🟡 Current used with* chronic and acute pain*
💥Interfrential current
💥HVPS
💥Tens
💥MES

🟡 Current used with* Chronic and acute inflammation*
💥MES
💥 iontophoresis

⚡️⚡️⚡️ acute and chronic inflammation is contraindicated for *faradic current*

🔻Muscle strenght
▪️faradic
▪️tens(acupuncture like tens)
▪️Russiun & Aussie
▪️IFC
▪️DD (MF)
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🔻Muscle re education
▪️faradic
▪️HVPS
▪️IFC
--------------
🔻Muscle spasm
▪️DF
▪️HVPS >chronic spasm
▪️IFC

Subsensory level:-
Stimulation occurs within the output interval between the point at which the output intensity rises from 0 to the point at which the patient receive a discrete electrical sensation.
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Sensory Level:-
Stimulation describes an output that stimulates only sensory nerves.
This level is found by increasing the output to the point at which a slight muscle twitch is seen and then decreasing the output by approximately 10%
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Motor level:-
Stimulation describes an intensity that produces a visible contraction without causing pain.
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Noxious Level:-
Current applied at an intensity that stimulates pain fibers.

Neuropraxia
Mild degree blockage
Local conduction block
No wallerian degeneration
Reversible
Axon isn't disrupted
No muscle waste
Decrease(loss) of strength
Absence of tendon reflex (below the level of lesion)
Slightly sensory loss
No sympathetic change
Class l.......
Recovery weeks to months

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Axonotmesis
Second degree
The axon only disrupted
Loss of nerve conduction
Wallerian degeneration occurs
Arreflxia occurs
Axon degeneration occurs at rate 1-8 mm/day
Occurs due to (profound nature compression, traction, prolonged friction, percussion injury,closed crush, injection and operation)
Class ll
Recovery may occur

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Neurotmesis
Greatest degree
Complete disruption
Wallerian degeneration occurs
Regeneration may occur
Disruption of axon
Paralysis of denervated muscle
Loss of nerve conduction
Sensory disruption
Vasomotor disruption
May occur due to (stap would,high velocity projectiles and nerve traction disrupting the connective tissue of the nerve with complete transaction of nerve trunk)
Class lll
Regeneration may occur

What is the functional goal of loading response?

-- Weight acceptance
#gait

What are the two phases analyzed in the gait cycle?

Stance Phase
--60% of cycle

Swing Phase
--40% of cycle

stance and swing phase differ in

--speed increases in running

--Running the swing phase is greater than the stance phase.

What is the hip flexion requirement for normal gait?

0-30 degrees

particular way or manner of moving on foot:-

Gait

المسافه ما بين الخط اللي بيقطع ال progression line بشكل عمودي هو أكيد ال BOS distance أو step width

1. No double limb support in running.

2. Float phase in running.

3. Greater muscular effort.

4. Greater ROM

✅ In normal walking speed

- Lower extremities ( primary ) , trunk and arms for stability ( secondary ).

✅In faster speeds

- Balance and stability with lower extremities for producing greater ROM.

- Upper extremities with trunk for propulsion.

دي نقط فى الـ Gait.🤩
#gait

Pathological Gait
#gait
❖ Influences on gait

(المؤثرات اللي بتأثر عالمشية وليست الأسباب)

1- Pain :-

الخلل اللي بيحصل نتيجة الـ pain بيكون اسمه Antalgic gait يعني
pain due to abnormal Walking.

2- Posture :-

أي خلل في الـ Proper body biomechanics اللي هي الـ Ideal posture دا يسبب خلل في ال Gait.

3- Flexibility and the amount of available joint motion.

بما إن ال Skeletal muscle ليها Mechanical properities زي الـContractility وهي القدرة على الانقباض والانبساط و flexibility, Extensibility القدرة على ال Stretching لو العضلة مبتعملش الحاجات دي دا هيسبب pathological gait.

4-Muscle Endurance\ strength

حد عنده ضعف في العضلات دا طبعا يأثر ع ال gait
5-Base of Support

أي خلل في ال BOS سواء نقصان أو زيادة

6- Inter limb coordination\ integration\ coupling :-

بيكون في Harmony بين حركة الأبر واللور و كمان بين الـ limbs both بتاعة ال limb Lower و ال both limbs بتاعة ال upper limb.. أي خلل يأثر ع ال gait على طول و عايزك كدا تقولي الخلل دا هيبقى في ايه مثلا واحد عنده Right side hemiplegia و عايز اعرف هو فقد ال harmony اللي هو الانسجام و التناسق بين العضلات.

7- Leg Length Discrepancy :- "LLD"

يعني shortening in limb سواء في ناحية واحدة أو ناحيتين يعملLimping و دا بردو
pathological pattern of gait.

8-Gender

ال Male pattern of walking بيختلف عن ال Female pattern of walking.. أي إنسان في الدنيا ليه مشيه مميزه زي بصمة ايدك كدا.

9-Pregnancy

أي واحدة حامل وهي ماشية بتكون ماشية بـ
Pathological pattern of gait (lurching gait).

10- Obesity

أي حد وزنه زايد بيحصل خلل في مشيته زي إن الـ stance phase تكون فترته طويلة أو ال swing phase فترتها قصيرة.
11-Age

بزيادة العمر بيحصل وهن في العضلات ، تيبس في المفاصل،وفقدان الFlexibility.

12-Lateral & vertical displacement of the COG

13-Properly functioning reflexes

14-Vertical Ground Reaction Forces

ال forces اللي بت affect على ال
Sole of foot / planter aspect

اثناء المشية زي مثلاً ال(GRF) ground reaction force اللي ممكن يكون عمودى ال GRF ، بردو ال shear force وهي القوة المسؤولة عن زحلقتك.

15-Medial-Lateral Shear Forces

16-Anterior-Posterior Shear Forces


❖ Causes of Pathological Gait :-

1. Deformity :-

(CONGENITAL وراثي OR AQUIRED مكتسب ).

2. Imparied motor control or spasticity :-

يعني عدم قدرتك على التحكم في الحركه

Notice that :-

لو الـ muscle tone قل دي يبقى اسمهاflaccidityاو hypotonia ولو زادت تبقى hypertonicity او spasticity.

3. Sensory loss
يعني فقدان الاحساس نتيجة compression علي ال blood vessels وال nerves.
4. Pain

5. Muscle weakness
يعني أي عضلة يحصل فيها ضعف أو atrophy disused.

الفرق بين Paresis و Paralysis ⬇️ :
- Paralysis (يعني شلل دائم)
- Paresis (مؤقت)

Types of deformity :

❖Deformity of Hip (Coxa=hip) :-

1- COXA VALGA:
increase neck shaft angle more than 110 degrees , Causes toe out gait.

2- COXA VARA:
decrease neck shaft angle less than 110, Causes toe in gait.

VALGA ___out لبره
VARA___ in لجوه

و الزوايه 110 تزيد مع اللي بره و تقل مع اللي جوه

❖ Deformity of Knee (Genu=knee)

1-Knock knee OR genu valgum.

يعني deviation Lateral يعني الركبة باصة لبرا

2-Bow leg OR genu varum.

يعني الرجل المقوسة ودي بتحصل للأطفال اللي بيمشوا قبل الميعاد و احنا نقعد نسقفله و نقوله شاطر يا حبيبي شاطر😂.

3- Hyper extension knee OR genu recurvatum .

و دي بيحصل فيها hyper extension للركبة وال fibula, tibia يحصلهم posterior displacement بالنسبة لل femur وميبقوش على استقامة واحدة.

❖ Deformity of Ankle (Equinus =
ankle)

1- Equinus deformity or plantar
flexion deformity: