Q: My son, who is 22 years old, recently experienced an accident resulting in a fractured thigh bone. Could you please provide guidance on the appropriate physiotherapy for this fracture?
Thigh bone fractures, also known as femoral shaft fractures, frequently result from motor vehicle accidents or other traumatic events. It is crucial to recognize that inadequate treatment can lead to limb shortening and deformities.
In both inpatient and outpatient settings, a physiotherapist assesses the patient based on the condition, surgical procedure, and chronicity of the case. Radiographs, including X-rays and sometimes CT scans, are required for assessment.
Fractures typically take 3 to 6 months to heal properly, with additional time needed for patients with comorbidities. Physiotherapy begins in an inpatient setting, allowing the patient to bear weight as tolerated and guiding them to start walking when appropriate, using walkers or crutches.
The physiotherapy program focuses on addressing impairments following a femoral shaft fracture, such as weight-bearing status, knee effusion, quadriceps control, and hip abduction strength. It is designed to be dynamic, incorporating interventions to restore normal muscle strength, joint motion, and flexibility.
During hospitalization, a therapist teaches the patient how to use a walking aid based on their weight-bearing status, with gait training promoting increased bone formation. Even using 30-50% body weight support during gait training can lead to enhanced bone formation.

The treatment phases include:
Initial Phase (Week 0-2): Involves gentle passive and active movements, gait training with assistive devices, education on daily activities, and soft tissue mobilization.
Middle Phase (Week 2-6): Aims to strengthen quadriceps, hamstrings, and gluteal muscles, progressing exercises as deemed safe by the surgeon/physiotherapist.
Late Phase (Week 3-12): Focuses on gradually returning the patient to normal activities, including sport-specific drills, and includes hydrotherapy if the wound has healed. Develops exercises for continued strengthening, balance, flexibility, and endurance.
Physiotherapy should continue until an acceptable functional range is achieved or a static position is reached. Regular recording of knee movements is essential, and strengthening exercises typically begin around six weeks post-op. Balance and proprioceptive rehab are crucial, especially after the consolidation phase, to address muscle atrophy and endurance loss during the immobilization period.

Q: Doctor my father has difficulty in swallowing. Kindly guide if physical therapy can help.
Proper assessment is imperative to confirm the diagnosis and gain a comprehensive understanding of the patient's condition, indicating a potential case of dysphagia. Dysphagia, characterized by difficulties in swallowing liquids or solid foods due to disruptions in the swallowing mechanism from the mouth to the pharynx, carries the risk of severe complications such as aspiration pneumonia, dehydration, malnutrition, and even death resulting from choking. The origins of dysphagia can be traced to structural or functional issues, impacting any of the four stages of the swallowing process and affecting swallowing physiology.
Problems in the oral stage of swallowing may manifest as food drooling, dehydration, a sensation of food trapped in the oral cavity, and difficulties in chewing and mastication. Dysfunction in the pharyngeal stage can lead to impaired swallowing initiation, a feeling of bolus retention in the pharynx, nasal regurgitation, and aspiration due to insufficient upper esophageal sphincter (UES) opening. While esophageal dysfunction is often asymptomatic, dysphagia in this stage may result in a perception of food retention in the esophagus, potentially leading to food aspiration.
Rehabilitative exercises play a pivotal role in modifying and enhancing swallowing physiology, focusing on force, speed, or timing. The overarching goal is to produce a long-term impact compared to short-term compensatory interventions. These exercises also entail the retraining of neuromuscular systems to induce neuroplasticity. Consistent and intense muscular engagement can bring about changes in neural innervation and movement patterns.
Rehabilitation exercises are broadly categorized into swallowing exercises and non-swallowing exercises, encompassing various maneuvers. These interventions aim to address the root causes of dysphagia and foster lasting improvements in the patient's ability to swallow effectively.