Transcript Physical Exercises

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Rehabilitation
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Rehabilitation:
Is the whole process of restoring a
disabled person to a condition in which
he is able, as early as possible, to
resume a normal life.
 The World Health Organization developed the “International
Classification of disease, Impairments, Disabilities and Handicaps”
in 1980.
 Disease:
a condition of altered pathophysiology.
 Impairment:
loss or abnormality of an organ or in
structure or function .
 Disability:
limitation of performing tasks, activities and roles to the expected
level considered normal for a human being.
 Handicap:
lack of societal role fulfillment for an individual due to a disability.
Rehabilitation team
 Attending physician.
 Occupational therapist .
 Physical therapist.
 Rehabilitation nurse.
 Psychologist.
 Social worker.
 Vocational counselor.
 Prosthetist - orthotist.
 Speech - language pathologist.
 Other
“functional
specialists”
e.g.(audiologist, electro physiologist).
Physical therapists:
Work principally with gross motor functions:
 Range of motion.
 Strengthening to facilitate ambulation, mobility and balance.

Evaluate and fit manual wheel chairs.
 Train the individual in the use of orthotics and
prosthetic limbs.
 Evaluate home environments.
 Use of modalities such as heat, cold, ultrasound
and massage.
 Occupational therapists:
Work principally with fine motor function:
 Upper extremity range of motion and strengthening to
facilitate grooming, feeding, dressing, and toileting.

They provide and train individuals to use adaptive
equipment to facilitate the functions mentioned.

They evaluate and manage the powered wheel chair.
 Home environment evaluations and educate on
energy-conserving methods of self-care and home
management tasks.
 The Rehabilitation psychologists:
Are well trained in addressing psychological issues related to an
injury.
 Mandate includes the patient’s and family’s needs .
 They also provide a variety of testing to evaluate personality issues
and cognitive functioning.
 The Rehabilitation Nurses:
 Wound care and skin management.

Adjustment of disability.
 Bowel and bladder rehabilitation.

Goal setting.

Psychological support and medication management.

Nurses encourage patients to be maximally independent
with their care, to be involved with the goal setting process and
ultimately to self-direct their care.
 Speech pathologists:
 They are experts in speech function such as
pronunciation and word finding.
 They also evaluate swallowing function and safety.
 They provide cognition and communication evaluations,
identifying deficits and providing compensatory strategies
for the patients, care givers and team members.
 Social workers:
 They provide
emotional support for families.
 Evaluate living situations and coordinate disposition.
 They identify community services available for patients.
Vocational counselors:
 Optimize the health and abilities of potential disabled
employees.
 Provide an expert reports for the individual and their
present or future employers, or the vocational service
working on behalf of the individual
 Assist
and
facilitate the individual
to achieve a
successful work and participation in this work in any
possible and reasonable way.
The prosthesis' / orthotist
works:
 They evaluate, design, and make
prosthetic limbs and orthoses.
 They also evaluate their fit and
function after fabrication.
General treatment lines:
 Define disability
 Measure the disability.
 Medical care : treat causative illness.
 prevent additional disability
 Enhance/support functional capacity of affected organ e.g. device &
equipments.
 Get family support as well as social & institutional.
 Modify social & vocational environment.
 Deal with psychological values to improve opinions, beliefs&
performance.
 Use the best education techniques.
 An example of disability measurements \ health assessment questionnaire
(HAQ):
At this moment , are you able to
With some
difficulty (=2)
With much
difficulty (=3)
Unable to do
(=4)
Dressing yourself, Including tying shoelaces & ---------doing buttons
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Get in & out of bed ?
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Lift a full cup or glass to your mouth ?
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Walking outdoors on flat ground ?
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Wash & dry your entire body ?
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Bend down to pick up clothing from floor ?
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Turn regular faucets on & off ?
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Get in & out of a car ?
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Without any
difficulty (=1)
Activities of daily living (ADL)
1) Self care:
3) Duties :
• Transfer & home mobility.
• Vocational.
• Eating.
• Non-vocational (e.g. shopping ,
• Bathing.
house keeping,….etc)
• Toileting.
• Dressing.
• Grooming.
2) Communication (speaking, listening, reading, writing)
• Functional independence measure (FIM)
• For each ADL performance a number is given:
ADL performance
Complete independence
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Modified independence (device)
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Modified dependence :Supervision
Minimal assist (subject =75% )
Moderate assist (subject =50%)
5
4
3
Complete dependence :Maximal assist (subject =25%)
Total assist (subject =100)
2
1
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Level of motor abilities
Gross motor functions classification
system (GMFCS):
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I) walks independent, runs, climbs
stairs, jumps.
II) walks independent, hang on
when climbs stairs.
II
III)
Walks
independent
with
aid(crutches,stick,rollator) for long
III
distance uses wheelchair (propels
independent).
IV) mobility mainly by wheelchair
(power chair), indoors walks with
IV
rollator.
V) No independent mobility,
abnormal postural control
(no stable head support),
needs help in all self-care
domains.
V
Resettlement:
The process of returning the patient to the most appropriate
social situation.
Disable resettlemet office( DRO):
Responsible for place the disable person in a suitable social work( if
necessary after employment rehabilitation or vocational training).
DRO main function:
1- It act as intermediary between industry and client.
2- Act as employment adviser to the disabled person.
3- Advice the clinical and social team about the possibility and
suitability of employment for the patient.
Resettling a disable patient on work depend on many
factors:
1- Severity of the disability.
2- Age of the patient.
3- Education and conjugal back ground of the patient.
4- Nature of the work.
5- Social and economic factors.
6- Time elapse from onset of disability till definite plans to return to
work or training.
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Physio - therapy
techniques
Physiotherapy (physical therapy):
Is a health profession concerned with
the
assessment,
diagnosis
and
treatment of disease and disability
through physical means.
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ROLE OF PHYSIOTHERAPY:
1. It provides psychological support for the patient in
depression.
2. It is useful in treating psychosomatic conditions.
3. It helps in treating deformities and making them
functionally independent.
4. It plays a role in treating neuromuscular disorders.
5. It improves the walking abilities.
6. It relieves the pain, spasm…. etc.
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 PRINCIPLES OF TREATMENT
1. To relieve pain and spasm.
2. To increase joint range of motion.
3. To reduce the stiffness or contractures.
4. To improve muscle power.
5. To prevent deformities.
6. To relieve spasticity.
7. To remove the secretions from the lungs.
8. To improve the breathing capacity.
9. To improve the aerobic capacity.
10. Improve gait pattern …. etc.
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Classification:
 Heat therapy(superficial and deep).
 Cold and ice therapy.
 Hydrotherapy.
 Electrotherapy (Gelvanic and Faradic stimulation).
 Spinal traction.
 Physical exercise.
 Orthoses & other aids & devices.
 Prostheses.
 Education & training.
 Invasive techniques.
Superficial Heat Therapy (HT):
•
It’s a passive procedure of physical treatment.
•
It can be done by two way:
1) Changing the heat of the environment.
2) Applying the heat to the skin (wax bath, electrical lump, hot pack,
heat lump).
•
Time is 3-30 minutes.
•
Its wiser to observe the thermal sensitivity
of the skin(other wise it may be burn).
• It can be used effectively at home.
 Indications
Painful conditions : muscle spasm ,tension myalgia,
chronic stage of tendinitis & bursitis.
To reduce joint stiffness & improve range of
movement(ROM).
Physical treatment of contracture.
Induction of reflex vasodilatation.
 precautions & contraindications
1) Acute inflammation, trauma or hemorrhage.
2) Bleeding disorders e.g. hemophilia.
3) Insensitive skin e.g. complete spinal cord injury.
4) Inability to communicate or respond to pain.
5) Malignancy.
6) Ischemia.
7) Edema.
8) Atrophic skin.
9) Scar tissue.
10) Poor thermal regulation.
Wax-bath:
 Wax is melt at 130°F(45-50°C),and remain
liquid at 120°F .
 Its heated by thermostatically controlled
tanks.
 Dipping the affected part 10 time in it, so
there is 6-7 coating of wax, the hand
remains covered by wax for 20 min.
 The wax easily peeled off after
a treatment period.
 Its useful for arthritis and hand
injury.
 It follows by active exercise to
mobilize stiff finger.
Deep Heat therapy
Ultrasound (U.S.).
Short wave diathermy (SWD).
Microwave diathermy (MWD).
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 Ultrasound
• Its effect by mechanical, chemical and
heating effect.
• It applied in contact with the patient
body.
• It can be repeated daily, twice-three
time weekly.
•
it used easily, safe, not expensive,
treated for few min.(5-10 min.), no
burn caused by it.
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Indication: 
 Indications
1. Acute sprain and strain.
2. Ligament infl., tenosynovitis.
3. Scaring after burn.
4. Fibrosis ( duputeryn contracture).
5. Traumatic athletic injury.
6. Chondromalacia patellae.
Contra indication
1. Malignancy and benign tumor.
2. Previous irradiated skin.
3. Avoid in: fluid filled cavities (e.g. eyes & gravid
uterus), heart , brain , testes.
4. Acute infection.
5. Hemophilia.
6. Pregnancy.
 Short wave diathermy (SWD):
• Its depth of penetration is half body.
• Application time 15- 30 minutes.
• Its heating effect is produced by putting the
patient with in electrical
field,
Patient
should be on a non conductive table.
• Its impossible to measure the input on the
patient, so only observe the skin sensation
of patient (it may cause burn).
• It relief joint pain.
Contra indication:
1) Malignancy.
2) Acute infection and inflammation.
3) Venous thrombosis and arterial insuffiency.
4) Hemorrhage.
5) Loss of skin sensation.
6) Metal in tissue.
7) Cardiac pace maker.
 Microwave diathermy (MWD):
• Electro magnetic radiation.
• commonly used for small joints & superficial muscles.
• Application time is 15-30 minutes.
 Contra indication:
• avoiding active or acute inflammatory and infective site.
• Children are better avoided.
• Precaution on edematous tissue and fluid
filled cavity.
• Protective glasses (goggles) are used by the
patient & therapist because MWD can cause
cataract.
• Skin loss of sensation.
• Hemorrhage.
• Malignancy.
 Cold (cryo-) therapy :
Application time 20 minutes & repeated few to several time / day.
It includes:
• Ice packs.
• Cold water sacs.
• Whirl pools.
 Indications:
1) Acute skeletal trauma.
2) Chronic Skeletal pain .
3) Exercising spastic muscle.
 Precautions & contraindications:
1) Ischemia ( even distant exposure ).
2) Reynaud’s phenomenon.
3) Unhealed wound.
whirlpool therapy
Cold Therapy
Hydrotherapy:
 Use of water (specially warm water ) in treatment of a disease.
 Total body or part of it is treated in water.
 Effect of hydrotherapy;
1) Increase of peripheral circulation (at 96°F).
2) Relief pain , muscle spasm, joint stiffness,
decrease sensitivity of muscle spindle to
stretching.
Hydro therapy
3) Buoyancy of water decrease body weight to
10% and this is utilized in walking and standing.
4) Hydrostatic pressure is the force acting on body surface (by the
water)=40.7 pound \inches, and it increaseed by 0.86 pound for
each 2 feet depth. This Pressure is sufficient to support the body
in standing.
5) Dynamic pressure: is resistance which body encounter in moving
in water, it depending on size
of moving part and its speed.
Hydro therapy
Indications:
1.
Muscle weakness (poliomyelitis).
2.
Amputation to strength the stamp.
3.
Hemiplegia, cerebral palsy.
4.
Spinal cord injury.
5.
RA , OA.
6.
Ankylosing spondylitis.
7.
After joint injury.
Hydro therapy
 Contra indication:
1.
Pop.
2.
Infection and inflammation.
3.
Incontinence.
4.
Opened wound.
5.
Cardiac and respiratory diseases.
Light therapy:
Infra-red therapy:
 It emit electromagnetic wave travel through air
and penetrate skin and S C T., causing peripheral
vasodilatation.
 It applied from special distance from the body for
10-30 min.
 It relief pain and muscle spasm.
 It gives relax and rest for patient before the next
part of treatment.
 Contra indication:
1)
2)
3)
4)
Loss of skin sensation.
Skin disease.
Vascular insuffiency.
Hemorrhage.
Electrotherapy
 Is the therapeutic use of electricity to stimulate nerve, muscle
or both using surface electrodes.
 Biological effects : muscle group contraction.
 Increase muscle strength.
 Retard muscle atrophy.
 pain relief.
 Enhance wound healing.
 Enhance osteo -genesis.
galvanic stimulation
Electrotherapy:
 Contraindications:
• Circulatory impairment & dysrhythmia.
• Over carotid sinus.
• Across the heart specially over a demand pace maker.
• Pregnancy.
• Epilepsy.
• Fresh fracture.
• Active hemorrhage.
• Muscles which are peripherally denervated (avoid neuro-muscular
electrical stimulation).
 Spinal traction:
 Traction is pulling.
 Generally limited to cervical & lumber (pelvic) traction.
 It has an elongation (separation) effect.
 CT-scan study during traction of disc herniation showed
size reduction or disappearance of prolapsed disc during
traction.
Spinal traction-common methods
Mechanical (pulley system ).
• Continuous traction : for 24 hr. and more if pain is severe( small
wt.).
• Intermittent: traction is applied and removed alternatively ( using
more weight).
• Sustained traction: for 20-30 min.
 Spinal traction- application
• Enhance muscle relaxation by superficial heat before
or during traction.
• Starting with lower force.
 Recommended force:
Cervical: 10% of body weight.
Lumbar : 35 -50 % of body weight.
Position :
 Cervical: sitting ,flexed neck
to 20-30 degree.
 Lumber : supine with flexed
hips.
 Session time :
about 20 min.
repeated 3-4 times / week.
 Evaluation: during & after the
course & if symptoms worsen.
 indication:
Disc herniation with or
without root symptoms.
Precautions:
1)
lack of experience therapist.
2)
Sever O.A.
3)
Suspicion of local malignancy.
4)
Significant Osteopenia.
5)
Acute soft tissue injury .
6)
Old age .
7)
Congenital spinal deformity.
8)
Cardiovascular disease.
contraindications:
For cervical traction :
1 – Cervical instability (R.A. ,sever O.A. ,hyper mobility).
2- Carotid & vertebrobasilar insufficiency.
For lumber traction :
1 - Pregnancy.
2 - Sever spinal canal compression.
3- Inability to stabilize chest(sever cardio-respirator disease).
4- Active peptic ulcer , aortic aneurysm ,hiatal & other
hernias (making pelvic brace difficult).
5 - Spondylolisthesis.
Rehabilitation
management techniques
Physical Exercises:
Performance of planned physical
movements, postures or activities
intended to enable the person to:
 Remediate or prevent impairment.
 Enhance function.
 Reduce risk.
 Improve overall health.
 Enhance fitness & wellbeing.
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Biology effect of active exercise:
It includes:
 Increased oxygen demand, increase
rate & depth of respiration.
 Increased heart rate.
 Increased B.P. (heavy exercise).
 Decreased
insulin
secretion
&increased
glucagon secretion to maintain blood sugar
level.
 Increased catecholamine secretion.
 Fatigue & muscle soreness if ability is
exceeded.
The beginning & the end:
• Sudden vigorous exercise may cause ECG
abnormalities & syncope. Therefore a
warm-up period is needed.
• Abrupt cessation of active rhythmic
exercise may cause a sudden drop in B.P.,
hence a cool-down period is needed.
Practical therapeutic classification:
 Mobility exercises.
 Range of motion exercises.
 Stretching exercises.
 Resistance exercises.
 Isometric (static) resistance exercise.
 Dynamic resistance exercise.
 Cardio pulmonary endurance exercises.
 Aerobic.
 Anaerobic.
 Motor coordination & skill exercises.
Benefits of ROM exercises:
• Maintaining joint mobility
• Nutrition to a joint
• Prevention of tissue adhesion &
contracture
Contraindications to ROM exercises:
Shortly after acute tears & surgery.
Acute local inflammation.
A serious precluding illness.
Stretching exercises:
 Usually passive. Can be done by the other hand,
as assistant or by a mechanical device.
 Used to overcome
adhesions or
contractures, e.g. in shoulder adhesive
capsulitis and joint flexion deformities.
 Contraindications to stretching exercises:

Bony obstacle.

Recent & local inflammation or

Active healing process.

Risk of stretch rupture (e.g. rotator cuff in old diabetics),

Bone fragility.
infection.
Resistance exercises:
It is any active exercise when a dynamic
or static (isometric) muscle contraction is
resisted by an outside force applied
manually or mechanically.
Types:
Isometric (static) resisted exercise.
Dynamic resisted exercise.
 They have few long term cardiovascular
effects. There is a little or no change in
resting: heart rate, B.P., stroke volume &
myocardial oxygen consumption.
Isometric (static) resistance exercise;
general features:
• Tension is generated in the muscle without
visible joint movement or appreciable
change in muscle length. It can also be done
against no resistance.
• It does not cause muscle hypertrophy.
• Is less effective than dynamic exercise in
developing muscle endurance.
• In
cardiac
patients
they
can
cause
arrhythmias & B.P. increase during exercise.
Uses of
exercises:
isometric
resistance
 To prevent or minimize muscle atrophy
due to external immobilization (splints,
casts, traction……..).
 To activate muscles while protecting
tissue healing.
 To improve muscle strength when
dynamic exercise is not advisable.
 To develop static muscle strength at
particular points in the ROM consistent
with specific task needs.
Dynamic resistance exercises:
It is a muscle contraction causing
joint movement it can be:
Concentric:
muscle
excrusion
&
shortening e.g. lifting a load.
Eccentric: muscle lengthening under
tension e.g. lowering a load.
 Is the most effective to improve
muscle performance & functional
abilities.
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 Orthoses, aids & devices:
It is an external device applied to body part for a
preventive or therapeutic purpose.
 Aims (uses) of orthoses:
Restriction of activity.
Protection or stabilization.
Correct flexible deformities.
Prevent progression of deformities.
Load transfer.
Improve function.
 Orthoses criteria
1) Gains acceptance regarding:
 Comfort (e.g. weight, size, tightness……etc).
 Function.
 Appearance.
2) Reasonable durability.
3) Easy maintenance.
4) Easy to don & off correctly.
5) Adjustable.
6) Low risk.
Orthoses structure:
 Metal:
Stainless steel: common for lower limbs.
Aluminum alloys: common for upper limbs.
Titanium: very light weight & corrosion resistant.
Desirable though more expensive.
 Plastic:
Thermo setting plastics: develop permanent shape
when heated & pressure is applied (can not be
softened when reheated).
Thermoplastics
(thermoforming):
soften
moldable when heated & harden when cooled.
 Others: leather, fabrics, rubber…….etc.
&
Prostheses:
An artificial substitute for a missing
body part.
 Aims of a prosthesis:
Functional: as usual in artificial legs.
Cosmetic: e.g. artificial eye ball & where ever the patient is not a
functional candidate.
In young children a prosthesis is often necessary to maintain
normal development.
 Temporary prosthesis is sometimes used for the initial
training evaluation (usually a socket design to accept full
weight bearing).
Prostheses Criteria:
Reasonable durability.
Light weight.
Adjustable.
Easy maintenance.
Easy to don & doff correctly.
Acceptable functionally &/or cosmetically.
Thank you
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