Ankle sprains are the most common injury in lower limb, comprising sports that require

running or jumping, such as football, basketball, badminton, soccer, and gymnastics.

the lateral ligament is the most frequently injured.
sprains occur when the foot lands in a plantar-flexed and inverted position.
One or more of the lateral ligament’s three parts may be stretched or torn.
the lateral ligament complex, consisting of the anterior talofibular, calcaneofibular, and
posterior talofibular ligaments.
grade I : mild sprain, the anterior talofibular, negative ankle drawer and talar tilt test.
grade II: disruption of the anterior talofibular + sprain of the calcaneofibular, positive ankle
drawer and a negative talar tilt test.
grade III: disruption of the lateral ligament complex, both positive ankle drawer and talar tilt
tests.
Treatment
- ice application
- compressive wrapping of the ankle
- elevation
- early mobilization
- bracing
- balance and proprioceptive training
- dynamic strengthening
With a functional rehabilitation program, the patient can return to full activity within a few days
to weeks.

ACL INJURY
Usually occurs during pivot motion when the knee is placed in positions the knee in flexion and
internal tibiofemoral rotation, such as landing from a jump, sharp cutting, or decelerating.
Pop sign.
The dynamic knee instability is caused by three factors: ligament dominance, quadriceps
dominance, and leg dominance.
Lachmann Test (knee flexed 20 dgrees, gold standar test)
Anterior drawer test (kne flexed 90 degrees)
Give them excessive translation by pulling the tibia proximal to the anterior.

STROKE
A stroke is the sudden occurrence of permanent damage to an area of the brain caused by a
blocked blood vessel or bleeding within the brain.

Strokes can be divided into two major categories:

- ischemic, caused by a vascular occlusion.
- hemorrhagic, caused by bleeding within the parenchyma of the brain

The most common symptom of stroke is

-focal weakness
- sensory loss,
- speech and language disturbance.
The resultant neurological deficits are generally referred to as impairments, which may or may
not result in functional limitations often characterized as disability.

RISK FACTOR -> book

Rehabilitation during the Acute Phase

In Stroke patients have risk for developing pressure ulcers. maintenance of proper position with
frequent turning.
high risk for development of contractures due to immobility. regular passive stretching and
moving the joints through a full range of motion, preferably at least twice daily.
High risk for deep venous thrombosis -> Early mobilization, may be started passively but that
quickly progress to active participation by the patient, like turning from side to side in bed and
changing position, sitting up in bed, sitting up in bed, transferring to a wheelchair, standing, and
walking. includes self-care activities such as self-feed- ing, grooming, and dressing
The timing and progression in these activities depend on the patient’s condition, activities
should begin as soon as possible (generally within 24 to 48 hours of admission) unless the
stroke survivor is unresponsive or medically/neurologically unstable.
criteria for admission into such a subacute rehabilitation

RECOVERY FROM STROKE

rehabilitation focused compensatory techniques, such as ambulating with a cane and AFO, or
the use of one-handed dressing techniques.
the goal of rehabilitation should be to maximize neurologic recovery and then teach
compensatory approaches to address whatever residual deficits exist.
Transient Ischemic Attacks
Transient ischemic attacks (TIAs) have historically been defined as a strokelike event that completely resolves
within 24 hours.
associated with complete resolution of symptoms.
In the first month after onset of TIAs, 4% to 8% of patients will develop a completed stroke,
and 30% in the next 5 years (23,24).
Generally, stroke prevention in patients with TIAs includes the use of an antiplatelet drug, such as aspirin

Spasticity is a component of the upper motor neuron syndrome (UMNS), which is caused by a lesion proximal to the
anterior horn cell; in the spinal cord, brainstem, or brain.

The main difference between spasticity and rigidity is that 

spasticity often affects antagonistic muscle groups, damage to the cortico-

reticulospinal or pyramidal tracts, characterized by a sudden increase in muscle

tone, occurring at a threshold velocity, angle, or amplitude

whereas rigidity occurs in both flexors and extensor muscles. dysfunction of

extrapyramidal tracts and lesions in the spinal cord and mesencephalon.

characterized by a high muscle tone that remains throughout the range of

movement of the joint.

An innovative interdisciplinary scientific field, focuses on new approaches to repairing and

replacing cells, tissues, and organs and may involve the use of gene therapy.
Rehabilitation medicine protocols deliver clinically relevant biophysical stimuli, include
functional loading and other types of mechanical stimulation -> most promising clinical and pre-
clinical advances such as in the nerve regrowth, muscle regeneration, cartilage repair and bone
healing.

Regenerative Rehabilitation is the integration of principles and approaches from rehabilitation

and regenerative medicine with the ultimate goal of developing innovative and effective
methods that promote the restoration of function through tissue regeneration and repair
BELL’S PALSY
Bell’s palsy is an Idiopathic peripheral nerve injury to the facial nerve (cranial nerve VII), which controls
movement of facial muscles. The condition is usually temporary and typically affects only one side of the face.

It results in inability or reduced ability, to move the  muscles on the affected

side of the face
The facial nerve is damaged by inflammation -> nerve become enlarged, at the point where the
nerve exits the skull through the stylomastoid foramen. -> blocking neural blood supply ->
Ischemia.
majority of cases it is likely to be linked to Herpes Simplex infection

Carpal tunnel syndrome is the most common entrapment nerve in the upper extremity, as the result of compression
on the median nerve as it passes within the carpal tunnel. The tunnel is formed by the transverse carpal ligament
superficially and the bony floor of the carpal bones deep.

Repetitive hand and wrist movement, diabetes, hypothyroidism, RA, obesity, and pregnancy are predisposing factors

Symptoms pain and paresthesias over the first four fingers, which worsens at night or when driving or holding objects, and
improves after flicking the hands. Weakness or atrophy of the thenar eminence muscles can be seen.

Both the Tinel sign and Phalen sign are sensitive tests

Treatment includes activity modifications, the wrist resting splinted in 0–5 degrees of extension, oral NSAIDs, local
corticosteroid injections, and surgical decompression.

Erb’s Palsy

The mechanism of injury is traction to the brachial plexus. Most frequent is a neuropraxic injury.

Risk factors include primiparous mothers, prolonged labor, birthweight more than 8.5 lb, shoul- der dystocia
(present in >50%), traumatic delivery with mid to high forceps, and breech presentation.

Erb’s palsy involving the upper plexus (C5-7) accounts for about 80% of injuries. Klumpke’s palsy involving the
lower plexus (C7, C8, T1) exclusively is now felt to be quite rare, with total plexus injuries accounting for 15%

Erb’s palsies pres- ent with the typical “waiter’s tip” posture of shoulder internal rotation and adduction, elbow
extension and pronation, wrist flexion and thumb in palm (due to loss of extensor pollicis)

Klumpke’s posture is the reverse, with shoulder external rotation (abduction usually not seen due to grav- ity),
elbow flexion and supination, wrist extension, and the intrinsic minus hand deformity due to loss of C8, T1 muscles