Rehabilitation

Amputations
orthopedic injuries,
arthritis,

It is prescribed after many types

  Definition
Rehabilitation is a treatment or treatments designed
to facilitate the

GOALS

Minimize functional deficits

Use remaining function to maximum

Prevent complications

Minimize functional deficits

Prevent complications

*Developed and delivered by the rehabilitation Team .
*Patient participation is essential

The key to Good Rehabilitation

Rehabilitation should be Comprehensive,with
extended care program .
Patient

What diagnostic tools are used in phy
medical history,
physical examinations,
X-rays.CT,MRI
.Electromyography

Physiatrists utilize
Medications
Injections.
Physical modalities.
Exercise.
Education individualized to the patient`s needs.
Assistive

Physician specialists head Rehabilitation teams including a
*The physical therapist
*occupational therapist.
* The

Definition of stroke
*A cerebrovascular event with rapidly developing clinical signs of

*HEMORRHAGIC(15%) -interacerebral(hypertention) -subarachnoid(ruptured aneurysm)

ISCHEMIC(85%) -thrombotic --embolic

TYPES OF STROKE

The physical therapist

The physical therapist assists the patient in functional restoration.
Tasks

OCCUPATIONAL THERAPISTS Are responsible for those therapeutic activities associated with patient’s

Occupational therapy
This may be achieved
by restoring old skills
or teaching

The social workers

Evaluation of the patient’s total Living Situation, Including
.

Therapeutic Recreation

implements various interventions
as a form of treatment
to increase

Hand Held Reacher

Flexible Sock Aid

Grip Drink Holder

What Are Assistive Devices

Assistive devices

                                                       Pediatric

Walkers

Types of Mobility Aids

help with
walking or moving
from place

Orthotist — A health care professional who is skilled
in making

Clinical evaluation

Neurologic recovery after a SCI
Occurs over a period of 18

We Begin Our Work With the Spinal Cord Patient by :

Early

The Vocational rehabilitation program will assist in training and placing disabled

NECK
PAIN

لواء
أد
رضا عوض

Anatomy

Head weighing 6:8 1b
7 cervical vertebrae
5 intervertebral discs
12 joints of Luschka
14

Prevalence

Neck Stiffness
25 : 30 % Age 25-29 year
Up to 50 %

Causes

Musculosketetal Causes

Osteoarthritis
Diffuse idiopathic skeletal hyperstosis
Cervical spondylosis
Disk disease
Rheumatoid arthritis
Fracture
Neoplasm
Thoracic outlet syndrome (cervical

Neurological Causes

Nerve root syndromes
Cervical myelopathy
Neuritis (brachial,occipital)
Torticollis
Meningitis
Cord tumors

Soft tissue and muscular pain

Acute cervical strain
Cumulative trauma, overstrain syndromes
Tendinitis, bursitis
Postural

Referred Pain

Heart and coronary artery disease
Apex of lung: Pancoast’s tumor
Migraine
Muscle tension

AIM

Relief of pain and stiffness in the neck and arms
Restore

Early mobilization exercises in patients with acute sprains
often improve outcome

HAND
BOOK

توعيه
المريض

التمرينات اليوميه بالمنزل

Traction

Traction forces over 9kg cause
separation of 1- 1.5 mm at

PROF.

SUN RISE (SHARM.)
BY
DR /REDA AWAD

REDA AWAD

AT AGOUZA

LBP: Statistics

Second only to the common cold in frequency among adult

.. Up to 50% of working adults have back pain each

The disc is made up of three basic structures: the nucleus pulposus,

Disc innervation

1981 Australian clinical anatomist and physician Nikoli Bogduk
The outer 1/3

interadiscal pressure

 is a synovial joint between the superior articular process, of one vertebra and the inferior articular

Degeneration
Before age 40 approximately 25%. Beyond age 40, more than 60%

As the disc dehydrates
the disc loose ability to support the

bear the highest loads and tend to undergo the most motion.

The majority of
spinal disc herniation cases occur in
 lumbar region
 (95% in

Pain provoked behind knee
By stretching of hamstrings

Pain in the back provoked

- progressive neurologic

herniated disc at the L5-S1

herniation (of the disc between the L4-L5

The Diagnosis of back pain should be
Based on a Good

Goals

*Relieve of pain

*Restoration
of physiological movements

*Prevention of relapses

Approximately 90%

Surgery should be considered for

Individuals With Motor Weakness

Other Treatment
muscle relaxants or
nonsteroidal anti-inflammatory drugs to control muscle spasms.

The patient should also be instructed in the proper body mechanics

modalities

HAND
BOOK

PERCUTANEOUS MINIMAL INVASIVE INTERVENTIONAL

PAIN MANEGMENT OF LOW BACK PAIN

fluoroscopy

CT

DISCECTOMY

AGOUZA
SPECIALISED SPINE CENTER
(ASSC)

Electromyography

Prof. Dr. Reda Awad

the normal neurophysiologic function of the nervous system.
Electrical signals are

Why It Is Done
To help in the diagnosis&assessment of the diseases

Electromyogram (EMG) and Nerve Conduction Studies
An electromyogram (EMG) measures the electrical

Electromography and nerve conduction studies is an important and helpful Extension

Key steps
Review of referral materials
Eliciting the patient’s history
Performing a physical

Electromyography
This procedure involves the placement of a needle into various muscles

EMG of normal muscle

At rest: no activity.
On minimal volition : MUAPs

The normal MUAP
is usually biphasic or triphasic with amplitude

Anatomical sites of involvement including possible aetiology

Site Aetiology
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Anterior horn cell poliomyelitis

Prof. Dr. Reda Awad

Motor nerve conduction studies

Almost any nerve that has motor fibers and

The Term Entrapment describes the mechanical irritation by which a specific

Nerve compression Can Occur at any point where a peripheral nerve

In addition to a
neurologic examination,
the evaluation of every patient

EMG and nerve conduction velocity measurements provide localizing information often necessary

Classification of nerve injuries

Neurapraxia: It is a comparatively mild injury with

Axonotmesis:
It is commonly seen in crush injuries The axon and

Neurotemesis
It describes a nerve that has been either completely served or

Characteristic features associated with Various nerve compressions

What Is
Carpal Tunnel Syndrome?

   * R . A
    * Hypothyroidism
    * Amyloidosis
    *

* Mixed sensor motor N.
* Sensory - paresthesias
*

If sever , the CTS may produce retro grade pain to

Double crush syndrome of the MEDIAN nerve

Treatment: Nonoperative: Splint the limb in the neutral position that maximize

Rest the Wrist Wrist rests help to avoid carpal tunnel syndrome by

Modify activity and avoid positions that can be a source

Operative: If despite of nonoperative treatment,there is evidence of continuing axonal

*surgery
produces good results in cases caused by ganglion , some

Anky losing spondy litis

Is a chronic systemic inflammatory disorder of

Eyes
Acute Anterior Uveitis
25 – 45 %

Skin
Psoriasis & Nail Changes
5 – 16

ETIOLOGY, PATHOGENESIS AND PATHOLOGY

Key initial inflammatory lesions occur at FIBROCARTILAGINOUS ENTHESES

Disease Progression in AS

Obliteration of lumbar lordosis with atrophy of

Inflammatory Back Pain according to experts*

*

*

*

Insidious onset
Pain at night(with

Signs painful sacro-iliac tests * limited spinal movements

Ankylosing Spondylitis

Key Features:
Low back pain
Prolonged AM stiffness
Nocturnal stiffness
Improves with exercise
Xrays with

Ankylosing Spondylitis is a disease charactrized by early onset& delayed diagnosis

Clearly

Why is Early Diagnosis of AS Important?

Improved diagnostic tools (MRI) and

Education, exercise, physical therapy, rehabilitation, patient
associations, self help groups

NSAIDs

Peripheral disease

Axial

Ankylosing spondylitis use NSAIDs

About 60-75% of patients with AS show good

20-50% of AS patients still have active disease despite treatment with

Spinal Inflammation in AS Before and After Treatment With TNF blockers

PRINCIPLES OF MANGEMENT OF AS

1- No cure , but most

5- Continuity of care

6- Daily exercise very important (e.g., swimming

A full explanation of the disease , its course , possible

* Lying prone for 15 to 30 minutes once or several

PHYSIOTHERAPY

* In a randomized controlled trial , a program of

A New Therapeutic Approach Is Needed for AS
Eeeeeer
Early, aggressive therapy &early introduction

Osteoporosis

PROF/
REDA AWAD

Osteoporosis
("porous bones",
from Greek: ὀστέον/
osteon meaning "bone" and πόρος/poros meaning

بسم الله الرحمن الرحيم ” قال رب إني وهن العظم مني

International statistics
Osteoporosis is by far the most common metabolic bone disease

العظم نسيج حى فى حركه نشطه دائمه فيتم ازاله العظم القديم

Bone is continuously turned over by Modeling & Remodeling The

osteoclasts - عمر الخليه الهدامه اسبوعين
. osteoblasts عمر الخليه البنائه ثلاث

Bone Modeling and Remodeling

Bone modeling
involves both the growth and

خلال الطفولة والنمو، تكون سرعة تكوين العظم أكثر من سرعة إزالته.

Once the skeleton has reached maturity, regeneration continues in the form

In the uninjured adult skeleton, all osteoclasts and osteoblasts belong to

In healthy human adults, 3–4 million BMUs are initiated per year

الحاله الطبيعيه

حاله الهشاشه

A condition characterized by reduced bone mineral density and increased bone

In 70 % of patients with osteoporosis the cause is primary

Postmenopausal bone loss Curves of bone loss with progress of age

(Remagen W,

High Risk Factors for Fractures

Low intake of Calcium + Vitamin D3
Low

Osteoporosis Risk Factors & Prevention

Fixed Risk Factors:
Age
Female gender
Family history
Previous fracture
Race/ethnicity
Menopause/ hysterectomy
Long

Most common fracture sites

Vertebra

Wrist

Hip

Diagnostic methods

Osteoporosis is diagnosed using:
DXA
x-ray
Bone biopsy

1. Kanis. Osteoporos Int. 1997, 7:390-406.

The most common way to diagnose osteoporosis is through a bone

T-score

T-score is useful for the expression of BMD
( bone mineral density)

Osteoporosis: BMD of < -2,5

A BMD of < -2,5 is officially

Bone Biopsy

Bone biopsy can be used to identify osteoporosis.
A small sample

Quick Osteoporosis Risk Test for Women >50

7. Regulary Smoker

6. Loss of

Diagnosing osteoporosis is usually a combination of BMD, Age, previous fractures

Osteoporosis: Underdiagnosis

Osteoporosis: ‘the silent epidemic’

Half of all patients:
may be asymptomatic
are not

Most Common Symptoms of Osteoporosis

Low back pain
Loss of height
Stooped posture

If calcium

Osteoporosis - Clinical Consequences

Kyphosis (stooped posture)
Loss of height
Bulging abdomen (

Osteoporosis: Treatment Options & Guidelines

Management of osteoporosis Ways to reduce fracture risk

calcium and vitamin D

Calcium + Vitamin D is the fundamental part of any Osteoporosis

الجرعه اليوميه للكالسيوم
--(غذاء وادويه1,200-1,500 mg
Take calcium supplements in doses

برنامج الوقايه من مرض هشاشه العظام

غذاء متوازن غنى بالكالسيوم وفيتامين د

منع السقوط

1تاكد من الابصار الجيد (تصحيح النظر) ---- والاضاءه جيده
2 تجنب

weight – bearing aerobic activity