SRIKUMARAN PHYSIOTHERAPY & FITNESS CENTRE ( ஶ்ரீகுமரன் ‌‌‌‌பிசியோதெரபி & உடற்பயிற்சி மையம் )

  TYPES OF CRUTCHES : 1. AXILLARY CRUTCHES: These are light weight and can be made of wood or metal. Axillary crutches consist of an axillary bar, hand piece, double uprights joined distally by a single leg covered with a rubber suction tip. The single leg allows height variations, by alterations of screws and wing bolts in predrilled holes known as telescopic arrangements. Hand grip variations can be done either by screws or push button mechanism. These help to improve balance and lateral stability. Provide functional ambulation and lateral stability. Can be used for stair ascending and descending MEASUREMENT OF LENGTH : A. IN LYING : WITH SHOES OFF : (most reliable method) measurement is with the help of inch tape from apex of axilla till the lower margin of medial malleolus. WITH SHOES ON : 5cm vertically down from apex of axilla till 20 cm lateral to the heel of the shoes. Measurement from axillary pad to hand grip : Elbow is flexed 15 degrees, mark a point 5 cm below the apex of a

 The Active Cycle of Breathing Technique (ACBT) The active cycle of breathing technique is performed to aid clearance of bronchial secretions (Webber & Pryor 1993). It combines thoracic expansion exercises, breathing control and forced expiratory technique in a treatment approach which is flexible to the patient's needs. A typical active cycle of breathing technique starts with a period of breathing control, the length of which will vary according to the patient's signs of bronchospasm (ACPRC 1996) but may be in the region of one minute or so (Tannenbaum 1995). This is followed by three or four thoracic expansion exercises to mobilize secretions in the smaller bronchi. Forced expiration technique from mid to low lung volume may then move the secretions proximally, and this may stimulate a cough, or alternatively, a huff from high lung volume may remove the secretions. It is vital that breathing control follows immediately after the forced expiratory technique as this helps

 Forced Expiration Technique (FET) Forced expiration technique consists of one or two huffs from mid to low lung volume followed by a period of breathing control to reduce any bronchospasm the huffs may have engendered (Tannenbaum 1995; Hardy 1994; ACPRC 1996; Webber & Pryor 1993; Webber 1990). The technique may be performed in postural drainage positions but is commonly performed in sitting or high side lying . The patient is instructed to take a medium sized breath in, followed by a lightly forced expiration through an open mouth and glottis (Webber & Pryor 1993). The huff should not be sharply forced or too prolonged as coughing may result. It is usual to perform one or two huffs followed by a period of breathing control to avoid inducement of bronchospasm. The cycle of huffs and breathing control may be repeated until secretions reach the proximal airways when a cough or short huff from high lung volume may remove them (Webber & Pryor 1993). Forced expiratory technique

 Thoracic Expansion Exercises (TEE) Thoracic expansion exercises emphasize the inspiratory phase of breathing and are performed from functional residual capacity (FRC) to maximal inspiratory capacity (Tucker & Jenkins 1996). To perform the technique, the patient is positioned appropriate to the goal of treatment, e.g. if secretion removal and subsequent improved ventilation to a particular lung zone is the goal, then thoracic expansion exercises may be performed in the appropriate postural drainage position (Hollis 1998). The patient is encouraged to breathe in slowly and as deeply as he can through the nose, followed by a relaxed passive expiration via the mouth. To avoid hyperventilation, this is repeated only three more times (Webber & Pryor 1993), before the patient is allowed to return to his tidal volume breathing. A three-second hold at full inspiration with the glottis open may be added (Tucker & Jenkins 1996; Webber & Pryor 1993), or alternatively the patient m