FUNCTIONAL ELECTRICAL STIMULATION

                      Nowadays due to lot of accidents , industrial accidents , burns, cut injuries,  most commonly cerebro vascular accidents like stroke, etc leads to affect the central nervous system which causes paralysed limbs. Once upon a time there is no other chance to get recover those kind of weaknesses, But Nowadays our medical technology is well developed like other technologies and it has lot of technologiese to recover from this paralysis. One of the most popular Technology  for STROKE is Functional Electrical Stimulation.

                      

                      Functional electrical stimulation (FES) is a low energy electrical pulses  by use of low frequency currents used  to generate body movements in individuals who have been paralyzed due to injury to the central nervous system.  FES can be used to generate muscle contraction in paralyzed limbs to produce desired functions such as grasping, walking, bladder voiding and standing. This technology used to develop neuroprostheses  in individuals with spinal cord injury (SCI), head injury and stroke and other neurological disorders. Patients can generate a desired function by use of  FES . This is sometimes also known as neuromuscular electrical stimulation.

SENSORY INTEGRATION THERAPY

  Sensory integration is the process through which the brain organizes and interprets external stimuli such as movement, touch, smell, vision and sound. Autistic children often exhibit symptoms of Sensory Integration Dysfunction (SID) making it difficult for them to process information brought in through the senses. Children can have mild, moderate or severe SID deficits manifesting in either increase(Hypersensitivity) or decreased ( Hyposensitive) to touch, sound, movement etc.

                                    

                                   The goal of Sensory Integration Therapy is to facilitate the development of the nervous system's ability to process sensory input in a more typical way. Through integration the brain pulls together sensory messages and forms coherent information upon which to act. SIT uses neurosensory and neuromotor exercises to improve the brain's ability to repair itself. When successful, it can improve attention, concentration, listening, comprehension, balance, coordination and impulsivity control in some children.

                                     Sensory integration is the process by which we receive information through our senses, organize this information, and use it to participate in everyday activities. Sensory interventions refer to any treatments and therapies which make use of, or which aim to improve sensitivity to, one or more of the senses. Some interventions- such as sensory integrative therapy - may use a range of motor and sensory techniques and be designed to improve a range of motor and sensory functions

                                    Most of the autistic kids having this sensory problems, Usually a TEAM including physiotherapists , occupational therapists, speech therapists are playing important role to rehabilitate autistic kids in lot of ways. 

                                   Sensory integration therapy by use of bare leg walking , or touching on the different structures, sensory board, walking or crawling into the tunnel, Using different shape and different textures made balls, some brushes , deep pressure activities, musical lights , etc..

DOWN SYNDROME AND ITS REHABILITATION

In every cell in the human body there is a nucleus, where genetic material is stored in genes.  Genes carry the codes responsible for all of our inherited traits and are grouped along rod-like structures called chromosomes.  Typically, the nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21.

This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome. A few of the common physical traits of Down syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm - although each person with Down syndrome is a unique individual and may possess these characteristics to different degrees, or not at all.

Approximately one in every 700 babies in the United States is born with Down syndrome, making Down syndrome the most common chromosomal  condition. About 6,000 babies with Down syndrome are born in the United States each year. 

 

TYPES :

1.TRISOMY 21 (NONDISJUNCTION)

Down syndrome is usually caused by an error in cell division called "nondisjunction."  Nondisjunction results in an embryo with three copies of chromosome 21 instead of the usual two.  Prior to or at conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate.  As the embryo develops, the extra chromosome is replicated in every cell of the body.  This type of Down syndrome, which accounts for 95% of cases, is called trisomy 21. 

2.MOSAICISM 

Mosaicism (or mosaic Down syndrome) is diagnosed when there is a mixture of two types of cells, some containing the usual 46 chromosomes and some containing 47.  Those cells with 47 chromosomes contain an extra chromosome 21. 

Mosaicism is the least common form of Down syndrome and accounts for only about 1% of all cases of Down syndrome.  Research has indicated that individuals with mosaic Down syndrome may have fewer characteristics of Down syndrome than those with other types of Down syndrome.  However, broad generalizations are not possible due to the wide range of abilities people with Down syndrome possess. 

3.TRANSLOCATION 

In translocation, which accounts for about 4% of cases of Down syndrome, the total number of chromosomes in the cells remains 46; however, an additional full or partial copy of chromosome 21 attaches to another chromosome, usually chromosome 14. The presence of the extra full or partial chromosome 21 causes the characteristics of Down syndrome.

Body shape and size

• Short stature (height). A child often grows slowly and is shorter than average as an adult.
• Low muscle tone (hypotonia) throughout the body. Belly muscles with low muscle tone can make the stomach stick out.
• A short, wide neck. The neck may have excess fat and skin.
• Short, stocky arms and legs. Some children also have a wide space between the big toe and second toe.

  Face shape and features

• Slanted eyes. The doctor may also notice small spots on the colored part of the eye

• A nasal bridge that looks pushed in. The nasal bridge is the flat area between the nose and eyes.
• Small ears. And they may be set low on the head.
• Irregularly shaped mouth and tongue. The child's tongue may partly stick out. The roof of the mouth (palate) may be narrow and high with a downward curve.
• Irregular and crooked teeth. teeth often come in late and not in the same order that other children's teeth come in.

Health problems

Some health problems related to Down syndrome are:
• Intellectual disability. Most children with Down syndrome have mild to moderate cognitive disability.
• Heart problems. About half of the children who have Down syndrome are born with a heart defect.
• Hypothyroidism, celiac disease, and eye conditions.
• Respiratory infections, constipation, hearing problems, or dental problems.
• Depression or behavior problems associated with ADHD or autism. 
• Rehabilitation:
  
  

  

  
  
  
  

  There is no single, standard treatment for Down syndrome. Treatments are based on each individual's physical and intellectual needs as well as his or her personal strengths and limitations. People with Down syndrome can receive proper care while living at home and in the community.
  
  A child with Down syndrome likely will receive care from a team of health professionals, including, but not limited to, physicians, special educators, physical therapists, speech therapists, occupational therapists, , and social workers. All professionals who interact with children with Down syndrome should provide stimulation and encouragement.
  
  we are doing upcoming therapies to Rehabilitate Down Syndrome kids.
  
  Physiotherapy includes activities and exercises that help build motor skills, increase muscle strength, and improve posture and balance.
   
  Physiotherapy is important, especially early in a child's life, because physical abilities lay the foundation for other skills. The ability to turn over, crawl, and reach helps infants learn about the world around them and how to interact with it.
  A physical therapist also can help a child with Down syndrome compensate for physical challenges, such as low muscle tone, in ways that avoid long-term problems. For example, a physical therapist might help a child establish an efficient walking pattern, rather than one that might lead to foot pain.
  
  Speech-language therapy can help children with Down syndrome improve their communication skills and use language more effectively.
  
  Occupational therapy helps find ways to adjust everyday tasks and conditions to match a person's needs and abilities.
  
  Emotional and behavioral therapies work to find useful responses to both desirable and undesirable behaviors. Children with Down syndrome may become frustrated because of difficulty communicating, may develop compulsive behaviors, and may have Attention Deficit Hyperactivity Disorder and other mental health issues. These types of therapists try to understand why a child is acting out, create ways and strategies for avoiding or preventing these situations from occurring, and teach better or more positive ways to respond to situations.

ROLE OF PHYSIOTHERAPISTS IN AUTISM

                               Autism is a neuro-developmental disorder characterized by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behavior. Parents usually notice signs in the first two years of their child's life.In addition to the behavioral, sensory and social-emotional difficulties, many children with an Autism Spectrum Disorder(ASD) will also experience difficulties with their motor skills and capabilities.

                               Children with ASD may achieve early gross motor milestones such as sitting,crawling and independent walking within the expected time frames, but the quality of their movements may be immature or stereotypical when compared with their peers. As a result, children with ASD may struggle to master higher level motor skills such as ball skills, skipping, riding a bike, balancing and hopping.  These skills impact the child’s overall participation in peer and community activities, which subsequently will affect their overall development.

Physiotherapist's Role:

Some signs a child with ASD might benefit from the help of a physiotherapist:

• Delayed achievement of gross motor milestones
• Difficulty with:
  • Throwing, catching, kicking or dribbling a ball
  • Jumping, hopping or skipping
  • Playing on a playground
  • Playing games or sports and keeping up with their peers
  • Participating in community recreational or sporting programs
  • Learning new physical skills
  • Sitting in a chair properly, or for very long without fidgeting
  • Poor posture
  • Clumsiness or frequent falls
• Toe walking

A number of motor, sensory and musculo skeletal issues may be underlying the motor difficulties experienced by a child with ASD:

• Low muscle tone – which means that they require more strength and energy to move, and also alters the sensory feedback of a child. 
• Motor planning difficulties – this affects the child’s ability to optimally time, sequence and execute a movement. This is often seen as clumsiness, frequent falls, poor balance, or poor coordination. 
• Poor posture – often develops as a result of the low muscle tone and poor core strength.
• Poor core muscle strength:
• Tight muscles and joints – these develop as a result of the poor motor strategies and posture
• Delayed achievement of, poor or inefficient balance reactions

A physiotherapist experienced in pediatrics will assess the child’s overall motor functioning, identify the underlying difficulties, and provide an intervention program to  improve these difficulties and subsequently the child’s overall functioning.  Strategies that may be used as part of a physiotherapy intervention plan include:

• Specific exercises or activities for muscle strength, posture, endurance, motor planning and balance reactions
• Sensory feedback strategies to improve a child’s awareness of their body posture and movements
• Recommendations for taping, orthotics, and/or other bracing or positioning strategies and equipment to enhance the child’s body alignment, posture and body awareness during functional or physical activities
• Recommendations and support to participate in community based physical activity programs that will support their physical skills and endurance

CORE MUSCLE STRENGTHENING FOR AUTISTIC KIDS:

Physiotherapy can be a key ingredient in the treatment of motor difficulties for children with ASD.  If you are concerned about your child’s development or their motor skills, or have a child you are working with who you think might benefit from physiotherapy intervention.

FUNCTIONAL SHOULDER ORTHOSIS

The Functional Shoulder Orthosis is very useful for stroke patients to prevent shoulder subluxation, which is made of modular parts, which interact with each other.

                        

                          A stainless steel ball-and-socket joint is externally interposed between the chest and arm and is attached to sturdy foundation of pelvic and thoracic bands. A grooved steel rod is similar like humeral shaft in man. The ball is giving the humeral rod a range of motion comparable to that of the humerus. The ball can also be locked in any position with the desired degree of flexion, abduction or extension.

                        

                          A pair of cuffs, humeral and forearm, attach to the limb above and below the elbow, respectively. Cuffs are connected by medial and lateral hinged bars forming an orthotic elbow joint. Orthotic elbow joint is giving full or partial range of motion or stability at any desired angle. An aluminum block is attached to the humeral cuff moves vertically and also rotates around it, completing the assembly of the FSO.

                           When the elbow joint of the orthosis is prevented from extending beyond 150° by a stop lock, and the block is selectively elevated on the rod and fixed by a locking bolt in one of its grooves, a constant pressure is exerted against the upper ulna by the forearm cuff. This pressure, transferred axially to the humerus, repositions the humeral head into the glenoid fossa. The locking bolt, when further tightened in the selected groove, will stabilize the arm at any desired degree of abduction

                            The orthosis is completely modular in design, is available in different sizes, and its fit and assembly by the orthotist are simple and minimally time consuming.

WHAT IS PHYSIOTHERAPY? WHY PEOPLE CHOOSING THIS?

                                                         Physiotherapy had proved a lots of hands on techniques, exercise and treatment massages to help treat different conditions like paediatric , neurological and orthopaedic etc.  To prevent additional damage we work to rehabilitate and restore the use of a body part. We will develop a treatment plan that meets your personal needs and we are thorough in our diagnosis and check-ups.Physiotherapists having magical hands to reduce your pain and to improve your quality of movements etc

                                               To ease the pain, the physiotherapist may use hands on treatment like massage, gentle hand pressure over joints and stretching muscles to help a person move easier and with less pain. We also teach special exercises and movements to reduce pain and speed healing. we are using some electrical equipments also to reduce pain .

WHY NEED PHYSIOTHERAPY:

                                                         Why we want to choose physiotherapy: Physiotherapy can help to move freely and pain free. It helps to do our daily routine activities independently. It helps to enjoy your hobbies , sports, and recreation time. Physiotherapy makes you fit always. In your old age helps to enjoy in all ways like family fun and playing with kids and grandkids.

WHAT  IS PHYSIOTHERAPY?

                                               Some of the benefits you can get physiotherapy. There is no side effect while comparing with other kind of treatments. It helps to kill and decrease your pain. Physiotherapy helps to heal faster. It is giving improvement with less or no medication. It helps to tret your condition on your own. It is giving a clear picture about your condition. It is giving long term solution for your problems. It helps to get back soon your passions and persue life.

WHAT IS ANKLE SPRAIN

What is Ankle Sprain?

An Ankle sprain is actually an injury to the ligaments of the ankle joint, which are elastic, band-like structures that hold the bones of the ankle joint together and prevent excess turning and twisting of the joint. In normal movement, the ligaments can stretch slightly and then retract back to their normal shape and size. A sprain results when the ligaments of the ankle have been stretched beyond their limits. In severe sprains, the ligaments may be partially or completely torn.

The ankle joint is fairly unstable and largely depends on the ligaments for its stability. The ankle sprain is of two types-

• 1-Pronation or eversion type.
• 2-Supination and inversion type.

  Mechanism of Ankle sprain

  The ligament is injured when the plantar flexed foot is suddenly forced into inversion, which may cause rupture, sprain of lateral ligament.
  The injury is common in sports activity. It is quite common when a person slips off or walk on uneven surfaces. The foot is forced into inversion and plantar flexion which results in external rotation of tibia. The site of injury is generally the centre and distal attachments of anterior and middle band of the ligament.
  When sudden inversion force occurs with the ankle in mid position of dorsi and plantar flexion, the injury involves the calcaneo-fibular ligament (CFL). Whereas when the excessive inversion-adduction movement is associated with forced plantar flexion, the injury commonly involves anterior talo-fibular ligament (ATFL). This can be identified by the site of pain and tenderness. Pain and tenderness over talus indicates injury to talo-fibular ligament while the same over calcaneus indicates the involvement of calcaneo-fibular ligament. This identification is necessary for prompt treatment 

  Sprained Ankle Symptoms

  • History- The patient describes 'going over' at the ankle.
  • Pain- There is sharp pain just below and anterior to the lateral malleolus. Passive stretching and weight bearing increase the pain. Pain because the nerves are more sensitive: The joint hurts and may throb.
  • Swelling- When an ankle is injured with a sprain, tissue injury and the resulting inflammation occur. Blood vessels become "leaky" and allow fluid to ooze into the soft tissue surrounding the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well. This is present from the lateral border of  tendo-achilles, over the lateral malleolus along the dorsum of the foot. In severe injuries, swelling may spread to the dorsum of the toe and up to the leg.
  • Bruising- This appears under the lateral malleolus and over the dorsum of the foot.
  • Loss of function- All weight bearing is painful, so the patient cannot run and has a gait with a very short stance phase on the affected foot.

FROZEN SHOULDER (ADHESIVE CAPSULITIS)

Frozen shoulder syndrome   (also known as adhesive capsulitis) is marked by pain, discomfort and limitation of movement across shoulder joint with “waxing waning” symptoms over time. It has been observed that the risk of developing adhesive capsulitis increases in certain medical or vascular conditions that limit the mobility of upper limb. 

It is concluded that the progressive joint discomfort starts with a painful stage in which minimal movement of upper limb or shoulder joint evokes strong pain and discomfort. This is followed by a stiff stage which the pain experienced is minimal but the joint is stiff with impaired range of motion. 

Causes of Frozen shoulder:

Frozen shoulder syndrome is the inflammation of shoulder joint capsule that encase and embrace all the tendons, ligaments, muscles, bones of the ball and socket joint. Typically, any ongoing inflammatory process limits physical activity due to shoulder pain and discomfort. In the absence of any intervention, the connective tissue components begin to thicken as a result of ongoing inflammatory process leading to prolonged stiffness and limited range of motion. This stage is known as froze shoulder position.

Advanced age: 45 years of age or above. Most common in females.

History of recent limb injury or immobility: tearing of rotator cuff tendons, any vascular, orthopedic surgery involving upper limb or impaired limb motion due to stroke

Diabetes : Diabetes is one of the strongest risk factors that are associated with the pathogenesis of secondary frozen shoulder syndrome.

Certain metabolic or endocrinological disorders: like hyper or hypothyroidism, untreated or poorly managed circulatory conditions and tuberculosis also increases the risk of developing frozen shoulder syndrome significantly. 

Best Exercises For Treating Frozen Shoulder Syndrome

Shoulder exercises are generally recommended by healthcare providers to regain mobility and range of motion. Physical therapy maneuvers and exercises are especially effective in stiffness stage and recovery stage.  Some of the best exercises for frozen shoulder syndrome suggested by healthcare providers are discuss below:

Shoulder Abduction

Physical therapist suggests active-passive exercises to restore joint range of motion. A variety of pulley exercises are devised for such patients like shoulder abduction .

Attach a pulley to a door (as high and as secure as possible). Use a chair or stool with your back facing the door and grasp the two ends of the pulley with your both hands.Now extend your injured arm using pulley handle as fulcrum to the side of your body while using the non-injured arm as your overhead support.Now pull down the non-injured arm to the side of your body while extending and lifting the injured arm overhead.Repeat the exercise for 10 minutes twice a  day

Shoulder External Rotation

The basic principle of all shoulder exercises in adhesive capsulitis or frozen shoulder syndrome is to improve the range of motion by allowing passive movements with minimal discomfort. Moreover, since the weight of upper body is supported by the pulleys, the movements are less stressful for the body that helps in directing all the force towards the joint components.  

For this exercise, secure the pulley around the door knob and extend your elbows while keeping your forearms parallel to the ground level.With gentle traction on injured arm, stretch your non-injured arm and rotate the pulley strings between two arms alternately. The benefit of this exercise is loosening of ligaments that control rotatory motion of shoulder joint.

Shoulder Flexion

It is very important to perform all the shoulder stretching exercises with your elbows fully extended. This exercise involves securing a pulley on top of a door or with a hook on wall.

Once pulley is secure, stand straight with your back supported by the wall. Now using pulley handle, lift your normal arm in the air in full-extended motion, while your injured arm is stretched by the side of your body (shoulder joint is flexed in this position). Hold the position for a few seconds and extend your injured arm overhead while your normal arm is stretched by the side of your body. Repeat the exercise for a few minutes every day at periodic intervals.

This exercise helps in decreasing stiffness by promoting joint activity in vertical motion. 

Shoulder exercises to improve frozen shoulder

Arm Circles

Arm circle is a common fitness exercise that is often advised to athletes to improve their overall range of motion. Instructions are simple and benefits are immense and almost immediate. It helps to break down adhesions.

Lie down on a flat horizontal surface like a table on your right side. Place your left hand on your left shoulder and try to make small circles in the air. Start off by making small circles and gradually increase the size and circumference of the circle by using elbow joint as the center point of focus. After making at least 20 clockwise circles, make 20 counter- clockwise circles. Repeat the activity with right side.

The most wonderful benefit of this exercise is increased flow of blood across the joint capsule and tissues that increase the pace of healing.

Back Clasp

Black clasp is another exercise that primarily aims at improving the flexibility of shoulder muscles and joint ligaments. It ensures pain-free movements and to restore full range of motion.

Stand straight with your legs wide apart. Next step is to use your hands and clasp on your back. Stabilize your arm and slowly raise the arms over your head. Stop the arm movement at the point of maximum resistance and hold your position for 30 seconds.Start from the base-level again and you will see that slowly your range of motion has increased by the time you are done with the exercise (at least for 5 to 8 minutes thrice a day).

Wall Climbing 

Wall climbing is an exercise or recreational activity that allows your shoulders to work in synchronous motion with the rest of your upper limb components. Since it is also a recreational activity, you may be able to work up your joint apparatus for a longer period of time without conscious perception. Stand straight with your legs wide apart. Now use your fingers to crawl or climb the wall and as you move up, stop and hold the position at every 6 inch to feel the grip. Discontinue when you begin to feel pain.