Physical Therapy Online

Hi,
Today I had a patient, four and a half year girl, who has spastic cerebral palsy. The mother was complaining of the patient's inability to stand and walk independantly.

She is pre-term baby; cried immediately after birth with low birth weight. She was not able to do any activities after birth for two years. Then, she was on physiotherapy treatment for the next six to eight months. That way, she achieved sitting with forward hand support. Thereafter, no medical or physiotherapy treatment was given.

Now, the patient has grade-1 spasticity in hamstrings and TA bilaterally with hamstrings, TA, adductor and hip flexor tightness. She can sit independantly with crouch position. She does transitions in and out of sitting, also pulls to kneeling and standing with support. She stands with bilateral knee slightly , foot plantaflexed and pronated with slight anterior pelvic tilt. She does well aligned weight shifts forward and lateral. She has good equilibrium reactions in sitting and quadripode. Her motor developmental age is one year.

She can grasp and release the objects; can make buildings of three or four blocks; can feed herself with spoon; can assist in wearing and unwearing of clothes; can speak normally. So, her fine motor development age is two years.

I think her impairments are inappropriate muscle force generation, poor selective control of truncal muscle and poor coactivation of antagonist and agonist muscle. So, my main goal of treatment is:

• to prevent secondary complications like contracture
• to improve hip and trunk control
• to improve pelvic stability and mobility
• to strengthen anti-gravity muscles (back and hip extensors)
• to recommend dynamic AFO to facilitate activity and limit inappropriate joint movement and alignment.

Cold Therapy refers to use of local or general body cooling for therapeutic purpose.
Cooling the body surface leads transfer of energy away from the tissue & thus reduces local tissue temperature.
THERAPEUTIC USES OF COLD THERAPY
oAcute Inflammation
Cold Therapy minimizes swelling,relieves pain,minimizes secondary tissue damage.
Because ofAlternation period of vasoconstriction & vasodilation affects the capillary blood flow.
Vasoconstriction of blood vessels limits extravasation of blood & tissue fluid in tissue spaces. Vasodilation, then, washes out chemical irritants from damaged part and provides nutrients. As a result, swelling minimizes.
Relief of Pain
Cold receptors effectively reduce excitability of nociceptor cells (in lamina of spinal cord) to pain generating stimuli. As a result, segmental inhibition occurs.
qCold stimulation itself could be noxious and causes stimulation of area in the mid-brain, releases endorphin or enkephalin at spinal level to cause inhibition of transmission of nociceptives.
oRelief of Muscle Spasm
It is a normal protective mechanism to pain.Cold application relieves spasm by decreasing sensitivity of muscle spindle. As pain relieves, spasm reduces.
oReduction Of Spasticity
qCooling can affect spasticity by operating at two different sites - skin & muscle.
Muscle strengthning
Chronic inflammatory Conditions
METHODS OF APPLICATION
Local Immersion.
Cold Packs –
Ice Packs.
Commercial cold Ice Packs.
Ice Towel.
Ice Massage.
Evaporating Spray.
DANGERS OF COLD THERAPY
Ice Burn - subsides in a day.
More severe ice burn with fatty necrosis showing bruises - subsides in 3 weeks.
Frost Bite - if body suffers extreme exposure.
Rapid ice crystal forms in cells, freezing extracellular fluid - cell death occurs
CONTRAINDICATIONS OF COLD THERAPYCardiac Conditions.
Vasospastic Diseases –
Raynaud’s Disease.
Sensory Deficiency.
Peripheral Vascular Disease.
Cold Sensitivity –
Cold urticaria.
Cryoglobinaemia.