive Devices in Gait Training

-Parallel bars (initial phase)

-Quad cane or hemi-walker

-Ankle Foot Orthosis (AFO) – for foot drop/spasticity

-Knee brace – for genu recurvatum

-Gait belts – for safety

-Harness systems – for treadmill training

⚠️ 𝘾𝙤𝙢𝙢𝙤𝙣 𝙂𝙖𝙞𝙩 𝘿𝙚𝙫𝙞𝙖𝙩𝙞𝙤𝙣𝙨 𝙞𝙣 𝙎𝙩𝙧𝙤𝙠𝙚 𝙋𝙖𝙩𝙞𝙚𝙣𝙩𝙨

Deviation--> Likely Cause

•Circumduction of leg--> Hip flexor weakness, foot drop

•Hip hiking--> Compensatory for knee/ankle weakness

•Knee hyperextension--> Quadriceps weakness, poor proprioception

•Foot slap--> Weak dorsiflexors

•Vaulting on sound limb--> Compensation for weak swing phase

🔁 𝙁𝙧𝙚𝙦𝙪𝙚𝙣𝙘𝙮 𝙖𝙣𝙙 𝘿𝙪𝙧𝙖𝙩𝙞𝙤𝙣

-Minimum 30–60 minutes/day, 5–6 days/week

-Progress from 2–5 meters to community ambulation

-Continue gait training for at least 3–6 months post-stroke with regular re-evaluation

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🧠 Tips for Effective Gait Training

Use mirrors for visual feedback

Incorporate verbal cues ("lift your toe", "step through")

Emphasize trunk control and posture

Correct gait deviations early to avoid compensation habits

Include dual-task walking to improve real-world skills

📝 Conclusion

Gait training is central to stroke rehabilitation. A tailored approach involving task-specific, repetitive, and progressive strategies, combined with proper assistive technologies and patient education, leads to the best functional outcomes.

22/07/2025

Bobath Therapy Concept and Techniques

22/07/2025

🧠 𝙃𝙀𝙈𝙄𝙋𝙇𝙀𝙂𝙄𝘼

✅ 𝘿𝙀𝙁𝙄𝙉𝙄𝙏𝙄𝙊𝙉

Hemiplegia is defined as complete paralysis of one side of the body, affecting the upper limb, lower limb, and sometimes the facial muscles on the same side. It results from damage to the contralateral side of the brain—most often the motor cortex or descending corticospinal tract.

🧠 𝘼𝙉𝘼𝙏𝙊𝙈𝙔 & 𝙉𝙀𝙐𝙍𝙊𝙋𝙃𝙔𝙎𝙄𝙊𝙇𝙊𝙂𝙔 𝙄𝙉𝙑𝙊𝙇𝙑𝙀𝘿

•The motor cortex (precentral gyrus) of the brain controls voluntary movement.

•Motor signals travel through:

-Corticospinal tract (pyramidal tract) → crosses over (decussates) at the medullary pyramids.

-Therefore, a lesion in the left hemisphere leads to right-sided hemiplegia, and vice versa.

-Lesions in the internal capsule, corona radiata, or brainstem can cause hemiplegia.

📌 𝘿𝙄𝙁𝙁𝙀𝙍𝙀𝙉𝙏𝙄𝘼𝙏𝙄𝙉𝙂 𝙏𝙀𝙍𝙈𝙎

1) 𝙃𝙚𝙢𝙞𝙥𝙡𝙚𝙜𝙞𝙖--> Complete paralysis on one side
2) 𝙃𝙚𝙢𝙞𝙥𝙖𝙧𝙚𝙨𝙞𝙨--> Partial weakness on one side
3) 𝙌𝙪𝙖𝙙𝙧𝙞𝙥𝙡𝙚𝙜𝙞𝙖--> Paralysis of all four limbs
4) 𝙋𝙖𝙧𝙖𝙥𝙡𝙚𝙜𝙞𝙖--> Paralysis of both lower limbs
5) 𝙈𝙤𝙣𝙤𝙥𝙡𝙚𝙜𝙞𝙖--> Paralysis of a single limb

🔍 𝘾𝘼𝙐𝙎𝙀𝙎 OF HEMIPLEGIA

🔴 VASCULAR (Most Common):

•Stroke (CVA) – Ischemic or hemorrhagic

•MCA stroke is most frequently involved

•Lacunar infarcts in internal capsule can cause pure motor hemiplegia

⚫ TRAUMA:

•Traumatic Brain Injury (TBI)

•Penetrating injuries affecting cerebral hemispheres

🟠 TUMORS:

•Brain neoplasms compressing motor areas

•Post-surgical complications from tumor excision

🟡 INFECTIONS:

•Encephalitis, brain abscess

•HIV-related neurological damage

🟣 CONGENITAL:

•Hemiplegic Cerebral Palsy (perinatal hypoxia, neonatal stroke)

⚪ DEMYELINATING / DEGENERATIVE:

•Multiple Sclerosis (rare but possible)

•Leukodystrophies in children

⚠️ 𝙏𝙔𝙋𝙀𝙎 𝙊𝙁 𝙃𝙀𝙈𝙄𝙋𝙇𝙀𝙂𝙄𝘼

𝙏𝙮𝙥𝙚 ------> 𝘿𝙚𝙨𝙘𝙧𝙞𝙥𝙩𝙞𝙤𝙣

1) Spastic Hemiplegia--> Increased muscle tone, exaggerated reflexes

2) Flaccid Hemiplegia--> Hypotonia, diminished reflexes in acute phase

3) Complete Hemiplegia--> Entire one side of the body affected

4) Incomplete Hemiplegia--> Partial involvement of one side

5) Facial Hemiplegia--> Involves facial muscles, commonly central (UMN lesion)

6) Alternating Hemiplegia--> Cranial nerve palsy on one side, limb weakness on the other (seen in brainstem lesions)

🧪 𝘾𝙇𝙄𝙉𝙄𝘾𝘼𝙇 𝙁𝙀𝘼𝙏𝙐𝙍𝙀𝙎

🦵 MOTOR SIGNS:

•Paralysis/weakness of one side (upper & lower limb)

•Decreased voluntary control

•Increased tone (spasticity) after initial flaccid phase

•Positive Babinski sign

•Exaggerated deep tendon reflexes

•Clonus and synergy patterns

•Gait disturbances (circumduction gait, equinovarus foot)

🖐 FUNCTIONAL IMPAIRMENTS:

•Loss of independent ADLs

•Dropping objects, difficulty grasping

•Shoulder subluxation, wrist drop, foot drop

🧠 ASSOCIATED SIGNS (Depending on Site):

•Aphasia – Broca’s/Wernicke’s (if left hemisphere involved)

•Apraxia – Inability to perform learned motor tasks

•Homonymous hemianopia – Visual field loss

•Neglect Syndrome – Right parietal lesions

🧬 𝘿𝙄𝘼𝙂𝙉𝙊𝙎𝙏𝙄𝘾 𝙒𝙊𝙍𝙆𝙐𝙋

🧠 NEUROIMAGING:

•CT Scan – First-line for stroke

•MRI Brain – Detects small infarcts, demyelination, tumors

🔬 LAB TESTS:

•CBC, coagulation profile (for stroke risk)

•Lipid profile, blood sugar (vascular risk factors)

⚡ NEUROPHYSIOLOGY:

•EMG, NCS (if peripheral involvement suspected)

👁️ NEUROPSYCHOLOGICAL ASSESSMENT:

•Cognitive & perceptual testing (especially for rehab planning)

🩺 𝙈𝘼𝙉𝘼𝙂𝙀𝙈𝙀𝙉𝙏

🧠 1. ACUTE MANAGEMENT

•Treat the underlying cause (stroke, infection, etc.)

•Thrombolysis (in ischemic stroke within 4.5 hours)

•Antiplatelet agents, anticoagulants

•Control hypertension, diabetes, cholesterol

•Surgical intervention if needed (e.g., decompression, tumor)

💪 2. PHYSIOTHERAPY REHABILITATION

🛏️ Acute/Flaccid Phase (0–2 weeks):

•Proper positioning (to prevent contractures and pressure sores)

•Passive Range of Motion (PROM) exercises

•Gentle facilitation techniques (Rood, Brunnstrom, PNF)

•Respiratory exercises

🔁 Spastic/Recovery Phase:

•Stretching spastic muscles (shoulder internal rotators, flexors)

•Tone-inhibiting techniques (e.g., Bobath/NDT)

•Use of orthoses (AFO for foot drop)

•Weight-bearing activities to normalize tone

🚶 Ambulation & Function Phase:

•Gait training using parallel bars, walkers, canes

•Balance training (static and dynamic)

•Functional task training (e.g., dressing, reaching, stair climbing)

•Mirror therapy, CIMT (Constraint Induced Movement Therapy)

•Use of Functional Electrical Stimulation (FES)

🧠 3. OCCUPATIONAL THERAPY

•Activities of daily living (ADLs)

•Hand function training (pegboards, grip trainers)

•Assistive device training (spoons, zippers, writing aids)

•Sensory stimulation

🗣️ 4. SPEECH & SWALLOW THERAPY

•For patients with aphasia or dysphagia

•Speech exercises, language retraining, and safe swallowing strategies

🧘 5. PSYCHOLOGICAL & SOCIAL SUPPORT

•Screening and treating depression and anxiety

•Family counseling

•Vocational rehabilitation (for working individuals)

🧭 PROGNOSIS

Depends on:

-Etiology (stroke vs. trauma vs. CP)

-Extent and site of brain lesion

-Age of the patient

-Early and multidisciplinary intervention

🔁 Recovery Stages (Brunnstrom):

1. Flaccidity

2. Spasticity begins

3. Increased spasticity, synergy pattern development

4. Spasticity decreases, voluntary movement begins

5. Complex movement combinations

6. Disappearance of spasticity, coordination improves

7. Normal function returns (rare)

🔴 RED FLAGS

•Sudden onset weakness

•Facial droop and slurred speech (FAST)

•Severe spasticity interfering with ADLs

•Shoulder pain with subluxation

•Loss of bowel/bladder control

💡 PHYSIOTHERAPIST'S ROLE – KEY POINTS

•Early mobilization is key

•Assess for neglect, aphasia, cognitive issues

•Focus on function over isolated muscle strengthening

•Use evidence-based techniques: Bobath, PNF, FES, mirror therapy

•Emphasize patient and caregiver education

21/07/2025

𝘿𝙚𝙚𝙥 𝙑𝙚𝙞𝙣 𝙏𝙝𝙧𝙤𝙢𝙗𝙤𝙨𝙞𝙨 (DVT)

Deep Vein Thrombosis (DVT) refers to the formation of a blood clot (thrombus) within a deep vein, most commonly in the lower extremities (legs, thighs, or pelvis). It is a potentially serious condition as the clot may dislodge and lead to pulmonary embolism (PE).

𝙀𝙩𝙞𝙤𝙡𝙤𝙜𝙮 (𝘾𝙖𝙪𝙨𝙚𝙨)
DVT commonly occurs due to Virchow’s Triad:

-Venous stasis – e.g., immobility, prolonged bed rest, long flights/travel
-Endothelial injury – e.g., surgery, trauma, inflammation
-Hypercoagulability – e.g., genetic clotting disorders, pregnancy, malignancy, hormone therapy

𝙍𝙞𝙨𝙠 𝙁𝙖𝙘𝙩𝙤𝙧𝙨
-Surgery (especially orthopedic or pelvic)
-Prolonged immobilization
-Pregnancy and postpartum period
-Oral contraceptives or hormone replacement therapy
-Cancer
-Obesity
-Smoking
-Age > 60
-Previous history of DVT or PE
-Inherited thrombophilias (e.g., Factor V Leiden)

𝙋𝙖𝙩𝙝𝙤𝙥𝙝𝙮𝙨𝙞𝙤𝙡𝙤𝙜𝙮
-Blood flow slows or becomes turbulent (venous stasis)
-Injury to the endothelium initiates platelet aggregation and clotting cascade
-A thrombus forms, obstructing venous return
-Risk of thrombus dislodging and migrating to lungs (PE)

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙁𝙚𝙖𝙩𝙪𝙧𝙚𝙨
-Unilateral leg swelling (calf or thigh)
-Pain or tenderness in the affected limb (especially on palpation)
-Redness and warmth over the area
-Dilated superficial veins
-Positive Homan’s sign (pain in calf with dorsiflexion of the foot) – not specific
-Often asymptomatic in early stages

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
1) D-Dimer Test
-Elevated in DVT but non-specific
2) Doppler Ultrasonography (Venous Duplex Scan)
-Most common diagnostic test
3) Venography (Contrast X-ray)
-Gold standard, but rarely used now
4) Blood coagulation profile – To detect clotting disorders
5) CT Pulmonary Angiogram (CTPA) – If PE is suspected

𝘾𝙤𝙢𝙥𝙡𝙞𝙘𝙖𝙩𝙞𝙤𝙣𝙨
•Pulmonary Embolism (PE) – Life-threatening condition
•Post-thrombotic syndrome (PTS) – Chronic pain, swelling, skin changes
•Chronic venous insufficiency
•Recurrent DVT

𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩
•Medical
1) Anticoagulation: Heparin, Low Molecular Weight Heparin (LMWH), Warfarin, DOACs (Apixaban, Rivaroxaban)
2) Thrombolytic therapy (in severe cases)
3) Inferior Vena Cava (IVC) filter – If anticoagulation is contraindicated

•Surgical
1) Thrombectomy – Rarely performed, in severe cases

𝙋𝙝𝙮𝙨𝙞𝙤𝙩𝙝𝙚𝙧𝙖𝙥𝙮 𝙍𝙤𝙡𝙚 𝙞𝙣 𝘿𝙑𝙏
⚠ Contraindicated: Mobilization or massage in acute undiagnosed DVT phase due to risk of embolization

𝙊𝙣𝙘𝙚 𝘿𝙑𝙏 𝙞𝙨 𝙙𝙞𝙖𝙜𝙣𝙤𝙨𝙚𝙙 𝙖𝙣𝙙 𝙖𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝙞𝙨 𝙨𝙩𝙖𝙧𝙩𝙚𝙙 (𝙖𝙛𝙩𝙚𝙧 24-48 𝙝𝙧𝙨):

1)Early Mobilization (when safe)
-Enhances venous return and prevents complications
2) Graduated Compression Stockings
-Prevents PTS and reduces swelling
3) Limb Elevation
-Reduces edema
4) Breathing Exercises
-Prevents PE and improves lung perfusion
5) Ankle Pumping and ROM exercises
-Enhances circulation in immobilized patients
6) Education
-Avoid prolonged immobility
-Encourage hydration
-Lifestyle changes: exercise, smoking cessation

𝙋𝙧𝙚𝙫𝙚𝙣𝙩𝙞𝙤𝙣
-Early ambulation post-surgery
-Use of compression stockings or intermittent pneumatic compression (IPC) devices
-Anticoagulant prophylaxis in high-risk individuals
-Leg exercises during long travel
-Avoiding dehydration

𝙆𝙚𝙮 𝙋𝙤𝙞𝙣𝙩𝙨
-DVT is a medical emergency with risk of pulmonary embolism
-Prompt diagnosis and appropriate anticoagulation are critical
-Physiotherapists must screen carefully before initiating mobilization
-Patient education is essential in both prevention and rehabilitation

21/07/2025

📱 Screen Height Ergonomics – A Key to Better Posture

Maintaining your screen at the correct height is crucial for preventing neck and back strain, especially for students, professionals, and anyone using digital devices for long hours.

❌ Poor Screen Height Can Lead To:

Forward head posture

Neck and shoulder pain

Eye strain and headaches

Slouched spine

✅ Ergonomic Screen Setup Tips:

Top of the screen should be at or just below eye level

Monitor should be an arm’s length away

Use a laptop stand or stack books if needed

Keep the screen directly in front, not to the side

Tilt the screen slightly upward for comfort

🔵 PHYSIO-graphy – Adjust your view, align your spine!

PHYSIO-graphy

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