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PHYSIOTHERAPY TREATMENT OF HEAD INJURY
The treatment may comprise of the following measures:
IMPROVES ALERTNESS OR AROUSAL THROUGH SENSORY STIMULATION:
The patient who is drowsy or confused need to be stimulated by makes them more alert and awake. The therapist should encourage the patient’s cooperation during the treatment. The main aim is to stimulate the reticular activating system by making the patient sit or even stand in the tilt table.
The therapist should provide tactile, visual, auditory and Proprioceptive stimulation to the patient that will send facilitatory signals to the brain and will enable the alert response to be provoked. Auditory stimulation can be given by speaking to the patient during the course of treatment. Visual stimulation is given by showing familiar faces, objects or movement in the visual field of the patient.
Proprioceptive stimulation by giving traction and approximation at joint structures is very helpful in stimulating the arousal response in the patient.
PREVENTION OF SPASTICITY:
As hyper tonicity generally sets in almost all head injury cases various measures need to be taken to keep them under control. Gentle passive movement, gradual rhythmic sustained stretch, prolonged icing for 20 minutes over the muscles, biofeedback, proper positioning are certain measures that needs to be employed for controlling spasticity.
MAXIMISE THE PATIENT’S FUNCTIONAL CAPACITY:
The main aim of this management is to improve the ROM, improve the control of voluntary movement, strengthening paretic muscles, improve the coordination, balance and teach various safety measures.
The treatment should be wide spread over the periods of time as the patient’s attention span and endurance is very less.
NEUROMUSCULAR TRAINING can be given through the development sequence by inhibiting abnormal movement pattern and by facilitating normal movement pattern.
The patient may give activities like bridging, prone on elbow, on all fours, side lying to sitting, sitting, kneeling, half kneeling, standing and walking.
PROPER DOCUMENTATION is necessary of the entire event through- out the day. Infact the routine of the patient should be maintained in the register and the patient need to be reminded of various activities especially if the patient has memory problems. The patient may be given register with photo and names of various health professional visiting him so that each day’s program can be entered. This will benefit both the patient and his acquaintance to know regarding the activities given to the patient.
USE OF VESTIBULAR BALL while training the patient for crawling, bridging, sitting, balance helps in building the Proprioceptive stimulation and teaches proper control to the patient.
Each task has various subtasks which need to be mastered by the patient so that he learns the actual activity using normal movement combination and performs it with precision. Like for training the patient to get up from bed, he may be taught to do asymmetrical push up with the trunk in partial rotation, then lower leg patterns are incorporated and finally the whole task of get up from sidelying is practiced.
REPETITION ACTIVITIES is key like any other neurological disorders. Ambulation training should always be done in upright position training the patient in each and every phase of the gait cycle. If the patient’s balance is poor then assistance may be used.
FUNCTIONAL ELECTRICAL STIMULATION has been shown more effective than kinetic joint training in certain types of cases. The upper extremity also appeared to use specific synergies for hand use in different positions. Clients often can opens hand in out stretched arm position but will be unable to perform the same action when the elbow is flexed. Some patient with minimal functional deficit in th upeer limb may be given some assistive devices or support for the hand so that they can perform some basic activity like eating, combing, writing, etc. this technique helps the shoulder and other proximal structures to produce appropriate movement sequences for hand use but does not facilitate hand function. The treatment however does provide whole task practice even though some basic component of the function is substituted by other means.
REVERSING TASKS in some patients helps in developing increased control by modifying a task or synergy as well as making the muscle work both eccentrically and concentrically. For instance lowering a glass of water on the table may help the patient in getting th glass close to the mouth by improving motor control of biceps during eccentric contraction.
Ringing in left ear from last four years triglyceride is 208 hdl ldl in range and total cholesterol is 173. Regular exercise from last 6 month jogging 3 km and exercise. Please I have faith in homeopathy.
I have a masturbation habit but now I want to quit it. Its more than 10 years and I am suffering from hair fall, premature ej and ed too. My semen quantity is less too please help.
I'm a student of class 12th. And there is too much dark circle in eye areas. Even if I take proper amount of sleep daily. What to do to reduce dark circle ?
I have allergy on my hand it happens after some time as reddish wil come out on my hands after that it will pain also.
Today I check my semen ,& the total 48 millions, 8.0 ph. It is normal or and I continue the ubi q plus tablets. This is wright.
Can we masturbate twice in a day? If now guide me the correct time about that. One more thing its take only 60 sec to realise out whn I masturbate I want to increase it how can I go through it?
Hi, i'm a smoker for the past 3 years, just started running from last week. I need to improve my stamina. I kind of exceed my limit while running, can such a fast heartbeat cause a stroke or something? Thank you.
I am suffering cold for last 2months I had taken medicine but it is not curing, can I get a solution to this problem.
I am suffering from dry cough for the lost 2 weeks and I have chest pain whenever I cough hard can you suggest what should be done.
He has hsv2, is it chronic disease or not, if it is chronic, how he can participate in sex without effecting to his partner and her pregnancy.
Sir I get pain in the middle of stomach (near belly- button. So pls guide me sir. I stated feeling this pain for last five days. Thanks.
Male Erectile Disorder (Impotence)
Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection.
This is also know as erectile dysfunction.
The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience ;while others report being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection,lose it when attempting penetration. Still other report that have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.
Male erectile disorder is frequently associated with anxiety, fear of failure, pressure of sexual performance, and decreased sexual excitement and pleasure. This can disrupt marital relationship and may be the cause of unconsummated marriage and infertility.
Aging:with advancing age,
-The orgasm is less intensive,
-The ejaculate is reduced
The interval between the two successive acts is increased.
Fear of failure,
Low self esteem
Traumatic initial experience
Negative feelings towards the partner
Use of tobacco/Alcohol
Venous leak or occlusion
Harmonal causes :
Estrogen excess Adrenal
pituitary of Hypothalamic disease
Neurogenic causes :
Autonomic neuropathy (in Diabetes)
Spinal cord disease
Drug related casuses :
Stamp Test :A long strip of postal stamps in wound around the base of the penis at night before going to bed. Next morning if the perforations of the strip are found to be torn off, impotence is supposed to be of psychological in origin.
Peno-brachial index : The ratio of penile systolic blood pressure to that of brachial systolic blood pressure is normally 0.6. If found to be low, impotence is vascular in origin .
Papaverine Injection Test : Papaverine is a vasoactive drug. Using a 26 gauge needle, 30 mg papaverine is injected at the mid-shift of Corpus cavernosum of the penis. He is isolated, asked to stoke the penis and expose to erotic literature. An erection will occur in 10 to 15 minutes. If the erection is short-lived or partial, then impotence is considered as vasculogenic. If the erection is full, then impotence is considered to be neurogenic or psychogenic. In origin.
Caution : This test should be performed in a hospital setting or where the facilities for detumescence are available. The patient should be observed for next few hours till the erection subsides.
Rigiscan Test :
This is a gold standard for evaluation of Nocturnal Penile Tumescence and Rigidity (NPTR). This test is based on the physiological principle that a male gets erection 3 to 5 times during REM sleep. At night before going to sleep one ring of Rigiscan is slid over the base of the penis and the over the tip. Next morning, the tracing obtained are studied. This test can quantify erectile tumescence and rigidity. Rigiscan tracing indicates whether the impotence is organic or psychological in origin.
Arterial insufficiency and venous leaks can also be suspected on the basis of Rigiscan graphs. Patients with purely artery disease have low levels of rigidity but of adequate duration. Patients with venous leak will have varying rigidity levels with shortened duration.
Penile Ultrasound :
This test is for evaluation of the functioning of the penile arteries. A simple acoustic Doppler emits auditory signals or a colour Doppler can help visualization of arteries. Cavernosometry and caver nosography: this haemodynamic test is useful for diagnosing venous-occlusive dysfunction of the corpora. Biothesiometry, electromyography , nerve conduction studies: these are for evaluation of neurogenic impotence.
Sexual dysfunction is a marital unit problem and therefore both, husband and wife, should attend. Counselling is towards strengthening the marital relationship. Wife is requested to co-operate. The client is requested to quit smoking and alcohol. He is advised relaxation exercise, yoga. The couple is educated about anatomy, physiology of sexual organs sexuality are countered. Their myths and misconceptions about sexuality are countered. They are also explained that he does not have to do anything to have an erection. Erection is a physiological response to effective stimuli.