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NEUROLOGICAL PHYSIOTHERAPY IN THE WAKE OF GLOBAL PANDEMIC (COVID 19)

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This article reviews the basic principles that underlie the subspecialty of neurological rehabilitation. Neurological rehabilitation is in many ways different from the other branches of physical rehabilitation. Neurological Physiotherapy is able to kick-start the message pathways that your brain is struggling to use, to make new pathways through repetitive actions and exercises. Many of the patients who undergo Neurological Physiotherapy can improve symptoms such as, difficulties with loss of balance, loss of hand and arm, or leg and foot function, walking, spasticity and pain. It is a process that centrally involves the disabled person in making plans and setting goals that are important and relevant to their own particular circumstances.

IMPAIRMENT DISABILITY AND HANIDCAP

These are key concepts that form the basic principles of neurological rehabilitation. The concepts were developed by the World Health Organization in 1980 and are concerned that it is worthwhile discussing the older terms in the first instance.

Impairment is just a descriptive term. It implies nothing about consequence. Examples are a right hemiparesis, left sided sensory loss, or a homonymous hemianopia. However, a right hemiparesis can obviously be relatively mild and lead to virtually no functional consequence, or can be severe and lead to a complete inability to walk. The functional consequence of impairment is the disability.  However, neurological rehabilitation goes beyond the impairment and looks at the functional consequence and tries to minimize the impact of the disability on the individual.

Thus, neurological rehabilitation mainly deals with disability. However, the concept of handicap is equally important. Handicap is the description of the social context of the disability. A person with a right hemiparesis, for example, may have a relatively mild weakness but even a limited weakness may have profound social consequences for some people. 

How it works?

By focusing on all aspects of a person's functional independence and well-being, Neuro-rehabilitation offers a series of therapies from the medications, physiotherapy, and speech and swallow therapy, psychological therapies, occupational therapies, teaching or re-training patients on mobility skills, communication processes, and other aspects of that person's daily routine. Neuro-rehabilitation also provides focuses on nutrition, psychological, and creative parts of a person's recovery.

Many neuro-rehabilitation programs, whether offered by hospitals or at private, specialized clinics, have a wide variety of specialists in many different fields to provide the most well rounded treatment of patients. These treatments, over a period of time, and often over the lifetime of a person, allow that individual and that person's family to live the most normal, independent life possible.

Neurological rehabilitation post Covid Era

The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. The  potential neuromuscular complications of COVID-19,  assessment and mitigation of COVID-19-related risk for patients with pre-existing neuromuscular disease,  guidance for management of neuro rehabilitation  therapies, practical guidance regarding neuromuscular care delivery, telemedicine, and education, and  effect on neuromuscular research.

In this rapid Review, we consider which neurological manifestations might be expected for COVID-19, given what is known about related coronaviruses and respiratory viruses more broadly.

Neurological physiotherapists are vital to the rehabilitation efforts in the acute phase of Covid 19. Neurological rehabilitation needs may be specific to the consequence of Covid 19 for most of the people suffering from different impairments and disabilities. Neurological physiotherapy in times  played a vital role in maintaining and restoring functional ability for those with disabilities and frail older people and didn’t compromised to the rehabilitation needs of people with pre-existing co-morbidities.  Neuro-rehabilitation services were adopted and evolved with changing practise environment as lock downs and public restrictions were imposed since the outbreak of Covid 19. Some reports are also highlighting some prominent neurological consequences of Covid 19 such as Guillain–Barré syndrome (GBS), stroke encephalitis, motor peripheral neuropathy and demyelinating lesions. It is imperative that a thorough neurological assessment is carried out during the rehabilitation of people post Covid 19.

 How CB Physiotherapy plays a role.

COVID-19 placed significant demands on healthcare resources and on healthcare professionals of CB Physiotherapy as it did on health care system throughout the world.  CB Physiotherapy being one of the prominent physiotherapy chains being operational at the times of Covid adopted to best practices to minimize the morbidity related to Covid 19 for patients with neurological disorders. With enhanced and amplified effort CB Physiotherapy played a vital role in mitigating the risk related to neurological disorders pertaining in the times of Covid.

During the current COVID-19 pandemic, physiotherapists at CB Physiotherapy for Neuro-rehabilitation were vigilant for neuromuscular complications that may be directly or indirectly related to coronavirus infection. CB Physiotherapy also planned to adjust their clinical practices to prevent the spread of COVID-19 and to care for patients with NMDs and the complications they experience during this time. Considering the effects of the pandemic are expected to persist for longer than several weeks, CB Physiotherapy adapted to advanced neuromuscular educational training and tele rehabilitation programs. Neuro- rehabilitation was consulted, and practitioners have to know that this may encounter in the acute setting. Given that there is limited data on neurological symptoms, health care providers at CB physio benefit from accurate and real-life data to better treat their patients.

 Latest Developments

The face of Neurorehabilitation has progressively changed in recent years. Traditional Neurorehabilitation procedures may have limited efficacy in most patients with common neurological diseases, such as stroke, Parkinson's disease, spinal cord injury, severe brain injury, spasticity, and cognitive disorders. New technologies have been reported to enhance the effectiveness of rehabilitation strategies in these conditions. They include robotic-assisted training, virtual reality, functional electro stimulation, non-invasive brain stimulation (NIBS) to enhance the intensity and quality of Neurorehabilitation, and to manipulate brain excitability and plasticity, as well as innovative approaches such as assistive technology and demotics.

The exploration of the effects of Neurorehabilitation technologies and NIBS on plasticity through the use of advanced technologies (i.e., functional MRI, near infrared spectroscopy, high-density EEG, etc.) may represent a surrogate outcome measure in the near future. On the other hand, translational and back-translational models are important to offer robust neurobiological grounds to current rehabilitative approaches to neurological disorders.

 Conclusion

A number of Neuro-Physiotherapy approaches emerged in various places around the world throughout the 20th century, each with their own rationale and strategies that could be used to encourage recovery of movement and function in patients with Central Nervous System (CNS) injury or disease Technology and innovation in the area of neuro-rehabilitation is expanding rapidly. It is difficult to predict the next chapter for Neurological Physiotherapy. Clinical and neuro-scientific research is expanding rapidly, and advances in technology such as tele-rehabilitation, motion analysis, robotics and functional electrical stimulation will no doubt influence our practice in coming years. As such in the times of global contagion like Covid 19 followed by global lockdown , Neurological rehabilitation process have countlessly evolved in its delivery process with advance practice in neuro physiotherapy covering various aspects of this discipline that include motor relearning exercise prescription and treatment approaches.

 

Physiotherapy for better life

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Physiotherapy or Physical Therapy helps people of all age groups who have some medical conditions, illness and injury that limits the ability to function and perform a specific task. This includes Lower Back Pain, Sports and Computer related Injuries, and so on. A customized physical therapy program can help individuals return to their prior level of functioning, and encourage activities that can help prevent further injury and improve overall health and well-being. That’s why physio services are both so helpful and so in vogue.

How does it actually work?

With the help of technologically advanced equipment’s and techniques, physiotherapists try and understand more about the injury and diagnose all the disorders related to movement. Through physiotherapy they guide the patient to perform some physio exercises which will offer the patient relief from the pain or discomfort caused by the injury, thus slowly helping the person to get back to his or her daily routine. Physiotherapy can definitely be considered pre injury as well. To reduce this potential risk and imbalance, physiotherapists perform a screening and going by the findings of this screening they try and retrieve the imbalance with necessary exercise. 

Here are few reasons why you need to stick to physiotherapy. Have a look!

 

Exercise is Important– Exercise should be performed in our day-to-day lives. Your physiotherapist will assign you a number of exercises keeping your pain in mind which you can easily do at home. Sometimes the patients feel that once they show themselves to the physiotherapist and they will no longer require their physiotherapy But this is not the actual case. The physiotherapist checks the improvement and then accordingly either he/she will increase or change your exercise.

 

Movement of muscles- If you have ever suffered from injury or any such condition that is affecting your muscles you would face problems in performing your daily activities which become a problematic thing. With physiotherapy you will be able to not only move muscles but can stay fit with it. Let’s take an example; stiffness in the shoulder can cause you  Frozen Shoulder, which has proved to be the worst case. With the help of physiotherapy, you can come back on the usual level of activity and better care for themselves.

 

Manage age-related issues- As individual age; they develop many health issues such as arthritis or joint replacements Physiotherapists help the patients in covering from arthritis and joint replacements conservatively.

 

Neurological Disorder- Physiotherapy helps in the recovery of the damage caused in the brain, spine and other nerves that connect them.  Parkinson’s disease is one such illness which results in shaking of hands. Physiotherapy can help the patients with Parkinson’s to recover from it by going under a period of physiotherapy to bring back full or partial function, and to stop further deterioration from taking place.

Relief from Cardiopulmonary Diseases– Breathing issues becomes severe mostly with the growing age and it becomes interference in the day to day life. How can you overcome this cardiopulmonary issue? Yes, physiotherapy is one such solution with which you can overcome the breathing issue. Cardiac patients also receive instruction on basic movement from the physiotherapist to regain their confidence.

 

Pain Management- Whether it is a chronic pain or pain from any accident or injury, physiotherapy is the solution to get not only relief but recover from your pain, allowing you to live a healthy and balanced life.

 

There are a lot more reasons to learn about how physiotherapy can maintain health for people of all ages and help the patients to manage pain and prevent diseases. You can benefit yourself from physiotherapy at any point in your life.

Physiotherapy for Ankle Sprain

Introduction:

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An ankle sprain is an injury to the tough bands of tissue (ligaments) that surround and connect the bones of the leg to the foot. The injury typically happens when you accidentally twist or turn your ankle in an awkward way. This can stretch or tear the ligaments that hold your ankle bones and joints together.

All ligaments have a specific range of motion and boundaries that allow them to keep the joints stabilized. When ligaments surrounding the ankle are pushed past these boundaries, it causes a sprain. Sprained ankles most commonly involve injuries to the ligaments on the outside of the ankle.

Causes:  A sprain occurs when your ankle is forced to move out of its normal position, which can cause one or more of the ankle's ligaments to stretch, partially tear or tear completely.

Causes of a sprained ankle might include:

·       A fall that causes your ankle to twist

·       Landing awkwardly on your foot after jumping or pivoting

·       Walking or exercising on an uneven surface

·       Another person stepping or landing on your foot during a sports activity

Symptoms: The inflammation that comes along with a sprained ankle can cause symptoms including:

• Swelling and bruising. It may be so swollen that you can press on the area with your finger and leave an indent.
• Pain. Your nerves are more sensitive after a sprain. The joint hurts and may throb. It’s often worse when you press on it, move your foot in certain ways, walk, or stand.
• Redness and warmth. A sprain causes more blood to flow to the area.
• Instability. The joint can feel weak when the ligament is totally torn.
• Trouble walking. A sprain may limit how much you can move your ankle

Risk factors:  Factors that increase your risk of a sprained ankle include:

·       Sports participation. Ankle sprains are a common sports injury, particularly in sports that require jumping, cutting action, or rolling or twisting of the foot such as basketball, tennis, football, soccer and trail running.

·       Uneven surfaces. Walking or running on uneven surfaces or poor field conditions may increase the risk of an ankle sprain.

·       Prior ankle injury. Once you've sprained your ankle or had another type of ankle injury, you're more likely to sprain it again.

·       Poor physical condition. Poor strength or flexibility in the ankles may increase the risk of a sprain when participating in sports.

·       Improper shoes. Shoes that don't fit properly or aren't appropriate for an activity, as well as high-heeled shoes in general, make ankles more vulnerable to injury.

Diagnosis: During a physical, your doctor will examine your ankle, foot and lower leg. The doctor will touch the skin around the injury to check for points of tenderness and move your foot to check the range of motion and to understand what positions cause discomfort or pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to evaluate in more detail the extent of ligament damage:

·       X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of the bones of the ankle. This test is good for ruling out bone fractures.

·       Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed cross-sectional or 3-D images of soft internal structures of the ankle, including ligaments.

·       CT scan. CT scans can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional or 3-D images.

·       Ultrasound. An ultrasound uses sound waves to produce real-time images. These images may help your doctor judge the condition of a ligament or tendon when the foot is in different positions.

Treatment:

Medical management: Anti-inflammatory pain medications reduce pain and fight swelling. Over-the-counter drugs such as ibuprofen and naproxen work for most people.

Surgical management: Surgery for sprained ankles is rare. It may be performed when the damage to the ligaments is severe and there is evidence of instability, or when the injury doesn’t improve with nonsurgical treatment. Surgical options include:

Arthroscopy: During an arthroscopy, a surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage.

Reconstruction: For reconstruction surgery, a surgeon will repair the torn ligament with stitches. They may also use other ligaments or tendons around the foot or ankle to repair the damaged ligaments.

Physical therapy:

Physiotherapy is required with functional therapy of the ankle shown to be more efficient than immobilization. Functional therapy treatment can be divided in 4 stages, moving onto to the next stage as tissue healing allows 

1.    Inflammatory phase,

2.    Proliferative phase, 

3.    Early Remodeling,

4.    Late Maturation and Remodeling. 

Ø  Inflammatory phase (0 to 3): The goal is to reduce pain and swelling and improve circulation and partial foot support.

The most common approach to manage ankle sprain is the price protocol. Protection, Rest, Ice, Compression, Elevation

Ø  Proliferative phase (4 to 10 days): The goal is to recover the function of ankle and foot and improve load carrying capacity.

·       Patient education

·       Practice foot and ankle functions

·       Apply tape as soon as swelling has decreased.

Ø  Early remodeling (11 to 21 days): The goal is to improve muscle strength, active (functional) stability, mobility. Practice balance, muscle strength.

Ø  Late remodeling and maturation:  The goal is to improve regional load-carrying capacity, walking skills, improve the skills needed during activities of daily living as well as work and sports.

References:

·       Kolby and Kisner Therapeutic exercises edition 7

·       The comprehensive manual of therapeutic exercises by Elizabeth Bryan,2018

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