Physio Revamp (2025)

13/07/2020

🖇Nerve Palsy's Of The Hand_
1. The median nerve... It controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers. It is the sensory nerve for the first three fingers. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles.
2. The ulnar Nerve.. claw hand, or 'spinster's claw' is a deformity or an abnormal attitude of the hand that develops due to ulnar nerve damage causing paralysis of the lumbricals. A claw hand presents with a hyper- extension at the metacarpophalangeal joints and flexion at the proximal and distal interphalangeal joints of the 4th and 5th fingers. The ring- and little finger can usually not fully extend at the proximal interphalangeal joint (PIP).
3. The Radial Nerve... Wrist drop, is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

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30/06/2020

🖇The Barthel Index__
The barthel index is used to measure function in clinical research & this assessment tool represents one if the earliest contribution to the functional status literature and identifies physical thera**st long standing inclusion of functional mobility and ADL measurement within their scopev of practice.
This index measures the degree of assistance required by an individual on 10 items of mobility and selfcare ADL, levels of measurement are limited to either complete indepence Or needing assistance. Each item is scored on ordinal scale with specified number of points assigned to each level.
E.g., an individual who uses human assistance in eating receives 5 points; independence in eating would receive a score of 10 points. A single global score ranging from 0-100 is calculated from the sum of all weighted individual item scores, so that 0 equals complete dependence for all 10 activities & 100 equal complete independence in all 10 activities.
This barthel index has been used widely to monitor functional changes in individuals admitted in IPD rehabilitation & particularly in predicting the functional outcome associated with stroke.
This tool has demonstrated strong interrater reliability as well as high correlation with other measure of physical disability.
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23/06/2020

🖇Forced Expiratory Technique (FET) ___
The FET is a combination of 1 or 2 forced expiration and period of breathing control.
1. Huffing is low-lung volume technique that moves the more peripherally situated secretions, & when the secretions reaches the larger more proximal airway;
2. A cough or huff from high-lung volume can be used to clear them.
A huff from mid-lung volume is more efficient and more effective (to huff from mid-lung volume a medium sized breath should be taken in with mouth and glottis open) but, If the huff is continued for too long - it may lead to unnecessary paroxysmal coughing.
A shorter huff or cough from high-lung volume is used to clear secretions.
To make the length of the huff and contraction of expiratory muscles effective, person should practice this technique using a peak-flow mouth piece or similar piece of tubing like straw. Huffing through a tube at a tissue or cotton-wool ballis helpful in practicing.
An essential part of the techn5 is to take pauses -for breathing control after 1 or 2 huffs to prevent any increase in airflow obstruction, the length of the pause nay vary from 5-20 seconds according to the condition of patient.⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵⤵

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22/06/2020

🖇Thoracic Expansion Exercise (ACBT)__
✅ACBT is a cycle of breathing control, thoracic expansion exercise and forced expiratory technique, & a flexible method for patient with problem of excess bronchial secretions that is used to mobilize and clear the excess secretions to improve lung function and saturation of oxygen.
✅Thoracic expansion exercise are deep breathing exercises that emphasizing on inspiration part and may be combined with 3-second hold before the passive relaxed expiration. It is very inappropriate in very breathless patients and holding 3-second value may be vary in patient with medical chest conditions.
- 3-4 expansion exercises are appropriate and post operative maneuver withh 3 second hold at full inspiration has been said to decrease collapse of lung tissue (anymore deep breathes may produce the effect of hyperventilation or tire the patient).
- These exercise can be encouraged with proprioceptive stimulation by placing hand over chest wall, where movement of chest wall and increase in lung volume are to be encourage (although there is no evidence of in ventilation) & the expansion exercise may be combined with chest shaking, vibration and chest clapping to assist further in clearance of secretions.
✅Sniff maneuver may also be used at end of deep inspiration to get additional increase in lung volume, but that may not be Appreciateable for patient with hyperinflatiled conditions. Although can be used to increase lung volume in post surgical patients.

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20/06/2020

🖇Breathing Control__
Breathing control is normal tidal breathing also called as Diaphragmatic Breathing. To taught this, patient should be in comfortable position preferably sitting or in high side lying.
The patient is encouraged to keep his upper chest, should n neck relaxed and hand positioned on upper abdomen to felt abdomen rise up-down with breath in-out pattern respectively.
Patients with breathing difficulties Or with conditions like asthma, emphysema, lung cancer or fibrosis get benefit from breath control technique, which encourage relaxation and use of lower chest.
For maximal relaxation, patient should be in high side lying (that considered as most useful position) with neck slightly flexed & pillow arranged aboved the shoulder supporting only head and neck.
*Other useful positions are shown above.
1- Breathing from mouth instead oof nose reduces the work of breathing and resistance to airflow.
2- Pursed-lip breathing generate positive pressure during expiration which reduces the some extent to collapse of unstable airway.
3- The combination of breathing control with walking can be helpful in improving exercise tolerance when walking on level ground and then to graded slopes and staircase.

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18/06/2020

🖇Cerebrospinal Fluid (CSF) ___
The cerebrospinal fluid is a modified tissue fluid, contained in the ventricular system of the brain and in the subarachnoid space around the brnin and spinal cord, CSF replaces lymph in the CNS.
FORMATION-
1. The CSF is formed by the choroid plexuses of the lateral ventricles, and lesser amounts by the choroid plexuses of the third and fourth ventricles.
2. Possibly, also formed by the capillaries on the surface of the brain and spinal cord.
3. The total quantity CSF is about 150 ml. It is formed at the rate of about 200ml/hour or 5000 ml per day. The normal pressure of CSF is 60 to 100 mm of CSF (or of water).
ABSORPTION-
1.CSF is absorbed chiefly through the arachnoid villi and granulations, and is thus drained into the cranial venous sinuses.
2.Partly absorb by perineural lymphatics around 1st, 2nd and 8th cranial nerves, And also by vein related to spinal nerves.
CLINICALLY- CSF fluid can be obtained by lumbar, cisternal Or ventricular puncture and analysed biochemically for diagnostic purposes.
Obstruction to the flow of CSF can lead to hydrocephalus and Increase in ICP pressure in children and adult respectively, And obstruction in vertebral canal can develop Froin's Or Loculation named syndrome.

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17/06/2020

🖇Lumbo-sacral plexus__
The anterior rami of spinal nerves L2-S2 merge to form the lumbosacral plexus.
The lumbar plexus is derived from L1-L4 anterior rami. It has the following peripheral nerve branches:- •Iliohypogastric + ilioinguinal nerves (L1).
•Genitofemoral nerve (L1-2).
•Lateral cutaneous nerve of the thigh (L2-3).
•Femoral nerve (L2-4, posterior fibres).
•Obturator nerve (L2-4, anterior fibres).
•Lumbosacral trunk (L4-5) – this
feeds the SACRAL plexus
The sacral plexus is derived from the lumbosacral trunk (L4-5) and the S1-4 anterior rami. It has the following-
branches: • Sciatic nerve (L3-5, S1-3, anterior + posterior fibres)
•nerve to piriformis (S1-2)
•posterior cutaneous nerve of the thigh (S1-3)
•pelvic splanchnic nerves (S2-1parasympathetic) •nerve to obturator internus (L5, S1-2)
•superior gluteal nerve (L4-5, S1)
•Inferior gluteal nerve (L5, S1-2)
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11/05/2020

Osteomalacia refers to a marked softening of your bones, most often caused by severe vitamin D deficiency. The softened bones of children and young adults with osteomalacia can lead to bowing during growth, especially in weight-bearing bones of the legs. Osteomalacia in older adults can lead to fractures.
Symptoms
The dull, aching pain associated with osteomalacia most commonly affects the lower back, pelvis, hips, legs and ribs. The pain might be worse at night.
Decreased muscle tone and leg weakness can cause a waddling gait and make walking slower and more difficult.
Causes
Osteomalacia results from a defect in the bone-maturing process. Your body uses the minerals calcium and phosphate to help build strong bones. You might develop osteomalacia if you don't get enough of these minerals in your diet or if your body doesn't absorb them properly. These problems can be caused by:
1.Vitamin D deficiency. Sunlight produces vitamin D in your skin. Dietary vitamin D is usually from foods to which the vitamin has been added, such as cow's milk.
2.Celiac disease. In this autoimmune disorder, foods containing gluten, a protein found in wheat, barley and rye, can damage the lining of your small intestine. A damaged intestinal lining doesn't absorb nutrients well, and can lead to vitamin D and calcium deficiency.
3.Kidney/liver disorders. Problems with your kidneys or liver can affect your body's ability to make active vitamin D.
4.Drugs. Some drugs used to treat seizures, including phenytoin (Dilantin, Phenytek) and phenobarbital, can cause severe vitamin D deficiency and osteomalacia.
Diagnosis
Osteomalacia can be difficult to diagnose. To pinpoint the cause and to rule out other bone disorders, such as osteoporosis, you might undergo one or more of the following tests:
Bone and urine test- Helps in determining Vitamin D and problems with calcium and phosphorus.
X-ray- Helps in seeing structural integrity of bone and any cracks present in bone.

Treatment
Fortunately, getting enough vitamin D through oral supplements for several weeks to months can cure osteomalacia. To maintain normal blood levels of vitamin D, you'll likely have to continue taking the supplements.

03/05/2020

Leg or Limb Length measurement is used when limb is deviated or unequal with respect to opposite limb.
✔There are two types of measurement:
- True LLD measurement, where actual length of limb is affected.
- Apparent LLD measurement, is one which measured with compensatory mechanism due to fixed deformity.
✔To measure the LLD following scanning methods are used:-
- Squaring of Pelvis: Look wheather the both ASIS and GT are at symmetry and line joining them are parallel (Chiene's line) or not.
Line from umbilicus to GT point via ASIS should be equivalent to opposite side measurement.
- Segmental Shortening Measurement: Supratrochanteric shortening involve,.
___Bryant's triange which is right angeled triangle formed by joining 3 pts. (ASIS, GT and their perpendicular intersecting point on hip reigon on supine).
____Nelaton's line, drawn from Ischial tuberosity to ASIS of pelvis. Indicated positive when gr. Trochanter of femur palpated above this imaginary line.
These above two methods are used to detect hip involvement.
Other segmental measure used for thigh and lower leg -- Iliac to GT(Gr.Trochanter) measurement, GT to lateral knee joint line & knee joint line to medial Malleolous.

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01/05/2020

🖇Primitive Reflexes___
Reflexes are involuntary movements and are spontaneous occur as part of the baby's normal activity. Others are responses to certain actions. Healthcare personel check reflexes to determine whether the brain and nervous system are working integrally well or not. Some reflexes occur only in specific periods of development.
The following are some of the normal reflexes seen in babies:
1.Rooting Reflex (3-4 months)
2.Moro's Reflex (2-4 months)
3.Palmar Grasp Reflex (5 month)
4.Asymmetrical Tonic Neck Reflex, ATNR (4-6 months)
5.Tonic Labrythine Reflex (3.5 years)
6. Spinal Gallant Reflex (3-9 months)
7.Symmetrical tonic neck Reflex (9-11 months).
Other Reflexes include:- Plantar Reflex (6 months), Stepping Reflex (3-4 months & reappear at 12 month) & landaus Reflex.

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29/04/2020

🖇🖇SHOCK___
Shock is loosely defined term to describe the clinical syndrome that develops when oxygen delivery is inadequate to meet the metabolic requirements of tissues due to some form of acute circulatory failure.
✔General features:
-Hypotension(SBP100/min), cold -Clammy skin, ra**st shallow respiration, drowsiness, confusion, multiorgan failure,
-Reduced central venous pressure in hypovolemic & anaphylactic shock, elevated in cardiogenic & obstructive and may be low/normal/high in septic shock.
✔Initial management:
-Measure blood gases
-correct hypoxaemia, consider intubation(if, paCO2>6.5kpa & RR>25/min), measure CVP.
-In hypovolemic, priority isto resuscitate the patient by administering IV fluids.
-Physiotherapy (if indicated).
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23/04/2020

🖇Ankylosing spondylitis__
- It is Chronic inflammatory disease of pelvis and spine Causes sacroilitis, leading to fusion of affected joints.
✔History / PE:-
-Fatigue.
- Intermittent hip pain.
- LBP worse in mornings, improves with activity.
-Enthesitis (pain wheře tendons/ligaments attach to bone).
-Anterior uveitis. -Heart block.
✔Diagnosis :-
-Positive HLA-B27 in 85-95% of cases.
- Negative RF, ANA.
-Radiographs show fused sacroiliac.
- joints ("bamboo sign") -ESR or CRP increased in 75% of cases Ankylosing spondyitis.
✔Treatment :-
- NSAIDS.
- TNF inhibitors or sulfasalazine.
-Physical therapy benefits, from pain relief.
Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. Proper sleeping and walking positions and abdominal and back exercises can help maintain your upright posture.
1Complications:-
- Chronic AS can lead to increased risk of vertebral fractures
✔Differential Diagnosis :-
-Reactive arthritis
- Psoriatic arthritis
- Enteropathic spondylitis
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