Showing posts with label Rehabilitation. Show all posts
Showing posts with label Rehabilitation. Show all posts

Sunday, 29 January 2017

GBS Rehabilitation



Although many people recover from GBS disease, the duration of your illness is unpredictable, and could require months of hospital care and rehabilitation.
As nerve function returns, patient may require assistance to learn how to use affected muscles. Rehabilitation can include several types of therapy.
Physical rehabilitation. Physical therapy stimulates joints and muscles to rebuild strength, flexibility and flexibility.
Occupational therapy. Occupational therapy concentrates on activities to help patient be as self-sufficient as you possibly can in daily life.
Assistive devices. patient might need to learn to use assistive devices, for example leg or arm braces, canes, walkers and wheelchairs to assist mobility during recovery or, if GBS causes permanent disabilities, for long-term use.
Physiotherapy strategy to GBS disease will:
Regain patient's independence with everyday tasks.
Retrain normal movement patterns by teaching patient how you can achieve activities diversely.
Muscle strength training, exercising as frequently as possible in the correct way.
Stretch tight muscles and stop soft tissue contractures.
Improve patient's posture in lying, sitting and standing and sleeping.
Increase patient's mobility.
Increase balance and coordination.
Increase fitness and levels.
Increased capability to relax.
Promote recovery.
educate about GBS disease and symptoms.
The role of physiotherapy for GBS disease could be divided into three parts -
acute phase
the center phase of rehabilitation
long-term, on-going rehabilitation
The key factor is communication with this particular multi-disciplinary approach with the purpose of the team to help the flow from the treatment of the patient.

The Acute Phase

Within the acute phase most of physio is perfect for respiratory care. Whether it affects the intercostal muscle - the main one between the ribs that lifts in the ribs as we have a breath. Equally when the diaphragm is affected - negligence the body between the abdomen and also the chest - patient possess the inability to take a large breath. So in acute phase regular breathing workouts are necessary.

Phase of Rehabilitation

So then your first part of the rehabilitation phase begins. Whenever we start to get patients moving we must keep in mind the physiotherapy should be graduated. We realize the patients can fatigue quite quickly and thus we try to build up the strength very gradually, deliberately providing a bit more demand each time in exercising the respiratory muscles.
The career of the patient is essential. He/she needs to be nursed so that the lungs are kept clear - laterally and if need be to become "jacked up" with the head down so allowing any secretion within the lungs to be drained out.
Patient struggling with GBS disease often complain of severe pain, which may be managed by applying TENS, IFT along with other pain relieving techniques.
If muscles are saved in a shortened position of sufficient length then there is an increase in the stiffness from the muscle. So there must be "passive" movements, ie aided - with the full range at least once each day. If there is too much movement with weak muscles around some pot, the joint may become quite loose and hang up later some pain. Not enough movement and you get a stiff joint. You could have muscle stiffness after which joint stiffness. It can can become quite painful.
You will find available Resting Splints for wrist/hands as well as for ankles which can be essential in the early stages. Tight leg muscles can later on allow it to be more difficult for one to walk, particularly upstairs and downstairs as well as on a slight slope. You receive too tired.
The key feature at the next phase when patient gets up out of bed is that his/her circulation is very dependent on the muscles in your body.
There will be swelling within the ankles and hands if a person doesn't move around much. So a patient's blood pressure level is monitored at this time to check there is no sudden drop. Such patients wear elastic stockings to push the blood to the heart and also to prevent thrombus. If the blood sits within the legs there is more possibility of clotting.
Some patients with weak stomach muscles may need abdominal corsets. When the patient is getting in the whole effect of the items gravity has on the joints becomes important. The shoulder joint particularly depends on its muscles around it. He/she may require the arms supported in early stages of sitting upright and walking.
You should get good seating. If required one can make do having a cushion, towel or pillow to aid the lumbar spine. Prolonged sitting having a curved spine can result in small damage to the joints inside your upper spine, producing backache. It's similarly important to offer the middle and the surface of the spine as well as the arms.
Stretching the arms such as the hands, legs such as the feet, body (particularly by slumping), helps you to rehabilitate not only the peripheral muscles but additionally, we believe, the associated nerves. This will be significant for GBS and CIDP patients struggling with nerve damage. One must be careful not to overstretch.
Functional tasks of everyday living that involve exercise are usually beneficial. These tasks include walking, repeated sitting to standing, allowing this to continue and moving up and down during sex, putting on and removing clothes. These tasks assistance to restore the patient to normalcy living.

Ongoing Rehabilitation

Hydro treatments are fantastic as patient can float; so how much they weigh is supported as well as can exercise from the graded resistance from the water - the faster they move greater it is, the slower the greater gentle. It does not suit everyone - some discover the heat too much.
You should watch the posture as muscle weakness can impact it. IT is often the physio's role to nag and provide patient advice about posture.
The individual may need balance retraining because we all know the ankles are essential for balance. The individual may find the hips need to be moved to keep the balance.
As patient progress only then do we begin some learning advanced skills of walking down and up slopes and stairs.
Being an ongoing practice you should have regular exercises to help keep stretching muscles which may be at risk of tightening up - leg muscles, hamstrings, arm muscles.
Hydrotherapy, walking, stationary bikes or anything that could possibly get patient's heart rate up are essential for ensuring that your cardiovascular and general fitness have been in good condition.

Wednesday, 5 October 2016

REHABILITATION PROTOCOL OF ACL INJURY



REHABILITATION PROTOCOL AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
PHASE 1 : Week 0-2
Goals-
• Protect graft fixation.• Minimise results of immobilization.• Control inflammation.• No CPM.• Achieve full extention, 90 amount of knee flexion.• Educate patient about rehabilitation progress.
Brace-• Kept in extention for ambulation & sleeping
Weight bearing-• Standing and walking with 2 cruthes.• Discontinue crutches as tolerated after 7 days.
Therapeutic exercises for acl knee injury-• Heel slides / wall slides.• Quadriceps sets, hamstrings sets [electrical stimulation as needed].• Patellar mobilisation.• Non-weight bearing gastrocsoleus, hamstring streches.• Sitting assisted flexion hangs. • Prone leg hangs for extension.• Straight leg raises(SLR) all planes with braces entirely extension untill quadriceps strength will prevent extention lag.
Functional training-
Proprioception• Active / passive joint positioning.• Balancing activities.• Stable platform, eyes open.• Stable platform, eyes closed.• Seated ball throwing and catches.
PHASE 2 : Week 2-4
Goals-
• Restore normal gait
.• Restore full ROM.• Protect graft fixation.• Improve strength, endurence and proprioception to organize for functional activities.
Weight- bearing• Patellar tendon graft- continue ambulation with brace kept in extension.• Hamstring graft and allograft- may discontinue brace use when normal gait pattern and quadriceps control are achieved.
Therapeutic exercises acl knee injury-• Mini-sqats 0-30 degrees.• Stationary bike (start with low tension and seat).• Closed chaion extension (leg press 0-30 degrees).• Toe raises.• Continue hamstings streches, progress to standing and walking gastrosoleus streches.• Continue prone leg hangs with progressively heavier ankle weights untill full extension is achieved.
Functional training-
Aerobic conditioning-• Continue upper extremity ergometry.• Advance to two-leg bicycling.Plyometrics / eccentric muscle training-• Stair walking- up/down, forward/backward.Aquatherapy-• Pool walking.• Pool jogging (deep water running).Proprioception-• Balancing activities.• Unstable platform (Kinesthetic Ability Training or Biomechanical Ankle Platform Mother board) with eyes open/closed.• Mini-tramp standing.• Standing ball throwing and catching.
PHASE 3 : Week 6- month 4
Goals-
• Improve confidence within the knee. • Avoid overstreching graft fixation.• Protect the patellofemoral joint.• Progress strength, power and proprioception to organize for functional activities.
Therapeutic exercises acl knee injury- • Continue flexibility exercises as appropriate for patient.• Advance closed kinetic chain strengthening (one the squat,leg press 0-60 degrees).• Elliptical stepper, stair stepper.• Cross-country skiing machine.
Functional training- (6-12 weeks)
Aerobic Conditioning• Continue bicycling/ upper extremity ergometry.• Stair stepper/ elliptical stepper.• Pool walking/ jogging.• Cross-country skiing machine.Plyometrics• Stair jogging.• Box jumps 6-12inch heights.
Running• Figure of 8 pattern.• Straight ahead walking, progressing to running.• Large circles, walking and slow jogging.Proprioception• Mini-tramp bouncing.• Pogowall balancing.• Lateral slide board.• Ball throwin and increasing in popularity unstable surface.
PHASE 4 : Month 4
Goals-
• Go back to unrestricted activities.
Therapeutic exercises acl knee injury-• Continue and progress flexibility and strengthing programs.
Functional training-
Aerobic Conditioning• Continue bicycling/ upper extremity ergometry.• Stair stepper/ elliptical stepper.• Pool walking/ jogging.• Cross-country skiing machine.Running• Figure of 8 pattern.• Small circles and running.Agility• Start at slow speed, advance slowly.• Shuttle run.• Lateral slides.• Carioca cross-overs.• Cutting drills.Proprioception • Reaction drills.• Advanced sport-specific drills (full speed).Plyometrics• Advance heights
PHASE 5 : Go back to Sports
Goals-
• Safe returns to athletics.• Maintain strength,endurence and proprioception.• Patient education concerning any possible limitations.
Brace-• Functional brace might be recommended by physician for use during support for the 1-2 year after acl knee injury for psychological confidence.
Therapeutic exercises acl knee injury-• Gradual go back to sport participation.• Maintaince program for strength and endurence.• Agility and sport specific drills progressed.
Protection against ACL knee injury
Use proper techniques when playing sports or exercising. Several women's college sports programs have reduced ACL tears via a training program that teaches athletes how you can minimize the stress they put on their ACL.
Although the concern is controversial, the use of knee braces during aggressive athletic activity (for example football) has not been proven to decrease the incidence of knee injuries and could give the player an incorrect sense of security.