Muscle length is known as the length at which muscle is able to generate the maximum amount of force. This length is determined by the joint angle corresponding to that muscle. Length of muscle is an important parameter of length-tension relationship. Muscle functions and its mechanics helps in surgical decision making, to establish primary ergonomic advice recommendations and to form a structure of recovery program using the benefits of length-tension relation. Understanding the optimal muscle length as well as its comparison between the extremities is very important as a part of examination in physiotherapy, particularly in the cases of musculoskeletal disorders. Several tests are available for testing the muscle length. However standardize and reliable tests are been chosen to prevent the error while testing as such measurement of hamstring, iliopsoas, rectus femoris and gastrocnemius length is been acquired through standard goniometer. The methods used for the assessment comprised of; active knee extension (AKE) tests the hamstrings, Thomas and modified Thomas test to evaluate iliopsoas and rectus femoris while prone, figure-four position accompanied by dorsiflexion for gastrocnemius. Many studies have done and their results had shown that there was difference in the lengths of muscle of lower extremity which was assessed in different players along with that normative data about the length of muscle was established. However there is paucity of study on the muscle length testing of individuals who are completely normal who are not having previous history of trauma to their lower limbs and those who are not an athlete.
Down syndrome (DS) is characterized by the presence of all or a portion of the third chromosome 21. In this population, congenital heart disease (CHD) is the primary cause of death and morbidity in the first two years of life. Atrioventricular septal defect (AVSD) is the most common CHD seen in DS patients, followed by an atrial septal defect (ASD), ventricular septal defect (VSD), and tetralogy of Fallot (TOF). There is a high possibility of serious cardiac abnormalities in DS patients thus; there must be a protocol in place for early screening, prompt diagnosis and early operative measures. Due to advancements in technique and postoperative care over the last few years, the prognosis following surgical repair has substantially improved. Most of the post-operative strategies for patients with CHD can be applied to patients with DS. Physiotherapists play an important role in managing patients after the surgical repair of cardiac abnormalities. They also help in facilitating physical activity in children with DS. Our case report aims to provide the post-operative physiotherapy protocol for a child with DS operated for the closure of ASD and VSD along with the ligation of Patent Ductus Arteriosus (PDA). The main aim of post-operative cardiac and respiratory physiotherapy management was to clear lung secretions, promote healthy healing of the incision, maintain patency of lungs, reduce work of breathing and improve chest mobility while addressing delayed developmental milestones. The case report illustrates the importance of inpatient post-operative physiotherapy management which will lead to a gain in the existing knowledge while dealing with such patients.
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