Shoulder Wheel

       The patient is made to stand near the wheel with the affected side holding the handle of the wheel. The hand of the patient may be supported by the normal hand of the patient himself, the zean or poplin glove is worn by the patient in the affected hand which is later on tied to it with buckles firmly so that when the patient is moving the shoulder wheel the hand does not slip at all. After sometime say about 10 revolutions of the wheel, the patient takes some rest and continues the same again with regular periods of rests in between.

Sanding : It is of the following types :

(A) Vertical Sanding : The standing apparatus is fixed in the wall. The sliding block is made to slide up and down. The patient holds the sliding block with his hands and moves it up and down in a vertical manner, for sometime till he feels tired. He is made to take some rest and continues the same.

(B) Inclined Sanding : The patient stands on front of the inclined sanding apparatus and holds the handle of the box with weights which is tied to a weight on the other side of the apparatus with a cord passing over a pulley. This is move up and down stabilizing both the shoulders of the patient from the back.

(C) Horizontal Sanding : The horizontal sanding board lies in the front of the patient and the block is held in the hand of the patient with a glove or the therapist holds the hand of the patient over the sanding block. These blocks are fitted with the sandpapers.

(D) Overhead Sanding : This apparatus is fixed on the ceiling and is having the semicircular sliding frame, which can be raised or lowered according to the height of the patient. The patient stands in the center of the arc, holding the sanding block in the hands and moving it overhead against the arc.
           This should be introduced in the final stages of the treatment.

Cold Therapy : This is the treatment given through ice on the spastic limb.
 
          The application of ice is very helpful in relieving spasticity as stated by Miss Rood. The use of ice lowers or depresses the nerve condition along the affected nerves. The reaction to cold appear to be longer lasting than the reaction to heat, however, so the optimum environment for reducing spasticity or spasm is good, but not excessive, general body heat, with localized cooling on the individual muscle. Both the small interior horn cells and the alpha motor cells in the spinal cord are bombarded by impulses with connections from all over the body, so the impulses coming from the exteroceptive stimulus of cold on the skin does affect the deep tissues.

         Effect on the nerve connection is so that the rate of conduction of impulses is slower and the size of the action potential reduced at a temperature 10°C. The sensitivity of cold receptors means that a cooling of 1°C raises the impulse frequently by 30 impulses / sec.

        Effect on muscle strength : Cold lowers the production of metabolites in a contracting muscle and reduces the O² requirements of that muscle. The short, brick applications of cold will alternate muscle contractions and that long, very cold application will diminish muscle activity. So application of cold for short time increases the work output of contractile force.

        Effect on Circulation : The surface vessels contract because of the way cold affects the vasoconstrictor sympathetic nerves. It is observed that vasodilation results in the deep vessels, bringing an increase of blood supply to the deep tissues. A successful treatment produces a pink flush, which, if not present, indicates that the treatment has not been effective.
         To obtain the deepest effects of cold, the application of ice toweling must completely envelope the part with the toweling may be less than 6" in width or part must be immersed in ice water. It is found that many of the characteristics of the deep effects are produced by shorter application of ice towels of ice cube massage.
           When the following requirements are needed, the long application is given :

I.       When it is necessary to reduce muscle spasm, spasticity, or habitual trick pattern of movements so often developed during the long physical disability, by depressing the activity of the nervous system.
II.      To enable muscle to contract for a longer duration because of the fewer metabolites produced and the reduced O² consumption, but the temperature of application in the region of 12° - 13°C
III.    To produce a deep vasodilation which improves the circulation
                 Although there is some doubt as to exact circulatory changes, cold application to reduce oedema and are particularly useful in recent injuries to reduce swelling and pain after 48 hrs. Of injury. It may also lead to increased joint movement such as with a frozen shoulder or other joints, which respond to improved circulation together with a relief from pain.
IV.  Cold applications at 0°C acts as an analgesic and counter irritant. A brief application of an ice cube stroked briskly on the skin whose dermatonic had the same nerve supply as the muscle requiring stimulation acts as a facilitation to the muscle contraction.

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