I got the best teachers award in the students survey conducted by sancheti healthcare academy for college of physiotherapy

First time  Sancheti Healthcare Academy  conducted  students survey for college of physiotherapy. this survey was done  by Dr. Priya Ramachandran Master’s degree Business management ( Gold medalist ) MA Economics. professor of PGP-HS (Post Graduate Programme in Healthcare Services) and PGA- HS (Post Graduate Advanced - Health Services). under the guidance  of Mrs. Manisha Sanghavi, executive director of Sancheti Healthcare Academy.

Sancheti  college of physiotherapy is third in India she wanted to find how who can make it number one in India. this one of the step in the process of it.

 Mrs. Manisha Sanghavi, Executive Director wanted to find out 

• how students learn in sancheti  college of physiotherapy. ?
• what methods of teaching they understand more and like more. ?
• what methods they want to incorporate in training and education of students. ?
• students suggestions
• There was students poll on the teachers teaching methods and their learning.  on the bases of students poll there was ranking done. 

Dr. Priya presented a full research report of 70 -80 pages with statistic. the result of research included what student's best methods of learning, what they feel most important and least important in training of physiotherapy.  Ranking of teachers according to students learning. 

In this survey

Dr. Gajanan Bhalerao got the First best teacher Award

Dr. seemi Retharekar got second  best teacher Award

 

Dr. Vivek Kulkarni got Third  best teachers Award  

TILT TABLE STANDING: early weight bearing and standing in patient with Total Hip Replacement with complications.

TILT TABLE STANDING:  early weight bearing and standing in patient with Total Hip Replacement with complications- para paresis, diabetic, high BP and cardiac problems.
This is patient with Total Hip Replacement rt side with bilateral lower limb weakness and trunk weakness. she was unable to stand on her even with walker. so we have to make her stand with help of tilt table. give her feedback of upright standing and weight bearing through legs. to improve the postural reactions and  to keep her engage in active participation patient is given a activity of ball catch and through. after few days of standing we made her stand with bilateral knee brace and walk with forearm support walker. initially we have passively start stepping forward for her. slowly she learned to take steps with help of walker with minimum assistance.

please click here for details of video

video will be live at: http://youtu.be/TbrKFsORYd0

SCI REHAB: Modified prone push up in high Paraplegics & Quadriplegics with weak triceps

Modified prone push up in high  paraplegics - who have weakness in trunk and unable to do push up for upper limb strengthening. in that case we can put a big bolster under the chest and  raise and support the upper trunk on the bolster that will help him balance and control the upper trunk and could put more efforts in prone push ups and help in strengthening of upper limb.

Quadriplegics with weak triceps also have difficulty in prone push up also can be benefited by this technique.

 please check the link of video
http://youtu.be/uNeEBhyyHUI

I HAVE COMPLETED FIVE YEARS IN SANCHETI COLLEGE OF PHYSIOTHERAPY AS A ASSISTANT PROFESSOR/ LECTURER.

Dear friends,
at the end of marc 2012 i have completed my
FIVE YEARS IN SANCHETI COLLEGE OF PHYSIOTHERAPY PUNE, INDIA
AS A ASSISTANT PROFESSOR/ LECTURER.
It unbelievable that i complete five years. what a journey….! i was a great experience. when i look back there are many more milestones and achievements i could do in and due to sancheti college of physiotherapy. 1. PUBLICATION:- i could done two publication (1 international -NDTA NETWORK and 1 national Journal of orthopedics and rehabilitation). Preparing for next 4-5 publications this year
2. RESEARCH PAPER PRESENTATIONS & AWARDS:- INTERNATIONAL
a.Winner Of Young Presenters Scholarship From Epilepsy Foundation India, in the conference of“International congress on neurology and rehabilitation Goa April 2010”,
STATE LEVEL:
a. Winner of best paper award in engeering and technology category In Avishkar 2010 of Maharashtra university of health sciences (MUHS), Nashik India.
b.WINNER OF BEST PAPER FOR scientific paper presentation in AVISHKAR 2010 of Maharashtra University of Health Sciences (MUHS), AURANGABAD, India.
3.REESOURCE PERSON/COURSE INSTRUCTOR:- I have conducted Conducted workshop on
a. 2D & 3D Gait Analysis and its Management
b. two workshops of MOTOR RELEARNING PROGRAM- for stroke rehab
c. two workshops of Spinal Cord Injury Rehabilitation
4. Development of new NEURO DEPT thanks so sancheti hospital and sancheti healthcare academy
5. SUPPORT GROUP: we have started with Spinal Cord Injury Rehabilitation, and very soon we will start stroke, Parkinson and brain injury.
6. i got opportunity to treat DADA J. P. VASVANI.
7. May be this academic year i will be a post graduate teacher and i will get opportunity to guide 2 PG students and be a READER.
8. Be a imp part of scientica- students conference.
I am very thankful for support of
Dr. K. H SANCHETI, MS ORTHO, founder chairman, Sancheti hospital.
DR. PARAG SANCHETI, MS ORTHO,  chairman, Sancheti hospital.
MRS. MANISHA SANGHAVI, executive director, Sancheti healthcare Academy
DR. S. M. SABNIS, EX PRINCIPAL, Sancheti college of physiotherapy,

DR. S. A. RAIRIKAR, PRINCIPAL, Sancheti college of physiotherapy,

DR. NILIMA BEDEKAR
DR. VASANTI JOSHI,
DR. VIVEK KULKARNI,
DR. RAZIA NAGARWALA,
DR. APURV SHIMPI,
DR. SEEMI RETHAREKARDR.
and all the consultant and staff of
Sancheti college of physiotherapy,
Sancheti healthcare academy and
Sancheti hospital. Thankful to all students for giving me opportunity to teach them and making me COMPLETE TEACHER.
THANKS TO MY FAMILY

There is a big difference in stretching and lengthening

In lengthening we just take the muscle to the normal length of the muscle which is the elongated state of muscle. i.e. extrafusal msucle fibers are put in the lengthen state from the lax state{ we just take the slag out} so that the intrafusal muscle fiber are elongated and the muscle spindle also under some degree of tension.
This is the optimum length of the muscle which helps in effective facilitation of muscle. this is what the Frank Starling law stated ” The length of muscle is directly proportional the strength of the muscle.” in this optimum length there are maximum number of cross bridges are available on actin and myosin filament for contraction ( walk along theory }.

where as in stretching we are not bothered about the optimum length of muscle but we ant get the normal range of the joint and length of the muscle even if the muscle has strength or not to maintain and work in that new length.

during this kind of stretching specially the spastic muscle we don’t get the change in the length of the contractile element of the muscle, instead we stretch the non contractile muscle. this will over lengthen the muscle and put under mechanical disadvantage and sometime changes the angle of pull of muscle.
all these abnormal stretching and mechanical disadvantage of muscle will reduce the strength of muscle make it permanent weak.
example over stretching of quadriceps or long flexors of hand put them in inefficient length or position. and what we call this condition as EXTENSION LAG in quadriceps. i will explain this in more details with diagram in new blog.

HOW TO DO WALKING TRAINING WITH WALKER IN PATIENTS WITH ASIS TYPE C QUADRIPLEGIA WHO DO NOT HAVE HAND CONTROL TO HOLD THE WALKER DUE TO LMN LESION AT C7, C8 & T1.

Quadriplegic patients who have LMN lesion at C7, C8 & T1 do not have hand control and are unable to hold the walker.  In spite of improvement in lower limb and trunk strength these patients are unable to walk with walker because they can’t hold the walker.

So what is the solution?

The solution is very simple. When they are not able hold the walker due to hand weakness we can use forearm support walker for gait training.

www.gajananbhalerao.wordpress.com/2011/12/09/how-to-do-walking-training-with-walker-in-patients-with-asis-type-c-quadriplegia-who-do-not-have-hand-control-to-hold-the-walker-due-to-lmn-lesion-at-c7-c8-t1/

Spastic muscles cant do eccentric lengthening

Spastic muscles are in the state of concentric contractions can’t do eccentric lengthening. Spastic muscles are in shortened state and active eccentric contraction in difficult. This can be due to
a. Weakness of antagonistic muscle
b. Due to reciprocal inhibition causes relaxation of antagonistic muscle

Spastic muscles act like spring that work in concentric contraction and remains in contraction mostly (flexed position) which creates motor imbalance between them and antagonist to them. Therefore strengthening antagonist assists in reducing tone of spastic muscles as this allows lengthening of spastic muscle!!

So in the initial phase of neuro rehabilitation of hemiplegic patients we should concentrate more on eccentric and static (placing reaction) contraction.
Avoid strengthening the concentric contraction. Because if the spastic muscle becomes strong then it is difficult to initiate the eccentric contraction.
During training of upper limb control we train the elbow flexion and shoulder flexion. The common mode is to train concentric contraction. We tell the patient to lift upper limb against gravity. This indirectly trains the flexor synergy make it strong then it becomes difficult to break the synergy.
So what to do? Work on placing reaction in upper limb. Place the shoulder in flexion above 90 degree and let him hold it and followed by slow lowering the upper limb (eccentric contraction).
What is the advantage of eccentric contraction? Eccentric contraction helps early and better in recruitments of motor units than concentric contractions. Eccentric contraction can generate more force with less motor unit recruitment. Concentric contraction requires more motor unit recruitment for even generation minimum muscle contraction. So it becomes difficult to initiate concentric contraction than eccentric contraction.
So in the spastic muscles we should concentrate more on eccentric lengthening. Increase in eccentric lengthening of muscles indirectly helps in reducing spasticity.

My first International publication as Co Author in Neuro Developmental Therapy Association (NDTA) Network on the net,

Thanks to Dr. Asha Chitnis, C/NDT for help and guidance in publishing the paper in NDTA NETWORK.
Participation and Participation Restrictions in a Teenager with Down Syndrome: an Indian Scenario
By by Reena Mody, PT, C/NDT, Gajanan Vithalrao Bhalerao, MPT, Sujata Noronha, PT, C/NDT Madhavi Kelapure, PT, C/NDT, Asha Chitnis, PT, C/NDT
NDTA Network  on the net November - December 2011 • Adults with Congenital Disabilities. Volume 18, Issue 6
link:
https://www.ndta.org/network/article.php?article_id=575

What to do while application of Bobath Approach?

What to do while application of  Bobath Approach?

The abnormal patterns must be stopped not so much by modifying the sensory input, but by giving back to the patient the lost or undeveloped control over his out put in developmental sequence.
The basic patterns of posture & movement, the righting reaction & equilibrium responses are elicited by providing the appropriate stimuli while the abnormal patterns are inhibited.
In this way patient the patient is given the opportunity to experience normal movement.
The sensory information of correct movement is absolutely necessary for the development of improved motor control.
Treatment therefore, concentrate on handling the patient in such a way as to inhibit abnormal distribution of tone & abnormal postures while stimulating or encouraging the next level of motor control.
 The abnormal postures & tone are controlled at key point (proximal body parts, I.e. head neck trunk, & sometimes distal parts I.e. thumb & fingers), using reflex inhibiting movement or patterns called as RIPs.
 If the patient lack s tone, sensory stimulation or tapping is used while the RIPs is applied so the is sensory inflow will not shunt into abnormal patterns.
Bobath believes that once the patient can move in & out of normal basic patterns of posture & movement he will automatically be able to elaborate on these patterns to learn the more skilled activities required in daily living.

KEY ELEMENT AND PINICPLES OF NEURO REHABILITAION

We should always treat in upright positions
work on
     Alignment
     Reactive postural control
     Righting reactions
      Postural adjustments
Adaptive postures and reactions
Change BOS first then COG then orientation or alignments
We should always work at the end  limit of stability. it should be just enough to challenge it. Not too much out of LOS or too short.
During reach there should lengthening on the side of reach out & weight shift and shortening on the opposite side.
Don't change the orientation too much. there should be short range of excursion.
Always work in the outer and middle range then progress to inner range of movement.
Always work with the knowledge of result than knowledge of performance for feedback.
Reach out should be just enough to challenge the limit of stability.
Avoid ballistic stretching to prolonged sustained stretching and functional stretching.
Adaptive tightness- can be due to contractile and non contractile element.