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A Hollistic Place For Musculoskeletal and Sports Rehabilitation.Our Centre is fully equipped with advanced Physiotherapy Modalities and Rehabilitation aids.Pioneer in Manual Therapy Concepts and Advanced Kinetic Control Approaches

06/03/2026

Athetosis is a neurological movement disorder characterized by slow, continuous, writhing, involuntary movements, mainly affecting the hands, fingers, arms, and sometimes the face or feet.

It occurs due to damage or dysfunction in the Basal Ganglia, a group of structures in the brain responsible for controlling voluntary movement and muscle coordination.

🔍 Key Characteristics of Athetosis

✔ Slow, twisting movements
✔ Continuous involuntary motion
✔ Difficulty maintaining a stable posture
✔ Movements increase during voluntary activity or emotional stress
✔ Movements may disappear during sleep

Commonly affected areas include:

Fingers and hands

Arms

Neck

Face

Toes and feet

⚠ Causes of Athetosis

Athetosis usually occurs due to damage to the basal ganglia from neurological conditions such as:

Cerebral palsy (especially dyskinetic CP)

Birth-related hypoxia (lack of oxygen)

Brain injury or trauma

Stroke

Wilson’s disease

Kernicterus (severe neonatal jaundice)

Degenerative neurological disorders

👀 Clinical Signs and Symptoms

Patients with athetosis may present with:

🔹 Slow writhing movements of fingers
🔹 Difficulty holding objects
🔹 Unstable posture
🔹 Poor coordination of movements
🔹 Speech difficulties in severe cases
🔹 Muscle tone fluctuation (hypotonia or dystonia)

These movements are non-rhythmic and unpredictable, which makes voluntary activities difficult.

🧪 Clinical Examination

Neurological assessment may reveal:

✔ Involuntary writhing movements
✔ Abnormal muscle tone
✔ Poor motor control
✔ Difficulty maintaining sustained contraction
✔ Associated dystonia or chorea

🏥 Physiotherapy Management

Physiotherapy plays an important role in improving functional movement and independence.

Treatment Approaches

✅ Postural control training
✅ Motor control exercises
✅ Balance and coordination training
✅ Functional task training
✅ Stretching for muscle tightness
✅ Strengthening of stabilizing muscles

🎯 Goals of Physiotherapy

✔ Improve motor control
✔ Reduce abnormal movement patterns
✔ Improve functional independence
✔ Enhance coordination and balance
✔ Promote better posture

04/03/2026

Limb Girdle Muscular Dystrophy (LGMD) is a group of genetic muscle disorders characterized by progressive weakness of:

✅ Pelvic girdle muscles (hips)

✅ Shoulder girdle muscles

✅ Proximal limb muscles

Unlike Duchenne muscular dystrophy, LGMD can begin in childhood, adolescence, or adulthood depending on the subtype.

🧬 Cause

Genetic mutations affecting muscle proteins

Can be:

Autosomal Dominant (LGMD Type 1)

Autosomal Recessive (LGMD Type 2 / R subtypes)

Progressive muscle fiber degeneration

🔍 Clinical Features

✔ Difficulty rising from floor (Gower’s sign)
✔ Difficulty climbing stairs
✔ Waddling gait
✔ Frequent falls
✔ Proximal muscle weakness
✔ Scapular winging (sometimes)
✔ Calf hypertrophy (in some types)
✔ Contractures (late stage)

🧪 Assessment
Subjective

Gradual onset weakness

Family history

Reduced endurance

Objective

Manual Muscle Testing (MMT)

Gait analysis

Postural assessment

Functional testing

Creatine kinase (CK) levels (medical evaluation)

Genetic testing

⚠ Complications

Joint contractures

Loss of ambulation

Respiratory weakness (advanced stage)

Cardiomyopathy (in some subtypes)

🏥 Physiotherapy Management

✅ Gentle strengthening exercises
✅ Stretching to prevent contractures
✅ Gait training
✅ Core stabilization
✅ Postural correction
✅ Energy conservation techniques
✅ Assistive device training (if required)

⚠ Avoid overexertion or heavy resistance training.

🎯 Rehabilitation Goals

✔ Maintain muscle strength
✔ Prevent deformities
✔ Improve functional independence
✔ Delay progression of disability
✔ Improve quality of life

03/03/2026

Facioscapulohumeral Muscular Dystrophy (FSHD) is a genetic muscle disorder characterized by progressive weakness of:

✅ Facial muscles

✅ Shoulder girdle muscles (scapular stabilizers)

✅ Upper arm muscles (humeral muscles)

It is one of the most common forms of muscular dystrophy and usually begins in adolescence or early adulthood.

🧬 Cause

Genetic mutation on Chromosome 4 (D4Z4 region)

Autosomal dominant inheritance

Abnormal expression of DUX4 gene

Progressive muscle fiber degeneration

🔍 Clinical Features

✔ Facial weakness (difficulty smiling, closing eyes tightly)
✔ Scapular winging
✔ Difficulty lifting arms overhead
✔ Shoulder drooping
✔ Asymmetrical muscle involvement
✔ Lumbar lordosis
✔ Mild lower limb weakness (later stages)
✔ Gower-like maneuver in advanced cases

🧪 Assessment

Subjective Findings

Gradual onset weakness

Difficulty combing hair or lifting objects

Family history present

Objective Examination

Manual Muscle Testing (MMT)

Observation of scapular winging

Postural assessment

Functional testing (overhead activity)

⚠ Complications

Shoulder instability

Postural abnormalities

Reduced endurance

Rarely respiratory involvement

🏥 Physiotherapy Management

✅ Scapular stabilization exercises
✅ Postural correction training
✅ Core strengthening
✅ Gentle resistance training
✅ Functional activity retraining
✅ Energy conservation techniques
✅ Avoid overexertion

🎯 Goals of Rehabilitation

Maintain muscle strength

Prevent contractures

Improve posture

Enhance functional independence

Improve quality of life

01/03/2026

Manual Muscle Testing (MMT) is a standardized clinical assessment technique used by physiotherapists to evaluate muscle strength, power, and functional integrity of individual muscle groups.

It helps in:

✅ Identifying muscle weakness

✅ Detecting neurological deficits

✅ Planning rehabilitation protocols

✅ Monitoring treatment progress

✅ Post-surgical & post-injury evaluation

🎯 Purpose of MMT

✔ Assess voluntary muscle contraction
✔ Grade muscle power (0–5 scale)
✔ Compare bilateral muscle strength
✔ Identify nerve root involvement
✔ Document baseline & recovery status

📊 MMT GRADING SCALE (Oxford Scale)
Grade Muscle Strength Description
0 No contraction No visible or palpable contraction
1 Trace Flicker of contraction, no movement
2 Poor Full ROM without gravity
3 Fair Full ROM against gravity
4 Good Movement against moderate resistance
5 Normal Full ROM against maximum resistance
🧠 Clinical Indications

Stroke (Hemiplegia)

Peripheral nerve injury

Muscular dystrophy

Post fracture / Post ORIF

Cervical / Lumbar radiculopathy

Post ACL reconstruction

Frozen shoulder

Tendon injuries

26/02/2026

Motor assessment is a systematic neurological examination used to evaluate the integrity of the motor pathways from the brain to the muscles.

It assesses:

Muscle bulk

Muscle tone

Muscle strength

Reflexes

Coordination

Motor examination helps localize lesions in:

Peripheral nerve injuries

Radiculopathy

Stroke

Spinal cord injury

Neuromuscular disorders

🔎 Components of Motor Examination
1️⃣ Muscle Bulk (Inspection)

✔ Look for atrophy
✔ Hypertrophy
✔ Fasciculations
✔ Asymmetry

👉 Suggests LMN lesion if severe wasting present.

2️⃣ Muscle Tone

Tone = Resistance to passive movement

Types of Abnormal Tone:

✔ Spasticity → Velocity dependent (UMN lesion)
✔ Rigidity → Not velocity dependent (Parkinson’s)
✔ Flaccidity → Decreased tone (LMN lesion)

3️⃣ Muscle Strength (Power)

Assessed using Medical Research Council (MRC) Scale

Grade Muscle Power
0 No contraction
1 Flicker
2 Movement without gravity
3 Movement against gravity
4 Movement against resistance
5 Normal power
4️⃣ Reflexes

Tested using reflex hammer.

✔ Biceps reflex (C5–C6)
✔ Triceps reflex (C7–C8)
✔ Knee jerk (L3–L4)
✔ Ankle jerk (S1)

Abnormal Findings:

Hyperreflexia → UMN lesion

Hyporeflexia → LMN lesion

5️⃣ Coordination

✔ Finger-to-nose test
✔ Heel-to-shin test
✔ Rapid alternating movements

Abnormal in cerebellar lesions.

23/02/2026

Sensory assessment is a systematic neurological examination used to evaluate the integrity of the sensory pathways — peripheral nerves, spinal cord, thalamus, and sensory cortex.

It helps localize lesions in:

Peripheral neuropathy

Nerve root compression

Spinal cord injury

Stroke

Brain lesions

🔎 Types of Sensation

Sensory testing is divided into:

1️⃣ Superficial Sensation (Primary Sensation)

✔ Light touch
✔ Pain (pin-prick)
✔ Temperature

👉 These travel via the spinothalamic tract

2️⃣ Deep Sensation

✔ Proprioception (joint position sense)
✔ Vibration sense (128 Hz tuning fork)
✔ Deep pressure

👉 These travel via the Dorsal column–medial lemniscus pathway

3️⃣ Cortical Sensation (Discriminative Sensation)

✔ Two-point discrimination
✔ Stereognosis (identify object by touch)
✔ Graphesthesia (identify number traced on skin)
✔ Tactile localization

👉 These require intact Parietal lobe

🩺 Procedure of Sensory Examination
✅ Step 1: Explain & Demonstrate

Patient closes eyes

Compare both sides

✅ Step 2: Test Distal to Proximal

Begin at fingers/toes

Move upward

✅ Step 3: Compare Bilaterally

Identify symmetry or dermatomal pattern

📍 Dermatomal Testing

Testing along Spinal nerve distribution helps detect:

Radiculopathy

Disc prolapse

Nerve root compression

Example:

C6 → Thumb

L5 → Dorsum of foot

S1 → Lateral foot

22/02/2026

Athetosis is a movement disorder characterized by slow, continuous, writhing, involuntary movements, mainly affecting the hands, fingers, arms, and sometimes face and tongue.

It is commonly associated with damage to the Basal ganglia, the part of the brain responsible for movement control.

🧠 Why Does Athetosis Occur?

Damage or dysfunction in:

✔ Basal ganglia
✔ Putamen
✔ Globus pallidus
✔ Thalamic pathways

This leads to abnormal regulation of muscle tone and movement control.

🚨 Causes

Birth asphyxia

Neonatal jaundice (kernicterus)

Stroke

Brain injury

Cerebral palsy

Metabolic disorders

Most commonly seen in Cerebral palsy (Athetoid/Dyskinetic type).

🔍 Clinical Features

✔ Slow writhing movements
✔ Involuntary twisting of fingers
✔ Fluctuating muscle tone
✔ Difficulty maintaining posture
✔ Speech difficulties (if facial muscles involved)
✔ Increased movements during stress

🧍 Body Parts Commonly Affected

Hands & fingers (most common)

Arms

Face

Tongue

Neck

🧘 Physiotherapy Management
✅ Goals

✔ Improve motor control
✔ Enhance postural stability
✔ Reduce abnormal movement patterns
✔ Improve functional independence

✅ Treatment Approaches

Neurodevelopmental techniques (NDT)

Postural control exercises

Functional training

Speech therapy (if needed)

Occupational therapy

21/02/2026

Gower’s sign is a clinical sign in which a child uses their hands and arms to “climb up” their own thighs in order to stand up from a sitting or lying position on the floor.

It indicates proximal muscle weakness, especially of the hip and thigh muscles.

🧠 Why Does It Occur?

Weakness of gluteus maximus

Weakness of quadriceps

Poor hip extensor strength

Difficulty generating enough power to stand upright

Because of proximal muscle weakness, the child compensates by pushing on their knees and thighs.

🚨 Common Conditions Associated

Most commonly seen in:

Duchenne muscular dystrophy

Becker muscular dystrophy

Limb-girdle muscular dystrophy

Spinal muscular atrophy

Inflammatory myopathies

🔍 How to Test

1️⃣ Ask the child to sit on the floor
2️⃣ Ask them to stand up without support
3️⃣ Observe if they:

Turn prone

Push on the floor

Climb up their legs with hands

Positive sign = Uses hands to push off thighs

🩺 Clinical Importance

✔ Early indicator of neuromuscular disease
✔ Often appears between 2–5 years in Duchenne muscular dystrophy
✔ May be associated with calf muscle pseudohypertrophy
✔ Progressive muscle weakness

🏃 Physiotherapy Role

Strengthening exercises

Functional training

Stretching to prevent contractures

Gait training

Parent education

20/02/2026

“Pill-rolling” tremor is a classic resting tremor seen in Parkinson's disease.
It appears as if the person is rolling a small pill or coin between the thumb and index finger.

🔍 Key Characteristics

✔ Occurs at rest
✔ Decreases with voluntary movement
✔ Typically unilateral at onset
✔ Frequency: 4–6 Hz (slow tremor)
✔ Worsens with stress or anxiety

🧠 Why Does It Happen?

Loss of dopamine-producing neurons in the substantia nigra

Imbalance between dopamine and acetylcholine in the basal ganglia

Disrupted motor control circuits

🩺 Clinical Importance

One of the cardinal signs of Parkinson’s disease

Helps differentiate from essential tremor (which occurs during action, not rest)

Often the first symptom noticed by patients

🧍 Common Presentation

Starts in one hand

May progress to other side

Can involve lips, chin, or legs in later stages

💊 Does It Improve?

✔ Improves with Levodopa therapy
✔ Reduces during sleep
✔ May respond to physiotherapy and relaxation techniques

19/02/2026

Locked-in syndrome is a rare but severe neurological condition in which a person is conscious and cognitively intact but unable to move most muscles due to damage in the brainstem—most commonly the ventral pons.

It is usually caused by occlusion of the Basilar artery.

📍 Cause

✔ Basilar artery thrombosis (most common)
✔ Brainstem infarction
✔ Severe pontine hemorrhage
✔ Trauma
✔ Central pontine myelinolysis

🧠 Area Affected

Ventral pons

Corticospinal tract

Corticobulbar tract

👉 The reticular activating system is intact, so consciousness is preserved.

🚨 Clinical Features
❗ Classic Triad

✔ Quadriplegia (paralysis of all four limbs)
✔ Anarthria (cannot speak)
✔ Preserved consciousness

👀 What Movements Are Preserved?

✔ Vertical eye movements
✔ Blinking
✔ Sometimes slight head movement

👉 Communication is usually through eye blinking or vertical gaze.

🧠 What Is NOT Affected?

✔ Awareness
✔ Hearing
✔ Sensation (often preserved)
✔ Cognitive function

Patients can understand everything but cannot respond verbally or move voluntarily.

🔎 Types of Locked-In Syndrome
1️⃣ Classic Locked-In Syndrome

Quadriplegia

Preserved vertical eye movement

2️⃣ Incomplete Locked-In Syndrome

Some additional voluntary movements

3️⃣ Total Locked-In Syndrome

Complete immobility including eye movements

Diagnosis requires EEG to confirm awareness

18/02/2026

Lateral medullary syndrome is a brainstem stroke caused by infarction of the lateral part of the medulla, most commonly due to occlusion of the Posterior inferior cerebellar artery (PICA) or vertebral artery.

It is one of the most important posterior circulation stroke syndromes.

📍 Cause

✔ Thrombosis of vertebral artery
✔ PICA occlusion
✔ Atherosclerosis
✔ Embolism

🧠 Structures Affected

Nucleus ambiguus

Vestibular nuclei

Spinothalamic tract

Spinal trigeminal nucleus

Inferior cerebellar peduncle

Sympathetic fibers

🚨 Clinical Features (Classic “5 D’s” + More)
🗣 Dysphagia

Difficulty swallowing

Hoarseness of voice

Loss of gag reflex

🤢 Dizziness / Vertigo

Severe vertigo

Nausea & vomiting

👀 Diplopia (sometimes)
🎯 Ataxia

Ipsilateral limb ataxia

Loss of coordination

😵 Dysarthria

Slurred speech

🔥 Sensory Findings (Crossed Findings – Important!)

✔ Ipsilateral loss of pain & temperature on face
✔ Contralateral loss of pain & temperature on body

👉 This is called crossed sensory loss, a hallmark of brainstem stroke.

👁 Other Signs

✔ Horner’s syndrome (ptosis, miosis, anhidrosis)
✔ Nystagmus
✔ Loss of taste

🩺 Diagnosis

MRI Brain (best investigation)

CT Brain

MR angiography

🧘 Physiotherapy Management
✅ Acute Stage

Airway management

Swallowing assessment

Chest physiotherapy

Positioning

✅ Rehabilitation Stage

Balance training

Coordination exercises

Gait training

Vestibular rehabilitation

Functional mobility training

16/02/2026

A Lacunar stroke is a type of ischemic stroke caused by occlusion of small penetrating arteries supplying deep brain structures.
It is commonly associated with chronic hypertension and diabetes mellitus.

📍 Commonly Affected Areas

Internal capsule

Thalamus

Basal ganglia

Pons

Corona radiata

These are deep brain structures supplied by small perforating arteries.

🚨 Causes

✔ Long-standing hypertension (most common)
✔ Diabetes mellitus
✔ Small vessel lipohyalinosis
✔ Atherosclerosis

🧠 Types of Lacunar Syndromes
1️⃣ Pure Motor Stroke

Contralateral hemiparesis

Face, arm, and leg equally involved

No cortical signs (no aphasia, no neglect)

2️⃣ Pure Sensory Stroke

Contralateral sensory loss

Usually due to thalamic involvement

3️⃣ Ataxic Hemiparesis

Weakness + incoordination on same side

4️⃣ Dysarthria–Clumsy Hand Syndrome

Slurred speech

Hand weakness and poor coordination

5️⃣ Sensorimotor Stroke

Combined motor and sensory deficits

🔎 Key Clinical Feature

👉 No cortical signs

This means:
❌ No aphasia
❌ No visual field defect
❌ No neglect

Because the cortex is not involved.

🩺 Diagnosis

MRI Brain (best for detecting lacunar infarcts)

CT Brain

Blood pressure evaluation

Blood sugar profile

🧘 Physiotherapy Management
✅ Acute Stage

Proper positioning

Prevent contractures

Passive ROM

Chest physiotherapy

✅ Recovery Stage

Strengthening exercises

Task-specific training

Balance training

Gait re-education

Fine motor training (especially hand)

Address

1, Abdul Kalam Salai, Lakshmi Nagar, Gerugambakkam
Chennai
600122

Opening Hours

Monday	8am - 9:30pm
Tuesday	8am - 9:30pm
Wednesday	8am - 9:30pm
Thursday	8am - 9:30pm
Friday	8am - 9:30pm
Saturday	8am - 9:30pm
Sunday	8am - 9:30pm

Telephone

+918056855869

Website

http://Www.Physio360.biz/

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