Encephalitis: How Physiotherapy management helps in reducing the inflammation of the Brain?

Does anyone among your loved ones suffer from encephalitis? And do you want to help them to understand and adapt to the condition and simultaneously recover from this condition? Then, this can be achieved by advising them to follow a rehabilitation program. A rehabilitation program can help to provide a safe environment and gentle stimulation to encourage the process of spontaneous recovery. A physiotherapist is part of this rehabilitation team. A well-trained and experienced physiotherapist teaches self-care, work, and daily activities that help to improve the quality of life. Through this blog, we can throw some light on this condition and the various interventions used by physiotherapists to treat a patient suffering from encephalitis.

 

What is Encephalitis?

Encephalitis is the irritation and inflammation (swelling) of the brain. This condition occurs more often in the first year of life and decreases with age. Young and elderly patients are more likely to have severe symptoms. It can be caused by a viral infection, contaminated food or drink, mosquito, and other insect bites or coming in contact with an infected person, an allergic reaction to vaccinations, autoimmune disease, few bacteria, and parasites may also be a cause. It can also be caused by the herpes simplex virus, the leading cause of severe cases in all ages, including newborns, babies suffering from encephalitis may have a problem with swallowing, speaking, balance, and coordination. It can cause mild symptoms like cold or stomach infection, mild fever, mild headache, low energy, clumsiness, poor appetite, unsteady gait, confusion, sensory issues, problems with movement, and seizures. The signs and symptoms of patients vary from patient to patient. It can cause mild to severe symptoms, and there are rare cases in which this condition becomes life-threatening. Several studies have revealed that even patients with active SARS – Co V- 2 infections can suffer from encephalitis. Treatment is given to provide supportive care, rest, nutrition, and fluids that help the body fight the infection and relieve symptoms. Emotional support and reorientation for confused or delirious people may be helpful.

 

Physiotherapy management:

Encephalitis causes a variety of physical symptoms that can be improved by physiotherapy treatment. Physiotherapy helps the patient to return to normal life as soon as possible. It helps to regain and relearn the skills of everyday living. The physiotherapist suggests some modifications and advises keeping the home or workplace safe.

Physiotherapy begins with an evaluation, and assessment of the patient's medical history, range of motion, strength, neurological involvement, and functional level.  And accordingly designs a treatments program according to the patient's needs.

 

Exercises:

Special exercises are recommended to the patient to help make the bones and muscles stronger. The physiotherapist uses various exercises to improve muscle strength, balance, overall flexibility, mobility, and motor coordination.  The physiotherapist also teaches special skills so that patient becomes independent in activities like bathing, dressing, eating, cooking, driving, etc.

 

Massage Therapy:

Massage therapy is a manual method used by physiotherapists that helps to restore movement and function of muscles and joints, It also improves circulation and eliminates metabolic toxins stored within muscles.

 

Acupressure:

Acupressure is a manual technique in which pressure is applied to the body on the specific, this relieves pain and promotes balance among the physiological systems. There are different acupressure points that correspond to different areas of the body. For example, when pressure is applied to the area between the thumb and forefinger, the intensity of the headache is decreased.

 

Aquatic therapy:

Aquatic therapy utilizes Hubbard tanks or whirlpools to allow individuals to exercise in a warm, buoyant, gravity-eliminated environment.

 

Transcutaneous Electrical Stimulation:

Transcutaneous electrical stimulation passes electrical currents through surface electrodes to provide pain relief and also helps in muscle re-education.

 

Thermotherapy:

Thermotherapy enhances blood flow, increases the extensibility of soft tissues, increases the function of the tissue cells, and helps relieve pain.

 

Therapeutic Ultrasound:

Therapeutic ultrasound converts electrical energy into mechanical sound waves that provide heat to deeper muscles, tendons, ligaments, and bones.

 

Range of motion Exercises:

Simple range of motion exercises is done on regular basis to maintain movement and flexibility of joints and muscles. In the case of encephalitis in babies emphasis should be on practicing sitting up against gravity and crawling.

 

Fine Motor Exercises:

Fine motor skills exercises are used to improve cognitive function, especially in case these skills have been impaired. Some examples of fine motor exercises are therapy putty exercises, stretching rubber bands, stacking pennies, and Jigsaw puzzles.

 

Strengthening Exercises:

As the patient with encephalitis suffers some brain damage. The problems associated with brain damage are weakness in the legs, arms, and torso. Encephalitis baby may not be able to crawl or may have difficulties in sitting up and standing therefore strengthening exercises are done.

 

Stretching Exercises:

Stretching exercises are done to decrease stiffness and tightness in the joints. Also, passive manual stretches are recommended to maintain muscle length and range of movement.

 

Cognitive Exercises:

Physiotherapy helps to improve cognitive functioning, mental health, and memory. The brain is stimulated through an activity that causes more neurons to fire, which helps to keep the brain operating properly. It is especially important to exercise the brain so that it can engage neuroplasticity, which is the brain's natural ability to rewire itself. E.g. repeat numbers and letters, rhythm matching, card recall, color sudoku, etc.

Physiotherapy teaches tips and methods to minimize the symptoms and maximize their ability to grow and develop.

Muscular Dystrophy: Regaining Muscle Function and Control by Physiotherapy

Muscular dystrophy (MD) is a progressive condition that begins by affecting a particular group of muscles and slowly involves the other muscles widely. It causes muscle weakness and loss of muscle control, it can even affect the heart or the muscles used for breathing and can become life-threatening. MD is an inherited genetic condition that gradually causes the muscles to weaken, leading to an increase in the level of disability. Though there is no cure for Muscular dystrophy, still treatment can help to manage many of the symptoms. These treatment interventions include physiotherapy that helps the patient with physical disabilities, lessens symptoms, and increases mobility. The physiotherapist can also help to keep the muscles strong and flexible, thus the patient should start working with the physiotherapist as soon as he/she is diagnosed with MD. This blog has been written to discuss physiotherapy management for patients suffering from muscular dystrophy.

 

Muscular Dystrophy

Muscular dystrophy is a deteriorating muscle-wasting condition caused by a mutation in the genes (responsible for the structure and functioning of a person's muscles) and is often inherited from a person's parents. It causes obstruction of the muscles' ability to function and over some time, this causes increased disability and can even affect the life span of a person.

Muscular Dystrophy is of many different types, and patients, children, or young adults have slightly different symptoms. For most people, the condition might worsen over time, and may lose the ability to walk, talk or care for themselves. But not all types bring about severe disability and many do not affect life span.

 

Physiotherapy Management

Physiotherapy is an approach that is required by all types of dystrophies to slow the progression of the disease progression, reduce pain, and maintain quality of life. Each child and adult may be affected differently by the disease and have unique needs. Therefore the physiotherapist develops a treatment plan according to the needs.  Manual muscle testing helps to evaluate the muscle strength and range of motion tests can measure a joint's movement. Physiotherapy treatment comprises massage, exercise, education, and advice.

 

Respiratory exercises:

Breathing exercises and techniques are recommended to maintain a person's respiratory function as well as to keep the respiratory muscles strong and the chest clear.

Specific exercises help to strengthen the throat, jaw, and tongue muscles are done so that the patient can do daily tasks, like eating, swallowing, etc.

 

Range of motion exercises:

Range of motion exercises are done to increase the movement, and muscle strength, improve daily function, and also lessen the risk of contractures. These exercises are simple and can be done regularly at home. The patient should not try to push the joints too hard as it can cause pain. Shoulder exercise involves raising the arms over the head by grasping the non-dominant arm with the dominant arm at the wrist and holding it, then raising it above the head. Hold this pose for several seconds. Then repeat the same exercise with the dominant hand grasping the non-dominant arm. Another example is in which the patient is asked to lie on the back of the bed and asked to raise one leg in the air. Then bend the leg at the knee and rotate the bottom half of the leg at the knee joint. The same is repeated with the other leg. Or this can be done by even lying on the side and lifting the leg and down slowly to help with joint mobility.

 

Low-impact cardiovascular Exercises:

Low impact exercises are done initially as high-impact exercises can cause cramps the next day. Low impact exercises such as taking a short 10-20 minute walk on flat surfaces, 10-20 minutes of regular swimming, and bike riding can be done. These scheduled exercises are energizing, rather than tiring and also relieve muscle tension. Regular exercises aim to keep muscles in shape, reduce weight, and relieve the burden on joints, tendons, and muscles.

 

Strengthening exercises:

Strengthening exercises by using light-weight 5-10 lbs, with 5-10 high-repetition strength training programs are done initially to avoid muscle injury. Gradually lightweight can be progressed to heavier weights as per the comfort of the patient. Then gradually the number of repetitions and sets are increased with the goal of 10-12 repetitions and 4 sets of each exercise, performed 3 times a week.

 

Stretching exercises:

Stretching exercises help to improve flexibility and muscle strength and also reduce muscle spasms, reduce joint and muscular contractures. For stretching, splints are designed to help stretch and support the limbs which prevent or delay contractures that can affect different parts of the body.

 

 

Orthotic devices:

The right type of brace is recommended and the patent is asked to maintain as much mobility as possible. Walking aids, calipers and orthoses can be used to provide mobility and reduce the risk of falling. Orthoses can be used on the feet to help keep the feet from pointing downward and can also be worn while walking, standing, and sleeping.

 

Positioning aids:

Patients are advised to maintain correct posture as this may elongate the muscles as well as improve the joint range in the knee, hip, ankle joints, and also in the spinal column. Several types of positioning aids, equipment, and mobility options can be used during the treatment to help improve the quality of life. Proper seating and also the right type of wheelchair are essential to help prevent scoliosis and maintain spinal curvature

 

Hydrotherapy:

Exercising safely in water gives the body an added layer of protection because the water makes the body weighs less, making the exercise even more low-impact exercises like arm circles, wrist circles, bending the elbow, flexing the fingers, and moving other joints while submerged in the water can be done.

 

As the condition progresses patients must adjust their exercise routine, this can be done by the concerned physiotherapist who assesses the patient's progress, and symptoms and makes the required changes in the treatment plan.

 

Guide to Choose a Perfect Pillow For Sound Sleep - Tips by a Physiotherapist

Do you feel pain and stiffness after waking up? Then, the reason behind it can be, disturbed sleep due to bad sleeping posture. Bad sleeping posture can lead to stress and tension in the neck and shoulders because of which the person wakes up with a feeling of discomfort or pain. Therefore it is important to sleep in a proper posture by using a comfortable pillow. A proper pillow supports the head, neck, and shoulders and helps the person have a sound sleep. An experienced physiotherapist can very well guide you to choose the right pillow, by taking a personalized assessment in resting spinal position and recommending the pillow that will optimize the patient’s rest. This blog can help you find out how to choose a proper pillow and when to replace it.

 

Physiotherapy Guide:

A proper pillow helps to maintain the alignment of the body, from the head, neck, spine, and through the spine to the chest, knees, and hips. It also helps in reducing snoring and improves breathing. Insufficient support to the neck and shoulders can put the spine and body, out of alignment, leading to strain and discomfort in the neck, shoulders, and back, resulting in sleeplessness, headaches, and neck pain.

 

Choosing a Proper Pillow

Several factors should be considered while choosing a proper pillow.  Pillows are available in varying sizes and shapes. Few characteristics make a pillow good for use and ensure the prevention of unnecessary strain on the neck and shoulders.

 

Spinal Curvature: A pillow should support the neck while resting, in such a manner that the natural curvature of the spine should maintain bone and muscle health. If the pillow is too high or too low, then it causes the neck to bend abnormally, which can strain the neck and back muscles. It can also cause difficulty in breathing, which is a sleep disturbance.

 

Relaxing: A pillow is used to provide rest and comfort to the person when sleeping. The pillow should be firm, soft, and comfortable, to relax the strained muscles and provide proper sleep.

 

Adaptable: Pillow height varies with sleeping positions, it is better to have pillows that can be adjusted according to the need and sleeping position.

 

Size:

A standard-size pillow is sufficiently large, that's fine, provided the sleeping posture is in alignment. There should be the right amount of thickness, thinness, firmness, and softness of the pillow so that the person can sleep with the head, neck, and shoulders aligned with the spine, as well as provide the right level of support and comfort during sleep.

 

Shapes:

Pillows are also made of various shapes, to provide support and stability for the head and neck. Cervical and contour pillows may help with neck and back pain, and contoured body pillows can provide stability, support, and relief for pressure points along the body.

 

Pillow Materials:

A good pillow is made from a suitable material. Latex, memory foam, and other materials are available in pillows, to provide the best comfort and support for the neck and shoulders. Memory foam pillow conforms to the individual's shape, softens and contours to the lines of the head, neck, and shoulders, and also distributes weight evenly across its surface. Down pillows are light and soft, made of different combinations of down, feathers, and other fillings, these compress around the head and neck's shape so that it is in line with the spine. Whereas latex pillows are more firm than down, but still very comfortable. Polyurethane foam pillows are suitable for all sleep positions, these pillows are responsive without having a viscous feel and have a pressure-relieving quality.

 

Fabric:

Natural, breathable fabrics should be used to cover the pillows. Pillow covers under pillowcases help to extend the life of the pillow, protecting it against stains and sweat.

 

Chemistry:

While selecting a pillow, allergies and chemical sensitivities should be taken into consideration. Synthetic materials like polyester and memory foam are made through chemical processes, and many pillows are put through antimicrobial treatments.

 

Pillow height:

In case of neck pain, a flatter pillow is a better option. Higher pillows create more craniocervical pressure, it is the spot where the head and neck join and also creates a greater cervical angle, i.e the head isn't lined up with the spine. This results in pain and stiffness if the neck stays at this angle all night.

 

Sleeping position affects pillow choice:

Almost everyone keeps on changing the position of sleeping throughout the night. A backside sleeper might also spend some time during the night on the side, the stomach sleeper shifts occasionally to one side. Therefore, a pillow is chosen that works in all sleeping positions.

 

Side sleepers:

Side sleepers need a firm and slightly higher pillow to keep the head in line with the spine, and a pillow with a bump under the neck to support it, also putting a thin pillow between the knees can help keep the spine in line with the head and neck.

 

Stomach sleepers:

Stomach sleepers may need a soft pillow or no pillow at all underneath the head if used a pillow may be kept under the stomach and pelvis which helps to prevent back pain.

 

Back sleepers:

Back sleepers may need a flat and soft pillow, to keep the head and neck in alignment. Back sleepers should use a pillow with a cervical spine curve, i.e a bit of a roll or bump under the neck and a flatter spot for the head.

 

Travelers:

During travel, the head can be kept upright by using a U-shaped travel pillow. This pillow prevents the head from getting angled to the side when sleeping in sitting up.

 

When to replace the Pillow?

Over time, pillows get compressed and lose their shape. Bed pillows should be replaced after 18 months. Memory foam pillows last longer, up to 3 years. Natural pillows tend to last longer than synthetic pillows, and also higher quality pillows last longer than inexpensive ones. To check whether the pillow has life left in it or not, some simple tests can be done:

First, take off the pillowcase and over, and examine it. Does it have stains from sweat? Is it torn? Does it smell? These are various signs of a pillow that needs to be replaced. Pillow collects dead skin cells, mold, fungus, dust mites, etc. which can cause allergies, interfere with breathing during sleep and make it harder to sleep well. The pillow should also be examined by folding it in half. If it lies there folded, rather than springing back to its original shape, then that is a dead pillow. For large, king-size pillows, fold into thirds, rather than in half. If the pillow drapes or hangs down when kept over the extended arm, then it's time to replace it.

When choosing a suitable pillow sleeping habits and personal needs should be taken into consideration as the wrong pillow can lead to headaches, and neck and shoulder pain.

 

Acid Reflux | How Physiotherapy helps in reducing the symptoms of Gastroesophageal Reflux Disease?

If you experience acid reflux frequently and suffer from gastroesophageal reflux disease (GERD) then you may need to do some exercises and make several lifestyle changes.  Exercise may help prevent or relieve the symptoms of acid reflux by helping you lose weight and support good digestion. Your physiotherapist is the professional who can recommend exercises to improve your overall health and increase your quality of life.

 

What is Gastric Reflux?

Acid reflux is a very common condition in which an individual feels burning pain in the lower chest area, known as heartburn. Heartburn happens when the stomach acid flows back up into the food pipe (esophagus). At the entrance of the stomach, there is a valve with a ring of muscles called the lower esophageal sphincter. When the lower esophageal sphincter does not close or open too often after the food passes from the esophagus to the stomach, the stomach acid flows back up to the esophagus causing acid reflux. In severe cases it is called Gastric reflux disease (GERD) a  condition, where small amounts of the stomach contents move upwards into the esophagus and are associated with severe symptoms, it may take up to hours to get rid of the discomfort. Burning pain in the upper chest or abdomen indigestion causes upset stomach, pain is often worse after eating, in the evening, or when lying down or bending over. Some of the early symptoms of acid reflux include dry cough, nausea, vomiting, pain or difficulty while swallowing food, and pain in the upper abdomen. Medication does not resolve the symptoms for all sufferers and long-term use may cause other health issues.

 

Physiotherapy Management

A well-trained and experienced physiotherapist designs a program that suits the individual's needs. Certain exercises can decrease blood flow to the gastrointestinal area, which causes gastric fluids to pool, leading to inflammation and irritation. Also, restrictive body positions can put pressure on the stomach and chest, which may trigger symptoms. Given below is the physiotherapy management for acid reflux patients.

 

Breathing Exercises:

Physiotherapists are trained professionals in breathing exercises, who can help an individual to do exercises correctly to gain the maximum benefit.  Breathing exercises, especially resisted inspiratory breathing exercises, can improve symptoms and reduce reflux. Breathing exercises help to improve diaphragm strength and reduce gastric reflux. Further progressing the exercises by applying resistance to make breathing more difficult can also help in strengthening. It can take more than a month to notice changes in strength and symptoms.

 

Weight loss:

Extra weight may cause acid reflux, it can push against the stomach and affect the lower esophageal sphincter, which can make the symptoms of acid reflux worse. Therefore losing weight is a priority, maintaining a healthy weight helps to reduce or relieve acid reflux symptoms.  For this exercising and also following a suitable diet plan is recommended. Low-impact exercise can lead to weight loss if done consistently. It may take longer to lose weight, but hopefully, an individual will have less reflux along the way.

 

Exercises:

Some types of exercise may make the symptoms worse. Though not everyone experiences worsening acid reflux with high-impact exercise. High-impact exercises such as running, sprinting, weightlifting, gymnastics, cycling, jumping rope, and stair-climbing may cause heartburn. Therefore, low-impact exercises should be tried first and see how an individual feels. If the patient doesn't experience heartburn or other symptoms, then he/she should try doing a higher-impact workout. If any discomfort is experienced, then stick to a low-impact regimen. Low-impact exercises keep an individual as upright as possible such as walking, light jogging, stationary biking, and pilates. But, avoid eating two to three hours before exercising.

 

Cycling:

Bicycling allows one to stay in an upright position, it can be a safe and asymptomatic exercise for sufferers of acid reflux. Cycling can be performed indoors or outdoors. When cycling indoors, a static cycle can be used that allows remaining in an upright position. While cycling outdoors, avoid bumpy terrain as the up-and-down motions can irritate the reflux. While cycling avoids hunching forward on the bicycle. This position places excessive stress on the stomach, which can cause symptoms of acid reflux.

 

Pilates:

With their gentle stretches and slow movements, Pilates can often be easily incorporated into a GERD sufferer's life. Though, the routines need to be modified to avoid triggering acid reflux. Avoid poses that require lying down, bending forward at the waist, or inverting the body. Although it may seem as though these restrictions rule out all Pilates poses, there are still several poses an individual can attempt. During a Pilates session, get the workout with the Plank, Saw, Side Leg Kicks, and Cat pose.

 

Walking:

Walking is good exercise for people with acid reflux. An individual can walk indoors or outdoors on a treadmill, around a track, across a beach, or down the sidewalk, these exercises do not involve excessive movement of the stomach and should not trigger reflux. It is important to stay hydrated and avoid drinking too much water during the walk since walking will cause the stomach contents to slosh around slightly. If the stomach is filled with water, this sloshing could easily lead to acid reflux.

 

Stretching Exercises for the Rib Cage and Sternum to Get Rid of Heartburn:

These exercises can help an individual get rid of the pain and other symptoms. If the pain is still too intense, one should proceed with the program step by step. Make sure to always stretch for 2 to 3 minutes.

• Bring 2 chairs and place them apart so that an individual can reach them with their hands. Place a soft mat between the chairs, kneel on it, and lay the palms on the seats. Be careful so that the arms and back do not form a straight line. The upper body should be positioned lower than the arms.  Then move the upper body to the ground, so that a stretch is felt in the chest and shoulders. Leave the elbows stretched the whole time. Hold this position for 2 to 3 minutes.
• Sit down comfortably on a chair. Take a deep breath and blow all the air out with full force until there is no air in the lungs left.  After exhaling completely, close the mouth and nose with your fingers. Make a move as if trying to suck in the fresh air, even though the mouth and nose are closed. Perform this breathing movement as long as an individual is capable of doing so. Now breathe back in normally and perform this exercise a few times to relax the chest muscles.
• Sit upright in a chair and place a mini ball under the sternum at the xiphoid process, roll in small and spiral-shaped movements along the left and right costal arch. Roll a little lower with each pass and then back to the middle of the chest.

 

Lifestyle modifications:

• Acid reflux symptoms can be reduced or relieved by:
• Eating smaller meals,
• Not lying down after eating,
• Quitting smoking as smoking impairs the lower esophageal sphincter's ability to function properly,
• Avoid wearing tight-fitting clothes or belts around the waist, which can put  pressure on the abdomen,
• Avoid bending over or exercising immediately after a meal, Reduce stress,
• Weight loss may help decrease symptoms, if the individual is overweight,
• Chewing sugarless gum after meals can help to promote saliva production, which neutralizes the acid,
• Some foods that might produce heartburn are fatty, fried, citrus, tomatoes and tomato-based foods, mint, chocolate, coffee, alcohol, and sodas. A food diary should be maintained to record foods that trigger GERD and avoid those foods

 

Sleep modification:

Sometimes sleeping might be difficult when an individual suffers from acid reflux. Therefore, some sleeping positions should be tried that may be preferred to ease the sleeping. Some of them are:

• Elevate the head of the bed about 6 inches with a wedge or by tilting the entire bed, do not use extra pillows to raise the head,
• Large wedge-shaped pillow help alleviate symptoms at night,
• Encourage an individual to sleep on the left side, right side-lying allows the acid to flow into the esophagus more easily,
• Head-up positions minimize reflux and reduce intraabdominal pressure,
• Back sleeping should be avoided,

 

Shaker Head-Lifting Exercise:

An individual should lie in the supine position on a firm and flat surface, without a pillow and arms resting by the sides. The person is asked to breathe slowly and steadily throughout the exercise. The exercise is as follows:

•  Lift the head to look at the toes and hold.
• Only the head lifts, shoulders should be kept flat on the surface.
• Hold this position for 1 minute then the head returns to the starting position.
• Repeat this exercise 2 times, and relax for 1 minute between each repetition.

 

Head Lift and Lower:

• Lift head to look toward the chin and then return to the start position, resembling a sit-up with the head. Repeat this 30 times and relax

Avoid high-impact activities such as jogging or aerobics that cause stomach contents to splash upward. Also avoid exercises that require bending over, laying head-down on an incline or turning upside-down, lying horizontally like swimming, etc. And always take care not to eat before a workout as it can also trigger acid reflux.