Selection of Dosage
Dosage depends on the patient’s condition.
In cases where the pain is experienced before tissue resistance, mobilizing the joint can induce pain relief and in cases where pain is experienced after tissue limitation, the effect desired is increase in ROM.
Here the dosage in Grades III, IV and V can be given at- 2-3 cycles/sec, for a duration of 2 to 5 minutes. This is different from manipulation, which is a passive movement done with greater force when the patient is under anesthesia.
Obviously the type of motion occurring between bony participants within a joint is influenced by the shape of joint circumference, the type of joint, the freedom of movement permitted, and accessory movements.
Techniques
1. Passive angular stretching 2. Joint glide stretching 3. Compression
4. Traction.
Cyriax Techniques
Cyriax was a physician who made medical diagnosis of musculoskeletal disorders localizing the “lesion” to a particular anatomical structure. The concept of referred pain which meant that the location of the pain was not always the exact location of the lesion was adapted by his method of examination. Later it included selective tissue tension to localize the lesion precisely. The treatment of the soft tissue lesions consisted of manipulation, massage, traction and injection.
ENDURANCE EXERCISES (REF CHAP 23)
Endurance exercises are any activity that challenges the cardiorespiratory function and increases heart rate and breathing for an extended period of time.
Examples of endurance exercises are:
Moderate: Examples of moderate exercise are bicycling, or cycling on a stationary cycle, and walking briskly on a level surface for three to five km.
For housewives who may not be able to take time off for their exercises, mopping or scrubbing the floor itself is a good exercise. In our country several ADL’s like working out in the fields or at home without gadgets would construe moderate exercise.
Vigorous: Climbing flights of stairs, brisk cycling up gradients, playing tennis (singles) swimming, hiking or jogging.
Therapeutic endurance exercise may be recommended for persons with Duchennes muscular dystrophy. Duration of exercise and its intensity should be based on each individual’s tolerance to exercise, and spontaneous walking speed. The physical medicine specialist and physical therapist design an exercise program that won’t aggravate the problem or cause muscle damage.
The patient is advised to walk as much as he can, use a stationary bicycle or elliptical trainer in moderation to work a number of muscles groups at the same time or go swimming. Sometimes light weights can be included. It is better to increase repetitions than weights.
Suspension Therapy
Sling suspension therapy is a form of physical therapy where joint movement and tissue stretches are achieved through pendular movements in a suspension frame fixed on to a bed. Motion may be assisted, neutral or resisted.
Weights are added to the slings, which are all suspended through hooks and pulleys to the overhead meshed frame. Correct placement of the suspension point above is important to get a good range of movement and also strengthen the muscles. Suspension can be used for all parts of the body.
Factors used in suspension therapy:
• Positioning of patient
• Size and shape of slings
• Fixing methods
• Supports above
• Control of ROM Hydrotherapy
The uniqueness of water lies mainly in its buoyancy, which relieves stress on weight bearing joints and permits movement to take place with reduced gravitational forces. The other properties of water that are used in pool rehabilitation are hydrostatic pressure, surface tension, and hydrodynamics.
The upward buoyancy exerts on an immersed body reduces the weight on the recovering muscles and joints in chronic arthritis.
Buoyancy varies according to depth; the deeper it is, the lesser is the weight in comparison to land-weight.
Hydrostatic pressure, which is the pressure exerted equally in all directions by the fluid on the surface of an immersed body in the water is used in management of edema.
Force is necessary to overcome the viscosity of the water, or its surface tension. This property of hydrodynamics can be used by progressively increasing resistance during strength training programs. Swimmers have extremely well developed Latissimus dorsi due to this property. In sports rehabilitation, the athletes are motivated to move their limbs or swim faster through water, by which more muscle fibres are recruited and strength increases.
The use of the Bad Ragaz technique in the rehabilitation of a child with spasticity, where proprioceptive neuromuscular facilitation is used, utilizes tubes or rings are used to support it in the water. Incorporation flotation devices to either assist or resist movements adds variety and interest to the treatment.
The therapist provides the source of manual stability as well as resistance to a functional pattern of movement, typically by pushing or pulling against a movement that the child is making. Stability and resistance are promoted with the patient suspended at the surface. Like PNF techniques on land, this enhances muscle activity to recruit the inactive muscle into the functional movement pattern.
The benefits of using an exercise pool are:
a. the relief of pain and muscle spasm,
b. the maintenance or increase in range of motion of joints,
c. the strengthening of weak muscles and an increase in their tolerance to exercise,
d. the re-education of paralyzed muscles,
e. the improvement of circulation,
f. the encouragement of functional activities, and
g. the maintenance and improvement of balance, co-ordination and posture.
Some of the conditions which benefit from hydrotherapy 1. Cerebral palsy and stroke
2. Arthritis 3. Poliomyelitis.
MASSAGE TECHNIQUES (FIG. 3.15) The massage techniques are:
• Stroking
• Effleurage
• Kneading
• Hacking
• Rolling
• Friction
Figure 3.15: Vacuum therapy—Mechanical form of massage (For color version see Plate 1)
STROKING
It is usually performed with the fingers or finger tips. The operator’s hands are relaxed and passed over the patient’s skin in a rhythmic manner with pressure on the finger tips producing a sedative effect.
Effleurage: It is performed by the palmar surface of the hands with moderate pressure and speed from distal to proximal in the direction of venous and
lymphatic drainage and ending into the major lymphatic glands of the body.
It produces an increase in venous and lymphatic drainage and also soothing effect, and is used in cases of gross lymph edema.
Kneading: Here the fingers are used for moulding the part by alternate compression and release in a circular manner, mainly performed for the soft tissues such as muscles. Occasionally thumb kneading may also be applied for irregular areas such as eyebrows. It increases blood circulation to the tissues.
Hacking: It is performed by the ulnar borders of ring and little fingers with alternate pronation and supination of the relaxed hand and the wrist slightly in extension. It produces a sensory stimulation to the tissues treated as in muscle re-education.
Rolling: Here both the hands are moved gently with constant pressure generally on the lower back. Lifting and releasing of the part occurs which helps in stretching of soft tissue adhesions and skin, apart from release of tension and improvement of blood supply.
Friction: These are similar to kneading but are applied to the joints. These are done with the finger tips and thumb and range from superficial to deep frictions. Friction may be performed in circular manner with considerable pressure on the fingers and thumb.
ALTERNATIVE HEALING TECHNIQUES
There are several alternative healing techniques that are practiced by some people like Pranic healing which utilizes the prana or life force to balance harmonize and transform the body’s energy processes.
Reiki: The word Reiki is made of two Japanese words - Rei which means
“God’s Wisdom or the Higher Power” and Ki which is “life force energy”.
Reiki is “spiritually guided life force energy.”
It is a technique for stress reduction and relaxation that also promotes healing, and is based on the idea that an unseen “life force energy” flows through us and is what causes us to be alive. Improving this energy is how Reiki is claimed to treat the whole person with beneficial effects like relaxation and feelings of peace, happiness and wellbeing.
Vipasana: Is a meditative technique of Lord Gautama Buddha, which requires the practitioner to be aware of his or her breathing. Though not propagated as a therapeutic technique, but as an inward journey for spiritual upliftment, vipasana is said to have long reaching benefits to health.
INTRODUCTION
India is a sovereign socialist democratic republic with a federal structure and an estimated population of over 100 crores. It is enshrined in the Constitution of India that there shall be equal opportunity for citizens of India, and protection of their rights. The persons with disability constitute a large percentage of our population, and it has been felt obligatory to include certain articles to provide for their rights to be enforced as law.
LEGISLATION AS A MEANS OF ACQUIRING EMPLOYMENT FOR PERSONS WITH DISABILITY (PWD)
• The government supports in principle the employment of the PWD.
• It introduces employers to the idea of employing PWD.
• The government recognizes the need for reservation for the persons with disability for specified occupations or posts.
However, there are some points raised against legislation, that person with disability placed in this way might be less efficient than other workers or that he might feel that undue attention was being focused on him, and that the jobs are being “doled out”, and not given on merit.
Areas of Concern
There have been problems in the implementation of this legislation. This can be overcome by enforcing a simple practical definition of a person with disability, with a system for disability evaluation. The Government must have effective machinery for the registration of persons with disability, a specialized employment service to assist employers and a system of enforcement.
Who is Handicapped?
According to the Oxford English Dictionary a handicapped is ‘a person placed at disadvantage.’
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