In this paper, we present the mechanism which will be helpful for an individual to cope up with the Rehabilitation exercises. Mechanism proposed here will be useful for assisting human being in case of the Hand Rehabilitation. We propose to design a
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Method Statement for Rehabilitation Works
A brief description on Repair and rehabilitation of structures after earthquakeFull description
SCOLIOSIS ¾ A general term used to describe a lateral curvature of the spine p ¾ Most often develops on childhood ¾ Can occur on cervical thoracic or lumbar vertebra
Types: 1. 2. 3 3. 4. 5 5. 6.
Structural vs. Non Structural According to the direction of curves Major vs minor curve Major vs. minor curve According to the shape of the curve According to the severity of the curve According to the severity of the curve According to etiology
STRUCTURAL • vertebral bodies rotates towards convex spinous process rotates towards concave Irreversible lateral curvature with fixed rotation of vertebrae. (+) rotation of p vertebrae; apex: greatest
NON STRUCTURAL (functional scoliosis) g of • No change structure Positional or dynamic y in nature Reversible
(-) rotation
( ) rib hump (+) p (p (posterior ((-)) rib hump p rib hump) (+) bony deformity (+) progressive (-) corrected by positioning or voluntary efforts
NOTE: Forward bending of trunk produces posterior rib hump on convex side (thoracic region) due to rotation of vertebra & rib cage (prominence of scapula) scapula).
CONCAVE Shortened Muscle & ligaments are contracted Th Thoracic: i • Spinous process • Compression of ribs • Prominence of rib cage anteriorly
CONVEX Lengthened Muscle & ligaments are stretched • Vertebral body • Separation of ribs • Prominence of rib hump and scapula posteriorly • Disc space widens • Pedicle in anteroposterior direction
CONCAVE • Disc space narrow – lateral displacement of nucleus pulposus. Wedging of vertebral body on concave part of curve 2º pressure on epiphyseal 2 plate. Most especially seen on >25º >25 curve. curve • Pedicle more transverse
Neck angle increases Bulging of ribs Shoulder increased
NOTE: Direction of the curve is always identified by the convexity ® thoracic scoliosis – convexity is on right (L) thoracic scoliosis – convexity is on left
MAJOR primary curve; most •primary significant •most most significantly occurs in thoracic region
MINOR Less severe – may •Less develop on the opposite direction of the major curve on either above or below the major curve. curve •Compensatory curve – structural or non structural
(+) structural
(+) structural / non structural
(+) structural
(+) structural / non structural
Primary Pi curve Idiopathic scoliosis: li i right i ht thoracic T4 –T12
Found F db below l or above b th the major curve Compensated C t d – shoulders h ld & hips are leveled Decompensated/ D t d/ uncompensated – when sum off degrees d off the th compensatory curve does not equall the th degrees d off d deformity f it of major curve. (+) ( ) lilisting ti shoulders not leveled
C-CURVE • high hi h shoulder h ld on convex; high pelvis on concave.
S-CURVE • most commonly l seen in idiopathic scoliosis
From thoracic to lumbar
• Usually right thoracic curve & left lumbar curve
Uncompensated/Decom Compensated pensated
Double Major curve – has 2 major curve of q severity y & significance; g ; Both structural equal Transitional vertebra – makes transition from one curve to another Neutral vertebra – least rotated vertebra Apical vertebra – most rotated vertebra
Severityy of scoliosis is determined byy the angle of curvature ¾The greater the rotation of vertebra; the more severe the lateral curvature ¾The more severe the curve; the greater the affectation on cardiopulmonary affectation ¾ Decrease vital capacity & total lung capacity ¾ Hypertrophy of the ® ventricle & atrium f from pulmonary l h hypertension t i
Measurement Techniques X –ray measurement Cobb method ¾ most commonly used; more reliable ¾ a line is drawn perpendicular to the upper margin of the vertebra that inclines most toward the concavity. A line is also drawn on the inferior border of the lower vertebra with greatest angulation toward the concavity. The angle of these transecting lines is noted & recorded
Risser Ferguson method ¾ look for 3 vertebra: uppermost, apical, and lowermost
Nash Moe method ¾ Normally pedicles are symmetrical positioned on either side of each spinous process Grading: 0 – no vertebral rotation + & ++ - mild or minimal rotation +++ - moderate rotation ++++ - severe rotation
SEVERITY
CURVE
MANAGEMENT
Mild
< 20º
Observe; exercise
Moderate
20º- 40º
Severe
40 - 50 40º 50º 40º > 60º - 70 60 70º
Structural changes Brace; exercise Brace & surgery Pain & DJD Cardiopulmonary affectation Decrease life expectancy
NOTE: Curves < 10º - WNL – no tx.
Etiology of Structural Scoliosis: 1. Idiopathic – unknown/ most common classification – idiopathic p adolescent scoliosis ¾ Age of onset yp Young g Adolescent – most common type. girls age 10-15 g 4 & 9. Juvenile – occurs between ages seen often in girls Infantile – from birth to age g 3. seen often in boys
¾ Causes: Causes 1. Bone malformation during development y muscle weakness 2. Asymmetric 3. Abnormal distribution of muscle spindle in paraspinal p p muscles 2. Neuromuscular – 15 2 15-20% 20% ¾ Neuropathic causes – problem in CNS. CP, Polio ¾ Myopathic causes – problem is on muscles ¾ Muscular dystrophy
3. Osteopathic – problem in bones 3 ¾ Hemivertebra, osteomalacia, rickets, fracture, dislocation of spine Etiology of Non Structural Scoliosis: 1. LLD 2. Spasm in back muscles 3. Habitual asymmetric postures
1. 2. 3. 4. 5. 6.
Factors affecting Decision making to initiate Treatment Etiology yp Type Location y Severity Age p g Rate of progression
Evaluation Postural assessment – plumb line – C7C7 gluteal cleft (S2) ¾ The following deviation are often noted: Asymmetric shoulder level Prominence of the scapula on the side of the convexity Protrusion of the hip in one side Pelvic obliquity Increased lumbar lordosis
Lateral bend test – done to determine whether the curve corrects or reverses as the pt. side bends towards the convex side of the curve. curve ¾ Asymmetric side bending is an early sign that the structural changes may have begun to develop in the spine Forward bending test – done to determine whether the curve straightens out as the pt. bends forward and to identify a visible, rotational deformity of the rib cage. MMT
Exercise in scoliosis: 1. exercise alone will not prevent progression of a scoliotic spine nor will correct an existing scoliosis 2. exercise has been traditionally been used to stretch t t h tight ti ht trunk t k and d hip hi muscles/ l / strengthen t th muscle of the trunk 3 exercise may be beneficial as tx for pt 3. pt. with mild idiopathic scoliosis 4 exercise will not alone halt the progression of or 4. correct an existing moderate or severe scoliosis 5. exercise is used in conjunction with other methods such as braces, cast, etc.
Exercise with Milwaukee brace: ¾Goals: to strengthen the muscle that provides stabilization to the trunk Decrease or correct spinal curves NOTE: j is to move away y from the p pads The objective that are inside the brace. Treatment is geared towards stretching of the CONCAVE side and strengthening g g of the CONVEX side
For C curve scoliosis: Cross walk ¾ Done with the pt. in quadruped position. ¾ Done by initially crossing the UE along the concave side towards the convex side, followed by the advancement of the contralateral LE. ¾ Cycle repeats until the pt. completes one whole round within the mat mat.
EXAMPLE: Pt. has C-curve dextroscoliosis ¾ Pt. assumes quadruped position. Crosses the (L) UE towards ® UE then hold that position for 15-30 sec. Followed by crossing of the ® LE being crossed over the (L) LE hold for 15-30 sec. This followed by crossing over the ® UE over the (L) UE…hold…then lastly…cross over the (L) LE over the th ® LE. LE Cycle C l repeats t
for S-curve scoliosis: Ambling A bli walk lk ¾ pt. in quadruped position. Advance the UE g the concave side followed by y along advancing by the ipsilateral LE. hold is maintained after each extremityy has been advanced
Klapp’s exercise ¾ Done D iin reference f tto the th apex off the th curve. ¾ Emphasis is placed on exercise designed f maximum for i straightening t i ht i off the th pathologic th l i curves whatever their site, direction, & magnitude it d
T3 - sala position (lowered)
T6 – on elbows (semi-lowered) ( )
T8 – on hands Horizontal quadruped)
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T11 – fingertips (semi straightened)
L4 – reversed position (reversed erect)
L2 – erectt k kneeling li pos’n ’ (erect) ( t)
Dry Swimming exercise ¾ Beginner Beginner’s s exercise ¾ Decrease static works of spinal muscles
1. 2. 3 3. 4. 5 5. 6.
In prone position prone (B) UE on the sides of the body prone; (B) UE abducted to 45º 45 prone; (B) UE in reverse T pos’n prone; (B) UE flying V prone; (B) UE crossed against the nape area
General instruction: As pt. assumes the pos’n: ’ pt. t lifts lift trunk t k off ff the th matt & rotate t t the th trunk towards the convex side. 15-30 SH.
CAT & CAMEL ¾ Designed to increase and improve fl ibili off the flexibility h spine i ¾ CAT exercise – performed by increasing thoracic kyphosis ¾ CAMEL exercise – performed by increasing lumbar lordosis
