PHYSIOTHERAPY IN CONSTIPATION

Keeping in pace with the rapid growth and development in the medical field, physiotherapy is also widening its horizons. It has become an integral part of management of a wide variety of diseases. Its largest concern is related to the management of constipation in patients.

Constipation may be defined as infrequent motions (fewer than 3 times a week) or the need to strain at defecation. It has been reported to affect between 2 & 34% of adults. It is more prevalent in women and people over the age of 65 years.

ETIOLOGY & CLASSIFICATION:
The etiology for constipation is often multifactorial possible the sign of an underlying organic disease. It may also be attributable to lesions or structural abnormalities within the colon. These abnormalities may result in compression or narrowing of the intestines and rectum, causing difficulty in passing stools. Once disease and structural abnormalities are ruled out, constipation can be subdivided into:
a. NORMAL TRANSIT CONSTIPATION
i. Most prevalent subgroup of constipation
ii. In this, the stools move through the colon at a normal rate and stool frequency is normal yet patients believe that they are constipated because of a perceived difficulty with evacuation or the presence of hard stools.
b. DEFECATORY DISORDERS
i. Result from pelvic floor or anal sphincter dysfunction such as pelvic floor dyssynergia, spastic pelvic floor syndrome and anismus.
ii. In this, the external and sphincter contracts and tightens rather than relaxing and opening during defection.
iii. It is characterized by straining and incomplete bowel emptying
c. SLOW TRANSIT CONSTIPATION
i. Result from decreased neuromuscular function of the colon
ii. It is usually idiopathic
iii. Assorted with symptoms of an infrequent urge to defecate, bloating and abdominal pain discomfort, in addition to dry, hard stools.

DIAGNOSIS:
It is difficult because constipation is a symptom rather than a disease, and its diagnosis is based primarily on the patients’ perception of normal bowel function.
Rome II criteria is commonly used for the diagnosis. It includes:
a. Bowel frequency of < 3 times per week
b. Need to strain more than 25% of the time during defection
c. Lumpy or hard stools for more than 25% of bowel movements.
d. Sensation of incomplete evacuation or anorectal blockage for more than 25% of bowel movements.
e. Need for manual maneuvers (digital evacuation or support of the pelvic floor) to facilitate more than 25% of bowel movements

Two or more of these symptoms must be present for atleast 12 (consecutive or non-consecutive) weeks within the 12 month period.

COMPLICATIONS:Include prolapsed, pelvic floor muscle weakening, perineal descent.

PT MANAGEMENT OF CONSTIPATION
a. Lifestyle changes
i. Modify Diet (increase fiber and fluid intake)
ii. Exercise regularly
b. Educate the patient about toileting techniques to avoid straining during a bowel movement in order to decrease the risk of developing pudendal nerve dysfunction. These techniques are:
i. Leaning forward while sitting on the toiled with feet positioned on a step stool (this position decreases the anorectal angle, thus easing the evacuation of stools)
ii. Perform huffing (forced respiratory expiration) rather than straining during defecation (this technique activates the abdominal oblique muscles, which assist in the propulsion of stools)
c. Propulsive abdominal bowel massage to promote bowel mobility throughout the colon. It helps in increasing peristalsis in the gut. It is beneficial as its safe, non-invasive technique and can be performed by the patient independently.
i. Technique: Apply constant moderate pressure to the abdomen with 2 or 3 fingers. Small, clockwise circular movements are initiated at the right anterior superior iliac spine, which is located at the base of the ascending colon. The progression of the massage occurs cranially, up the ascending colon towards the base of the rib cage, where it meets the transverse colon. The circular movements are continued across the transverse colon toward the left upper quadrant of the abdomen and then down over the descending colon toward the left anterior superior iliac spine. This massage should be performed daily for 10 minutes.
d. Exercises to strengthen pelvic floor and sphincter muscles. Aerobic exercises also help in increasing gut transit.
e. Retraining pelvic floor muscle functioning during evacuation. This can be done by using Biofeedback. Patients can be trained to relax their External Anal Sphincter (EAS) during straining as well as to coordinate abdominal contractions to assist stool propulsion into the rectum.

Normal transit and slow transit constipation are managed well by directly modifications, exercises and abdominal massage, whereas defecatory disorders require retraining of pelvic floor muscle function.

3rd Model Test paper for MPT

Hey All.....Some more to test your brains :)

1. Coughing is usually considered a reflex controlled primarily by afferent stimulation of the
a. Trigeminal Nerve
b. Vagus Nerve
c. Phrenic Nerve
d. Glossopharyngeal Nerve

2. PEEP in chest care physiotherapy stands for
a. Peak Expiratory Exercise Programmes
b. Positive End Expiratory Pressure
c. Positive Endurance exercise for Pulmonary Performance
d. Peak Eletromyography and Electrocardiography of Pulmonary Performance

3. While treating patient in ward for chest care through coughing it should be ensured that
a. Sputum is not expectorated
b. The patient is in supine lying position
c. The diaphragmatic breathing not used
d. The bronchospasm is not induced

4. To determine the real leg length measurement is taken from
a. A.S.I.S to lateral malleolus on the same side
b. A.S.I.S to the great toe on the same side
c. A.S.I.S to the heel on the same side
d. A.S.I.S to the Medial malleolus of the leg

5. Ober test is used to test contracture of the
a. Rectus femoris
b. Glutens Medius
c. Piriformis
d. Illio-Tibia band

6. A 15 year old boy has pain over the Tibial Tubercle and clinically very prominent. The pain has been for four months and no history of injury and systemic illness. He most probably has
a. Osgood Schlatter’s disease
b. Rupture of Quadriceps Tendon
c. Fracture of Tibial Tubercle
d. Anterior Cruciate Ligament Instability

7. The Carpal tunnel located on the volar aspect of the wrist contains
a. Nine tendons and mediah nerve
b. Eleven tendons and ulnar nerve
c. Eight tendons and radial nerve
d. Seven tendons and median nerve

8. In electrocardiogram ‘QRS’ Complex represents
a. Atrial depolarization
b. Atrial jrepolarization and closure of semilunar valves
c. Venticular repolarization and opening of semilunar valves
d. Ventricular depolarization and it precedes ventricular systole

9. Conduction of nerve impulses is faster in Myelinated nerves because of
a. Uninterrupted flow of impulse
b. Salutatory conduction
c. Circular current flow
d. Quick reversal of current flow

10. The speed of conduction of impulse is a nerve fiber depends upon
a. The diameter
b. The strength of current
c. The muscle it supplies
d. Absence of myelin sheath

11. The elife of a Red Blood Cell is
a. 12 weeks
b. 12 days
c. 60 days
d. 120 days

12. Due to Paralysis or marked weakness of right side Zgluteus Meius the positive Trendelenburg sign results into
a. Dropping of Pelvis on the opposite side i.e. left side
b. Dropping of Pelvis on the same side i.e. right side
c. Flexion of Hip & Knee joint on the same side i.e. right side
d. Plantar flexion of right ankle to increase the length of right lower limb

13. The shortness of Tensor fasciae latae muscle causes
a. Adduction of the Hip
b. Extension of the Hip
c. Knocking (Genu Valgum) of the knee
d. Plantar flexion of the ankle

14. Thrombo angitis obliterans is also known
a. Trendelenburg’s disease
b. Thomas and Andy’s disease
c. Buerger’s disease
d. Philip’s disease

15. In Pseudo Gout the features include
a. Involvement of smaller joints and uric acid crystals
b. Involvement of large joints and calcium pyrophosphate crystals
c. Involvement of large joints and hyperuricemia
d. Involvement of large joints uric acid crystals

16. The mallet finger results from injury to
a. Abductor digiti minimi
b. Exgtensor carpi radialis longus
c. Extensor carpi ulnaris
d. Extensor tendon of the termincal phalanx of finger

17. Gower’s sign is seen in
a. Herpes Zoster
b. Sciatic Nerve Palsy
c. Duchemne muscular dystrophy
d. Marfan’s syndrome

18. Erb’s palsy is due to injury of
a. Head involving pre-central motor area
b. Pelvis involving Lumbo sacral plexus
c. Thorax involving Diaphragm
d. Upper roots of Brachial plexus involving C 5,6

19. The normal angle between vertical lines of Fermur and Tibia is
a. 7 Degrees
b. 12 Degrees
c. 1.5 Degrees
d. 0.5 Degrees

20. As per the WHO’s ICIDH classification, an impairment means
a. Pathological process due to microbes attacking a human body
b. Inability to perform activities of daily living with physiological dysfunction
c. Disabled, ambulatory on wheel chair with psychological impairment
d. Any loss or abnormality of psychological, physiological or anatomical structure or function

21. The head of femur receives its blood supply from
a. Medial and lateral femoral artery
b. Medial and lateral circumflex artery
c. Medial and lateral iliac artery
d. Medial and lateral gluteal artery

22. Piriformis syndrome involves
a. Gluteal nerve
b. Femoral nerve
c. Sciatic nerve
d. Obturator nerve

23. The thermal conductivity in the following tissues is higher
a. Muscles
b. Skin
c. Ligaments
d. Fat

24. To reduce spasticity the following modality is more suitable
a. Cryotherapy
b. Ultrasonic
c. T.E.N.S
d. Hot packs

25. In normal erect posture the Lumbo sacral angle is about
a. 5 Degree
b. 2.5 Degree
c. 45 Degree
d. 30 Degree

2nd Model Test Paper for MPT Preperation

Hi Folks....
There is another ser of 25 questions specially for you all....

1. The valsalva manoeuvre
a. Is an attempt to forcibly exhale with the glottis, nose and mouth closed
b. Increases the intra-thoracic pressure
c. Increases the intra-discal pressure
d. All of the above

2. Unilateral neglect is characterized by
a. The inability to register and to integrate stimuli and perceptions from one side of the environment
b. Patients usually ignore stimuli occurring on the side of neglect
c. Both (A) & (B)
d. None of the above

3. Monteggia fracture is described as
a. Fracture and dislocation of the lower 1/3 of the ulna
b. Fracture of the upper 1/3 of the ulna associated with dislocation of the head of radius (with or without a fracture)
c. Fracture of the upper 1/3 of the radius with dislocation of the ulna
d. Fracture of the lower 1/3 of the humerus with dislocation

4. A skin autograft is best described as
a. A graft where the skin is taken from the patient himself/herself
b. A graft where the skin is taken from another person or a donor
c. A graft where the skin is taken from another species
d. All of the above

5. Which of the following statements describes a phantom limb
a. A limb that is gangrenous
b. A limb that has lost all sensation
c. A limb that no longer exists but the patient complains of excruciating pain from its fingers/toes
d. All of the above

6. Which of the following testing procedures is used to quantify muscle soasticity
a. Pendulum test and the H-reflex
b. MMT
c. Cable tensiometers
d. Functional ambulation profile

7. On a chest X-ray the SILHOUETTE sign presents as
a. The two separate structures adjacent to each other are not identificable because of the lack of contrast in densities
b. Paralysis of diaphragm over shadows the lungs
c. Enlargement of Cardiac field in transverse direction
d. A sharp contrast between the two adjacent structures with pathological changes

8. The close packed position of Hip Joint is
a. Full Flexion, External rotation and Abduction
b. Full Flexion, Internal rotation and Abduction
c. Full Extension, Internal rotation and Abduction
d. Full Extension, External rotation and Abduction

9. The specific gravity of a human body is
a. 1.995
b. 0.095
c. 0.95
d. 9.05

10. Fluido-therapy is
a. Dry heat modality
b. Fluid immersion therapy
c. Application of analgesic fluid
d. Application of radiation through fluid

11. To calculate %age TBSA (according to the rule of nines) Left lower extremity is given weightage of
a. 9%
b. 9.9%
c. 27%
d. 18%

12. In De Quervain’s syndrome the following tendons are inflamed
a. Extensor pollicis longus and Extensor pollicis brevis
b. Extensor carpi radialis longus and Opponens
c. Extensor pollicis brevis and Abductor pollicis longus
d. Abductor pollicis longus and Extensor carpi radialis brevis

13. The SAID principle stands for
a. Specific Adaptations to Imposed Demands
b. Severe and Incurable Disability
c. Shock After Infusion of Drugs
d. Specific Amputation for Impairment and Disability

14. The three types of polio virus isolated are
a. Brunhilde, Mcmurray and Newon
b. Leon, Mcburney and Vlodik
c. Brunhilde, Lansing and Leon
d. Mchilde, Salk and Newon

15. The rate of pin rolling tremors in Parkinson’s disease is
a. 1-2 times per sec
b. 20-30 times per sec
c. 16 times per sec
d. 6-8 times per sec

16. The normal A-VpO2 difference is
a. 14.5 mm Hg
b. 95 mm Hg
c. 9.5 mm Hg
d. 55 mm Hg

17. The Bohr’s effect causes
a. Increase of hemoglobin level
b. Loading of CO2 and unloading of O2 in blood
c. Loading of O2 and unloading of Co2 in blood
d. Loading of CO2 and unloading of NO2 in blood

18. The resting membrane potential of skeletal muscle fibre is
a. -90 mv
b. -0.9 mv
c. -0.09 mv
d. -0.009 mv

19. The commonest site of Myositis Ossificans Traumatica is
a. Brachialis
b. Extensor carpi radialis longus
c. Triceps Brachii
d. Brachioradialis

20. The clinical Triad of Reiter’s syndrome consists of
a. Hepatitis, arthiritis and otitis media
b. Hepatitis, arthiritis and conjunctivitis
c. Urethritis, conjunctivitis and crystal formation
d. Urethritis, arthritis and conjunctivitis

21. The ideal length of stump amputated below knee should be about
a. 5 cm
b. 7 cm
c. 30 cm
d. 14 cm

22. The Dielectric constant of tissues with high water content
a. Is less than the Fatty tissues
b. Is less than the bonny tissues
c. Is less than the skin
d. Is more than the tissue with low water content

23. The Dielectric constant of water is
a. 8.1
b. 81.1
c. 18.1
d. 1.08

24. The cavitation effect of ultrasound application to human body is
a. Micro-massage
b. Rise in local temperature
c. Analgesic effect on nerves
d. Gas bubble in tissues

25. The cross section of a muscle is equal to
a. Width X Thickness
b. Length X Width
c. Length X ½ Thickness
d. 2 (Thickness) + 2 (Width)

1st Model Test Paper for MPT Entrance Examinations

Hello Folks.....
I am posting a set of 25 MCQs as a model test paper for MPT entrance examinations. To get the solutions please reply to the blog with your email-id so that I can send you the answers.
Remeber friends, this is just the beginning of the set of questions.....
Each question has 4 choices (a,b,c,d)

1. In absence of Deltoid, trick abduction movement of shoulder joint is performed by:
a. Spurious contraction of pectoralis major
b. Deceptive action performed by the favorably placed muscles around shoulder joint.
c. Tenodesis action
d. Serratus anterior and Trapezius

2. Nerve root value of hip abductors and extensors is:
a. L3, 4
b. S2, S3
c. L4,5, S1
d. T12, L1, 2

3. Co-ordination is space, rhythm and approach is disturbed in the lesion of:
a. Pyramidal tract
b. Cerebellum
c. Mid brain
d. Spinal Cord

4. Clawing of the hand results due to the paralysis of
a. Flexor digitorum sublimis and profundus
b. Thenar and hypothenar group of muscles
c. Extensor groups of muscles
d. Intrinsic group of muscles

5. Which of the following are indicative of posterior column disturbances?
a. Ataxia, ataxic gait, ramberg sign, and athtosis
b. Ataxia, athetosis, asthenia and dystonia
c. Dystonia, dysmetria, dys synergia and dysdiadochokinosia
d. Ataxia and Romberg sign

6. Which one of the following, a person must have innervated for active triceps
a. C5
b. C6
c. C7
d. C8

7. If a patient has a diagnosis of C5 quadriplegia which of the following group of muscles would he have active use of?
a. Pectoralis major, biceps and deltoids
b. Biceps, supinator and deltoids
c. Serratus anterior, latissimus dorsi and wrist extensors
d. Bicep, deltoids and serratus anterior

8. Strengthening excercises during the acute inflammatory stage of the arthritic joint should be
a. Encouraged
b. Reduced
c. Avoided
d. The same as in the sub acute and chronic stages

9. Approximately after how many weeks, generally, the ptient is allowed to resume normal activities following tendon repair
a. 8 weeks
b. 10 weeks
c. 12 weeks
d. 16 weeks

10. The short head of the Biceps Brachii has a common origin with the
a. Long head of biceps brachii
b. Coraco brachialis
c. Brachialis
d. Long head of triceps brachii

11. A child is said to be severely mentally retarded when IQ is in the range of
a. 35-49
b. Below 20
c. 20-34
d. 50-70

12. The voluntary opening terminal device of an upper extremity Prosthesis is activated by
a. Humeral extension
b. Shoulder gridle protraction
c. Humeral Flexion
d. Scapular adduction

13. The best splint to correct claw hand is Median and ulnar palsy is the
a. Cock-up
b. Spring wire suspension
c. Knuckle bender
d. Pan cake

14. A patient with a complete musculocutaneous nerve injury would have no function of the
a. Triceps brachii muscle
b. Pronator teres muscle
c. Biceps brachii muscle
d. Deltoid muscle

15. The MAIN purpose of passive range of motion exercises is to:
a. Strengthen muscles
b. Prevent contractures
c. Increase coordination
d. Provide proprioceptive input

16. Contraction of the diaphragm
a. Draws the central tendon of the diaphragm downwards
b. Increases the volume and increases the pressure within the thoracic cavity
c. Decreases the volume and decreases the pressure within the abdominal cavity
d. All of the above

17. The phalen’s test:
a. A test designed to determine the presence of laternal epicondylitis (tennis elbow)
b. A test designed to determine the presence of peripheral neuropathy
c. A test designed to determine the presence of an impingement syndrome
d. A test designed to determine cvarpal tunnel syndrome

18. Which of the following best describes an action potential
a. A brief regenerative electrical potential that propogates along a single axon or muscle fibre
b. It is an all-or-none phenoemenon
c. Whenever the stimulus is at or above threshold, the action potential generated has a constant size and configuration
d. All of the above

19. Cycles of gradual increase in rate and depth of respiration with apenic pauses between cycles, describes which of the following
a. Tachypnea
b. Orthopnea
c. Bradpynea
d. Cheyne-Stokes respiration

20. The Barthel’s Index is used to measure one of the following
a. Muscle strength
b. Sensory-motor abilities
c. Functional abilities
d. All of the above

21. During crutch walking using a four point gait, which of the following statements is true?
a. One crutch is advanced followed by the advancement of the opposite lower extremity
b. Only one leg or crutch is off the floor at a time, leaving three points for support
c. This is a stable and safe gait and is thus useful in patients who are able to move their lower extremities alternately but who have poor balance or are not able to bear full weight bilaterally without the support of crutches
d. All of the above

22. The wavelength range of Short Wave Diathermy is
a. 300 X 109 to 30 X 109
b. 1 X 109 to 1.5 X 109
c. 30 X 109 to 3 X 109
d. All of the above

23. The performance of which of the following muscles is affected by forearm position
a. Brachialis
b. Biceps Brachii
c. Brachioradialis
d. Only B & C

24. Which of the following statements describes diastasis of rectus abdominis
a. Widening of the linea alba
b. Condition associated with pregnancy
c. The presence can be palpated as a hollow between the superficial rectus abdominus muscle
d. All of the above

25. The gate control theory explains
a. Theory of pain
b. Theory of spasm
c. Theory of stiffness
d. Theory of flexibility