Rehab Realm

10/04/2025

17/10/2023

17/10/2023

CERVICOGENIC HEADACHE (CGH) Syndrome

• Chronic hemicranial pain that is referred to the head from either bony structures or myofascial soft tissues of the upper CSP, - OA, C1-3 segments.
• The C1-C3 nerves relay pain signals to the nociceptive nucleus of the head and neck, the trigeminocervical nucleus. This connection
is thought to be the cause for referred pain to the occiput and/or eyes.
• The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to
interact with sensory fibres from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathways allows the bidirectional referral of painful sensations
between the neck and trigeminal sensory receptive fields of the face and head.
• A functional convergence of sensorimotor fibres in the spinal accessory nerve (CN XI) and upper cervical nerve roots ultimately converge with the descending tract of the trigeminal nerve and
might also be responsible for the referral of cervical pain to the head.

Important to differentiate between: Migraine without aura, Tension-type, and Cervicogenic
headache.

• In Cervicogenic Headache, patient may present with combination of:

- movement dysfunction in whole of Csp
- muscle function impairment
- upper cervical individual joint dysfunction

• Pain and tenderness in sensitive structures in the upper neck, fascia in the head, TMJ,
mandible.
• History is important, look for activities involving some repetitive movement
static posture, maybe previous injury.
• Usually Ipsilateral pain but it can be bi-lateral!
• Patient can report unsteadiness and light-headedness, but fainting is a red flag!

05/06/2023

EXERCISE AS A TOOL TO DEALING WITH MUSCULAR WEAKNESS IN FACIAL AND BELL’S PALSY

When this topic popped up on my mind, I said to myself how can I kill this one?

Indeed exercise is an important tool as far as dealing with weakness in Bell’s palsy and facial palsy concerned. Both conditions causes a unilateral facial paralysis, which means that, one way or another, there is weakness in some of the facial muscles on just one side of the face.

Truth be told, there is no drug or medication that helps improve muscle strength. Even if there may be, it will only clear the path for an exercise to make it all happen. It is the more reason why patients with any of the two conditions are being referred all the time to physical therapists by their doctors. If drugs administration can do all the work, do you think referrals to therapists would have been necessary?

To deal with facial or Bell’s palsy really needs exercise therapy. There are exercises which can be incorporated in the patient treatment plan that are purposeful to improve muscle strength. These exercises one way or another engage the facial muscles actively, and that alone gives the patient the ability to voluntarily control the muscles. Therapists can apply all the potential treatment protocols, but without exercising the weakened facial muscles, it is just COS90.

There are many forms of facial exercises that can be prescribed to patients with Bell’s and facial palsy.But there are some potent ones I have personally used and still using whenever I’m treating a case like that which I want to share with you. These exercises help to facilitate facial expressions which get lost following the recent development. They include.

1. Wrinkling of your forehead
2. Whistling
3. Puffing of the cheeks
4. Closing both eyes tightly
5. Frowning
6. Puffing cheeks against resistance
7. Widely opening and closing mouth
8. Drinking with a straw
9. Blowing balloon/inflating balloon
10. Surprise look or looking frightened

03/06/2023

Traction is a set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. There are two types of traction: skin traction and skeletal traction. They are used in orthopedic medicine.

01/06/2023

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of a medical problem. It is not a medical condition by itself.
Sciatica most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

01/06/2023

Mobilization is a manual therapeutic technique that fosters movement in stagnant tissues and joints. Spinal mobilization uses massage to break down scar tissue and restrictions that are typically associated with trauma to the soft tissue such as a strained muscle or pulled ligament.

31/05/2023

An infant has been diagnosed with a complete rapture of C8 and T1 resulting in Klumpke's paralysis. Which movement can be expected to be impaired?

A. Shoulder elevation

B. Wrist and finger flexion

C. Elbow extension

D. Elbow Supination

30/05/2023

A stroke, sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death.

29/05/2023

Common Physical Therapy Abbreviations

AAROM Active Assistive Range of Motion
ABD Abduction
ADD Adduction
(A) assist
AD assistive device
Amb. ambulate, ambulated
Ant Anterior
ā before
abd. abduction
ACL anterior cruciate ligament
ADL’s activities of daily living
Add. adduction
AFO ankle foot orthosis
@ at
AKA above knee amputee
ALS Amyotrophic Lateral Sclerosis
amb ambulate
Appt. appointment
AROM active range of motion
As tol As tolerated
A/P Anterior Posterior
(B) Bilateral
B/L Bilateral
BAPS Biomechanical Ankle Platform System
bed mob. bed mobility
bk back
BKA below knee amputation
BID Twice a day
BIW bi-weekly, twice weekly
BOS Base of support
BP Blood pressure
bpm Beats per minute
Bwd Backward
CA Cancer
cerv. cervical
CC Chief Complaint
CF Cystic Fibrosis
CGA Contact Guard Assist
CHF Congestive Heart Failure
CHI closed head injury
Cont. continue
COTA certifi ed occupational therapy assistant
COPD Chronic Obstructive Pulmonary Disease
C/o Complains of
COG Center of gravity
Cont Continue
CP coldpack, cerebral palsy
CPM Continuous passive motion
C/S cervical spine
CVA Cerebral Vascular Accident
CVD Cardio-Vascular Disease
CRPS Complex Regional Pain Syndrome
CP Cerebral Palsy
CTS Carpal Tunnel Syndrome
Cx. cancel, cancellation
dep., D dependent
Dexa Dexamethazone
DC discharge, discontinue
D/C Discharge
DDD Degenerative Disc Disease
DF dorsiflexion
Diag Diagonal
DIP Distal Interphalangeal Joint
DJD Degenerative Joint Disease
DM Diabetes Mellitus
DMD Duchenne Muscular Dystrophy
DME durable medical equipment
DOB Date of birth
DOI Date of injury
DOS Date of surgery
DVT Deep Vein Thrombosis
Dx Diagnosis
Eval. evaluation eversion
Ev. eversion
Equip. equipment
ER Emergency Room
E-stim Electrical Stimulation
EOB Edge of bed
Ex. exercise
Ext. extension
Ext. rot., ER external rotation
freq frequency
F, 3/5 fair (in reference to manual muscle testing)
FES Functional Electrical Stimulation
Flex. flexion
FCR Flexor Carpi Radialis
FCU Flexor Carpi Ulnaris
F/u Follow up
FWW Front wheeled walker
FWB full weight bearing
fwd forward
Fx. fracture
GH Gleno-Humeral
Gt. Trng. gait training
G, 4/5 good (in reference to manual muscle testing)
GMT gross muscle test
HA Headache
Hemi. hemiplegia, hemiparesis
HEP home exercise program
HHA home health aide
HKAFO hip knee ankle foot orthosis
HOB Head of bed
Hor Horizontal
HP hot pack
H/S Hamstring
HNP Herniated Nucleus Pulposus
HTN Hypertension
HVGS high voltage galvanic stimulation
HX history
H/o History of
I , Indep independent
IDDM insuline dependent diabetes mellitus
IE initial evaluation
IFC interferential current
IMS intramuscular stimulation
Inf Inferior
Int. rot., IR internal rotation
Inv. inversion
Ionto Iontophoresis
Isom isometric
ITB Ilio-tibial Band
Jt Joint
KAFO Knee ankle foot orthosis
L , L, Lt. left
LAQ long arc quad (exercise.)
Lat Lateral
Lats Latissimus Dorsi
LBP low back pain
LB lower body
LBQC large base quad cane
LCL Lateral Collateral Ligament
LE lower extremity
LQ lower quadrant
LTG long term goal
L/S Lumbar Spine
Max Maximum
MCL Medial Collateral Ligament
MCP Metacarpophalangeal Joint
Med Medial
MDL moderately limited
MENS microcurrent electrical nerve stimulator
MFR myofacial release
MI Myocardial Infarction
Min Minimum
M/L Medial Lateral
MFR Myofascial Release
MHP Moist Hot Pack
MKL markedly limited
mm. muscle
MMT manual muscle test
MNL minimally limited
Mob Mobilization
mod Moderate
MS Multiple Sclerosis
MSW medical social worker
MTP Metatarsophalangeal Joint
MVA Motor Vehicle Accident
Max. maximal
N, .5/5 normal (re: muscle strength)
NAGS Natural Apophyseal Glides
NBQC Narrow Based Quad Cane
NCV nerve conduction velocity
NIDDM non-insulin dependent diabetes mellitus
N/T numbness and tingling or not tested
NF No Fault
NMR Neuromuscular re-education
NWB non-weight bearing
NS No Show
OA Osteoarthritis
OOB Out of bed
OT occupational therapy/therapist
OTR registered occupational therapist
_
p after
PBall Physio-Ball
PD Parkinson’s Disease
P, 2/5 poor (re: muscle strength)
Pec Pectoral / Pectoralis
PCL Posterior Cruciate Ligament
PIP Proximal Interphalangeal Jt
PF plantar fl exion
PMH past medical history
Pn pain
PNF Proprioceptive Neuromuscular Facilitation
POC plan of care
P/A Posterior Anterior
PRE progressive resistive exercises
Post Posterior
Prec. Precautions
Prep. preparation
Prox Proximal
P**n P**nation
Phono Phonophoresis
PRN As needed
Pt. patient
PT physical therapy/therapist
PTA physical therapist assistant
P/u Push up
PVD Peripheral Vascular Disease
PWB partial weight bearing
Quad Quadriceps
QS Quadriceps Set
RA Rheumatoid Arthritis
R , R, rt right
Re recheck
Rec’d received
Rehab. rehabilitation
Reps. repetitions
Req/d. required
RGO reciprocating gait orthosis
ROM Range of Motion
Rot. rotation
r/o Rule out
RSD Reflex Sympathetic Dystrophy
RTC Rotator Cuff
RTW Return to work
Rx. treatment
RW Rolling Walker
SAQ short arc quad (exercise)
SB Sidebend
SBA standby assist
SBQC small base quad cane
SCI spinal cord injury
Script Prescription
SI, SIJ sacroiliac joint
Sh shoulder
S/L Sidelying
SLP speech-language pathologist
SLR Straight Leg Raise
SNAGS Sustained Natural Apophyseal Glides
SOB Shortness of Breath
S/p Status post
SPC Single point cane
SPT student P.T.
SPTA student P.T.A.
ST speech therapy
STG short term goals
STM Soft Tissue Mobilization
(S) Supervision
Sup Supination or Superior
SW Standard Walker
T-Band Theraband
T, 1/5 trace (re: muscle strength)
TA Therapeutic Activities
TBI Traumatic Brain Injury
TENS transcutaneous electrical nerve stimulator
THA total hip arthroplasty
THR total hip replacement
TIW three times per week
THA Total Hip Arthroplasty
THR Total Hip Replacement
Ther Ex Therapeutic Exercise
TIA Transient Ischemic Attack
TKA total knee arthroplasty
TKR total knee replacement
TLSO Thoracolumbosacal orthotic
TM treadmill
TMJ Temporomandibular Joint
Tol Tolerated
TTWB Toe Touch Weight Bearing
T/S Thoracic Spine
Tx Traction
UB upper body
UBE Upper Body Ergometer
UE upper extremity
UQ upper quadrant
US ultrasound
UV ultraviolet
VC verbal cues
VIC Verbalized informed consent
W/cm2 watts per centimeter squared
WB weight bearing
WBQC Wide based quad cane
WBAT weight bearing as tolerated
W/C Wheelchair
WFL within functional limits
WNL within normal limits
y/o Years old
// Bars Parallel Bars
4WW Four wheeled walker
_
s without
_
c with
1° primary
2° secondary
approx. approximately
# pound
(3 dots in a triangle) therefore
(Triangle) change
= equals
Z, 0/5 zero (re: muscle strength)
< Less Than
> Greater Than
1:1 One to one
‘ Foot or Feet
‘’ Inches
# Pounds
↑ Up, increased
↓ Down, decreased
√ Flexion
∕ Extension

29/05/2023

Facial Palsy!!

Paralysis of facial muscles is generally called Facial Palsy. It can be of a central or a peripheral origin.

1️⃣ Central facial palsy happens when certain structures of the brain get damaged by for example, a stroke. The main symptomatic difference between central facial palsy and the peripheral one is that in the former case the upper side of the face is almost not affected. The patient can close both eyes and can blink normally.

2️⃣ Peripheral facial palsy leads to a complete paralysis of (mostly) one side of the face.The nature of damages to the nerve fibers and the prognosis for recovery is also different depending on the causes.

➡️• Ramsay Hunt syndrome: comes from herpes zoster virus
➡️• Lyme disease: derives from borellia type bacteria, which we get mostly from the tick bite
➡️• Otitis media (inflammation of the middle ear)
➡️• Tumors of various types, including acoustic neuroma
➡️• Iatrogenic damages (damages incurred during surgical interventions in the area)
➡️• Trauma (temporal bone fractures and other injuries involving temporal and zygomatic areas of the face)
Bell’s Palsy. Often results from local over-cooling of face, head and neck area from cold weather, wind, airco, drafts (driving with both windows open). Additional risk factors are: stress, hypertension, last weeks of pregnancy. Some sources also name diabetes as a risk factor.

Bell's Palsy:
‼️ Bell’s Palsy is the most common form of facial paralysis, and is caused by inflammation of the facial nerve, and is most likely related to reactivation of a virus known to cause cold sores (Herpes Simplex Virus). This swelling prevents the nerve from sending correct signals to the brain and facial muscles, resulting in paralysis. Bell’s Palsy can occur very quickly, with symptoms and paralysis setting in as quickly as 48 hours.

⚠️Difference:
‼️ The main difference between facial paralysis and Bell’s Palsy is that when a patient is diagnosed with facial paralysis, a cause for the paralysis can be identified, be it a tumor, infection, or nerve damage.
‼️ In cases of Bell’s Palsy, the disorder appears without any reason, which can be quite troublesome for the afflicted patients.

‼️ Both involves facial nerve.. But, the difference is bell's palsy (LMN type) occurs at the Level of stylomastoid foramen - hence there is ONLY symptoms of paralysis of facial muscles ipsilaterally.
‼️ Whereas, facial nerve palsy is a broad term ( includes UMN type as well as LMN type of palsy)..
🔑 In LMN type of facial nerve palsy, IF nerve is injured above stylomastoid foramen, then obviously in addition to features of facial muscle paralysis, there is also HYPERACUSIS and INABILITY TO SENSE TASTE SENSATION IN ANTERIOR 2/3 rds OF TONGUE.
In LMN type of palsy, if nerve is injured at the Level of stylomastoid foramen - it is called bell's palsy..!
🔑 In UMN type of facial nerve palsy, all the above symptoms are present but, EYES ARE UNAFFECTED ( both eyes can be closed nicely)

‼️ In Bell's palsy there is inflammation around the facial nerve and this pressure causes facial paralysis on the affected side.
‼️ Facial nerve palsy is the most common acute condition involving only one nerve, with Bell's palsy being the most common cause of acute facial paralysis..!!!!