Physical Therapy

Many of you have sent us emails asking about physical therapy and exercise. Well, you are viewing the most comprehensive online resource regarding physical therapy and dystonia. This page has been put together with the help of multiple physical therapists. We hope you will find this of value. Please visit our site as we update it frequently.

What is Physical Therapy (PT)?

It’s an important question, and the answer will help you understand how a physical therapist can improve your ability to move and function, as well as benefit your general fitness and health.

Physical therapists are experts in “the science of healing and the art of caring.” Their primary focus is on assisting patients in the ability to return to functional movement by limiting complications such as contractures, pain and other problems that many dystonia patients suffer from.

The Physical Therapy team provides advanced evaluation and management of acute and chronically ill patients with musculoskeletal, neuromuscular, cardiopulmonary, and/or soft tissue impairment. The goal is restoration or maintenance of sensorimotor abilities to promote cognitive, affective and psychomotor skills that will prevent or retard the development of potential sensorimotor dysfunction.
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Types of PT :

There are many specialty areas in the field of physical therapy. Although this is well known throughout the profession, it is often overlooked by the general public. Below is a brief description of the five most common specialty areas in physical therapy. Read on to find out what specialty area is most appropriate for you or your family member.

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system as well as rehabilitate patients post orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post operative joints, acute sports injuries, arthritis, and amputations just to name a few.

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to: arthritis, osteoporosis, cancer, alzheimer’s disease, hip and joint replacement, balance disorders, incontinence and more. Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, increase fitness levels and more.

Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer’s disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke. Common problems of patients with neurological disorders include paralysis, vision impairment, poor balance, inability to ambulate, and loss of functional independence. Therapists work with patients to improve these areas of dysfunction.
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How do I know if I need PT ?

Many people wonder if they are a candidate for physical therapy, or if physical therapy can help their ailment. For physical therapists, however, this is an easy question to answer: Most people can benefit from physical therapy, whether their condition varies from a simple ankle sprain to a complex neurological disorder. Physical therapist Dana Davis describes physical therapy as a conservative treatment method addressing the management, healing, and prevention of injuries and disabilities. Physical therapy uses non-invasive and non-medical tools to help improve total body function. Physical therapists focus on relieving pain, promoting healing, restoring function and movement, and facilitation and adaptation associated with injury. Therapy also focuses on ergonomics or body mechanic training, fitness, and wellness.

What are some important things a physical therapist does?

Physical therapists have many rehab tools available, some specific aspects of physical therapy which you may encounter include:

Stretching

Stretching is vital to maintain good range of motion around a joint. If a patient has stiff joints, normal activities such as opening a jar or climbing stairs can be severely affected. By proper stretching, these functions can be preserved. After an injury or surgery, scar tissue forms, and soft-tissue contracts; this is when stretching is most important. Read more about stretching exercises in this Nature article : http://www.nature.com/sc/journal/v40/n8/full/3101340a.html

Strengthening

Strengthening exercises are performed to help the patient improve the function of their muscles. The goal is to improve strength, increase endurance, and maintain or improve range of motion. Common types of strength training include:

Closed Chain - The closed chain exercises are performed with the foot locked in position on the ground–for example a leg squat. These exercises are performed to help balance the muscle strength. By performing closed chain exercises, the weak muscle (e.g. the quadriceps) and its antagonist (e.g. the hamstrings), will both be exercised and balanced.
Open chain exercises, such as a leg extension, do not balance the muscles this way.

Proprioceptive

Proprioception is the sense of knowing where a body part is in space. This can be a difficult concept to grasp until you lose the use of a body part, because so much proprioception occurs without out conscious thought. When you lose proprioception of, for example, an ankle joint after a sprain, patients often complain of an unstable sensation of the joint. Proprioception training reteaches your body to control the position of an injured joint. This problem is also referred to medically as spatial disorientation.

Ice and Heat Therapy

Ice and heat are useful to warm up and cool off muscles. In addition, these modalities can stimulate blood flow and decrease swelling. These can be important aspects of the therapeutic process.

Ultrasound

Ultrasound uses high frequency sound waves (not within the range we can hear) to stimulate the deep tissues within the body. By passing an ultrasound probe over the body, deep tissues are stimulated by the vibration of the sound wave. This leads to warming and increased blood flow to these tissues.

Electrical Stimulation

Electrical stimulation is a therapy that is not well understood. By passing an electrical current to an affected area, nerve conduction within the region is altered, which can in turn alter muscle contractility. Patients often experience diminished pain after this type of treatment. An article on use of TENS unit can be found in our Dec 2007 Newsletter.

Aquatic Therapy

Aquatic therapy is a terrific way to regain mobility and maintain strength by doing exercises in a swimming pool. This has become very popular in recent years because many patients who have difficulty exercising can often do very well in the water. The added buoyancy helps support the body and the water provides gentle resistance to increase strength and endurance.

Splinting

Different forms of the splint have been used sparingly throughout history, however, the splint gained great popularity as a medical device during the French and Indian War. Generally consisting of two small wooden planks, the splint was commonly tied around the fracture with rope, cloth, or even rawhide during frontier times in American history. To this day, the splint is commonly used to secure small fractures and breaks as well is being used as a rehab tool post-stroke, neurological events including dystonia. There are many reasons to splint a limb, among them:

To immobilize a limb
To support a limb
To prevent contractures
To assist in movement
To restrict movement
To reduce scar tissue development
To prevent-reduce pain
To decrease stiffness
To prevent deformity
To increase function
To increase -maintain strength
To decrease stiffness

Visit the site : http://www.righthealth.com/Health-Basic_Facts/wrist_splints/-od-webresultsonly-s to learn more about splinting.

There are also many types of splints. The wrist support has among other good qualities an exceptional cosmetic design that is attractive to lovers of fashion and aesthetics. It is useful in the pre and post operative management of ailments around the wrist. Other uses include sports injuries, after treatment for ganglion, carpal tunnel syndromes, tenosynovitis, trigger fingers, rheumatoid wrist/hand and nonspecific pains.

Hand cock-up splints have similar profile as the lower limb splint. They are used in hand, phalangeal, wrist and forearm injuries as well as pre- and post-operative immobilization of the forearm and wrist. Apart from limb immobilization it also provides compression bandaging system.

The lower limb splint are of various shapes and sizes used in immobilizing injured lower limbs. They are not cumbersome, water and body fluid resistant, easily washable, reusable, heat resistant, skin friendly and durable. They are useful in immobilization of all forms of lower limb injuries including trochanteric fractures. It includes the ankle support, below and above knee splints and the trochanteric splints.

Precautions when using a splint : If you have a removable splint, follow your doctor’s instructions and only remove the splint if he or she says you can. Keep dirt and sand from getting into the splint.

Call your doctor immediately if:

You can’t move your fingers or toes.
You have severe pain or increased pain that you think is from swelling, and your splint feels too tight.
Your hand or foot feels numb or tingles.
You have a lot of swelling below your splint.
The skin under your splint is burning or stinging.
It’s also important to keep up your muscle strength and tone as much as possible while protecting your injured limb or joint. Your doctor may want you to tense and relax the muscles protected by the cast or splint. Check with your doctor or physical therapist for instructions.

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What is a PT Assessment ?

A physical therapist will initially conduct a subjective examination (interview) of a patient’s medical history, and then provide objective assessment in the form of a physical examination. The subjective examination is guided by the presenting symptoms and complaint, and the objective assessment is in turn guided by the history. This semistructured process is used to rule out serious pathology (so-called red flags), establish functional limitations, establish the diagnosis, guide therapy, and establish a baseline for monitoring progress. The objective exam will then use certain quantifiable measurements to both guide diagnosis and monitor progress. The particular focus of a regimen will depend on the system and area being managed. Where a musculoskeletal exam might assess joint range of motion, muscle power, and posture among other metrics, a cardiopulmonary assessment might involve lung auscultation and exercise physiology testing.

In some countries a physical therapist may order diagnostic imaging tests such as x-rays and MRIs to obtain more information about a patient’s presenting condition and determine a treatment plan, including referral to other practitioners. Physical therapists may also perform sonography, electromyography and nerve conduction testing to aid in the diagnostic process.

Dystonia and PT

www.emedicine.com/med/topic620.htm

http://www.ptjournal.org

www.stayinginshape.com/3osfcorp/libv/i81.shtml

www.clinicalevidence.bmj.com/ceweb/conditions/nud/1211/1211.jsp

www.somatics.com/dystonia.htm

www.functionalrestoration.com/Dystonia%20and%20Secondary%20Symptoms.htm