Vol. 1, Issue : 03, 1st Sept.

2023

(A Quarterly Physio Magazine)

Editor
Dr. Sasanka Sekhar Parida

Editorial Board
Dr. Anjali Send
Dr. Subrata Rout
Dr. Pranati Hota
Dr. Nibedita Samal
Dr. Jagat Jaya Sharma
Dr. Basanta Kumar Singh
Dr. Priyabrata Kalikinkar Ojha

Printed, Published and owned by :

All Odisha Physiotherapy Service Association (AOPSA)

Printed at :
Maa Santoshi Offset, Brahmapur-760001 (Gm.)
 Physios' Digest September 2023

CONTENTS...
1. Significance Of Cpd For Physiotherapist In Odisha Dr. Jyotiranjan Sahoo, 03

2. Exercise as first prescribed Medicine in Todays’ Era Dr. Aurobinda Chinara 05

3. Exploring Basic Body Awareness Therapy: Dr. Srikanta Padhan 09

4. World physiotherapy day and our role as physiotherapist Dr. Sasanka Sekhar Parida 14

5. Headache and physiotherapy Dr SidharthSekharPatra 16

6. Lymphedema in breast cancer and its management Dr. Abhilash Patra 19

7. Progressive Supranuclear Palsy ... Dr. Shalini Singhal 22

8. Role of Physiotherapy in Diabetes Rehabilitation Dr. Anand Chandra Sahoo 29

9. Role of Cupping Therapy for Osteoarthritis Knee Dr. Rakesh Ranjan Nanda 33

10. Role of Physiotherapy in Stress Incontinence Dr. Neha Jeevan Kulkarni 35

11. Red Flags Developmental Disabilities Dr. Durga Prasad Mishra 37

12. Cumulative Trauma Disorders-Workplace Peril Dr. Vipsa Gupta 39

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 Physios' Digest September 2023

SIGNIFICANCE OF CPD FOR

PHYSIOTHERAPIST IN ODISHA
Dr. Jyotiranjan Sahoo, BPT, MPT(Neurology) , Physiotherapist, NISER Health Centre Bhubaneswar
Continuing Professional development Review 2. Professional Activities
(CPD) has been defined as any This stage of the CPD process • Attending a conference
process or activity that provides includes a self-directed review of your • Presenting at a conference,
added value to the capability of the knowledge, skills, performance and webinar, or at other professional
professional through increase in professional qualities in the context of learning events
knowledge, skills and personal your professional role, being mindful 3. Formal Education
qualities necessary for the appropriate of current and future practice. • Attending formal courses
execution of professional duties. Plan • Carrying out research
According to World Confederation You should identify your priority 4. Self-Directed Learning
for Physical Therapy (WCPT) the learning needs, the outcomes you • Reading articles, journals,
importance of CPD for would like to achieve and the learning and books
physiotherapists is to maintain activities that will help you achieve • Following up on questions or
competence, enhance patient care, them. topics discussed in the workplace or
and contribute to the profession’s Implement in learning environments, or following
development. This is where you take action on your up on professional curiosity
CPD activities include attending plan and undertake the learning What benefits CPD in
workshops, conferences, and activities you identified. Physiotherapy?
courses, reading research papers, and Evaluate and Reflect 1. Enhanced Knowledge and Skills:
participating in practical training This stage of the CPD process is CPD helps physiotherapists stay up-
sessions. It’s an essential aspect of about evaluating and reflecting on the to-date with the latest research,
maintaining high standards of practice impact that the learning and its techniques, and advancements in the
and ensuring that physiotherapists are integration into your professional field.
well-equipped to deliver effective practice has on quality service 2. Improved Patient Care: Updated
care. delivery and service user outcomes. skills and knowledge gained through
Regularly participating in CPD It is best practice that each stage of CPD enable physiotherapists to offer
activities allows us to continue to learn the CPD process should be better and evidence-based care to
and develop throughout our careers. documented to demonstrate how you their patients, resulting in improved
Our skills and knowledge must be ensure your knowledge, skills and treatment outcomes.
kept up to date to ensure that we are performance are of a high quality, up 3. Professional Growth: CPD
able to work safely, legally and to date and relevant to your practice. supports career advancement by
effectively. By doing this we will Category expanding a physiotherapist’s
benefit ourselves, our service and our CPD activities fall into four categories expertise and credibility, which can
service user. 1. Work Based Learning lead to increased opportunities for
Process of CPD • Reflecting on experiences at leadership roles and specialized
4 process work practice areas.
Review – Plan-Implement - Evaluate • Workplace learning and 4. Adaptation to Change: Healthcare
and Reflect training is constantly evolving, and CPD helps
physiotherapists adapt to new
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 Physios' Digest September 2023
technologies, treatments, and (innovative)&informal (learning) uploads/files/592.pdf, [Last
regulations, ensuring they remain activities of CPD to ensure their accessed on 28th December
relevant and effective in their practice. competence of pract ice.The 2010]
5. Ethical Practice: Staying updated Governments need to give utmost 2. Australian Physiotherapy
through CPD helps physiotherapists importance to CPD to enhance Association; 2010. Available
maintain ethical standards and provide patient care, also the professional a t :
evidence-based care, which is crucial bodies have to demonstrate that their www.physiotherapy.asn.au
for patient safety and trust. members are accountable, efficient [last accessed 18 December
6. Personal Satisfaction: Continuous and effective through CPD. 2010].
learning can lead to personal References 3. Mays MJ. Assessing the
fulfillment and a sense of achievement, 1. Professional Associations change of pract ice by
knowing that one is consistently Research Network: Analysis physical therapists after a
improving their skills and contributing of survey of professional continuing education
positively to patient well-being. body members on program. Phys Ther.
Conclusion Continuing Professional 1984;64:50–4.
CPD is an essential aspect in the Development (CPD), Higher 4. Seymour RJ, Connelly T,
profession of physiotherapy to Education Institutions (HEIs) Gardiner D. Continuing
maintain up to date knowledge with as providers of CPD, and education: an attitudinal
delivery of high quality patient care. online delivery, survey of physical therapists.
The Physiotherapist working in 2008.Available online http:// Phys Ther. 1979;59:399–
Odisha must involve in formal www. parnglo bal. co m/ 404.

World Physiotherapy Day celebration at DEIC, Koraput.

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 Physios' Digest September 2023

EXERCISE AS FIRST PRESCRIBED MEDICINE

IN TODAYS’ ERA
Dr. Aurobinda Chinara, Asst. Professor, Dept. of Physiology, BBMCH, Balangir
INTRODUCTION Ï% Lower heart rate and blood cancer of the colon, and type 2
Definition of HEALTH, pressure at a given submaximal diabetes
According to the World Health intensity Ï%Secondary prevention (i.e.,
Organization,is “a state of complete Ï% Increased capillary density in interventions after a cardiac event [to
physical, mental and social well-being skeletal muscle prevent another])
and not merely the absence of disease Ï% Increased exercise threshold for OTHER POSTULATED
7
and infirmity”. Due to sedentary, the accumulation of lactate in the BENEFITS
mobile addict, nuclear and virtual blood Ï% Decreased anxiety and
lifestyle NCD is in a bloom all over Ï% Increased exercise threshold for depression
the globe. Non-communicable the onset of disease signs or Ï% Enhanced physical function and
diseases (NCDs), often referred to symptoms (e.g., angina pectoris, independent living in older persons
as chronic diseases, are the leading ischemic ST-segment depression, Ï% Enhanced feelings of well-being
cause of death and disability claudication) Ï% enhanced performance of work,
worldwide, responsible for REDUCTION IN CORONARY recreational, and sport activities
approximately 71% of all global ARTERY DISEASE RISK Ï% Reduced risk of falls and injuries
deaths. India is going to become the FACTORS3,4 from falls in older persons
global capital of Diabetes. NCDs Ï% Reduced resting systolic/diastolic Ï% Prevention or mitigation of
encompass a range of conditions, pressures functional limitations in older persons
including cardiovascular diseases, Ï% Increased serum high-density Ï% Effective therapy for many
diabetes, chronic respiratory lipoprotein cholesterol and decreased chronic diseases in older adults
diseases, cancer, and obesity. serum triglycerides Mechanisms Underlying the Benefits
Lifestyle factors, particularly physical Ï% Reduced total body fat, reduced of Exercise
inactivity and poor dietary habits, play intra-abdominal fat 3.1. Insulin Sensitivity Exercise
a pivotal role in the development and Ï% reduced insulin needs, improved enhances insulin sensitivity by
progression of these diseases. glucose tolerance improving glucose uptake in muscle
Exercise as a Preventive and cells.BY INCREASED GLUT 2
DECREASED MORTALITY AND
Therapeutic Intervention
MORBIDITY5,6 PRODUCTION, This effect helps
IMPROVEMENT IN
Ï% Primary prevent ion (i.e., regulate blood sugar levels and
CARDIOVASCULAR AND
interventions to prevent an acute reduces the risk of insulin resistance
RESPIRATORY FUNCTION 1,2
cardiac event) and type 2 diabetes.8,9
Ï% Increased maximal oxygen
Higher activity and/or fitness levels 3.2. Inflammation Chronic
uptake owing to both central and
are associated with lower death rates inflammation is a common feature of
peripheral adaptations
Ï% Lower minute ventilation at a from coronary artery disease NCDs. Exercise has ant i-
given submaximal intensity Higher activity and/or fitness levels inflammatory effects, reducing the
Ï% Lower myocardial oxygen cost are associated with lower incidence production of pro-inflammatory
for a given absolute submaximal rates for combined cardiovascular molecules and promoting the release
intensity diseases, coronary artery disease, of anti-inflammatory cytokines.10

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 Physios' Digest September 2023
3.3. Metabolic Regulation Physical important for individuals with insulin supports the growth and maintenance
activity influences various metabolic resist ance or diabetes. of nerve cells. This is believed to
pathways, including lipid metabolism Endorphins: Exercise stimulates the contribute to improved cognitive
and mitochondrial function, leading to release of endorphins, which are function and memory.
improved metabolic health.11 natural painkillers and mood Glucagon-Like Peptide-1 (GLP-
Exercise triggers the release of elevators. These chemicals help 1): Exercise can increase the secretion
various hormones and chemicals in reduce stress, alleviate anxiety, and of GLP-1, which helps regulate
the body, each playing specific roles create a sense of well-being. appetite and may contribute to weight
in regulating physiological responses Dopamine and Serotonin: Exercise management.
to physical activity. These substances increases the production of dopamine The release of these hormones and
are essential for energy production, and serotonin, neurotransmitters that chemicals during exercise is part of
muscle contraction, and overall bodily play key roles in mood regulation, the body’s adaptive response to
functions. Here are some of the key pleasure, and motivation. This physical stress. They collectively help
hormones and chemicals secreted contributes to the “feel-good” aspect prepare the body for increased
during exercise.12 of exercise and its positive impact on energy expenditure, improved muscle
Epinephrine (Adrenaline): mental health. Growth function, and enhanced overall health.
Exercise, especially intense physical Hormone (GH): Intense exercise, The specific hormones and their levels
activity, stimulates the adrenal glands especially resistance training, can can vary depending on factors such
to release epinephrine. This hormone trigger the release of growth as the type, intensity, and duration of
prepares the body for “fight or flight” hormone. GH supports muscle exercise, as well as individual
by increasing heart rate, dilating growth and repair, as well as overall physiology and fitness level.
airways, and redirecting blood flow tissue maintenance and regeneration. Practical Application
to muscles. It provides an immediate Testosterone: Exercise, particularly Grades of exercise
surge of energy. Norepinephrine: strength training, can lead to a
Like epinephrine, norepinephrine is temporary increase in testosterone
released during exercise and helps levels in both men and women.
increase heart rate and blood Testosterone promotes muscle
pressure, supporting increased growth and recovery. Adenosine Every individual cannot do all grades
oxygen delivery t o muscles. Triphosphate (ATP): ATP is the of exercise(Low, Moderate&
Cortisol: Exercise, especially during primary energy currency of cells. Heavy). Exercise should be
intense or prolonged sessions, During exercise, the body increases prescribed as per age,sex, Body built
triggers the release of cortisol from ATP product ion to meet the or BMI, any history of
the adrenal glands. This hormone heightened energy demands of illness(Cardiovascular or skeletal or
helps regulate energy metabolism, muscles. Nitric Oxide: systematic) because it should be
maintain blood glucose levels, and Exercise can stimulate the production guided by the trained persons in
reduce inflammation. However, of nitric oxide, which helps relax exercise physiology otherwise
excessive cortisol production can lead blood vessels, improving blood flow exercise may result in complications
to muscle breakdown. and oxygen delivery to muscles. This rather than benefits.
Insulin: Exercise enhances the is important for endurance and Clinical Prescription Healthcare
body’s sensitivity to insulin, which cardiovascular healt h.Brain- professionals should integrate
helps regulate blood sugar levels by Derived Neurotrophic Factor exercise prescription into routine
facilitating the uptake of glucose into (BDNF): Exercise promotes the clinical practice. Tailored exercise
muscle cells. This is particularly release of BDNF, a protein that programs can be designed to address
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 Physios' Digest September 2023
specific NCDs and individual patient diseases. But there can be an Exercise 2)Nystoriak MA, Bhatnagar
needs common to all can be done mostly A. Cardiovascular Effects and
Public Health Initiatives Governments by every one that is walking Benefit s of Exercise. Front
and organizations should promote .Moderate to brisk walking. Cardiovasc Med. (2018) 5:135.
physical activity through public health Integrating exercise into daily 10.3389/fcvm.2018.00135 [PMC
campaigns, infrastructure routines, clinical practice, and public free article] [PubMed]
development, and educational health initiatives can lead to healthier [CrossRef] [Google Scholar]
programs to combat the growing populations and reduced healthcare 3)Hambrecht R, Wolf A, Gielen S,
NCD epidemic. costs, ultimately improving the quality Linke A, Hofer J, Erbs S, et al.. Effect
Lifestyle Medicine The concept of of life for millions worldwide. of exercise on coronary endothelial
lifestyle medicine, which includes SO LET’S WALK….. FOR function in patients with coronary
exercise as a cornerstone, should be LIFE… art ery disease. N Engl J
widely embraced in healthcare REFFERANCE Med. (2000) .
settings to prevent and treat NCDs. 1)Che L, Li D. The effects of exercise 4)Laughlin MH, Bowles DK,
RECOMENDED EXERCISE FOR on cardiovascular biomarkers: new Duncker DJ. The coronary
A HEALTHY INDIVIDUAL Insight s, recent data, and circulation in exercise training. Am J
Physiol-Heart C. (2012) 302:H10–
23. 10.1152/ajpheart.00574.2011
5)Anderson L, Thompson DR,
Oldridge N, Zwisler AD, Rees K,
Martin N, et al. Exercise-based
cardiac rehabilitation for coronary
heart disease. Cochr Database Syst
Rev. (2016)
6)Tao L, Bei Y, Lin S, Zhang H, Zhou
Y, Jiang J, et al.. Exercise training
protects against acute myocardial
infarction via improving myocardial
energy metabolism and mitochondrial
b i o g e n e s i s . C e l l
PhysiolBiochem. (2015)
7) Glynn A, Fiddler H. Introduction
to Exercise Physiology. In: Chambers
G. editor. The Physiotherapist’s
Pocket Guide to Exercise:
Assessment, Prescription and
Training. London: Churchill
Livingstone; (2009).
Conclusion Exercise is a powerful applicat ions. AdvExp Med 8)Stanford KI, Goodyear
form of medicine that holds immense Biol. (2017) 999:43–53. 10.1007/ LJ. Exercise and type 2 diabetes:
potential in preventing, managing, and 978-981-10-4307-9_3 [PubMed] molecular mechanisms regulating
even reversing non-communicable [CrossRef] [Google Scholar glucose upt ake in skeletal

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 Physios' Digest September 2023
muscle. AdvPhysiol on chronic inflammation. 12) Gawel MJ, Park DM,
Educ. (2014) 38:308–14. 10.1152/ ClinChimActa. (2010) 411:785– Alaghband-Zadeh J, Rose
advan.00080.2014 793. 10.1016/j.cca. 2010.02.069 FC.Exercise and hormonal secretion.
9)Conn VS, Koopman RJ, Ruppar [PMC free article] [PubMed] Postgrad Med J. 1979
TM, Phillips LJ, Mehr DR, Hafdahl [CrossRef] [Google Scholar] Jun;55(644):373-6. doi: 10.1136/
AR. Insulin sensitivity following 11) Egan B, Zierath JR. Exercise pgmj.55.644.373. PMID: 482180;
exercise interventions: systematic metabolism and the molecular PMCID: PMC2425585.
review and met a-analysis of regulation of skelet al muscle 13) World Health Organization 2020
outcomes among healthy adults. J a d a p t a t i o n . C e l l guidelines on physical activity and
Prim Care Community Metab. (2013) 17:162–84. sedentary behaviour. Br J Sports
Health. (2014) 5:211–22. 10. 1016/j.cmet . 2012.12. 012 Med. 2020 Dec;54(24):1451-1462.
10) Beavers KM, Brinkley TE, [PubMed] [CrossRef] [Google doi: 10.1136/bjsports-2020-
Nicklas BJ. Effect of exercise training Scholar] 102955.

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 Physios' Digest September 2023

EXPLORING BASIC BODY AWARENESS THERAPY: A

HOLISTIC APPROACH TO MOVEMENT AND
REHABILITATION IN PHYSIOTHERAPY
Dr. Srikanta Padhan, Ph.D. Scholar, All India Institute of Medical Sciences, Raipur
Introduction:Physiotherapy has every movement and sensory information and
witnessed a paradigm shift in recent sensation originates from the mot or responses. This
years, moving beyond conventional cohesive interplay of various principle recognizes that
approaches to encompass a more body parts. By optimal movement patterns
holistic understanding of the human acknowledging the body as arise when sensory input,
body and its complex interactions. a unified system, BBAT such as proprioception and
One such innovative technique gaining encourages individuals to tactile feedback, are
prominence is Basic Body Awareness develop a holistic seamlessly integrated with
Therapy (BBAT), a therapeutic underst anding of their motor control. Through
modality emphasizing heightened physical experiences and BBAT, individuals learn to
body awareness and mindful movements. harmonize these
movement.1 BBAT offers a unique  Mindfulness and components, resulting in
perspective that integrates principles Awareness: At the heart of smoother, more efficient, and
of embodiment, mindfulness, and BBAT lies the practice of controlled movements that
sensorimotor integration to enhance mindfulness – cultivating support functional activities.
rehabilitation outcomes.2This article heightened awareness and  Exploration and Self-
delves into the principles, techniques, presence in the moment. By Discovery: BBAT
clinical applications, efficacy, and fostering a non-judgmental, encourages individuals to
potential advancements of BBAT present-focused awareness embark on a journey of
within physiotherapy. of bodily sensations, movement exploration. By
Principles of Basic Body movement, and emotions, engaging in guided sequences
Awareness Therapy3: At the core BBAT enables individuals to of movements, patients gain
of BBAT’s effectiveness lie a set of tune into their bodies’ signals. insights into their own range
fundamental principles that shape its This mindfulness enhances of motion, muscle activation
philosophy and practice: movement quality, facilitates patterns, and joint mobility.
 Embodiment and the detection of subtle This process promotes self-
Integration: BBAT changes, and empowers discovery, helping individuals
recognizes the inseparable patients to adapt their actions recognize t heir unique
connection between the in response to their body’s movement tendencies and
body and mind, treating them feedback. areas of improvement.
as an integrated unit rather  Sensorimotor Integration:  Non-Judgmental Self-
than separate entities. This BBAT places significant Perception: BBAT fosters a
principle emphasizes that emphasis on the integration of positive and non-judgmental
attitude towards one’s body
9 and movements. This
Physios' Digest September 2023
principle helps individuals  Holistic Wellness: Beyond deliberate movements as well
overcome self-criticism or addressing physical aspects, as dynamic patterns. By
negative perceptions, BBAT recognizes t he consciously experiencing
promot ing a sense of influence of emotional and movement through different
acceptance and trust in their psychological factors on planes and ranges of motion,
body’s capabilities. This movement and well-being. individuals develop a better
compassionate perspective By nurturing a positive body- understanding of their body’s
encourages pat ients to mind connection, BBAT capabilities and limitations.
engage in movements without contributes to emotional  Body Scanning: Mindful
fear of failure, facilitating an regulation, stress reduction, body scanning involves
environment conducive to and an improved sense of systematically directing
healing and growth. overall wellness. attention to different parts of
 Individualized Approach: Techniques and Practices4: BBAT the body. Individuals observe
Recognizing that each employs a diverse range of and acknowledge any
person’s body and techniques that work collectively to sensat ions, tension,
experiences are unique, enhance body awareness and refine discomfort, or areas of ease
BBAT tailors interventions to movement patterns: as they scan through each
individual needs. Therapists  Breath Awareness: The region. This technique
collaborate with patients to foundation of BBAT often enhances body awareness
customize movement begins with breath and facilitat es t he
sequences and mindfulness awareness. Patients are identification of areas that
practices, ensuring that the guided to focus their attention may require attention or
therapy aligns with the on the rhythm and quality of relaxation.
patient’s goals, preferences, their breath. By observing the  Grounding Exercises:
and physical condition. inhalations and exhalations, Grounding techniques involve
 Integration into Daily individuals cultivate a strong promoting awareness of the
Life: BBAT extends beyond connection between their body’s connection with the
therapy sessions, breath and movement. This supporting surface, such as
emphasizing the integration of technique not only promotes the feet on the ground. This
its principles into daily life. relaxation but also enhances technique is particularly
Individuals are encouraged to awareness of how breathing effective in enhancing
apply mindfulness, body patterns influence various proprioception and balance.
awareness, and movement movements and postures. Patients learn to distribute
techniques outside of formal  Movement Exploration: weight evenly, activate
therapy set tings. This BBAT incorporates guided stabilizing muscles, and
integration enhances patients’ movement sequences that establish a solid foundation
ability to transfer learned encourage patients to explore for movement.
skills into real-world a wide range of motions and  Visualization: Visualization
situations and sustains their postures. These sequences techniques leverage the
progress over the long term. may encompass slow,
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Physios' Digest September 2023
power of t he mind to practice contributes to both  Chronic Pain
enhance body awareness relaxation and enhanced Management: The
and movement quality. body awareness. mindfulness-based approach
Pat ient s are guided to  Functional Movement of BBAT makes it a powerful
visualize specific movements Integration: BBAT aims to tool for managing chronic
or actions, facilitating the bridge the gap between pain conditions. Individuals
neural pathways responsible therapy and functional learn t o observe pain
for mot or control. act ivit ies. Therapists sensations without judgment,
Visualizat ion can be collaborate with patients to reducing emotional reactivity
especially beneficial for integrate the principles to pain and promoting a
individuals with limited learned during BBAT sense of control. This shift in
physical mobility, allowing sessions into everyday tasks. perception can lead to
them to rehearse movements This integration ensures that decreased pain intensity and
mentally. individuals can apply mindful improved pain coping
 Mindful Walking: movement strategies to real- strategies.
Incorporating mindfulness life scenarios, enhancing their  N e u r o l o g i c a l
into the act of walking, this overall quality of life. Rehabilitation: BBAT is
technique encourages Clinical Applications5: BBAT’s adaptable for individuals with
individuals to focus their versatility is evident through its neurological conditions such
attention on each step, the applicability in various clinical as stroke, traumatic brain
sensations in the feet, and the scenarios: injuries, and multiple
rhythm of movement.  Musculoskeletal sclerosis. By focusing on
Mindful walking promotes a Conditions: BBAT is neuromuscular re-education
heightened sense of present- particularly valuable in the and motor control, BBAT
moment awareness during a rehabilitat ion of helps patients regain lost
daily activity, fostering a musculoskeletal conditions movement patterns, improve
mindful connection between such as injuries, strains, and coordination, and enhance
the body and t he post-operative recovery. By overall motor function.
environment. emphasizing proper  Postural Improvement:
 Progressive Muscle movement mechanics and BBAT is effect ive in
Relaxation: This technique body awareness, BBAT aids addressing postural
involves sequentially tensing in restoring functional imbalances and promoting
and then releasing different movement patterns. Patients better alignment. Through
muscle groups. By learn to identify movement exploration and
intentionally engaging and compensatory movements awareness practices,
relaxing muscles, individuals that might exacerbate their individuals gain insights into
develop a great er condition and develop their postural habits, allowing
understanding of muscle alternative strategies to them to make conscious
tension and how it can impact prevent further injury. adjustments and prevent
movement and comfort. This strain-related discomfort.
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Physios' Digest September 2023
 Stress Reduction and that promote stability and potential benefits of BBAT, further
Anxiety Management: spatial awareness. empirical evidence is necessary to
Beyond physical  Preventive Care: BBAT establish its efficacy conclusively.
rehabilitation, BBAT extends can be a preventive tool by Rigorous clinical trials encompassing
to psychological well-being. promoting body awareness diverse populations and conditions
The mindfulness aspects of and mindful movement will provide a more comprehensive
BBAT contribute to stress practices in healt hy understanding of BBAT’s impact.
reduction and anxiety individuals. Engaging in Moreover, integrating technology,
management by promoting BBAT helps individuals such as virtual reality platforms and
relaxation responses and identify movement patterns wearable sensors, holds the promise
fostering emotional that could lead to injuries or of enhancing BBAT’s precision,
regulation. Individuals learn discomfort, fostering a customization, and patient
to ground themselves in the proactive approach to engagement.
present moment, reducing maintaining physical well- Conclusion: Basic Body Awareness
rumination and worry. being. Therapy stands at the crossroads of
 Enhancing Body Image  Children and Adolescents: conventional physiotherapy and a
and Self-Esteem: BBAT BBAT’s adaptable nature holistic understanding of human well-
plays a role in improving makes it suitable for children being. By nurturing body awareness,
body image and self-esteem and adolescent s with mindfulness, and sensorimotor
by encouraging individuals to developmental coordination integration, BBAT provides a
develop a posit ive disorders, posture-related multifacet ed approach to
relationship with their bodies. issues, or growing pains. By rehabilitation that acknowledges the
By cultivating body instilling healthy movement intricate interplay of physical and
awareness and embracing habits and body awareness psychological aspects of health. As
non-judgmental self- at a young age, BBAT can the therapeutic landscape continues
perception, BBAT positively influence their to evolve, BBAT’s potential remains
empowers patients to physical development. ripe for exploration. Through ongoing
appreciate their bodies’  Aging Population: BBAT is research, interdisciplinary
abilities and strengths. beneficial for older adults in collaboration, and the integration of
 Balance and Fall maintaining mobility, balance, cutting-edge technologies, BBAT
Prevention: Grounding and overall function. As aging holds the promise of revolutionizing
exercises and sensorimotor often comes with a decline in physiotherapy and contributing to
integration techniques within sensory-motor coordination, improved rehabilitation outcomes and
BBAT are effect ive in BBAT’s emphasis on overall quality of life.
enhancing balance and mindfulness and movement References:
reducing fall risk. Individuals can help counteract these 1. Vancampfort D, Brunner E,
with a history of falls or those effects and promote active Van Damme T, Stubbs B.
seeking to improve their aging. Basic body awareness
balance benefit from Efficacy and Future Directions: therapy within physiotherapy:
practicing mindful movements While emerging research highlights the More clarity about its’ core
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Physios' Digest September 2023
concepts and more scientific Physiotherapy. 2020 Jan Movement Awareness,
evidence is needed. 2;22(1):29-35. Everyday Movements and
Physiotherapy Research 3. Louise D. Basic Body Health Promot ion in
International. 2023 Awareness Therapy in Physiotherapy.
Apr;28(2):e1995. Clinical Practice-Reflections 5. Engelsman K-J den.
2. Gard G, Nyboe L, Gyllensten Here-and-Now and for the International Association of
AL. Clinical reasoning and Future. AIJR Abstracts. Teachers in basic body awareness
clinical use of basic body 2022 Nov 30:52. therapy [Internet]. [cited 2023 Aug
awareness therapy in 4. Skjærven LH, Sundal MA. 25]. Available from: http://
physiotherapy–a qualitative Basic Body Awareness www.iatbbat.com/basic-body-
study?. European Journal of Therapy (BBAT)– awareness-therap.html

Blood Donation Camp organized by DHH, Balangir on the eve of World Physiotherapy Day

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 Physios' Digest September 2023

WORLD PHYSIOTHERAPY DAY AND OUR ROLE

AS PHYSIOTHERAPIST
Dr. Sasanka Sekhar Parida (PT)
Father of modern medicine physical challenges associated with considering the individual / client give
‘Hippocrates’ first advocated manual injuries, diseases and other imparts. the appropriate treatment.
therapy techniques and hydrotherapy According to the National In simple way to solve the
in 460 B.C. which reflects how old Commission for allied and health care client’s problem efficiently and safely,
our profession is ? profession Act2021,a Physiotherapist the physio must acquire information
After the World War II can practice independently or as a regarding the following issues-
physiotherapy became an important member of the medical team. - Source of the symptoms
part of the treatment procedure for Therefore, a physiotherapist and dysfunction
early recovery as well as preventing has to be very sound in clinical - Any contributing factors
disabilities. decision making. -Precautions and
WCPT formed in 8th Sept. All clinician’s motto with their contraindication to the physical
1951 in keeping view of moving patients is same i.e. to solve the examination and treatment.
physiotherapy profession forward, so patient’s problem whether it be pain, What is the progress ?
the profession will be recognized stiffness / reduced ROM, weakness What treatment should be
globally for its significant role in etc or some functional complaints with selected and what progression is
improving health and well being. One combination of all these things. likely ?
of the important mission / rising of And also no two patients, The information enabling
WCPT is to promote high standards clinical situation or professional roles appropriate by patients to be made
of physiotherapy practice education are the same, each requires the about these basic issues is obtained
and research. consultants to use their skills and and tested during the subjective and
As we know the importance knowledge to determine the most objective examination as well as the
of physiotherapy and the contribution appropriate action. ongoing treatment.
of physiotherapists for a healthy We, as physiotherapists have We will discuss this with the
society. WCPT started campaigning at our disposal a multitude of example of this year’s World PT Day
8th Sept as World Physiotherapy Day treatment options including manual theme i.e. “Arthritis” let it be
to create awareness about therapy, therapeutic modalities, “Osteoarthritis of Knee”.
physiotherapy since 1996. supports, advices and referral to other One more thing I want to add
WHO says physiotherapists disciplines for medical, surgical, here which is very important from
assess, plan and implement psychological consultation. theraputic view i.e. ‘diagnosis’.
rehabilitative program that improve or Hence, physios must use their A medical diagnosis refers to
restore human motor function skills and knowledge to carry out a the identification of a disease, disorder
maximize movement ability, relieve relevant accurate assessment and or condition (Pathology /
pain syndrome and treat or prevent using clinical resolving skill and Pathophysiology) by evaluating the
14
 Physios' Digest September 2023
presenting signs, symptoms, history health, history of any previous trauma, not get more benefit from
laboratory test results and medication, investigation, nature and physiotherapy. In this case we may
procedures. It is identified primarily severity of pain, aggravating factors, discharge or refer for further
at the cellular level. reliving factors, diurnal variation, management.
Where as the physiotherapist quality of movement during active and Thus the responsibility for this
use the term diagnosis to identify the passive movement, thigh and leg decision making process lies with the
impact of a condition on function at muscle integrity including quality of physiotherapist and t he
the level of the system (especially the contraction, length, strength and physiotherapist is also accountable for
movement system) and the level of endurance etc. Obtaining information this decision.
the whole person. on the above aspect of the patience Our role as responsible
Medical Diagnosis - presentation may be considered as in physiotherapists to carry out ethical
Osteoarthritis Knee general / routine. However, the depth and evidence based practice with
Physiotherapy diagnosis - and the detail of examination should understanding the implications of
Impaired mobility / movement with be tailored to each individual client. various therapeutic process for the
pain due to degenerative changes in Throughout the whole benefit of the client.
the knee joint. decision making process the clients References :
As a Physio we have to gain should be educated and informed of 1. Chartered Society of
information from scanning different the options available and be given the Physiotherapy.”What is
angles of the patients presentation. opportunity to participate fully in their Physiotherapy?”. Chartered Society
Basically we deal with the mechanical management. This includes of Physiotherapy. http://
www.csp.org.uk/director/public/
problem with the knee of course consideration of the indication for
whatphysiotherapy.cfm. Retrieved
osteoarthritis is a mechanical managing the patient in physiotherapy,
2010-07-10
problem. But a patient’s pain due to discharging them or referring them on. 2. WCPT. Policy statement:
septic arthritis knee may get worsen For example a client having Description of physical therapy.
if treated as OA knee. secondary OA Knee with cartilage http://www.wcpt.org/policy/ps-
Therefore, in our examination damage and changes in t he descriptionPT#appendix_1
we must include the site and subchondral bone, leading to 3. Wharton MA. Health Care
behaviour of symptoms, general mechanical instability of the knee may Systems I; Slippery Rock
University. 1991

For Publishing Article and

Advertisement in our Magazine
Contact : Dr. Priyabrata Kalikinkar Ojha
Cell : 9439361017
or Mail us : [email protected]
15
 Physios' Digest September 2023

HEADACHE AND PHYSIOTHERAPY

Dr SidharthSekharPatra (PT), BPT, MPT in Neurology, I/C, Physiotherapist, IPU, DHH, Puri

Headache is a pain or Primary headaches come from the posture while sitting or standing at
discomfort in the head or face varying inflammation or mal alignment of work. If you’re a driver, carpenter,
in intensity affecting any site of head pain-sensitive parts of face, head and hairstylist, or someone who sits at a
or face. A headache may appear as a cervical and thoracic spine including desk, you may unknowingly push
sharp pain, a throbbing sensation or Nerves, Blood vessels, Muscles and your chin forward which moves your
a dull ache. Headaches can develop the soft tissues.These types of head out in front of your body. This
gradually or suddenly, and may last headaches can be very painful, but is called cervical protraction. Sitting
from less than an hour to several they are not dangerous. The most or standing in this position for long
days.Headaches can vary significantly common types of primary headaches periods of time can put pressure or
in number of ways, including Intensity, are cervicogenic headache (CGH), stress on the neck and base of the
Location, Frequency and Causes. In tension type headache (TTH) and skull, triggering a CGH.
ancient times, there was belief that migraine headache (MH). In addition, symptoms of a CGH may
headaches were caused by evil spirits Secondary headaches include:
that took over the bodies, so the come from another condition that • pain on one side of your head or
treatment used initially consisted of triggers pain-sensitive areas in the face
trepanning the skulls, so that these neck and head. They are rare, but can • a stiff neck and restricted neck
spirits would leave the body. With the also be much more serious than movement
advent of technology, and also human primary headaches. They can be a • pain around the eyes
evolution, the treatments have been warning sign of a more serious • pain while coughing or sneezing
adapted. Nowadays, there are underlying condition, including: Brain • a headache with certain neck
pharmacological and non- tumors, Aneurysm, Meningitis, a postures or movement
pharmacological treatment options for bacterial or viral infection causing
headaches. Currently, the worldwide inflammation of the brain and Neck
prevalence of active headaches or brain injury.
reaches 52%, representing a The most common headaches to
common and almost universal human be discussed:
complaint throughout history. Cervicogenic headache
Headaches, according to t he (CGH): Originating in the cervical
International Classification of spine, this type of headache will
Headache Disorders, correspond to usually be associated with neck pain.
a group of disorders that affect the Accounting for 15-20% of
head region, with more than 200 headaches, it is most often unilateral
categorized types, which can belong (one-sided) and can be aggravated
to three distinct groups: primary by sustained postures or particular
headaches, secondary headaches and neck movements. Different conditions
the group that includes painful cranial like cervical spondylosis, cervical
neuropathies, other facial pains and PIVD, a whiplash injury, repetitive
other headaches. stress to neck or bad posture of neck.
CGH may also occur due to your
16
 Physios' Digest September 2023
Tension Type Headache Common clinical diagnostic Treatment:
(TTH): They are generally techniques used include the flexion- 1. Relaxation techniques
characterized as mild to moderate in rotation t est (FRT),cervical Progressive Relaxing Exercises for the
intensity, tend to feel like a generalized AROM,passive accessory Jaws, Eyes, Forehead, and Shoulders (at
Home)
pressure or tightness around the front, intervertebral movement (PAIM/ A. Open your mouth and clench your teeth
alternately. Relax.
side or back of the head and can PAIVM),passive physiological B. Move your jaw sideways five times in
often spread into or arise from the intervertebral movement (PPIM/ each direction. Relax.
C. Raise your eyebrows as high as you can,
neck but not associated with PPIVM),cervical muscle and then lower them. Relax.
D. Wrinkle your eyebrows. Relax.
nausea.They vary in frequency and strength,cross-sectional area (CSA) E. Close your eyes tightly. Relax.
can last anywhere between 30 measurements of cervical extensor F. Raise your shoulders as high as you can,
and then let them fall. Relax.
minutes up to 7 days. Though the muscles,cranio-cervical flexion test
exact cause is unknown but there are (CCFT),palpation for trigger points. Autogenic Relaxation Program During a Short Break (30
Seconds) at Work place
many factors that are thought to Role of physiotherapist in A. Sit down on a chair with firm support for your back; put your hands
contribute to developing a tension headaches: on your knees and your feet on the floor.
B. Lean your head against the wall.
type headache and will vary between Diagnosis:A physiotherapist has a C. Lower your shoulder.
D. Relax your jaw so that there is a small gap between the molar
individuals. These can include Stress, vital role to differentiate the types of teeth.
E. Close your eyes and breathe calmly and rhythmically.
Anxiety, Tiredness, Dehydration, headache with proper investigation F. Feel how your whole body becomes relaxed from your toes up to
your forehead.
Squinting, Poor Posture, Missing and physical examination which is G. Use an individually chosen cue word (e.g., “relax”) and subvocalize
at each inhalation (induces a deeper state of relaxation).
meals, Noise, Bright sunlight, Caffeine mentioned above. Common clinical After 30 seconds:
A. Open your eyes.
and Alcohol excess consumption. diagnostic techniques used include the B. Take a deep breath and end with a big yawn and stretch.

Migraine: A migraine is a unilateral, flexion-rotation test (FRT), cervical 2. Ergonomics and Antistress
severe headache with throbbing pain AROM, passive accessory Training
sometimes accompanied by nausea/ intervertebral movement (PAIM/ A hyperextended position of the neck
vomiting, phot ophobia (light PAIVM), passive physiological with anupward turning of the face
sensitivity) or phonophobia (noise intervertebral movement (PPIM/ oft en coexists with a
sensitivity). It can be triggered by PPIVM), cervical muscle strength, forwardflexedposit ion of t he
factors including hormonal changes, cross-sectional area (CSA) shoulders in a person who sits
poor sleep, certain foods or unusual measurements of cervical extensor workingat a desk. During the course
smells, and usually requires bed rest muscles, cranio-cervical flexion test of the day’s stress, t hismay
or medication. (CCFT), palpation for trigger points. progressively give rise to cramping,
Differential diagnosis of headaches excessive tone, oreven trigger points
Clinical features Cervicogenic headache Migraine Tension type headache
Female:Male 50:50 75:25 60:40
in the neck and shoulder muscles.
Lateralization Unilateral without sideshifts
60% Unilateral with
Diffuse bilateral Thesymptoms can have many
sideshifts
Location
Occipital to fronto-parietal and Frontal, peri-orbital,
Diffuse
different expressions:
orbital temporal
Frequency Chronic, episodic 1-4 per month 1-30 per month headache,dizziness, and pain in the
Severity Moderate – severe Moderate/severe Mild/ moderate
Duration 1hr to weeks 4-72 hrs Day to weeks
neck with or without decreasedrange
Pain character
Non throbbing, non-lancinating, pain
Throbbing, pulsating Dull of movement. An important part of
usually starts in the neck
Triggers
Neck movement, postures, limited Multiple, neck movement Multiple, neck movement the physical therapyprogram is to
ROM, pressure over C0-C3 not typical not typical
Investigation/ X-ray or MRI of cervical spine, ROM make the patient aware of positions
CT scan of brain Pericranial tenderness
examination of cervical spine, thatmay lead to or aggravate pain and
Nausea, vomiting, visual Occasionally decreased
Associated Usually absent or similar to migraine
symptoms but milder, decreased ROM of neck
changes, phonophobia, appetite, phonophobia, or spasm, and that frequentvariation
photophobia photophobia
Source: Physiopedia between static and dynamic activity
is veryimportant.
17
 Physios' Digest September 2023
3. Massage, Heat/Cold raising arms on either side for the seconds and return to the starting
Application to the muscles around duration of the hold. Once the neck position. The procedure is repeated
the neck and head are strong, sit against a wall on the left side. These muscles were
4. Transcutaneous Electronic and perform the nodding motion and strengthens by hand as resistance
NerveStimulation (TENS) holding position without neck support against the temple. The
TENS devices use two frequency support. position is to be hold for 10 seconds
areas: high-frequency TENS at 50 to Flexion and Extension Exercise: on each side
In a sitting or standing position, the Chin Tuck Exercise: While in a
100 Hz and low-frequency TENS at
chin was brought to the chest slowly standing or sitting position, gently
1 to 4 Hz. A third type of stimulation
and hold for 30 seconds for a gentle move the shoulders backward as the
gives high-frequency sequences chin is tucked down towards the
repeat ed at a low frequency stretch to the back of the neck. Next,
the head is moved back so that the chest. Remain forward facing and
(subcutaneous train stimulation). hold the position for 10 seconds. The
eyes are focused on the ceiling to
Patients with headache are most procedure is to be repeated 10 times.
stretch the front neck muscles. This
suitably treated with high-frequency position is to be hold for 30 seconds. Shoulder Blade Exercise: This is
or train stimulation on the pericranial Strengthen the neck muscles by done while sitting or standing with hips
and neck musculature because; pure placing hand on forehead and straight, not leaning forward or
low-frequency stimulation requires attempting to push it against the hand. backward. Slowly move t he
high intensity to be effective, which in Hold the position for 10 seconds. shoulders backwards and gently
turn can cause unpleasant muscle Next, is to place the hand on the back thrust the chest outwards and hold the
contractions. A recommended of the neck and head and move the position for five seconds. Release and
stimulation time is 20 to 30 minutes, head backward with eyes looking up return to the staring position and
which can be repeated three times toward the ceiling. Hold this position repeat 10 times
for 10 seconds Back-Strengthening Exercise:
per day or as required. TENS is
Rotation Exercise: This is done by During back strengthening exercise,
contraindicated if the patient has a
standing or sitting in an erect position one lie on stomach with face down
cardiac pacemaker. to floor. This is followed by deep
5. Manipulation as the head turning to the right,
looking over the shoulder. This inhalation and exhalation several
The effect of cervical manipulation times. Then prop the upper body onto
positioning is to be hold for 30
appears equivalent to amitriptyline but elbows and hold the position for up
seconds before returning to the
has a greater durability and fewer side original position. The procedure is to two minutes
effects. Cervical mobilization and repeated on the left side. Then REFFERANCE
manual therapies have also been gradually progress to placing the right Bogduk N (2004) The neck and
shown to produce both a central hand on the right temple of the head headaches. NeurolClin 22(1):151–
mechanism of action and disinhibition for resistance as turning the head. The 71, vii [PubMed]
of weak muscles after mobilization of position is to be hold for 10 seconds Nilsson N. A randomized controlled
the appropriate spinal segment, before repeating on the left side with trial of the effect of spinal
resulting in improved muscular control the left hand and temple manipulation in the treatment of
6. Exercise: Lateral Flexion Exercise: This is cervicogenic headache.J
done by standing or sitting and Manipulative PhysiolTher.
Craniocervical Flexion (CCF)
dropping the head to the right side. 1995;18(7):435–440. [PubMed]
Exercise: This is done by lying down
This is followed by touching right [Google Scholar]
on the back with a rolled towel behind h t t p s : / /
the neck. A nodding motion will be shoulder to the right ear without
moving the shoulder upward. This www.thealignmentstudio.com.au/
made with neck and head and hold services/physiotherapy-melbourne/
for 10 seconds. This is Progress to positioning is to be hold for 30
18
 Physios' Digest September 2023

LYMPHEDEMA IN BREAST CANCER

AND ITS MANAGEMENT
Dr. Abhilash Patra1, 1Indian Institute of Public Health, Hyderabad

Introduction and perometry. The International various methods share similar

In India, the incidence of Society of Lymphology (ISL) has underlying mechanisms of action.
breast cancer is on the rise, attributed developed a practical clinical The utilization of compression sleeve
to increased screening efforts and classification system for breast techniques also serves as a preventive
advancements in treatment, leading to cancer-related lymphedema, measure for women who are at a
improved long-term survival rates categorizing it into stages 0 to III heightened risk of developing
(1,2). Nevertheless, this enhanced based on two criteria: limb “softness” lymphedema within the first year
survivorship and the adoption of or “firmness” and response to following breast cancer surgery.
comprehensive treatment approaches elevation (6). Stage 0 represents According to a randomized study
bring forth the possibility of an subclinical lymphatic transport conducted by Vicent et al, the
elevated occurrence of long-term impairment, while stage III indicates prophylact ic applicat ion of
treatment-related complications, nearly complete lymphostasis, compression sleeves in the post
such as breast cancer-associated characterized by fat deposits, operative period for up to three
lymphedema. In India, breast cancer- acanthosis, warty growth, and other months has been shown to
related lymphedema affects trophic skin changes. However, there substantially decrease the likelihood
approximately 41.1% of patients, exists diversity in diagnosing and of arm swelling in women at high risk
with clinically significant lymphedema managing breast cancer-related of lymphedema during the initial year
affecting 16.5% of cases (3). Factors lymphedema, with numerous invasive post-surgery (7). Furthermore, the
contributing to this condition include and non-invasive methods available. effect iveness of alternative
more aggressive local therapies This article aims to provide insights Conservative Therapy (CT) methods
(mastectomy vs. breast and a summary of non-invasive compared to the traditional approach
conservation), types of axillary modalities for the treatment of breast of compression bandaging has been
surgery (axillary dissection vs. cancer-related lymphedema. the subject of various randomized
sentinel node biopsy), radiation Compression Therapy control trials. Smykla et al examined
therapy (including regional nodal Conservative therapy (CT) often 65 women with stage II or III Breast
irradiation), and the use of systemic entails the repetitive and/or extended Cancer-Related Lymphedema and
treatments (4,5). application of low-stretch found a remarkable 53% reduction
Breast cancer-related lymphedema compression bandages firmly wound in edema after one month of
manifests as an accumulation of around the swollen limb. This employing a multilayer compression
protein-rich lymphatic fluid, resulting technique encourages the drainage of therapy approach, compared to the
in swelling of the upper extremity due excess interstitial fluid from the baseline (P= 0.000001).(8)This
to lymphatic vessel disruption. extremity, synergizing with the improvement was also significantly
Various diagnostic methods are contracting muscles during better when compared to both the
available, ranging from traditional movement. Other approaches for kinesiology tape and placebo groups
measurements of circumference and achieving this effect include the (P=0.02 and 0.02, respectively).(9)
volume/water displacement to patient utilization of compression arm Manual Lymphatic Drainage
self-reported symptoms. More recent sleeves, gloves (gauntlets), intermittent (MLD)
diagnostic techniques aim to identify pneumatic compression devices, or Manual Lymphatic Drainage (MLD)
lymphedema at its subclinical stage, kinesiology compression tape. These is a non-invasive massage therapy
such as bioimpedance spectroscopy technique that involves certified
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 Physios' Digest September 2023
physical therapists using various Here are the key components of Acupuncture
pressure-based movements like Complex Decongestive Therapy: Acupuncture is a complementary
circular, pumping, scooping, and  Manual Lymphatic Drainage therapy that involves the insertion of
rotary actions. MLD helps open up (MLD), thin needles into specific points on the
the lymphatic channels and stimulates  compression therapy body to stimulate energy flow and
the smooth muscles in the lymphatic  skincare promote healing. While some breast
vessels, gently pushing lymphatic fluid  exercise and remedial exercises cancer patients have explored
from the extremities toward the  Education and Self-Care acupuncture as a potential treatment
central lymphatic system. This  Int ermittent Pneumatic for managing lymphedema, its
process results in the movement of Compression (IPC) effectiveness in this context is a topic
excess fluid from the body’s tissues  Dietary and Weight Management of ongoing research and discussion.
into the lymphatic system.  psychological support The scientific evidence supporting the
Bergmann and colleagues conducted  monitoring and follow-up. use of acupuncture as a primary
a study to assess the effectiveness of Gradalski and colleagues conducted treatment for lymphedema in breast
MLD as part of a Complex a study in which they randomly cancer patients is limited. Most
Decongestive Therapy (CDT) assigned 51 patients to receive either studies on acupunct ure for
regimen. They compared a group that Complex Decongestive Therapy lymphedema have been small-scale
received MLD, skin care, bandaging, (CDT) or compression bandage and inconclusive in demonstrating
and remedial exercises with another treatment. They assessed various clear benefits.
group that only received skin care, factors, including limb volume, A randomised controlled trial
bandaging, and remedial exercises. edematous volume, volume change, reported by Bao et al stated no
The study involved 57 women, and and quality of life (QoL) after 26 significant difference between groups
both groups showed a reduction in weeks of therapy. Both treatment for arm circumference difference or
excess volume after 24 days. groups showed improvements in bioimpedance difference. Although it
However, the addition of MLD to the reductions of limb volumes and QoL can be considered as a
treatment regimen did not lead to a scores compared to baseline. complementary therapy for managing
significant increase in the therapeutic However, there was no statistically symptoms associated with
response.(10) significant difference between the two lymphedema, such as pain,
Complex Decongestive Therapy groups. Despit e t he study’s discomfort, and limited range of
(CDT) limitations, such as a small patient motion. It is believed that
CDT is a non-invasive multimodality sample size and limited follow-up acupuncture may help improve
treatment thatincludes MLD, skin duration, the fact that the patient circulation and reduce inflammation,
care, compression bandaging, and population was homogenous and potentially providing relief from these
exercises.The exercise component of adhered to the treatment plan adds symptoms.(11) Also, acupuncture
CDT is typically conductedby a credibility to the data. CDT is typically should not be viewed as a standalone
physical therapist and includes active customized to meet individual patient treatment for lymphedema in breast
and passive mobilizationof all arm, needs, considering factors like cancer patients. It is best used as part
wrist, and hand joints, ball- lymphedema severity, the affected of an integrative approach to
squeezingmaneuvers, and stretching body part, and the patient’s overall lymphedema management, alongside
of the pectoral and trapezius muscles. health. It is widely regarded as the conventional medical treatments,
It is typically being performed in gold st andard for managing compression therapy, exercise, and
2phases with phase I involving weeks lymphedema, effectively alleviating proper self-care techniques.
of intensive care withdaily treatment symptoms and enhancing the quality Conclusion
sessions and phase II involving of life for those affected by this The majority of studies have indicated
ongoingmaintenance treatments less condition. the short-term effectiveness of
frequently.
20
 Physios' Digest September 2023
treatments for breast cancer-related 2. GLOBOCAN 2020: New Kulkarni AM, Nair NS, et al.
lymphedema in reducing lymphedema Global Cancer Data | UICC Prophylactic Use of Compression
volumes. Among non-invasive [Internet]. [cited 2023 Jul 31]. Sleeves Reduces the Incidence of
treatments, Complex Decongestive Available from: https://www.uicc.org/ Arm Swelling in Women at High Risk
Therapy (CDT) has been the most news/globocan-2020-new-global- of Breast Cancer-Relat ed
extensively studied and has shown the cancer-data Lymphedema: A Randomized
greatest efficacy when compared to 3. Pillai PR, Sharma S, Ahmed Controlled Trial. Journal of Clinical
baseline measurements. SZ, Vijaykumar DK. Study of Oncology. 2022 Jun
Consequently, CDT has been Incidence of Lymphedema in Indian 20;40(18):2004–12.
established as the standard non- Patients Undergoing Axillary 8. Smykla A, Walewicz K,
invasive treatment for early-stage Dissection for Breast Cancer. Indian Trybulski R, Halski T, Kucharzewski
lymphedema due to its J Surg Oncol [Internet]. 2010 Sep 4 M, Kucio C, et al. Effect of
comprehensive approach. [cited 2023 Sep 3];1(3):263–9. Kinesiology Taping on breast cancer-
Despite being considered the gold Available from: ht tps:// related lymphedema: a randomized
standard, there is limited data link.springer.com/article/10.1007/ single-blind controlled pilot study.
regarding CDT’s effectiveness for s13193-011-0046-x Biomed Res Int [Internet]. 2013
high-grade lymphedema. 4. Shah C, Vicini FA. Breast [cited 2023 Sep 3];2013. Available
The treatment recommendations for cancer-related arm lymphedema: from: https://
lymphedema following breast cancer incidence rates, diagnost ic pubmed.ncbi.nlm.nih.gov/24377096/
surgery are as follows: Compression techniques, optimal management and 9. King M, Deveaux A, White
therapy is recommended at stage 0 risk reduction strategies. Int J Radiat H, Rayson D. Compression garments
of lymphedema, manual lymphatic Oncol Biol Phys [Internet]. 2011 versus compression bandaging in
drainage is advised at stage 0, and Nov 15 [cit ed 2023 Sep decongestive lymphatic therapy for
complex decongestive therapy is 3];81(4):907–14. Available from: breast cancer-related lymphedema: a
recommended at stage 1. However, https://pubmed.ncbi.nlm.nih.gov/ randomized controlled trial. Support
for stages 2, 3, and beyond, there is 21945108/ Care Cancer [Internet]. 2012 May
a scarcity of reported studies on the 5. DiSipio T, Rye S, Newman [cited 2023 Sep 3];20(5):1031–6.
effectiveness of non-invasive B, Hayes S. Incidence of unilateral Available from: ht tps://
procedures, leading to their non- arm lymphoedema after breast pubmed.ncbi.nlm.nih.gov/21553314/
recommendat ion. These cancer: a systematic review and 10. Physiotherapy in upper limb
recommendations are based on a meta-analysis. Lancet Oncol lymphedema after breast cancer
limited number of randomized [Internet]. 2013 May [cited 2023 treatment: a randomized study -
controlled trials, and further research Sep 3];14(6):500–15. Available from: PubMed [Internet]. [cited 2023 Sep
focusing on breast cancer-related https://pubmed.ncbi.nlm.nih.gov/ 3]. Available from: ht tps://
lymphedema staging is needed to 23540561/ pubmed.ncbi.nlm.nih.gov/25282874/
establish a standardized approach to 6. Powell SN, Taghian AG, 11. Bao T, Iris Zhi W, Vertosick
care. Kachnic LA, Coen JJ, Assaad SI. EA, Li QS, DeRito J, Vickers A, et
Reference Risk of lymphedema after regional al. Acupuncture for breast cancer-
1. Viral P, Pavithran K, Beena nodal irradiation with breast related lymphedema: a randomized
K, Shaji A, Vijaykumar D. Ten-year conservation therapy. Int J Radiat controlled trial. Breast Cancer Res
survival outcome of breast cancer Oncol Biol Phys [Internet]. 2003 Apr Treat [Internet]. 2018 Jul 1 [cited
patients in India. J Carcinog [Internet]. 1 [cited 2023 Sep 3];55(5):1209–15. 2023 Sep 3];170(1):77–87.
2021 Jan 1 [cit ed 2023 Sep Available from: ht tps:// Available from: ht tps://
3];20(1). Available from: /pmc/ pubmed.ncbi.nlm.nih.gov/12654429/ pubmed.ncbi.nlm.nih.gov/29520533/
articles/PMC8202444/ 7. Paramanandam VS, Dylke
E, Clark GM, Daptardar AA,
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 Physios' Digest September 2023

PROGRESSIVE SUPRANUCLEAR PALSY AND ITS

PHYSIOTHERAPY MANAGEMENT: IMPROVING
QUALITY OF LIFE
Dr. Shalini Singhal, MPT (Neuro), All India Institute of Medical Sciences, Raipur, Chhattisgarh

Introduction pseudobulbar palsy, and mild sporadic (occurring without a family

Progressive Supranuclear Palsy dementia,PSP is a progressive history), there are rare familial forms
(PSP) is a rare and complex condition, meaning that its symptoms of PSP linked to specific genetic
neurodegenerative disorder that worsen over time, leading to mutations which are responsible for
significantly affects the brain’s control significant disability. It is often referred a small percentage of PSP cases.
of movement and balance. PSP to as a “Parkinson-plus” syndrome PSP belongs to the family of
remains a challenging condition to because some of its symptoms tauopathies. PSP is associated with
diagnose and manage due to its varied overlap with those of Parkinson’s a pathological buildup of the tau
and often subtle symptoms. disease and is often misdiagnosed as protein in specific regions of the brain
While there is no cure for PSP, Parkinson’s disease or other where brain cells gradually
physiotherapy plays a vital role in movement disorders due to the deteriorate.Tau normally supports
managing these symptoms and similarities in some of the symptoms, nerve cells as part of its natural
enhancing the quality of life for but PSP has distinct clinical features activity. In PSP, tau clumps
affected individuals. In India, as in that set it apart.PSP also produces accumulate and are suspected to harm
many parts of the world, the mental impairment in addition to nerve endings in the cerebral cortex,
prevalence of PSP remains relatively motor symptoms, which explains why basal ganglia, and brain stemresulting
low, making it crucial to raise PSP is also one of a group of diseases in disturbances ofbalance, thought
awareness about the condition and under the umbrella of so-called processes, eye movements, speech
highlight the importance of frontotemporal dementias (FTD). and the ability to swallow.
physiotherapy as a key component PSP is the second most common Clinical Features of Progressive
of comprehensive care. form of neurodegenerative atypical Supranuclear Palsy
This article explores t he Parkinsonism but it is still a relatively PSP typically presents with a
comprehensive overview of PSP and rare disease, with low prevalence combination of motor and cognitive
emphasizes the role of physiotherapy estimates ranging from 1.39 to 6.4 symptoms. Common symptoms
in managing the unique challenges per 100,000. PSP appears to affect include:
posed by the disease, highlighting its both males and females, but some 1. Motor Symptoms: The
benefits and strategies based on studies suggest a slightly higher hallmark of PSP is the presence of
current research. prevalence in males. The reasons for vertical gaze palsy, which means
Understanding Progressive any gender differences are not well individuals with PSP have difficulty
Supranuclear Palsy understood.PSP typically affects moving their eyes up or down
First described in 1964, by Steele, people aged 50 and older with amean voluntarily which can cause issues
Richardson, and Olszewski as a age of onset around 60 to 65 years with focusing, double vision, and
progressive illness characterized by but can occur in individuals as young difficulty reading. This leads to
vertical supranuclear as their 40s or as old as their problems with maintaining balance, as
ophthalmoplegia, axial rigidity, 80s.While most cases of PSP are they cannot adjust their gaze to see

22
 Physios' Digest September 2023
the ground or look up while walking. tendency to fall backward, a greater 5 to 10 years from the onset of
People with PSP often experience degree of gait and balance symptoms. However, some people
difficulty wit h balance and impairment, the absence of rest may live longer, while others may have
coordination, leading to frequent falls. tremor, greater axial (neck and trunk) a more rapid progression of the
A characteristic symptom is a sudden than limb rigidity, the presence of disease.
backward fall without trying to protect severe dysarthria (spastic speech), Treatment
themselves. Their gait may become dysphagia, and a restriction in Although there are no known effective
unsteady, and they often exhibit a voluntary downward gaze that can be medical or surgical treatments for
distinctive walking pattern, where they overcome with the doll’s eyes head progressive supranuclear palsy
may take small, hesitant steps, similar maneuver.Patients with PSP may (PSP), treatment primarily focuses on
to a “Penguin” gait.Other motor have an extended trunk or retro colic managing symptoms and improving
symptoms include muscle stiffness, neck posture as opposed to the the individual’s quality of life. Certain
rigidity (axial especially neck and flexed posture of PD patients, and medications may help alleviate
upper trunk), slowness of movement, they respond t o Parkinson’s symptoms, such as levodopa for
and postural instability, resembling medications far more poorly as Parkinsonian features like
those seen in Parkinson’s disease. compared to Parkinsonism. bradykinesia and stiffness of gait,
2. Cognitive Changes: PSP Diagnosis antidepressant s for mood
can lead to cognitive impairment, Early diagnosis is important for disturbancesand botulinum toxin often
although this typically occurs later in effective management. Patients with can decreaseinvoluntary eye closing.
the disease course. Cognitive PSP typically progress to the third A multidisciplinary approach involving
symptoms may include problems with year from their first symptom by the neurologists, physical therapists,
memory, attention, judgment, time of diagnosis. occupational therapists, speech
executive function and problem- Diagnosing PSP can be challenging therapists, and psychologists is often
solving. because its symptoms overlap with recommended.Individuals can benefit
3. Behavioral Changes: those of other neurological conditions from physiotherapyand occupational
Some individuals with PSP may like Parkinson’s disease and multiple therapy to accomplish daily tasks,
experience behavioral changes, such system atrophy and it often requires retain mobility, and avoid falling. It
as mood swings, depression, and an experience in movement disorders. consists of fall-prevention assistive
apathy. There is no specific laboratory or walking aids (sometimes with
4. Speech and Swallowing imaging techniques that can counterweights for extensor
Difficulties: As t he disease specifically diagnose PSP at this time, postures). Prism glasses are
progresses, speech may become so diagnosis typically involves a frequently provided to persons to
slurred and swallowing problems can thorough neurological examination, treat their impaired ability to look
lead to choking and an increased risk assessment of medical history, down and improve their visual input
of aspiration pneumonia. specialized tests such as brain for balance and walking. Physical
5. Other Symptoms: PSP can imaging, and ruling out other possible therapy exercises have been shown
also cause problems with sleep, such causes of similar symptoms. to help these patients maintain their
as insomnia and REM sleep behavior Prognosis strength, coordination, and balance.
disorder, where individuals physically PSP is a progressive disease, and its Speech therapists can assist with
act out their dreams. course can vary from person to communication difficulties and
Clinically, PSP is distinguished from person. On average, individuals with swallowing problems. Adequate
Parkinson’s disease (PD) by an early PSP have a life expectancy of around nutrition and hydration are crucial, and

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 Physios' Digest September 2023
in advanced stages, feeding tubes PSP.Gait training programs focus on manage symptoms, and improve the
may be necessary to prevent optimizing walking patterns, reducing overall quality of life for individuals
malnut rition and aspiration shuffling steps, and promoting a more living with PSP.An exercise program
pneumonia. natural gaitto help individuals maintain has to be prescribed for 5 days a
The Role of Physiotherapy in PSP their ability to walk and reduce the week to gain improvements.
Management risk of falls.As the disease progresses, Challenges of PSP Management
Physiotherapy is a vital component of individuals may benefit from assistive in India
the multidisciplinary care team for devices like canes or walkers for safe Managing PSP in India presents
individuals with PSP.Patients are ambulation and transfers. At late unique challenges, including limited
frequently recommended to stages, wheelchair may be used as awareness of the disease among both
physiotherapy to manage their maintaining balance becomes the public and healthcare
symptoms because there is no excessively difficult. professionals. This often leads to
medicine for this condition. Research 4. Functional Independence: delayed diagnosis and a lack of
supports the significance of an Physiotherapy aims to maximize an specialized care. Additionally, access
aerobic, interdisciplinary, motor- individual’s functional independence. to advanced medical facilities,
cognitive, goal-based, and intensive Techniques like energy conservation neurologists and neuro-
approach to the rehabilitation of PSP and adaptive strategies for activities physiotherapists specializing in
patients.Individual demands and the of daily living are emphasized. Visual movement disorders may be limited
stage of the disease should be taken or auditory cues may be used to help in cert ain regions, making
into account while selecting individuals initiate movements, comprehensive care delivery a
physiotherapy interventions for especially when voluntary control is significant concern.
PSP.The primary goals of compromised. Conclusion
physiotherapy and some evidence- 5. R e s p i r a t o r y Progressive Supranuclear Palsy is a
based approaches include: Management: As breathing rare and complex neurodegenerative
1. Improving Mobility: difficulties may arise in advanced disorder with distinct clinical features
Strengthening exercises can help stages of PSP, respiratory exercises that make it challenging to diagnose
combat muscle weaknessthrough can help to maintain lung function and and manage. While there is currently
targeted exercises.Stretching reduce the risk of pneumonia. no cure, ongoing researches hope for
exercises and range of motion 6. Education and Support: improved treatments and a better
exercises can alleviate stiffness, Education about the disease and its understanding of the underlying
muscle rigidity and improve joint progression, along with emotional mechanisms of the disease. In the
mobility. support, is an integral part of meantime, early diagnosis and a
2. Fall Prevention: Given the physiotherapy in PSP management. multidisciplinary approach to care can
high risk of falls in PSP, balance This support extends to caregivers help individuals with PSP maintain
exercises, such as weight shifting can and family members. their quality of life and manage their
improve postural stability and reduce Individuals with PSP need to work symptoms more effectively.
the risk of falls. Coordination closely with a healthcare team that Physiotherapy plays a pivotal role in
exercises can help minimize the includes a physiotherapist, managing motor symptoms and
likelihood of accidents.Injury risk can neurologist, occupational therapist, enhancing the quality of life for
be reduced by paying extra and other specialists to address the individuals with PSP. By increasing
consideration to “learning to fall”. comprehensive needs associated with awareness, expanding access to
3. Gait Training: Gait the disease. Regular physiotherapy specialized care, and promoting
disturbances are a hallmark of sessions can help maximize function, multidisciplinary collaboration, we
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 Physios' Digest September 2023
can work towards improving the care 2. Clerici I, Ferrazzoli D, et al. 4. Slade SC, Underwood M,
and support available to those Rehabilitat ion in McGinley JL, Morris ME. Exercise
affected by PSP. progressivesupranuclear palsy: and Progressive Supranuclear Palsy:
References Effectiveness of two multidisciplinary the need for explicitexercise reporting.
1. Armstrong MJ, Litvan I. treatments. PloS one. 2017 Feb BMC neurology. 2019 Dec
Advances in progressive supranuclear 3;12(2):e0170927. 1;19(1):305.
palsy: new diagnostic criteria, 3. Rowe JB, Holland N,Rittman 5. Stamelou M, Quinn NP,
biomarkers, and t herapeut ic T. Progressive supranuclear palsy: Bhatia KP. Progressive supranuclear
approaches. The Lancet Neurology. diagnosis and managementPract palsy: Recent advances. Current
2020;19(8), 677-688. Neurol2021;21:376–383. Opinion in Neurology. 2016;29(4),
424-432.

World Physiotherapy Day Celebrated at DHH Ganjam

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 Physios' Digest September 2023

MENTAL HEALTH AND PHYSICAL HEALTH

Mrs. Aparna Mohanty, Sr. Clinical Psychologist, DMHP, DHH, Puri

Exercise is the key not only between life activities and efforts to their responsibility to inform
to the physical health but to peace of achieve resilience. According to the individuals adequately about mental
mind; told by Nelson Mandela. World Health Organization (WHO), health, eliminate misconceptions
Mental health is a topic of growing mental health is ‘a state of well being about mental illness and refer them
interest our society and various in which the individual realizes his or when necessary to specialized
mental health organizations are her own abilities, can cope with the professionals in mental health and
engaged in the prevention, treatment normal stresses of life, can work psychiatry.
and rehabilitation of persons with productively and fruitfully, and is able Consciously or unconsciously,
mental health problems and to make a contribution to his or her colleagues will be confronted in their
disorders. Unfortunately, community’. Furthermore, it is practice with individuals with frail
physiotherapy is not always important to follow a healthy lifestyle mental health, chronic
considered to be a significant that includes, having healthy eating musculoskeletal disorders, chronic
profession within mental health but habits, not smoking or drinking and pain and psychosomatic disorders. In
however, physiotherapy is a not taking no prescribed drugs and their stories, components of mental
recognized conventional profession at least being able to achieve some health are interwoven, and the
within health care and can offer an goals in life. patients deserve an appropriate
extensive range of physical Common disorders refer to obsessive physiotherapy intervention. In
approaches (physical activity, compulsive and related disorders, addition to these conditions, more
exercise, movement, relaxation trauma and stressor related disorders, severe physical diseases such as
techniques and body and movement dissociative disorders, somatic cardiovascular diseases, Parkinson’s
awareness). These approaches are symptom and related disorders, disease, rheumatoid arthritis,
aimed at sympt om relief, the eating disorders, disruptive, impulse hypertension, Diabetes mellitus,
enhancement of self confidence and control and conduct disorders, metabolic syndrome, asthma, asthma/
the improvement of quality of life. substance related and addictive chronic obstructive pulmonary
Additionally, they are relevant to disorders and neurocognit ive disorder (COPD), cerebrovascular
rehabilitation programmes in mental disorders. Severe mental health diseases (stroke), obesity, epilepsy,
health care. The goal of this chapter disorders: Severe mental disorders cancer and other diseases are
is to present an overview of why include schizophrenia, bipolar frequently accompanied with a
physiotherapy in mental health is disorders, mood disorders. ‘rollercoaster’ of emotions, feelings
necessary and what it can offer to fulfil of anxiety and pain. After all,
requests for help and to increase the Not all physiotherapists realize that individuals with mental disorders have
quality of life of persons with mental mental health is all the business of numerous physical health complaints
health problems. physiotherapy. However, it is well (cardiovascular diseases, metabolic
Mental health refers to how a person illustrated in the following quotation: syndrome, obesity, osteoporosis,
thinks, feels and behaves. Mental ‘no health without mental health’. etc.) due to medication, sedentary
health can affect daily life, As health care providers, behaviour or inactivity and consult
relationships, the ability to enjoy life physiotherapists are also involved in primary health services.
and even physical health. Mental the prevention and promotion of Scope of physiotherapy in mental
health involves finding a balance health, including mental health. It is health
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 Physios' Digest September 2023
Depending upon the problem, the due to the complex situation, functional disturbances in the
story of the patient, and the results of physiotherapists who work in mental musculoskeletal system as well as
the observation/evaluation, the health require supplementary psychosomatic disorders. Symptoms
patient’s treatment goals will be knowledge (e.g. psychopathology are viewed as an expression of a
established, and the physiotherapist and psychological frames) and disturbance in posture, respiration,
can choose a more health-related specific skills and competences (e.g. muscle tension or aut onomic
approach or psychotherapeutic communication) to assess, treat, functions, which are often related to
physiotherapy. support and refer people with mental emotional conflicts or mental
The physical health related disorders effectively problems. In Norwegian
approach aims to improve the global Psychomotor therapy is a type of psychomotor physiotherapy, the case
physical health of patients with body oriented therapy based on body report and the examination are central
psychiatric disorders. Physical awareness, movement and physical to documenting and evaluating
activity can help to reduce activities. It is based on the holistic respiration, posture, function, muscles
cardiovascular disease and view and, therefore, integrates and other soft tissues as well as
premature mortality in people with cognitive, emotional, social and motor automatic functions and reactions.
psychological problems. The aspect s into an individual’s The patient’s body and self awareness
psychosocial related development. The starting point is a are taken into consideration.
approach emphasizes the acquisition strong acknowledgement of the Relaxation as a therapeutic
of mental and physical proficiencies continuous and complex interactions intervention is recommended in the
related to the body in motion and between the different developmental treatment of stress and stress related
support of personal development to domains. Psychomotor therapy is problems. The term relaxation therapy
enhance people’s ability to function offered in different disciplines, is used to describe a number of
independently in society. The including mental health care, child techniques that promote stress and
psychotherapeutic related psychiatry, youth care, special anxiety reduction by decreasing
approach uses the body in education and rehabilitation, as well tension throughout the body and
movement as a gateway to as private practice. Psychomotor creating a peaceful state of mind.
ameliorate the social affective functional training is primarily aimed Although t here are different
functioning of an individual. When at improving the motor domain and techniques, physiotherapists have
using this approach, t he includes activities that are aimed at primarily used the modified
physiotherapist creates a setting that learning, developing, practicing and Jacobson’s progressive relaxation
favours the initiation and development training (psycho) motor, sensorimotor method by Bernstein and Borkovec,
of a process in the patient by and perceptual abilities. applied relaxation of Öst , Mitchell
employing specific working methods The roots of Norwegian method and autogenic training. Yoga,
that aim to help patients to access their psychomotor physiotherapy began Tai Chi, mindfulness related exercises
inner workings. in the early 1950s and were the result and Pilates are also used to cope with
Physiotherapy is a specialized field in of a collaboration between Trygve stressful situations.
health care and is recognized as a Braatøy, a psychoanalytically trained Psychomotor physiotherapy for
convent ional therapy. psychiatrist, and Aadel Bülow severe mental health problems is a
Physiotherapists who work in mental Hansen, an orthopaedic method of treatment that uses
health are physiotherapists first and physiotherapist. Indications for this systematically a wide variety of
use interventions within the scope of physiot herapy approach are (adapted) physical activities as well
general physiotherapy. In addition, conditions associated with strain and as movement, body and sensory
awareness to stimulate and to
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 Physios' Digest September 2023
integrate motor, cognitive and The consequences of mental health Today, there is a professional need in
affective competences within the problems are devastating for the society for a physiotherapeutic
psychosocial context. This approach person and society as a whole and approach to treat people who are
aims to realize clearly formulated are compounded by physical health suffering from chronic
consent goals, which are relevant to comorbidities with which most people musculoskeletal and mental health
the patient’s mental health problems with mental health problems are problems. The general aims of
(depression, anxiety, schizophrenia, confronted. The health benefits of physiotherapy in mental health are
autism, eating disorder, etc.). This regular exercise are improved summarized below
approach is based on evidence based cardiovascular fitness, improved General aims of physiotherapy
research and 50 years of clinical sleep, better endurance, a positive in mental health.
practice. influence on metabolic syndrome and “Promoting, advising, teaching,
Body awareness is a term that is diabetes, stress relief, improved warning, motivating maintaining,
frequently used in mental health and mood, increased energy and reduced working, treating, assessing”
psychiatry. It refers to the ability to tiredness. Exercise reduces anxiety, To promote human well being and
pay attention to ourselves and feel our depression, negative mood and social autonomy in people with physical
sensations and movements online, isolation and improves self esteem, health needs that are associated with
along with the motivational and cognitive functions and quality of life a mental illness or learning disability
emotional feelings that accompany Old age psychiatry consists of two and/or to use physical approaches
them in the present moment, without groups: dementia syndrome safely to influence mental health.
the mediating influence of judgemental (Alzheimer, frontot emporal To offer advice on the prevention of
thoughts degeneration, vascular dementia) and stress and physical problems as well
The psychosomatic approach functional psychiatric disorders as quality improvement techniques.
differs from the somatic approach (depression, addiction, mood To teach on topics relating to
which involves the cells of the body disorders, personality disorders and exercise, relaxation and
and is based on the physical and schizophrenia). Elderly people communication.
biological aspects of the problem. The experience declining physical activity To warn people about the side
somatic approach is the traditional levels and functional capabilities, loss effects and to advise people on the
approach and usually addresses the of dependence, decreasing social use of quality improvement
symptoms of the problem. contacts, increasing problems with techniques.
Psychosomatic means that a physical mental health, loss of adaptive To motivate people to engage in
condition is caused or greatly capabilities and quality of life. healthy living habits.
influenced by psychological factors. Exercise helps to improve general To maintain (or to regain) physical
The psychosomatic approach views daily activity, cognition and mental and social skills to preserve
illness as a form of communication independency; increase the ability to function and the quality
between the conscious and the cardiorespiratory fitness, strength and of life.
unconscious mind through the body. balance; reduce osteoporosis, To work with the senses and motor
Illness is a person’s way of adapting skills of children with bodily and
sarcopenia, falls and risk factors for
to the environment. It is a message behavioural difficulties.
falls; increase quality of life and social
To treat physical and psychosomatic
that communicates a need for activities; and reduce social isolation, problems.
change. loneliness, fear and institutionalization To assesstreatment effectiveness
and patient satisfaction.
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 Physios' Digest September 2023

ROLE OF PHYSIOTHERAPY IN DIABETES

REHABILITATION
Dr. Anand Chandra Sahoo, Assistant Professor,
Abhinav Bindra Sports Medicine & Research Institute, BBSR
Diabetes is a term that dates v Dipsogenic Diabet es and drug or chemical-induced
back to ancient Greece and means Insipidus induced.
“passing through; a large discharge of v Gestat ional Diabet es According to the American Diabetes
urine.” The significance is connected Insipidus Association, previous assumptions of
to frequent urination, a sign of v Diabetes Mellitus:The Type 1 Diabetes occurring only in
diabetes. majority of the world’s population is children and Type 2 Diabetes in adults
The Latin word insipidus affected by diabetes mellitus, a are now outdated as the two
means lacking taste or flavor whereas chronic metabolic illness that is conditions can be expressed both in
the Latin word mellitus means defined by high blood sugar levels. adults and children alike.2
pleasant taste, like honey/sugar. The American Diabetes Association v In Diabetes Insipidus, the
Blood glucose, commonly (ADA) classified diabetes into four blood glucose level will be normal,
known as blood sugar, is too high categories which are:2 but the patient will have severe
when you have diabetes mellitus. The v Type 1Diabetes mellitus (5% dehydration due to greater fluid loss
additional glucose is attempted to be to 10% of all cases of from the body, which could lead to
eliminated by your kidneys by being diabetes)occurs from absolute an electrolyte imbalance and
excreted in urine. But people with deficiency of insulin due weakness. In Diabetes Insipidus, the
diabetes insipidus the blood glucose toautoimmune destruction of â cells blood glucose level will be normal,
levels are normal, while their kidneys found in the pancreas. This also but the patient will have severe
struggle to appropriately concentrate includeslatent autoimmune diabetes in dehydration due to greater fluid loss
the urine. adulthood. from the body, which could lead to
v Diabetes Insipidus: The v Type 2 Diabetes mellitus an electrolyte imbalance and
incidence is very rare 1 in 25,000 in (90% to 95% of all cases of diabetes) weakness.
general population which mostly is an insulin resistance and a v Diabetes mellitus, a
occur in adult but can occur at any progressive reduction in insulin chronic metabolic disorder caused by
age, cause is due to hormonal secretion & largely attributed to a deficiency in the pancreatic
abnormality known as Arginine physical inactivity and excess body hormone insulin, damages a number
Vasopressin (AVP) which also known weight known as obesity. of bodily systems, most notably the
as anti-diuretic hormone (ADH). This v Gestational Diabetes is cardiovascular, neurological,
hormone’s main function in our bodies diagnosed in the second or third musculoskeletal, and integumentary
is to keep the fluid balance and blood trimester of pregnancy and was not ones. It also has an impact on a
volume in check. present before the pregnancy. number of specific organs, including
Ø Types of Diabetes Insipidus:1 v Specific types of diabetes are the eyes, kidneys, nerves, and heart,
v Central / Cranial Diabetes due to other causes such as which raises the risk of comorbidities
Insipidus monogenic diabetes syndromes,
v Nephrogenic Diabet es diseases of the exocrine pancreas, v Acute complications of
Insipidus diabetes Mellitus3

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 Physios' Digest September 2023
· Hypoglycemia effective strategy for peripheral · Musculoskeletal Pain:
· Diabetic ketoacidosis neuropathy patients with balance Diabetes can contribute to muscle and
· Hyperosmolar nonketotic problems as well as gait joint pain. Physiotherapists use
coma disturbances.6 different techniques in manual therapy
v Chronic complications of · Diabetic Foot Ulcers and to improve joint ROM, Progressive
diabetes Mellitus4 Neuropathic Foot: Physiotherapists resistance exercises for maintenance/
Ø Microvascular can educate patients about proper improve muscle strength, and different
complications include: foot care techniques to prevent foot modalities like TENS and static
· Retinopathy ulcers and infections. Physiotherapists magnetic field therapy to alleviate
· Nephropathy can educate individuals about proper neuropathic pain10 , and enhance
· Neuropathy foot care and provide exercises to overall musculoskeletal function.
Ø Macrovascular improve foot mobility, strength, and · Frozen Shoulder (Adhesive
complications include: circulation. These measures can Capsulitis): Diabetes is associated
· Cardiovascular disease prevent complications and promote with an increased risk of frozen
· Peripheral vascular disease overall foot health. They may also shoulder, a condition that causes
· Stroke provide exercises to improve foot stiffness and pain in the shoulder joint.
In medical interventions, oral strength and mobility, as well as Physiotherapists can provide
medications & insulin therapy play a guidance on appropriate footwear to mobilization techniques &
significant role in diabetes Mellitus minimize the risk of complications. strengthening exercises to improve
management but a multidisciplinary Low-intensity laser therapy has been shoulder mobility and reduce
approach that includes collaboration found to be very effective in the discomfort. Different elect ro
bet ween physiot herapist s, management of foot ulcers.7 modalities like transcutaneous
endocrinologists, dietitians, and other · Cardiovascular electrical nerve stimulation (TENS),
healthcare professionals is very much Complications: Diabetes increases the Interferential Current (IFT), Low-
crucial to prevent complications, risk of cardiovascular issues such as level laser therapy (LLLT) &
enhancement of overall well-being, heart disease and peripheral vascular therapeutic ultrasound are beneficial
and improving the quality of life in the disease. Physiotherapists can design to adhesive capsulitis.
context of diabetes as a holistic exercise programs like aerobics · Balance and Gait Issues:
approach. exercises (low to moderate intensity), Peripheral neuropathy and other
REHABILITATION FOR DM: progressive resistive exercises, factors can affect balance and
· Peripheral Neuropathy: This endurance training, etc. to improve increase the risk of falls in individuals
is a common complication of diabetes cardiovascular fitness & and overall with diabetes. Physiotherapists can
that affects the nerves, often leading heart health. Studies have shown that design balance training programs to
to pain, numbness, tingling in the type 1 diabetes exercises play a vital improve stability and reduce fall risk
extremities, and balance problems. role which can help to improve insulin thereby preventing injuries, and
Physiotherapists provide sensitivity as well as regulate blood enhancing safety & confidence in daily
neurodynamic techniques that include sugar levels8, and manage blood activities.
neural mobilization of peripheral pressure and cholesterol levels · Physical Inactivity: Many
nerves and sensory re-education to whereas in the case of type 2 studies have shown an association
help manage symptoms and improve diabetes, it helps to maintain a healthy between physical inactivity and
nerve function.5 Balance training weight with individuals having individuals wit h diabet es.
exercises are proven to be the most diabetes.9 Physiotherapists can develop exercise

30
 Physios' Digest September 2023
plans tailored to an individual’s educate individuals about the S62–69. https://doi.org/10.2337/
abilities and preferences, encouraging importance of physical activity, dc10-S062.
regular physical activity.11 proper footwear, and injury 3.Bagheri, Shahrokh C. “Medical
· Obesity and Weight prevention strategies. They also assist Conditions.” In Clinical Review of
Management: Obesity is a risk factor in making necessary lifestyle Oral and Maxillofacial Surgery, 489–
for type 2 diabet es and can modifications, such as maintaining a 538. Elsevier, 2014. https://doi.org/
exacerbate complications like healthy weight and managing stress.14 10.1016/B978- 0-323-17126-
hypertension and cardiovascular REHABILITATION FOR DI: 7.00015-7.
complications. Physiotherapists can Diabetes insipidus can have a variety 4.Deshpande, Anjali D, Marcie
contribute to weight management by of causes, and an interprofessional Harris-Hayes, and Mario
designing exercise programs that team composed of a pharmacist, Schootman. “Epidemiology of
support weight loss and improve nurse practitioner, and physician are Diabetes and Diabetes-Related
metabolic health. the greatest resource for treating the Complications.” Physical Therapy
· Stress and Mental Health: condition. Education of patients is 88, no. 11 (November 1, 2008):
Stress can negatively impact blood essential. Hydration, electrolyte 1254–64. https://doi.org/10.2522/
sugar control. Chronic stress, replacement, and management of the ptj.20080020.
depression, and anxiety can increase underlying disease that is producing 5. Domingues, Márcio. “Diabetic
glucose levels in the blood. DI are the three critical steps. Peripheral Neuropat hy and
Physiotherapists may incorporate Therefore, the physiotherapist’s Neurodynamics.” International
relaxation techniques, breathing involvement in treating this problem Physical Medicine & Rehabilitation
exercises, and mindfulness practices symptomatically to improve quality of Journal 3, no. 1 (February 2, 2018).
to help individuals manage stress and life, and if the condition is linked to ht t p s: / / d o i. o r g / 1 0 . 1 5 4 0 6 /
enhance overall emotional well- other comorbidities, it becomes ipmrj.2018.03.00075.
being.12 extremely important for t he 6. Akbari, Mohammad, Hassan
· Circulation Issues: Diabetes rehabilitation. Jafari, Afsaneh Moshashaee, and
can affect circulation, leading to Conclusion: Bijan Forugh. “Do Diabetic
impaired wound healing and Physiotherapy plays a significant role Neuropathy Patients Benefit from
increased risk of infections. in managing diabetes because it Balance Training?” The Journal of
Physiotherapists can recommend addresses a variety of issues. In Rehabilitation Research and
mobility exercises and aerobics to addition to its physical benefits, it also Development 49, no. 2 (2012): 333.
improve blood flow and support contributes to improved mental health htt ps://do i.o r g/10.1682/
wound healing. BFRT is a novel and a higher standard of living. JRRD.2010.10.0197.
approach for type 2 diabetes which References: 7. Beckmann, Kathrin H., Gesa
helps in protein synthesis and 1.Christ-Crain M, Bichet DG, Fenske Meyer-Hamme, and Sven Schröder.
biogenesis of mitochondria.13 WK, et al. Diabetes insipidus. Nature “Low Level Laser Therapy for the
· Lifestyle Modification: Reviews. Disease Primers. Treatment of Diabetic Foot Ulcers:
Overall physiotherapists can provide 2019;5(1):54. doi: 10.1038/s41572- A Critical Survey.” Evidence-Based
education on healthy lifestyle 019-0103-2. Complementary and Alternative
behaviors, including proper nutrition, 2.American Diabetes Association. Medicine 2014 (2014): 1–9. https://
hydration, and sleep. This “Diagnosis and Classification of doi.org/10.1155/2014/626127.
comprehensive approach can Diabetes Mellitus.” Diabetes Care 33, 8. Lin, Yajuan, Rui Fan, Zhujing Hao,
contribute to better diabet es no. Supplement_1 (January 1, 2010): Jiatian Li, Xiaolei Yang, Ying Zhang,
management. Physiotherapists and Yunlong Xia. “The Association
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Between PhysicalActivity and Insulin 15, no. 1 (July 4, 2023): 148. https:/ 13. Saatmann, Nina, Oana-Patricia
Level Under Different Levels of Lipid /doi.org/10.1186/s13098-023- Zaharia, Jeremy P. Loenneke,
Indices and Serum Uric Acid.” 01123-9. Michael Roden, and Dominik H.
Frontiers in Physiology 13 (February 11. Brugnara, Laura, Serafín Murillo, Pesta. “Effects of Blood Flow
2, 2022): 809669. https://doi.org/ Anna Novials, Gemma Rojo- Restriction Exercise and Possible
10.3389/fphys.2022.809669. Martínez, Federico Soriguer, Albert Applications in Type 2 Diabetes.”
9. Borghouts, L. B., and H. A. Goday, Alfonso Calle-Pascual, et al. Trends in Endocrinology &
Keizer. “Exercise and Insulin “Low Physical Activity and Its Metabolism 32, no. 2 (February
Association with Diabetes and Other
Sensitivity: A Review.” International 2021): 106–17. https://doi.org/
Cardiovascular Risk Factors: A
Journal of Sports Medicine 21, no. 1 10.1016/j.tem.2020.11.010.
Nationwide, Population-Based
(January 2000): 1–12. https://doi.org/ Study.” Edited by Jose Vina. PLOS 14. Harris-Hayes, Marcie, Mario
10.1055/s-2000-8847. ONE 11, no. 8 (August 17, 2016): Schootman, Jeffrey C. Schootman,
10. Nazeri, Armin, Ali e0160959. https://doi.org/10.1371/ and Mary K. Hastings. “The Role of
Mohammadpour, Mohammad-Hadi journal.pone.0160959. Physical Therapists in Fighting the
Saeed Modaghegh, and Mojtaba 12. Sharma, Kapil, Shivani Akre, Type 2 Diabetes Epidemic.” Journal
Kianmehr. “Effect of Static Magnetic Swarupa Chakole, and Mayur B of Orthopaedic & Sports Physical
Field Therapy on Diabet ic Wanjari. “Stress-Induced Diabetes: Therapy 50, no. 1 (January 2020):
Neuropathy and Quality of Life: A A Review.” Cureus, September 13, 5–16. https://doi.org/10.2519/
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Diabetology & Metabolic Syndrome cureus.29142.

AOPSA members attended a CPE Programme at AMRI Hospital, BBSR on the eve of World Physiotherapy Day

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 Physios' Digest September 2023

ROLE OF CUPPING THERAPY FOR

OSTEOARTHRITIS KNEE
Dr. Rakesh Ranjan Nanda (PT)
Introduction: are 60 years or older have significant In the former vacuum created by
Increase in life expectancy over the clinical problems thatcan be attributed mechanical means andwhere as in
years globally contributes towards the to osteoarthritis knee. (Picavet H and later method a scarifier is used to
increasedburden of chronic diseases; Hazes J et al, 2003). Knee cause bloodletting before or together
which in turn results in larger portions Osteoarthritis i s associated with withdry cupping. In osteoarthritis, the
of society living longer but in variety of pathophysiologic deficits, proteoglycan synthesis rate is brought
poorhealth. (Kyu HH and Abte D et including joint instability, reduced joint down fromhalf-life of weeks to a
all, 2017). This scenario is indeed a range of motion and disuse atrophy more rapid one whereas, that collagen
reality for peoplesuffering from one ofquadriceps muscle. (Dekker J, Tola from a half-life of several years to a
of the leading causes of chronic pain P. et al 1993 and Ettinger WH, Bums shorter period leading to
and disability worldwide, knee R etal 1997). The pathology ofknee chondriocysticloss. This loss is a
osteoarthritis (OA). (KyuHHand OA affects wholej oint, causing result of disturbance in the three-
Abte Detall,2017). synovial inflammation, cartilage dimensional frame work that holds
Osteoarthritis is defined as a damage,andbone remodeling and theproteogly can sincollagen.
condition characterized by osteo phyteformation. (Hunter Cupping has the potential to alter this
progressive loss of articularcartilage DJBierma-Zeinstra2 019).Typical mechanism by changing t he
within a joint resulting in a pain, which symptoms include pain,muscle chemicalstructure. (Thomas O,
is commonly seen in weight weakness, jointinstability, brief Schnitzer Jetal 2000, Nuki G. 1995
bearingjoint. (John Ebnezar, Esential morningst iffness, crepitus and and Brandt KD1998)
of Orthopedics). The common functional limitations. (Hunter DJ Common Problems
causes of osteoarthritis areage more Bierma-Zeinstra2019). Frequently, Encountered in OA Knee which are
than 40 years, female, hereditary symptoms are related to physical addressed by Cupping Therapy:
condition, previous joint injury, inactivity, which has been linked to v Pain during movement
obesity,diseaseof joint, poor posture, morbidity andmortality in the v Stiffness: Usually Early
occupational stress and contemporary era and is a significant Morning
strain.(JohnEbnezar,Esential of contributor to the incidence ofchronic v Loss of Range of Motion
Orthopedics). The disease is ranked diseases worldwide. (Hoffmann TC, v Pain after prolonged sitting or
as the 10th largest contributor to Hons B etal, 2016 and Booth FW, lying
global years livedwith disabilities. Roberts CKetal,2012). v Pain on Joint line palpation
(March L and Cross M et al, 2016) Cupping therapy is utilized v Joint Enlargement/ Swelling
and it s prevalence has more for local bloodletting and for local around Joint
thandoubled in last 10 years. (Kyu hemodynamic changes. Itensures v Muscle Imbalance
HH and Abte D et all, 2017 and enhancement of tissue metabolism by Study Design
Palazzo C and Nguyen Cet al, 2016). increasing the blood circulation to Aquasi-experimental facility based qu
The WHO scientific group on thesite. (Arzani MA, Mufarreh Q et antitativest udytechniqueusing
rheumatic disease estimates that 10 al 1915) Cupping therapy is of two subjective questionnaire to detect the
percentof worlds populations who typesdry cupping and wet cupping. effectiveness of my otherapy in

33
 Physios' Digest September 2023
osteoarthrit is of kneejoint. from a specialized physician. Al- persists or there is a need, cupping
Cupping Therapy Protocol hijamah may better be practiced at: • therapy may be conducted. Thus, it
Ø Static Cupping: 1-55• 9-10-11-12-13 • 53 (for right can be concluded that as a part of
Position of Patient: Supine lying or knee) or 54 (for left knee) • Knee Myotherapy, Cuppingcan be used as
Long Sitting should be surrounded by putting 6-8 a treatment method in reducing the
Method of Application: The points cups. symptoms associated with OAKnee.
may be considered as SP9, SP10, Result REFERENCES
ST34, ST36 Total Number of participants included 1. Kyu HH ,Abate D , Abate KH et al.
(2017) Global, regional, and national
SP9 located in the depression just in the study was 138. The majority disability-adjusted life-years (DALYs) for
below and behind the medial condyle of them werefemale about 78.26% 359 diseases and injuries and healthy
of tibia. SP10 located approximately (N=108) and male were 21.73% life expectancy (HALE) for 195 countries
and territories, 1990-2017: a systematic
2 inches above the superior-medial (N= 30). The different age group analysis for the Global Burden of
corner of patella. ST 34 located participants were included in the Disease Study.
2. John Ebnezar, Rakesh John Essential
approximately 2 inches above the study. The majority of the participants of Orthopedics for Physiotherapists
superior-lateral corner of patella. ST were from 51-55 years age group edition.
36 located approximately 4 inches 43.47% (N=60), followed by 46-50 3. March, L., Cross, M., Lo, C., Arden, N.
K., Gates, L., Leyland, K. M., Hawker, G.,
below the inferolateral corner of years age group 25.36% (N=35), King, L., & Leyland, K. (Accepted/In
patella, and 1 inch lateral to tibia. followed by 56-60 years age group press). Osteoarthritis: A Serious Disease:
Submitted to the U.S. Food and
Generally medium to stronger cupping 23.91% (N=33). The least number Dr ugAdministr ation . https://
for 10-15 mins can be applied. For participants werefrom group 40-45 www.oarsi.org/sites/default/files/docs/
acute pain use stronger suction and years 7.24% (N=10). The mean 2016oarsi_white_paper_oa_serious_disease_121416_1.pdf
4. Clémence Palazzo, Christelle Nguyen,
for chronic pain weak cupping can change in VAS score was 2.90 Marie-Martine Lefevre-Colau, François
be used. whichwas statistically significant with Rannou, Serge Poiraudeau,Risk factors
and burden of osteoarthritis,Annals of
Dynamic Cupping p value <0.05. Themeanchangein Physical and Rehabilitation
Position of Patient: Long Sitting and WOMAC score was16.63 which Medicine,Volume 59, Issue 3,2016,Pages
Pronelying was statistically significant with p 134-138,
5.Picavet HSJ, Hazes JMWPrevalence of
Method ofApplication: With help of value<0.05. self reported musculoskeletal diseases is
Silicon cup or vacuum cup, after Conclusion: highAnnals of the Rheumatic
Diseases 2003;62:644-650.
lotion is applied. Dynamic cupping The study showed the effect of 6. Dekker J., Tola P., Aufdemkampe
can be performed over Quadriceps, Cupping Therapy in OA Knee, to be G., WinckersM.(1993)Negative affect,
Hamstring and Calf Muscles followed wit h good analgesic andanti- pain and disability in osteoarthritis
patients: the mediating role of muscle
by active exercises. Dynamic cupping inflammatoryeffect.Cupping The rapy weakness Behaviour Research and
is performedfor5-7minut es in results in significant changes in VAS Therapy, 31 (2) , pp. 203-206.
7. Emery, C.A., Whittaker, J.L.,
horizontal manner or along the course and WOMAC score between pre Mahmoudian, A. et al. Establishing
of muscles, pressure in the cup and post intervention sessions. outcome measures in early knee
depends upon the tolerance of Cupping therapy can be used osteoarthritis. Nat Rev Rheumatol 15,
438–448 (2019).https://doi.org/
patients. individually or a as part of treatment 10.1038/s41584-019-0237-3
Ø Flash Cuppingcan be applied known as Myotherapy which includes 8. Arzani MA. Mufarreh Quloob.
Lucknow: Matba Nami Grami Munshi
over quadriceps muscle in case of cupping, dry needling, massage, Nawal Kishore; 1915. p. 583-8.
chronic swelling and highly painful TENS and exercises with stretching. 9. Thomas O, Schnitzer J. Cecil’s Text
site. After removing cup gentle Individual Cupping therapy can be Book of Medicine. Vol. 2. Philadelphia:
Harcourt Asia Pte. Ltd.; 2000. p. 1550-2
effleurage can be performed. performed on 0-6th day; 9-11th day 10. Khan AA, Jahangir U, Urooj S.
Ø Al-hijamah should be and 14th day or depending upon the Managementof knee osteoarthritis with
cupping therapy. J Adv Pharm
combined with conventional treatment situation of patient. If the symptoms TechnolRes 2013;4:217-23.
34
 Physios' Digest September 2023

ROLE OF PHYSIOTHERAPY IN STRESS

INCONTINENCE
Dr. Neha Jeevan Kulkarni, Consultant Physiotherapist, Curie Physiotherapy & Rehabilitation Centre
Urinary incontinence(UI) is a very bathroom immediately to void and Stress urinary incontinence can have
common problem experienced by once you feel you can’t stop. a huge effect on your quality of life.
many people now a days. where one Overflow incontinence: This type of The physical and emotional demands
may feel an occasional leakage when incontinence occurs when the bladder created by Stress urinary
they cough or sneeze or also a strong does not completely empty during incontinence can leave you feeling
urge or pee but can’t hold it till they urination. It causes frequent, constant exhausted, embarrassed, and even
reaches the toilet. Regardless of dribbling of urine. depressed. Urinary incontinence is
urinary incontinence experience, it Functional incontinence: With this distressing and socially disruptive. It
can add anxiety to daily activities and type you never fully empty your may be the cause of personal health
may even affect quality of life. bladder, you feel like you have to go and hygiene problems. It may restrict
Incontinence is the involuntary to the bathroom all the time. employment, and educational or
leakage of urine or faeces (stool) at Stress Incontinence: It is another type leisure opportunities. It is widely
unsocial times and inappropriate when you leak urine on coughing, understood that stress incontinence is
places. Around 25-45% people sneezing, and laughing. a sensitive health issue and many
suffer from urinary incontinence.1,2 A women delay treatment for many
survey of Asian countries showed Stress urinary incontinence years due to embarrassment or
variation in the prevalence of UI but Stress urinary incontinence is shame. Women may believe that
confirmed that the condition affects a type of incontinence that causes an incontinence is inevitable after
individuals throughout the region. It involuntary loss of urine on effort or childbirth or with advancing age and
increases with the age; child bearing physical exertion e.g. coughing, may not be aware of treatment
is being most significant risk factor in jumping, sneezing, laughing, or lifting options.
women. Although male UI is less any heavy object. It is the most What causes a female to leak
common, but can be noted that common type of urinary incontinence urine?
association of incontinence with seen in women. One out of five Cause2,6,7

disabilities related to the brain, women in the world suffers from 1. Certain 2. Certain 3. The most 4. Some
muscles, or nerves affects both urinary incontinence. Impact activities drinks, food, medical common cause addictions e.g.
and medication conditions like in females is Smoking.
genders equally.2 produce a strong, rapid increase in may act as chronic due to the

Types: Not all bladder leakage is the intra-abdominal pressure that diuretics that constipation, weakness of
stimulate your urinary tract pelvic floor
same. There are different types of transmits to the bladder. To be bladder and infection, and muscle.
increase the neurological Normal vaginal
incontinence observed in female, continent, the bladder closure volume of cases like delivery, birth

male, children, and old age groups pressure must be higher than the urine. e.g. multiple trauma,
Caffeine, sclerosis, spinal infection,
and each has a different cause. Let’s bladder pressure, if your pelvic floor Chocolate, cord injury, Pelvic organ
Alcohol, Chili stroke where prolapse,
look at some common types of muscles are weak it can’t withstand pepper, a large nerve supply to Menopause are

Urinary incontinence in females. that pressure, and that results in dose of vitamin the bladder is common
C. affected which conditions that
Urge incontinence: Involuntary loss of leaking of urine. results in result in pelvic
incontinence. floor damage
urine associated with a strong desire How does stress incontinence and thus
to void. When you need to go to the affect your life? urinary
incontinence.

35
 Physios' Digest September 2023
Don’t keep the problem secret. Talk back muscles to stabilize and support 2. Therapeutic Management of
to your Urogynaecologist and the spine.3,4,5 Pelvic floor muscle Incontinence and Pelvic Pain: 2nd
Physiotherapist to help find the best training with or without other Edition: J.Haslam and J.Laycock
treatment for you. There are many treatment modalities such as2 3. Gödl-Purrer B. Training and
treatment options as well as simple vaginal cones should be used during functional exercises for the muscles
management techniques that can help increased activity, going up and down of the pelvic floor. In: Carriére B,
you get your life back the way you stairs, coughing, jumping, Feldt CM, eds. The pelvic floor.
want it. biofeedback- a physical therapist uses Stuttgart, New York:Thieme Verlag,
Treatment options: a biofeedback instrument in 2006, pp 252–266.
Several conservative treatment conjunction with Kegel exercises. 4. Carriére B. The Swiss ball.
opt ions are available for t he This helps to measure the strength and Heidelberg, New York: Springer
management of Stress Urinary control of the pelvic muscles Verlag, 1998, pp 43–51.
Incontinence, e.g. physical therapy, electrical stimulation- electrical 5. Umphred D. The nervous
behaviuoral modification, and stimulation are applied on the pelvic system and motor learning. In:
pharmacological intervention. floor muscles. Carriére B, Feldt CM, eds. The
Physical therapy management: are the standard for conservative pelvic floor.Stuttgart, New York:
Coping with the incontinence Follow treatment and prevention of stress Thieme Verlag, 2006, pp 21–33
the proper bathroom schedule. You urinary incontinence. 6. Bø K. Pelvic floor muscle
can start this type of program by Pelvic floor muscle awareness can exercise for the treatment of stress
keeping track of a few days of each also be taught by using whole body urinary incontinence: An exercise
time you use the bathroom and of any approach t echniques such as physiology perspective. Int Urogyn J
accident. Your Physiotherapist will progressive relaxation, seated ball 1995;6:282–291.
use this information to develop a work which is as known synergistic 7. Hay-Smith EJC, Dumoulin C.
bladder training program just for you pattern of pelvic floor muscle.2,6,7 Pelvic floor muscle training versus no
with a fixed time to go to the Advantage of swiss ball2: Exercising treatment, or inactive control
bathroom to avoid accidents similarly on the ball is fun and motivating. treatments, for urinary incontinence in
having someone to remind you to go Focuses on Coordination of the PFM women.Cochrane Database of
the bathroom at regular intervals also wit h abdominal muscles and Systematic Reviews, 2006.
known as time voiding can help pulmonary diaphragm.
prevent accidents. It can help to improve balance,
Physiotherapists are skilled at strength and posture while restoring
facilitating the pelvic floor retraining the pelvic floor functions.
motor control. The ‘pelvic floor 3. Wear comfortable clothing that is
muscle’ is very effective and is easy to get off quickly like pants with
considered the first line of treatment elastic waist.
in the management of stress urinary 4. Dietary modification such as reduce
incontinence. The pelvic floor muscles Caffeine intake, Alcohol intake.
in women also provide support for 5. Stop smoking
the baby during pregnancy and need References
to be relaxed during the birthing 1. Tanzberger R. Incontinence. In:
process. The muscles of the pelvic Carriére B, ed. The Swiss ball.
floor work with the abdominal and Heidelberg, New York: Springer
Verlag, 1998, pp 327–358.
36
 Physios' Digest September 2023

RED FLAGS DEVELOPMENTAL DISABILITIES

Dr. Durga Prasad Mishra, Principal, DRIEMS College of Occupational and Physiotherapy

Developmental disabilities lethargy suggests the presence of a · Doesn’t smile at people by 3

are a group of conditions that occur potentially life-threatening metabolic months
due to an impairment in physical, disorder. Parents need to understand · Cannot support head well at
intellectual, learning, language or that it is not always possible to identify 3 months
behavioral domain. These disabilities a single defined disease process · Doesn’t reach for and grasp
are usually identified in childhood, responsible for their toys by 3 to 4 months
arise before adulthood and affect a child’s developmental disability. Even · Doesn’t bring objects to
person throughout their lives. They if a specific etiology is not found, mouth by 4 months
cause difficulties in certain areas of comprehensive clinical assessments · Doesn’t push down with
life like language, mobility, learning, can identify the child’s profile of legs when feet are placed on a firm
self-help, and independent strengths and weaknesses. Children surface by 4 months
living.Disabilities affect a person in with developmental disabilities will · Has trouble moving one or
different ways, and to varying extents. require meticulous monitoring over both eyes in all directions
Examples of development al time and coordination of care to · Crosses eyes most of the
disabilities include ADHD, autism, optimize their functional status. time (occasional crossing of the eyes
learning disabilities, and cerebral All children with developmental is normal in these first months)
palsy,etc. Developmental disabilities disabilities will benefit from early Developmental Red Flags( 4 to 7
are common, affecting about 1 in 6 intervention and therapeutic services months)
children. Some developmental to help maximize their developmental · Seems very st iff, tight
disabilities are more common than potent ial and to promote muscles
others. Developmental disability that independence and personal · Seems very floppy, like a rag
affects all areas of a child’s autonomy. For this first and foremost doll
development is commonly called as important is to identify the red flags · Head still flops back when
global developmental delay. and intervene accordingly. body is pulled to sitting position (by
Identifying children with Red flags include 5months still exhibits head lag)
developmental delay involves both development al regression, · Shows no affection for the
specific attention to children with developmental delay associated with person who cares for them
biologic and/or sociocultural risks and vomiting or lethargy, and recognition · Doesn’t seem to enjoy being
routine developmental surveillance of a treatable cause of delay or CP. around people
and screening every visits. All children Developmental Red · One or both eyes consistently
with suspected developmental delay Flags( 1 to 3 months) turn in or out
should receive a formal · Doesn’t seem to respond to · Persistent tearing, eye
multidisciplinary assessment that loud noises drainage, or sensitivity to light
includes a systematic diagnostic · Doesn’t follow moving · Does not respond to sounds
approach with a “tiered” strategy for objects with eyes by 2 to 3 months around them
laboratory and neuro-imaging · Doesn’t smile at the sound of · Has difficulty getting objects
evaluat ions. Developmental your voice by 2 months to mouth
regression, vomiting, seizures, or · Doesn’t grasp and hold · Does not turn head to locate
objects by 3 months sounds by 4 months
37
 Physios' Digest September 2023
· Doesn’t roll over (stomach · Does not use two-word · Shows no interest in
to back) by 6 months sentences by age 2 interactive games
· Cannot sit with help by 6 · By 15 months does not seem · Ignores other children
months (not by themselves) to know the function of common · Doesn’t respond to people
· Does not laugh or make household objects (brush, telephone, outside the family
squealing sounds by 5 months bell, fork, spoon) · Doesn’t engage in fantasy
· Does not actively reach for · Does not imitate actions or play
objects by 6 months words by 24 mos. · Resists dressing, sleeping,
· Does not follow objects with · Does not follow simple one- using the toilet
both eyes step instructions by 24 mos. · Lashes out without any self-
· Does not bear some weight Developmental Red Flags(24 to control when angry or upset
on legs by 5 months 36 months) · Doesn’t use sentences of
Developmental Red Flags( 8 to 12 · Frequent falling and difficulty more than three words
months) with stairs · Doesn’t use “me” or “you”
· Does not crawl · Persistent drooling or very appropriately
· Drags one side of body while unclear speech Red flags at any age:
crawling (for over one month) · Inability to build a tower of · Strong parental concerns
· Cannot stand when more than 4 blocks · Significant loss of skills
supported · Difficulty manipulating small · Lack of response to sound
· Does not search for objects objects or visual stimuli
that are hidden (10-12 mos.) · Inability to copy a circle by · Poor interaction with adults
· Says no single words 3 years old or other children
(“mama” or “dada”) · Inability to communicate in · Lack of, or limited eye
· Does not learn to use short phrases contact
gestures such as waving or shaking · No involvement in pretend · Differences between right
head play and left sides of body in strength,
· Does not sit steadily by 10 · Failure to understand simple movement or tone
months instructions · Marked low tone (floppy) or
· Does not show interest in · Little interest in other children high tone (stiff and tense) and
“peek-a-boo” or “patty cake” by 8 · Extreme difficulty separating significantly impacting on development
mos. from primary caregiver and functional motor skills
· Does not babble by 8 mos. Developmental Red Flags( 3 to 4 Wait and see approach is a killer
(“dada,” “baba,” “mama”) years) assumptions when it comes to
Developmental Red Flags( 12 to · Cannot jump in place children’s development. Early
24 months) · Cannot ride a tricycle identification is crucial in optimizing
· Cannot walk by 18 months · Cannot grasp a crayon out come. Moreover, timely
· Fails to develop a mature between thumb and fingers neurodevelopment assessment can
heel-toe walking pattern after several · Has difficulty scribbling prevent the emergence of secondary
months of walking, or walks · Cannot copy a circle problems such as anxiety, low self-
exclusively on toes · Cannot stack 4 blocks esteem, low mood, school refusal,
· Does not speak at least 15 · Still clings or cries when and disengagement in learning, a
words by 18 months parents leave him feeling of helplessness, despair, self-

38
 Physios' Digest September 2023
harm and even being excluded from 2. Ait es J, Schonwald A, Monitoring Network, 11 Sites,
school. Augustyn M, Torchia M. United States, 2014. MMWR
Early identification of the De velo p ment al- beha vio ur al Surveill Summ 2018 Apr 27;67(6):1-
child’s difficulties can help receive surveillance, and screening in primary 23.
appropriate interventions, family care. UpToDate Inc. Wolters 5. Weissman L et al. Autism
support, and medical treatment of Kluwer. Accessed on Nov 15 2020. Spectrum Disorder: Surveillance and
associated conditions such as sleep, 3. National/ Center/ on Birth screening in primary care. UpToDate
attention, and anxiety. Finally, it Defects and Development al Inc. Wolters Kluwer. Accessed on
prevents the child and family receiving Disabilities (NCBDDD) Fiscal Year Jan 15 2021.
distressing social labels. 2018 Annual Report. cdc.gov/ 6 h t t p s : / /
References: ncbddd/aboutus/report/ www.childrens.health.qld.gov.au/wp-
1. Gada S. Community 4. Jon Baio et al. Prevalence of content/uploads/PDF/red-flags-
Paediatrics. Oxford Specialist Autism Spectrum Disorder Among a3.pdf
Handbook in Paediatrics. Oxford Children Aged 8 Years – Autism and 7. https://www.tclny.org
University Press. ISBN 978 0 19 Development al Disabilit ies
969695 6. Published Sept 2012.

CUMULATIVE TRAUMA DISORDERS-

WORKPLACE PERIL
Dr. Vipsa Gupta, MPT, MSc. QA Analyst

Cumulative trauma disorders is a new CTDs sometimes called Work – repeated motions with computer
threat to employees in the workplace related MSD, repetitive strain mouse, Frequent lifting, Typing with
that has developed into today’s fastest injuries, or overuse syndrome. These wrists at an odd angle, improper tool
growing occupational hazard. No are musculoskeletal disorders that grip etc.
matter what the field of work, ranging form due to work-related activities Just what is a cumulative trauma
from people who work white-collar wearing on the body that can affect disorder (CTD)?
jobs in the office to people who work muscles, tendons, ligament, joint Cumulative = occurring gradually
blue-collar jobs out in the field. cartilage, and nerves. over a period of weeks, months, or
Just what is a cumulative trauma If you work in a physically demanding years.
disorder (CTD)? environment on a daily basis, it is Trauma = bodily injury to muscles,
Cumulative = occurring gradually natural to experience the normal nerves, tissues, tendons, ligament or
over a period of weeks, months, or aches and pains that come with joints
years. physically demanding activities. This Disorders =conditions causing
Trauma = bodily injury to muscles, will be even more obvious when you physical ailments or abnormal
nerves, tissues, tendons, ligament or are performing an activity you are not conditions
joints used to doing. Cumulative trauma disorders, or
Disorders =conditions causing The majority of CTDs are caused by CTDs sometimes called Work –
physical ailments or abnormal repetitive motions that would not result related MSD, repetitive strain
conditions in injury if only performed once. Such injuries, or overuse syndrome. These
Cumulative trauma disorders, or as Thousands of keystrokes typing, are musculoskeletal disorders that

39
 Physios' Digest September 2023
form due to work-related activities times, not having frequent breaks Correct posture: Make sure you are
wearing on the body that can affect during work. always lifting with the proper
muscles, tendons, ligament, joint Warning Signs technique; life with your legs, not your
cartilage, and nerves. Pay attention to the signals your body back!
If you work in a physically demanding provides you. Right tool grip: Always use the correct
environment on a daily basis, it is If your neck hurts at work, examine tool for the task at hand. This will help
natural to experience the normal your body position to try to figure out you avoid awkward movements or
aches and pains that come with what might be causing the soreness. overexertion.Keep your wrists in a
physically demanding activities. This Tingling or numbness in the hands or “neutral position” while using hand
will be even more obvious when you fingers . tools. Repetitively bending them up
are performing an activity you are not Pain in fingers, hands wrists, or even and down or sideways during your
used to doing. shooting up into the arms or forearms. work will only increase your risk of
The majority of CTDs are caused by Loss of strength or coordination in the developing a CTD.
repetitive motions that would not result hands. Be Cautious: Be aware of the fact that
in injury if only performed once. Such Numbness or discomfort in the hands your body will not react the same to
as Thousands of keystrokes typing, that wakes you up at night. conditions as your coworkers.
repeated motions with computer Preventive measures Different people and different bodies
mouse, Frequent lifting, Typing with You can greatly reduce you chance have different tolerances, strengths,
wrists at an odd angle, improper tool of getting a CTD by doing the and weaknesses. Don’t ignore the
grip etc. following: messages your body is sending you
Risk Factors Warm Up: Take the time to perform simply because your coworkers seem
The main risk factors for occupation- some warm up exercises before unaffected by a particular task.
related CTDs are Physical stressors. engaging in any physically strenuous Thanks for reading and be careful!
They can place additional stress or work. This is the same concept as We will learn about common CTDs
specific body parts and how we when athletes warm up before a and their management in upcoming
routinely perform our work will practice or game. posts. Please free to leave a comment.
directly affect the stress on those body Avoid awkward positions: Routinely Take away point
part. rotate your work position. This will Remember, CTDs resultCTD from
Constantly repeated motions during switch up how your muscles are being awkward and repetitive movements
the process of carrying of process. used so that you are not performing that are not natural for the human
Awkward positions or stat ic the same movements over and over. body to make. These types of strains
postures. 20/20 rule: If you get tired, take a can lead to long-term physical issues,
Excessive overuse or pressure or break! This doesn’t mean take a 20 so we cannot overemphasize the
force or vibration or muscle tension minute break. importance of prevention.The best
or nerve tension. Stretching: If you are aware that you way to tell the difference between
Improper lifting can cause substantial have tired and overworked muscles, normal aches and pains and CTDs is
strain on your back, causing pulled be sure to carefully stretch them. This how long the discomfort lasts. If it lasts
muscle or slipped disc. will increase circulation and reduce longer than a few days, then you could
Psychosocial factors (Mental stress tension. possibly have developed a CTD.
,due to time pressure, low control of Accessorize: When needed, use anti- Again, The good news about CTDs
job, processes, and problems with shock or anti-vibration gloves, wrist is that they can be prevented with just
social support on the job). supports, back support, or other a bit of awareness and proactive
Poor tool and equipment design. personal protective equipment (PPE) measures.
Fatigue due to inadequate recovery that can prevent CTD.
40