Occupational therapy is a client-centred health profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. This is achieved with the help of self-help devices.

DEFINITION

The appliances or devices, which are useful for the mobility as well as stability purpose of an individual who cannot walk independently without any support, is called as mobility aids or walking aids. These devices are mostly prescribed for some of the following cases, such as Pain, Muscle weakness, Problem in balancing, Fractures, Joint diseases, Injured or inflamed limbs, lack of proprioception etc. In short it can be said that mobility aids are useful for mainly muscle skeletal and neuromuscular problems. Major varieties of mobility aids are

1. Crutuches
2. Canes
3. Walkers
4. Wheelchairs

CRUTUCHES

Are mainly used to relieve the weight – bearing in the one or both the lower extremities and provide additional support where the balance is impaired for the patients. 3 types of crutuches are available – Axillary crutuches. Elbow crutuches and Gutter crutuch.

AXILLARY CRUTUCHES:- These types of crutuches are made out of either aluminium or wood. It has an axillary pad, a hand piece and a rubber ferrule. The length of these types of crutuches are usually adjustable. The crutuches should be designed in such a way that the axillary pad should always rest against the chest wall, below to the apex of the axilla. The handgrip should be adjusted to allow the elbow to be slightly flexed to about 20 degrees. MECHANISM – the weight of the patient is transmitted down the arm to the hand piece when the elbow is extended.

ELBOW CRUTUCHES: – these type of crutuches are made of plastic or metal and have a band which fastens on to the forearm to prevent the crutuch from slipping out of grip. They have metal buttons or press clip, which helps to adjust the length of the crutuches. These are particularly suitable for patients with good balance and strong arms. Here the weight is transmitted exactly the same way as for the axillary crutuches.

GUTTER CRUTUCHES: – these type of crutuches are made out of metal frames with a padded support for the forearm and strap. Along with that there is, an adjustable handpiece and  arubber ferrule. The forarm support will be placed parallel to the ground.  This kind of cutuches are used in patients, who require some form of support but cannot take weight through hands, wrists and elbows because of deformity and/or pain. Like the elbow crutuches, these also allow length/height adjustment for comfortable.

Walking with CRUTUCHES:- the function of crutuches is to prevent undue weight – bearing. Sometimes crutuches are needed only temporarily, at other times their need is permanent. In most cases, patients consider the use of cutuches as unnesessary because of the existing social stigma of being dubbed as a cripple. The patients ability to use them depends upon a number of factors.

• The strength of the muscles required in the use of crutuches.
• The correct selection and adjustment of the crutuches.
• A good sense of balance.
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• Good eyesight.
• The pateient of gait employed and the energy necessary for it.

CANES

Are not normally recommended for the non-weight – bearing and partial weight – bearing cases. It is useful for increasing the base of support and to improve the balance. They are preferred to provide opposite to the affected side. During the normal gait, the stance hip abductors counterbalances the swinging hip and prevent it from tilting. It may create the compressive force in the stance hip. Providing the canes in the stance side upper limb reduces this force and straining in the stance side hip. The major types of Canes are

1. Standard canes.
2. Standard adjustable canes.
3. Standard adjustable offset canes.
4. Tripod canes and Quadruped canes.

STANDARD CANES: – made of either aluminium or wood or plastic. It has a curved or half circled handpiece. It is not a height adjustable one. It has to be made depends on the height of the patient. It is not expensive and is easy to carry around. Mostly indicated or advised to elderly patients.

STANDARD ADJUSTABLE CANES: – made up of aluminium and may be having the plastic covering. It normally have  acurved or semi curved handpiece. Contains a height adjustable press clips. It is very portable form of cane.

ADJUSTABLE OFFSET CANES: – Upper half of the cane is offset anterirorly so that the weight falls on the cane and it gives more stability. It contains adjustable screws or press clips. All the sticks are having the handpiece and the rubber ferrule except the wooden made standard canes. The handpiece comes up to the greater trochanter level for the person using it.

TRIPOD & QUADRUPED CANES: – this type of canes has 3 or 4 legs respectively along with a rubber tip. This gives more stability than any other varites of canes. This is more useful for the neurological cases like hemiplegia and other elderly patients who had the injury of the lower limb. It also contains height adjustbale clips /screws.

WALKERS / WALKING FRAME

It is useful for the non-weight bearing / partial weight bearing and the full weight bearing gait patterns. Because of its boarder base, it has got more stability. The walker is having 2 anterior and 2 lateral bars, the horizontal bars connecrt all the vertical bars in 3 sides, and one side is kept opened. A drawback for this walker is that, the patients practicing with this frame will never walk in a proper gait pattern. 5 different types of walking frames / walkers are: –

1. Rigid walking frame
2. Foldable walker
3. Gutter walker
4. Rollator
5. Reciprocal walker

RIGID WALKING FRAME: – the standard type of walking frame used. It has got a rubber ferrule and a handgrip. The patient has to lift and place it front and walk. It is difficult to carry easily in and out of the house.

FOLDABLE WALKER: – similar to that of the above said walking frame with an exception that it is of folding in nature. That is it is not a fixed frame. Its portable nature makes it a more frequently prescriped form of walker.

GUTTER WALKER: – along with the features of the rigid walker, it has an additional feature of a forearm support insteas of a handgrip. It can be prescriped to patients suffering from any wrist problems. (RA, wrist bone frature, wrist or hand injuries)

ROLLATOR: – the anterior vertical bars having the caster and lateral bar remains same as said in rigid walker. While walking the patient has to lift the rear bars off the ground and the wheels move forward and ends with he rear bar placing on the ground. It can be adviced foe patients who cannot lift the walker or needs more stability. It can be avoided for elderly patients as it may move fast and there is a chance that the patient can loose the stability.

RECIPROCAL WALKER: – this is designed to allow unilateral forward movement of one side of the walker. Thesetypes of walkers are useful for the patients who cannot lift and walk.

WHEELCHAIRS

one of the variety of mobility aids used by patients who has both lower limbs non functional or partially functional. It is considered as the secondary house of the patient as the patient has to spend most of his time on the wheelchair. Wheelchairs can be modified depending upon the condition of the patient. It gives 100% stability to the patient. Indicated for patients suffering from paraplegic, quadriplegic, muscular dystrophy, spinal cord injuries, fracture conditions etc. the use of wheelchair provides physical as well as mental support to the patient. Some of the types of wheelchairs are

1. Rigid
2. Foldable
3. One arm driven wheelchair
4. Powered wheelchair

RIGID wheelchairs are having a solid/ stable frame and also it is lighter. It is mainly used for the sports and is very difficult to carry while travelling.

FOLDABLE type contains a stable frame but which is foldable in nature. It occupies less space and is very easy to carry even while travelling also.

ONE ARM DRIVEN wheelchairs are used for the patient those who are not able to use their one side upper limb mainly in hemiplegia like conditions. The wheelchair is activated and steered by one upper limb.  The wheelchair contains 2 hand rims in one side which are used to control the wheels.

POWERED wheelchairs are the sophisticated one and arm more used on the developed countries. It is steered, propelled, adjust the seat hand rest, back rest by the power control. When compared to the other types of wheelcharis, this type is much more expensive.

INDICATIONS: –

• Quadriplegia
• Paraplegia
• Hemiplegia
• Spinal cord injury
• Muscular dystrophy
• Amputation
• Lower limb fracture.

PHYSIOTHERAPY EXERCISES FOR – 

PARALYTIC DISORDERS

Paralysis is the loss of muscle function in part of your body. It happens when something goes wrong with the way messages pass between your brain and muscles. Paralysis can be complete or partial. It can occur on one or both sides of your body. It can also occur in just one area, or it can be widespread. Paralysis of the lower half of your body, including both legs, is called paraplegia. Paralysis of the arms and legs is quadriplegia. Most paralysis is due to strokes or injuries such as spinal cord injury or a broken neck.

Types of Paralysis:

1. Paraplegia: It occurs usually owing to injury or illness of neural structure and occurs in both the legs. it’s generally amid loss of sensation below the extent of injury and disturbed bladder perform.
2. Diplegia: This type of palsy involves either side of the body, and severely affects the legs than the arms. Cerebral paralysis is way additional severe and dangerous when the harm is widespread.
3. Hemiplegia: It’s palsy of one aspect of the body, when movements of face ar affected additional severely than those of the leg. it’s caused by illness of the other (contralateral) hemisphere of the brain.
4. Monoplegia: It’s palsy of a single a part of the body.
5. Poliomyelitis: It’s caused by an infective virus that affects the Central system. This disorder is commonest in those areas wherever there is poor sanitation infantile paralysis is common are most areas in our country, however the illness are often controlled.

Treatment for paralysis:

1. Physical therapy is used to treat paralysis usually. Treatments such as heat massage, physiotherapy and exercise are done to stimulate the nerves and muscles. Functional Electrical stimulation is used in some cases to offer help to the patient.
2. Occupational therapy concentrates on ways to perform activities of daily living.
3. Mobility aids include manual and electric wheelchairs and scooters.
4. Supportive devices include braces, canes, and walkers.
5. Assistive technology such as voice-activated computers, lighting systems, and telephones.
6. Adaptive equipment such as special eating utensils and controls for driving a car.

Exercises:

1. Hip Rotation Exercise:-

*Lie down on the back and place the legs straight. The therapist will hold one leg by keeping a hand on the thigh and another just below the knee to give support.

*Your therapist will then help you gently bend the knee upwards towards your chest. The ideal position will be a 90-degree angle that will form around the knee and hip area.

*The therapist will then gently pull your leg towards him or her and again push it away to the opposite side. Repeat this for 10 times with one leg and then with the other.

2. Variation Of Hip Rotation Exercise:-

*Lie down on the back and place your legs straight. The therapist will stand on one side and hold your leg and place one or two hands on the leg for support.

*The therapist will help to roll your leg inward in such a way that your big toe touches the bed. Next, the therapist will help you roll your leg in such a way that your little toe will touch the bed. Repeat this for 10 times with one leg and then with the other.

3. Ankle Rotation Exercise:-

*For the ankle rotation exercise, you can sit down or lie down, depending on what is more comfortable for you.

*The therapist will take one ankle in each hand and help to rotate your foot and your ankle in circular motions. Repeat this for 10 times with each foot.

4. Toe Rotation Exercise:-

*For the toe rotation exercise, the therapist will help to curl your toes in a downward motion so that the toes go towards the bottom part of your foot.

*The therapist will then gently straighten and stretch out each toe.

*Repeat this for 10 times with each leg.

5. Leg Rotation Exercise:-

* Lie down on the back and place your legs straight. The therapist will provide support to the knee joint and the ankle as you move one leg outward and then take it inward.

* While doing so, you have to lift the leg a little so that it crosses over the other leg. The therapist will help you return to the starting position and repeat the same with the other leg and do more repetitions.

6. Physical Conditioning:-

*Balance, coordination and stability are the foundation of starting an exercise program for a partially paralyzed patient, which in turn improve gait and mobility. Active or passive range of motion exercises will help prevent muscles from atrophying, whether full use of the limb is regained or not. Physical conditioning promoted through passive range of motion may improve strength and help the patient to adapt or learn how to gain as much use from damaged limbs as possible.

CERVICAL SPONDYLOSIS

In Cervical spondylosis, physiotherapy is mainly indicated mainly for improving pain, ROM, muscle weakness. The main physical modalities that can be performed TENS, traction, immobilization using neck collar, Contrast therapy, Neck exercises, Ultrasound etc.

FROZEN SHOULDER

Frozen shoulder, also known as adhesive capsulitis, is defined as “a condition of uncertain aetiology, characterised by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder”

Frozen shoulder often progresses in three stages: the freezing (painful), frozen (adhesive) and thawing phases. In the freezing stage, which lasts about 2–9 months, there is a gradual onset of diffuse, severe shoulder pain that typically worsens at night. The pain will begin to subside during the frozen stage with a characteristic progressive loss of glenohumeral flexion, abduction, internal rotation and external rotation. This stage can last for 4–12 months. During the thawing stage, the patient experiences a gradual return of range of motion that takes about 5–26 months to complete. Although adhesive capsulitis is often self-limiting, usually resolving in 1–3 years, it can persist, presenting symptoms that are commonly mild; pain is the most common complaint.

In Freezing Phase, where pain is the most severe factor. The following physical therapy methods can be advised. Gentle shoulder mobilization exercises can be advised such as pendulum exercise, passive supine forward elevation, passive external rotation and active assisted range of motion in extension, horizontal adduction and internal rotation. Heat as well as cold trherapy can be administered before exercise. Application of moist heat along with stretching has been shown to improve muscle extensibility.

In Frozen Phase, heat or ice packs can be applied during this phase before exercise. Stretching exercises for the chest muscles and muscle at shoulder back should be maintained. Rotation before elevation exercises, such as external rotation stretch, etc.

In the thawing phase, the patient experiences a gradual return of range of motion. It is crucial to get the shoulder back to normal as quickly as possible by regaining full movement and strength. Strengthening exercises are important, as the shoulder is considerably weakened after a few months of little movement. Compared to the frozen phase, the patient can perform more mobility exercises and stretches with a longer holding duration, within tolerated boundaries. Strengthening exercises can also progress from isometric or static contractions to exercises using a resistance band, and eventually to free weights or weight machines. Rotator cuff exercises, as well as posture exercises and exercises for the deltoid and chest muscles, can be included in the treatment as well.

SLIP DISC

In slip disc conditions, physiotherapy is mainly aimed at reducing the pain and to make the joints more flexible. To increase the ROM of the joints.

The physical therapies which can be adopted for this condition are TENS, IFT, lumbar traction, Contrast therapy, active and passive exercises, Ultrasound etc