Additional Information
Book Details
Abstract
A classic textbook and a student favourite, Tidy’s Physiotherapy aims to reflect contemporary practice of physiotherapy and can be used as a quick reference by the physiotherapy undergraduate for major problems that they may encounter throughout their study, or while on clinical placement. Tidy’s Physiotherapy is a resource which charts a range of popular subject areas. It also encourages the student to think about problem-solving and basic decision-making in a practice setting, presenting case studies to consolidate and apply learning.
In this fifteenth edition, new chapters have been added and previous chapters withdrawn, continuing its reflection of contemporary education and practice. Chapters have again been written by experts who come from a wide range of clinical and academic backgrounds. The new edition is complemented by an accompanying online ancillary which offers access to over 50 video clips on musculoskeletal tests, massage and exercise and an image bank along with the addition of crosswords and MCQs for self-assessment.
Now with new chapters on:
- Reflection
- Collaborative health and social care / interprofessional education
- Clinical leadership
- Pharmacology
- Muscle imbalance
- Sports management
- Acupuncture in physiotherapy
- Management of Parkinson’s and of older people
- Neurodynamics
Part of the Physiotherapy Essentials series – core textbooks for both students and lecturers!
- Covers a comprehensive range of clinical, academic and professional subjects
- Annotated illustrations to simplify learning
- Definition, Key Point and Weblink boxes
- Online access to over 50 video clips and 100’s of dowloadable images (http://evolve.elsevier.com/Porter/Tidy)
- Online resources via Evolve Learning with video clips, image bank, crosswords and MCQs! Log on and register at http://evolve.elsevier.com/Porter/Tidy
- Case studies
- Additional illustrations
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Half title page | i | ||
| Tidy's Physiotherapy | iii | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Contributors | vii | ||
| Preface | xi | ||
| Student’s Testimonial | xiii | ||
| Dedication | xv | ||
| 1 The responsibilities of being a physiotherapist | 1 | ||
| Introduction | 1 | ||
| Background to the chapter | 1 | ||
| History of the physiotherapy profession | 2 | ||
| Responsibilities of being A professional | 3 | ||
| Characteristics of a profession | 3 | ||
| Possessing knowledge and skills not shared by others | 4 | ||
| Autonomy | 5 | ||
| Person-centred practice | 5 | ||
| Making a commitment to assist those in need | 5 | ||
| Scope of practice | 6 | ||
| Competence | 6 | ||
| Responsibility to patients | 7 | ||
| Responsibility to those who pay for services | 7 | ||
| Responsibility to colleagues and the profession | 7 | ||
| Belonging to A profession | 7 | ||
| Regulation: The Health and Care Professions Council (HCPC) | 7 | ||
| Professional membership: the Chartered Society of Physiotherapy (CSP) | 8 | ||
| Code of professional values and behaviour | 8 | ||
| Quality Assurance Standards for Physiotherapy Service Delivery | 9 | ||
| Physiotherapy Framework | 9 | ||
| Physiotherapy education programmes | 9 | ||
| Delivering safe and effective physiotherapy services: Clinical governance | 9 | ||
| Evidence-based practice | 10 | ||
| Clinical effectiveness | 12 | ||
| Standards | 13 | ||
| Nationally-developed standards | 13 | ||
| National Service Frameworks | 13 | ||
| Clinical guidelines | 13 | ||
| CSP endorsed guidelines | 14 | ||
| National Institute for Health and Clinical Excellence (NICE) | 14 | ||
| Scottish Intercollegiate Guidelines Network | 14 | ||
| Care Quality Commission (CQC) | 14 | ||
| Evaluating services | 14 | ||
| Clinical audit | 15 | ||
| Patient feedback | 15 | ||
| Health outcomes | 15 | ||
| Patient-reported outcome measures (PROMs) | 15 | ||
| NHS outcomes framework | 15 | ||
| Peer review | 16 | ||
| Continuing professional development (CPD) | 16 | ||
| Skill mix | 16 | ||
| The future | 17 | ||
| Structural changes | 17 | ||
| More services delivered in primary care and community settings | 18 | ||
| Delivering clinical and cost-effective services | 18 | ||
| Influencing the agenda | 18 | ||
| Sources of critical appraisal tools | 19 | ||
| Books and articles | 19 | ||
| Weblinks | 19 | ||
| Acknowledgements | 19 | ||
| References | 20 | ||
| 2 Collaborative health and social care, and the role of interprofessional education | 23 | ||
| Introduction | 23 | ||
| History of interprofessional education (IPE) | 24 | ||
| Is IPE an international phenomenon? | 25 | ||
| The IPE context within the UK | 26 | ||
| IPE and collaborative working | 28 | ||
| Interprofessional education (IPE) in practice | 29 | ||
| IPE and technology | 31 | ||
| Practice-based learning | 32 | ||
| Simulated learning | 32 | ||
| Problem-based learning | 32 | ||
| Student-led interprofessional learning | 33 | ||
| Professional identity and interprofessionalism | 33 | ||
| Conclusion | 34 | ||
| References | 36 | ||
| 3 Clinical leadership | 41 | ||
| Introduction | 41 | ||
| Context | 42 | ||
| The allied health professions and physiotherapy | 43 | ||
| NHS leadership qualities framework (LQF) | 44 | ||
| Personal qualities | 44 | ||
| Setting direction | 45 | ||
| Delivering service | 45 | ||
| Commissioning world class healthcare services: the role of clinical leadership and service improvement | 45 | ||
| Service improvement | 46 | ||
| The case for clinical leadership | 47 | ||
| Social interaction, spheres of influence and professional practice examples | 47 | ||
| Developing your leadership competencies | 48 | ||
| Organisational requirements | 48 | ||
| Individual requirements | 49 | ||
| Conclusion | 51 | ||
| References | 51 | ||
| 4 Pharmacology | 53 | ||
| Introduction | 53 | ||
| Pharmacology? | 53 | ||
| What is pharmacology? | 53 | ||
| Why would I, a physiotherapist or a student, want to know about this? | 54 | ||
| Basic science | 54 | ||
| Where do drugs act (Table 4.2)? | 54 | ||
| How may drugs get to their destination? | 54 | ||
| Metabolism and excretion – the body gets hostile | 57 | ||
| A note on dosing | 57 | ||
| Medicines you will (probably) encounter | 57 | ||
| The heart and vascular systems | 57 | ||
| The lungs | 58 | ||
| Neurological medicine | 59 | ||
| Antibiotics | 59 | ||
| Analgesia/anaesthesia | 59 | ||
| Final thoughts | 61 | ||
| Pharmacology glossary | 61 | ||
| Drugs | 63 | ||
| Acknowledgement | 65 | ||
| Further reading | 65 | ||
| 5 Reflection | 67 | ||
| Introduction | 67 | ||
| Defining reflection | 67 | ||
| Rationale for reflection in practice | 68 | ||
| Clinical reasoning and evidence-based practice | 69 | ||
| Applying the above concepts to a real world physiotherapy context, for example the painful shoulder | 69 | ||
| Requirements for reflective practice | 71 | ||
| Use of reflection as A form of assessment | 71 | ||
| Processes of reflection: using reflection in practice | 72 | ||
| Reflection following action/reflection on action (Schon 1983) | 72 | ||
| Reflection during action/reflection in action | 73 | ||
| Reflection before action/reflection on the future | 73 | ||
| Reflecting with a supervisor | 73 | ||
| Important principles of reflective practice | 75 | ||
| Closing the loop | 75 | ||
| Planning | 75 | ||
| Appropriate timing | 76 | ||
| Others' perspectives | 76 | ||
| Knowing yourself | 77 | ||
| What to reflect on | 77 | ||
| Ways to reflect | 78 | ||
| Verbal reflection | 78 | ||
| Graphical (mindmaps, spider diagrams, concept maps) | 78 | ||
| Reflective diary | 78 | ||
| Prose/free writing | 78 | ||
| Using models of reflection | 79 | ||
| Kolb | 79 | ||
| Gibbs | 80 | ||
| Johns | 80 | ||
| Rolfe | 80 | ||
| Conclusion | 80 | ||
| Acknowledgements | 81 | ||
| References | 82 | ||
| 6 Management of respiratory diseases | 83 | ||
| Introduction | 83 | ||
| Chronic obstructive pulmonary disease: basic issues | 84 | ||
| Chronic bronchitis | 85 | ||
| Aetiology of chronic bronchitis | 85 | ||
| Pathology of chronic bronchitis | 86 | ||
| Emphysema | 86 | ||
| Causes and types of emphysema | 86 | ||
| Causes and predisposing factors | 86 | ||
| Types of emphysema | 86 | ||
| Pathology of emphysema | 87 | ||
| Clinical features of COPD | 87 | ||
| Dyspnoea or shortness of breath | 88 | ||
| Cough | 88 | ||
| Sputum | 88 | ||
| Wheeze | 88 | ||
| Deformity | 88 | ||
| Cyanosis | 88 | ||
| Cor pulmonale | 88 | ||
| Lung function | 90 | ||
| Blood gases | 90 | ||
| Auscultation signs | 90 | ||
| Examination | 90 | ||
| X-ray signs | 90 | ||
| Other non-respiratory manifestations of COPD | 90 | ||
| Loss of skeletal muscle mass | 90 | ||
| Reduced exercise tolerance | 90 | ||
| Increased cardiovascular risk | 90 | ||
| Osteoporosis | 90 | ||
| Varying clinical presentation in COPD | 91 | ||
| Blue bloaters | 91 | ||
| Pink puffers | 91 | ||
| Medical treatment of COPD | 91 | ||
| Medications | 92 | ||
| β2 agonists | 92 | ||
| Anticholinergics | 92 | ||
| Xanthene derivatives | 92 | ||
| Corticosteroids | 92 | ||
| Mucolytic agents | 92 | ||
| Drug delivery systems | 92 | ||
| Physiotherapy techniques in COPD | 93 | ||
| General aims of treatment | 93 | ||
| Treatment in the early stages | 93 | ||
| Increasing/maintaining exercise tolerance | 93 | ||
| Inspiratory muscle training | 93 | ||
| Removal of secretions | 94 | ||
| The active cycle of breathing technique (ACBT) (illustrated on Figure 9.9, p.178) | 94 | ||
| Postural drainage/positioning | 94 | ||
| Humidification | 94 | ||
| Improving the breathing pattern | 94 | ||
| Treatment in the later stages | 94 | ||
| Non-invasive positive-pressure ventilation | 94 | ||
| Terminal care | 95 | ||
| Asthma | 95 | ||
| Types of asthma | 95 | ||
| Extrinsic asthma | 95 | ||
| Intrinsic asthma | 95 | ||
| Aetiology and prevalence of asthma | 95 | ||
| Pathology of asthma | 96 | ||
| Clinical features of asthma | 96 | ||
| Extrinsic asthma | 96 | ||
| Wheeze and dyspnoea | 96 | ||
| Cough | 96 | ||
| Posture | 96 | ||
| Pulse | 96 | ||
| Electrocardiogram | 97 | ||
| Cyanosis | 97 | ||
| Blood gases | 97 | ||
| Breath sounds | 97 | ||
| Percussion note | 97 | ||
| Chest X-ray | 97 | ||
| Lung function | 97 | ||
| Intrinsic (chronic) asthma | 98 | ||
| Acute severe asthma | 98 | ||
| Medical treatment of asthma | 98 | ||
| Oxygen therapy | 98 | ||
| Medications | 98 | ||
| β2 agonists | 98 | ||
| Corticosteroids | 98 | ||
| Leukotriene antagonists | 98 | ||
| Other agents | 99 | ||
| Delivery of medication | 99 | ||
| Metered-dose inhalers | 99 | ||
| Nebulisers | 99 | ||
| Guidelines for drug therapy | 100 | ||
| Management between attacks | 101 | ||
| The environment | 101 | ||
| Measurement of peak flow | 101 | ||
| Inhaler technique | 101 | ||
| Physiotherapy techniques in asthma | 102 | ||
| General aims of treatment | 102 | ||
| Patient education | 102 | ||
| Acute attacks | 102 | ||
| Pulmonary rehabilitation | 102 | ||
| Removal of secretions | 102 | ||
| Relaxation | 103 | ||
| Breathing control | 103 | ||
| Bronchiectasis | 103 | ||
| Types and prevalence of bronchiectasis | 103 | ||
| Congenital bronchiectasis | 103 | ||
| Acquired bronchiectasis | 103 | ||
| Prevalence | 103 | ||
| Pathology of Bronchiectasis | 103 | ||
| Clinical features of bronchiectasis | 104 | ||
| Cough and sputum | 104 | ||
| Dyspnoea | 104 | ||
| Haemoptysis | 104 | ||
| Recurrent pneumonia | 104 | ||
| Chronic sinusitis | 104 | ||
| General ill-health | 104 | ||
| Clubbing | 104 | ||
| Thoracic mobility | 104 | ||
| Radiography | 104 | ||
| Prognosis of bronchiectasis | 104 | ||
| Management of bronchiectasis | 105 | ||
| Principles of treatment | 105 | ||
| Physiotherapy for bronchiectasis | 105 | ||
| Aims of treatment | 105 | ||
| Clearing secretions | 105 | ||
| Maintaining exercise tolerance | 105 | ||
| Cystic fibrosis | 105 | ||
| Pathology of CF | 106 | ||
| Pulmonary changes | 106 | ||
| Other pathological changes | 106 | ||
| Prognosis of CF | 106 | ||
| Clinical features of CF | 107 | ||
| Children | 107 | ||
| Adolescents and adults | 107 | ||
| Complications | 107 | ||
| Social–psychological problems | 107 | ||
| Terminal features | 108 | ||
| Management of CF | 108 | ||
| General principles | 108 | ||
| Medications | 108 | ||
| Antibiotics | 108 | ||
| Bronchodilators | 108 | ||
| Oxygen therapy | 108 | ||
| Mucolytic agents | 108 | ||
| Physiotherapy in CF | 108 | ||
| Clearing lung fields | 109 | ||
| Maintenance of physical fitness/increasing exercise tolerance | 109 | ||
| Terminal stages | 110 | ||
| Surgery | 110 | ||
| Restrictive pulmonary diseases | 110 | ||
| Pneumonia | 110 | ||
| Classification | 110 | ||
| Community-acquired pneumonia | 110 | ||
| Predisposing factors | 110 | ||
| Pathological changes | 111 | ||
| Clinical features | 111 | ||
| Investigations | 111 | ||
| Prognosis | 111 | ||
| Management | 111 | ||
| Complications | 111 | ||
| Physiotherapy in pneumonia | 112 | ||
| Clearing lung fields | 112 | ||
| Re-expansion of the lungs to improve ventilation | 112 | ||
| Exercise tolerance and fitness | 112 | ||
| Pleurisy | 112 | ||
| Aetiology and pathological changes | 112 | ||
| Clinical features | 112 | ||
| Investigation and treatment | 112 | ||
| Physiotherapy in pleurisy | 112 | ||
| Pleural effusion | 113 | ||
| 7 Adult spontaneous and conventional mechanical ventilation | 129 | ||
| Introduction | 129 | ||
| Spontaneous ventilation | 129 | ||
| The respiratory muscles | 129 | ||
| Respiratory mechanics and airflow | 130 | ||
| The opposing forces to ventilation | 131 | ||
| Compliance | 132 | ||
| The frictional forces | 132 | ||
| Respiratory failure | 133 | ||
| Acute hypoxaemic (type I) respiratory failure | 133 | ||
| Ventilatory (type II) respiratory failure | 133 | ||
| Pathways to respiratory failure | 134 | ||
| The hypoxic drive concept | 135 | ||
| Mechanical ventilation | 135 | ||
| A potted history | 135 | ||
| Invasive/conventional ventilation | 135 | ||
| Volume controlled ventilation | 136 | ||
| Pressure controlled ventilation | 136 | ||
| Ventilation modes | 136 | ||
| Pressure supported ventilation | 137 | ||
| Advanced pressure modes | 137 | ||
| The complications of mechanical ventilation | 137 | ||
| Pulmonary complications | 137 | ||
| Atelectasis | 137 | ||
| Ventilator-induced lung injury | 138 | ||
| PEEPi | 138 | ||
| Oxygen toxicity | 138 | ||
| Ventilator associated pneumonia | 138 | ||
| Non-pulmonary complications | 139 | ||
| The role of the respiratory physiotherapist | 139 | ||
| Pulmonary interventions | 140 | ||
| Suction | 140 | ||
| Positioning | 140 | ||
| Manual hyperinflation | 140 | ||
| Manual techniques | 141 | ||
| Other considerations | 141 | ||
| Rehabilitation for the critical care population | 141 | ||
| Who needs critical care rehabilitation? | 142 | ||
| What is critical care rehabilitation? | 142 | ||
| Guidance and evidence base | 142 | ||
| Further reading | 143 | ||
| References | 143 | ||
| 8 Cardiac rehabilitation | 147 | ||
| Cardiac rehabilitation | 147 | ||
| Background | 147 | ||
| What is cardiac rehabilitation? | 148 | ||
| Research evidence for cardiac rehabilitation | 148 | ||
| Evidence for physical activity and exercise | 148 | ||
| Evidence for education and psychosocial interventions | 148 | ||
| Patient groups in cardiac rehabilitation | 149 | ||
| Post-revascularisation | 149 | ||
| Stable angina | 149 | ||
| Chronic heart failure | 149 | ||
| Special needs groups | 149 | ||
| Women | 149 | ||
| Older adults | 149 | ||
| Ethnic groups | 149 | ||
| Other groups | 149 | ||
| Cardiac transplant | 149 | ||
| Valve surgery | 150 | ||
| Congenital heart disease | 150 | ||
| Implanted cardioverter-defibrillators | 150 | ||
| Provision in the UK and cost-effectiveness | 150 | ||
| Components of cardiac rehabilitation | 150 | ||
| Operation and delivery | 150 | ||
| Phase I: Inpatient period | 150 | ||
| Phase II: Early post-discharge period | 150 | ||
| Phase III: Supervised outpatient programme, including structured exercise | 151 | ||
| Phase IV: Long-term follow-up/maintenance in primary care | 151 | ||
| Cardiac rehabilitation team | 151 | ||
| The role of the physiotherapist | 151 | ||
| Benefits of exercise training | 152 | ||
| Physiological adaptations to exercise training in healthy individuals and coronary heart disease patients | 153 | ||
| Adaptations at submaximal level of aerobic exercise | 153 | ||
| Central changes as a result of aerobic exercise training | 153 | ||
| Peripheral changes as a result of aerobic exercise training | 153 | ||
| Increase in VO2 max | 153 | ||
| Assessment for exercise prescription | 154 | ||
| Contraindications to exercise | 154 | ||
| Exercise prescription: The FITT principle | 154 | ||
| Intensity of exercise | 154 | ||
| Heart rate | 154 | ||
| Age-adjusted predicted maximum heart rate formula | 155 | ||
| Karvonen formula (heart rate reserve) | 155 | ||
| Rating of perceived exertion | 155 | ||
| Metabolic equivalent | 156 | ||
| Frequency | 157 | ||
| Time | 157 | ||
| Type | 157 | ||
| Risk stratification | 157 | ||
| Classification | 157 | ||
| High risk | 157 | ||
| Moderate risk | 158 | ||
| Low risk | 158 | ||
| Functional capacity | 158 | ||
| Functional exercise testing | 158 | ||
| Exercise programming | 158 | ||
| Warm-up | 159 | ||
| Pulse-raising exercises | 159 | ||
| Mobilising major joints and stretching | 159 | ||
| Specific movements | 159 | ||
| Cardiovascular conditioning | 160 | ||
| Class management | 161 | ||
| Cool-down | 161 | ||
| Progression | 161 | ||
| Resistance training | 161 | ||
| Exercise considerations for special populations | 162 | ||
| Heart failure | 162 | ||
| Older adults | 163 | ||
| 9 Physiotherapy in thoracic surgery | 169 | ||
| Anatomy of the thorax | 169 | ||
| The lungs | 169 | ||
| The oesophagus | 169 | ||
| Thoracic surgery | 169 | ||
| Indications for surgery | 169 | ||
| Tumour | 169 | ||
| Pneumothorax | 171 | ||
| Empyema | 171 | ||
| Bronchiectasis | 171 | ||
| Oesophageal perforation | 171 | ||
| Pre-operative investigations | 171 | ||
| Chest X-ray | 171 | ||
| Computerised tomography scan | 171 | ||
| Positron emission tomography scan | 171 | ||
| Bronchoscopy/oesophagoscopy | 171 | ||
| Pulmonary function tests | 171 | ||
| Arterial blood gases | 171 | ||
| Types of thoracic incision | 171 | ||
| Posterolateral thoracotomy | 171 | ||
| Anterolateral thoracotomy | 172 | ||
| Median sternotomy | 172 | ||
| Left thoraco-laparotomy | 172 | ||
| Video-assisted thoracoscopic incisions | 172 | ||
| Operations on the lung | 173 | ||
| Pneumonectomy | 173 | ||
| Lobectomy | 173 | ||
| Segmental resection | 173 | ||
| Wedge resection | 173 | ||
| Lung volume-reduction surgery | 173 | ||
| Complications of pulmonary surgery | 173 | ||
| Operations on the pleura | 174 | ||
| Pleurectomy | 174 | ||
| Decortication | 174 | ||
| Operations on the oesophagus | 174 | ||
| Oesophageal resection | 174 | ||
| Repair of oesophageal perforations | 174 | ||
| Complications of oesophageal surgery | 174 | ||
| Intercostal drains | 174 | ||
| Amount and type of drainage | 175 | ||
| Pain control in thoracic surgery | 175 | ||
| Epidural anaesthesia | 176 | ||
| Paravertebral block | 176 | ||
| Patient-controlled analgesia | 176 | ||
| Transcutaneous nerve stimulation | 176 | ||
| Oral analgesia | 176 | ||
| The physiotherapist and thoracic surgery | 177 | ||
| Pre-operative care | 177 | ||
| Postoperative care | 177 | ||
| Patient assessment | 177 | ||
| Modalities of physiotherapy | 178 | ||
| Breathing exercises | 178 | ||
| Forced expiration | 178 | ||
| Supported cough | 178 | ||
| Positioning | 179 | ||
| Early mobilisation | 179 | ||
| Shoulder exercises | 179 | ||
| Adjuncts to physiotherapy | 179 | ||
| Incentive spirometer | 179 | ||
| Mini-tracheostomy | 179 | ||
| Heated humidification | 180 | ||
| Continuous positive airways pressure | 180 | ||
| Intermittent positive pressure breathing | 180 | ||
| Discharge | 180 | ||
| Acknowledgements | 181 | ||
| References | 181 | ||
| 10 Changing relationships for promoting health | 183 | ||
| Introduction | 183 | ||
| Between people | 183 | ||
| Communication | 183 | ||
| Cultural differences | 187 | ||
| Context of relationships | 188 | ||
| Inequalities in health | 188 | ||
| Different models | 190 | ||
| The individual model of disability | 191 | ||
| The social model of disability | 192 | ||
| Changing relationships | 193 | ||
| Partnership and user involvement | 193 | ||
| Participation | 194 | ||
| Accessible communication | 195 | ||
| Diversity and flexibility | 196 | ||
| Human relations | 196 | ||
| Use of inclusive language | 197 | ||
| Health promotion | 198 | ||
| Conclusion | 202 | ||
| Acknowledgements | 202 | ||
| References | 202 | ||
| 11 Musculoskeletal assessment | 207 | ||
| Introduction | 207 | ||
| General issues | 207 | ||
| When should physiotherapists assess patients? | 207 | ||
| Aims of the subjective assessment | 208 | ||
| Aims of the objective assessment | 208 | ||
| Subjective assessment | 208 | ||
| Initial questioning | 208 | ||
| Present condition | 208 | ||
| Area of the symptoms | 208 | ||
| Severity of the symptoms | 209 | ||
| Duration of the symptoms | 209 | ||
| Aggravating and easing factors | 209 | ||
| Positional factors | 209 | ||
| Time factors | 210 | ||
| Determining the SIN factors | 210 | ||
| Severity | 210 | ||
| Irritability | 210 | ||
| Nature | 210 | ||
| History of the present condition | 210 | ||
| Insidious onset | 210 | ||
| Traumatic onset | 210 | ||
| Progression of the condition | 210 | ||
| Chronicity or age of the condition | 210 | ||
| Previous treatments | 211 | ||
| Investigations | 211 | ||
| X-rays, MRI scans, CAT scans and bone scans | 211 | ||
| Blood tests | 211 | ||
| Other investigations | 211 | ||
| Past medical history | 211 | ||
| Medication | 211 | ||
| Objective assessment | 212 | ||
| General observation | 212 | ||
| Local observation | 212 | ||
| Posture | 212 | ||
| Palpation | 212 | ||
| Assessment of movement | 212 | ||
| Active movements | 212 | ||
| Passive movements | 212 | ||
| Resisted movements | 212 | ||
| Assessment of range of movement | 212 | ||
| Measurement of joint range using a goniometer | 212 | ||
| Differentiation tests | 213 | ||
| End-feel | 213 | ||
| Assessment of muscle strength | 213 | ||
| Symptoms arising from resisted contractions | 213 | ||
| Measurements using isokinetic machines | 213 | ||
| Differentiation tests of muscles and tendons | 214 | ||
| Passive insufficiency of muscles | 214 | ||
| Active insufficiency of muscles | 214 | ||
| Differentiation tests of ligaments | 214 | ||
| Differentiation tests of bursae | 214 | ||
| Differentiation tests of menisci | 214 | ||
| Characteristics of degenerative joint disease | 214 | ||
| Writing up the assessment | 215 | ||
| Spinal assessments | 215 | ||
| The lumbar spine | 215 | ||
| Posture | 215 | ||
| Normal alignment | 215 | ||
| Common deviations from normal posture (refer to Figure 11.6) | 215 | ||
| Movements | 216 | ||
| Active movements | 216 | ||
| Flexion | 216 | ||
| Extension | 216 | ||
| Side flexion (Figure 11.9) | 217 | ||
| Passive physiological intervertebral movements (PPIVMs) | 217 | ||
| Overpressure | 217 | ||
| Repeated movements | 217 | ||
| Combined movements | 217 | ||
| Differentiation between the hip and lumbar spine as a source of symptoms | 218 | ||
| Assessing the sacroiliac joint | 219 | ||
| Sitting flexion (Piedello’s sign) | 219 | ||
| Standing flexion (stork test) | 219 | ||
| Compression tests | 219 | ||
| Posterior ligaments | 219 | ||
| Anterior ligaments – Faber test | 219 | ||
| Neurological testing | 219 | ||
| Dermatomes | 219 | ||
| Myotomes | 219 | ||
| Reflexes | 220 | ||
| Adverse mechanical tension | 220 | ||
| Passive neck flexion | 220 | ||
| Straight leg raise (SLR) | 220 | ||
| Prone knee bend (femoral nerve stretch) | 221 | ||
| Slump test | 222 | ||
| Testing for lumbopelvic stability | 222 | ||
| Palpation | 222 | ||
| Accessory spinal movements | 222 | ||
| Biopsychosocial assessment (lumbar spine) | 223 | ||
| Fundamental differences between acute and chronic pain | 223 | ||
| Predictors of chronic incapacity | 223 | ||
| Management guidelines for LBP (CSAG 1994; RCGP 1999) | 224 | ||
| Biopsychosocial assessment | 224 | ||
| Psychological factors | 224 | ||
| Social factors | 224 | ||
| Physical examination | 224 | ||
| Outcome measures questionnaires | 225 | ||
| Treatment of biopsychosocial aspects of LBP disability | 225 | ||
| Example of the content of a back rehabilitation programme | 225 | ||
| The cervical spine | 225 | ||
| Posture | 225 | ||
| Movements | 225 | ||
| Active movements | 226 | ||
| Flexion | 226 | ||
| Extension | 226 | ||
| Side flexion | 227 | ||
| Right and left rotation | 227 | ||
| Overpressures repeated and combined movements | 227 | ||
| The shoulder complex | 227 | ||
| Passive physiological intervertebral movements (PPIVMs) | 227 | ||
| Vertebral artery testing | 227 | ||
| Differentiation test to determine between vestibular and VBI symptoms | 227 | ||
| Vertebrobasilar testing (Maitland 2001) | 228 | ||
| Neurological testing | 228 | ||
| Dermatomes | 228 | ||
| Myotomes | 228 | ||
| Reflexes | 228 | ||
| Mechanical tension tests | 229 | ||
| Palpation | 229 | ||
| Bony anomalies | 229 | ||
| Accessory spinal movements | 229 | ||
| Peripheral joint assessments | 230 | ||
| The shoulder joint | 230 | ||
| Posture | 230 | ||
| Posterior alignment | 231 | ||
| Anterior alignment | 231 | ||
| Lateral alignment | 231 | ||
| Palpation | 231 | ||
| Muscle length tests | 231 | ||
| Levator scapulae | 231 | ||
| Pectoralis minor | 231 | ||
| Movements | 231 | ||
| Active movements | 231 | ||
| Shoulder girdle movements | 231 | ||
| Shoulder joint flexion | 231 | ||
| Shoulder joint abduction | 232 | ||
| Shoulder joint rotation | 232 | ||
| Shoulder joint horizontal flexion and extension (scarf-test) | 232 | ||
| Shoulder joint extension | 233 | ||
| Shoulder functional movements | 233 | ||
| Other shoulder joint abnormalities | 233 | ||
| Passive movements | 233 | ||
| Accessory movements | 233 | ||
| Acromioclavicular and sternoclavicular joints | 233 | ||
| Glenohumeral joint | 233 | ||
| Further tests (Maitland 2001) | 233 | ||
| Resisted muscle testing | 233 | ||
| Muscle length tests | 233 | ||
| Acromioclavicular joint compression and distraction | 234 | ||
| Tests for shoulder instability | 234 | ||
| Anterior draw/translation (Lachmann’s of the shoulder) | 234 | ||
| Posterior draw test | 234 | ||
| Inferior draw (sulcus) test (Figure 11.36) | 234 | ||
| Medial kinetic rotation test | 235 | ||
| Impingement test | 235 | ||
| Supraspinatus (empty-can test) | 235 | ||
| The hip joint | 235 | ||
| Gait | 235 | ||
| Posture | 236 | ||
| Standing | 236 | ||
| Supine | 236 | ||
| Leg length discrepancy | 236 | ||
| Muscle length assessments | 236 | ||
| The Thomas test | 236 | ||
| Modified Ober’s test (iliotibial band) | 236 | ||
| Piriformis test | 236 | ||
| Hamstrings | 237 | ||
| Quadratus lumborum | 237 | ||
| Movements | 237 | ||
| Lumbar spine differentiation | 237 | ||
| Trendelenberg test | 238 | ||
| Palpation | 238 | ||
| Active movements | 239 | ||
| Hip flexion/extension | 239 | ||
| Hip abduction/adduction | 239 | ||
| Hip rotation | 239 | ||
| Passive movements | 239 | ||
| Muscle strength testing | 239 | ||
| Accessory movements | 240 | ||
| Neural tests | 240 | ||
| Functional tests | 240 | ||
| The knee joint | 241 | ||
| Gait | 241 | ||
| Knee examination | 241 | ||
| Posture with patient standing | 241 | ||
| Swelling and discoloration | 241 | ||
| Loss of muscle bulk | 242 | ||
| Patellar tap | 242 | ||
| Fluid displacement test | 242 | ||
| Tenderness at the knee (tibiofemoral joint) | 242 | ||
| Patellofemoral joint assessment | 242 | ||
| Movements | 243 | ||
| Active movements | 243 | ||
| Passive movements | 243 | ||
| Valgus stress test (medial collateral ligament of the knee) | 243 | ||
| Varus stress test (lateral collateral ligament of the knee) | 244 | ||
| Anterior draw test (anterior cruciate ligament) | 244 | ||
| Posterior draw test (posterior cruciate ligament) | 244 | ||
| Lachman’s test (modified anterior draw test) | 245 | ||
| The pivot shift test | 245 | ||
| McMurray’s medial and lateral meniscus tests | 245 | ||
| Apley’s compression/distraction test (for differentiation between meniscus and ligament) | 245 | ||
| Proprioception | 245 | ||
| Accessory movements | 245 | ||
| The ankle and foot | 246 | ||
| Gait | 246 | ||
| Foot and ankle examination | 246 | ||
| Pulses (leg circulation) | 246 | ||
| Oedema | 246 | ||
| General condition | 246 | ||
| Temperature | 246 | ||
| Tenderness | 246 | ||
| Alignments | 247 | ||
| The leg and hindfoot | 247 | ||
| The hindfoot and forefoot | 247 | ||
| The toes | 248 | ||
| Functional activities | 248 | ||
| Movements | 248 | ||
| Active movements | 248 | ||
| Ankle joint | 248 | ||
| Subtalar and midtarsal joints | 248 | ||
| Toe movements | 248 | ||
| Passive movements | 248 | ||
| Muscle strength | 248 | ||
| Ligament tests | 248 | ||
| Accessory movements (Maitland 2001) | 249 | ||
| Inferior tibiofibular joint | 249 | ||
| Ankle joint | 249 | ||
| Subtalar joint | 249 | ||
| Metatarsophalangeal and interphalangeal joints | 250 | ||
| Thompson’s squeeze test | 250 | ||
| References | 250 | ||
| 12 The physiotherapy management of inflammation, healing and repair | 253 | ||
| Introduction | 253 | ||
| The continuum of tissue healing and repair | 254 | ||
| Soft tissue injury | 255 | ||
| Ischaemic mechanisms | 255 | ||
| Enzymatic mechanisms | 255 | ||
| Phases 1 and 2 of tissue healing and repair | 255 | ||
| Phase 1: bleeding (0–10 hours) | 255 | ||
| Phase 2: inflammation (0–4 days) | 255 | ||
| Physiotherapy interventions in phases 1 and 2 (0–72 hours post-injury) | 256 | ||
| General physiotherapy aims of early phase management (phases 1 and 2) | 256 | ||
| The PRICE principles | 256 | ||
| Protection | 257 | ||
| Strapping | 257 | ||
| Other methods of protecting injured and healing tissues | 257 | ||
| Walking aids | 257 | ||
| Rest | 257 | ||
| Cryotherapy (ice therapy) | 258 | ||
| Compression | 259 | ||
| Elevation | 259 | ||
| First-line management | 260 | ||
| Applying the PRICE principles in practice | 260 | ||
| Severity of injury and progression through the healing continuum | 260 | ||
| Phases 3 and 4: proliferation and remodelling | 261 | ||
| Plasticity in human tissue | 261 | ||
| Factors influencing the rate of healing in the stages of proliferation and remodelling | 261 | ||
| Phase 3: tissue proliferation (fibrous repair) (1–10+ days post-injury) | 262 | ||
| Pathophysiology | 262 | ||
| General physiotherapy aims in the tissue proliferation stage – phase 3 | 262 | ||
| Physiotherapy in the tissue proliferation stage (1–10+ days post-injury) | 263 | ||
| Use of cryotherapy at this stage | 263 | ||
| Prescribing activity and exercise in the proliferative stage | 263 | ||
| Grading the level of activity | 263 | ||
| Electrotherapy in tissue healing and repair | 265 | ||
| Choosing when and how to use electrotherapy? | 265 | ||
| Phase 4: tissue remodelling (10 days + post-injury) | 265 | ||
| Pathophysiology | 265 | ||
| General physiotherapy aims in the remodelling stage (phase 4) | 266 | ||
| Physiotherapy in the remodelling phase (Phase 4) | 266 | ||
| Preventing tissue contraction and adhesion formation | 266 | ||
| Passive and accessory mobilisation techniques | 267 | ||
| References | 271 | ||
| 13 Exercise in rehabilitation | 273 | ||
| Introduction | 273 | ||
| Strengthening exercises | 274 | ||
| Introduction | 274 | ||
| Measurement of muscle strength | 274 | ||
| The Oxford scale | 274 | ||
| Functional tools | 275 | ||
| Isokinetic assessment | 275 | ||
| Drawbacks | 275 | ||
| Strength training | 275 | ||
| Benefits | 275 | ||
| Free active exercise | 276 | ||
| Muscle contractions | 276 | ||
| Treatment with eccentric exercise | 277 | ||
| Open-chain and closed-chain kinetic strengthening | 278 | ||
| Resisted exercise | 278 | ||
| Types of muscle fibre | 278 | ||
| Number of repetitions | 279 | ||
| Resistance training in different populations | 279 | ||
| The elderly | 279 | ||
| Children and adolescents | 280 | ||
| Mobilising exercises | 280 | ||
| Introduction | 280 | ||
| Classes of mobilising exercise | 280 | ||
| Passive exercises | 280 | ||
| Active-assisted exercises | 280 | ||
| Auto-assisted exercises | 281 | ||
| Active exercises | 281 | ||
| Stretching exercises | 281 | ||
| Dynamic stretching | 282 | ||
| Note on ballistic stretching | 282 | ||
| Static stretching | 282 | ||
| Spinal position | 283 | ||
| Teaching stretching exercises: A practical guide | 283 | ||
| Contraindications to stretching | 284 | ||
| Hold/relax techniques | 284 | ||
| Progression of exercise | 284 | ||
| The starting position | 284 | ||
| Length of the lever | 285 | ||
| Speed of movement | 286 | ||
| Range of movement | 286 | ||
| Resistance to movement | 286 | ||
| Dealing with movement dysfunction | 286 | ||
| Rehabilitation of sensorimotor control | 287 | ||
| Exercises aimed at accessing the sensorimotor control loop to develop and enhance movement control | 287 | ||
| Introduction | 287 | ||
| The mechanism of proprioception | 288 | ||
| Instability | 288 | ||
| Assessing proprioception | 289 | ||
| Rehabilitation of sensorimotor control of the limbs | 290 | ||
| Issues | 290 | ||
| The lower limb | 291 | ||
| The upper limb | 292 | ||
| Rehabilitation of sensorimotor control of the spine | 293 | ||
| Plyometric exercises | 295 | ||
| Functional testing and rehabilitation | 296 | ||
| Group exercise | 298 | ||
| Benefits and drawbacks | 298 | ||
| Planning group work | 298 | ||
| Format of a group session | 299 | ||
| Circuit training | 299 | ||
| Hydrotherapy | 299 | ||
| Buoyancy | 299 | ||
| Turbulence | 300 | ||
| Streamlining | 300 | ||
| Exercise prescription and compliance | 300 | ||
| Acknowledgements | 301 | ||
| Further reading | 301 | ||
| References | 301 | ||
| 14 Muscle imbalance | 305 | ||
| Introduction | 305 | ||
| What is muscle imbalance? | 305 | ||
| Stability | 306 | ||
| Neurophysiological components of muscle balance | 309 | ||
| Motor control | 309 | ||
| Muscle length adaptations | 309 | ||
| Stretch weakness | 309 | ||
| Positional weakness and length associated changes | 309 | ||
| Relative flexibility and relative stiffness | 310 | ||
| Examination and assessment principles | 311 | ||
| Treatment, intervention and management principles | 311 | ||
| The Lumbo-pelvic region | 312 | ||
| Transversus abdominis (TrA) | 313 | ||
| Subjective examination | 314 | ||
| Objective examination | 315 | ||
| On observation | 315 | ||
| In standing: Lateral view | 315 | ||
| Measurements | 315 | ||
| Analysis | 316 | ||
| Plan | 317 | ||
| Technique | 317 | ||
| Evaluation | 317 | ||
| The cervical spine region | 317 | ||
| Muscles | 318 | ||
| Deep cervical flexors | 318 | ||
| Posture | 319 | ||
| Assessment and treatment | 320 | ||
| The shoulder complex | 320 | ||
| Scapulo-humeral rhythm | 320 | ||
| Muscles acting on the scapulo-thoracic joint | 321 | ||
| Muscles acting on the glenohumeral joint | 322 | ||
| Clinical presentations of the shoulder complex | 323 | ||
| Causes of shoulder pain | 323 | ||
| Subjective | 323 | ||
| Objective and analysis | 323 | ||
| Plan (Treatment) | 324 | ||
| Evaluation | 325 | ||
| The knee | 325 | ||
| Vastus medialis oblique | 325 | ||
| Assessment | 326 | ||
| Treatment/management | 327 | ||
| Acknowledgements | 328 | ||
| References | 328 | ||
| 15 Biomechanics | 331 | ||
| Introduction | 331 | ||
| Clinical gait analysis | 331 | ||
| Kinematics | 332 | ||
| The gait cycle | 332 | ||
| Spatial and temporal parameters of gait | 332 | ||
| Spatial parameters | 332 | ||
| Temporal parameters | 332 | ||
| Analysis of joint movement during gait | 333 | ||
| How to find segment angles and joint angles | 333 | ||
| Motion of the ankle joint | 334 | ||
| Phase 1 | 334 | ||
| Phase 2 | 335 | ||
| Phase 3 | 335 | ||
| Phase 4 | 335 | ||
| Motion of the knee joint | 335 | ||
| Heel strike | 336 | ||
| Phase 1 | 336 | ||
| Phase 2 | 336 | ||
| Phase 3 | 336 | ||
| Phase 4 | 336 | ||
| Phase 5 | 336 | ||
| Motion of the hip joint in the sagittal plane | 336 | ||
| Motion of the pelvis in the coronal plane (pelvic obliquity) | 337 | ||
| Motion of the pelvis in the transverse plane (pelvic rotation) | 337 | ||
| How to find linear displacement, velocity and acceleration | 338 | ||
| Linear displacement | 338 | ||
| Linear velocity | 338 | ||
| Linear acceleration | 338 | ||
| Kinematics of a reaching task | 338 | ||
| Linear displacement of the hand during reaching with and without shoulder dysfunction | 339 | ||
| Linear velocity of the hand during reaching with and without shoulder dysfunction | 339 | ||
| Linear acceleration of the hand during reaching with and without shoulder dysfunction | 339 | ||
| How to find angular displacement, velocity and acceleration | 340 | ||
| Angular displacement | 340 | ||
| Angular velocity | 340 | ||
| Angular acceleration | 340 | ||
| Kinematics of the knee during walking | 340 | ||
| Knee angular displacement of normal knee function and medial compartment knee osteoarthritis during walking | 341 | ||
| Knee angular velocity of normal knee function and a patient with medial compartment knee osteoarthritis during walking | 341 | ||
| Knee angular acceleration of normal knee function and a patient with medial compartment knee osteoarthritis during walking | 342 | ||
| Methods of movement analysis | 342 | ||
| Common clinical tools | 343 | ||
| Walk mat systems | 343 | ||
| Movement analysis systems | 343 | ||
| Understanding forces | 344 | ||
| Forces | 344 | ||
| Newton’s first law | 344 | ||
| Newton’s second law | 344 | ||
| Newton’s third law | 344 | ||
| Mass and weight | 345 | ||
| Mass | 345 | ||
| Weight | 345 | ||
| Acceleration owing to gravity | 345 | ||
| Static equilibrium | 345 | ||
| Free-body analysis | 345 | ||
| Worked example | 345 | ||
| How forces act on the body | 346 | ||
| Ground reaction forces | 346 | ||
| Ground reaction forces during the gait cycle | 346 | ||
| Vertical force component | 346 | ||
| Heel strike to first peak | 346 | ||
| First peak to trough | 347 | ||
| Trough to second peak | 347 | ||
| Second peak to toe off | 348 | ||
| Anterior–posterior force component | 348 | ||
| Clawback | 348 | ||
| Heel strike to posterior peak | 348 | ||
| Posterior peak to crossover | 348 | ||
| Crossover to anterior peak | 348 | ||
| Anterior peak to toe off | 348 | ||
| Mediolateral force component | 349 | ||
| Pedotti diagrams | 349 | ||
| Methods of force analysis | 350 | ||
| Video vector generators | 350 | ||
| Force platforms | 350 | ||
| Pressure systems | 350 | ||
| Understanding moments and forces | 350 | ||
| How forces and moments act on the body | 354 | ||
| How to find moments in the upper limb | 354 | ||
| Resolving the force | 354 | ||
| Moments about the elbow | 354 | ||
| How to find moments in the lower limb | 354 | ||
| Resolving the forces | 355 | ||
| Moments about the knee | 355 | ||
| How to find muscle and joint forces | 355 | ||
| Muscle forces | 355 | ||
| Joint forces | 355 | ||
| Worked example 1: How to find muscle and joint forces in the upper limb | 356 | ||
| Finding the moment about the elbow joint | 356 | ||
| Finding the force in the muscle | 356 | ||
| Finding the joint force | 357 | ||
| Vertical forces | 357 | ||
| Horizontal forces | 357 | ||
| Resultant joint force | 357 | ||
| Worked example 2: How to find moments in the lower limb | 357 | ||
| Resolving | 358 | ||
| Moments about the ankle (Figure 15.48) | 358 | ||
| Moments about the knee (Figure 15.49) | 358 | ||
| Moments about the hip (Figure 15.50) | 358 | ||
| What are the effects of these moments on the muscles? | 358 | ||
| Worked example 3: How to find muscle and joint forces on the base of the spine | 358 | ||
| Solution | 359 | ||
| Moments about the ankle knee and hip joints during normal walking | 359 | ||
| Typical ankle moments during normal gait | 359 | ||
| Typical knee moments during normal gait | 359 | ||
| Typical hip moments during normal gait | 359 | ||
| How to find linear work, energy and power | 360 | ||
| Linear work | 360 | ||
| Linear power | 360 | ||
| Linear energy | 360 | ||
| Conservation of energy | 361 | ||
| Potential energy | 361 | ||
| Kinetic energy | 361 | ||
| How to find angular work and power | 361 | ||
| Angular work | 361 | ||
| Angular power | 361 | ||
| Joint power during normal walking | 362 | ||
| Ankle power | 362 | ||
| Knee power | 362 | ||
| Hip power | 362 | ||
| Strength testing and training | 362 | ||
| Changing the effective moment caused by the body segment inclination | 364 | ||
| The position and size of the applied load | 364 | ||
| Muscle insertion points | 364 | ||
| The effect of the angle of muscle pull | 366 | ||
| Type of muscle contraction | 366 | ||
| The effect of the speed of contraction | 366 | ||
| Methods of objective assessment | 367 | ||
| Conclusion | 368 | ||
| References | 368 | ||
| 16 Sports management | 369 | ||
| Introduction | 369 | ||
| Qualifications, skills and relevant continuing professional development | 369 | ||
| Knowledge and skills needed | 370 | ||
| Knowledge of sports | 371 | ||
| CPD | 371 | ||
| Legal responsibilities | 371 | ||
| Medical insurance | 372 | ||
| Doping, and WADA and TUEs | 372 | ||
| Concussion management | 372 | ||
| Second impact syndrome | 373 | ||
| Summary | 374 | ||
| Role of the physiotherapist in sport | 374 | ||
| Key preseason considerations | 374 | ||
| Key pre-match considerations | 375 | ||
| Pitch-side | 375 | ||
| Pitch-side equipment | 375 | ||
| Principles of first aid | 375 | ||
| Practicalities of injury management | 376 | ||
| Protection | 376 | ||
| Rest | 376 | ||
| Ice | 376 | ||
| Compression | 377 | ||
| Elevation | 377 | ||
| Mobilisation/movement | 377 | ||
| 17 Pain | 381 | ||
| Introduction | 381 | ||
| The physiology of pain | 381 | ||
| Activation of the nociceptive system | 382 | ||
| Peripheral transmission | 382 | ||
| Thresholds of unsensitised nociceptors | 382 | ||
| Spinal transmission | 382 | ||
| Transmission from the dorsal horn to the brain | 382 | ||
| Brain transmission | 382 | ||
| Parallel processing | 382 | ||
| Different aspects of pain seem to involve different brain areas | 383 | ||
| Multiple inputs: The neuromatrix theory | 384 | ||
| Sensitisation of the nociception/ pain system | 385 | ||
| Peripheral mechanisms | 385 | ||
| Spinal cord mechanisms | 385 | ||
| Dorsal horn mechanism | 385 | ||
| Brain mechanisms | 385 | ||
| Neuropathic pain | 386 | ||
| Pain modulation via psychological and social influences | 386 | ||
| Anxiety | 386 | ||
| Expectation | 386 | ||
| Social context | 386 | ||
| Assessment and measurement of pain | 387 | ||
| The WHO international classification of functioning, disability and health (WHO ICF) | 387 | ||
| The interview | 387 | ||
| Measures and scales | 387 | ||
| Self-reporting measures | 387 | ||
| Behavioural measures | 388 | ||
| Measures of the impact of pain | 388 | ||
| Measuring potential impact of beliefs and thoughts | 388 | ||
| Self-efficacy | 389 | ||
| Red, yellow, blue and black flags | 389 | ||
| Measures of functional limitation and disability | 389 | ||
| Management of pain | 390 | ||
| Promoting optimal function with reference to WHO ICF | 390 | ||
| Deactivating/desensitising the nociceptive system | 390 | ||
| Addressing peripheral mechanisms of nociception | 391 | ||
| Addressing spinal mechanisms of nociception | 391 | ||
| Addressing brain mechanisms of nociception and pain | 392 | ||
| Cognitive-behavioural therapy | 392 | ||
| Explaining pain biology | 392 | ||
| Motivation | 392 | ||
| Relaxation | 393 | ||
| Pacing | 393 | ||
| Graded activity versus graded exposure | 393 | ||
| Targeting cortical representations of the body | 394 | ||
| Limitations and opportunities | 394 | ||
| Case study: inflammatory phase (immediate post-injury to 2–5 days) | 395 | ||
| Introduction | 395 | ||
| The physiology of pain | 395 | ||
| Activation of the nociceptive system | 395 | ||
| Sensitisation of the nociceptive/pain system | 395 | ||
| Pain modulation via psychological and social influences | 395 | ||
| Physiotherapy appointment (day 2 post-injury) | 395 | ||
| Assessment and measurement of pain | 395 | ||
| From the initial interview (refer to Table 17.2) | 395 | ||
| Management of pain | 396 | ||
| Case study: the remodelling phase (from three weeks to two+ years) | 396 | ||
| Introduction | 396 | ||
| The physiology of pain | 396 | ||
| Activation of the nociceptive system | 396 | ||
| Sensitisation of the nociceptive/pain system | 396 | ||
| Pain modulation via psychological and social influences | 397 | ||
| Physiotherapy appointment (four months post-injury) | 397 | ||
| Assessment and measurement of pain | 397 | ||
| From the initial interview (refer to Table 17.2) | 397 | ||
| Management of pain | 397 | ||
| Acknowledgements | 398 | ||
| References | 398 | ||
| 18 Acupuncture in physiotherapy | 403 | ||
| A brief history of acupuncture | 403 | ||
| Acupuncture in the twentieth century | 404 | ||
| Acupuncture from A traditional chinese medicine perspective | 404 | ||
| Western medical acupuncture | 405 | ||
| Prevalence of acupuncture use | 406 | ||
| Safety of acupuncture | 406 | ||
| Acupuncture research in the twentieth century | 406 | ||
| Brain imaging acupuncture research | 407 | ||
| Acupuncture research since the turn of the twenty-first century | 408 | ||
| The current Western scientific understanding of acupuncture | 409 | ||
| Western correlates of traditional Chinese medicine paradigms | 409 | ||
| Conditions that may be treated – from the AACP site | 410 | ||
| Clinical implications | 410 | ||
| Acknowledgements | 411 | ||
| References | 412 | ||
| 19 Electrotherapy | 417 | ||
| Introduction | 417 | ||
| Electrotherapy versus electrophysical agents | 417 | ||
| Scope | 418 | ||
| Model of electrotherapy | 418 | ||
| Therapeutic windows | 419 | ||
| Electrotherapy modality grouping | 419 | ||
| Electrical stimulation modalities | 420 | ||
| General principles of electrical stimulation | 420 | ||
| Nerve action potentials | 420 | ||
| Transcutaneous electrical nerve stimulation (TENS) | 421 | ||
| Machine parameters | 421 | ||
| Mechanism of action | 422 | ||
| Traditional TENS (hi-TENS, normal TENS) | 423 | ||
| Acupuncture TENS (lo-TENS, AcuTENS) | 423 | ||
| Brief intense TENS | 423 | ||
| Burst mode TENS | 423 | ||
| Frequency selection | 424 | ||
| Stimulation intensity | 424 | ||
| Electrode placement | 424 | ||
| Interferential therapy (IFT) | 424 | ||
| Frequency sweep | 427 | ||
| Physiological effects and clinical applications | 427 | ||
| Pain relief | 428 | ||
| Muscle stimulation | 428 | ||
| Blood flow | 428 | ||
| Oedema | 429 | ||
| Treatment parameters | 429 | ||
| Muscle stimulation modalities | 429 | ||
| Microcurrent therapy | 431 | ||
| Other forms of electrical stimulation | 431 | ||
| Thermal modalities | 432 | ||
| Introduction | 432 | ||
| Principles of thermal treatments | 432 | ||
| Therapeutic effects of heating therapies | 432 | ||
| Infrared radiation | 433 | ||
| Wax therapy | 433 | ||
| Hot packs | 433 | ||
| Shortwave and microwave diathermy | 433 | ||
| Other radio frequency (RF) therapies | 434 | ||
| Non-thermal modalities | 434 | ||
| Introduction | 434 | ||
| Therapeutic ultrasound | 435 | ||
| Ultrasound transmission through the tissues | 436 | ||
| Absorption and attenuation | 436 | ||
| Pulsed ultrasound | 437 | ||
| Clinical uses of ultrasound therapy | 437 | ||
| Thermal effects and uses | 437 | ||
| Non-thermal effects and uses | 437 | ||
| Ultrasound application in relation to tissue repair | 437 | ||
| Inflammation | 437 | ||
| Proliferation | 438 | ||
| Remodelling | 438 | ||
| Treatment doses | 439 | ||
| Low intensity pulsed ultrasound (LIPUS) and fracture healing | 439 | ||
| Pulsed shortwave therapy (PSWT) | 440 | ||
| Main machine parameters | 441 | ||
| Pulse repetition rate (Hz or pps) | 441 | ||
| Pulse duration (width) | 441 | ||
| Power output of the machine | 441 | ||
| Mean power | 441 | ||
| Tissue heating | 442 | ||
| Effects of PSWT | 442 | ||
| PSWT: Clinical effects | 443 | ||
| Suggested treatment doses | 444 | ||
| Acute conditions | 444 | ||
| Sub-acute conditions | 444 | ||
| Chronic conditions | 444 | ||
| Laser therapy/low level laser therapy/low intensity laser therapy | 444 | ||
| Terms | 445 | ||
| Parameters | 445 | ||
| Light absorption in the tissues | 446 | ||
| Laser–tissue interaction | 446 | ||
| Treatment doses | 447 | ||
| Clinical applications | 447 | ||
| Open wounds | 447 | ||
| Inflammatory arthropathies | 448 | ||
| Soft tissue injury | 448 | ||
| Pain | 448 | ||
| Shockwave therapy | 448 | ||
| Summary | 450 | ||
| References | 450 | ||
| 20 Physiotherapy for people with major amputation | 457 | ||
| Introduction | 457 | ||
| Causes and levels of amputation | 457 | ||
| The psychosocial impact of amputation | 458 | ||
| Pain and pain relief | 459 | ||
| Residual limb pain | 459 | ||
| Phantom limb pain and sensations | 459 | ||
| Secondary pain | 460 | ||
| The role of the physiotherapist following lower limb amputation | 460 | ||
| Physiotherapy aims | 460 | ||
| Considerations | 460 | ||
| Physiotherapy assessment | 461 | ||
| Assessment | 461 | ||
| Problem list | 462 | ||
| Treatment plan | 462 | ||
| Stages of physiotherapy management | 462 | ||
| Pre-operative stage | 462 | ||
| Postoperative stage | 463 | ||
| Pre-prosthetic stage | 465 | ||
| Prosthetic stage | 465 | ||
| Lifelong stage | 467 | ||
| Falls | 468 | ||
| Prostheses | 468 | ||
| Prosthetic gait deviations | 468 | ||
| Transtibial level deviations | 468 | ||
| Transfemoral level deviations | 469 | ||
| Outcome measures | 469 | ||
| Special considerations | 470 | ||
| Children with amputation and limb absence | 470 | ||
| Trauma and tumour amputation | 470 | ||
| Upper limb amputation | 470 | ||
| Complex cases | 471 | ||
| Further reading | 472 | ||
| References | 473 | ||
| 21 Massage | 475 | ||
| Introduction | 475 | ||
| Preparation | 475 | ||
| Treatment room | 475 | ||
| Couch | 475 | ||
| Self preparation | 475 | ||
| Stance | 475 | ||
| Clothing | 475 | ||
| Hands | 476 | ||
| Exercises | 476 | ||
| Practice rhythm | 476 | ||
| Practice strokes | 477 | ||
| Palpation | 477 | ||
| Patient preparation | 478 | ||
| Coupling media | 478 | ||
| Legal aspects | 479 | ||
| Contraindications | 479 | ||
| Techniques | 480 | ||
| Stroking manipulations | 480 | ||
| Stroking | 480 | ||
| Effects of stroking | 480 | ||
| Effleurage | 481 | ||
| Effects of effleurage | 481 | ||
| Pressure manipulations or petrissage | 481 | ||
| Kneading | 481 | ||
| Effects of kneading | 481 | ||
| Picking up | 483 | ||
| Effects of picking up | 483 | ||
| Wringing | 483 | ||
| Effects of wringing | 484 | ||
| Rolling | 484 | ||
| Effects of rolling | 484 | ||
| Shaking | 484 | ||
| Effects of shaking | 484 | ||
| Percussion or tapotement manipulations | 485 | ||
| Hacking | 485 | ||
| Effects of hacking | 485 | ||
| Clapping | 485 | ||
| Effects of clapping | 485 | ||
| Beating | 485 | ||
| Effects of beating | 486 | ||
| Pounding | 486 | ||
| Effects of pounding | 486 | ||
| Vibrations | 486 | ||
| Effects of vibrations | 486 | ||
| Other techniques | 487 | ||
| Myofascial release | 487 | ||
| Myofascial spread | 487 | ||
| Effects of myofascial spread | 487 | ||
| Fascial lift and roll | 487 | ||
| Effects of fascial lift and roll | 487 | ||
| Myofascial mobilisation | 487 | ||
| Effects of myofascial mobilisation | 488 | ||
| Frictions | 488 | ||
| Effects of frictions | 488 | ||
| Trigger pointing and acupressure | 488 | ||
| Types of trigger point | 489 | ||
| Effects of trigger pointing | 489 | ||
| Acupressure | 489 | ||
| Effects of acupressure | 489 | ||
| Specific usage of massage | 489 | ||
| Tension headaches | 489 | ||
| Specific frictions for tennis elbow | 491 | ||
| Friction of tendo-Achilles | 491 | ||
| Massage for lymphoedema | 491 | ||
| The next steps in massage – how to build on and enhance basic massage skills | 491 | ||
| Final thoughts | 492 | ||
| Further reading | 493 | ||
| References | 493 | ||
| 22 An introduction to fractures | 495 | ||
| Definition and classifications | 495 | ||
| Classification of fractures | 495 | ||
| The causes of fractures | 496 | ||
| Trauma | 496 | ||
| Pathological fractures | 496 | ||
| Clinical features of fractures | 496 | ||
| Pain | 497 | ||
| Deformity | 497 | ||
| Oedema | 497 | ||
| Muscle spasm | 497 | ||
| Abnormal movement/crepitus | 497 | ||
| Loss of function | 497 | ||
| Shock | 497 | ||
| Limitation of joint movement | 497 | ||
| Muscle atrophy | 497 | ||
| Fracture healing | 497 | ||
| Healing of compact bone | 497 | ||
| Haematoma | 497 | ||
| Periosteal and endosteal proliferation | 497 | ||
| Callus formation | 498 | ||
| Consolidation | 498 | ||
| Remodelling | 498 | ||
| Healing of cancellous bone | 498 | ||
| When is a fracture healed? | 498 | ||
| Time for a fracture to unite | 499 | ||
| Complications of fractures | 499 | ||
| Critical blood disorders | 499 | ||
| Fat embolism (acute respiratory distress syndrome) | 499 | ||
| Skin plaster sores | 499 | ||
| Muscle damage and atrophy | 499 | ||
| Compartment syndrome | 499 | ||
| Avascular necrosis | 500 | ||
| Problems with union | 500 | ||
| Growth disturbance | 500 | ||
| Complex regional pain syndrome I (CRPS I) | 500 | ||
| Intra-articular fractures | 500 | ||
| Visceral injuries | 500 | ||
| Adhesions | 500 | ||
| Injury to large vessels | 501 | ||
| Nerve injury | 501 | ||
| Oedema | 501 | ||
| Principles of fracture management | 501 | ||
| Reduction | 501 | ||
| Immobilisation | 502 | ||
| Common methods of fracture immobilisation | 502 | ||
| Plaster of Paris | 502 | ||
| Functional bracing (cast bracing) | 503 | ||
| Internal fixation | 503 | ||
| Advantages of ORIF | 503 | ||
| Disadvantages of ORIF | 503 | ||
| Intramedullary nailing | 504 | ||
| External fixation | 504 | ||
| Traction | 506 | ||
| Physiotherapy and fractures | 506 | ||
| General issues | 506 | ||
| Initial patient assessment | 507 | ||
| The problem-oriented medical record | 507 | ||
| The subjective assessment | 508 | ||
| Basic background information to record | 508 | ||
| History of present condition | 508 | ||
| Previous medical history | 508 | ||
| Social history | 508 | ||
| Pain | 508 | ||
| The objective assessment | 508 | ||
| Look | 508 | ||
| Feel | 509 | ||
| Move | 509 | ||
| Setting goals for orthopaedic patients | 509 | ||
| General points | 509 | ||
| Commonly encountered fractures and some principles of management | 510 | ||
| Fractures of the upper limb | 510 | ||
| Fractures of the clavicle and scapula | 510 | ||
| Fractures of the proximal humerus | 510 | ||
| Fractures of the surgical neck of humerus | 510 | ||
| Fractures of the shaft of the humerus | 510 | ||
| Fractures of the condyles of the humerus | 510 | ||
| Fractures of the radius | 511 | ||
| Radial head fractures | 511 | ||
| Fractures of the distal radius | 511 | ||
| Fracture of the scaphoid | 512 | ||
| Fractures of the phalanges or metacarpals | 512 | ||
| Bennett’s fracture | 513 | ||
| Fractures of the lower limb | 513 | ||
| Fractures of the pelvis | 513 | ||
| Fracture of the neck of the femur | 513 | ||
| Complications | 514 | ||
| Fractures of the shaft of the femur | 515 | ||
| Fractures around the knee | 515 | ||
| Complications | 515 | ||
| Fracture of the patella | 515 | ||
| Fractures of the tibia and fibula | 515 | ||
| Complications | 516 | ||
| Fractures around the ankle | 516 | ||
| Fractures of the foot | 517 | ||
| Complications | 517 | ||
| Spinal fractures | 517 | ||
| Cryotherapy | 517 | ||
| Acknowledgements | 523 | ||
| Further reading | 523 | ||
| References | 523 | ||
| 23 Joint arthroplasty | 525 | ||
| Introduction | 525 | ||
| Upper limb arthroplasty | 525 | ||
| Shoulder arthroplasty | 525 | ||
| Total elbow arthroplasty | 528 | ||
| The hand | 528 | ||
| Lower limb arthroplasty | 531 | ||
| Total hip replacement | 533 | ||
| The implant | 533 | ||
| Complications of hip replacement | 533 | ||
| The immediate postoperative period | 534 | ||
| Suggested rehabilitation protocol following total hip replacement | 534 | ||
| Day 1 | 535 | ||
| Day 2 | 535 | ||
| Day 3 onwards | 535 | ||
| After discharge | 535 | ||
| Rehabilitation following revision surgery | 535 | ||
| Total knee replacement | 535 | ||
| The implant | 536 | ||
| The operation | 536 | ||
| Suggested rehabilitation protocol following total knee replacement | 536 | ||
| Total ankle replacement | 537 | ||
| Suggested rehabilitation protocol following total ankle replacement | 537 | ||
| Further reading | 538 | ||
| References | 538 | ||
| 24 Physiotherapy management of Parkinson’s and of older people | 539 | ||
| Introduction | 539 | ||
| About ageing | 539 | ||
| About parkinson’s | 540 | ||
| Tremor | 540 | ||
| Rigidity | 541 | ||
| Akinesias | 541 | ||
| Postural instability | 541 | ||
| Diagnosis | 542 | ||
| Aetiology and epidemiology | 542 | ||
| Neuropathology | 542 | ||
| Classification | 542 | ||
| The International Classification of Functioning, Disability and Health | 543 | ||
| Assessment | 544 | ||
| Subjective assessment | 546 | ||
| Objective assessment | 546 | ||
| Drug history | 546 | ||
| Pain | 547 | ||
| Transfers | 548 | ||
| Posture (including range of joint movement) | 548 | ||
| Balance | 548 | ||
| Functional gait (including freezing, and indoor and outdoor mobility) | 549 | ||
| General mobility | 550 | ||
| Falls | 550 | ||
| Mental health | 551 | ||
| Intervention | 551 | ||
| Goals | 551 | ||
| Measuring outcome | 552 | ||
| Specific intervention for people with Parkinson’s | 552 | ||
| General intervention in the form of physical activity and exercise | 552 | ||
| Physical activity and exercise for falls | 554 | ||
| Principles of physiotherapy practice and Parkinson’s (Morris et al. 2010) | 554 | ||
| Conclusion | 556 | ||
| Acknowledgements | 557 | ||
| References | 557 | ||
| 25 Neurodynamics | 561 | ||
| Introduction | 561 | ||
| Mechanics of the peripheral nervous system | 561 | ||
| Pathophysiology of the nervous system | 561 | ||
| Extraneural dysfunction | 562 | ||
| Intraneural dysfunction | 562 | ||
| Mechano-sensitivity | 562 | ||
| Double and multiple crush syndrome | 563 | ||
| Assessment principles | 563 | ||
| Indications | 563 | ||
| Structural differentiation | 563 | ||
| Sensitising manoeuvres | 564 | ||
| Interpretation of findings | 565 | ||
| Normal neurogenic response | 565 | ||
| Abnormal neurogenic response | 565 | ||
| General tests | 566 | ||
| Passive neck flexion | 566 | ||
| Indications | 566 | ||
| Technique | 566 | ||
| Structural differentiation | 566 | ||
| Slump test | 567 | ||
| Indications | 567 | ||
| Technique | 567 | ||
| Sensitising manoeuvre | 567 | ||
| Lower limb neurodynamic tests (LLNTs) | 568 | ||
| Straight leg raise test (SLR) | 568 | ||
| 26 Neurological physiotherapy | 579 | ||
| Introduction | 579 | ||
| The fundamentals of CNS damage | 580 | ||
| Principal causes of neurological damage | 580 | ||
| Clinical features of damage to the CNS | 580 | ||
| Movement disorders | 580 | ||
| Ataxia | 580 | ||
| Dystonia (previously known as athetosis) | 580 | ||
| Chorea | 580 | ||
| Ballismus | 581 | ||
| Tremor | 581 | ||
| Bradykinesia | 581 | ||
| Impairments | 581 | ||
| Motor impairments | 581 | ||
| Sensory impairments | 581 | ||
| Visual impairments | 581 | ||
| Cognitive impairments | 581 | ||
| Behavioural changes | 582 | ||
| Perceptual disturbances | 582 | ||
| Auditory disturbances | 582 | ||
| Communication disturbances/swallowing | 582 | ||
| Fatigue | 582 | ||
| Bladder/bowel incontinence | 582 | ||
| Autonomic disturbances | 582 | ||
| Assessment of neurological patients | 582 | ||
| Why do we do assessments? | 582 | ||
| Subjective assessment | 583 | ||
| Objective assessment | 583 | ||
| International Classification of Functioning, Disability and Health | 583 | ||
| Outcome measures | 584 | ||
| Outcome measures in context | 584 | ||
| Goal-setting | 586 | ||
| List of problems and goals | 586 | ||
| Interventions | 586 | ||
| Task-specific practice | 586 | ||
| How the intervention might work | 587 | ||
| Evidence | 587 | ||
| Exercise | 587 | ||
| Treadmill training | 587 | ||
| Novel interventions | 588 | ||
| Constraint-induced movement therapy | 588 | ||
| Virtual reality | 588 | ||
| Robotics | 589 | ||
| Functional electrical stimulation (FES) | 589 | ||
| Neurological conditions | 590 | ||
| Stroke | 590 | ||
| Pathology | 591 | ||
| Ischaemic stroke | 591 | ||
| Haemorrhagic stroke | 591 | ||
| Subarachnoid haemorrhage | 591 | ||
| Clinical features | 591 | ||
| Management | 592 | ||
| Time | 592 | ||
| Medical management | 592 | ||
| Physiotherapy management | 592 | ||
| Multiple sclerosis | 592 | ||
| Introduction | 592 | ||
| Pathology | 593 | ||
| Acute stage | 593 | ||
| Later stages | 593 | ||
| Forms of multiple sclerosis and diagnosis | 593 | ||
| Clinical features | 594 | ||
| Vision | 594 | ||
| Sensation | 594 | ||
| Motor function | 594 | ||
| Swallowing | 594 | ||
| Bladder and bowel | 594 | ||
| Pain and fatigue | 594 | ||
| Cognition | 595 | ||
| Management | 595 | ||
| Medical management | 595 | ||
| Physiotherapy management | 595 | ||
| Motor neurone disease | 595 | ||
| Introduction | 595 | ||
| Clinical features and diagnosis | 596 | ||
| Forms of MND | 596 | ||
| Amyotrophic lateral sclerosis (ALS) | 596 | ||
| Progressive bulbar palsy | 596 | ||
| Progressive muscular atrophy | 596 | ||
| Primary lateral sclerosis | 596 | ||
| Diagnosis | 596 | ||
| Management | 596 | ||
| Medical management | 596 | ||
| Physiotherapy management | 597 | ||
| Terminal stage | 597 | ||
| Brain injury | 597 | ||
| Introduction | 597 | ||
| Pathology | 598 | ||
| Potential problems following TBI | 598 | ||
| Post-traumatic epilepsy | 598 | ||
| Post-traumatic hydrocephalus | 598 | ||
| Neuroendocrine and autonomic disorders | 598 | ||
| Cranial neuropathies | 598 | ||
| Gastrointestinal and nutritional needs | 598 | ||
| Orthopaedic and musculoskeletal complications | 599 | ||
| Continence | 599 | ||
| Sexual dysfunction | 599 | ||
| Motor function | 599 | ||
| Sensation | 599 | ||
| Cognition and behavioural impairments | 599 | ||
| Management | 599 | ||
| Medical management | 599 | ||
| Physiotherapy management | 599 | ||
| Early stages | 599 | ||
| Later stage – after months or years | 600 | ||
| Glossary | 600 | ||
| Acknowledgements | 600 | ||
| Further reading | 600 | ||
| General | 600 | ||
| Stroke | 601 | ||
| Head injury | 601 | ||
| References | 601 | ||
| 27 Physiotherapy in women’s health | 605 | ||
| Introduction | 605 | ||
| Anatomy and physiology | 605 | ||
| Bones and joints of the pelvis | 605 | ||
| Muscles | 606 | ||
| Organs of reproduction | 607 | ||
| The physiology of pregnancy | 607 | ||
| Musculoskeletal changes during pregnancy | 608 | ||
| Postural changes | 608 | ||
| Articular and connective tissue changes | 608 | ||
| Neuromuscular changes | 609 | ||
| Rectus abdominis | 609 | ||
| Lateral abdominal muscles | 609 | ||
| Pelvic floor muscles | 609 | ||
| Labour, birth and the puerperium | 609 | ||
| Labour | 609 | ||
| Stages of labour | 610 | ||
| First stage | 610 | ||
| Second stage | 610 | ||
| Observations | 610 | ||
| Pain relief | 610 | ||
| Perineal trauma | 611 | ||
| Episiotomy | 611 | ||
| Third stage of labour | 611 | ||
| Caesarean section | 611 | ||
| Assisted birth | 611 | ||
| Induction | 611 | ||
| Puerperium | 612 | ||
| Physiotherapy in the childbearing year | 612 | ||
| Pelvic floor dysfunction | 612 | ||
| Pregnancy-related lumbar spine and pelvic girdle pain | 612 | ||
| Symphysis pubis dysfunction | 613 | ||
| Diagnosis of PGP | 613 | ||
| Non-musculoskeletal causes of PGP | 613 | ||
| Management of lumbopelvic pain and dysfunction | 614 | ||
| Advice, posture, education and general exercise | 614 | ||
| Treatment of articular dysfunctions/movement restriction of the spine and pelvic girdle | 614 | ||
| Muscle re-education | 614 | ||
| Management of diastasis rectus abdominis | 615 | ||
| Pain management | 615 | ||
| Rib pain | 615 | ||
| Nerve compression syndromes | 615 | ||
| Exercise and pregnancy | 616 | ||
| General issues | 616 | ||
| Benefits and contraindications | 616 | ||
| Advice | 616 | ||
| Regular exercisers | 616 | ||
| Non-regular exercisers | 617 | ||
| When to stop | 617 | ||
| Types of exercise | 617 | ||
| General categories | 617 | ||
| Aquanatal classes | 617 | ||
| Antenatal classes | 617 | ||
| Postnatal physiotherapy | 618 | ||
| Postnatal groups | 618 | ||
| Urogenital dysfunction | 618 | ||
| Bladder dysfunction | 618 | ||
| Pelvic organ prolapse | 619 | ||
| Factors contributing to urogenital dysfunction | 619 | ||
| Physiotherapy | 619 | ||
| Pelvic floor muscle training | 619 | ||
| Teaching PFM exercises | 620 | ||
| Biofeedback | 620 | ||
| Electrical stimulation | 620 | ||
| Behavioural modification | 620 | ||
| Men | 620 | ||
| Anorectal dysfunction | 620 | ||
| Faecal incontinence | 620 | ||
| Sphincters | 620 | ||
| Index | 637 | ||
| A | 637 | ||
| B | 639 | ||
| C | 640 | ||
| D | 643 | ||
| E | 644 | ||
| F | 646 | ||
| G | 647 | ||
| H | 648 | ||
| I | 649 | ||
| J | 650 | ||
| K | 650 | ||
| L | 651 | ||
| M | 652 | ||
| N | 654 | ||
| O | 655 | ||
| P | 656 | ||
| Q | 660 | ||
| R | 660 | ||
| S | 662 | ||
| T | 665 | ||
| U | 667 | ||
| V | 667 | ||
| W | 667 | ||
| X | 668 | ||
| Y | 668 |