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Physiotherapy

Physical therapy also known as physiotherapy, includes evaluating, diagnosing and treating numerous disorders and disabilities through the physical way. This branch of medicine helps people restore, retain and maximize their strength, function, movement and overall well-being.

People who practice this branch of therapy are called physiotherapists. Diagnosis, treatment and rehabilitation of patients are their main areas of work. They primarily work with physical disorders and disabilities. Physiotherapy helps a person


  • Become flexible
  • Improve mobility
  • Reduce pain
  • Stay active
  • Prevent injury
  • Recover from injury

Physiotherapy helps the human body to remain functional. Physiotherapy is recommended when the human body suffers some physiological trauma. During physiotherapy the patient is examined physically and if required imaging studies are carried out so as to decide the right type of therapy. It is recommended in the following conditions:



Heat therapy: Heat therapy improves the blood flow to the injured area thus speeding up healing. Heat therapy also loosens the tight tissues thereby relieving pain. Various heat treatments include ultrasound, hot pack, infrared heat, Paraffin wax bath, Diathermy

Cryotherapy: Cold therapy helps in minimizing the swelling and pain. It is very useful in acute injuries. Various treatments include ice massage and ice pack application

Strengthening exercises with Physical Therapy: Certain conditions may have caused the muscles to weaken, there are certain types of exercises aimed at strengthening the muscles thereby helping rehabilitation and improving performance.

Range Of Motion exercises: ROM exercises help in improving and maintaining the flexibility of joints. They also help in reducing the stiffness of the joints. Various exercises include:

Passive Range of Motion exercises: (PROM)

Active Range of Motion exercises: (AROM)

Active Assistive Range of Motion exercises: (AAROM)

Soft tissue mobilization/Therapeutic massage:This relaxes the tight muscles thus relieving pain and reducing swelling

Electrical stimulation: This method is used to prevent muscle atrophy in people with paralysis. Electrodes are placed on the surface of the skin thus causing the muscle to shorten.

TENS: Transcutaneous Electrical Nerve Stimulation is a type of never stimulation wherein a low degree electrical current is passed through the surface of the skin to the affected part. This process helps in relieving pain momentarily.


Other types of physical therapy treatment include taping, bandaging, joint mobilization, ergonomic training, postural training, balance exercise, traction, fitting of orthosis, etc. Physiotherapy has various specializations like geriatric, pediatric, orthopedic, neurological, sports, cardiovascular and pulmonary.


Osteogenesis Imperfecta

Osteogenesis imperfecta or OI, also known as brittle bone disease, is a genetic disorder that is characterized by weak and fragile bones that break easily. Osteogenesis imperfecta is caused by a genetic defect that disables the body to make strong bones. A person may experience occasional fractures or may have multiple fractures throughout life depending upon the severity of Osteogenesis imperfecta present. Apart from fragile bones, people with OI suffer from teeth problems - Dentinogenesis Imperfecta, hearing loss, muscle weakness, loose joints (joint laxity) and skeletal malformations.


Causes of OI

Osteogenesis imperfecta is either inherited from a parent who has the defective gene or could be a result of new mutations. Due to the defective gene, an important protein substance called type I collagen is not produced in the body. This protein plays an important role in forming connective tissues in bones and also helps in forming ligaments, teeth and the white outer tissue of the eyeballs (sclera). Due to poor production of the protein, bones become brittle and fragile and tend to break easily. Most of the mutations in OI exist in the two type I collagen genes, COL1A1 and COL1A2 and account for almost all the forms of OI.


Classification of Osteogenesis imperfecta

Depending upon the severity of the Osteogenesis imperfecta, the condition is divided into type 1, type 2, type 3, type 4. These types are classified mostly by fracture frequency and by characteristic features. Recently, research has identified three more additional variations to Osteogenesis imperfecta known as type 5, 6 and 7.


Type 1

Type 1 Osteogenesis imperfecta is the mildest and the most common form of OI. More than 50% patients suffer from Type 1 Osteogenesis imperfecta. In this type, though body produces normal type I collagen but only half the normal quantity. People with Type 1 OI may experience fewer fractures, and most often the condition may go unnoticed for several years after their birth.


Type 2

Type 2 Is the most severe form of Osteogenesis imperfecta often resulting in bone deformities in the child. Type 2 OI normally turns out to be fatal with the production of very little or poor quality collagen being produced in the body. Infants with type 2 OI are born with fragile rib cage and underdeveloped lungs. They usually die either in the womb or soon after birth.


Type 3

Osteogenesis imperfecta type III is severely progressive type associated with symptoms like short stature, a triangular face, severe scoliosis, grayish sclera, and Dentinogenesis imperfecta (impaired and irregular teeth with yellow-blue tinge). Infants with type 3 OI have fractures at the time of birth itself, and few infants reveal a fractured and eventually healed bones in the womb itself.


Type 4

Type 4 Osteogenesis imperfecta can range from very mild to severe form often resulting in growth retardation in children. A child with type 4 OI is short with bow shaped legs. Symptoms like tinted sclerae (white of the eye) and dental deformities may also be present at the time of the birth. Child normally suffers from Long bone fractures, vertebral compression, scoliosis, and ligament laxity with type 4 OI.

Type 4 also has two sub types called type 5 and type 6 OI. Though clinically they resemble type 4, types 5 and 6 have unique patterns to the bones. Type 5 exhibits features like ossification of interosseous membrane of the forearm with radial head dislocation, large callus formation and an abnormal histopathological pattern. Type 6 will have elevated alkaline phosphatase and blue-white sclerae.


Diagnosis

Most severe forms are diagnosed before birth itself. Ultrasound scanning during second trimester may reveal deformity of limbs, abnormally short fetus, irregular skull shape, lack of mineralizations and narrow chest cavity. Few cases are diagnosed soon after the birth and mild type of OI is found out much later in life when such individuals suffer from repeated fractures. However, the following diagnostic methods are used to assess the condition.


  • Clinical examination, wherein history of frequent fractures with minimal trauma is noted

  • X-Ray

  • Genetic testing of a blood sample (DNA )

  • Skin biopsy to assess collagen production.

Treatment

Since Osteogenesis imperfecta is a genetic condition, it does not have a cure. Patient will be treated symptomatically and will be aided with external tools to provide maximum possible mobility. Efforts are also taken to improve muscle strength and boost the bone mass in the patient through physical therapy. Professionally designed exercise programmes are highly beneficial and play an important role in treating the patients suffering from OI. Patient may also be prescribed required nutritional supplements like calcium, and vitamin D along with physical therapy. Few suitable candidates are also treated with surgical procedure called intramedullary rod surgery wherein metal rods are inserted through the length of the long bones to support and strengthen them.


Of late, Bisphosphonates drugs are being used in treating Osteogenesis imperfecta. Bisphosphonates are used to decrease the amount of bone resorption. It also helps in preventing fractures and improve person's functional mobility. There is also research being done to understand the role of gene therapy in treating Osteogenesis imperfecta.


Prognosis

Prognosis of Osteogenesis imperfecta depends upon the severity of the conditions. Despite bone deformity, restricted activity, and short stature, often patients with OI lead productive and near to normal lives.


Terminologies :

  • Osteogenesis : Growing new bone
  • Osteocytes : Bone cells
  • Osteoblasts : Bone cells building new bone structure
  • Osteoclasts : Bone cells which scavange bone tissue


Myotonia

In medical terms, Myotonia is a neuromuscular condition. It is characterized by delayed relaxation of muscles after voluntary muscle contraction. It can affect any muscle type, the skeletal muscles, cardiac muscles (obvious) and smooth muscles (not obvious). The condition is usually inherited.


Myotonia is a characteristic feature in Myotonic Dystrophy, Myotonia Congenital and Paramyotonia Congenital. Myotonia is only a part in myotonic dystrophy. In Myotonia congenital and paramyotonia, it is the only main symptom. Also, in people who have a group of neurological disorders called the channelopathies, Myotonia is a symptom.


What happens in Myotonia?

Extra effort is required to relax the muscle soon after contraction. When the same action is repeated immediately, the condition improves as the muscles have warmed up.

Releasing the grip on objects or difficulty rising from a seated position is common with people with Myotonia. Immediately after rising from a seated position the individual may walk with a stiff, awkward gait. The posture improves after taking few steps forward. Another incidence is the time lag in opening eyes after initial tight eyelid closure.


What causes Myotonia?

Myotonia is caused by mutations in the chloride sodium or potassium channels that regulate the muscle membrane. Specific triggers that have been recognized so far include stress and exposure to cold.


What is the treatment for Myotonia?

If the condition is mild, exercise would suffice. If the condition is severe, treatment is necessary. Neurologist or medical geneticist with specific knowledge of the condition treats Myotonia. After a physical examination and a detailed family history, doctors prescribe medicines. Sodium channel blockers such as procainamide, phenytoin and mexiletine, tricyclic antidepressant drugs such as clomipramine or imipramine, benzodiazepines, calcium antagonists, taurine and prednisone are prescribed for the treatment. Physical therapy and other rehabilitative measures are recommended to help muscle function.


What is the prognosis for Myotonia?

Recognized as a chronic disorder, prescription medications when combined with physical therapy and other rehabilitative measures help alleviate symptoms later in life.


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Bibliography / Reference

Collection of Pages - Last revised Date: August 23, 2019