About Physiotherapy

HISTORY OF PHYSIOTHERAPY

Physiotherapy is dedicated to the restoration of the human function which has been impaired due to disease, trauma or injury. It is practiced in India since the last fifty years. It plays a big role in preventive aspects and pain management.


Physiotherapy dates back to 250 AD, when gold fish-electric fish was used for pain relief in gout and headache cases. Physiotherapists today use certain type of currents to give pain relief.

In prehistoric era, buddhists and hindus recognised "pain as a sensation" but gave greater importance to its emotional aspects. Non-invasive methods were used for pain relief. Today's physiotherapists also use non-invasive, electro-therapy modalities for pain relief.

Physiotherapy is "tending to the cure or providing relief from disease or injury." It involves rehabilitating the patient from "bed to job".

Be it acute or intensive care, respiratory and cardiac rehabilitation, pain management, Arthritis, headache, post-operative pain, heel pain, fitness, or sports injury, physiotherapy has a role to play in restoring the patient to normalcy or atleast a functional capacity.

PHYSIOTHERAPY TODAY


Physiotherapy today is an independent health care profession for all the age groups from neonatal to geriatrics. (from birth to old age.)

The task of early intervention in neonatal cases is taken over by a physiotherapist, new born babies with birth defects are evaluated and treated, which helps in minimizing disabilities and helps in early ambulation.

Women's wellness, maintaining healthy lifestyle after menopause needs attention.

Common problems are: obesity, Arthritis, incontinence of urine, fatigue, aches & pains in joints etc
Pain management in acute & chronic cases are managed by physiotherapists.

Sports physiotherapy is becoming popular amongst the young physios. In fact special post-graduate courses are conducted by the association, to promote this new emerging avenue of physiotherapy.

Industrial physiotherapy deals with ergonomics and safety measures. Guidance on work positions etc. is given by physiotherapists.

Manipulative Therapy is gaining momentum due to its instant relief in pain and increase in range of motion. Special training is required before practicing this technique.

All these have gained immense popularity for today's Physiotherapists.
 
PHYSIOTHERAPY TOMORROW AND FUTURE


There is scope for physiotherapy even in space, where there is a high possibility of gravity related injury.
Backpain, muscle strain and headache is common in space-craft. Micro-gravity induces calcium loss from bones. Assessment of the limbs or back are difficult in space.

The future of physiotherapy for the astronauts in space is promising. Physiotherapists can help "body positioning", and exercises for micro-gravity posture.

	Aims of Physiotherapy:
	1. To relieve pain and spasm. 2. To improve range of motion and mobility. 3. To prevent stiffness and contractures. 4. To teach ergonomics and self help care. 5. To prevent frequent falls in elderly persons. 6. To improve strength and co-ordination.

This article is taken from physiotherapytoday.com/. Credit to the original author.

Neurology - Internal Capsule and Nuclei

This is another great video uploaded by hyperhighs explaining about internal capsule and nuclei. Hope you enjoy studying.

Neurology - Basal Ganglia

A very very nice video on the web explaining clearly about basal ganglia. This video is more to physiology. Credit to the uploader, hyperhighs for such good video. Happy studying. 

The Sacrifice

Physiotherapist getting patient out of bed, 

strengthening their legs,

teaching them how to walk again, 

dance again,

run again,

live life again. 

They never always get the thanks that they deserve, 

they don't have parades for them, 

no TV shows about them... 

but they wake up the next day and are glad to do it all over again...

Manual Muscle Testing - Common Misconception

manual muscle testing is a manual technique used to determine the power and strength of muscles. many of the students and some professional practitioners describe this technique wrongly. this test is more to determine the power and strength of the muscles motion. for example, for elbow flexion, we determine the strength for elbow flexor, not the biceps strength. this is because the body movement is not succeeded by individual muscle but as a group. According to Hislop and Montgomery (2007) in their book entitled Muscle Testing, Techniques of Manual Examination, the techniques is actually based on test of motions rather than of individual muscle. the grades of the strength is represents the performance of all muscles as a group in that motion. the grading for manual muscle testing are as follows:

Score                                                    Description
5                                                           with maximal resistance by therapist/normal
4                                                           with minimal resistance by therapist/good
3                                                           against gravity, without extra resistance by therapist/fair
2                                                           with gravity minimised/poor
1                                                           only muscles contraction visible, no movement/trace
0                                                           no contraction/very week/zero

for more details about this technique, i have uploaded a good book as mentioned above. below is the link. suitable for students and professionals. Happy studying... =D
Manual Muscle Testing - Hotfile

Cold or Heat Therapy

 Hot pack

Cold pack

Last Friday (15th July 2011) was my last day of clinical practice at Hospital Sungai Buloh. There are much knowledge i had learn from the practice. Its give me a larger idea about being a physiotherapist. 

          Since I had been placed at the hospital, one thing that interests me is the issue of using ice or heat therapy to certain injury among patient. Patients always ask me whether to use ice or heat modalities for their case. Besides, they are also saying that they do not know which one to use at home and eventually, they use both without a correct guideline. 

This confusion is not only occurred in Hospital Sungai Buloh. When I was searching about the application of hot and cold therapy in the internet, many results show the confusion whether to use hot or cold. 

For quick guideline, I'll bring to you to this website for your reading:

Ice or Heat Therapy - Medicinenet.com

for summarization, this will be the simpler one. use cold treatment such as ice application for fresh injury like ankle sprain that usually characterized by occurrence of swelling and slightly increase in temperature (warmth)

use heat therapy such as hot pack for chronic pain such as back pain or OA knee.

There are two simpler methods on how to prepare the ice or heat applications at home. For ice application, a patient needs to wrap ices in a plastic bag. Then, cover the affected area with a handkerchief. Apply the ice bag and tie it with a cloth or another handkerchief so that the bag is compressed at the affected area. Next, elevate the affected area higher than heart level for circulation.

For heat therapy, a patient can buy hot pack from the pharmacies and just heat it up. Apply towel to the hot pack about 6 to 8 layers from the skin to prevent skin burn to affected area. Both these applications should be applied not more than 20 minutes for 1 session because the effectiveness of thermal treatment may reduce after 20 minutes. Besides, if you put ice application for more than 20 minutes, it may cause you frostbite.

Dermatome

A dermatome is an area of skin that is mainly supplied by a single spinal nerve. There are eight cervical nerves, twelve thoracic nerves, five lumbar nerves and five sacral nerves. Each of these nerves relays sensation (including pain) from a particular region of skin to the brain. Dermatomes are useful in neurology for finding the site of damage to the spine.

Below is the list of dermatomes key muscles:
C5 - clavicle
C6 - Thumb
T4 - level of nipples
T10 - level of umbilical
T12 - inguinal region
L2 - midthigh anteriorly
L4 - medial side of great toe

There are 2 standard ways to test the dermatome: by using sharp and blunt test using a pin and a light touch test using the cotton wool.

Joint Mobilization

Joint mobilization or joint mob is a manual technique to improve joint accessory motion and to reduce joint pain by using specific oscillatory or sustained stretch technique. Mobilization is a manual therapy intervention and is classified by five grades of motion, each of which describes the range of motion of the target joint during the procedure.

Grade 1 - Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension. Activates cutaneous mechanoreceptors.

Grade 2 - Similar effect as Grade I. By virtue of the large amplitude movement it will affect Type II mechanoreceptors to a greater extent.

Grade 3 - Similar to Grade II. Selectively activates more of the muscle and joint mechanoreceptors as it goes into resistance, and less of the cutaneous ones as the slack of the subcutaneous tissues is taken up.

Grade 4 - Similar to Grade III. With its more sustained movement at the end of range will activate the static, slow adapting, Type I mechanoreceptors, whose resting discharge rises in proportion to the degree of change in joint capsule tension.

Grade 5 - This is the same as joint manipulation. Use of the term Grade 5 is only valid if the joint is positioned near to its end range of motion during joint manipulation.

Knee joint mob

 Shoulder joint mob

I have uploaded videos of joint mobilization for each joint. Below is the link. So, happy studying...! =D

Hotfile - Joint Mobilization

Myotome

Myotome is a group of muscles innervated from a single spinal segment. The term myotome is also used to describe the muscles served by a single nerve root. It is the motor equivalent of a dermatome. Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal nerve. The muscle and its nerve make up a myotome.

Myotome testing can be an integral part of neurological examination as each nerve root coming from the spinal cord supplies a specific group of muscles. Testing of myotomes, in the form of isometric resisted muscle testing, provides the clinician with information about the level in the spine where a lesion may be present. During myotome testing, the clinician is looking for muscle weakness of a particular group of muscles. Results may indicate lesion to the spinal cord nerve root, or intervetebral disc herniation pressing on the spinal nerve roots.

Myotome distributions of the upper and lower extremity are as follows:

C3,4 and 5 supply the diaphragm (the large muscle between the chest and the belly that we use to breath).
C5 also supplies the shoulder muscles and the muscle that we use to bend our elbow .
C6 is for bending the wrist back.
C7 is for straightening the elbow.
C8 bends the fingers.
T1 spreads the fingers.
T1 –T12 supplies the chest wall & abdominal muscles.
L2 bends the hip.
L3 straightens the knee.
L4 pulls the foot up.
L5 wiggles the toes.
S1 pulls the foot down.
S3,4 and 5 supply the bladder. bowel and sex organs and the anal and other pelvic muscles.

*for further reading, you may go to this website:
           http://www.whiplash101.com/2009/11/myotomes-dermatomes-pain-help/

Clinical Practice - Transverse Myelitis

OK, today is my 3rd day of my clinical practice where I have learn how the physiotherapy department in hospital is managed. Besides, I can also see and learn how the physios are communicate and apply the hands on skill on the patient. I have been placed in Hospital Sungai Buloh and will be practising for 2 months and today is just my 3rd day. Hope I can learn more and more from this clinical practice. =)

For today, I have learn a disease call tranverse myelitis. A patient, female, 62 y/o come to the physio department with a weak right leg. She have been walking to the department by using the walking frame and accompanied by his daughter.

Transverse myelitis is a condition where the spinal cord especially the myelin sheath undergo inflammation. The causes is categorised as idiopathic which mean unknown and it can be related to the multiple sclerosis.

So, after she and I having some chats about the disease and collecting her personal details, i have done some objective assessment on her. Below are the list of a few assessments I have done on her::

1. sensation test using pin prick test.
2. Joint senses
3. coordination test, heel shin test.
4. functional test, rolling on bed, getting up from lyin, standing

The treatment I have done is just a few, some of them are,
Gait training
going up stair
standing up
dynamic and static balance

I hope, I can learn more about the disease and can manage well on this patient in the future. =)

*for more information about the transverse myelitis, below is the link for the website:

http://www.myelitis.org/tm.htm

Things To Do Before Exercise - Stretching

Below is the link for the complete guideline of stretching. Hope we all can use this guideline to have a better and proper technique of stretching and hope that any injury occurence can be minimised. Happy reading!! =D

http://hotfile.com/dl/118438387/a50df6a/Stretching.pdf.html

Things To Do Before Exercise - Warming Up

There has been some controversy in recent years about stretching before warm up. If you gonna stretch, will you injured if you stretch without specifically warming up first? NO...if you stretch comfortably and strenously. However I suggest that you do several minutes of general movement like walking, swinging arm to warm the muscles and related soft tissue before you stretch. This will get the blood moving.

Some runners have reported they are more likely to get injured if they dont warm up before stretching. It is possible to get hurt stretching if:
1) too much of a hurry, not relaxed
2) push too far, too soon, overstretching
3) not paying attention to the stretching

Here's my advice, if you are engaging in an activity such as running or cycling, warm up by doing the activity you are about to do, but at lower intensity. Example, if you are about to run, walk or jog for 2 to 5 minutes until become slightly sweat. This will increase muscle and blood temperature. Then stretch.

So, lastly from me, have a good health with a proper technique of exercise preparation so that injury can be prevented. Good luck!! =D

Joints

Now, we are going to next component in our body, that is the joints. You can learn more about joints from the link below.
Happy studying!!! =D

*credit to Gerard J. Tortora and colleague, Principles of Anatomy and Physiology

http://hotfile.com/dl/118412708/356ea3f/09_-_Joints.ppt.html

Anatomy or Body Structure - Bones

Next component that important for a physiotherapist to know is the skeletal system. Below are the links that describe more detail about skeletal system. Happy studying!! =)


 *credit to Gerard J. Tortora and colleague, Principles of Anatomy and Physiology.

http://hotfile.com/dl/118106148/1c96247/07_-_The_Skeletal_System_-_The_Axial_Skeleton.ppt.html

http://hotfile.com/dl/118107211/c6eaae5/08_-_The_Skeletal_System_-_The_Appendicular_Skeleton.ppt.html

Parkinson's Disease

Do you know who is this? Yeah, you're right!! =) The one and only man in this world who can beat George Foreman in knock out, Muhammad Ali. Great boxer, a great man, a great father who have also a great daughter, Laila Ali.
But, a great and strong man like him can't even escape from the power of nature, that is having disease that he is now many people know as Parkinson's Disease. Some have said that the disease is came from the blow by George Foreman. Maybe true because that kind of blows physically to Ali is like defending from being hit by a truck. If you didnt watch the match yet, just search in Youtube. What a great match to watch.

Alright, now, what we are discussing here is about the Parkinson's disease, how does it happen, the symptoms and how to overcome them.

Parkinson's disease is a chronic degenerative disease of the central nervous system that produce movement disorder and changes in mood and cognition. The movement disorder in this disease as you can see how Ali is walking, shaked hand, slow movement, gait pattern abnormalities and shuffling gait.

The disease occur is because there is a deplete production of dopamine in the brain. Dopamine reduces the influence of the indirect pathway while increasing the actions of the direct pathway within the basal ganglia. Reduced number of dopamine will lead to the symptom described above, loses the ability to execute smooth, controlled movements.
If you want to know more about basal ganglia, you can watch this video
     http://www.youtube.com/watch?v=J3po7dUCCoE

how the dopamine can be depleted? It is because of aging process, environmental factor and genetic factor. And in Muhammad Ali case?? I think it is because aging process. PLUS, damage done during his boxing career to the brain. =D (I guest)

So, how to treat patient with Parkinson disease physically?

}Gait re-education

}Improve balance and flexibility

}Facilitate initiation of movement

}Improve or maintain general(cardiovascular) fitness

}Increase functional independence

}Ensuring safety within at home

}To prevent muscle contracture

 

 Below is the link for a powerpoint presentation describing more on detail about Parkinson's disease treatment in physiotherapy

http://www.mediafire.com/?83icwl730b02050

Anatomy or Body Structure - Muscles

The human muscles are the component that a physiotherapy must know and master. The origin and insertion for each muscle, nerve that supply the muscle and how does it work. For example, the biceps is to bend the elbow joint. 

1 Community, 1 Medical Team

sounds like 1Malaysia right? haha

The medical team is responsible to provide quality home care services in private homes and senior communities. The team is comprised of doctor, physiotherapist, nurses, occupational therapist and medical social workers.

Interesting to know that in other country, such as Australia, they have one medical team in one street. Just compare to our country, we still far behind to reach that situation. 

Malaysian people view on physiotherapist

OK, let us ask our parent about physiotherapist. Do they know actually about it? If u decide to further study in this course, especially for SPM and Matriculation student, do our parent agree with our decision? And of course, they will come with a lot of question, how about the study, how about the job chances and so on.

When I was finishing my matriculation year, I was choosed to study in physiotherapy, my parent said 'OK'. Then, when I went to the hospital for medical checkup, the counterman asked me. What course do you study further? I said, physio. Then he said, ohh, the person that give massage arr?? That is the counterman in HOSPITAL !!!

Quite surprising that many people dont know the real job for this field, eventhough the person who work in the hospital.
Yeah, of course, one of the job of physio is giving massage or soft tissue manipulation, but there are a lot more. Here are some of the job that covered by a physiotherapist:
Neurological disease patient such as stroke, parkinson's disease or cerebral palsy
musculoskeletal injury such as motor vehicle accident, sports injury or daily routine injury
cardiorespiratory complications such as asthmatic patient, lung complication and bedridden patient.




So, these are some of the job that done and covered by physiotherapist. I hope, with this writing, it can give a brief idea about what the physiotherapy is about especially to student who wanted to further their study in this field.

Official Malaysian Physiotherapy Association (MPA) Website

You can access to the website with the link http://www.mpa.net.my/main.php

This website is suitable to those who are interested to further their study in this field, especially to SPM 'fresher'. This course may be consider new in our country and in ongoing to 'grow' further. So, let's check it out!