D WellĂ˘Â Aq 60000 IU Capsule is important for proper absorption and metabolism of calcium and phosphate present in the blood stream. It can be either taken as a supplement or in the form of fish and dairy products which are rich in D WellĂ˘Â Aq 60000 IU Capsule like Salmon, Sardine, Cod liver oil, milk, mushroom etc. D WellĂ˘Â Aq 60000 IU Capsule is an essential element to improve the overall health condition and to treat diseases related to bones like osteoporosis. D WellĂ˘Â Aq 60000 IU Capsule deficiency causes Rickets among children while adults may suffer from brittleness of bones known as Osteomalacia. It also helps to maintain proper blood pH levels in our body.
D WellĂ˘Â Aq 60000 IU Capsule is a useful fat-soluble vitamin synthesised in the human body from Cholesterol with the help of sunlight. It helps the body to absorb and metabolize calcium and phosphate . It is an important element to promote good health, to cure bones related diseases and also helps in normal growth of bones and cells. If the level of D WellĂ˘Â Aq 60000 IU Capsule goes down in body then it may cause Rickets in children and Osteomalacia & Osteoporosis in adults.
It can be supplied to your body either through your food or by supplements, medicine or an injection. Foods rich in D WellĂ˘Â Aq 60000 IU Capsule are cod liver oil, marine fishes like salmon, tuna, sardines, dairy product like milk, soy milk and cheese, egg, mushrooms etc.
The common symptoms related to the deficiency of D WellĂ˘Â Aq 60000 IU Capsule are:
People who are affected with Liver?s disease, Celiac and Crohn?s disease or those with darker skin colour are prone to deficiency of D WellĂ˘Â Aq 60000 IU Capsule.
Doctors can prescribe medicines, supplements and food remedies according to age, weight, gender and other physical conditions of the patient if he is diagnosed as a D WellĂ˘Â Aq 60000 IU Capsule deficient person.
In rare cases excess intake of D WellĂ˘Â Aq 60000 IU Capsule (Amount> 40,000 IU per day for several months) may cause toxicity leading to kidney and heart failure.
TREATMENT FOR CONTROL OF MOVEMENTS OF THE ARM:
The patient has great difficulty in lifting and holding his arm up against gravity ,because flexor spasticity of the trunk and shoulder girdle with shoulder girdle with pressure downwards prevents the action of the extensors, i.e. serratus anterior, deltoid and supraspinatus.
Inhibition of spasticity can be achieved more easily in supine, as already described in the first stage of treatment and this has to be continued in preparation for working in the upright posture. It is easily obtained in standing, rather than in sitting,because in standing extension of the hips facilitates lifting of the arm whereas, in sitting, flexion of the hips and trunk make inhibition of flexor spasticity more difficult.In order to make lifting of the arm possible, the patient must first be able to hold it at various stages when lowering it.
He should extend his elbow and keep it extended all the way down. But extension alone is not sufficient.The arm should be in external rotation and supination, as internal rotation and pronation are part of the flexor pattern which counteracts lifting and holding the arm up. Control for holding the arm up at the shoulder is easier when it is held sideways rather than forward and down. T
his is because extension with external rotation and supination can be maintained more easily sideways than forward.In supine, standing and sitting, it is easier for the patient to hold his arm against gravity than to lift it up.
If he can control the weight of his arm all the way downward, he can also learn to lift it up from any downward point at which he is able to hold it. If the arm pulls down at any stage of the downward movement, the therapist will feel downward pressure against her support and the movement should then immediately be reversed upward, either by the therapist or better if possible by the patient. He soon learns to recognize the moment when flexor spasticity occurs and his elbow tends to bend.
To begin with the therapist holds the patient’s hand with wrist and fingers extended, the thumb abducted. The patient extends his elbow, pushing against the therapist’s hand. She would be able to use some intermittent pressure to stimulate active extension.
When he can hold his elbow in full extension, she moves his hand slowly sideways and down, but only as long as he is able to keep his elbow extended. He is then asked to move his arm up again. Gradually, the whole range of movement sideways for full horizontal abduction is performed. The movement is then done diagonally forward, as long as external rotation can be maintained.
As a progression, the therapist holds the patient’s fingers but only lightly to prevent the occurrence of flexion until she is able to take he hand away at various points of the downward movement and the patient is able to control his arm at each stage. This is called placing.If the patient’s arm is more flaccid than spastic, contraction of the deltoid, for holding the arm up in horizontal abduction, can be facilitated by suddenly and without warning dropping the arm, but letting it fall only a little way down, then moving it up again. Letting it fall may produce a protective holding reaction through sudden stretch in the inner range of the deltoid and supraspinatus.
The patient can then use this contraction immediately, i.e. before its effect has subsided, for lifting his arm up again.This manoeuvre will not work, however, if there is any flexor spasticity. Another way of stimulating active extension of the flaccid arm is a technique which we call (pull- push). With the patient’s hand held with wrist and fingers extended, his arm is raised sideways to the horizontal and a quick pull followed by a push against his extended arm, is given through his hand.
This stimulates mobile extension of the elbow and a holding action at the shoulder. The patient now feels that he can extend his arm without it stiffening, and through the pull, followed quickly by pushing against the extended arm, the therapist inhibits flexor spasticity. This combination of inhibition and stimulation is very useful and should be done with the patient’s arms in any direction, sideways, forward and diagonally, and also gradually downwards.
When sufficient activation has been obtained at shoulder and elbow,the therapist lets go of the patient’s hand and he should hold his arm up unaided. Inhibition of flexor spasticity has to be done during and if necessary, in between all the placing maneuvers described above, i.e. when the patient’s arm becomes heavy and uncontrolled, or when a pull downwards is noticed by the therapist.
The patient may now be able to lift and hold his arm at the shoulder,provided he keeps his elbow extended. The moment he is asked to bend his elbow so that he can bring his hand to his body or face, the whole pattern of flexion, pronation and downward pressure of the side flexors of his trunk and retraction of his shoulder girdle may come into play and he can no longer hold his arm up.
For functional use, i.e. for feeding, dressing and other activities, it is essential that he should be enabled to bend and supinate his elbow and open his hand to grasp, while holding and stabilizing his raised arm at the shoulder. Treatment therefore, should be advanced towards obtaining independent movements of the elbow without letting the arm fall.
TREATMENT IN SPASTIC STAGES:
In case of spasticity the therapist should try to achieve the following aims:·
First normalize the tone.
Development of normal functional pattern.
Prevention of contracture and deformity.
Train the patient to be functionally independent.
Achieve highest possible physical security for the patient.
Spasticity in the muscle can be reduced by the following methods:
Gentle rhythmic passive movement.
Sustained gradual stretching either manually or by using splints.Prolonged icing over the spastic muscle bulk for about 15 to 20 min.
Faradic stimulation to the weak antagonist muscles can reduce the
Spasticity of the agonist muscle by the principle of reciprocal inhibition.
Reflex inhibiting postures or patterns.
Biofeedback: This can be used to relax spastic muscle as well as to activate its antagonist.
EXERCISES IN SPASTIC STAGE:
EXERCISES IN LYING:
Scapular movement: The patient scapula should be mobilized passively and also the patient should be asked to perform protraction and elevation movement of the scapula.Touching the opposite shoulder: The patient is trained to take his arm from extension, abduction and external rotation position towards his opposite shoulder into flexion , adduction, supination and external rotation.Touching the head: The patient is trained to touch the head by maintaining external rotation and supination. The Therapist maintains the hand in extension of the fingers with the thumb in abducted position and then she moves the hand into abduction and elevation maintaining the elbow in extension. This exercise can be progressed to active the as the patient learns to control the movement.Elbow extension with shoulder in 90 degree of flexion.The patient is then trained to maintain the arm in space in different directions. This exercise will help the patient in developing good control of the upper limbs and also increase the proximal fixation.
Bridging should be done by weight bearing on the affected limb only. The therapist maintains the normal limb in flexion and encourages weight bearingt hrough the hemiplegic lower extremities.
Unilateral rotation of the pelvis:
The patient performs hip-knee flexion of the affected lower limb and then rotated the pelvis to the opposite side. The patient tries to maintain this posture so that the spasticity of the trunk is inhibited. This exercise also help in encouraging forward rotation of the pelvis and correcting pelvic retraction.The patient is encouraged to perform flexion adduction and extension abduction pattern of the lower limb keeping the knee in extension position throughout.
The affected lower limb is kept in abduction at the edge of the plinth such that the knee is in flexion. In this position the patient is encouraged to perform knee extension and flexion without any adduction or flexion movement at the hip.
The patient may be trained to perform dorsiflexion with hip extension and plantar flexion with hip flexion. In case the patient is unable to perform dorsiflexion he may be trained to do with hip-knee flexion and the flexion at the hip and knee gradually reduced.
MOBILIZATION AND STRETCHING
During flaccid stage mobilization in the form of gentle passive exercises and stretching of various biarticular muscles should be given as they are very prone to develop tightness. Thus muscles like tendon Achilles, hamstring,quadriceps, adductors, tensor fascia latae, biceps, wrist flexors, etc. should be stretched.Passive exercises should be given of all the movements at all the joints for at least 10 repetitions three to four times in a day.
Some forms of splints may be given to maintain the body parts in the desired position.Commonly dorsiflexion splint or L splint may be given to prevent the foot from going into plantar flexion attitude. Similarly wrist extension splint is given to maintain the wrist and the fingers in extension position. Care should be taken to maintain the first web space.
WEIGHT BEARING ACTIVITIES
Weight bearing exercises are necessary to promote development of tone in muscles and also to maintain the absorption of calcium into the bones. Thus the patient should be given activities like bridging ,supine on elbows ,sitting with weight bearing on the affected arm, and standing should be given as soon as possible within the limitation of the patient’s general medical status.
SUBLUXATION of the glenohumeral joint is very common complication in stroke patient, which can be prevented by proper positioning and handling. Some form of support may be given to prevent distraction of the joint when the patient assumes an erect position. Generally a shoulder sling or Bobath splint is given to prevent this complication. Skillful
TAPING is also helpful in preventing the subluxation very effectively. It also gives a tactile feedback which helps in faster development of tone in the shoulder muscles. Weight bearing exercises for the involved upper limb has also been found to be beneficial in preventing this.
Chest physiotherapy in the form of inspiratory breathing exercises should be given to maintain the lung compliance and to prevent any chances of secretion accumulation. In cases of necessity nebulization or postural drainage can be given.
TREATMENT PHYSIOTHERAPY IN THE FIRST STAGE (FLACCID MAINLY):
Turning over from supine to side lying .
One of first activities the physiotherapist should work for in treatment is that of turning over to either side. The patient should not always remain in the supine position but should soon learn to use his trunk; i.e. his shoulder girdle and pelvis to turn over and lie on his side for some part of the day.
If patient rolls over and lies on the sound side, with the affected arm uppermost, the shoulder and arm should be moved well forward, the elbow should be extended, and the affected leg lie in a natural position of semi-flexion.If patient rolls over and lies on the affected side, the shoulder of that side should again, be placed forward with the elbow extended and in supination.
This position helps to prevent shoulder retraction and the development of flexor spasticity with pronation of the affected arm.Patients clasps hands, he then raises arms. In this shoulder girdle is moved forward and upwards. Patient’s arms are then moved, with clasped hands to chest. With clasped hands, patient turns towards sound side keeping shoulder well forward.
Lying down from sitting
The physiotherapist holds affected hand of the patient, his arm externally rotated and extended diagonally forward at shoulder height, while the patient slowly lies down, using his sound arm for support. In this way, physiotherapist will prevent retraction of the shoulder and flexion of the affected arm. The patient then lifts the sound leg on the bed. If at all possible, he should then bend the affected leg at the knee and move it into the bed, the nurse giving a little help by lifting from under the knee.
Sitting and standing up
A foam rubber mat should be placed in front of the bed for standing. The therapist never be on patient’s sound side when he sits, stands or walks, since he can use his sound side. If he takes weight on his affected side, the patient will gradually overcome his fear of falling.
We all know about it. In simple words, we can say damage to the brain from interruption of its blood supply. It’s also called CVA: cerebro vascularaccident. Now just have a simple look or idea about the patient’s structure means his look so that he can recognize about that. Firstly side of the face drops or feels numb with speech difficulties as face involves in it, then muscles weakness on one side of the body.
There are three types of stroke:
1 Ischemic strokes
2 Hemorrhagic strokes
3 Transient ischemic attacks (TIAs)
BUT there is also something that we should know:-
There are two types of patients, first those patients with both flexor and extensor spasticity; but predominant extensor hyper tonus of the leg, i.e.excessive co-contraction.
They can stand and take some weight for a moment.Other patients with more moderate degrees of spasticity and little co-contraction can walk and move the weight free leg.Both types of patients have balance problem, the first because of lack of mobility and the other due to lack of stability.
NOTE: If left brain involved then right side affected and if right brain involved then left side.
TREATMENT FOR STROKE
Before start treatment one should know about the following things.
Check the muscle first either it’s flaccid or spastic.
Sensory part involvement is there or not.
Check the reflexes
Bo bath: This is based in normal movement or Neuro -development approach.The main aim is to prevent abnormal movement and adverse plastic adaptations and to facilitate normal movement and subsequent plastic changes.
Brunstorn: He makes use of abnormal synergies and incorporate them into functional activities.
Motor relearning program: This training of motor control is based on an understanding of kinematics and kinetics of normal movement, motor control process and motor learning.
Proprioceptive neuromuscular facilitation (PNF): To maximize sensory stimuli on the pool of AHC in order to stimulate purposeful muscle contraction.
Roods: This was mainly done to achieve purposeful muscular contraction by stimulating the skin through facilitating strokes on the skin. The combination of treatment used differs from patient to patient.