Thursday, 22 December 2011

Community based falls prevention rehabilitation

Wednesday, 21 December 2011

Unusual 'GyroStim' Among New Treatment Options For Brain Injuries

Tuesday, 20 December 2011

Electric stimulation 'aids physio rehab' for stroke patients

Stroke can have life-long consequences, even for those who aren’t among the hardest hit, so any developments that may help stroke patients’ recovery can be a huge step forward. A new study from Oxford University has found that using tiny electric currents across particular areas of the brain improved hand movements in people recovering from stroke.
The study, published in the journal Brain, involved 13 patients who’d had a stroke at least six months before. The participants were men and women, aged from 30 to 80, who’d had different types of stroke. Oxford University researchers, led by Professor Heidi Johansen-Berg, with colleagues at the Oxford Centre for Enablement at the Nuffield Orthopaedic Centre set out to find out whether a brain stimulation technique designed to increase the activity in the motor cortex would improve hand movements in people who’d had a stroke.
When a stroke affects a patient’s movement, recovery seems to be linked to the amount of activity that can be restored in the original brain region governing movement – the primary motor cortex. The brain stimulation technique, called transcranial direct current stimulation (TDCS) works by assigning a small electrical current across part of the brain. This technique is surprisingly simple to carry out using pads applied to the head.
This is a relatively new technique that increases the ‘exciteability’ of neurons in the targeted region of the brain. It doesn’t cause pain, but recipients might feel a slight tingling or itchy sensation on their scalp. For the study patients carried out a simple task involving hand movement, in response to images on a screen. They did this three times, before, during and after brain stimulation using the electric current for 20 minutes.
The results showed that reaction times improved by five to 10%, while the current was switched on and afterwards. “The improvement was almost immediate. It really did work,” says researcher Dr Charlotte Stagg of the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) at Oxford University. “The approach seems to have an effect in a wide range of stroke patients. Those who had seen least recovery from their stroke seemed to show most improvement in this simple test.
“The improvements in movement and reaction times were significant. Patients certainly noticed them, but they were short-lived; the effects of a single treatment lasted for about an hour. However, we are very hopeful that daily brain stimulation would lead to longer-lasting improvements.”
This was a study in a small group. Much larger clinical studies are needed to show that brain stimulation has a lasting effect in producing clinical benefits for stroke patients. These include greater recovery of movement and the ability to carry out normal daily activities.
While there is still some way to go, this approach already has a number of points in its favour, as Dr Stagg points out. “The brain stimulation technique is relatively cheap, easy to use and it’s portable. You could imagine physiotherapists using it in their practice in the future.”
The Oxford team are now recruiting about 30 stroke patients for a new trial. This will study whether brain stimulation, as well as physiotherapy exercises, can lead to clear benefits after three months.
Stroke can cause severe and lasting damage, such as weakness or total loss of movement on one side of the body. Many stroke patients need a great deal of rehabilitation and physiotherapy to recover or simply regain some movement. So a new therapy, that could clearly aid recovery, would be welcomed with open arms.

source saga

Thursday, 24 November 2011

EQ-5D-5L

EQ-5D-5L is a standardised measure of health status and measuring change in Musculoskeletal Physiotherapy Outpatient Services using the EQ-5D-5L.

source CSP

Tuesday, 22 November 2011

Manipulating the brain - biopsychosocial management strategies

msk_6_-_butler.ppsx

source CSP

Factors influencing physiotherapists’ assessment of occupational psychosocial factors (blue flags) in individuals with low back pain

msk_6_-_gray.ppsx

source CSP

Increasing activity in people with long term conditions

neurology_2_-_trenell.ppsx

source CSP

Breathlessness Intervention

Breathlessness Intervention Service

Toe walking and torticollis

Toe Walking & Torticollis: Implications for Therapy

http://www.atotalapproach.com/docs/PT.pdf

source CSP

Explaining Pain - Patient information leaflet

explaining_pain_1_-_updated_lk-bc_2008-04-02.pdf

explaining_pain_2_ak.bc_.lk_.mt_2008_4_15.pdf

summary_of_persistant_pain_3.8.06.pdf

source csp

Monday, 21 November 2011

Insurance and Physiotherapy Practice

pd027_insuranceandphysiotherapy_sept11.pdf

source csp

Sunday, 20 November 2011

Physiotherapy in limb reconstruction

KCH Limb Reconstruction Trust

British Limb Reconstruction Society

Lindop Parkinson's Assessment Scale - for physiotherapists

The Lindop Parkinson's Assessment Scale (LPAS) is a validated, physiotherapy-specific, objective measure of functional mobility.
Physiotherapists can use the scale as a base-line measurement and also at intervals to determine whether problems have developed.
The scale can indicate where intervention should be targeted.

Lindop Parkinson's Assessment Scale (PDF, 60KB)

Guidelines for physiotherapists using Lindop Parkinson's Assessment Scale (Word, 34KB)

source parkinsonsUK

Sunday, 13 November 2011

Balance Disorders - BBC Podcast

Balance Disorders in the Case Notes:

http://www.bbc.co.uk/programmes/b00tgcsz

Benign Paroxysmal Positional Vertigo - References

References:
Pollak et al 2011. Beliefs and emotional reactions in patients with benign paroxysmal positional vertigo: a longitudinal study
http://www.ncbi.nlm.nih.gov/pubmed/21872359

Chang et al 2008. Balance improvements in patients with benign paroxysmal positional vertigo
http://www.ncbi.nlm.nih.gov/pubmed/18390977

Helminski et al 2008. Daily exercise does not prevent recurrence of BPPV
http://journals.lww.com/otology-neurotology/Abstract/2008/10000/Daily_Exercise_Does_Not_Prevent_Recurrence_of.18.aspx

Stambolieva & Angov 2006. Postural stability in patients with different durations of BPPV
http://www.ncbi.nlm.nih.gov/pubmed/16267685

Jeong et al 2009. Osteopenia and osteoporosis in idiopathic benign positional vertigo
http://www.neurology.org/content/72/12/1069.abstract

Hillier & Holohan 2011. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction
http://www.ncbi.nlm.nih.gov/pubmed/21328277

Clinical practice guideline: benign paroxysmal positional vertigo , Otolaryngol Head Neck Surg. 2008 Nov;139(5 Suppl 4):S47-81. http://www.ncbi.nlm.nih.gov/pubmed/18973840

source csp

Monday, 26 September 2011

Setting Realistic Goals

Patient with lesion at C6 level:

Propping in long sitting and moving weight forwards

Therapist's aim

To improve the ability to prop in long sitting.

Client's aim

To improve your ability to prop in long sitting.

Therapist's instructions

Position the patient in long sitting. Instruct the patient to transfer their weight from behind their hips to in front of their hips.

Client's instructions

Position yourself sitting with your legs straight out in front of you. Practice transferring your weight from behind your hips to in front of your hips.

Progressions and variations

Less advanced: 1. Decrease the excursion of movement. More advanced: 1. Increase the excursion of movement.

Precautions

1. Preserve tenodesis grasp.

Propping back and forth in long sitting

Therapist's aim

To improve the ability to prop in long sitting.

Client's aim

To improve your ability to prop in long sitting.

Therapist's instructions

Position the patient in long sitting. Instruct the patient to transfer their weight from in front of their hips to behind their hips, and then bring their weight forwards again.

Client's instructions

Position yourself sitting with your legs in front of you. Practice transferring your weight from in front of your hips to behind your hips then bringing your weight forwards again.

Progressions and variations

Less advanced: 1. Transfer weight between the hands. More advanced: 1. Perform functional tasks in this position.

Precautions

1. Preserve tenodesis grasp.

Sitting up via sidelying

Therapist's aim

To improve the ability to move from lying to sitting.

Client's aim

To improve your ability to move from lying to sitting.

Therapist's instructions

Position the patient in half sidelying on a plinth. Instruct the patient to `walk` on their elbows around the side of their body and use their top arm to pull up into long sitting.

Client's instructions

Position yourself lying on your side on a plinth. Practice `walking` on your elbows around the side of your body and use your top arm to pull up into sitting.

Progressions and variations

Less advanced: 1. Transfer body weight from one elbow to the other. 2. Place stools under the elbows and practice transferring body weight from one elbow to the other. 3. Place a high plinth beside the body and `walk` the elbows along the plinth. 4. Perform the task in reverse. More advanced: 1. Perform the task on a soft mattress.

Precautions

1. Maintain the integrity of the skin over elbows. Can use elbow pads for this purpose.

Sitting up via half-sidelying

Therapist's aim

To improve the ability to move from lying to sitting.

Client's aim

To improve your ability to move from lying to sitting.

Therapist's instructions

Position the patient in half sidelying on a plinth with their elbows aligned with their knees. Instruct the patient to use their top arm to pull up into long sitting.

Client's instructions

Position yourself lying halfway on your side. Practice using your top arm to pull up into long sitting.

Progressions and variations

Less advanced: 1. Place a stool under the propping elbow. 2. Position the propping elbow onto a higher plinth beside the patient. 3. Secure the hand that is being used to pull up. More advanced: 1. Position patient on a soft mattress.

Rolling over using elbow splints

Therapist's aim

To improve the ability to roll over in bed.

Client's aim

To improve your ability to roll over in bed.

Therapist's instructions

Position the patient in supine with elbow extension splints in situ and their two wrists connected together. Instruct the patient to roll over by rapidly moving their arms across their body.

Client's instructions

Position yourself lying on your back with splints on your elbows and your wrists connected together. Practice rolling over by rapidly moving your arms across your body.

Progressions and variations

Less advanced: 1. Place pillow behind back so patient is quarter off supine. 2. Flex hips and knees. 3. Cross ankles. More advanced: 1. Remove assistive devices. 2. Position patient on a soft mattress.

source physiotherapyexercises

Sunday, 18 September 2011

Assessment and Management BPPV

Dix Hallpike Test:

Epley Maneuver for posterior canal BPPV (vertical/torsional Nystagmus that fatigues):

For Horizontal Canal BPPV (direction changing horizontal positional Nystagmus):

Specific Test:

Maneuver:

For further information:

Dizziness and balance

Special Interest Groups - Vestibular Rehabilitation

Saturday, 16 July 2011

General Musculoskeletal Assessment Principles

Contents

1.0 Introduction
2.0 General Points on Questioning
3.0 What do our Patients come to see us
for?
4.0 Red Flags
5.0 The Present Condition (PC)
5.1 Type of Pain
5.2 Depth of Pain
5.3 Behaviour of Symptoms
5.4 24 Hour Pattern
5.5 Special Questions
5.6 Behaviour of Pain & Pain Mechanisms
6.0 History of Present Condition (HPC)
7.0 Yellow Flags
8.0 Previous Medical History (PMH)
9.0 Drug History (DH)
10. Social History (SH)
11. SIN Factor
12. Planning the Objective Examination
13. The Objective Examination
14. Observation
15. ROM (active/passive/resisted)
15.1 End feel
15.2 Capsular Patterns
16. Neurological Examination
17. Neurodynamic Examination
18. Muscle Length/Strength/Endurance
19. Palpation
20. Specific Testing
21. The Impression
22. Initial Treatment Plan
23. Bibliography
App 1 – Masqueraders
App2 – Theoretical Aggravating & Easing
Factors
App3 – Lower Limb Dermatomes

sourece 2.hud.ac.uk

Low Back Pain

The aims of back pain assessment are:¹

To recognise serious pathology.
To relieve pain.
To improve function.
To recognise and assess level of disability.
To identify barriers to recovery.
To prevent recurrence or persistence of symptoms.

Red flags from history

Red flags for possible serious spinal pathology from the history are:¹

Recent violent trauma (such as vehicle accident or fall from a height)
Minor trauma, or even just strenuous lifting, in people with osteoporosis
Age at onset less than 20 or over 50 years (new back pain)
History of:
- Cancer
- Drug abuse
- HIV
- Immunosuppression
- Prolonged use of corticosteroids
Constitutional symptoms, e.g. fever, chills, unexplained weight loss
Recent bacterial infection, e.g. urinary tract infection
Pain that is:
- Worse when supine
- Severe at night time
- Thoracic
- Constant and progressive
- Non-mechanical without relief from bed rest or postural modification
- Unchanged despite treatment for 2-4 weeks
- Accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis)
- Severe and leaves patients unable to walk or self-care
- Accompanied by saddle anaesthesia or recent onset of difficulty with bladder or bowels

source patient.co.uk

When Back Pain May Be a Medical Emergency

Patients who experience any of the following symptoms should seek medical attention as quickly as possible:

Progressive leg weakness and/or loss of bowel or bladder control
Unexplained weight loss accompanied by pain and neurological impairment
Acute, severe stomach pain along with low back pain such that the patient can not stand straight
Fever with increased pain which does not respond to common fever reducers

Progressive Leg Weakness, Loss of Bladder or Bowel Control

Patients who experience sudden bladder and/or bowel incontinence (dysfunction that causes retention of urine, inability to hold urine in, or loss of rectal control), or feel progressive weakness or numbness in the hips and legs should seek immediate medical attention. These symptoms are indicative of cauda equina syndrome, which is usually caused by a compressed nerve in the lower spine.
Typical symptoms include:

Severe or progressive weakness, numbness or altered sensation in the lower extremities - the legs and/or feet
Loss of sensation or altered sensation in the “saddle” area (the area where a body is positioned on a saddle: inner thighs/between the legs, buttocks, back of legs, sacral region)
Difficulty walking without stumbling because of pain or numbness or weakness in one or both legs

Left untreated, cauda equina syndrome can result in paralysis, or loss of sensation in areas below the lumbar spine if the nerve is permanently damaged.

Unexplained Weight Loss, Loss of Appetite, Pain and Neurological Problems

Adult patients who have weighed the same for months and for no apparent reason lose weight rapidly (e.g. more than 5 pounds a week for a couple of weeks) or lose their appetite for even favorite foods should consult with their doctor. Rapid, unexplained weight loss can indicate a serious medical condition, such as cancer. For example, a spinal tumor that is lodged in or around the spine would typically result in the following symptoms:

Pain in the neck or back, followed by neurological problems (such as weakness or numbness of the arms or legs or a change in normal bowel or bladder habits)
Back pain that does not diminish with rest, and pain that may be worse at night - even waking the patient during sleep - than during the day
Any of the above symptoms along with loss of appetite, unplanned weight loss, nausea, vomiting, or fever, chills or shakes

A CT scan and blood tests will most likely be ordered as preliminary steps to identify the cause of symptoms.

Severe, Continuous Abdominal and Lower Back Pain

More Back Pain Info
Back Pain Causes
Types of Back Pain
Back Surgery

Low back pain from a spine condition generally is localized in the back or extremities affected by nerves aligned with spine segments. Rarely does low back pain migrate to the abdomen. However, abdominal disorders can often extend to the low back and be experienced as acute back pain in the lower back.
Acute (meaning quick onset) lower back pain that does not follow an obvious trauma, or movement associated with the onset of pain, can be a symptom of an enlargement of the aorta (large artery) in the abdomen, called an abdominal aortic aneurysm. This condition becomes a serious medical emergency if the blood vessel ruptures or internal bleeding occurs.
The primary symptoms of an abdominal aortic aneurysm are unremitting sharp and crushing pain in the low back and abdomen, so severe that it can prevent someone from being able to stand up straight, leaving them literally doubled over in pain.

Unresponsive Fever Followed by Increased Pain

Fever (defined as a sustained temperature of more than 101° in adults) can indicate an infection. In the spine an infection can arise gradually if the immune system has been weakened, or it can occur following surgery. Although relatively rare, spinal infections can give rise to an epidural abscess (a pus-filled cavity in the epidural space) that can press on the nerve structures in the cervical spine (neck) or thoracic spine (upper back). This can impair gross motor skills, and result in paraplegia or quadriplegia.
Most infections can be treated successfully with antibiotics if brought to the attention of a physician.

Post-surgical or wound infections occur in about 1% of patients, and more frequently in diabetics or people in poor health. An infection may develop 1 to 2 weeks after the procedure, even as pain from the surgery is abating. The most common infection is a wound infection, which results in a fever of greater than 101 degrees, increased redness and pain around the incision, and a change in drainage from the wound, such as clear discharge becoming yellow and thick and the wound not closing.
A vertebral body infection (called vertebral osteomyelitis, or bone infection) spreads to the spine by veins carrying bacteria generated in other parts of the body. This kind of infection could arise after a urologic procedure such as a colonoscopy or a cystoscopy, a diagnostic test using a thin telescope to inspect the bladder, often prescribed when there is blood in the urine or before prostate surgery. Other conditions that make a vertebral body infection more likely are intravenous drug abuse, or long-term use of epidural steroids (e.g. to treat rheumatoid arthritis), because both of these activities increase the chances that bacteria will be introduced to the body.

source spine-health

Causes of Low Back Pain

Condition	Clinical clues
Nonspecific back pain (mechanical back pain, facet joint pain, osteoarthritis, muscle sprains, spasms)	No nerve root compromise, localized pain over lumbosacral are
Sciatica (herniated disc)	Back-related lower extremity symptoms and spasm in radicular pattern, positive straight leg raising test
Spine fracture (compression fracture)	History of trauma, osteoporosis, localized pain over spine
Spondylolysis	Affects young athletes (gymnastics, football, weight lifting); pain with spine extension; oblique radiographs show defect of pars interarticularis
Malignant disease (multiple myeloma), metastatic disease	Unexplained weight loss, fever, abnormal serum protein electrophoresis pattern, history of malignant disease
Connective tissue disease (systemic lupus erythematosus)	Fever, increased erythrocyte sedimentation rate, positive for antinuclear antibodies, scleroderma, rheumatoid arthritis
Infection (disc space, spinal tuberculosis)	Fever, parenteral drug abuse, history of tuberculosis or positive tuberculin test
Abdominal aortic aneurysm	Inability to find position of comfort, back pain not relieved by rest, pulsatile mass in abdomen
Cauda equina syndrome (spinal stenosis)	Urinary retention, bladder or bowel incontinence, saddle anesthesia, severe and progressive weakness of lower extremities
Hyperparathyroidism	Insidious, associated with hypercalcemia, renal stones, constipation
Ankylosing spondylitis (morning stiffness)	Mostly men in their early 20s, positive for HLA-B27 antigen, positive family history, increased erythrocyte sedimentation rate
Nephrolithiasis	Colicky flank pain radiating to groin, hematuria, inability to find position of comfort

Red Flags for Acute Low Back Pain

History
Cancer
Unexplained weight loss
Immunosuppression
Prolonged use of steroids
Intravenous drug use
Urinary tract infection
Pain that is increased or unrelieved by rest
Fever
Significant trauma related to age (e.g., fall from a height or motor vehicle accident in a young patient, minor fall or heavy lifting in a potentially osteoporotic or older patient or a person with possible osteoporosis)
Bladder or bowel incontinence
Urinary retention (with overflow incontinence)
Physical examination
Saddle anesthesia
Loss of anal sphincter tone
Major motor weakness in lower extremities
Fever
Vertebral tenderness
Limited spinal range of motion
Neurologic findings persisting beyond one month

source aafp

Tuesday, 21 June 2011

Risk assessment

source csp

Clinical governance

"Clinical governance is a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish." (Scally and Donaldson 1998, p.61)

Evidence Based Medicine in Practice

"Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values" Dave Sackett

source cebm

Wednesday, 15 June 2011

Bridging the Gap

Physiotherapy management of adults with complete spinal cord injury

TKR and THR - criteria for progression to a walking stick

The criteria for progression to a walking stick is Single leg stand (SLS) for 10 seconds. SLS is also the criteria to progress to stairclimbing in a reciprocal manner and use of treadmill and cross-trainer.

source icsp