The physiotherapy department sees a large variety of musculoskeletal (orthopedic) conditions in IPD as well as OPD. The rehabilitation process incorporates assessment, goal setting, treatment, education as well as preventive aspect. Some of the common musculoskeletal conditions seen are:

• Neck & back pain, including post operative cases
• Degenerative conditions
• Complex hand & foot injuries / crush injuries
• Shoulder - cuff tears, bankarts repair, adhesive capsulitis, painful shoulder.
• Joint replacement & ligament injuries
• Trauma and acute post operative care

Treatment Techniques:

• Mechanical Diagnosis and Therapy (MDT)/ McKenzie method: Each patient is evaluated thoroughly using the MDT assessment forms and classified into one of the syndromes namely derangement, dysfunction, posture or other (if they don’t fit into any syndrome). Treatment is then provided as per the classification; which includes an active exercise component & an education component emphasizing posture awareness & prophylaxis.

Other treatment methods.

• Kinetic control & movement therapy
• Mulligan & Maitland mobilization
• Taping & muscle activation
• Soft tissue mobilization.
• Strengthening by weight cuffs, ARKE, Kinesis &Theraband.
• Electrotherapy used as an adjunct.

Cardiac Rehabilitation is provided by cardio respiratory therapists to enhance and maintain cardiovascular health. This Cardiac Rehabilitation program includes exercise testing, education on heart healthy living and counseling to reduce stress and help the patient to return to an active life. Cardiac Rehabilitation is indicated in post bypass surgery, angioplasty, myocardial infarction, valve replacement surgery and peripheral vascular diseases.

Cardiac Rehabilitation is a customized exercise program based on functional testing which includes the following stages -:

PHASE I - In-patient Rehab -This starts immediately when the patient is admitted in the hospital for the surgery.

PHASE II - Out-patient Rehab - Post suture removal and after discharge from hospital.

PHASE III - Out -patient Rehab- Custom made for the patient to attain previous level of fitness.

Equipments used for Cardiac Rehabilitation at Lilavati Hospital include high end medical equipments like Run excite med (Treadmill), bike excite med (cycle) and cross trainer. It is a supervised exercise program using telemetry ECG System and polar heart belt for monitoring vital parameters ensuring patient safety.

Pulmonary rehabilitation at Lilavati is a program incorporating exercise, education and support to help pulmonary patients breathe better and function at the highest level possible. The patient works with a team of specialists who help in improving the overall physical condition. This program is beneficial for patients suffering from COPD, bronchiectasis, asthma, interstitial lung diseases, sarcoidosis and post lung surgeries.

Pulmonary Rehabilitation Program incorporates:

• Detailed patient assessment
• Custom made exercise program which includes
  • Breathing exercises, chest clearance techniques (using postural drainage bed, nebulization ,vibrator) in an isolated room. Assistive devices like spirometer, acapella, flutter, ezypap may be a used as and when necessary.
  • Conditioning, strength training and functional training.
  • Patient education sessions are conducted by cardiac and pulmonary rehabilitation specialists on a monthly basis. These sessions cover topics like breathing retraining, lifestyle modification, etc. and encourage patients to share their experiences.

Our Neurosciences specialized team offers supervised programs designed for people with neurological disorders in the Intensive Care Unit, In Patient Stroke Rehabilitation Unit and Outpatient Neurorehabilitation department in order to achieve the following goals:-

• Maximize functional independence in transfers and activities of daily living and thus improve quality of life.
• Improve voluntary control, strength, balance, co-ordination and gait.

This program caters to people with neurological problems like stroke, Parkinson’s disease, Multiple sclerosis, Traumatic brain injury, Spinal cord injury, nerve palsy, polyneuropathy and other imbalance and co-ordination issues.

Treatment plan includes:-

• Bobath, Neurodevelopmental therapy, Proprioceptive neuromuscular facilitation and Sensory integration
• Motor control and postural control training
• Balance and co ordination training using balance master, swiss ball, wobble board, balance beam & foam.
• Gait training using partial body support treadmill system
• Hand rehabilitation exercises using various functional training equipments and peg boards.
• Mirror therapy using mirror box.
• Constrained induced movement therapy
• Tilt table standing .
• Skifit for upper and lower limb work out
• Arke and Kinesis for core training and strengthening

Our Pediatric physiotherapists work with children with special needs and help them achieve age appropriate milestones and maximal functional independence with the following goals:

• Help facilitate & guide movement aiming towards correct posture & movement pattern
• Improve strength, flexibility, balance & co-ordination
• Provide opportunities of sensory experiences in a controlled fashion in order to enhance motor behaviour, social interaction & active participation.
• In the NICU, help in maintaining state regulation, range of motion and Oro-motor stimulation

Target population:

• Developmental Delays
• Cerebral Palsy
• Downs Syndrome
• Muscular Dystrophies
• Autism Spectrum Disorder
• ADHD
• Erb’s palsy
• Post orthopedic surgeries and Botox

Treatment plan includes a range of approaches like Bobath, Neurodevelopmental facilitation, Sensory integration, Early Intervention and postural control training with use of appropriate orthotics and walking aids. We work in partnership with parents and other health care professionals like Neurologists, Pediatricians, Orthopedic consultant, Speech therapist and Orthotist to ensure that the best care is given to children requiring Neuro and ortho rehabilitation.

Vestibular Rehabilitation is an exercise based program for reducing symptoms of disequilibrium and dizziness associated with vestibular pathology with the following Goals:

• To reduce dizziness & visual symptoms
• To improve balance and gait
• To improve general activity levels

It caters to patients with:

• BPPV (Being paroxysmal positional vertigo)
• Vestibular hypofunction
• Meniere’s disease
• Labyrinthitis
• Functional training
• Vestibular neuritis

Vestibular Rehabilitation include Barndfdaroff exercise, Epley’s maneuvers and Semontmaneuvers along with Gaze stability exercises, balance and gait training and counseling to increase confidence levels.

With increased age patients often face many physical changes that can affect level of function and well being. The primary purpose of rehabilitation is to enable people to function at the highest possible levels despite physical impairments.

This program caters to the elderly population who have problems like multi joint pain, frequent falls, osteoporosis, imbalance &mobility issues, arthritis, incontinence etc.

Goals of management include

• Improving strength and endurance, flexibility, balance and coordination
• Promoting functional independence and improving quality of life
• Reducing the number of falls
• Decreasing pain

Treatment plan includes:

• Sarah Meek’s protocol for Osteoporosis
• Strength training using theraband station and weight cuffs.
• Balance training with balance master
• Gait training
• Aerobic exercise program including treadmill and elliptical

Physiotherapy is provided for cancer patients to reduce the complications arising due to its medical and surgical treatment, thus promoting an increase in the level of activity thereby improving the quality of life.

Lymphedema post breast surgery is managed in the physiotherapy department in the following manner:

• Manual lymphatic drainage and nodal stimulation
• Soft tissue and scar mobilization.
• Range of movement, stretching and strengthening
• Posture re-education
• Pressure garments.

• Ozone therapy is used to enhance wound healing & is provided for In Patients &Out Patients.
• The treatment time depends upon the size of the wound.
• On completion of treatment, wound dressing is done.
• Aseptic precautions are followed at every stage of the treatment.

Although most patients understand the importance of physical activity and healthy eating, many seem unable to change their unhealthy behavior to reduce weight and improve chronic conditions like abnormal lipids (cholesterol or triglycerides), High blood pressure, Diabetes etc. These chronic conditions & sedentary lifestyle increase the risk for heart attack, stroke and peripheral artery disease. Lifestyle changes with Fitness program have shown to significantly reduce morbidity and mortality rates.

Components of fitness program In Lilavati hospital include:

• Assessment of functional capacity.
• Exercises tailored to patients’ abilities and interests.
• Fitness training on treadmill, sci- fit and elliptical under continuous monitoring and supervision by the therapist.
• Strength training using ARKE, theraband, pilates, kinesis.
• Education and counseling regarding lifestyle changes to lower the risk of heart/medical problems.

Pelvic floor exercises (Keigel’s exercises) and/ or electrical stimulation are used to strengthen the pelvic floor muscles.

Infrared radiation therapy is given post normal deliveries and vaginal hysterectomy for suture healing and pain relief.

COVID-19 is an infectious viral disease which mainly attacks the lung and is transmitted through the droplets produced when an infected person coughs ,sneezes or exhales.

Symptoms :

Patients are classified into : Asymptomatic and Symptomatic

Recovering from Covid-19 will be slow and the ability to return to everyday tasks will be gradual.

Rehabilitation improves health outcomes of covid-19 patients and benefits through :

• Optimizing health and functioning outcomes of elderly and patients with pre-existing health conditions who may be more vulnerable to the effects of severe illness.Rehabilitation can be beneficial for achieving and maintaining their previous level of independence.
• Facilitating an early discharge.
• Reducing the risk of hospital readmissions.
• Improving overall psychological wellbeing.
• Improving the quality of life.

At LHRC physiotherapists have been at the forefront in providing the rehabilitation services to covid-19 affected patients since the beginning of the pandemic.

We provide the rehabilitation services in all the 3 phases of recovery :

• Acute-ICU : Chest physiotherapy, Postural drainage positioning, Breathing techniques, Bed mobility.
• Subacute-Wards : Breathing retraining, Coping techniques, Relaxation techniques, Graded mobilization.
• Long term-Return to home :
  • Managing breathlessness : Breathing control, Positions to relieve breathlessness, Relaxation techniques, Coping techniques.
  • Airway clearance techniques : Postural drainage positions, Coughing and huffing techniques.
    Breathing techniques to clear airways and use of breathing instruments.
  • Energy conservation techniques : Positioning, Planning, Pacing, Prioritizing.
  • Functional training : Managing activities of daily living, Goal oriented activities, Return to your hobbies/related activities
  • Aerobic training : Monitored exercise regime will be prescribed to improve cardio respiratory endurance/overall fitness.
  • Strength training : Upper and lower body major muscle group strengthening exercises.

Timely reassessment and progression of exercises will be done by the cardio respiratory physiotherapists.

Covid-19 affected patients may experience remnant symptoms post discharge as well.Rehabilitation with trained physical therapists will aid them to regain their functional independence. So along with OPD services,we at LHRC are also available for VIDEO-BASED rehabilitation for all covid-19 affected patients.