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Cerebral Palsy
09Mar

CEREBRAL PALSY

Author dynafisio Categories foot pain

Cerebral Palsy (CP) is a disorder of movement and posture that appears during infancy or early childhood resulting from damage to the brain. The damage to the brain is permanent and cannot be cured but the earlier we start with intervention the more improvement can be made.Any non-progressive central nervous system (CNS) injury occurring during the first 2 (some say 5) years of life is considered to be CP. There are several definitions of Cerebral Palsy within the literature, although these may all vary slightly in the way they are worded they are all similar and can be summarised to:

Cerebral Palsy is a group of permanent, but not unchanging, disorders of movement and/or posture and of motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain

The type of cerebral palsy has also changed:

  • In the 60’s Athetoid / Dyskinetic Cerebral Palsy accounted for approximately 20% of children with Cerebral Palsy.
  • Today only 5 to 10% have this type, with Spastic Cerebral Palsy now accounting for 80-90% of children with Cerebral Palsy.
  • This decrease is mainly due to advances in the treatment of hyperbilirubinemia (Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there’s a risk of bilirubin passing into the brain ie. acute bilirubin encephalopathy. Prompt treatment may prevent significant lasting damage)[2].
  • The increase of Spastic Cerebral Palsy is predominantly a result of higher survival rates for (very small premature) babies.
  • The most common cause of Cerebral Palsy is idiopathic which means that the cause of damage to the brain during pregnancy is not known.

Risk Factors

There are different risk factors for each stage at which a child might develop Cerebral Palsy. These can be broken down into Prenatal, Perinatal and Postnatal.

Prenatal

  • Prematurity (Gestational age less than 36 weeks)
  • Low Birth Weight (less than 2500 g), which could be due to poor nutritional status of the mother
  • Maternal epilepsy
  • Hyperthyroidism
    Infections (TORCH = Toxoplasmosis, Other (Syphilis, Varicella-Zoster, Parvovirus B19,) Rubella, Cytomegalovirus (CMV), Herpes Simplex Virus)
  • Severe Toxemia, Eclampsia
  • Drug Abuse
  • Trauma
  • Multiple Pregnancies
  • Placental Insufficiency

Perinatal

  • Premature Rupture of Membranes
  • Prolonged and Difficult Labour
  • Vaginal Bleeding at the time of admission for labour
  • Bradycardia

Postnatal (0-2 years)

  • Central Nervous System infection (encephalitis,meningitis)
  • Hypoxia
  • Seizures
  • Coagulopathies
  • Neonatal Hyperbilirubinemia
  • Head Trauma

Anatomical classification are as follows:

  • Unilateral: One side of the body is affected
  • Bilateral: Both sides of the body are affected

Spastic Cerebral Palsy: are used to distinguish between quadriplegia, diplegia and hemiplegia. Spastic Cerebral Palsy is either bilateral or unilateral.

Dyskinetic Cerebral Palsy and Ataxic Cerebral Palsy: always involve the whole body (bilateral).

PHYSIOTHERAPY APPROACH

Neurodevelopmental Treatment (NDT)

One of the more popular approaches utilised in the management of cerebral palsy, the NDT Approach also know as Bobath Approach

Passive Stretching

It is a manual application for spastic muscles to relieve soft tissue tightness. Manual stretching may increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity. [5]  Stretch may be applied in a number of ways during neurological rehabilitation to achieve different effects. The types of stretching used include;

  1. Fast / Quick
  2. Prolonged
  3. Maintained

Splinting

Static Weight-bearing Exercises

Stimulation of antigravity muscle strength, prevention of hip dislocation, reduction in spasticity and improvements in bone mineral density, self-confidence and motor function have all been achieved through the use of Static Weight-Bearing exercises such as Tilt-Table and Standing Frame.

Muscle Strengthening Exercises

AT our Physiotherapy centre in Gurgaon we have got the best team of physios who are specialised in advance techniques.

For more info contact our best team of physiotherapists on www.dynafisio.com or call us at 8929294515

 

Trigger Finger- Treatment
05Mar

Trigger Finger- Treatment at Dynafisio(Physiotherapy and rehabilitation centre) sector 89, DLF Phase 4 Gurgaon

Author dynafisio Categories finger or thumb pain

Trigger finger is a painful condition that makes your fingers or thumb catch or lock when you bend them. It can affect any finger or more than one finger at a time. You can also have it in both hands. You might hear it called stenosing tenosynovitis. When it affects your thumb, it’s called trigger thumb.

Trigger Finger Symptoms

You might notice:

  • A painful clicking or snapping when you bend or straighten your finger. It’s worse when your finger’s been still, and it gets better as you move it.
  • Stiffness in your finger, especially in the morning
  • Soreness or a bump at the base of the finger or thumb. Your doctor will call this a nodule.
  • A popping or clicking as you move your finger
  • A locked finger that you can’t straighten

Symptoms often start mild and get worse over time. It’s more likely to happen after a period of heavy hand use than after an injury. It’s often worse:

  • In the morning
  • When you grasp something firmly
  • When you try to straighten your finger

Causes of Trigger Finger

Most of the time, it comes from a repeated movement or forceful use of your finger or thumb. It can also happen when tendons — tough bands of tissue that connect muscles and bones in your finger or thumb — get inflamed. 

Trigger Finger Diagnosis

There are no X-rays or lab tests to diagnose trigger finger. Your doctor will do a physical exam of your hand and fingers, and they’ll ask about your symptoms.

Physical Therapy Management

Patient Education

Since trigger finger is observed as an overuse injury, education is very important. Education should be given on:

  • Rest
  • Modifications of activities[14]
  • Specialized tools
  • Splinting
  • Modalities
  • Posture

Splinting

Exercises

AT our Physiotherapy centre in Gurgaon we have got the best team of physios who are specialised in advance techniques.

For more info contact our best team of physiotherapists on www.dynafisio.com or call us at 8929294515

Trapezius Myalgia
04Mar

Trapezius Myalgia

Author dynafisio Categories Neck Pain Gurgaon

Myalgia is generally known as a muscle ache or muscle pain.

Trapezius myalgia (TM) is the complaint of pain, stiffness, and tightness of the upper trapezius muscle. It is characterised by acute or persistent neck-shoulder pain.

Aetiology

Monotonous jobs with highly repetitive work, forceful exertions, high level of static contractions, prolonged static loads, constrained work postures or a combination of these factors are possible causes of neck and shoulder disorders (which include TM) in the working population.

As recent research suggests with most musculoskeletal conditions there is a strong relationship between psychosocial factors and the occurrence of TM

Clinical Presentation

  • Sudden onset of pain
  • Muscle stiffness and spasms
  • Tightness of the neck-shoulder complex
  • Heaviness of the head and occipital headache
  • Tenderness of the upper trapezius area

Other symptoms:

  • Low mood
  • Anxiety
  • Paresthesia

Medical Management

  • Analgesia
  • Ergonomic advice
  • Referral to physiotherapy
  • Injection therapy
  • Radiofrequency denervation

Physical Therapy Management

Raising awareness for at risk groups of people:

  • Repetitive movement jobs
  • Sedentary jobs (computer work)
  • High work demands
  • Work posture
  • Vibration
  • Stress
  • Low activity level outside of work
  • Gender (women)

Exercise Therapy

Different forms of exercise is recommended for acute or persistent neck pain

Physical activity and exercise have been proven to give the most immediate and long-term pain relief in patients with TM]. Both general fitness training and specific strength training generate significant effects on decreasing pain. However; strength training has been proven to be more effective compared to general fitness training.

High-intensity strength training relying on principles of progressive overload for 20 minutes has been shown to be successful in reductions of neck and shoulder pain.

Following a specific neck strengthening exercise program for up to 1 year can lead to long term reduction and further prevention of recurring pain even after the strength program has ceased.

  1. Shoulder shrugs:
    The subject is standing erect and holding the dumbbells to the side, then elevates the shoulders while focusing on contracting the upper trapezius muscle.
  2. One-arm row:
    The subject bends their torso forward to approximately 30° from horizontal with one knee on the bench and the other foot on the floor. The subject now pulls the dumbbell towards the ipsilateral lower rib, while the contralateral arm is maintained extended and supports the body on the bench.
  3. Upright row:
    The subject is standing erect and holding the dumbbells while the arms are hanging relaxed in front of the body. The dumbbells are lifted towards the chest in a vertical line close to the body while flexing the elbows and abducting the shoulder. The elbows are pointing out- and upwards.
  4. Reverse flies:
    The subject is prone on a bench at a 45° angle from horizontal and the arms pointing towards the floor. The dumbbells are raised until the upper arm is horizontal, while the elbows are in a static slightly flexed position (~5°) during the entire range of motion.
  5. Lateral raise:
    The subject is standing erect and holding the dumbbells by their side, and then abducts the shoulder joint until the upper arm is horizontal. The elbows are in a static slightly flexed position (5°) during the entire range of motion.

Manual Therapy

Ischaemic compression, stretching of the upper trapezius muscle, and transverse friction massage are manual techniques to help patients with TM. These techniques appear to have instant improvement on pain. 

cupping

kinesotaping

dry neeedling

MFR techniques

AT our Physiotherapy centre in Gurgaon we have got the best team of physios who are specialised in advance techniques.

For more info contact our best team of physiotherapists on www.dynafisio.com or call us at 8929294515

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