Physical therapy is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention through therapeutic exercise, physical modalities, assistive devices, and patient education carried out by physical therapist.
Our unit is well equipped with TheraSuit, Universal Exercise Unit, Spider Cage, Paraffin Wax Bath, Walkers, Treadmill, Hydrotherapy, Exercise therapy equipment, and Electro therapy modalities.
Intensive Rehabilitation Process includes initial evaluation and treatment program.
EVALUATION PROCESS:
- General Evaluation, Gross Motor Evaluation using GMFM (Gross Motor Function Measure) 88 Scale or Gross Motor Movements and Milestones, Orthopedic Examination (which includes Range of Motion, Manual Muscle Testing, Spasticity Grading, Orthopedic Special Test, Posture and Gait Examination) and Clinical Risk Examination.
- Obtaining signature from parents in patient information, sickness policy, and informed consent form.
- Discussion with parents regarding assessment, evaluation outcomes, therapy approach, expecting therapy outcomes and home plan/program.
TREATMENT PROGRAM:
Intensive physical therapy program is for 2-3 hours per day, 6 days per week for 3 weeks, and 3 days per week for 8 weeks thereafter.
- 30-60 minutes of preparation time, including moist heat/whirlpool bath, massage, soft tissue lengthening techniques, stretching, joint mobilization, and sensory preparation.
- One hour of exercise and functional activities in the TheraSuit™.
- One hour of exercises and functional activities by using Universal Exercise Unit, Equicizer, and other exercise therapy equipment.
METHODS OF TREATMENT:
1.THE THERASUIT: A soft dynamic proprioceptive orthosis consisting of a cap, vest, shorts, knee pads, arm attachments, and shoe attachments. All the mentioned above elements of the suit are connected with each other through a system of elastic bands. Its goal is to improve and change proprioception (pressure from the joints, ligaments, muscles), reduce pathological reflexes, normalize muscle tone, increase correct movement patterns, and strengthen muscles by providing resistance to movement. The patient performs exercises and functional activities, such as transitioning between positions, functional activities and walking, while in the suit. The input the suit provides to the neuromuscular system helps to retrain the brain to produce correct movement patterns.
2.THE UNIVERSAL EXERCISE UNIT: The Universal Exercise Unit or cage is used in two different ways: The monkey and spider cages allow a huge variety of activities, which can specifically address areas, which need improvement while allowing a child to experience the thrill of independent movement. Goals of the exercise is to counteract (prevent) muscle atrophies, to improve muscle strength, to increase Range of Motion (both Active and Passive), to prevent joint contractures, and improve (normalize muscle tone).
- Pulley System: Utilizes a system of pulleys and weights to isolate and strengthen specific muscles. The unit is used to teach the patient the normal pattern of movement and to strengthen muscles associated to the pattern. By induction of resistive force (weights) and isolating weakened muscle or group of muscles, while gravitational force is eliminated, the exercise can be focused on a particular proper movement.
- Spider cage: Uses a belt and bungee cord to either assist upright positioning or provide resistance when pushing to stand. The spider cage can allow a child to stand without a therapist’s assistance while allowing freedom of movement and facilitating balance, trunk control, and reaching. In this device, the patient can move without fear from falling and it will eliminate gravity to a calculated degree, making the weight of the body lighter. The decrease in body weight, by a system of elastics and special belts, will make the patient practice with maximum safety and easiness therefore; the normal pattern of movement thought in addition to the development of muscle strength.
3.HYDROTHERAPY:
- Whirlpool therapy: Water always relaxes and warm water especially, encourages the muscles to relax and eases any pain and discomfort in joints making it easier to exercise. Where the child suffers from a decreased range of joint movement, the reduced gravity in a heated pool improve the child’s range of movement. Where he or she is suffering from muscle weakness, the gentle resistance of water to movement helps increase muscle power. By pushing their arms and legs against the water, children improve their muscle strength. Experience also shows that bathing increases social interaction, builds confidence, provides sporting opportunities and help mobility, all of which are intrinsic to successful therapy.
- Paraffin wax bath: Paraffin wax heat therapy bath is one of the superficial heating modalities that we use in our physiotherapy set up. This modality speeds healing, and soothes soft tissues and muscle pains and will increase the range of motion by decreasing the joint stiffness.
- Moist heat: Another superficial heating modality used to warm the muscle, relax muscles and increase range of motion. In a moist heat treatment, a hot pack is placed on the specific area for about 10 or 15 minutes.
4.EXERCISE THERAPY: Exercise therapy can take many different forms. Through active graded exercises, patients put directly into an exercise program aimed to develop muscle tone or reduce muscle spasticity, increasing endurance and strength, as well as improving activities of daily living. Emphasis is on optimal grading to increase the tolerance for loading and to normalize muscle imbalance and coordination. Our exercise therapy unit is well equipped with treadmill (including new vest and suspension system), parallel bar, stairs with rails on both sides, children exercise training chairs, double wall pulleys, manual gait trainer, weight cuffs, Dumbbells, bicycle, horse rider, children ladder chair, wall bar, posture correction chairs and mirror, standing frame, balance board and coordination mat, crawling barrel, wedges, bolsters, immobilizers, therabands and therapy balls.
NEW EXERCISE EQUIPMENT HAS BEEN PROCURED FOR PATIENT USE:
- Intelligent Movement Rehabilitation Trainer ZEPU k-2000. Arm & Leg Ergometer
- C1 Intelligent Feedback System
- Various exercise wheels (Shoulder, Hand, Wrist, Power wheels)
- Multi-function mini bike
- Upper limb exerciser
- Upper/Bottom limb pulley trainer
- Adjustable finger ladder
5.ELECTRO THERAPY: Electrotherapy is used for relaxation of muscle spasms, prevention and retardation of disuse atrophy, increase of local blood circulation, muscle rehabilitation and re-education, electrical muscle stimulation, maintaining and increasing range of motion, a rehabilitation and preventive tool for partially or totally immobilized patients;
- Electrical muscle stimulation (EMS): Also known as neuromuscular electrical stimulation (NMES) or electromyostimulation. This is the elicitation of muscle contraction using electric impulses. The impulses generated by a device and delivered through electrodes on the skin. In direct proximity to muscles stimulated. The impulses mimic the action potential coming from the central nervous system, causing the muscles to contract. The electrodes are generally pads that adhere to the skin.
6.CONVENTIONAL THERAPY:
- NDT or Bobath Techniques: The Bobath concept is a broad and ever-evolving approach in neurological rehabilitation applied in patient assessment and treatment of children with cerebral palsy. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through initiation and completion of intended tasks.
- Roods Approach: This approach is used to normalize the tone by using facilitatory or inhibitory techniques.
7.EARLY INTERVENTION:
This approach is a therapeutic intervention to promote the development of movement (motor) skills with the children of delayed development.
8.EQUICIZER:
This therapy helps to improve the lives of children with physical, mental, and emotional challenges. The Equicizer is warm, friendly in appearance, and built incredibly strong. Providing a continuous, rhythmical motion with client mounted on its back.
Most common benefits reported include increased physicality, facilitation of normal movement patterns including protective extension and righting reactions, development of equilibrium reactions in trunk for improved posture, weight bearing, balance, and maintenance of trunk symmetry, increase in motivation & self-confidence, improved concentration and self-control, improved spatial awareness, better body image, and a sense of achievement.
Physical therapists incorporate the multi-dimensional movement of the horse to achieve balance, postural/core control, strengthening and range of motion. Improvement in gross motor skills and functional activities is seen. Impairments are addressed through the variability of the horse’s movement by modifying the rhythm, tempo and cadence of the horse’s movement.
On the other hand, Occupational therapists providing Hippotherapy utilize the movement of the horse to improve motor control, coordination, bilateral integration, balance, attention, sensory processing and performance in daily tasks.
Sensory processing via Hippotherapy simultaneously addresses the vestibular, proprioceptive, tactile, visual and auditory systems. Characteristic movements of a horse to provide carefully graded motor and sensory input. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities.