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demonstration class taken on 19/11/07

dr. ashish gohiya
assistant professor
department of orthopaedics
gandhi medical college bhopal

*the responsibility of the doctor does not end when the

“temperature touches normal and stitches are removed”
*the combined and coordinated use of medical, social,
educational and vocational measures for training and
retraining the individual to the highest possible level of
functional ability.
*(who (1969) techn. rep. ser. , no. 419)
*medical rehabilitation
*vocational rehabilitation
*social rehabilitation
*psychological rehabilitation

physical medicine and rehabilitation

*it’s not after care, it is a part of care.
*it includes
*assessment of the patient
*planning the intervention
*implementing the treatment
*altering the treatment if required.

*physiotherapy during immobilization
*physiotherapy after removal of immobilization.
during immobilization
*to reduce edema – limb elevation, static contraction of the
muscles reduce adhesions.
*maintenance of circulation
*maintain muscle function
*maintain joint range
*maintain optimal function

after removal of immobilization

*to reduce swelling
*to regain full range of movement – pain, edema, adhesion,
muscle weakness.
*to regain full muscle power
*to re educate full function
movement technique
*passive movement
*assisted active movement
*free active movement
*resisted movement
passive movement
*indicated when patient can not perform the movements on
his own
*muscle paralysis / weakness
*patient not conscious
*passive movements regain
*range of joint movement
*muscle length
passive movement
*starting position
*position of therapist
assisted active movement
*indicated when
*muscles are weak
*free movement is painful
*patient is encouraged to do most of the movement with the
physiotherapist assisting when necessary.
*suspension slings may be used for assistance
active movement
*movements performed by the patients without external
assistance or resistance.
*indicated to
*increase the range of joint movement
*increase the muscle strength
*retrain balance and coordination
*regain independence
range of movement
*protective mechanism - may be a contraindication to active
*medical treatment , electrical , thermal t/t.
*limb elevation
*static contraction of muscles
*free exercise of other joints
*stretches the adhesions
*improve the blood supply
to strengthen the muscles
*technique will depend on the grade of the muscle.
*grade 0, 1
*grade 2 (gravity counterbalanced )
*grade 3 (against the gravity )
*grade 4 (against mild resistance )
*grade 5 (normal power)
*increasing the no. of times the movement is made.
*gradually increasing the resistance.
retrain balance & coordination
*this is problem with muscle weakness and neurological
*started with forearm supported prone lying, progressing to
prone kneeling, half kneeling, sitting and standing.
*in coordination due to muscle weakness improves on
improving the muscle power.
resisted exercises
*to facilitate activity and strengthen muscles.
*resistance to the movement can be given by
*patient himself
*mechanical resistance
*electronic operated machines.

*this modality includes use of various methods of heating or
cooling the tissues.
*heating the tissues
*paraffin wax
*ir radiation
*heat pads
*hot moist packs
*short wave diathermy
*cooling the tissues
*ice therapy
paraffin wax
*low melting point 40 oc – 44 oc
*heats slowly but retains heat for long
*wax solidifies on the skin - energy released by the latent heat of
fusion results in - heating of tissues.
*only for distal part of extremities

infra-red radiation
*radiation are absorbed – radiant heat is converted to heat.
*two type of generators
*luminous – penetrates epidermis and dermis
*non luminous – penetrates only sup. epiderm
*rays should strike the part at 90o

infra-red radiation
*vasodilatation in tissues
*improves nutrition
*removes waste products
*sedative effect on sensory nerve endings
*relaxes muscles
heat pads
*plastic covered pads
*pad has three level of heating
*used for treating neck & back
*pt. lies on it, heat passes by conduction
hot moist packs
*canvas bags filled with hydrophillic substance
*part covered by towels packs applied and moulded to part
heat passes by conduction
*moist heat is conducted more uniformly than dry heat.
short wave diathermy (swd)
*application to tissues an electric field which oscillates at a
frequency of 27.12mhz& have a wave length of 11.06 m.
*the oscillating field produces distortion of molecules which
generates heat.
*the amount of heat depends on the arrangement of field
and electrical impedance of tissues

*can be used to treat both superficial and deep lesions

*rapid and greater rise in temperature than conductive methods.
*swd can be pulsed, during resting period the heat is dispersed in to
tissues through circulation and the treatment is non thermal

ice therapy
*when ice applied to skin it melts and removes the heat from
the tissues (the latent heat of fusion)
*application of cold leads to alternate vasoconstriction and
vasodilation, reduced nerve conductivity and reduction of
muscle spasm and spasticity.
ice therapy
*to relieve pain
*reduce muscle spasm
*reduce swelling
*reduce spasticity
*facilitate muscle contraction
*increase muscle endurance
*reduce hematoma formation
*prevent pressure sore
*promote healing of wounds

*production of longitudinal mechanical waves above the
audible range (20khz)
*produced by distortion of quartz crystal by a high frequency
alternating currents.
*longitudinal sound waves cause to-and-fro movement of
particles giving alternate areas of compression and

*treatment head is applied perpendicular to the surface.
*head continuously moved to prevent concentration to one
tissue site.
*higher the frequency greater the absorption and smaller the
depth of penetration.
*lower frequency deeper penetration

*release of chemical mediators
*proliferation of granulation tissue
*stimulation of fibroblast
*increased circulation
*increased activity of phagocytes & macrophages
*this results in healing and reduced pain.