Handbook of Neurological Physical Therapy: Evidence-Based Practice P Shanmuga Raju
INDEX
A
Activities of daily livings (ADLs) 82
Spinal cord injury 86
ADLs 82, 106
Evaluation scales 45
Adductors innervations of 11
Airway clearances 46
American spinal cord injury association (ASIA) 88, 133
Scale
Angiography 25, 43
Cerebral for stroke evaluation 43
Acupuncture 113
Ankle clonus 105
Contracture 104
Deformity of ankle foot orthosis 55, 98
Anterior cord syndrome 87
Aphasia 5
Stroke related to 44
Ashworth scales
For spasticity management 91
Asymmetric tonic neck reflex 18
Ataxia
Cerebellar lesions 116
Friedreich's 120
dysarthria 117
dysdiadochokinesia 116
Dementia 79
hypotonia 12, 117
Nystagmus 116
Tremor 77
Athetoid 105
Cerebral palsy related 103
Attension tests 5
Autonomic dysreflexia 89
Bladder, bowel dysfunction 90
Spinal cord injury- related. 86
B
Balance 81, 82
Babinski sign 17
Basilar artery 42
Baclofen
As spasticity treatment 92
cerebral palsy 102
Intra thecal pumb 92
Barthel's Index 45
Basilar artery 42
Beds, pressure ulcer prevention 62
Behavior disturbance 4
Bell's Palsy 30
Biceps reflex 15
Biofeedback 35
Bladder dysfunction 90
Urinary incontinence 93
Hyperreflexia 15
Parkinson's related 76
Spinal cord injury related 86
Blood flow 40
Blood pressure
See also hypertension, hypo- tension 8
Bobath approach 46, 108
Bowel dysfunctions 90
Brachialis muscle innervations 15
Bradycardia 91
Brown sequard syndrome 87
Brunstrom 51
C
Cane 56
Cartoid artery 42
Cardio-respiratory
dysfunction 48
Casts, splints management 55
Cerebral arteries 42
Vascular supply and
distribution 41
Cerebrovascular syndrome 42
Cerebral hemispheres 40
Cerebral palsy 102
Extrapyramidal 105
Pyramidal 103
Cerebrovascular accidents see also stroke 40
Chorea 14
cerebral palsy related 102
choreo-athetoid movements 105
Coma scale 3, 132
Computed tomography (CT) 24
Head for stroke 43
Conductive Education 112
Contractures 56, 60
Constraint- induced therapy 55
Conus medullaris syndrome 87, 91
Coughing, spinal cord injury 92
Cranial nerves 5
Crutches 56
Cryotherapy
for spasticity management 120
Cueing. 81, 82
D
Débridement, pressure sores 60
Decubitus ulcers 90
Deep tendon reflexes 15
Deep vein thrombosis 89
Deep breathing exercise 96
Deltoid muscle innervations 11
Dementia 79
stroke 40
Parkinson disease 76
Depression 79
Developmental delay 102
Diplegia 103
Diplopia 117
Disability scale 78
Dressing for pressure sores 60
Dynamometer 9
Dysdiadochokinesia 21
Dysmetria 116
Dysphagia 79
Orophargyngeal 121
Parkinson's disease 76
Stroke 40
Pneumonia risk factors 46
E
Electrical stimulation 35, 112
Elecrtomyography 26, 67
see Muscular dystrophy 64
Feed back 54
Bell's palsy 30
Stroke 40
Edema 41
Electroencphalography 26
Echocardiography 66
Embolism
pulmonary risk factors 46
Emotional support 52
Endurance 83
Eye movements 6
See optic nerve 5
oculomotor nerve. 6
F
Facial nerve
see cranial nerve VII 6
Facial palsy
See for bell's palsy treatment 34
Family history 3
Fascio-humeral-muscular dystrophy 64
Facial manipulation 36
Finger to nose 21
Flaccidity 12
Foot drop
dorsiflexion
deformity 55
Foot orthosis 124
Forearm orthosis 127
Four poster brace 125
Functional electrical stimulation 127
Functional independence measure (FIM) 45
G
Gait training
ataxic 117
cerebellar 116
hemiplegic 45
scissoring 104
waddling 65
GCS (Glasgow coma scale) 3
Glenohumeral joint 58
Glossopharyngeal nerve
See cranial nerve IX. 7
H
Hand function 110
Halo brace 125
Heel-to-shin test 21
Hematological examination 42
Hemiplegia
shoulder pain 57
shoulder subluxation
upperlimb 58
Hemorrhagic cerebraovascular disorders 40
hemorragicstroke 40
cerebral ischemia 41
hypertension 41
Heterotopic ossification, see HO 89
Hippotherapy 113
Hydrotherapy 70
Hyper extension device, Jewett 125
Hyper tone
see spastic hypertonia 105
see muscle tone 11
Hyperbaric oxygen therapy 113
Hypertension 41
See stroke 40
I
ICH (Intra cerebral hemorrhage) 40
Imaging studies
Computed tomo
graphy (CT Scan) 24
Magnetic resonance
imaging (MRI) 25
Myelography 25
Plain radiography 24
Ultrasonography 44
Ischemia
ischemic stroke 41
J
Jaw reflex 6
Jewett hypertension device 125
Joint position sense 19
Romberg's test 21
Joint range of motion 67
K
Kabot technique 37
Kernig sign 8
Kinesthetic sense 21
Knee ankle foot orthosis (KAFO) 124
Knee orthosis 124
L
Language/communication disorders 5
Lofstrand forearm 127
Lower motor neurone lesion (LMNL) 30
see bell's palsy 31
Lower limb orthosis 124
AFO (Ankle foot orthosis) 70
Foot orthosis (FO) 124
Ambulation aid 56
Cane 56
Crutch Axillary, elbow
Walker 96
RGO (Reciprocating gait orthosis) 126
KAFO (Knee-Ankle-foot orthosis) 124
Lumbar Puncture 27
M
Magnetic resonance imaging
see MRI, Neuro Radiology imaging 25
Manipulation
see Bell's palsy 36
Manual muscle test (MMT) 9
Memory 4
Long term 5
Short term 4
Meningeal irritation, test for
kernig's sign 8
MCA (Middle cerebral Artery) 42
Medical complications
see spinal cord injury 89
Medical research scale (MRC) 9
Milwaukee brace 126
Mini- mental examination 3
MMT (Manual manual testing) 9
Mobility transfer 96
Wheel chair mobility 97
Modified Ashworth scale 91
Muscle biopsy, 27, 67
see muscular dystrophy
Muscle
see duchenne muscular dystrophy 68
Muscular dystrophy
see DMD 64
Becker's muscular dystrophy (BMD) 64
Facial scapulohumeral dystrophy (FSHD) 64
Emery Dreifuss muscular dystrophy (EDMD) 64
Limb Girdle muscular dystrophy (LGMD) 64
Myelography 25
Myometers 9
N
National institute of health stroke scale (NIHSS) 46
NCS (Nerve conduction study) 26
Neurogenic bladder dysfunction 90
Neurovascular symptoms 42
Neurogenic bowel 90
Neuro-radiolgy imaging 24
Nystagmus 116
ataxia 116
O
ORLAU hip guidance orthosis (HGO) 125
Orthosis
use, in cerebral palsy 124
stroke 40
spinal cord injury 86
muscular dystrophy 64
Occupational therapist, 121
cerbellar ataxia 116
Ocular examination 6
Oculomotor nerve III 6
Olfactory nerve I 5
Optic nerve II 5
Outpatient Rehabilitation 50
cerebrovascular diseases 40
Oxygen 46
P
Pain 19
Palpation 13
Patient education 34
Patient history 2
Patterning 112
Paraplegia 96
see spinal cord injury 86
Patient positioning 49
use for stroke
spinal cord injury 86
Percussion 48
Parkinson's disease 76
Platelet count 42
Pneumatic compression
devices 47
Pneumonia, cerebral
infarction 46
Positron emission
tomography 44
Posture impairment 77
Pharmcological intervention 92
Phenol injection 92
Physcial therapy 80
Examination 3
coughing technique 47
breathing exercise 96
conductive education 112
deformity correction 55
Plantar reflex 17
Posture 77
Pressure sores
pressure points 59
Prevention 60
PNF (Proprioceptive neuromuscular facilitation
techniques) 37
Q
Quadriplegia
Quality of life 95
R
Radial nerve 15
Radiographs in spinal cord injuries 94
Reflex 14
Biceps 15
Triceps 15
knee jerk 15
Ankle jerk 15
Superficial reflexes 17
Abdominal 17
ATNR 18
Plantar 17
STNT 18
Reciprocating gait
orthosis (RGO) 97
Relaxed Passive movements 96
Respiratory problems
SCI (spinal cord injury) 92
Resistance exercises 96
Rigidity 77
ROM (Range of motion) exercise 82
Rinne's test 7
Romberg's test 21
S
SCI (Spinal cord injury) 86
Classification 88
Incidence 86
Medical complications 89
ASIA (American spinal cord injury Association) 88
Respiratory 92
skin changes 90
Pressure sores 90
heterotopic ossification 89
spinal orthosis 97
rehabilitation for
assistive device 98
Scoliosis 126
Sensation 19
Skin sensation 19
Sensory dermatomes 19
Sexual dysfunction 95
Shoulder pain
cerberovascular accident 57
Spasticity (hypertonia) 13
Speech
communication problems 5
Spinal orthosis
lumbaosacral orthosis 126
TLSOs (thoracolumbaosacral orthoses) 126
cervical orthosis 126
four poster brace 125
halo brace 125
Jewett hyperextension
device 125
Soft collar 126
SOMI brace 126
Thoracolumbaosacral
orthosis 126
Splint
in cerebral palsy 102
in hemiplegia 55
in muscular dystrophy 70
in talipes equinovarus 104
Standing frame 98
Stretching 68
Stroke 44
Subarachnoid hemorrhage 40
Superficial thrombophlebitis 88
Swallowing disorder
see dysphagia 79
T
Task related training 51
Tapping technique
see shoulder subluxation
in hemiplegia 58
TENS (transcutaneous electrical stimulation) 99
Temperature sensation 19
Treadmill walking with body support 54, 112
Trigeminal nerve
see cranial nerve V 6
Trochlear nerve
see cranial nerve IV 6
Trunk instability 81
Tetraplegia
transfer training in spinal cord injury 95
in stroke 52
Transient ischemic attack (TIA) 40
Tremor 77
Two point discrimination 20
U
Ulcers
see pressure sores 59
Unconscious patient 3
UMN (upper motor neuron) 45
Upper limb orthosis 126
Ultrasonography 60
V
Vagus nerve
see cranial nerve X 7
Vascular problems 42
Ventilation assistance support 72
Vertebral artery 42
Vertebrobasilar distruibution
ischemia 41
Vestibulocochler nerve VIII cranial nerve 7
Visual impairment 104
Visual feed back movements 120
Visual acuity 5
Vibration
see chest physical therapy 48
W
Walking training 81
see cerebral palsy 111
spinal cord injury 98
parkinson's disease 81
cerebellar ataxia 121
hemiplegia 53
Walking aids 98, 56
Walker 56
Waddling gait 65
Weakness 79
Weber's test 7
Weight cuffs 120
Wheelchairs 71
Y
Yahr scale 78
see Parkinson's disease 76
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Chapter Notes

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1Handbook of Neurological Physical Therapy
Evidence-Based Practice
P Shanmuga Raju, MPT, MIAP Head Department of Physical Therapy Chalmeda Anand Rao Institute of Medical Sciences Karimnagar (Andhra Pradesh) India Foreword C Lakshmi Narasimha Rao V Surya Narayana Reddy
2Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24, Ansari Road, Daryaganj, New Delhi 110 002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
Offices in India
Overseas Offices
Handbook of Neurological Physical Therapy-Evidence-Based Practice
© 2012, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2012
9789350255537
Typeset at JPBMP typesetting unit
Printed in India
3To
All our Patients at Chalmeda Anand Rao Institute of Medical Sciences Karimnagar
4
5Foreword
I am happy to know that Dr P Shanmuga Raju, HOD, Department of Physical Therapy of this Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India is bringing out Handbook of Neurological Physical Therapy—Evidence Based Practice.
I have gone through the book and found exemplary hard work and interest shown by Dr P Shanmuga Raju in treating the people suffering from various disabilities in the rural areas, where this Institute is located. Neurological disabilities cripple one's life. Overcoming this by Physical Therapy is challenging and Rehabilitation is of utmost concern.
I congratulate Dr P Shanmuga Raju for successfully bringing out this edition. This book would be much help to upcoming physical therapists, faculty, students and all health care professionals.
C Lakshmi Narasimha Rao be mba
Chairman,
Chalmeda Anand Rao
Institute of Medical Sciences
Arihant Educational Society
Karimnagar
India
6Foreword
It gives me great pleasure to write this foreword for the Handbook of Neurological Physical Therapy Evidence based Practice written by Dr Shanmuga Raju. This book follows a simple principle, and easy to implement it in a day-to-day practice.
This Handbook explains the problem of threatening neurological disability with Physical Therapy interventions in the step by step manner. It is designed to give advance informative, resources and practical guidance for Undergraduate and Postgraduate Physical therapy students and also for the practicing all Rehabilitation professionals. All Chapters dealt with technological interface are equality informative.
I congratulate Dr P Shanmuga Raju for successful completion of this work. I hope that this book will be useful to students and postgraduates.
I wish this book a great success.
V Surya Narayana Reddy ms (gen. surg)
Director
Chalmeda Anand Rao Institute of
Medical Sciences
Karimnagar, Andhra Pradesh
India
7Preface
Handbook of Neurological Physical Therapy - Evidence-based Practice, is to help clinicians make better decisions about patient care. This book is to provide simple format, evidence based Physical Therapy and Rehabilitation.
Mission
This edition, will be useful to Physical Therapy students, Interns, Medical students, Faculty, Nurse practitioners, Occupational therapists, Physiatrist and physicians Assistant's will find the descriptions of diagnostic and Physical therapy management with citations to the current literature useful in day-to-day patient care.
Outstanding Features
P Shanmuga Raju
8Acknowledgments
I would like to thank our parents Shri K Perumal, Smt P Nallammal, sisters, and all my teachers.
I express deep thanks to our Chief Patron Shri C Anand Rao, BL, Ex. Minister of law, AP and Social worker, Dr V Bhoom Reddy, MS (AIIMS), Ex-Vice President of National IMA, Shri C Lakshmi Narasimha Rao, BE, MBA, Chairman, Prof. Dr V Surya Narayana Reddy, MS, Director, Arihant Educational Society, Karimnagar, who provided me heart felt support always, in publishing this educational hand book.
My Sincere thanks to Prof. Dr SA Aasim MD, Medical Superintendent, Prnicipal, Prof. Dr Sudha Deshpande, MD, Prof. Dr Jawhar, MS, Prof. Dr Gopal Rao S Jogdand, Ph.D, Prof. Dr N Samanta, M.Ch, Prof. Vittal Reddy, MD, Prof. Dr Aruna, MD, Prof. Dr Neelee Jayasree, MD, Dr Ezhilarasi Ravindhran, MD, Dr. Charan Paul, MD, Dr Jyothi, DGO Dr EV Sridher, MD, Dr HarshaVaradhan, MD, and Mr P Ramakrishana, Mr G Malla Reddy (Steno), Mr Y Venkateshwer Rao, Mr Tiwari, Mr CH Prithvidhar Rao and all CAIMS teaching and nonteaching staff.
I would like to express my thanks to Dr George Williams PT, Dr Hendry Mohan Doss, PT, Prof. Dr V Murugesan, MPT, Prof. Dr SD Sivaganesa, MPT and my friends for their extensive guidance.
I am very grateful to Shri Jitendar P Vij, Group Chairman and CEO, Mr Tarun Duneja, Director (Publishing), Mr Jayanandan, Author Co-ordinator (Chennai), Jaypee Brother's Medical Publishers (P) Ltd, New Delhi, for ideas and extended cooperation in publishing this handbook.
Finally, I thank our patients for their role in inspiring me to write this book.
P Shanmuga Raju