demonstration class taken on 19/11/07

dr. ashish gohiya assistant professor department of orthopaedics gandhi medical college bhopal d

*the responsibility of the doctor does not end when the “temperature touches normal and stitches are removed” *the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability. *medical rehabilitation *vocational rehabilitation *social rehabilitation *psychological rehabilitation


*(who (1969) techn. rep. ser. , no. 419)


physical medicine and rehabilitation *it’s not after care, it is a part of care. *it includes
*assessment of the patient *planning the intervention *implementing the treatment *evaluation


*altering the treatment if required.

*physiotherapy during immobilization *physiotherapy after removal of immobilization. *to reduce edema – limb elevation, static contraction of the muscles reduce adhesions. *maintenance of circulation *maintain muscle function *maintain joint range *maintain optimal function


during immobilization

*to reduce swelling *to regain full range of movement – pain, edema, adhesion, muscle weakness. *to regain full muscle power *to re educate full function *passive movement *assisted active movement *free active movement *resisted movement

after removal of immobilization

movement technique

*indicated when patient can not perform the movements on his own
*muscle paralysis / weakness *patient not conscious *range of joint movement *muscle length

passive movement

*passive movements regain

*starting position *grasp *position of therapist *traction *movement *indicated when

passive movement

assisted active movement

*muscles are weak *free movement is painful

*patient is encouraged to do most of the movement with the physiotherapist assisting when necessary. *suspension slings may be used for assistance *movements performed by the patients without external assistance or resistance. *indicated to
*increase the range of joint movement *increase the muscle strength *retrain balance and coordination *regain independence

active movement


range of movement


*protective mechanism - may be a contraindication to active exercise. *medical treatment , electrical , thermal t/t. *limb elevation *static contraction of muscles *free exercise of other joints *stretches the adhesions *improve the blood supply


to strengthen the muscles

*technique will depend on the grade of the muscle.
*grade 0, 1 *grade 2 (gravity counterbalanced ) *grade 3 (against the gravity ) *grade 4 (against mild resistance ) *grade 5 (normal power)

*increasing the no. of times the movement is made. *gradually increasing the resistance. *this is problem with muscle weakness and neurological deficit. *started with forearm supported prone lying, progressing to prone kneeling, half kneeling, sitting and standing. *in coordination due to muscle weakness improves on improving the muscle power. *to facilitate activity and strengthen muscles. *resistance to the movement can be given by
*physiotherapist *patient himself *mechanical resistance

retrain balance & coordination

resisted exercises

*weights *springs *electronic operated machines.

*this modality includes use of various methods of heating or cooling the tissues. *heating the tissues
*paraffin wax *ir radiation *heat pads *hot moist packs *short wave diathermy *ice therapy


*cooling the tissues

paraffin wax

*low melting point 40 oc – 44 oc *heats slowly but retains heat for long *wax solidifies on the skin - energy released by the latent heat of fusion results in - heating of tissues. *only for distal part of extremities

*radiation are absorbed – radiant heat is converted to heat. *two type of generators *rays should strike the part at 90o
*luminous – penetrates epidermis and dermis *non luminous – penetrates only sup. epiderm

infra-red radiation


infra-red radiation

*vasodilatation in tissues *improves nutrition *removes waste products *sedative effect on sensory nerve endings *relaxes muscles

*plastic covered pads *pad has three level of heating *used for treating neck & back *pt. lies on it, heat passes by conduction *canvas bags filled with hydrophillic substance *part covered by towels packs applied and moulded to part heat passes by conduction *moist heat is conducted more uniformly than dry heat.

heat pads

hot moist packs

*application to tissues an electric field which oscillates at a frequency of 27.12mhz& have a wave length of 11.06 m. *the oscillating field produces distortion of molecules which generates heat. *the amount of heat depends on the arrangement of field and electrical impedance of tissues
*can be used to treat both superficial and deep lesions *rapid and greater rise in temperature than conductive methods. *swd can be pulsed, during resting period the heat is dispersed in to tissues through circulation and the treatment is non thermal

short wave diathermy (swd)

*when ice applied to skin it melts and removes the heat from the tissues (the latent heat of fusion) *application of cold leads to alternate vasoconstriction and vasodilation, reduced nerve conductivity and reduction of muscle spasm and spasticity. *used

ice therapy

ice therapy

*to relieve pain *reduce muscle spasm *reduce swelling *reduce spasticity *facilitate muscle contraction *increase muscle endurance *reduce hematoma formation *prevent pressure sore *promote healing of wounds

*production of longitudinal mechanical waves above the


audible range (20khz) *produced by distortion of quartz crystal by a high frequency alternating currents. *longitudinal sound waves cause to-and-fro movement of particles giving alternate areas of compression and rarefaction.

*treatment head is applied perpendicular to the surface. *head continuously moved to prevent concentration to one tissue site. *higher the frequency greater the absorption and smaller the depth of penetration. *lower frequency deeper penetration




*release of chemical mediators *proliferation of granulation tissue *stimulation of fibroblast *increased circulation *increased activity of phagocytes & macrophages *this results in healing and reduced pain.

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