ADVANCED PHYSIOTHERAPY

A. MODALITIES & TECHNIQUES

1. Bio-Physics, Instrumentation, Physiological / Molecular effect, therapeutic

actions, penetrability selectivity in human tissues, dosimetry, indication,
contraindications,
Technique & Usage, recent views and controversies in
i) All modalities of heat and cold
ii) All modalities of therapeutic Electricity (HF, MF, LF)
iii) Other LASER.

B. NEWER EQUIPMENT

Principles and Theory, Biophysics, Technique and usage, Therapeutic results,

indications, contraindication and recent views on
i) Traction instrument
ii) Biofeed back
iii) Treadmills, Bicycle-ergometer
iv) Balance Training instrument, posturopraphy units.
v) CPM Unit
vi) CPM Unit.
vii) Maintenance and care of instruments, keeping records of equipment /
inventory management.
viii) Theory and Methodology, Physiological actions, adverse effects, indication,
contraindications, use and abuse, therapeutic actions and limitations, recent
knowledge and controversies in
ix) Traction
x) Isometric, Isotonic, Isokinetic, Eccentric exercises
xi) Massage, Manipulation
xii) Mobilisaiton
xiii) Active, Passive and resisted exercises
xiv) NDT, PNF, Neuromotor control / Retraining
xv) Stretch and spray
xvi) Gait, gait analysis
xvii) Co-ordination training and exercises
xviii) Dexterity exercises
xix) Design and organization of physiotherapy gym. Techniques usage of
equipment in gym, for exercise, Limits of endurance Identifying toward
effects of exercise. Exercise on mat, crutch exercise.
xx) Education patients / caregivers on exercise regimen. Designing home
programme exercises.

B. PHYSIOTHERAPY IN SPECIFIC CONDITIONS

a) Physiotherapy in Orthpaedic Conditions
 Application of modalities, use of appropriate techniques, arranging suitable sets /
combination of exercises, monitoring and evaluation in the following orthopaedics
conditions.

i) LBA, Neck / Neckarm pain, myalgia, myofascitis

ii) Vertebral curvature, disc diseases
iii) Osteoarthritis and other degenerative athropathies Rheumatic diseases and
inflammatory arthropatheis)
iv) Fracture, after care of fractures, Reflex dystrophy CRPS, Bone, Joint and
tendon surgery rehabilitation, Bone lengthening.
v) Gait training in amputation, stump exercise, bandaging
vi) Deformities, contracture, paralytic polio, limb deficiencies.

b) Physiotherapy in Neurologic conditions

Applications of modalties, use of appropriate techniques, arranging suitable sets /

combination of exercise, monitoring and evaluation in the following neurologic condition

i) LMN paralysis, entrapment neuropathy, isolated nerve palsy, cranial nerve

lesions, poliomyelitis, peripheral neuropathy including traumatic, infective,
parainfective neoplastic diseases.
ii) Primary muscle diseases
iii) Anterior horn cell diseases
iv) Spinal cord diseases, Cauda equine diseases.
v) CVA, (Stroke), TBM, Meningeal diseases, MS
vi) Diseases producing ataxia inco-ordination, dystonia, dyskinesia, tremor and
vertigo.

C) Physiotherapy in Cardio Respiratory Conditions

Awareness of cardiac and respiratory conditions that require physiotherapy

management, Cardiac and respiratory function test, surgical producers in the heart and
lung, including chest, trauma. Clinical signs of emergency, identification and prevention.
Physician’s liability, Physiotherapist’s liability, ethical and legal issues in cardio-
respiratory prentice of physiotherapy. Exercise testing and training, indications and
contraindications, goals of physiotherapy, Breathing exercises, postural drainage, use of
humidifiers, exercises to accessory respiratory muscles, aerobic exercise. Principles of
cardiac rehabilitation, precautions and contraindications to exercises. Exercises to
improve function, endurance and well being. Relaxation exercises, Yoga Risk factors in
Cardio respiratory conditions.

D) Physiotherapy in Paediatric conditions

Growth and development, developmental disorders, principles of evaluation of

infant and child, principles of paediatric Nursing, Intensive and critical care, care of
Instruments. Paediatric nutrition, Physiotherapy in critical care. Use of modalities in the
child, use of techniques and choice of exercise. Physiotherapy in musculoskeletal,
Neurologic and cardio respiratory conditions.

E) Sports Physiotherapy

Kinematics and kinetics of walking and running. overuse injuries, injuries in

contact and non-contact sports. Identification of injuries. Assessment of on-field trauma.
Detection of serious / life threatening injury indications for referral. First aid for sports
trauma. Early and subsequent management of soft tissue injury. Prevention of injuries.
The growing athlete, consent for treatment, principles of rehabilitation.

C) PRINCIPLES OF REHABILITATION

I. Concept of Rehabilitation
Definition, concepts of Disability & Handicap: ICIDH, community and
Institutional rehabilitation. Advantages and scope of rehabilitation: Social implications of
rehabilitation.

II. Law Related to Rehabilitation

Consumer Law Therapists’ liability, Compensation: law related to compensation:
persons with disabilities act, RCI Act, WHO Position on Health and healthcare.

III. Ergonomics
Work capacity analysis, pre-employment screening Industrial therapy.
Examination of postures. Job task analysis, Education for prevention of injury, Economic
stress management. Principles of work hardening.

IV. Outcome Measures

ADL assessment, PULSES Profile. Barthel Index. FIM, Assessment of
improvement. Glosgow, Coma scale, other objective evaluation scales, Types of
Disabilities.

V. Strategies for improving function

Prevention of deformities, marinating range / function static and dynamic
splinting, Mechanics of dynamic splints of the upper limb. Positioning in bed, Activities
of Daily living, Self care, Toilet transfers, Ambulation wheelchairs.

VI. Strategies for improving function.

Exercises for wheelchair ambulation, use of aids and appliances. Driving by the
disabled, ambulation using crutches, Environmental manipulation, Respiratory support
systems, technology in rehabilitation.

VII. Principles of Orthotic and Prosthetics

 Definition, Types of Orthoses and Prostheses. Training with appliances, care of
appliances, gait deviations.

VIII. Geriatric Rehabilitation

Principles of rehabilitation, geriatric amputee, musculoskeletal problems related
to ageing and their physiotherapy. Physiotherapy to control geriatric morbidity. Aerobic
exercises in the elderly. dementia: in coordination parkinsonism, Alzheimer’s diseases
and their physical therapy.

IX. Nutrition
Nutrition and energy metabolism, various corms nutrition, Diabetes, obesity, PCM
Anaemia control of obesity.

X. Burns management
Principles and goals of burns management, Burns unit, Early management of
Burns unit, Early management of Burns, complications, physiotherapy of burns
deformities.

XI. Rehabilitation of Special situations

Needs of differently abled children, setting goals of rehabilitation in cerebral

palsy, myopathy, TBI and congenital disorders. Genetic influences on disabilities,
Leprosy and Cancer rehabilitation. Improvement of intervention strategies and
physiotherapy in cancer rehabilitation. Sensory – Perceptual Dysfunction. Rehabilitation
and community. Models of community related rehabilitation.

XII. Introduction to Occupational therapy

Principles and objectives of Occupational therapy, Response of individual to
disability, Hand functions. Home making.

XIII. Architectural Barriers

Definitions and types of barriers, Barrier free environment. Principles of
management.

XIV. EMG & NCV

Motor unit Action potentials, instrumentation for EMG, Types of electrodes,
Physics relating to EMG – NCV.
- Normal and abnormal EMG
- NCV motor and sensory conduction, Latency
- EMG Biofeed back

XV. Emerging issues / Recent advances

Rehabilitation, gender and empowerment, HIV TB and related issues, Recent
advance in knowledge in different areas of rehabilitation.

D. Ethics and Practice

I. Ethics
Morals and Ethics, Ethical analysis of moral problems. Beliefs and orientation of
people and community towards health / healthcare.

Basis of Ethical practical in Physiotherapy, Relationship between professions and

professional groups, Physiotherapist – patients relationship. Types of consent, referrals,
over-utilisation and under-utilsation of physiotherapy services. Obligations and
Responsibilities to patient.
Rights of patients, Citizens charter for hospital services, fee for service,
confidentiality, information to patients.
Records, maintaining inventory, different types of records needed in
physiotherapy practices, planning and organizing a unit of physical therapy, Rationing of
time, manpower and money resources to consumers.
Quality of professional service, peer review, continuing education, research,
community work, social audit, other forms of quality assurance.
Need for outcome studies, Evidence based practice.

II. Practice

Hospital as an organization. Different services of a hospital, clinical and

supportive services, PMR department – community based practice, visits, principles /
strategies of community work.

List of Books recommended

1. Downie, Patricia A – cash’s text book of Orthopedics and Rheumatology for

Physiotherapist – Jaypee Publishers, Chennai.
2. Downies, Patricia A – Cash’s text book of Neurology for Physiotherapist – Jaypee
Publishers, Chennai.
3. Downies, Patricia A – Cash’s text book of Chest, Heart and Vascular Disorder for
Physiotherapist – Jaypee Publishers, Chennai.
4. Downies, Patricia A – Cash’s text book of Medical and surgical conditions for
Physiotherapist – Jaypee Publishers, Chennai.
5. Sunder. S. Lecture notes on Rehabilitation Medicine – Jaypee Publishers.
Chennai.
6. Joshi, Jayant; Kotwal Prakash. Essentials of Orthopedics and Applied
Physiotherapy – B.I. Churchill Lingstone. Pvt. Ltd., New Delhi.
7. Low, John, Reed Ann Electrotherapy Explained, Principles and Practice –
Butterworth – Heineman Ltd.,
8. Kishner, Cardyn: Colby, Lyn Allen. Therapeutic Exercise, Foundations and
Techniques – Jaypee Publishers
9. Clayton’s Electrotherapy – 12th En. – CBS publishers, HD
10. Kendall F.P., Kendall. E., Proronce P.G. Muscle testing and function. Williams
and Walkins.
11. De Doruaico. Geovanni, Wood Elizabeth. C., Beard’s Message W.B. Saunders,
London.
 12. Deusen, Can and Burnt. Assessment in Occupational therapy and Physical therapy
– W.B. Sunduts, London.
13. Kahn. Joseph, Principles and Practice of Electrotherapy, Churchill Lingstone.
14. Cyriax, James, Text book of Orthopedics Medicine (Vol.I & II) Bailieve, Tindall,
London.
15. Smidt, Gary L. Gait in Rehabilitation (1990) Churchill Livinstone, N.Y.
16. Natarjan, M. Mayilvahavan. M. Orthopedics and Traumatology, M.M.
Orthopedics Hospital, Madras.
17. Michaud, Thomas, C Foot Orthosis (1993) William and Wilkine, Mayland.
18. Holey, Therapeutic Massager (1998). Jaypee Publishers, Chennai.
19. McGravey III, Charles – Physical Therapy for the Cancer patient Churchill
Linstone M.Y.
20. Wolff, Stera L. – Electrotherapy – Churchill Livingstone.
21. Jackson Osa – Physical Therapy of the Geriatric patient. Churchill Lingstone. NY.
22. Adkians, Hagel, V., Spinal Cord Injury. Churchill, Livingstone N.Y.
23. Rothstein, Jules. M. – Measurement in Physical Therapy. Churchill Livingstone
N.Y.
24. Wilder, Elaine – Obstetric and Gynacologic Physical Therapy Churchill
Livingstone. N.Y.
25. Lehmann, Justas F – Therapeutic Heat and Cold, Williams & Williams
26. Goodarll J.C. Chamberlaine A.M. Eras C. – Rehabilitation of the Physically
Disabled Audit – Stanlay Thorns, Chettelam (1997)
27. Zubuga. M., Breggs, C., Carlile, J. Sports Physiotherapy Churcill Livingstone,
1990.
28. Gardiner, Dena. M. – Principles of Exercise Therapy, CBS Pubilsher – ND
29. Digregoria, Vincent R – Rehabilitation of the Bunrs patient – Churchill
Livingstone.
30. Goodgold Joseph. Rehabilitation Medicine – CV Mosly Co.
31. Nichols, PJR – Rehabilitation Medicine in Physical Disability Butterworth.

JOURNAL

1. Journals of Orthopaedic and Sports Physical Therapy – Williams & Wilkins,

Baltimore
2. Sports Medicine – Adis Internal, Auckland, NZ
3. Amercian Journal of Physical Medicine & rehabilitation – Lippincott, Williams
Wilkins Baltimore.
4. Archives of physical Medicine & Rehabilitation – WB Saunders Co. Philadelphia.

ELECTIVE – PHYSIOTHERAPY IN ORTHOPEDICS CONIDTIONS

Unit – I Musculoskeletal Conditions

Orthopedics Conditions requiring physiotherapy with emphasis on congenital

musculosketetal disorder / deficiencies, trauma-fractures / dislocation / soft tissue
injuries, inflammatory diseases, degenerative spine and bone diseases. Investigations, &
Tests, Evaluation & Bio-mechanics of injury.

Unit – II Other diseases producing musculoskeletal problems

Spinal injury, nerve injury, cancers, pathological fractures, Genetic / inherited

disorders (Eg. Achondroplasia, Mucopoly-saccharidosis, arthorogyposis)

Unit – III Pathomechnaics

Mechanics of static / non paralytic muscular skeletal deformities – static and

dynamic factors. Factors to be considered in surgical/conservative management.
Mechanics of hand and foot-functional aspects of motion, stability and equilibrium.

Unit – IV Other neuro / musculo / skeletal / problems

Common entrapment neuropathes periarthritis. contruacture, deformities,
including kyphosoliosis, chronic neck / Neck-arm pain, LBA, IVDP, radiculopathy,
Myalgia, myofascities, assessment and physiotherapy management.

Unit – V
Principles of evaluation, outcome measures, goals of treatment, types of
evaluation, bio-chemical / neuro developmental.

Unit – VI Orthotics
Principles of Orthotics, materials used in Orthotics, types and classification,
Shoes and shoe modifications. Effectiveness and limitations of orthoses.

Unit – VII Prosthetics

Principles of prosthetics: upper and lower limb prosthesis. Types of upper
extremity prosthesis, Mechanics and function. Types of Lower Extremity prosthesis,
mechanics and functions.

Unit – VIII Physiotherapy in surgical conditions

Immediate post operative period-goals of physiotherapy, Physiotherapy after
reduction of fracture / dislocation, ORIF / Total / Partial joint replacement. Bone
lengthening surgery, tendon transfers, antrodesis other bone and joint surgery their
physiotherapy management, Identifying and preventing complications, preventing
pressure sores / DVT.

Unit – IX Physiotherapy in Burns

Physiotherapy management in early phase, mobilization, sprinting & Positioning

management of late phase, management of contractures, tightness and deformities.

Unit – X Physiotherapy in medical musculoskeletal conditions

 Physiotherapy assessment and management of non-articular Rheumatism,
Overuse injuries and strains, postural problems, arthropathy / polyarthopathy, LBA IVDP,
neck pain, Osteoarthritis, Setting goals / Monitoring and evaluation.

UNIT – XI Physiotherapy in special situations

Physiotherapy in spinal cord injury, Chronic ulcer, Leprosy, Spine bifida, post
polio paralysis / syndrome, Guilaine Barre Syndrome, Care of patient in ICU,
Physiotherapy of unconscious patients. Physiotherapy assessment / evaluation /
management in cancer, setting goals supportive physiotherapy.

Unit – XII Amputations

Introduction to amputations, impacts of amputations on the patient, pre-

amputation management, problems following amputations and their physiotherapy
management, Management of immediate post operative fitting of prosthesis –
Advantages, Problems, limitations. Types of wheelchairs, training on wheelchairs.

Unit – XIII Massage, Mobilisation and traction

Detailed study of these techniques, indications, contraindications / limitations,

Application of these technique in appropriate situations with emphasis on neck and low
back diseases mobilization of peripheral joints, massage in non articular diseases.

Unit – XIV Modalities

Choice and correct use of modalities, assessment and evaluation.

Unit – XV Physiotherapy & Community

Relevance of community physiotherapy. Role of aerobics, visiting community,

planning physiotherapy in the community. Home programme, principles of rehabilitation,
rapport with other groups working in community.

LIST OF BOOKS

Physiotherapy in Orthopaedic Conditions

1. Natarajan M & Mayilvahanan N. Orthopedics & Traumatology – M.N. Ortho

Hospital, Madras
2. Rathstein, J.M. Measurement in Physical therapy Churchill Livingstone, New
York
3. Echternach, J.L. Pain Churchill Livingstone, New York
4. Hunt, M Gray Physical therapy of the foot and Ankle Churchill Livingston, New
York.
5. Banwell, B. & Gall V. Physical Therapy Management of Arthitis Churchill
Livingstone. New York.
6. Ecthenach, J.L. Physiotherapy of the Hip Churchill livingstone, New York.
7. Smidth G.L.Gait in Rehabilitation Churchill Livingstone –New York
8. Bloch, R.F & Basbaum. M.Management of Spinal cord Injuries – Williams &
wilkins, Balt; more
9. Hochschuler, S.H cotler HB Guyer Rd Rehabilitation of the spine CV Mosby –
Peladephia.
10. Nattox. K.L. Complications of Trauma Churchill Livingston – New York.
11. Donatelli.R. Wooden MJ. Orthopaedic physical Therapy, Churchill Livingstone,
New York.
12. Generd JA. Kleinfield SL Orthopaedic Testing
13. David C Lloyd Jill Rheumatological physiotherapy Harcourt Brace, Edinburgh
14. Bogduk.N. Twomey LT Cliical Anatomyof the Lumber Spine Churchill
Livingstone, New York.