Ipsit Brahmachari PhD Physiotherapist
Proprietor Marg Physiotherapy and Rehabilitation Clinic
Ahmedabad, Gujarat, India
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A Practical Guide to Hemiplegia Treatment
First Edition: 2015
9789351524120
Printed at
5Dedicated to
My Teachers
and
7Preface
Physiotherapy is a field of science dealing with physical agents and using them to bring about positive changes to the health of the receiver. Hence, it has to be highly objective in nature and its results should be reproducible on application of same treatment techniques on similar conditions. However, it does not hold true in clinical practice. It is observed by every physiotherapist that a similar technique can bring about dissimilar results in patients with similar conditions. This is because of the difference in the skill levels, effort, basic knowledge, dedication, and will of the treatment provider. Thus, execution of the treatment is an art. Physiotherapy is a combination of science and art. Science is the body and art is the soul of physiotherapy. In this light, we can say that physiotherapy is also subjective in nature. This combination of ‘objectivity’ and ‘subjectivity’ gives a unique flavor to this profession. Subjectivity, rather than becoming a negative trait, blossoms like a flower when a physiotherapist is treating a patient.
A lot has been written on physiotherapeutic management of a patient suffering from hemiplegia/paresis by developed nations. But, as a matter of fact, the requirement of the patient as well as availability of resources does differ from nation to nation. Our nation too has a different approach to disease, disability and impairment and hence, subtle changes are mandatory and strongly advocated in approach towards the condition and its treatment.
Hemiplegia is not just a neurological or a musculoskeletal dysfunction, but rather is a dysfunction of the personality as a whole. It is extremely difficult for the patient to keep his physical disability and its psychological impact separate. This psychosocial impact on the patient's life spreads its fangs towards their respective family members too, and they become victims of the situation. Thus, there arose a need to address the issue of physiotherapeutic management of hemiplegia in a new light, focusing on needs of our society.
This treatment guide would be beneficial to all the physiotherapy students and fresh graduates who want to make difference in the lives of the patients by doing justice to their profession. This book can become a useful guide for a practicing physiotherapist (undergraduate/postgraduate) working in private setup, government setup, hospitals or as a homecare therapist, for a quick 8reference and progression of therapy with logical reasoning, as assessment and treatment parts go hand in hand.
For the ease of readers, an attempt has been made to cover all major topics in a nutshell in simple, lucid language with an optimum flow and continuity. The book is divided into various topics ranging from Basic Anatomy and physiology of brain, development of nervous system, to clinical diagnosis, symptomology and detailed assessment. It also deals with essentials of Rehabilitation medicine and approach to treatment. For the ease of quick reference, various exercises and treatment techniques are divided into lying, sitting and standing positions. Topics of orofacial rehabilitation, perception, orthotics, and management of complications are also dealt with. It concludes with homecare program.
I sincerely hope that this book will throw light on the dark path of disability and will help in bringing about improvement in the quality of life of individuals suffering from hemiplegia.
Ipsit Brahmachari
9Acknowledgments
Any stream of knowledge is not a discrete entity but rather is a perennial flow which flows from teachers to students over centuries. To claim any creation to be ‘self-owned’ is erroneous, as present-day creation has its roots in the soil of yesteryears. In bringing out this compilation in the form of a book, I have been highly motivated and influenced by many persons and events, both known and unknown to my conscious mind. Several texts have been instrumental in teaching us the nuances of physiotherapy. To mention a few, Principles of Exercise Therapy by Dena Gardiner, Hemiplegia by Berta Bobath, PNF in Practice by Adler, Beckers and Buck and, Physical Rehabilitation by O'Sullivan, Cash's Textbook of Neurology, and Steps to Follow by Patricia Davies.
I would like to thank all my teachers who have always been guiding force in my life. Some teachers of physiotherapy deserve a special mention; Dr Mina Desai, Dr Sarala Bhatt, Dr Anjali Bhise, Dr Yagna Shukla, and Dr Dilip Patel. I extend my thanks to Dr Roshan Vania and Dr Preeti Shah for initiating me into the teaching of Bobath techniques and neurodevelopment techniques. I sincerely thank Dr Maya Nanavati, an Occupational Therapist for teaching her valuable hands-on skills. I thank Dr Sudhir Shah, a master Neurophysician and a great scholar who extended support, believed in me and allowed me to treat his patients. I thank Dr Amit Bhatt for being always supportive. I extend my thanks to Dr Dhiren Ganjwala (Orthopedic Surgeon) for contributing chapter on Orthopedic Management of Stroke.
I thank my staff and colleagues at Marg Physiotherapy and Rehabilitation Clinic, especially Dr Darshan Rana for photography, coordination, and tolerating me, and Dr Vikas Dhimmar for typing. I also thank Dr Jugal Sherdiwala for his support. I take this opportunity to thank my family Dr Urvi, my wife, Jalormi, my daughter and my parents as pillars of my strength.
I thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), Mr Sharad (Gujarat branch) and all the staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for bringing out this book and believing in me.
Last but not least, I thank all my patients who have lovingly cooperated in this process.