Among the different variants of cerebral palsy (CP), spastic diplegia has a greater frequency than the other variants, with each subtype having a diverse clinical presentation. Pelvic asymmetry is observed frequently in children with spastic diplegia which influences the functional abilities of the child such as balancing abilities and independent walking. Currently, physical therapists tackle this condition through numerous strategies of treatment, with each treatment strategy having its own significance. This case report emphasizes the effectiveness of pelvic proprioceptive neuromuscular facilitation (PNF) techniques in optimizing the balance and gait parameters in an eight-year-old female child who presented with spastic diplegia. The child came into the outpatient Department of Neuro Physiotherapy with complaints of delay in attaining milestones according to her age as well as her inability to balance and walk on her toes. History revealed that there was a delayed cry pointing toward birth asphyxia and the linkage of birth asphyxia in the emergence of CP. Pelvic PNF has a beneficial impact on optimizing trunk control and stability. This research presents evidence that pelvic PNF optimizes the balancing capacities and gait parameters and rectifies the malalignment of the pelvis in children with spastic diplegia. The findings of this case report prove that pelvic malalignment which influences the balance and walking abilities of the child can be rectified and tackled with pelvic PNF techniques.
Guillain-Barre syndrome (GBS) is a rare inflammatory demyelinating polyradiculoneuropathy characterized by motor impairment, progressive, ascending, symmetrical flaccid limb paralysis, areflexia or hyporeflexia, and with or without cranial nerve involvement, which are the hallmark clinical indications of GBS, which can last over weeks to months. Miller-Fisher syndrome (MFS) is a post-infectious localized variant of GBS that includes ophthalmoplegia, ataxia, and areflexia, and is often associated with lower cranial and facial nerve involvement. In this case, a 22-year-old young man was taken to a hospital after 10 days with complaints of bilateral symmetrical upper extremity and lower extremity paralysis, with the legs being more afflicted than the arms. For the past six days, he had an episode of fever, slurred speech, bilateral eye drops, and swallowing difficulty. On examination, the patient was identified with MFS, a variant of GBS. On the first and last day of treatment, the patient's outcome measures were recorded on Manual Muscle Testing, Hughes (GBS disability score), and the Functional Independence Measure Scale. Treatment options have been shown to reduce challenges and improve patient outcomes and quality of life, all of which are important at this stage. This case study concluded with a rehabilitation program that helped the patient to enhance his strength, range of motion, functional mobility, postural control, balancing abilities, weight-bearing, and prevent secondary impairments.
BackgroundAmong several variants of Cerebral Palsy, Spastic Diplegic is encountered most commonly in clinical setups. A majority of children with Spastic Diplegia manifest themselves with a disturbance in the geometrical orientation of their pelvis, which imposes an effect on their functional capabilities like walking with independence. This research had an emphasis on the extraction of the efficacy of Pelvic Proprioceptive Neuromuscular Facilitation (PNF) Techniques on Balance and Gait Parameters in children suffering from Spastic Diplegia. MethodParticipants included in the study were between the age groups of 8 to 12 years who were diagnosed with Spastic Diplegia with an independent sitting and walking ability and who are coming in stages I to III according to Gross Motor Function Classification System. Subjects in group A were given Pelvic PNF techniques for 15 minutes on both sides along with Task-Oriented training for 30 minutes, six days a week and continuously for four weeks, while the subjects in group B were given only Task-Oriented activity for the same duration. The pre-and post-treatment assessments of all 40 subjects were gathered using the Paediatric Balance Scale, Palpation Meter device, and Gait Parameters. ResultsThe study included 40 participants, which were segregated into two groups of 20 subjects in each group. Group A received Pelvic Proprioceptive Neuromuscular Facilitation with Task-Oriented Training, and group B received only Task-Oriented training activities. The contrast of pre-and post-treatment findings of both the groups revealed that group A reported a significant improvement in their outcomes (P>0.0001). ConclusionThe present study, which included 40 subjects, has generated evidence regarding the efficacy of Pelvic PNF on Balance and Gait Parameters in children with Spastic Diplegia.
An abrupt hemorrhage or ischemia causes acute onset of stroke. The characteristic feature of hemiplegia is the loss of voluntary movement with the alteration of muscle tone, reflexes, and sensation. In this case, we present a 56-year-old man who suffered from right hemiplegia, facial palsy, and expressive aphasia. The MRI of the brain revealed a hemorrhagic transformation of acute infarct in the left frontoparietal-temporooccipital lobe. The patient was managed immediately by medical interventions. The physiotherapy treatment was initiated after the stabilization of acute symptoms at an early stage. This case report details the management of the patient with physical therapy and highlights the advantages of exercise therapy, particularly the proprioceptive neuromuscular facilitation technique for enhancing the patient's condition by incorporating physiotherapy protocol from an early stage.
Intracerebral haemorrhage, the most lethal form of stroke, accounts for almost a third of all strokes. The brain receives and expels blood through blood arteries. Veins or arteries may rupture due to trauma, improper development, or excessive pressure. Blood itself has the potential to harm brain tissue. Here, we discuss the case of a 36-year-old individual who experienced giddiness, two to three seizure episodes, and left extremity weakness. Investigation revealed an intracerebral bleed. Physiotherapy was necessary to enable the patient to carry out his everyday activities comfortably in addition to medical management. The patient's condition was improved with the help of a physiotherapy protocol.
As a result of non-progressive brain damage, cerebral palsy (CP) has traditionally been seen as a disorder of movement and posture; however, more recent classifications enable clinicians to understand more than just the movement issue. Research has evolved with the accurate categorization of cerebral palsy into distribution, motor type, and functional level. Children with spastic diplegia usually have pelvic asymmetry, which affects the child's functional abilities, including their ability to balance and walk independently. Physical therapists currently treat this illness using a variety of treatments, each of which is significant in its own way. A model for enhancing organizational capabilities is clinical management in physical therapy, which incorporates effective practices supported by research and improves outcomes. This case study demonstrates the efficiency of a deliberate physical therapy strategy to enhance functional independence in a three-year-old male child with spastic diplegia. The young patient complained of difficulties with balance and toe-walking and a delay in reaching age-appropriate milestones when seen in the neuro physiotherapy outpatient department. History demonstrated that a delayed cry occurred with an abrupt onset of fever, foaming at the mouth, and other symptoms described.
Acute demyelinating inflammatory polyneuropathy is a variant of Guillain-Barre syndrome (GBS) -an asymmetrical condition that primarily affects the segment of the peripheral nervous system. Weakness or tingling sensations that be commenced in the inferior limbs and progress to the brachium and face are early signs of this condition. Physiotherapy plays a very crucial role in acute demyelinating inflammatory polyneuropathy in combination with medical management. Criteria through which the clinicians conclude the same are marked affection in the proximal musculature, lower motor neuron type of manifestation, and commencement of symptoms in an ascending sequence. In this study, we presented a case of a 62-year-old male who manifested with the complaint of bilateral superior and inferior limb weakness and was admitted to our hospital. He was diagnosed with acute demyelinating inflammatory polyneuropathy after investigations, such as a lumbar puncture, which revealed a raised level of proteins in cerebrospinal fluid (CSF). With these complaints, he was referred to the physiotherapy wing, and physiotherapy rehabilitation was commenced. Thus, we concluded from this study that in the case of acute demyelinating inflammatory polyneuropathy, physiotherapy rehabilitation was proven to be fruitful in the speedy recovery of the patient and preventing secondary complications along with improving strength and activities of daily living (ADLs) and enhancing the overall quality of life.
A stroke is a medical emergency characterized by a sudden onset of focal neurological deficits due to an interruption in the blood flow to the brain tissues, with signs and symptoms persisting for more than 24 hours. Motor, sensory, recognition, language, and perceptual deficiencies are typical signs of the disease, depending on the areas affected, the size of the injury, and the origin of the injury. Patients who have had a stroke frequently have problems like weakness, stiffness, and altered movement patterns in addition to poor balance and mobility issues. Numerous physiotherapeutic strategies concentrate on helping stroke victims recover quickly. Stroke-related mortality rates have decreased over the past few decades due to advancements in stroke therapy and rehabilitation. One approach that can be primarily used to normalization of tone is facilitation by Rood's technique. The present case report is of a 45-year-old female with a history of hypertension presented with complaints of weakness on the right side of the body. The patient had right hemiplegia with more involvement of the right upper extremity. The patient underwent a decompressive craniotomy. On investigation, the magnetic resonance imaging (MRI) report revealed an area of blood density attenuation with multiple air foci in the left gangliocapsular region. Treatment was started after the patient was operated on. An approach-oriented rehabilitation program was planned for the patient. Physiotherapy maneuvers such as the proprioceptive neuromuscular facilitation (PNF) approach and Rood's approach were used to restore and normalize functional potencies and recover the patient's condition. Oral facial facilitation was also used for swallowing frequency control, sensory awareness, and motor control. Posttreatment changes such as changes in muscle tone, strength, and mobility, which are essential for patients with the activity of daily living (ADLs), were observed. Outcome measures used in this patient are the Functional Independence of Measures (FIM) scale, Brunnstrom grading, voluntary control grading, and the National Institute of Health Stroke Scale (NIHSS).
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