Group Therapy

Class work is used when a more competitive activity is desirable to make exercises more interesting and stimulating for the patients. Group teaching may range from ward classes to encourage maintenance of muscle tone in the unaffected parts of the body, or ante- and post-natal exercises, to classes in the Physiotherapy Department for those who need remedial exercise for hands, for legs, for shoulders or any other particular body part. Patients whose hands are recovering from injury or disease, or which require re-education after surgery, benefit from the variety and competition obtained by working with others. Patients with weak or damaged feet enjoy working together in groups and in this way games and competitions can aid in retraining muscle function. Those with shoulders, back, and knees affected gain much from watching others and from the realisation that they too have a real problem to get their temporarily awkward limbs going again.

Later, as the condition improves, many of the patients progress to eurytlunics, dancing, and games and then to full educational gymnastics in order to obtain the best results. At all stages in treatment, the patients are instructed about correct positioning and how and what to practise on their own.

Prophylactic Activity

Physical treatment is usually considered to be for the treatment of conditions already in existence but it is, in fact, often used as a form of preventive or prophylactic activity for both adults and children. Growing children are taught correct posture, and any tendency to flat feet, knock-knees, and spinal curvature is in many instances corrected before it becomes a real deformity. Schoolchildren and students can be taught correct posture, and nurses in training and workers in industry may be instructed in body mechanics and in methods of lifting. In hospital, early exercises and early ambulation often prevent the development of complications in both surgical and medical cases. Chest complications after anxsthetics are greatly reduced by pre- and post-operative breathing exercises.

Chest Conditions

Common chest conditions which need remedial treatment are faulty breathing, coughing spasms, defective posture, limited chest movements, or reduced capacity of the lungs with low tolerance to exercise. The therapy may take the form of instruction in correct breathing, postural drainage of the lungs, posture training, or in improved movement of the chest wall. All help to restore the patient's confidence and to facilitate his recovery. Communal games are often used for the children, and frequently the department looks rather like a playroom with the young patients imitating windmills, playing express trains or blowing pingpong balls across a tub of water.

Patients with asthma and bronchitis are taught to live with their condition and to control it by learning to relax, to do correct diaphragmatic breathing and to acquire a new breathing rhythm if their earlier pattern was incorrect. Other chest conditions which may benefit are pre- and post-operative chest surgery, pneumonia, or cases of shock. Elderly people are also kept much fitter by breathing exercises and by carefully graduated movements during the period in which their activity is restricted.

Pre-natal and Post-partam Exercises

Exercises and other therapy are given to promote mental and physical well-being during pregnancy and to help the mother to co-operate during labour.

The mothers are given explanations of the need for correct breathing and relaxation during pregnancy and during the birth process itself. This is followed by instruction in relaxation and in breathing control. Afterwards, exercises are taught to correct the mother's posture, to tone up the muscles (especially those of the abdominal wail), or as a preventive against swelling of the legs and feet. Later, if necessary, treatment may be given to relieve breast congestion and to prevent thrombosis in the limbs.

Disabilities in Children

In the treatment of infants and children with muscular and limb disabilities, simpler versions of the routine exercises for adults are widely used. Deformities are now treated quite early in the child's life; special equipment and walking aids are devised to suit different cases, and for general activity much use is made of adapted and carefully graduated toys.

To help children with cerebral palsy to lead as normal a life as possible, several different methods of treatment are available and the best possible one for each child has to be selected and a full programme of treatment carefully carried out. Such children are taken at their own slower pace through all stages of normal development, e.g., rolling, crawling and sitting, however long it takes. They are also educated within their limits and taught to help themselves in feeding, toilet requirements, washing, dressing, and so on.

Nervous Diseases

Among the largest groups of disorders which benefit from physical treatment are those of the nervous system.

Flaccid Paralysis occurs when the nerve to the muscle is no longer conducting impulses and therefore the muscle cannot be made to move; this happens after poliomyelitis or after direct injury to the nerve. Re-education and exercises are then needed to restore power and endurance.

A surgical repair of the nerve may be needed before physiotherapy can be given, but in other cases treatment is given to get the part into the best possible state before surgery. Recovery of nerve function is a very uncertain matter.

No known treatment influences the rate at which the damaged nerve will recover, but electrical treatment may help the muscle fibres to contract during recovery and so reduce tissue wasting.

The muscles fibres themselves contract to the stimulus of a certain strength of current even when the nerve supply is cut off, and so they can be kept somewhat active until the nerve cells and fibres regenerate and become able to function again.

For electrical treatment, metal plates with a moist pad between each plate and the patient's skin, or else special padded discs, are placed on the affected muscle for short periods.

As soon as there is any sign of nerve recovery, careful re-education of each individual muscle is instituted. Severely affected patients are taught to make the best possible use of muscles remaining active and to walk if at all possible, even if calipers (leg splints), special shoes, crutches, or walking aids have to be used.

Sometimes the doctor and therapist have to devise ingenious methods to get a patient to walk again. A patient with weak hip flexion, for instance, who cannot step up on to the pavement may be able to step on backwards.

Sensory, Cerebellar and Ataxic Conditions occur when certain parts of the nervous system are damaged, making movements of the limbs and trunk clumsy, uncontrolled, and incoordinate.

The co-ordinating centres in the patient's brain are no longer receiving stimuli (or messages) from nerves in distant parts of the body and they cannot therefore return instructive impulses to the limbs, or other parts, for the correct movements, as in walking or picking up objects.

Such patients need to be taught how to walk by sight instead of by the natural automatic means. Certain of their exercises consist of placing the feet on footprints marked on a strip of matting. New movement is at first very jerky, and music is sometimes used to gain better rhythm in the gait.

In Hemiplegia, one arm and one leg of the same side are paralysed, while Paraplegia means that both legs are affected.

Partial or full paralysis is frequently the result of traffic or industrial accidents which have caused damage to the spinal cord or brain.

Treatment is often started as soon as the patient recovers consciousness.

Splints of aluminium, plaster of Paris, or plastic, and shaped to suit the injured part of the body may be used to prevent deformities.

Passive movement is given early to relieve stiffness and to train the feeling of movement, but as soon as possible active movements are started, sometimes using the suspension technique. Treatment is not only given to improve the local condition, but also to encourage self-reliance and the general progress to walking and recreation.

Sciatica associated with a lumbar disc injury causes acute pain which must be relieved as early as possible. Rest in bed is essential for one or two weeks and then hyperextension exercises in bed are often given. The exercises are graduated as improvement occurs. Similarly, the severe pain of brachial neuritis in a busy housewife is first relieved by resting the arm from all activity before exercise is begun.

Amputations and Surgical Cases

For athletic injuries, amputations, reconstruction of damaged hands (including plastic surgery), fractures, and tendon and soft tissue injuries, internal surgical methods of fixation are often used in preference to immobilisation for long periods in splints; and movements to re-educate the muscles are also started early in these cases. After a joint repair, constant repetition of each newly obtained movement is essential and the patient has to relearn how to balance, how to remain stable and how to move his muscles in a comfortable way. In the case of the lower limbs he will need tuition in correct weight-bearing and in daily living activities such as getting up steps, and on and off the toilet seat.

Heart Disorders

Techniques used in the treatment of circulatory and heart disorders are very carefully regulated. Precise records are kept in these cases in order to assess gradual progress and to forestall any strain or relapse.

Record and assessment charts are kept of each patient's muscle power and reactions, activities, dosages, and so on in order to modify a plan of treatment, or so that alternative methods may be compared, and new ideas investigated and applied. Progress recorded on the charts is also encouraging for the patient.

Rheumatic and Arthritic Conditions

These include fibrositis, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis and form a very high percentage of the crippling diseases treated. All these conditions have symptoms of muscle spasm, restricted range of movement in joints, wasting and weakness of muscle and gradual loss of useful activity.

Painful swollen joints need rest, progressing to rest interspersed with exercise. If a patient wears splints, they are usually removed regularly for remedial movements; and the remainder of the body is kept active while the splints are being worn. Even a patient with ankylosing spondylitis may need limited exercise so as to preserve the functioning of his muscles and to restore his independence as much and as soon as possible. Many techniques are devised and used by the physiotherapist to obtain the required results for each of her patients but analgesics (pain-relieving drugs) are not given too often when remedial exercises prove painful because the condition may be worsened by too much activity being done under their protective 'cover'. Arthritic and rheumatic patients benefit particularly from hydrotherapy and spa treatment because the water lightens some of the weight-bearing from the weak muscles and painful joints.

Therapy for The Elderly

Geriatrics is that department of medicine which treats all problems peculiar to ageing and old age. It is a great help if a therapist sees and talks to these patients in their home surroundings before admission to hospital. They fear that once they are admitted they will never get out again, and therefore they get emotionally upset and anxious. They are afraid of the strange words used, and fear they will be rejected by their families. For these reasons they are reluctant to call for help until a crisis arises. But once in the care of a physiotherapist and the other members of the team, much can be done to get them going and to relieve their fears. Given enough time and the right approach, however, they will co-operate and so have a chance of improving their powers of activity and mobility which will enable them to return home.

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