104 F I S I O T E R A P I E DESEMBER 1980

R E P O R T  ON A R E F R E S H E R  CO URS E H E LD  BY T H E  N A TA L 
CO A S T A L BRANCH OVER T H E  W E E K E N D  

O F  11 TO 13 J U L Y  1980
I n  th e  first se ssio n  M iss M . A s h b y  a n d  M rs . J. M o r ­

to n , a ssiste d  b y  M iss A . C la y to n , d e a lt w ith  M a itla n d  
m o b ilis a tio n  o f th e  c erv ica l sp in e . A  b r ie f  in tr o d u c tio n  
c o v e re d  g ra d e s o f m o v e m e n t, effects o f m o b ilis a tio n , th e  
irrita b ility  f a c to r  a n d  d iffere n ce s b e tw e e n  p a in  a risin g  
f ro m  in fla m m a tio n  a n d  m e c h a n ic a l lesions. A fte r a d e ­
m o n s tra tio n , th e  c o u rse  p a rtic ip a n ts  h a d  th e  o p p o rtu n ity  
to  p ra c tic e  e x a m in a tio n  a n d  so m e  m o b ilis a tio n  te c h ­
n iq u e s  o f th e  c e rv ic a l sp in e . M e th o d s  o f tre a tin g  so m e  
c o m m o n  d is o rd e rs  o f th e  c e rv ic a l sp in e  b y  m e a n s  of 
m o b ilis a tio n  te c h n iq u e s  w e re  d isc u sse d .

T h e  se c o n d  se ssio n  d e a lt w ith  N e u ro lo g ic a l T e c h ­
n iq u e s . M r. C. L ig g in s a n d  M rs . H . T a r r  g a v e  th e  
p h ilo s o p h y  a n d  e x p la in e d  h o w  R o o d  m e th o d s  a re  u se d  
to  o b ta in  e ith e r  fa c ilita tio n  o r  in h ib itio n  u sin g  stre tc h , 
re s is ta n c e , v ib ra tio n , b ru s h in g , icin g , p o s itio n in g , jo in t 
c o m p re ss io n , m o v e m e n t, etc. A  p ra c tic a l d e m o n s tra tio n  
o f b ru s h in g , icin g  a n d  v ib r a tio n  to  h e m ip le g ic s in  th e  
flaccid sta g e  w a s g iv en . T h e y  a lso  sh o w ed  h o w  a s p a s ­
tic  h a n d  c o u ld  b e  re le a s e d . A fte r stre ssin g  th e  im p o r­
ta n c e  o f a n k le  d o rsiflex io n  in  th e  h e m ip le g ic , p ra c tic a l 
fa c ilita tio n  o f th is  w as sh o w n . T h e  im p o rta n c e  of 
w e ig h t-b e a rin g  o n  th e  a ffe c te d  lim b  w as e x p la in e d , f o l­
lo w ed b y  a p ra c tic a l d e m o n s tr a tio n  o f in h ib itio n  o f a 
s tro n g  flex o r w ith d ra w a l reflex in  th e  lo w e r lim b . A  
d isc u ssio n  o n  th e  u se  of ice in b la d d e r  r e te n tio n  a n d  
in c o n tin e n c e  fo llo w e d . F in a lly  h a m s trin g  re le a s e  w as 
d e m o n s tra te d .

F o c u s s in g  on  s p a stic ity  in  h e m ip le g ia  a n d  c e re b ra l 
p a lsy , M rs . E . B u rn e tt a n d  M r. P . G o u n d e n  in tro d u c e d  
th e  n e u ro p h y s io lo g y  o f th e  d e v e lo p m e n ta l a p p ro a c h  to  
th e ra p y . A ’d isc u ssio n  o n  th e  p rin c ip le s  o f p h y s io th e ra p y  
in  th e  m a n a g e m e n t of s p a s tic ity  u sin g  N D T  w as 'fo l­
lo w e d  b y  a d e m o n s tr a tio n  o f th e  a p p lic a tio n  o f th ese  
p rin c ip le s .

I n  th e  th ir d  se ssio n  M r. C . L ig g in s d isc u sse d  p o ssib le  
re a s o n s  f o r  p a in  a n d  its m a n a g e m e n t. H e  su g g e ste d  th a t 
tra d itio n a l a ttitu d e s , d ifficulties o f d e fin itio n  a n d  p o o r 
o rg a n is a tio n  w e re  so m e  o f th e  re a s o n s  th a t th is w as a 
re la tiv e ly  u n d e v e lo p e d  c lin ic a l a re a . H e  d isc u sse d  th c o ; 
rie s o f p a in  s u c h  as sp e c ificity , p a tte r n  a n d  g a te  c o n ­
tro l, as w ell as th e  ro le  o f  e n k e p h a lin  a n d  th e  e n d o r ­
p h in s  a n d  th e  p o ss ib le  lin k  b e tw e e n  g a te  c o n tro l th e o ry  
a n d  th e  e n d o g e n o u s  o p ia te s. T h e  re st o f  th e  session 
c o n c e n tra te d  o n  p a in  .m a n a g e m e n t. P h y s io th e ra p e u tic  
m o d a litie s  s u c h  a s a c tiv e  a n d  p a ssiv e  m o v e m e n t, m a s ­
sage, m o b ilis a tio n , lo w  fre q u e n c y  e le c tric a l stim u la tio n , 
c o ld , “ a c u p re s s u re ” a n d  r e la x a tio n  w e re  m e n tio n e d  a n d  
p o ss ib le  m e c h a n is m s  e x p la in e d .

M iss S. B la c k w o o d , M r. P . G o u n d e n  a n d  M iss H . 
W ilso n  p re s e n te d  a sp e c ts o f p a e d ia tric , m e d ic a l a n d  s u r­
g ica l r e s p ir a to r y  th e ra p y , in  th e  f o u r t h  se ssio n . A  c o m ­
p a r is o n  w a s m a d e  b e tw e e n  th e  m e c h a n ic s  of re s p ira ­
tio n  in th e  a d u lt a n d  th e  in fa n t, d isc u ssin g  th e  a n a to m i­
cal a n d  p h y sio lo g ic a l d is a d v a n ta g e  o f t h e  in f a n t 
re s p ir a to r y  sy ste m  w ith  th e  th e r a p e u t ic  m o d if ic a tio n s  
n e c e ssa ry . T h e r a p e u tic  m o d a litie s  re le v a n t to  th e  t r e a t ­
m e n t of th e  c h ild  w e re  in c lu d e d . A  re v ie w  o f re c e n t 
lite r a tu r e  o n  a sp e c ts o f p h y s io th e ra p y  in re s p ira to ry  
c o n d itio n s  le a d  to  a d isc u ssio n  o n  th e  v a rio u s m e th o d s  
o f a d m in is tr a tio n  o f  in h a le d  b ro n c h o d ila to rs ; th e  e f ­
fic a c y  o f p o s tu r a l d ra in a g e , v ib ra tio n s , p e rc u ss io n  
a n d  sh a k in g ; th e  effect o f lo c a lis e d  lo w e r la te ra l c ostal 
b r e a th in g  in n o r m a l d is tr ib u tio n  o f v e n tila tio n ; th e  e f ­
fe c tiv e n e ss of a n  e x erc ise  tra in in g  p ro g ra m m e  im p ro v ­

ing e x e rc is e  to le ra n c e  w h ilst h e a r t ra te  a n d  lu n g  f u n c ­
tio n  re m a in  u n a ffe c te d , a n d  a m e th o d  f o r  te a c h in g  
p a tie n ts  w ith  c h ro n ic  o b s tru c tiv e  a irw a y  d ise a s e  effec­
tive c o u g h in g . C h a rts  to  d e m o n s tr a te  g e n e ra l tr e n d s  in 
p a tie n t c o n d itio n  w e re  d e sc rib e d . T h e  lo n g  a n d  s h o r t 
te r m  e ffects of in te r m itte n t p o sitiv e  p re s s u re  b re a th in g  
in th e  p h y s io th e ra p y  c o n te x t w e re  d isc u sse d . Slides 
w e re  sh o w n  to  illu s tra te  tr a u m a  to  th e  c h e s t, su rfa c e  
m a rk in g s  a n d  te c h n iq u e s  o f th o ra c o to m y . T h e  m o re  
c o m m o n  th o r a c ic  su rg e ry  w as h ig h lig h te d . T h e  im p o r ­
ta n c e  o f  p h y s io th e r a p y  in  b o th  p re o p e r a tiv e  a n d  p o s t­
o p e ra tiv e  m a n a g e m e n t, b y  p h y sic a l m e a n s  su c h  as 
b r e a th in g  e x erc ises, c o u g h in g , s u p p o r t o f th e  w o u n d ,, 
lim b  a n d  tru n k  e x erc ises, as w ell as p sy c h o lo g ic a l p re -' 
p a r a tio n  e v en  in  sm a ll c h ild re n  w e re  stre sse d . W ith in  
a n  h o u r  o f r e tu r n  to  c o n sc io u s n e s s th e  p a tie n t sh o u ld  
b e s tim u la te d  to  m o v e  th e  lim b s, to  b r e a th e  a n d  to  
c o u g h , a u g m e n te d  b y  v ib ra tio n s  a n d  sh a k in g , even 
w h e n  a tta c h e d  to  a v e n tila to r. E a rly  a m b u la tio n  sh o u ld  
b e  e n c o u ra g e d  c o n s is te n t w ith  th e  a g e  a n d  c o n d itio n  
o f th e  p a tie n t.

In  se ssio n  five M r. C . A . L ig g in s g a v e  th e  h is to ry  of 
co ld  as a th e ra p y  a n d  d e sc rib e d  its p h y sio lo g ic a l effects. 
T h e s e  w e re  re la te d  to  th e  v a rio u s m e th o d s  o f  th e r a ­
p e u tic  a p p lic a tio n  o f a n d  th e  c o n tra in d ic a tio n s  to  cold. 
A  p ra c tic a l d e m o n s tra tio n  o f m e th o d s  o f  c o n d u c tiv e  
a n d  e v a p o ra tiv e  c o o lin g  w as fo llo w e d  by  c o u rse  p a r ti ­
c ip a n ts  p ra c tis in g  th ese  m e th o d s  th em se lv es.

In  se ssio n  six  M rs . J. M o rto n  a n d  M iss S. E a g e r 
d e a lt w ith  s p o rts in ju rie s  by  c o m m e n tin g  o n  th e  fu n c ­
tio n  o f s p o r t f r o m  th e  e a rly  G re e k s  to  th e  m o d e rn  
O ly m p ic s. A s p e c ts o f th e  p h y sio lo g y  o f  p h y s ic a l a c tiv ity  
w e re  h ig h lig h te d , in c lu d in g  m a x im u m  o x y g e n  in ta k e  
a n d  e n e rg y  u tilis a tio n  d u rin g  p h y sic a l a c tiv ity . T h e  e f ­
f e c t o f tra in in g  o n  gly co g e n  u tilis a tio n , th e  effects of 
e n v iro n m e n t a n d  stre ss, a n d  fluid in ta k e , w e re  m e n ­
tio n e d . In c re a s in g  p a r tic ip a tio n  in  s p o rt h a s  led to  an 
in c re a s e  in  th e  n u m b e r  o f  s p o rt in ju rie s. W h e re a s  in a 
n o n -s p o rtin g  p e rs o n  a jo in t  s tr a in  c a n  b e  im m o b ilise d , 
in  a s p o rts m a n  im m o b ilis a tio n  s h o u ld  b e  a v o id e d  a t all 
c o sts a n d  if n e c e ssa ry , th e  p a tie n t s h o u ld  b e  ta u g h t â - 
tra in in g  r o u tin e  w h ic h  h e  c a n  still d o  to  m a in ta in  hi^ 
level o f  fitness.

A c u te  d ia g n o s is o f  in ju rie s  su c h  as m u sc le  a n d  te n ­
d o n  te a rs  a n d  s tra in s ; h a e m a to m a  a n d  c o n tu s io n s ; jo in t 
in ju rie s  w ith  c a rtila g e , c a p s u le  a n d  lig a m e n to u s in v o lv e ­
m e n t; fra c tu r e s  a n d  b o n y  h a e m a to m a  a re  o f  p rim e  im ­
p o r ta n c e  to  a ssess w h e th e r th e  in ju ry  is to  c o n tra c tile  
o r  n o n -c o n tra c tile  tissu e . T re a tm e n t s ta r ts  w ith  first- 
a id  a n d  th e n  d u r in g  th e  first 48  h o u rs  sh o u ld  in clu d e : 
re st —  to  ta k e  a w a y  s tra in  fro m  th e  a r e a ; ice —  to 
r e d u c e  th e  a m o u n t o f b le e d in g ; c o m p re ss io n  —  to  r e ­
d u c e  th e  b le e d in g  a n d  sw elling; e le v a tio n  —  to  re d u c e  
sw ellin g  a n d  p a in , a n d  u ltr a s o u n d  —  s h o u ld  b e  p u lse d  
a n d  a t  a low  d o se . A f te r  48 h o u rs  h e a t a n d  d e e p  tr a n s ­
v e rse  fric tio n s  c a n  b e  s ta rte d , as w ell as s tre tc h in g  a n d  
g ra d e d  ex erc ises. T h e  m a in  a im s of tr e a tm e n t  a re  to  
re g a in  m o b ility , in c re a s e  e n d u ra n c e  a n d  s tre n g th , a n d  
to  r e e d u c a te  c o o rd in a tio n .

T h e  re fr e s h e r  c o u rse  a tt r a c te d  a g r e a t d e a l o f in ­
te re s t fro m  p h y s io th e ra p is ts  f r o m  a ll p a r ts  o f N a ta l a n d  
th e r e  w e re  m o re  a p p lic a tio n s  th a n  c o u ld  b e  a c c o m m o ­
d a te d . A ll th e  s p e a k e rs  w e re  B ra n c h  m e m b e rs  a n d  
p ro fits o f  th e  c o u rse  w ill go to  th e  P P K  fu n d  a n d  to ­
w a rd s fin a n c in g  f u tu r e  B ra n c h  a c a d e m ic  a c tiv itie s. All 
w h o  p a r tic ip a te d  fe lt th a t th e  c o u rse  w as in v a lu a b le .

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Sticky Note
page 105-108 are missing