PHYSIO STUDY

Improving global health through universal access to physiotherapy knowledge.

Showing posts with label Neurology. Show all posts
Showing posts with label Neurology. Show all posts

December 09, 2017

Panda sign | Panda sign in head injury

Neurology ,
Panda sign | Panda sign in head injury
Panda sign / Raccon sign

It is called as peri orbital eccymosis.
indicate: 
draining of blood down to the periorbital soft tissue due to fracture at the base of the skull.
It can be unilateral and bilateral suggest highly severe basalar fracture.
sign:
It may accompanied by battel sign .
They may not appear after 2-3 day if the injury. 
Advice:
It is recommended that the patient should blow their nose cough vigorously or strained less to prvent further tearing of the meninges.

Panda sign,panda sign in head injury
Panda sign

Read more »
By No comments:
Labels:

December 06, 2017

Battel sign / Mastoid ecchymosis

Neurology ,
Battel sign / Mastoid ecchymosis
Battle sign  0®  Mastoid ecchymosis

It is an presence of bruising  over the mastoid process.
As we know most of the extra vascular section of blood go along the path of posterior oricular artery.
Indicate:
* fracture of the base of the posterior portion of the skull
                                or
* may indicate any underline brain trauma
- This sign usually will take at least one day to appear after the initial trauma causing boggy and discoloured tissue behind ear and over the mastoid process.

   bruises is present behind the ear were the mastoid process is present.
Read more »
By No comments:
Labels:

December 05, 2017

Neurological special test | Purpose | Romberg test|special test for neurological examination

Neurology ,
Neurological special test | Purpose | Romberg test|special test for neurological examination
Neurological special test 
(a) Romberg test
This test is used in the examination of neurological function. This is based on the premise that person require at least two of the following three senses to maintain balance that is proprioception, vestibular function and vision.
The romberg test is used to investigate the cause of ataxia.
Procedure: 
Ask the subject to stand erect with the feet together first with eye open and then with eye closed. Make the subject to stand near to the wall or the examiner to stay close to the subject to prevent him or her from falling or hurting.
Watch the movement of the body if the subject start sway within closed eye then the test is considered as a positive sign.
Note: 
* A positive romberg test suggests that the ataxia is sensory in nature.
* If the romberg test is negative it suggests that the ataxia is cerebral in nature.
Read more »
By 1 comment:
Labels:

November 05, 2017

Management For Muscle Tone

Neurology ,
Management For Muscle Tone
Management For Muscle Tone

The management is done by different techniques and approach based on the type of lesion it can be UMN (upper motor neuron) or LMN (lower motor neuron) eg: spasticity, dystonia

muscle tone management,abnormal muscle tone management
Muscle tone .
(a) Medical management
 BOTOX
 Baclofen
 Clonidine
(b) Surgical management
 Tendon release and transfer
 Osteotomy
 Deep brain stimulation
(c) Physiotherapy management
Muscle tone was managed by rood’s approach. It is an extroceptive technique which was proposed by Margret Roods in 1970.

It was based on two techniques

1. Facilitatory techniques: Due to LMN lesion the muscle will go for flaccid, so this facilitatory technique is used to increase the muscle tone

(a) Light moving touch:-
Stimuli: light touch
Procedures: It is done with a fingertip, camel hairbrush or cotton swab and apply 2 times per sec for 10 times for 3-5 strokes and allow 30 seconds of rest between strokes to prevent over stimulation

(b) Fast brushing:-
Stimuli: brush
Procedures: Apply it over the dermatomes to stimulate the muscle which supplies the myotome for 3 to 5 sec and repeat after 30 seconds. Facial brushing is inhibited in high cervical brain stem or spinal cord lesion to prevent autonomic dysreflexia.

(c) Icing:-
Stimuli: quick icing
Procedures: Ice is applied the skin in 3 quick swipes and it is given from insertion to origin of muscle bulk.

(d) Proprioceptive Facilitatory techniques:
Heavy joint compression: I can be given with weighted cuff or sand bags. It helps to facilitate co-contraction activity of muscles

Stretch: Activates the proprioceptors in selected muscles and imply the principle of reciprocal innervations.

Tapping: This stimulus acts on the afferent of the muscle spindles and increases the tone of the underlying muscles.It can be given on the muscle bulk with the fingertips or percussed 3-5 times

Vestibular stimulation: The vestibular system is found to activate the antigravity muscles and their antagonist muscle before the stretch reflex of the muscle spindles. It can be used to obtain extensor pattern in neck, trunk and extremities

2.Inhibitory techniques: Due to UMN lesion the muscle will go for spasticity and to reduce it inhibitory technique can be used

(a) Neural warmth: Affect the temperature receptors in hypothalamus. It stimulate the parasympathetic nervous system and relieve hypertonia, spasticity, rigidity

(b) Gentle rocking / shaking: Shifting the weight forward and backward, progressing to side to side then diagonal patterns, helps to reduce the hypertonia

(c) Tendinous pressure: Manual pressure applied to the tendon insertion of a muscle; can be used in spastic or tight muscle

(d) Maintain /prolonged stretching: Positioning in the elongated position to cause lengthening of the muscle. Spindle to reset the afferents of the mm spindle to a longer position so they become less sensitive to stretch

(e) Prolong icing: Helps to reduce the spasticity of muscle to maintain normal tone

(f) Slow stroking: Patent should be on prone lying while the therapist provides a rhythmical, moving deep pressure over the dorsal distribution of the posterior rami of the spine; done from occiput to coccyx and alternated and should not exceed 3 minutes because it causes a rebound phenomenon


 







Read more »
By No comments:
Labels:

Muscle tone and Physiology of muscle tone | muscle tone definition,effect and physiology

Neurology ,
Muscle tone and Physiology of muscle tone | muscle tone definition,effect and physiology
Muscle tone & Physiology of muscle tone | muscle tone examination

Muscle tone is defined as an increase in the resistance of a muscle tone during passive range of motion.
                                               
                                                       OR                                                                                                                                   
Muscle resistance to passive stretch during resting state.       

Physiology of muscle tone
physiology of muscle contraction,physiology of muscle tone
physiology of muscle tone

- Tone is responsible to maintain the posture
- Muscle consist of muscle spindle and each spindle contain specialized muscle fibers they are 
intrafusal fibers and extrafusal fibers
The intrafusal fibers are (a) Nuclear bag fibers
                                       (b) Nuclear chain fibers
 In nuclear bag fibres their nuclei are clustered together in a bag like enlargement near the center of the fibres.
- In nuclear chain they donot have any enlargement and their nuclear chain has been arranged in chain fashion

- Thus both nuclear fibers have the contracting ability
- And the nuclear bag have greater diameter than the nuclear chain. So a typical muscle spindle might have 8 nuclear chain and 2 bags

- In this nuclear chain is attached to the nuclear bags, which in turns attached to the endomysium of the extafusal muscle which is the large contractile fibers.

- Thus intrafusal muscle consist two types of fibers which has both motor and sensory innervations and one or two gamma motor neuron

- So firing of gamma motor neuron will stimulate the intrafusal muscle fibers to contract
- Which activate the reflex action

- And an impulse from intrafusal muscle fibers passes through afferent fibers (1o sensory nerve fibers) and reaches the anterior gray horn of spinal cord

- Which stimulate alpha motor neuron
- Sending impulse to extrafusal fibers through efferent fibers and this will result in the contraction of muscle fibers

Effect:

Due to lesion in the UMN & LMN cause abnormal muscle tone:
(a) Hypertonia : Increase in the muscle tone on passive movement.eg: spasticity , rigidity (lead pipe and cog wheel)

(b)Hypotonia : Decrease in the muscle tone on passive movement. eg: flaccidity, floppy


(c) Myotonia : It is a congenital disease characterized by continuous contraction of muscle and slow relaxation even after the cessation of the voluntary action
Read more »
By 1 comment:
Labels:

October 26, 2017

Myasthenia gravis pathology | Myasthenia gravis pathogenesis

Neurology ,
Myasthenia gravis pathology | Myasthenia gravis pathogenesis
Myasthenia gravis
Myasthenia gravis is a neuromuscular disorder characterized by weakness and fatiguing of some or all muscle groups, weakness worsening on sustained exertion, or towards the end of the day, relieved by rest.

Aetiopathology
- In humans MG cause reduction of acetylcholine receptor sites in the postsynaptic folds
- Antibodies bind to the receptor sites resulting in their destruction. These antibodies are referred to as acetylcholine receptor antibodies.
- Reduced receptor synthesis and increased receptor destruction as well as well as the blocking of receptor response to acetylcholine is responsible for the disorder.
Myasthenia gravis Pathology,Myasthenia gravis defination
Myasthenia gravis
Clinical features:
Fatigue
Muscle wasting
Weakness of facial muscles
Ptosis
Nasal quality to speech
Weakness of jaw muscle – mouth remain open
Dysarthria
Dysphonia
Dysphagia
Weakness of neck muscle
Most commonly proximal muscle are affected

Sub division of clinical features:
 Class 1-          ocular muscle only
Class 2-           mild generalized weakness
 Class 3-          moderate generalized and mild to moderate ocular-bulbar weakness
Class 4-          severe generalized and ocular-bulbar 
                       weakness
Class 5-          Myasthenic crisis

Total: Class 1 (20%)
Class 2,3,4,5 (80%)

Management
Medical treatment:
 Anticholinesterase drugs 
 Steroids
 Immunosuppressants other than steroids
 Thymectomy 

Physiotherapy treatment
(a) Goals
- Myasthenia patient should find optimal balance between the physical activity and rest
- It’s not able to cure the weakness by active physical training, so low to medium intensity training is     recommended
- Enhance ability to function daily
- Decrease risk of falling
- Completion of functional tasks and maintenance of independence

(b)General exercise programs
- Should be done progressively
- Range of motion (flexibility) to light resistance to full resistance – Start with lower prescription : 3     sets of 5 reps
- The primary goal of therapy is to build the individual's strength to facilitate return to work and             activities of daily living
- Do not overdo resistive training to the point of fatigue

Type of exercise for strength are as follows :
Aerobic Exercises
Strength exercises 
Swimming
Postural exercise
Breathing exercise

(c)Postural exercise
-Important in assisting with breathing, speaking and swallowing
-Keeps bones and joints in the correct alignment so that muscles are being used properly
-Prevents fatigue because muscles are being used more efficiently, allowing the body to use less   energy

(d)Breathing exercise
- Help improve lung function
- Include inspiratory muscle training
- Pursed lip breathing
- Diaphragmatic breathing
- These exercises can improve respiratory endurance as many people with MG have affected                   respiratory muscles

(e) Exercise intensity
- The therapist has to look for the vitals after each sets of exercise
- During the time of exercise the symptoms should not be worsen
- Exercise peak dose is taking pyridostigmine
Read more »
By 2 comments:
Labels: