python3 << 'EOF' from pptx import Presentation from pptx.util import Emu prs = Presentation("/tmp/workspace/attachments/2d80939b-efe3-4620-83c1-0c995d091949/Physiotherapy Management in the Disorders of Peripheral Nerves-1.pptx") print(f"Total slides: {len(prs.slides)}") print(f"Slide width: {prs.slide_width.inches:.2f} inches") print(f"Slide height: {prs.slide_height.inches:.2f} inches") print() for i, slide in enumerate(prs.slides, 1): print(f"--- Slide {i} (layout: {slide.slide_layout.name}) ---") for shape in slide.shapes: pos = (round(Emu(shape.left).inches, 2), round(Emu(shape.top).inches, 2)) if shape.left is not None else None size = (round(Emu(shape.width).inches, 2), round(Emu(shape.height).inches, 2)) if shape.width is not None else None print(f" Shape: {shape.name}, type: {shape.shape_type}, pos: {pos}, size: {size}") if shape.has_text_frame and shape.text_frame.text.strip(): for para in shape.text_frame.paragraphs: if para.text.strip(): # Get font info from first run font_size = None font_bold = None font_color = None if para.runs: r = para.runs[0] font_size = r.font.size.pt if r.font.size else None font_bold = r.font.bold if r.font.color and r.font.color.type: try: font_color = str(r.font.color.rgb) except: font_color = None print(f" [{font_size}pt bold={font_bold} color={font_color}] {para.text[:100]}") EOF

python /tmp/skills/pptx/scripts/office/unpack.py "/tmp/workspace/attachments/2d80939b-efe3-4620-83c1-0c995d091949/Physiotherapy Management in the Disorders of Peripheral Nerves-1.pptx" /tmp/workspace/pn-pptx/unpacked/

ls /tmp/workspace/pn-pptx/unpacked/ppt/slides/ | head -40

python3 << 'PYEOF' # Add new slides to the existing presentation matching the existing style exactly from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN import copy src = "/tmp/workspace/attachments/2d80939b-efe3-4620-83c1-0c995d091949/Physiotherapy Management in the Disorders of Peripheral Nerves-1.pptx" dst = "/tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx" prs = Presentation(src) # ── helper: read layout names ───────────────────────────────────────────────── for i, lay in enumerate(prs.slide_layouts): print(i, lay.name) PYEOF

python3 << 'PYEOF' from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN import copy src = "/tmp/workspace/attachments/2d80939b-efe3-4620-83c1-0c995d091949/Physiotherapy Management in the Disorders of Peripheral Nerves-1.pptx" dst = "/tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx" prs = Presentation(src) # Layout indices LAY_TITLE_CONTENT = 1 # "Title and Content" LAY_SECTION = 2 # "Section Header" LAY_TWO_CONTENT = 3 # "Two Content" LAY_TITLE_ONLY = 5 # "Title Only" def add_slide(prs, layout_idx): layout = prs.slide_layouts[layout_idx] slide = prs.slides.add_slide(layout) return slide def set_title(slide, text, bold=True, size=24): tf = slide.shapes.title.text_frame tf.clear() p = tf.paragraphs[0] run = p.add_run() run.text = text run.font.bold = bold run.font.size = Pt(size) def fill_content(slide, bullets, placeholder_idx=1, title_run_size=18, bullet_size=16): """Fill content placeholder. bullets = list of (text, bold, level)""" ph = slide.placeholders[placeholder_idx] tf = ph.text_frame tf.clear() first = True for (text, bold, level) in bullets: if first: p = tf.paragraphs[0] first = False else: p = tf.add_paragraph() p.level = level run = p.add_run() run.text = text run.font.bold = bold run.font.size = Pt(title_run_size if (bold and level == 0) else bullet_size) # ──────────────────────────────────────────────────────────────────────────────── # SECTION DIVIDER — Ulnar Nerve Injury # ──────────────────────────────────────────────────────────────────────────────── s = add_slide(prs, LAY_SECTION) # Section header layout has title and text placeholders for ph in s.placeholders: print(ph.placeholder_format.idx, ph.name) PYEOF

python3 << 'PYEOF' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor src = "/tmp/workspace/attachments/2d80939b-efe3-4620-83c1-0c995d091949/Physiotherapy Management in the Disorders of Peripheral Nerves-1.pptx" dst = "/tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx" prs = Presentation(src) def set_ph_text(slide, ph_idx, lines): """lines = list of (text, bold, level, size)""" ph = slide.placeholders[ph_idx] tf = ph.text_frame tf.word_wrap = True tf.clear() first = True for (text, bold, level, size) in lines: if first: p = tf.paragraphs[0]; first = False else: p = tf.add_paragraph() p.level = level run = p.add_run() run.text = text run.font.bold = bold if size: run.font.size = Pt(size) # ── Slide 27: SECTION DIVIDER — Ulnar Nerve Injury ─────────────────────────── s27 = prs.slides.add_slide(prs.slide_layouts[2]) # Section Header set_ph_text(s27, 0, [("Ulnar Nerve Injury", True, 0, 32)]) set_ph_text(s27, 1, [("Physiotherapy Management", False, 0, 18)]) # ── Slide 28: Anatomy & Clinical Features ───────────────────────────────────── s28 = prs.slides.add_slide(prs.slide_layouts[1]) # Title and Content set_ph_text(s28, 0, [("Ulnar Nerve — Anatomy & Clinical Features", True, 0, 24)]) set_ph_text(s28, 1, [ ("Anatomy & Course", True, 0, 18), ("Largest unprotected nerve; C8–T1 roots; medial cord of brachial plexus", False, 1, 16), ("Courses posterior to medial epicondyle through cubital tunnel (elbow)", False, 1, 16), ("Enters hand via Guyon's canal (wrist) — between pisiform & hook of hamate", False, 1, 16), ("Innervates: flexor carpi ulnaris, medial half FDP, all intrinsic hand muscles (except LOAF), hypothenar muscles", False, 1, 15), ("Clinical Deformities", True, 0, 18), ("Claw hand (Ring & Little fingers) — intrinsic minus posture; MCP hyperextension, IP flexion", False, 1, 16), ("Froment's sign — thumb IP flexion on pinch (FPL compensates for adductor pollicis weakness)", False, 1, 16), ("Wartenberg's sign — little finger abduction at rest (palmar interosseous weakness)", False, 1, 16), ("Sensory loss: little finger, ulnar half ring finger, ulnar palm, dorsum of hand", False, 1, 16), ]) # ── Slide 29: Splinting & Protection (Ulnar) ────────────────────────────────── s29 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s29, 0, [("Ulnar Nerve Injury — Splinting & Protection", True, 0, 24)]) set_ph_text(s29, 1, [ ("Lumbrical Bar Splint (Anti-Claw Splint)", True, 0, 18), ("Blocks MCP hyperextension in ring & little fingers — corrects intrinsic minus posture", False, 1, 16), ("Enables IP extension via extrinsic extensors — improves grip and finger function", False, 1, 16), ("Worn during functional activities; reviewed as reinnervation progresses", False, 1, 16), ("Elbow Splint (Cubital Tunnel)", True, 0, 18), ("Extension splint at night — maintains elbow <30° flexion", False, 1, 16), ("Prevents sustained flexion which increases ulnar nerve tension by up to 55%", False, 1, 16), ("Elbow pad/foam sleeve — protects medial epicondyle from direct pressure during day", False, 1, 16), ("Wrist Splint (Guyon's Canal Entrapment)", True, 0, 18), ("Neutral wrist splint — reduces compression at Guyon's canal for occupational ulnar nerve entrapment", False, 1, 16), ("Avoid: tight gripping tools, prolonged leaning on elbow, cycling (handlebar palsy)", False, 1, 16), ]) # ── Slide 30: Exercise Therapy (Ulnar) ──────────────────────────────────────── s30 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s30, 0, [("Ulnar Nerve Injury — Exercise & Nerve Mobilization", True, 0, 24)]) set_ph_text(s30, 1, [ ("PROM — Acute/Denervation Phase", True, 0, 18), ("Daily passive ROM: MCP, PIP, DIP of ring & little fingers; wrist flexion/extension", False, 1, 16), ("Web space stretching: prevent 4th–5th web space contracture", False, 1, 16), ("Hypothenar stretch: prevent flexion contracture of little finger", False, 1, 16), ("Ulnar Nerve Gliding Exercises", True, 0, 18), ("Sequential positions: fist → finger extension → wrist extension → supination → elbow extension", False, 1, 16), ("Slider: mobilizes nerve without tension (preferred in acute phase)", False, 1, 16), ("Tensioner: applied once pain/irritability subsides to restore neural mobility", False, 1, 16), ("Progressive Strengthening (Reinnervation Phase)", True, 0, 18), ("Finger abduction/adduction (interossei): paper-grip exercises, rubber band abduction", False, 1, 16), ("Hypothenar strengthening: little finger opposition to ring, middle, index fingers progressively", False, 1, 16), ("Pinch & grip training: lateral pinch, power grip — progressive loading using therapy putty", False, 1, 16), ("Intrinsic strengthening: MCP flexion with IP extension (lumbrical pattern) using resistance", False, 1, 16), ]) # ── Slide 31: Electrotherapy & Sensory (Ulnar) ──────────────────────────────── s31 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s31, 0, [("Ulnar Nerve Injury — Electrotherapy & Sensory Re-education", True, 0, 24)]) set_ph_text(s31, 1, [ ("Electrotherapy Modalities", True, 0, 18), ("NMES: Applied to hypothenar muscles, interossei, FDP (ulnar half) — retard denervation atrophy", False, 1, 16), ("TENS: Medial epicondyle / Guyon's canal — pain modulation", False, 1, 16), ("Ultrasound (pulsed): Over cubital tunnel / Guyon's canal — reduce perineural fibrosis", False, 1, 16), ("LLLT: May accelerate axonal regeneration — apply over nerve trunk", False, 1, 16), ("Sensory Re-education", True, 0, 18), ("Target areas: little finger, ulnar half of ring finger, ulnar palm, dorsal hand (ulnar)", False, 1, 16), ("Early phase: moving touch discrimination, vibration (256 Hz tuning fork), localization", False, 1, 16), ("Late phase: object identification (stereognosis) — coins, shapes; textured fabrics", False, 1, 16), ("Mirror therapy: helpful in chronic cases for cortical remapping", False, 1, 16), ("Desensitization: if hyperesthesia over medial epicondyle scar post-surgery", False, 1, 16), ]) # ── Slide 32: Functional Training & Post-Surgical (Ulnar) ───────────────────── s32 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s32, 0, [("Ulnar Nerve — Functional Retraining & Post-Surgical Rehab", True, 0, 24)]) set_ph_text(s32, 1, [ ("Functional Retraining", True, 0, 18), ("Grip & dexterity tasks: jar opening, coin manipulation, pinch-grip activities", False, 1, 16), ("Writing & keyboard use: adaptive pen grips; compensatory strategies during denervation", False, 1, 16), ("ADL retraining: dressing (buttons, zips), grooming, kitchen tasks — occupational therapy integration", False, 1, 16), ("Post-Surgical Rehabilitation (Ulnar Nerve Transposition / Cubital Tunnel Release)", True, 0, 18), ("Immobilization: posterior splint elbow 90° for 1–2 weeks post-op", False, 1, 16), ("Week 2–4: gentle AROM elbow & wrist; wound care, oedema management", False, 1, 16), ("Week 4–8: Progressive strengthening, nerve gliding, scar massage over incision", False, 1, 16), ("Week 8+: Functional retraining, return-to-work program, ergonomic assessment", False, 1, 16), ("Tendon Transfer Rehab (e.g., Brand's transfer for claw correction)", True, 0, 18), ("Immobilization 3–4 weeks; progressive re-education of transferred tendon function", False, 1, 16), ("Graded retraining: motor learning of new muscle function (biofeedback, EMG-assisted)", False, 1, 16), ("Outcome measure: DASH score, grip dynamometry, Semmes-Weinstein monofilaments", False, 1, 16), ]) # ── Slide 33: SECTION DIVIDER — GBS Elaborated ──────────────────────────────── s33 = prs.slides.add_slide(prs.slide_layouts[2]) set_ph_text(s33, 0, [("Guillain-Barré Syndrome (GBS)", True, 0, 30)]) set_ph_text(s33, 1, [("Elaborated Physiotherapy Management — Across All Phases", False, 0, 18)]) # ── Slide 34: GBS Overview & Subtypes ───────────────────────────────────────── s34 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s34, 0, [("GBS — Overview, Subtypes & Clinical Course", True, 0, 24)]) set_ph_text(s34, 1, [ ("Definition", True, 0, 18), ("Acute immune-mediated polyradiculoneuropathy; most common cause of acute flaccid paralysis", False, 1, 16), ("Typically follows viral/bacterial infection (Campylobacter jejuni, CMV, EBV, COVID-19)", False, 1, 16), ("Subtypes", True, 0, 18), ("AIDP (Acute Inflammatory Demyelinating Polyneuropathy): Most common; demyelination", False, 1, 16), ("AMAN (Acute Motor Axonal Neuropathy): Motor axons attacked; faster motor recovery or worse prognosis", False, 1, 16), ("AMSAN (Acute Motor Sensory Axonal Neuropathy): Both motor and sensory axons", False, 1, 16), ("MFS (Miller Fisher Syndrome): Ophthalmoplegia, ataxia, areflexia; anti-GQ1b antibodies", False, 1, 16), ("Clinical Course", True, 0, 18), ("Phase 1 — Progression (days to 4 wks): ascending weakness, nadir", False, 1, 16), ("Phase 2 — Plateau (days to weeks): stable, requires intensive supportive care", False, 1, 16), ("Phase 3 — Recovery (weeks to months/years): slow improvement; residual deficits in ~20%", False, 1, 16), ("20-30-40 Rule: FVC <20 mL/kg, MIP <30 cmH2O, MEP <40 cmH2O → ICU transfer", False, 1, 16), ]) # ── Slide 35: GBS Acute/ICU Phase ───────────────────────────────────────────── s35 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s35, 0, [("GBS — Acute / ICU Phase Physiotherapy", True, 0, 24)]) set_ph_text(s35, 1, [ ("Respiratory Physiotherapy (PRIORITY)", True, 0, 18), ("Continuous monitoring: FVC every 4–6 hrs; SpO2 pulse oximetry; inspiratory/expiratory pressures", False, 1, 16), ("Positioning: 30–45° head-up; semi-Fowler's position reduces aspiration risk & aids ventilation", False, 1, 16), ("Breathing exercises: diaphragmatic breathing, incentive spirometry (if tolerated)", False, 1, 16), ("Chest PT: manual or mechanical secretion clearance — percussion, vibration, postural drainage", False, 1, 16), ("Assisted / manually assisted cough — if bulbar weakness impairs cough efficacy", False, 1, 16), ("Suction clearance: cautious — may trigger bradyarrhythmia due to autonomic instability", False, 1, 16), ("Musculoskeletal & Preventive Care", True, 0, 18), ("Passive ROM all joints q 2–4 hrs: prevent contracture during paralysis phase", False, 1, 16), ("Positioning: heel protectors, foot drop prevention (AFO or foam wedge), pillow bridging", False, 1, 16), ("DVT prophylaxis: compression stockings + passive ankle pumps; coordinate with medical team", False, 1, 16), ("Pressure area care: regular turning schedule (q 2 hrs), pressure-relieving mattress", False, 1, 16), ("Shoulder positioning: arm boards to prevent subluxation", False, 1, 16), ("Pain management: positioning, gentle TENS for neuropathic pain, cold packs", False, 1, 16), ("KEY: Monitor for autonomic instability — sudden BP swings, arrhythmias during ALL interventions", True, 0, 15), ]) # ── Slide 36: GBS Subacute Phase ────────────────────────────────────────────── s36 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s36, 0, [("GBS — Subacute (Plateau/Recovery) Phase", True, 0, 24)]) set_ph_text(s36, 1, [ ("Progressive Verticalization & Mobilization", True, 0, 18), ("Tilt table: gradual upright progression (start 20–30°, advance 10–15° per session) — manage orthostatic hypotension", False, 1, 16), ("Bed mobility training: rolling, sitting up, edge-of-bed sitting with assistance", False, 1, 16), ("Transfer training: bed-to-chair, progressive weight bearing, standing with support", False, 1, 16), ("Hydrotherapy / Aquatic Therapy", True, 0, 18), ("Buoyancy offloads gravity — allows active exercise even at MRC grade 2–3", False, 1, 16), ("Warm water (33–35°C): muscle relaxation, pain relief, improved circulation", False, 1, 16), ("Gentle walking in pool, limb movements, balance training — excellent early mobilization tool", False, 1, 16), ("Strengthening & Gait Rehabilitation", True, 0, 18), ("Progressive resistive exercise as MRC grades improve: start gravity-eliminated, progress to against gravity", False, 1, 16), ("Gait retraining: parallel bars → walker → elbow crutches → walking stick → independent", False, 1, 16), ("Balance retraining: static (standing) → dynamic (weight shifts) → perturbation training", False, 1, 16), ("Cycling ergometer / task-specific training once adequate limb strength achieved", False, 1, 16), ("Fatigue Management", True, 0, 18), ("Energy conservation: activity pacing, prioritization — major long-term problem in 60–80% GBS patients", False, 1, 16), ("Graded return to activity: avoid overexertion (may worsen fatigue and recovery)", False, 1, 16), ]) # ── Slide 37: GBS Rehabilitation Phase ──────────────────────────────────────── s37 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s37, 0, [("GBS — Rehabilitation & Long-term Management", True, 0, 24)]) set_ph_text(s37, 1, [ ("Sensory & Motor Re-education", True, 0, 18), ("Sensory re-education when protective sensation returns: graded textures, localization, discrimination", False, 1, 16), ("Proprioceptive training: unstable surfaces, eyes-closed balance, reaching tasks", False, 1, 16), ("Coordination & fine motor: pegboard tasks, handwriting, dexterity drills", False, 1, 16), ("Orthoses & Equipment", True, 0, 18), ("AFO (Ankle-Foot Orthosis): if foot drop persists; enables safe ambulation", False, 1, 16), ("Wrist splints / thumb splints: if upper limb weakness persists during daily activities", False, 1, 16), ("Wheelchair/mobility aids: prescribed based on residual deficit and functional need", False, 1, 16), ("ADL & Functional Independence", True, 0, 18), ("Self-care: dressing, grooming, bathing — graded independence restoration", False, 1, 16), ("Return to work/school planning: graduated reintegration; cognitive-fatigue assessment", False, 1, 16), ("Psychosocial support: anxiety, depression common — refer for counselling; group therapy", False, 1, 16), ("Outcome Measures (GBS Specific)", True, 0, 18), ("GBS Disability Scale (0–6); MRC Sumscore; FVC trends; Fatigue Severity Scale (FSS)", False, 1, 16), ("SF-36; 10-MWT; Berg Balance Scale; 6-Minute Walk Test; Functional Independence Measure (FIM)", False, 1, 16), ("Prognosis: 85% independent ambulation at 6 months; ~20% have significant residual deficits at 1 yr", False, 1, 16), ]) # ── Slide 38: SECTION DIVIDER — Meralgia Paresthetica ───────────────────────── s38 = prs.slides.add_slide(prs.slide_layouts[2]) set_ph_text(s38, 0, [("Meralgia Paresthetica", True, 0, 32)]) set_ph_text(s38, 1, [("Lateral Femoral Cutaneous Nerve Entrapment", False, 0, 18)]) # ── Slide 39: Anatomy, Etiology & Diagnosis ─────────────────────────────────── s39 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s39, 0, [("Meralgia Paresthetica — Anatomy, Etiology & Diagnosis", True, 0, 24)]) set_ph_text(s39, 1, [ ("Anatomy", True, 0, 18), ("Lateral Femoral Cutaneous Nerve (LFCN): purely sensory; L2–L3 nerve roots", False, 1, 16), ("Exits lateral border of psoas → along ilium → passes under/through inguinal ligament medial to ASIS", False, 1, 16), ("Most common entrapment site: inguinal ligament just medial to ASIS", False, 1, 16), ("Supplies sensation to anterolateral thigh (anterior & posterior branches)", False, 1, 16), ("Etiology / Risk Factors", True, 0, 18), ("Obesity, pregnancy, ascites — increased abdominal girth compresses nerve", False, 1, 16), ("Tight belts, tight waistbands, tool belts, body armor — direct external compression", False, 1, 16), ("Diabetes, trauma to thigh/inguinal region, prolonged standing/walking", False, 1, 16), ("Post-surgical: appendectomy, inguinal herniorrhaphy, iliac bone graft, bariatric surgery", False, 1, 16), ("Clinical Features & Diagnosis", True, 0, 18), ("Burning pain, dysesthesia, numbness of anterolateral thigh — NO motor deficit (pure sensory nerve)", False, 1, 16), ("Aggravated by: prolonged standing, walking, leg extension, crossing legs, tight clothing", False, 1, 16), ("Tinel's sign at ASIS; pelvic compression test (lying, lateral pressure relieves symptoms)", False, 1, 16), ("Differential: L2–L3 radiculopathy, lumbar spinal stenosis, hip OA — no motor or reflex change in MP", False, 1, 16), ("EMG/NCS: sensory nerve conduction study of LFCN; ultrasound-guided nerve block confirms diagnosis", False, 1, 16), ]) # ── Slide 40: PT Management — Meralgia Paresthetica ─────────────────────────── s40 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s40, 0, [("Meralgia Paresthetica — Physiotherapy Management", True, 0, 24)]) set_ph_text(s40, 1, [ ("Conservative Approach (Mainstay — condition is often self-limiting)", True, 0, 18), ("Patient education: explain benign, self-limiting nature; reassurance reduces anxiety", False, 1, 16), ("Activity modification: avoid prolonged standing, hip extension, crossing legs", False, 1, 16), ("Clothing advice: loose waistbands, avoid tool belts, loosen tight corsets/pants", False, 1, 16), ("Weight reduction program: BMI reduction relieves inguinal ligament pressure", False, 1, 16), ("Manual Therapy & Soft Tissue Techniques", True, 0, 18), ("Lumbar & hip joint mobilization: address L2–L3 stiffness contributing to nerve irritation", False, 1, 16), ("Iliopsoas/hip flexor stretching: lengthening tight structures around inguinal ligament", False, 1, 16), ("Soft tissue release: inguinal ligament region, tensor fasciae latae, quadriceps fascia", False, 1, 16), ("Neural mobilization (LFCN slider): careful nerve tensioning from hip extension with knee extension", False, 1, 16), ("Electrotherapy for Symptom Management", True, 0, 18), ("TENS: over anterolateral thigh — gate control; reduce burning pain and dysesthesia", False, 1, 16), ("IFT (Interferential Therapy): deeper modulation of pain in thigh", False, 1, 16), ("LLLT: may reduce perineural inflammation at entrapment site", False, 1, 16), ("Therapeutic Ultrasound (pulsed): over inguinal ligament entrapment site — reduce fibrosis", False, 1, 16), ]) # ── Slide 41: Meralgia — Exercise & Advanced Mx ─────────────────────────────── s41 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s41, 0, [("Meralgia Paresthetica — Exercise Therapy & Special Considerations", True, 0, 24)]) set_ph_text(s41, 1, [ ("Stretching & Flexibility", True, 0, 18), ("Hip flexor / iliopsoas stretch: standing lunge stretch — relieves inguinal ligament tension", False, 1, 16), ("Sartorius stretch, TFL/IT band stretch: reduces lateral thigh compression forces", False, 1, 16), ("Lumbar extension exercises (McKenzie-based): if lumbar component contributing", False, 1, 16), ("Postural Correction", True, 0, 18), ("Anterior pelvic tilt correction: activate core (TA, multifidus), hip extensors", False, 1, 16), ("Avoid hyperlordosis: strengthening gluteals and abdominals reduces ASIS stress", False, 1, 16), ("Ergonomic modification: sitting posture — avoid deep hip flexion >90° for prolonged periods", False, 1, 16), ("Sensory Re-education & Desensitization", True, 0, 18), ("Graded desensitization if allodynia present: start with light touch (cotton), progress to textures", False, 1, 16), ("Vibration therapy (100 Hz) over anterolateral thigh: reduces neuropathic sensitization", False, 1, 16), ("Mirror therapy: if chronic with central sensitization component", False, 1, 16), ("Advanced & Surgical Considerations (for refractory cases)", True, 0, 18), ("Corticosteroid injection at ASIS: if conservative PT fails at 6–8 weeks", False, 1, 16), ("Surgical decompression (neurolysis) or neurectomy: for chronic unremitting pain", False, 1, 16), ("Post-injection PT: resume nerve mobilization and stretching within 1–2 weeks", False, 1, 16), ("Prognosis: 85–90% improve with conservative management; recurrence with weight gain/tight clothing", False, 1, 16), ]) prs.save(dst) print("Saved:", dst) print(f"Total slides now: {len(prs.slides)}") PYEOF

python3 << 'PYEOF' # Verify the new slides from pptx import Presentation prs = Presentation("/tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx") print(f"Total slides: {len(prs.slides)}") for i in range(26, len(prs.slides)): slide = prs.slides[i] print(f"\n--- Slide {i+1} (layout: {slide.slide_layout.name}) ---") for shape in slide.shapes: if shape.has_text_frame and shape.text_frame.text.strip(): print(f" {shape.text_frame.text[:120]}") PYEOF

ls -lh /tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx

python3 -c " from pptx import Presentation prs = Presentation('/tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx') print('Total slides:', len(prs.slides)) print('Last slide layout:', prs.slides[-1].slide_layout.name) "

python3 << 'PYEOF' from pptx import Presentation from pptx.util import Pt src = "/tmp/workspace/pn-pptx/Physiotherapy_Management_Updated.pptx" dst = "/tmp/workspace/pn-pptx/Physiotherapy_Management_Final.pptx" prs = Presentation(src) def set_ph_text(slide, ph_idx, lines): """lines = list of (text, bold, level, size)""" ph = slide.placeholders[ph_idx] tf = ph.text_frame tf.word_wrap = True tf.clear() first = True for (text, bold, level, size) in lines: if first: p = tf.paragraphs[0]; first = False else: p = tf.add_paragraph() p.level = level run = p.add_run() run.text = text run.font.bold = bold if size: run.font.size = Pt(size) # ── Slide 42: SECTION DIVIDER ───────────────────────────────────────────────── s42 = prs.slides.add_slide(prs.slide_layouts[2]) # Section Header set_ph_text(s42, 0, [("Post-Surgical Physiotherapy Management", True, 0, 28)]) set_ph_text(s42, 1, [("Peripheral Nerve Injuries — General Principles Across All Surgeries", False, 0, 17)]) # ── Slide 43: Types of Surgery & PT Rationale ───────────────────────────────── s43 = prs.slides.add_slide(prs.slide_layouts[1]) # Title and Content set_ph_text(s43, 0, [("Types of Peripheral Nerve Surgery & PT Rationale", True, 0, 24)]) set_ph_text(s43, 1, [ ("Common Surgical Procedures", True, 0, 18), ("Primary Neurorrhaphy: direct end-to-end nerve repair under tension-free conditions — best prognosis", False, 1, 16), ("Nerve Grafting: bridging gaps using donor nerve (sural, MABC, lateral antebrachial cutaneous)", False, 1, 16), ("Nerve Transfer (Neurotization): healthy donor nerve coaptated to denervated distal nerve stump", False, 1, 16), ("Nerve Decompression / Neurolysis: release of external compression (e.g., cubital tunnel, CTS release)", False, 1, 16), ("Tendon Transfer: paralyzed muscle function replaced by expendable donor tendon", False, 1, 16), ("Free Functioning Muscle Transfer: vascularized muscle transplanted for irreparable nerve injury", False, 1, 16), ("Why PT is Indispensable After Nerve Surgery", True, 0, 18), ("Nerve regeneration is slow (~1 mm/day); PT bridges the gap until reinnervation occurs", False, 1, 16), ("Prevents contracture, muscle wasting, and joint stiffness during the denervation interval", False, 1, 16), ("Maintains passive ROM — prerequisite for tendon transfer to succeed (full passive movement essential)", False, 1, 16), ("Sensory and motor re-education guides cortical reorganization for functional recovery", False, 1, 16), ("Intensive physiotherapy and orthoses are often necessary to maximize final outcome", False, 1, 15), ]) # ── Slide 44: Immediate Post-Op Phase (0–2 weeks) ───────────────────────────── s44 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s44, 0, [("Post-Surgical PT — Phase 1: Immediate (0–2 Weeks)", True, 0, 24)]) set_ph_text(s44, 1, [ ("Goals: Protect repair, manage pain/oedema, prevent complications", True, 0, 18), ("Wound & Immobilization Management", True, 0, 18), ("Respect surgical immobilization: splint/cast as instructed by surgeon — NO active movement at repair site", False, 1, 16), ("Positioning: elevate limb above heart level — reduces oedema and haematoma at repair site", False, 1, 16), ("Wound care: aseptic dressing changes; monitor for signs of infection, dehiscence, haematoma", False, 1, 16), ("Compression bandaging: graduated compression (light to moderate) to manage post-op oedema", False, 1, 16), ("Oedema Control", True, 0, 18), ("Manual lymphatic drainage (MLD): gentle effleurage proximal to distal if wound healed", False, 1, 16), ("Retrograde massage: gentle centripetal strokes over digits/forearm", False, 1, 16), ("Intermittent pneumatic compression: for significant limb oedema", False, 1, 16), ("Active Exercises of UNINVOLVED Joints", True, 0, 18), ("Full active ROM of all joints NOT immobilized: shoulder, elbow, or hand exercises as appropriate", False, 1, 16), ("Proximal joint maintenance: prevents deconditioning, maintains circulation, reduces risk of proximal contracture", False, 1, 16), ("PROM of immobilized joints: ONLY with surgeon clearance — gentle, pain-free within splint protocol", False, 1, 16), ("Deep breathing exercises: prevent atelectasis, especially in post-op upper limb/trunk cases", False, 1, 15), ]) # ── Slide 45: Early Mobilization Phase (2–6 weeks) ──────────────────────────── s45 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s45, 0, [("Post-Surgical PT — Phase 2: Early Mobilization (2–6 Weeks)", True, 0, 24)]) set_ph_text(s45, 1, [ ("Goals: Restore joint ROM, initiate nerve gliding, early scar management", True, 0, 18), ("PROM & AROM Progression", True, 0, 18), ("Initiate PROM at all involved joints: achieved as immobilization is lifted (surgeon guidance)", False, 1, 16), ("Progress to active-assisted ROM then full AROM as healing permits", False, 1, 16), ("Joint mobilization (Maitland Grade I–II): restore accessory movement if joint stiffness develops", False, 1, 16), ("Nerve Gliding Exercises", True, 0, 18), ("Begin gentle SLIDER techniques: mobilize nerve without tension — reduces intraneural oedema", False, 1, 16), ("Median nerve: fist → full finger extension → wrist extension sequence", False, 1, 16), ("Ulnar nerve: elbow flexion/extension with wrist/finger positions (slider protocol)", False, 1, 16), ("Radial nerve: wrist flex-extend; supination-pronation sequence", False, 1, 16), ("TENSIONER techniques: deferred until inflammation settled (usually week 4–6)", False, 1, 16), ("Scar Management (once wound fully healed — ~3 weeks post-op)", True, 0, 18), ("Scar massage: circular and cross-friction massage — prevent perineural adhesions around repair site", False, 1, 16), ("Silicone gel sheet: apply 12–24 hrs/day over scar — reduces hypertrophic scarring", False, 1, 16), ("Transverse friction massage: mobilize scar from underlying nerve to prevent tethering", False, 1, 16), ("Desensitization: graded tactile stimulation (cotton, velvet, textures) over hypersensitive scar", False, 1, 16), ]) # ── Slide 46: Two-Column — Splinting Post-Op ────────────────────────────────── s46 = prs.slides.add_slide(prs.slide_layouts[3]) # Two Content set_ph_text(s46, 0, [("Post-Surgical Splinting & Orthosis Principles", True, 0, 24)]) set_ph_text(s46, 1, [ ("Static / Protective Splints (Acute Phase)", True, 0, 17), ("Post-neurorrhaphy: limb positioned to relax nerve (e.g., elbow flexed 90° post-ulnar repair; wrist neutral post-median repair)", False, 1, 15), ("Duration: typically 3–4 weeks; removed only for gentle exercises under supervision", False, 1, 15), ("AFO: foot drop post-peroneal nerve repair; maintains neutral ankle", False, 1, 15), ("Thumb spica splint: post-digital nerve repair — protects coaptation site", False, 1, 15), ("Static progressive splinting: for persistent joint stiffness — applies sustained low-load stretch", False, 1, 15), ]) set_ph_text(s46, 2, [ ("Dynamic / Functional Splints (Rehab Phase)", True, 0, 17), ("Lumbrical bar (ulnar): corrects claw deformity; enables functional grip during denervation", False, 1, 15), ("Cock-up wrist splint (radial): enables tenodesis grip; prevents wrist flexion contracture", False, 1, 15), ("Opponens splint (median): maintains thumb web space; prevents adduction contracture", False, 1, 15), ("Dynamic MCP extension assist: for finger drop (radial/PIN palsy) — spring-loaded outrigger", False, 1, 15), ("Reviewed & adjusted every 4–6 weeks as reinnervation progresses", False, 1, 15), ("Weaned off as muscle strength reaches MRC grade 3+", False, 1, 15), ]) # ── Slide 47: Electrotherapy Post-Op ────────────────────────────────────────── s47 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s47, 0, [("Post-Surgical PT — Electrotherapy Modalities", True, 0, 24)]) set_ph_text(s47, 1, [ ("NMES / Electrical Muscle Stimulation (EMS)", True, 0, 18), ("Begin: 2–4 weeks post-op (avoid over repaired nerve acutely)", False, 1, 16), ("Retards denervation atrophy: maintains muscle bulk and contractile protein while awaiting reinnervation", False, 1, 16), ("Reduces fibrotic changes in denervated muscle: preserves muscle architecture for reinnervation", False, 1, 16), ("Parameters: surged faradic / exponentially rising pulses for denervated muscle (longer pulse widths 10–100 ms)", False, 1, 16), ("TENS", True, 0, 18), ("Post-op pain management: gate control; reduces analgesic requirement in early post-op period", False, 1, 16), ("Neuropathic pain: high-frequency TENS (80–100 Hz) for burning/dysesthetic pain along nerve territory", False, 1, 16), ("Therapeutic Ultrasound (Pulsed Mode)", True, 0, 18), ("After wound closure: pulsed ultrasound (1 MHz, 0.5–1.0 W/cm²) over repair site — reduces fibrosis", False, 1, 16), ("Promotes tissue healing, reduces peri-neural adhesion formation around graft/repair", False, 1, 16), ("LLLT (Low Level Laser Therapy)", True, 0, 18), ("Evidence for accelerating axonal regeneration and remyelination after nerve repair", False, 1, 16), ("Apply along nerve trunk and repair site — 2–3 sessions/week; safe post wound closure", False, 1, 16), ("Biofeedback / EMG Biofeedback", True, 0, 18), ("Used in motor re-education: visual/auditory feedback of muscle activation — accelerates relearning of motor patterns", False, 1, 16), ("Particularly useful after nerve transfer and tendon transfer for new motor learning", False, 1, 15), ]) # ── Slide 48: Progressive Strengthening ─────────────────────────────────────── s48 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s48, 0, [("Post-Surgical PT — Progressive Strengthening & Motor Re-education", True, 0, 24)]) set_ph_text(s48, 1, [ ("Exercise Progression Ladder", True, 0, 18), ("Stage 1 — Gravity eliminated (MRC 1–2): AROM in gravity-eliminated plane; water-assisted exercise", False, 1, 16), ("Stage 2 — Against gravity (MRC 3): Full AROM against gravity; no added resistance", False, 1, 16), ("Stage 3 — Resistive (MRC 3+): Light resistance (putty, rubber bands, Theraband); gradual loading", False, 1, 16), ("Stage 4 — Progressive loading (MRC 4–5): Task-specific resistance, grip/pinch strengthening, functional loads", False, 1, 16), ("Motor Re-education Techniques", True, 0, 18), ("Biofeedback EMG: visual cue of muscle activation for earliest reinnervation signals (MRC 1)", False, 1, 16), ("Mental/motor imagery: neuroplastic priming — patient imagines movement to preserve motor cortex maps", False, 1, 16), ("Mirror therapy: cortical reorganization; used before clinical reinnervation is detectable", False, 1, 16), ("Task-specific training: dexterity tasks matched to patient's work/daily needs", False, 1, 16), ("Tendon Transfer Re-education (Special Consideration)", True, 0, 18), ("Phase 1 (0–4 wks): protective immobilization; active contraction of DONOR muscle only", False, 1, 16), ("Phase 2 (4–8 wks): gentle active exercise of transferred tendon; patient learns new movement pattern", False, 1, 16), ("Phase 3 (8–12 wks): progressive resistive exercise; synergistic movement patterns; biofeedback aided", False, 1, 16), ("Full functional use expected at 3–6 months; strength typically 1 MRC grade below pre-transfer", False, 1, 15), ]) # ── Slide 49: Sensory Re-education Post-Op ──────────────────────────────────── s49 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s49, 0, [("Post-Surgical PT — Sensory Re-education", True, 0, 24)]) set_ph_text(s49, 1, [ ("When to Begin", True, 0, 18), ("When moving touch is perceived along nerve territory (typically 3–6 months post-repair)", False, 1, 16), ("Do NOT begin formal sensory re-education during the complete anaesthesia phase", False, 1, 16), ("Early Phase Sensory Re-education", True, 0, 18), ("Localization training: patient closes eyes, touch applied, patient identifies location", False, 1, 16), ("Moving touch discrimination: cotton wool strokes; graded textures — cotton, velvet, sandpaper", False, 1, 16), ("Vibration: 30 Hz (moving touch) then 256 Hz tuning fork (static touch) — track recovery progression", False, 1, 16), ("Constant touch: Semmes-Weinstein monofilament graded stimulation", False, 1, 16), ("Late Phase Sensory Re-education", True, 0, 18), ("Object identification (stereognosis): coins, keys, pen tops — eyes closed identification tasks", False, 1, 16), ("Textured fabric discrimination: increasingly similar textures to challenge cortical mapping", False, 1, 16), ("Functional discrimination: identifying temperature, texture in ADL context", False, 1, 16), ("Chronic / Hypersensitivity Management", True, 0, 18), ("Desensitization: start below pain threshold — rice bucket, beans, textures progression", False, 1, 16), ("Mirror therapy: for chronic cases with central sensitization; cortical remapping", False, 1, 16), ("TENS (high frequency): reduces hyperalgesia and allodynia over hypersensitive nerve territory", False, 1, 16), ("Outcome: Track with Semmes-Weinstein Monofilaments + Static/Moving 2-Point Discrimination", False, 1, 15), ]) # ── Slide 50: ADL, Return to Work & Outcomes ────────────────────────────────── s50 = prs.slides.add_slide(prs.slide_layouts[1]) set_ph_text(s50, 0, [("Post-Surgical PT — ADL Training, Education & Outcome Measures", True, 0, 24)]) set_ph_text(s50, 1, [ ("Patient Education (Critical Throughout)", True, 0, 18), ("Skin care: inspect insensate areas daily; thermal precautions (hot water, cooking); padded gloves/footwear", False, 1, 16), ("Activity modification: avoid aggravating postures (sustained elbow flexion, wrist flexion, pressure on nerve)", False, 1, 16), ("Realistic expectation setting: nerve regeneration 1 mm/day; full recovery may take 12–24 months post-repair", False, 1, 16), ("ADL Retraining", True, 0, 18), ("Compensatory strategies during denervation: adaptive equipment, built-up handles, universal cuffs", False, 1, 16), ("Progressive task training: writing, buttoning, coin manipulation, jar opening, dressing, grooming", False, 1, 16), ("Lower limb: safe gait with orthosis; stair training; balance training on uneven surfaces", False, 1, 16), ("Work hardening / Return-to-work programme: graduated increase in work demands matched to nerve recovery", False, 1, 16), ("Outcome Measures (Post-Surgical)", True, 0, 18), ("Motor: MRC grading (0–5) at each muscle group; grip/pinch dynamometry (Jamar, B&L pinch)", False, 1, 16), ("Sensory: Semmes-Weinstein Monofilaments; Static & Moving 2-Point Discrimination (S2PD / M2PD)", False, 1, 16), ("Function: DASH / QuickDASH; ABILHAND; 9-Hole Peg Test; Purdue Pegboard", False, 1, 16), ("Pain: NPRS / VAS; Neuropathic Pain Scale (NPS)", False, 1, 16), ("QoL & Satisfaction: SF-36; Patient Global Impression of Change (PGIC)", False, 1, 16), ("Electrodiagnostics: NCS/EMG at 3, 6, 12 months — monitor reinnervation timeline", False, 1, 15), ]) prs.save(dst) print("Saved:", dst) print("Total slides:", len(prs.slides)) PYEOF

python3 -c " from pptx import Presentation prs = Presentation('/tmp/workspace/pn-pptx/Physiotherapy_Management_Final.pptx') print('Total slides:', len(prs.slides)) for i in range(41, len(prs.slides)): slide = prs.slides[i] title = '' for shape in slide.shapes: if shape.has_text_frame and shape.text_frame.text.strip(): title = shape.text_frame.text[:80] break print(f'Slide {i+1} ({slide.slide_layout.name}): {title}') " ls -lh /tmp/workspace/pn-pptx/Physiotherapy_Management_Final.pptx