What is Cervicogenic Headache?

By Bijal Shah

Cervicogenic headache is a secondary headache with the primary cause being a pathology in the neck. This means a problem in the neck is causing a headache as a symptom.

The cervicogenic headache typically starts from the back of neck/back, travels up to the front of the head. It usually is on one side of the head. And therefore, this type of headache is a referred pain to the head.Cervicogenic Headache

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Physical therapy for COVID 19 – A complete guide to managing COVID 19 patients with Rehabilitation

By Bijal Shah

Corona Virus has made its way globally. At this point, we all are aware of COVID 19 and the majority of symptoms caused by COVID 19.  While every nation around the globe is fighting hard to design some method that can either manage symptoms or viruses, exercise remains one important factor. This includes various options like vaccines, medicines, antibodies, blood transfusions, etc. In this article, I am going to share some proven exercise strategies, and core outcome measures for patients with COVID 19. 

Physical Therapy for COVID 19 patient

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Neurology Evaluation for Physical Therapy

By Bijal Shah

This article is all about how to perform a neurology evaluation.  Neurology evaluations are long and sometimes time-consuming. It is not really possible to perform every single item during a session.

A while back I did a Physical Therapy general evaluation format. This was more of a general intake form. Here I want to go a little deep in a specific neurological diagnosis/ category in physical therapy.

For me, I go over the categories and check if there are any deficits, and I move to another category. If a patient is unable to answer or shows deficits in one area, then I will perform a detailed assessment of that area. This helps me to go over the eval quickly and also allows me to concentrate on the areas that are weak.

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Modified Independence after Modifying the Home

By Bijal Shah

Recently I wrote on SCI, TBI, ALS and other neurological disorders. In these blogs, I mentioned modified functional independence. I discussed how a person can stand, walk, commute in a car, go up and down the stair with limited or no active use of his or her extremities. These all come with the help of technology and use of assistive devices. Continue reading “Modified Independence after Modifying the Home”

SCI: A Comprehensive Guide to Spinal Cord Injury Management

By Bijal Shah

What is SCI?

The spinal cord is a band of nerves that act as a transporter of the information between the brain and the body parts. Any injury to the spinal cord (Congenital or acquired) is called spinal cord injury.

The spinal cord is protected by vertebrae or spine. It is referred to as cervical, thoracic, and lumbar spine. Many times, there is an injury to the vertebrae or soft tissues (muscles or ligaments) around it. This kind of injury is not classified as spinal cord injury.

Acquired injuries are a result of Motor vehicle accident, falls, or gunshot wounds. SCI can also happen due to medical or surgical complications or falling an object on back. Continue reading “SCI: A Comprehensive Guide to Spinal Cord Injury Management”

Parkinsons Disease: Understanding the Causes, Symptoms & Treatment

By Bijal Shah

What is Parkinson’s Disease?

Parkinson’s Disease is one of the most common neurodegenerative diseases that are progressive in nature. The disease is a result of degeneration of dopamine-secreting neurons in basal ganglia. The loss or lack of dopamine also causes an imbalance in neurotransmitters in the brain like an increase in acetylcholine neurotransmitter. This increases the influence of acetylcholine neurotransmitter. The disruption of neurotransmitter activity results in neuromotor symptoms which are referred to as parkinsonian symptoms.


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Spinal Stenosis

By Bijal Shah

What is Spinal Stenosis:

Spinal stenosis is the narrowing of the spinal canal. It is more common in older populations, mainly after 50 years of age. As the degeneration takes place in the vertebrae, the spinal canal narrows down. As a result, it may push the spinal cord inside the spinal canal. Spinal Stenosis usually occurs in the cervical and lumbar area. Patients may or may not show symptoms or restrictions in their daily routine. The presence, as well as the severity of signs and symptoms, depends on the severity of the condition and varies from person to person. Continue reading “Spinal Stenosis”

Improving functional independence with Feeding Assistance

By Bijal Shah

Feeding Assistance or making a person independent in feeding may not really seem like a physical therapy topic. Also, it is not that commonly encountered problem in orthopedic setting or high-level functioning individuals. Only until you start seeing patients with some neurological deficits or trauma. With my experience as a PT, one thing for sure is walking is an important aspect of independence but it is not the only aspect of functional independence. There are many tasks a person needs to do to perform his/her daily routine activities independently. Some of the examples of these are feeding, dressing, grooming, hygiene, moving in and out of bed, transferring on different surfaces and walking. You can add some more high-level activities like cooking, laundry, cleaning the house, grocery shopping and even driving but they are not really the basic tasks that a person will need to do on a daily basis. Continue reading “Improving functional independence with Feeding Assistance”

ALS: A Comprehensive Rehabilitation Guide

By Bijal Shah

ALS is otherwise also known by its full name amyotrophic lateral sclerosis. It is a type of progressive neurodegenerative disease that affects upper and lower motor neurons in the brain and the spinal cord. It comes from the Greek language where “A” means no. “Myo” refers to muscle, and “Trophic” means nourishment – “No muscle nourishment.” The motor neurons are responsible for initiating voluntary muscle movements. They also act as a bridge between the brain and the muscles for crucial communication. So, as the name suggests, when a muscle does not have any nourishment, it “atrophies” or wastes away. As the motor neurons degenerate, it leads to a hardened area in the brain or scarring which is also known as “sclerosis”. Continue reading “ALS: A Comprehensive Rehabilitation Guide”

Body Neglect: A Challenge in Stroke Recovery and How to Treat it.

By Bijal Shah

Body Neglect of an affected limb is a real challenge in stroke recovery. Stroke Recovery starts from using proper position, facilitating awareness of affected extremity, and use it in a functional task. Along with proper positioning challenge, another challenge that we, as rehab professionals, usually face, is facilitating the use of neglected/affected side after hours in stroke patients. It can start by talking and having a casual conversation with the patient on providing some cues to use that affected limb during evenings or weekends. When we in-service the non-rehab staff regarding how to facilitate the use of an affected limb, we need to make sure that we convey the important message that it may not be for all stroke patients. A patient needs to be ready to use that paretic limb during non-rehab hours. Otherwise, just facing constant failures while attempting to use a paretic limb, will only cause more aggression, depression and no motivation to use that affected limb. 

Continue reading “Body Neglect: A Challenge in Stroke Recovery and How to Treat it.”

Physical Therapy to Treat TBI : Treatment Approaches for Brain Injury Cases

By Bijal Shah

Traumatic Brain Injury (TBI) is anything that can impact the normal function of a brain after birth (mostly caused due to an accident).  Rehab treatment approach varies as per what stage and how fresh the brain injury (TBI) is. It also depends on the therapist’s experience level and belief in the treatment approach. For me, not one approach is a gold standard or right than others. I have also experienced that treatment approaches vary depending on the patient’s prior level of function, age and comfort level. TBI

Some treatment will give excellent results with one patient while the other patient may complain of pain or discomfort with that same method. So the goal of this blog is to discuss some basic methods that therapists use to treat TBI patients. I will try to keep it real simple so not only therapists but other readers can also get some knowledge out of this article.  I discuss types and etiology of TBI here. The other thing to keep in mind is, the same treatment method can be used as the main treatment approach versus just a preventive measure depending on the acuity of an injury. So let’s talk about treatment methods for TBI patients. Continue reading “Physical Therapy to Treat TBI : Treatment Approaches for Brain Injury Cases”

What is Traumatic Brain Injury (TBI)

By Bijal Shah

Since I work with brain injury patients, Traumatic Brain Injury is my favorite topic to discuss and write. For me, it is difficult to put down words on Traumatic Brain Injury (TBI) as there is so much involved with TBI. But I also don’t want to write five pages long article and bore all my readers. So I am going to try to keep this a short and sweet article. In this article, I am going to discuss definition, types and some basic information on TBI. I discussed different treatment approaches to TBI here.  So let’s start! TBI

Brain injury is anything that can impact the normal function of a brain. An acquired brain injury is when an injury happens after birth. Here the brain is normally developed already.  There are two types of acquired brain injury: Traumatic and non-traumatic brain injury. Continue reading “What is Traumatic Brain Injury (TBI)”

Contracture Management – Definition and Treatment

By Bijal Shah

Contracture Definition:

A Contracture is a fixed loss of range of motion of a joint. It is usually due to any pathology of soft tissues like muscles, tendons, ligaments, cartilages, or connective tissues. 

contracture management

Types of Contracture:

There are two main types of contractures:

Orthosis in Gait training – Successful Story of recovery from Spinal Cord Injury(SCI)

By Bijal Shah

Recovery after SCI (spinal cord injury) depends on the level of injury as well as the type of injury. This is a case of 65 years old healthy woman who fell from seven steps and had a loss of consciousness for a few minutes almost a year and a half ago.

Learning to walk again after SCI

The patient sustained C7 cervical spinal cord injury (SCI) from a fall. Her injury was classified as ASIA A SCI and she had to undergo cervical spinal fusion after the injury. She received basic rehabilitation at the hospital and had few complications like PNA and UTI during her hospitalization. She came to our facility for neurorehabilitation. Gait training was the most difficult task for my patient to achieve after her injury.  And of course, gait training was one of her main goals. This article summarizes her progress in rehab and the creative ideas I had to use during her gait training. SCI Continue reading “Orthosis in Gait training – Successful Story of recovery from Spinal Cord Injury(SCI)”