from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from io import BytesIO

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)

blank = prs.slide_layouts[6]

# ─── Color Palette ────────────────────────────────────────────────
NAVY   = RGBColor(0x1A, 0x3C, 0x6E)   # deep navy header bg
GOLD   = RGBColor(0xC9, 0xA0, 0x2E)   # accent / underline
WHITE  = RGBColor(0xFF, 0xFF, 0xFF)
DARK   = RGBColor(0x1A, 0x1A, 0x1A)
LIGHT  = RGBColor(0xF0, 0xF4, 0xF8)   # slide bg tint
TEAL   = RGBColor(0x00, 0x7B, 0x83)   # bullet accent

def add_rect(slide, x, y, w, h, color):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = color
    shape.line.fill.background()
    return shape

def add_tb(slide, x, y, w, h, text, font_size, bold=False,
           color=DARK, align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.size = Pt(font_size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = "Calibri"
    return tb

def add_bullet_tb(slide, x, y, w, h, items, font_size=15, bullet_color=TEAL, text_color=DARK):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(4)
    first = True
    for item in items:
        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(4)
        # bullet symbol
        r1 = p.add_run()
        r1.text = "▪ "
        r1.font.size = Pt(font_size)
        r1.font.bold = True
        r1.font.color.rgb = bullet_color
        r1.font.name = "Calibri"
        r2 = p.add_run()
        r2.text = item
        r2.font.size = Pt(font_size)
        r2.font.color.rgb = text_color
        r2.font.name = "Calibri"
    return tb

def header_slide(slide, title, subtitle=""):
    """Full header bar + optional subtitle for content slides."""
    add_rect(slide, 0, 0, 13.333, 7.5, LIGHT)          # bg
    add_rect(slide, 0, 0, 13.333, 1.25, NAVY)           # header bar
    add_rect(slide, 0, 1.25, 0.12, 6.25, GOLD)          # left accent strip
    add_tb(slide, 0.25, 0.1, 12.8, 1.05, title, 28,
           bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_tb(slide, 0.25, 1.35, 12.8, 0.55, subtitle, 14,
               italic=True, color=TEAL)

def divider_line(slide, y=1.85):
    add_rect(slide, 0.25, y, 12.83, 0.04, GOLD)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 1 – TITLE SLIDE
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, NAVY)
add_rect(s, 0, 0, 0.22, 7.5, GOLD)
add_rect(s, 0, 5.8, 13.333, 1.7, RGBColor(0x0D, 0x24, 0x4A))

add_tb(s, 0.5, 0.4, 12.5, 0.8,
       "MGM ALLIED HEALTH SCIENCES INSTITUTE (MAHSI)", 14,
       bold=False, color=GOLD, align=PP_ALIGN.CENTER)
add_tb(s, 0.5, 1.0, 12.5, 0.6,
       "MGM Medical College, Indore (M.P.)", 13,
       color=RGBColor(0xCC, 0xCC, 0xCC), align=PP_ALIGN.CENTER)

add_rect(s, 1.5, 1.7, 10.333, 0.05, GOLD)

add_tb(s, 0.5, 1.9, 12.5, 1.0,
       "CASE PRESENTATION", 22, bold=True,
       color=WHITE, align=PP_ALIGN.CENTER)
add_tb(s, 0.5, 2.8, 12.5, 1.2,
       "TOPIC: Scaphoid Fracture Rehabilitation", 32,
       bold=True, color=GOLD, align=PP_ALIGN.CENTER)
add_tb(s, 0.5, 3.9, 12.5, 0.6,
       "Post-Immobilization Physiotherapy Management", 18,
       italic=True, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(s, 1.5, 4.7, 10.333, 0.05, GOLD)

add_tb(s, 1.0, 5.0, 5.0, 0.5, "PRESENTED BY:", 11, color=GOLD)
add_tb(s, 1.0, 5.45, 5.0, 0.45, "Student Name", 14, bold=True, color=WHITE)
add_tb(s, 1.0, 5.85, 5.0, 0.45, "MPT 1st Year", 12, color=RGBColor(0xCC, 0xCC, 0xCC))

add_tb(s, 7.0, 5.0, 5.5, 0.5, "GUIDED BY:", 11, color=GOLD)
add_tb(s, 7.0, 5.45, 5.5, 0.45, "Dr. Niketa Shobhit", 14, bold=True, color=WHITE)
add_tb(s, 7.0, 5.85, 5.5, 0.45, "Ass. Professor, MAHSI", 12, color=RGBColor(0xCC, 0xCC, 0xCC))

# ══════════════════════════════════════════════════════════════════════
# SLIDE 2 – INTRODUCTION
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "INTRODUCTION", "Scaphoid Fracture – An Overview")
divider_line(s)

bullets = [
    "The scaphoid is the most commonly fractured carpal bone, accounting for ~70% of all carpal fractures.",
    "Scaphoid fractures typically result from a fall on an outstretched hand (FOOSH) mechanism with the wrist in dorsiflexion and radial deviation.",
    "Most common in active males aged 20–40 yrs; however, incidence in older adults (>45 yrs) is increasing due to osteoporosis and sporting activity.",
    "The scaphoid has a unique retrograde blood supply (branches of radial artery entering distally). This predisposes proximal pole fractures to avascular necrosis (AVN) and non-union.",
    "Fractures are classified by location: distal pole (~10%), waist (~70%), and proximal pole (~20%). Waist fractures are most common.",
    "Diagnosis requires clinical suspicion (anatomical snuffbox tenderness) + imaging (X-ray, CT scan, MRI for occult fractures).",
    "Management: non-displaced fractures → cast immobilization (thumb spica cast 8–12 weeks); displaced/unstable → surgical fixation (headless compression screw).",
    "Rehabilitation is essential to restore wrist ROM, grip strength, and functional ADL performance post-immobilization."
]
add_bullet_tb(s, 0.35, 1.9, 12.7, 5.3, bullets, font_size=14)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 3 – CLINICAL ANATOMY
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "CLINICAL ANATOMY", "Scaphoid Bone & Surrounding Structures")
divider_line(s)

col1 = [
    "BONE STRUCTURE: The scaphoid (from Greek: 'boat-shaped') is the largest bone in the proximal row of the carpus. It bridges the proximal and distal carpal rows.",
    "FACETS: Proximal convex articular surface (with radius), distal pole (with trapezium & trapezoid), medial surface (with capitate & lunate).",
    "BLOOD SUPPLY: 70–80% via dorsal branch of the radial artery entering at the dorsal ridge (waist). Proximal pole has no direct vascular entry → risk of AVN.",
    "LIGAMENTOUS SUPPORT: Scapholunate interosseous ligament (SLIL), radioscaphocapitate ligament, long radiolunate ligament stabilize the scaphoid.",
    "WRIST KINEMATICS: Scaphoid flexes during radial deviation and extends during ulnar deviation, acting as a link between proximal and distal rows.",
    "SNUFFBOX: Anatomical snuffbox bordered by EPL (dorsomedially) and APL/EPB (laterally). Tenderness here is pathognomonic of scaphoid injury.",
]
col2 = [
    "JOINTS: Radiocarpal joint (proximal), midcarpal joint (distal). Both affected post-fracture due to intra-articular extension in some fractures.",
    "MUSCLES CROSSING WRIST: FCR, FCU (flexors); ECRL, ECRB, ECU (extensors); APL, EPB, EPL (thenar/thumb ray).",
    "TENDONS: No tendons insert directly on the scaphoid, but adjacent tendons (FCR, APL) exert deforming forces on fracture fragments.",
    "NERVE SUPPLY: Posterior interosseous nerve (PIN) supplies dorsal wrist capsule; median and radial nerves provide sensory supply to adjacent structures.",
    "IMPORTANCE IN GRIP: Scaphoid stability is essential for force transmission across the carpus during pinch and power grip activities.",
]

add_bullet_tb(s, 0.35, 1.9, 6.4, 5.3, col1, font_size=13)
add_bullet_tb(s, 6.9, 1.9, 6.1, 5.3, col2, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 4 – EPIDEMIOLOGY
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "EPIDEMIOLOGY", "Scaphoid Fracture – Incidence & Demographics")
divider_line(s)

epi = [
    "Scaphoid fractures account for ~70% of all carpal fractures and ~2–7% of all fractures.",
    "Annual incidence: ~38 per 100,000 population in the general population.",
    "Peak incidence in young adult males (15–40 yrs); a second peak is seen in older adults (>50 yrs) due to osteopenia.",
    "Male:Female ratio ≈ 4:1 in younger populations; ratio narrows in older adults (osteoporotic falls).",
    "The most common mechanism is a FOOSH injury (fall on outstretched hand), accounting for >90% of cases.",
    "In older adults (>45 yrs), low-energy falls from standing height are a common mechanism, unlike high-energy trauma in youth.",
    "Non-union occurs in ~5–10% of cases overall; rises to 30–40% in untreated or delayed-diagnosis proximal pole fractures.",
    "Avascular necrosis (AVN) of the proximal pole affects ~13–50% of proximal pole fractures.",
    "Delayed diagnosis (>4 weeks) is common due to negative initial X-rays in ~20–30% of scaphoid fractures.",
    "Source: Rhemrev SJ et al., Injury 2011; Duckworth AD et al., J Bone Joint Surg Br 2012."
]
add_bullet_tb(s, 0.35, 1.9, 12.7, 5.2, epi, font_size=14)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 5 – FRACTURE CLASSIFICATION
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "CLASSIFICATION OF SCAPHOID FRACTURES")
divider_line(s)

# Box function
def box(sl, x, y, w, h, heading, items, hbg=NAVY, tbg=LIGHT):
    add_rect(sl, x, y, w, 0.45, hbg)
    add_tb(sl, x+0.1, y+0.04, w-0.2, 0.38, heading, 13, bold=True, color=WHITE)
    add_rect(sl, x, y+0.45, w, h-0.45, tbg)
    tb2 = sl.shapes.add_textbox(Inches(x+0.1), Inches(y+0.5), Inches(w-0.2), Inches(h-0.6))
    tf2 = tb2.text_frame
    tf2.word_wrap = True
    first = True
    for it in items:
        p = tf2.paragraphs[0] if first else tf2.add_paragraph()
        first = False
        r = p.add_run()
        r.text = "• " + it
        r.font.size = Pt(12)
        r.font.color.rgb = DARK
        r.font.name = "Calibri"
        p.space_before = Pt(3)

box(s, 0.3, 1.9, 4.0, 2.0, "Herbert Classification",
    ["Type A1 – Stable, tubercle", "Type A2 – Stable, waist (undisplaced)",
     "Type B1 – Unstable, distal oblique", "Type B2 – Unstable, displaced waist",
     "Type B3 – Proximal pole", "Type B4 – Trans-scaphoid perilunate dislocation"])

box(s, 4.6, 1.9, 4.0, 2.0, "By Location",
    ["Distal Pole (~10%) – good vascular supply, quick healing",
     "Waist (~70%) – most common; moderate healing risk",
     "Proximal Pole (~20%) – poor blood supply; high AVN risk",
     "Tubercle Fractures – avulsion; generally stable"])

box(s, 9.1, 1.9, 4.0, 2.0, "By Displacement",
    ["Non-displaced (<1 mm) – conservative management",
     "Minimally displaced (1–2 mm) – borderline; consider surgery",
     "Displaced (>2 mm) – surgical fixation recommended",
     "Angulated – humpback deformity; ORIF with bone graft"])

box(s, 0.3, 4.15, 12.8, 2.2, "Russe Classification (Fracture Line Orientation)",
    ["Horizontal Oblique – most stable; fracture line perpendicular to compressive forces",
     "Transverse – moderate stability; perpendicular to long axis of scaphoid",
     "Vertical Oblique – least stable; prone to displacement under loading"],
    hbg=TEAL)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 6 – CASE BACKGROUND
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "CASE BACKGROUND", "Patient Referred to Physiotherapy OPD – MYH, Indore")
divider_line(s)

add_bullet_tb(s, 0.35, 1.9, 12.7, 1.0,
    ["A 50-year-old male patient was referred to the Physiotherapy OPD at Mahatma Gandhi Hospital (MYH), Indore (M.P.) from the Orthopaedic Department on 18th June 2025."],
    font_size=15)

add_bullet_tb(s, 0.35, 2.7, 12.7, 0.5,
    ["Chief Complaints: Pain over right wrist (dorsoradial aspect), persistent swelling, restricted wrist and thumb movements, and inability to perform daily activities including gripping objects and driving."],
    font_size=14)

add_bullet_tb(s, 0.35, 3.3, 12.7, 1.2,
    ["Diagnosis: Fracture of the waist of right scaphoid (Herbert Type A2 – undisplaced, stable)",
     "Mechanism: FOOSH (fall on outstretched right hand) while descending stairs at workplace on 10th May 2025",
     "Management pre-referral: Thumb spica cast immobilization for 6 weeks at Orthopaedic OPD; cast removed on 17th June 2025.",
     "Referred to Physiotherapy on 18th June 2025 for post-immobilization rehabilitation."],
    font_size=14)

add_rect(s, 0.35, 4.85, 12.63, 0.05, GOLD)
add_tb(s, 0.35, 4.95, 12.63, 0.4,
       "Department of Orthopaedics has referred the patient to initiate post-fracture physiotherapeutic rehabilitation programme.",
       13, italic=True, color=TEAL)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 7 – SUBJECTIVE ASSESSMENT / PATIENT PROFILE
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "SUBJECTIVE ASSESSMENT", "Patient Profile")
divider_line(s)

# Left column – profile table
profile_data = [
    ("NAME", "Mr. R.K. Sharma"),
    ("AGE", "50 Years"),
    ("GENDER", "Male"),
    ("OCCUPATION", "Office Administrator (Desk Job + Field Work)"),
    ("ADDRESS", "Rajendra Nagar, Indore"),
    ("HAND DOMINANCE", "Right Handed"),
    ("DATE OF ASSESSMENT", "18/06/2025"),
    ("DIAGNOSIS", "Fracture Waist of Scaphoid (Right)"),
]
y_start = 2.0
for k, v in profile_data:
    add_rect(s, 0.35, y_start, 3.0, 0.4, RGBColor(0x1A, 0x3C, 0x6E))
    add_tb(s, 0.45, y_start+0.04, 2.9, 0.35, k, 11, bold=True, color=GOLD)
    add_rect(s, 3.35, y_start, 3.0, 0.4, RGBColor(0xE8, 0xEE, 0xF5))
    add_tb(s, 3.45, y_start+0.04, 2.9, 0.35, v, 11, color=DARK)
    y_start += 0.44

# Right column – chief complaints
add_tb(s, 7.0, 1.9, 5.9, 0.4, "CHIEF COMPLAINTS", 14, bold=True, color=NAVY)
add_rect(s, 7.0, 2.25, 5.9, 0.04, GOLD)
complaints = [
    "Pain over dorsoradial aspect of right wrist",
    "Swelling and puffiness over wrist and anatomical snuffbox region",
    "Restricted wrist flexion, extension, and radial deviation",
    "Restricted thumb abduction and opposition",
    "Weakness of grip strength (right hand)",
    "Inability to perform ADL: writing, gripping, driving, lifting",
    "Stiffness in wrist and thumb after prolonged rest",
    "Fear of re-injury on loading the wrist"
]
add_bullet_tb(s, 7.0, 2.35, 5.9, 4.5, complaints, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 8 – HISTORY OF PRESENTING ILLNESS
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "HISTORY OF PRESENTING ILLNESS")
divider_line(s)

hopi = [
    "On 10th May 2025, Mr. R.K. Sharma (50 yr, male) slipped while descending stairs at his workplace during the afternoon shift. In an attempt to prevent falling, he landed on his outstretched right hand with the wrist hyperextended and radially deviated (FOOSH mechanism).",
    "He immediately experienced severe pain over the radial aspect of the right wrist, along with localized swelling and inability to grip objects. No deformity was visually apparent.",
    "He self-medicated with a topical NSAID gel and rested the wrist by self-applying a crepe bandage. Due to persistence of pain (7/10 NRS) the following day, he presented to MYH Orthopaedic OPD on 11th May 2025.",
    "X-ray wrist (PA, lateral, and scaphoid views) performed on 11/05/2025 revealed a non-displaced fracture at the waist of the right scaphoid (Herbert Type A2). CT scan confirmed undisplaced fracture with no displacement >1 mm.",
    "The fracture was managed conservatively. Patient was placed in a short-arm thumb spica cast (including the thumb up to IP joint) for 6 weeks. NSAIDS (Tab. Ibuprofen 400 mg TDS × 5 days), analgesics (Tab. Paracetamol 500 mg SOS) were prescribed.",
    "At 6-week follow-up (17/06/2025), repeat X-ray showed fracture union with callus formation. Cast was removed and patient was referred to the Physiotherapy Department for rehabilitation.",
    "Patient complained of persistent stiffness of wrist, thenar muscle wasting, reduced grip strength, and apprehension about loading the hand.",
]
add_bullet_tb(s, 0.35, 1.9, 12.7, 5.3, hopi, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 9 – PAST / PERSONAL / SOCIAL HISTORY
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "PAST, PERSONAL & SOCIAL HISTORY")
divider_line(s)

def section_box(sl, x, y, w, h, title, items, hbg=NAVY):
    add_rect(sl, x, y, w, 0.38, hbg)
    add_tb(sl, x+0.1, y+0.04, w-0.2, 0.32, title, 12, bold=True, color=WHITE)
    tb2 = sl.shapes.add_textbox(Inches(x+0.1), Inches(y+0.42), Inches(w-0.2), Inches(h-0.5))
    tf2 = tb2.text_frame; tf2.word_wrap = True
    first = True
    for it in items:
        p = tf2.paragraphs[0] if first else tf2.add_paragraph()
        first = False
        r = p.add_run(); r.text = "• " + it
        r.font.size = Pt(13); r.font.color.rgb = DARK; r.font.name = "Calibri"
        p.space_before = Pt(4)

section_box(s, 0.35, 1.9, 6.1, 1.6, "PAST HISTORY",
    ["No previous fractures or musculoskeletal injuries",
     "No prior wrist/hand surgeries",
     "Hypertension – controlled on Tab. Amlodipine 5 mg OD (3 years)"])

section_box(s, 6.7, 1.9, 6.0, 1.6, "MEDICAL HISTORY",
    ["Hypertension (HTN) – well controlled",
     "No diabetes mellitus, no cardiac/renal comorbidities",
     "No known drug allergies"])

section_box(s, 0.35, 3.7, 6.1, 1.5, "PERSONAL HISTORY",
    ["Non-smoker; occasional social alcohol (stopped since injury)",
     "Diet: balanced, vegetarian; normal BMI (24.1 kg/m²)",
     "Sleep: mildly disturbed due to wrist pain at night"])

section_box(s, 6.7, 3.7, 6.0, 1.5, "SOCIO-ECONOMIC & FAMILY HISTORY",
    ["Lives in a nuclear family, urban residential area, Indore",
     "Middle class family; supportive and cooperative spouse",
     "No family history of bone disease or rheumatoid arthritis"])

section_box(s, 0.35, 5.35, 12.35, 1.5, "NUTRITIONAL & OCCUPATIONAL HISTORY",
    ["Adequate calcium and Vitamin D3 intake post-fracture (as advised by orthopaedic surgeon)",
     "Predominantly sedentary desk job but involves occasional field visits and driving company vehicle",
     "Ergonomic risk: prolonged computer use with mouse – contributory factor for wrist loading",
     "Patient motivated and has good health literacy; able to follow home exercise protocol"],
    hbg=TEAL)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 10 – PAIN HISTORY
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "PAIN HISTORY")
divider_line(s)

pain_left = [
    ("Onset", "Sudden – FOOSH mechanism on 10/05/2025"),
    ("Duration", "6 weeks during immobilization; now persistent dull ache post-cast removal"),
    ("Character", "Dull aching pain with sharp exacerbation on wrist loading"),
    ("Site", "Dorsoradial wrist, anatomical snuffbox, thenar eminence"),
    ("Radiation", "Occasional radiation into thumb and distal forearm"),
    ("Aggravating", "Wrist extension, radial deviation, gripping, pinching, weight-bearing on wrist"),
    ("Relieving", "Rest, elevation, cold pack, wrist splint (worn at night)"),
    ("Sleep disturbance", "Mild – wakes up when rolling on right side"),
]
y_s = 2.0
for k, v in pain_left:
    add_rect(s, 0.35, y_s, 2.8, 0.38, RGBColor(0x1A, 0x3C, 0x6E))
    add_tb(s, 0.45, y_s+0.03, 2.7, 0.33, k, 11, bold=True, color=GOLD)
    add_rect(s, 3.15, y_s, 5.5, 0.38, RGBColor(0xE8, 0xEE, 0xF5))
    add_tb(s, 3.25, y_s+0.03, 5.4, 0.35, v, 11, color=DARK)
    y_s += 0.42

# NRS scores
add_tb(s, 9.1, 1.9, 4.0, 0.38, "NRS PAIN SCORES", 13, bold=True, color=NAVY)
add_rect(s, 9.1, 2.25, 4.0, 0.04, GOLD)
nrs_data = [
    ("On Activity (18/06)", "8 / 10"),
    ("On Rest (18/06)", "4 / 10"),
    ("On Activity (25/06)", "5 / 10"),
    ("On Rest (25/06)", "2 / 10"),
]
yn = 2.35
for k, v in nrs_data:
    add_rect(s, 9.1, yn, 2.5, 0.42, NAVY)
    add_tb(s, 9.2, yn+0.04, 2.4, 0.35, k, 11, bold=True, color=WHITE)
    add_rect(s, 11.6, yn, 1.5, 0.42, GOLD)
    add_tb(s, 11.65, yn+0.04, 1.4, 0.35, v, 14, bold=True, color=DARK, align=PP_ALIGN.CENTER)
    yn += 0.46

# ══════════════════════════════════════════════════════════════════════
# SLIDE 11 – OBSERVATIONS & PALPATION
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "OBSERVATIONS & PALPATION")
divider_line(s)

obs = [
    "BUILT: Mesomorphic; BMI 24.1 kg/m². Good general condition.",
    "POSTURE: Holding right wrist in guarded, slightly flexed, pronated position. Elbow flexed to protect wrist.",
    "SKIN: Mild skin creasing and slight disuse discolouration over right wrist (post-cast skin changes). No wounds.",
    "DEFORMITY: No visible bony deformity. Mild thenar muscle wasting (right > left).",
    "SWELLING: Diffuse swelling over dorsoradial aspect of right wrist; anatomical snuffbox slightly fullness.",
    "MUSCLE WASTING: Thenar eminence wasting (right hand) – indicative of disuse atrophy after 6 weeks immobilization.",
    "EXTERNAL APPLIANCES: Cast removed. Night wrist splint recommended. No current appliance in situ during assessment.",
]
add_bullet_tb(s, 0.35, 1.9, 6.5, 5.1, obs, font_size=13)

add_tb(s, 7.1, 1.9, 5.9, 0.38, "PALPATION FINDINGS", 13, bold=True, color=NAVY)
add_rect(s, 7.1, 2.25, 5.9, 0.04, GOLD)
palp = [
    ("Skin temperature", "Slightly warm over dorsal right wrist"),
    ("Skin texture", "Normal; mild dryness (post-cast)"),
    ("Tenderness", "Grade 2 tenderness over anatomical snuffbox; scaphoid waist on palmar surface"),
    ("Oedema", "Pitting oedema (mild) over dorsum of wrist"),
    ("Crepitus", "Absent"),
    ("Swelling", "Present over dorsoradial wrist; measured by volumetry (water displacement)"),
    ("Muscle tone", "Mildly reduced thenar tone"),
]
yp = 2.35
for k, v in palp:
    add_rect(s, 7.1, yp, 2.5, 0.44, NAVY)
    add_tb(s, 7.2, yp+0.04, 2.4, 0.38, k, 11, bold=True, color=GOLD)
    add_rect(s, 9.6, yp, 3.4, 0.44, RGBColor(0xE8, 0xEE, 0xF5))
    add_tb(s, 9.65, yp+0.04, 3.35, 0.4, v, 11, color=DARK)
    yp += 0.48

# ══════════════════════════════════════════════════════════════════════
# SLIDE 12 – ICF MODEL
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "ICF MODEL – SCAPHOID FRACTURE REHABILITATION")
divider_line(s)

add_rect(s, 4.5, 1.95, 4.3, 0.65, NAVY)
add_tb(s, 4.5, 1.97, 4.3, 0.62, "HEALTH CONDITION\nScaphoid Fracture (Post-immobilization)", 12,
       bold=True, color=WHITE, align=PP_ALIGN.CENTER)

# Body Functions
add_rect(s, 0.3, 3.0, 3.8, 0.45, TEAL)
add_tb(s, 0.3, 3.0, 3.8, 0.45, "BODY FUNCTIONS & STRUCTURE", 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 0.3, 3.45, 3.8, 2.6, LIGHT)
body_items = ["Pain in wrist/snuffbox","Reduced wrist ROM","Thenar atrophy","Swelling (oedema)","Bone healing at waist scaphoid","Soft tissue contracture"]
tb = s.shapes.add_textbox(Inches(0.4), Inches(3.5), Inches(3.6), Inches(2.5))
tf = tb.text_frame; tf.word_wrap = True
for i, it in enumerate(body_items):
    p = tf.paragraphs[0] if i==0 else tf.add_paragraph()
    r = p.add_run(); r.text = "• "+it; r.font.size = Pt(12); r.font.color.rgb = DARK; r.font.name = "Calibri"

# Activity
add_rect(s, 4.7, 3.0, 3.8, 0.45, TEAL)
add_tb(s, 4.7, 3.0, 3.8, 0.45, "ACTIVITY LIMITATION", 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 4.7, 3.45, 3.8, 2.6, LIGHT)
act_items = ["Unable to grip objects","Cannot write/type fluently","Difficulty lifting >2 kg","Cannot drive (steering control)","ADL limitations: dressing, grooming","Difficulty with pinch tasks"]
tb2 = s.shapes.add_textbox(Inches(4.8), Inches(3.5), Inches(3.6), Inches(2.5))
tf2 = tb2.text_frame; tf2.word_wrap = True
for i, it in enumerate(act_items):
    p = tf2.paragraphs[0] if i==0 else tf2.add_paragraph()
    r = p.add_run(); r.text = "• "+it; r.font.size = Pt(12); r.font.color.rgb = DARK; r.font.name = "Calibri"

# Participation
add_rect(s, 9.1, 3.0, 3.9, 0.45, TEAL)
add_tb(s, 9.1, 3.0, 3.9, 0.45, "PARTICIPATION RESTRICTION", 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 9.1, 3.45, 3.9, 2.6, LIGHT)
par_items = ["Unable to return to full work duties","Cannot drive to field visits","Avoids social activities requiring handshake","Cannot participate in recreational activities (badminton)","Dependent on others for heavy tasks"]
tb3 = s.shapes.add_textbox(Inches(9.2), Inches(3.5), Inches(3.7), Inches(2.5))
tf3 = tb3.text_frame; tf3.word_wrap = True
for i, it in enumerate(par_items):
    p = tf3.paragraphs[0] if i==0 else tf3.add_paragraph()
    r = p.add_run(); r.text = "• "+it; r.font.size = Pt(12); r.font.color.rgb = DARK; r.font.name = "Calibri"

# Contextual Factors
add_rect(s, 0.3, 6.15, 5.9, 0.38, RGBColor(0xC0, 0x4A, 0x20))
add_tb(s, 0.3, 6.15, 5.9, 0.38, "BARRIERS", 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 0.3, 6.53, 5.9, 0.7, LIGHT)
add_tb(s, 0.4, 6.55, 5.7, 0.65, "Kinesiophobia | Pain on loading | Workplace ergonomics (computer use) | Middle-age deconditioning", 11, color=DARK)

add_rect(s, 6.5, 6.15, 6.5, 0.38, RGBColor(0x1A, 0x7A, 0x3A))
add_tb(s, 6.5, 6.15, 6.5, 0.38, "FACILITATORS", 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 6.5, 6.53, 6.5, 0.7, LIGHT)
add_tb(s, 6.6, 6.55, 6.3, 0.65, "Motivated patient | Good family support | Easy hospital access | Adequate nutrition | Bone union confirmed", 11, color=DARK)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 13 – INVESTIGATIONS
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "INVESTIGATIONS")
divider_line(s)

inv_left = [
    "X-RAY WRIST (11/05/2025):\n  - PA, Lateral & Scaphoid (Ulnar deviation) views\n  - Findings: Undisplaced fracture line at waist of scaphoid; no displacement (Herbert Type A2)",
    "CT SCAN WRIST (13/05/2025):\n  - Confirmed non-displaced fracture at scaphoid waist\n  - No humpback deformity; carpal alignment maintained\n  - No evidence of AVN at proximal pole",
    "X-RAY FOLLOW-UP (17/06/2025 – Pre-rehab):\n  - Callus formation visible at fracture site\n  - No malunion or displacement\n  - Cast removal approved; Orthopaedic clearance given for physiotherapy",
    "BONE DENSITY (DEXA) (referred):\n  - T-score: -1.1 (Osteopenia range)\n  - Relevant: 50-year-old male, implications for bone healing rate and fracture risk",
]
add_bullet_tb(s, 0.35, 1.9, 7.2, 5.0, inv_left, font_size=13)

# Right side – clinical tests
add_tb(s, 7.9, 1.9, 5.0, 0.38, "CLINICAL SPECIAL TESTS", 13, bold=True, color=NAVY)
add_rect(s, 7.9, 2.25, 5.0, 0.04, GOLD)
tests = [
    ("Anatomical Snuffbox Tenderness", "POSITIVE ✓"),
    ("Scaphoid Compression Test", "POSITIVE ✓"),
    ("Watson Scaphoid Shift Test", "Negative (stable SLIL)"),
    ("Finkelstein Test", "Negative (no De Quervain)"),
    ("Grind Test (CMC-1)", "Negative"),
    ("Lunotriquetral Shear Test", "Negative"),
    ("Grip Strength (Jamar)", "Right: 14 kg | Left: 28 kg"),
    ("Pinch Strength (lateral)", "Right: 3 kg | Left: 7 kg"),
]
yt = 2.35
for k, v in tests:
    col = RGBColor(0x8B, 0x00, 0x00) if "POSITIVE" in v else (GOLD if "kg" in v else DARK)
    add_rect(s, 7.9, yt, 3.2, 0.42, NAVY)
    add_tb(s, 8.0, yt+0.04, 3.1, 0.36, k, 11, bold=True, color=WHITE)
    add_rect(s, 11.1, yt, 1.9, 0.42, LIGHT)
    add_tb(s, 11.15, yt+0.04, 1.85, 0.36, v, 11, bold=True, color=col)
    yt += 0.46

# ══════════════════════════════════════════════════════════════════════
# SLIDE 14 – PROBLEM LIST
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "PROBLEM LIST")
divider_line(s)

add_tb(s, 0.35, 1.9, 5.9, 0.38, "PATIENT IDENTIFIED PROBLEMS", 13, bold=True, color=NAVY)
add_rect(s, 0.35, 2.25, 5.9, 0.04, GOLD)
pt_problems = [
    "Pain and swelling over right wrist (especially snuffbox area)",
    "Inability to grip or hold objects firmly",
    "Cannot write or type without pain",
    "Unable to drive due to weak wrist control on steering",
    "Restricted wrist and thumb movements",
    "Weakness in right hand compared to left",
    "Fear of re-fracture if wrist is loaded",
    "Cannot resume full work duties",
]
add_bullet_tb(s, 0.35, 2.35, 5.9, 4.7, pt_problems, font_size=13)

add_tb(s, 6.6, 1.9, 6.4, 0.38, "THERAPIST IDENTIFIED PROBLEMS", 13, bold=True, color=NAVY)
add_rect(s, 6.6, 2.25, 6.4, 0.04, GOLD)
th_problems = [
    "Kinesiophobia (Tampa Scale TSK – high score)",
    "Reduced wrist flexion and extension ROM",
    "Restricted radial deviation and thumb abduction",
    "Thenar muscle atrophy (disuse post-immobilization)",
    "Reduced grip strength (right 14 kg vs left 28 kg)",
    "Reduced pinch strength (lateral pinch: 3 kg vs 7 kg)",
    "Mild pitting oedema – dorsum of wrist",
    "Risk of wrist stiffness due to post-immobilization capsular tightening",
    "Postural guarding – protective wrist posture affecting shoulder/neck mechanics",
]
add_bullet_tb(s, 6.6, 2.35, 6.4, 4.7, th_problems, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 15 – EXAMINATION (ROM & MMT)
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "EXAMINATION – ROM & MUSCLE STRENGTH", "Baseline Assessment on 18/06/2025")
divider_line(s)

add_tb(s, 0.35, 1.9, 12.7, 0.38, "RANGE OF MOTION (Goniometry)", 13, bold=True, color=NAVY)

rom_headers = ["Movement", "Normal", "Right (18/6)", "Left (18/6)", "Right (25/6)"]
rom_data = [
    ["Wrist Flexion", "0–80°", "0–28°", "0–78°", "0–45°"],
    ["Wrist Extension", "0–70°", "0–22°", "0–68°", "0–38°"],
    ["Radial Deviation", "0–20°", "0–8°", "0–18°", "0–14°"],
    ["Ulnar Deviation", "0–30°", "0–22°", "0–28°", "0–26°"],
    ["Forearm Supination", "0–90°", "0–65°", "0–88°", "0–78°"],
    ["Forearm Pronation", "0–90°", "0–72°", "0–88°", "0–82°"],
    ["Thumb Abduction", "0–70°", "0–35°", "0–68°", "0–48°"],
    ["Thumb Opposition", "Full", "Partial", "Full", "Near full"],
]

row_colors = [RGBColor(0x1A, 0x3C, 0x6E), RGBColor(0xE8, 0xEE, 0xF5)]
text_colors = [WHITE, DARK]
col_w = [2.5, 1.5, 1.8, 1.8, 1.8]
col_x = [0.35, 2.85, 4.35, 6.15, 7.95]

# header row
for ci, h in enumerate(rom_headers):
    add_rect(s, col_x[ci], 2.3, col_w[ci], 0.38, TEAL)
    add_tb(s, col_x[ci]+0.05, 2.32, col_w[ci]-0.1, 0.34, h, 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

for ri, row in enumerate(rom_data):
    bg = row_colors[ri % 2]
    fc = text_colors[ri % 2]
    for ci, cell in enumerate(row):
        add_rect(s, col_x[ci], 2.7 + ri*0.42, col_w[ci], 0.4, bg)
        tc = RGBColor(0xC0, 0x15, 0x15) if ci==2 else fc
        add_tb(s, col_x[ci]+0.05, 2.72 + ri*0.42, col_w[ci]-0.1, 0.36, cell, 11, color=tc, align=PP_ALIGN.CENTER)

# MMT quick table
add_tb(s, 9.9, 1.9, 3.0, 0.38, "MUSCLE STRENGTH (MMT)", 13, bold=True, color=NAVY)
add_rect(s, 9.9, 2.25, 3.0, 0.04, GOLD)
mmt = [
    ["Wrist Flexors", "3+/5", "4+/5"],
    ["Wrist Extensors", "3/5", "4/5"],
    ["Thumb Abductors", "3/5", "4/5"],
    ["Thumb Flexors", "4/5", "4+/5"],
    ["Finger Flexors", "4/5", "4+/5"],
    ["Thenar (OpP)", "3-/5", "4/5"],
]
add_rect(s, 9.9, 2.35, 1.0, 0.35, NAVY); add_tb(s, 9.9, 2.35, 1.0, 0.35, "Muscle", 10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 10.9, 2.35, 1.0, 0.35, NAVY); add_tb(s, 10.9, 2.35, 1.0, 0.35, "18/6", 10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 11.9, 2.35, 1.0, 0.35, NAVY); add_tb(s, 11.9, 2.35, 1.0, 0.35, "25/6", 10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
for ri, row in enumerate(mmt):
    bg2 = row_colors[ri % 2]; fc2 = text_colors[ri % 2]
    add_rect(s, 9.9, 2.72+ri*0.38, 1.0, 0.36, bg2); add_tb(s, 9.9, 2.74+ri*0.38, 1.0, 0.32, row[0], 9, color=fc2)
    add_rect(s, 10.9, 2.72+ri*0.38, 1.0, 0.36, bg2); add_tb(s, 10.9, 2.74+ri*0.38, 1.0, 0.32, row[1], 11, color=fc2, align=PP_ALIGN.CENTER)
    add_rect(s, 11.9, 2.72+ri*0.38, 1.0, 0.36, bg2); add_tb(s, 11.9, 2.74+ri*0.38, 1.0, 0.32, row[2], 11, color=RGBColor(0x1A, 0x7A, 0x3A), align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 16 – OUTCOME MEASURES
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "OUTCOME MEASURES")
divider_line(s)

om_data = [
    ("NRS Pain Scale", "18/06: 8/10 (activity), 4/10 (rest)", "25/06: 5/10 (activity), 2/10 (rest)", "To monitor pain reduction"),
    ("DASH Questionnaire\n(Disabilities of Arm, Shoulder, Hand)", "18/06: Score 62/100\n(Moderate-severe disability)", "25/06: Score 38/100\n(Moderate disability)", "Functional recovery tracking"),
    ("Patient-Rated Wrist Evaluation\n(PRWE)", "18/06: 55/100", "25/06: 32/100", "Wrist-specific patient outcome"),
    ("Grip Strength\n(Jamar Dynamometer)", "18/06: Right 14 kg (50% deficit)", "25/06: Right 19 kg (68% of contralateral)", "Strength recovery"),
    ("Tampa Scale of Kinesiophobia\n(TSK-17)", "18/06: 52/68 – High kinesiophobia", "25/06: 30/68 – Moderate kinesiophobia", "Fear-avoidance monitoring"),
    ("Sollerman Hand Function Test", "18/06: 52/80", "25/06: 68/80", "Functional hand task performance"),
]

add_rect(s, 0.35, 1.9, 3.8, 0.4, NAVY); add_tb(s, 0.35, 1.9, 3.8, 0.4, "Outcome Measure", 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 4.15, 1.9, 3.8, 0.4, NAVY); add_tb(s, 4.15, 1.9, 3.8, 0.4, "Baseline (18/06/2025)", 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 7.95, 1.9, 3.2, 0.4, NAVY); add_tb(s, 7.95, 1.9, 3.2, 0.4, "1-Week Follow-up", 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 11.15, 1.9, 1.9, 0.4, NAVY); add_tb(s, 11.15, 1.9, 1.9, 0.4, "Purpose", 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

for ri, (m, b, f, p) in enumerate(om_data):
    bg = row_colors[ri % 2]; fc = text_colors[ri % 2]
    h = 0.75
    add_rect(s, 0.35, 2.32+ri*h, 3.8, h-0.02, bg); add_tb(s, 0.4, 2.34+ri*h, 3.7, h-0.06, m, 11, bold=True, color=fc)
    add_rect(s, 4.15, 2.32+ri*h, 3.8, h-0.02, bg); add_tb(s, 4.2, 2.34+ri*h, 3.7, h-0.06, b, 11, color=RGBColor(0x8B,0x00,0x00) if ri==0 else fc)
    add_rect(s, 7.95, 2.32+ri*h, 3.2, h-0.02, bg); add_tb(s, 8.0, 2.34+ri*h, 3.1, h-0.06, f, 11, color=RGBColor(0x1A,0x7A,0x3A) if ri==0 else fc)
    add_rect(s, 11.15, 2.32+ri*h, 1.9, h-0.02, bg); add_tb(s, 11.2, 2.34+ri*h, 1.8, h-0.06, p, 10, color=fc)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 17 – DIAGNOSIS
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "DIAGNOSIS")
divider_line(s)

add_rect(s, 0.35, 1.9, 6.2, 0.45, NAVY)
add_tb(s, 0.35, 1.9, 6.2, 0.45, "MEDICAL DIAGNOSIS", 14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 0.35, 2.35, 6.2, 1.4, LIGHT)
add_tb(s, 0.5, 2.4, 6.0, 1.3,
    "Non-displaced fracture of the waist of right scaphoid (Herbert Type A2)\n\n"
    "ICD-10: S62.001 – Fracture of scaphoid bone of wrist\n"
    "Post 6-week thumb spica cast immobilization; fracture union confirmed on X-ray",
    13, color=DARK)

add_rect(s, 6.9, 1.9, 6.1, 0.45, TEAL)
add_tb(s, 6.9, 1.9, 6.1, 0.45, "PHYSIOTHERAPY DIAGNOSIS", 14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 6.9, 2.35, 6.1, 1.4, LIGHT)
add_tb(s, 7.0, 2.4, 5.9, 1.3,
    "Post-scaphoid fracture immobilization syndrome with:\n"
    "• Wrist and thumb stiffness   • Grip and pinch weakness\n"
    "• Thenar muscle atrophy      • Wrist oedema\n"
    "• Kinesiophobia               • ADL/Occupational dysfunction",
    13, color=DARK)

add_rect(s, 0.35, 3.85, 12.65, 0.45, GOLD)
add_tb(s, 0.35, 3.85, 12.65, 0.45, "YELLOW FLAGS", 13, bold=True, color=DARK, align=PP_ALIGN.CENTER)
add_rect(s, 0.35, 4.3, 12.65, 1.3, LIGHT)
add_bullet_tb(s, 0.5, 4.35, 12.3, 1.2,
    ["Patient fears loading wrist will displace or re-fracture the scaphoid (kinesiophobia score 52/68 on TSK)",
     "Concerns about permanent loss of grip strength and inability to resume driving and full work duties",
     "Avoidance of wrist-loading activities (typing, lifting) reinforcing disuse atrophy"],
    font_size=13, bullet_color=RGBColor(0xC0,0x4A,0x20))

add_rect(s, 0.35, 5.7, 12.65, 0.45, NAVY)
add_tb(s, 0.35, 5.7, 12.65, 0.45, "COMPLICATIONS TO MONITOR", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(s, 0.35, 6.15, 12.65, 1.0, LIGHT)
add_bullet_tb(s, 0.5, 6.2, 12.3, 0.9,
    ["Avascular necrosis (AVN) of proximal scaphoid – monitor with serial X-ray/MRI",
     "Non-union – risk increased in older adults, smokers; monitor with CT at 3 months",
     "Complex Regional Pain Syndrome (CRPS) – watch for disproportionate pain, vasomotor changes"],
    font_size=12, bullet_color=RGBColor(0x8B,0x00,0x00))

# ══════════════════════════════════════════════════════════════════════
# SLIDE 18 – PHYSIOTHERAPY GOALS
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "PHYSIOTHERAPY MANAGEMENT – GOALS")
divider_line(s)

add_rect(s, 0.35, 1.9, 6.0, 0.42, NAVY)
add_tb(s, 0.35, 1.9, 6.0, 0.42, "SHORT-TERM GOALS (Weeks 1–4)", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
stg = [
    "Reduce pain and swelling (NRS < 3/10 at rest, < 5/10 on activity)",
    "Educate patient about scaphoid anatomy, healing process, and kinesiophobia management",
    "Restore wrist ROM: Flexion to 45°, Extension to 40°, RD to 15°",
    "Restore thumb mobility – abduction and opposition for basic pinch tasks",
    "Initiate thenar muscle re-activation exercises (AROM, low-load)",
    "Control oedema via elevation, retrograde massage, and contrast bath",
    "Initiate safe grip strengthening (grip putty, low resistance)",
]
add_bullet_tb(s, 0.35, 2.35, 6.0, 4.8, stg, font_size=13)

add_rect(s, 6.7, 1.9, 6.3, 0.42, TEAL)
add_tb(s, 6.7, 1.9, 6.3, 0.42, "LONG-TERM GOALS (Weeks 4–12)", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
ltg = [
    "Achieve full functional wrist ROM (within 85% of contralateral side)",
    "Restore grip strength to >80% of contralateral hand (target ≥22 kg right vs 28 kg left)",
    "Restore lateral pinch to >80% of contralateral (target ≥5.5 kg)",
    "Full thenar muscle strength recovery (MMT 5/5)",
    "Reduce TSK kinesiophobia score to <24/68 (minimal kinesiophobia)",
    "Achieve DASH score <20 (minimal disability)",
    "Full return to work (desk duties + field driving)",
    "Independent home exercise programme with ergonomic wrist protection",
    "Prevent recurrence and educate on fall prevention, FOOSH mechanism",
]
add_bullet_tb(s, 6.7, 2.35, 6.3, 4.8, ltg, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 19 – EXERCISE PROTOCOL WEEK 1–2
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "EXERCISE PROTOCOL – WEEKS 1 & 2", "Post-Cast Removal Phase: Restore Mobility & Control Swelling")
divider_line(s)

add_rect(s, 0.35, 1.9, 6.0, 0.42, NAVY)
add_tb(s, 0.35, 1.9, 6.0, 0.42, "WEEK 1 – ACUTE POST-CAST PHASE", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
w1 = [
    "Cryotherapy (ice pack 10–15 min, 3×/day) for first 3 days to control oedema",
    "Wrist elevation above heart level at rest – use pillow support",
    "Retrograde massage – distal to proximal for oedema reduction",
    "AAROM wrist: Flexion / Extension / Radial-Ulnar deviation (10 reps × 3 sets, pain-free range only)",
    "Thumb AAROM: Abduction, extension, opposition – gentle (10 reps × 2 sets)",
    "Tendon gliding exercises (straight fist → full fist → hook fist) – 7 repetitions, 3×/day",
    "Wrist cock-up splint: worn between sessions and at night for protection",
    "Grip putty (extra-soft) – light squeezing for proprioception re-training (5 reps × 2 sets)",
    "Pain and movement education: reassure patient re: bone union; address kinesiophobia",
]
add_bullet_tb(s, 0.35, 2.35, 6.0, 5.0, w1, font_size=13)

add_rect(s, 6.7, 1.9, 6.3, 0.42, TEAL)
add_tb(s, 6.7, 1.9, 6.3, 0.42, "WEEK 2 – MOBILITY PHASE", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
w2 = [
    "Paraffin wax bath (3 days per week) – warmth to improve tissue extensibility pre-exercises",
    "AROM wrist (progress to active, unassisted) – all planes, 10 reps × 3 sets",
    "Thumb opposition with each finger – active, 10 reps × 2 sets",
    "Hydrotherapy (warm water) exercises – encouraged for home programme",
    "Tendon gliding continued and progressed",
    "PNF (D1 & D2 flexion/extension patterns for wrist and hand) – hold-relax technique",
    "Grip strengthening: soft rubber ball squeeze → 50 mL grip putty (10 reps × 1 set, twice daily)",
    "Individual digit strengthening: resistance from therapist (gravity-assisted, 10 reps each)",
    "ADL retraining: practice writing, picking up objects, pouring water – functional tasks",
    "Continue wrist splint at night; daytime splint only for high-risk activities",
]
add_bullet_tb(s, 6.7, 2.35, 6.3, 5.0, w2, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 20 – EXERCISE PROTOCOL WEEK 3–6
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "EXERCISE PROTOCOL – WEEKS 3–6", "Strengthening Phase: Progressive Loading")
divider_line(s)

add_rect(s, 0.35, 1.9, 6.0, 0.42, NAVY)
add_tb(s, 0.35, 1.9, 6.0, 0.42, "WEEKS 3–4", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
w3 = [
    "Active resisted wrist exercises: theraband for flexion, extension, RD, UD (10 reps × 2 sets)",
    "Grip strengthening: progressed to medium putty / 0.5 kg weighted ball (10 reps × 2 sets)",
    "Pinch strengthening: lateral, tripod, and two-point pinch with pegs/clothespins",
    "Contrast bath therapy (10 min alternating hot/cold) for circulation and pain relief",
    "Wrist mobilization (Grade III–IV Maitland oscillation): radiocarpal and midcarpal joints",
    "Proprioception training: wrist circles, wobble board for wrist (supervised, low load)",
    "PNF: Contract-relax and slow-reversal-hold for wrist flexors/extensors",
    "Functional task training: writing, typing drills (graduated duration), opening jars",
    "Scapular and shoulder kinetic chain exercises to normalize proximal biomechanics",
]
add_bullet_tb(s, 0.35, 2.35, 6.0, 5.0, w3, font_size=13)

add_rect(s, 6.7, 1.9, 6.3, 0.42, TEAL)
add_tb(s, 6.7, 1.9, 6.3, 0.42, "WEEKS 5–6", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
w5 = [
    "Progressive resistance training: theraband (medium → heavy) for wrist and forearm",
    "Grip strengthening: progress to medium-firm putty / 1 kg sandbag / hand gripper",
    "Weight-bearing on wrist: table push-ups → partial weight through wrist (graded)",
    "Bimanual tasks: heavy lifting simulation (grocery bag lifting 1–2 kg), bilateral ADL",
    "Ergonomic retraining: computer workstation setup, mouse posture, neutral wrist position",
    "Work simulation: driving steering wheel mock-up exercises (shoulder-wrist co-contraction)",
    "Continue proprioception and neuromuscular control training",
    "Reassess grip (target ≥20 kg), ROM (target: 80% contralateral), and DASH score",
    "Wrist splint: discontinue during the day; continue at night until Week 8",
]
add_bullet_tb(s, 6.7, 2.35, 6.3, 5.0, w5, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 21 – EXERCISE PROTOCOL WEEK 7–12
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "EXERCISE PROTOCOL – WEEKS 7–12", "Return to Function Phase")
divider_line(s)

w7 = [
    "WEEK 7–8 – Advanced Strengthening:",
    "  • Dumbbell wrist curls / reverse curls (0.5–1 kg, 3 × 12 reps)",
    "  • Forearm pronation-supination with resistance",
    "  • Pinch strengthening with finger strengthener board / therapy putty (firm)",
    "  • Ball catching and tossing drills for dynamic wrist stabilization",
    "  • Return to typing full sessions – monitor fatigue and pain",
    "",
    "WEEK 9–10 – Functional & Occupational Retraining:",
    "  • Full ADL independence training: cooking, personal hygiene, lifting household items",
    "  • Driving simulation exercises: grip and rotation of steering column",
    "  • Low-load plyometric wrist exercises: light ball bouncing against wall",
    "  • Workplace ergonomic assessment and counselling",
    "",
    "WEEK 11–12 – Return to Work Clearance:",
    "  • Full grip and pinch strength re-assessment with Jamar dynamometer",
    "  • Final DASH, PRWE, and TSK outcome measure scoring",
    "  • Assess readiness for full duty return (desk + field work + driving)",
    "  • Home exercise plan issued; patient education on fall prevention",
    "  • Discharge criteria: DASH < 20, grip ≥ 80% contralateral, TSK < 24, full ROM",
]
add_bullet_tb(s, 0.35, 1.9, 7.2, 5.3, w7, font_size=13)

add_tb(s, 7.9, 1.9, 5.1, 0.38, "PRECAUTIONS & CONTRAINDICATIONS", 13, bold=True, color=NAVY)
add_rect(s, 7.9, 2.25, 5.1, 0.04, GOLD)
prec = [
    "Avoid WBAT (weight-bearing as tolerated) until fracture union confirmed by CT (3-month scan)",
    "No axial loading or FOOSH simulation exercises in early phase",
    "Avoid radial deviation under load (stresses scaphoid waist)",
    "Monitor for signs of AVN: increasing pain, X-ray sclerosis of proximal pole → refer back to orthopaedics",
    "Monitor for CRPS: burning pain, allodynia, temperature changes → immediate referral",
    "Avoid forceful passive stretching of wrist in first 4 weeks",
    "Do not progress to resisted exercises until MMT ≥ 4/5 in all movements",
    "Night splint to be continued until Week 8 minimum",
    "Haematological parameters (Vit D3, Calcium, PTH) should be reviewed for optimization of bone healing in osteopenic patient",
]
add_bullet_tb(s, 7.9, 2.35, 5.1, 5.0, prec, font_size=12, bullet_color=RGBColor(0xC0,0x4A,0x20))

# ══════════════════════════════════════════════════════════════════════
# SLIDE 22 – HOME EXERCISE PROGRAMME
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "HOME EXERCISE PROGRAMME & ERGONOMICS")
divider_line(s)

add_rect(s, 0.35, 1.9, 6.0, 0.42, NAVY)
add_tb(s, 0.35, 1.9, 6.0, 0.42, "HOME EXERCISE PROGRAMME", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
hep = [
    "1. Wrist AROM exercises (flexion/extension/deviation): 10 reps × 3 sets, twice daily",
    "2. Tendon gliding (straight → hook → full fist): 7 reps cycle, 3× daily",
    "3. Thumb opposition and abduction exercises: 10 reps × 2 sets",
    "4. Grip putty squeezing: progress from soft to medium putty over 4 weeks",
    "5. Contrast bath (warm 10 min / cold 10 min alternating): daily from Week 2",
    "6. Ice application post-exercise if swelling occurs: 10–15 min",
    "7. Thenar strengthening: oppose thumb to each finger against light resistance",
    "8. Ball squeeze (soft foam ball): 10 reps × 3 sets, twice daily",
    "9. Wrist circles: clockwise and counter-clockwise, 10× each direction",
    "10. Night wrist splint: worn every night until Week 8",
]
add_bullet_tb(s, 0.35, 2.35, 6.0, 4.9, hep, font_size=13)

add_rect(s, 6.7, 1.9, 6.3, 0.42, TEAL)
add_tb(s, 6.7, 1.9, 6.3, 0.42, "ERGONOMICS & PROTECTIVE MEASURES", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
erg = [
    "WORKSTATION: Neutral wrist position while typing; use wrist rest pad; elbow at 90°",
    "MOUSE: Use a vertical or ergonomic mouse to minimize ulnar/radial deviation stresses",
    "LIFTING: Avoid lifting >2 kg until Week 6; use two-handed technique thereafter",
    "DRIVING: Postpone driving until wrist ROM ≥ 50% and grip strength ≥ 16 kg; use foam steering wheel grip",
    "SLEEPING: Avoid sleeping on outstretched arm; use wrist splint at night",
    "FALL PREVENTION: Avoid slippery floors; use handrails; wear non-slip footwear",
    "SELF-MONITORING: Report increase in pain, warmth, or swelling to therapist immediately",
    "NUTRITION: Ensure adequate Vitamin D3 (800–1000 IU/day) + Calcium (1200 mg/day) supplementation as advised by orthopaedic surgeon",
    "RETURN TO SPORTS: No impact sports (badminton, racquet sports) until Week 12 minimum",
]
add_bullet_tb(s, 6.7, 2.35, 6.3, 4.9, erg, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 23 – SPLINT / ORTHOSIS
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "SPLINTING & ORTHOTIC MANAGEMENT")
divider_line(s)

add_rect(s, 0.35, 1.9, 5.5, 0.42, NAVY)
add_tb(s, 0.35, 1.9, 5.5, 0.42, "THUMB SPICA CAST (Pre-Rehab)", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
sp1 = [
    "Applied immediately post-diagnosis (11/05/2025)",
    "Type: Short-arm thumb spica cast (fibreglass)",
    "Position: Wrist in slight extension (15°), thumb IP joint included",
    "Duration: 6 weeks (until fracture union confirmed on X-ray)",
    "Purpose: Immobilize scaphoid waist, prevent displacement, allow bone healing",
    "Cast removed: 17/06/2025",
]
add_bullet_tb(s, 0.35, 2.35, 5.5, 3.0, sp1, font_size=13)

add_rect(s, 6.3, 1.9, 6.7, 0.42, TEAL)
add_tb(s, 6.3, 1.9, 6.7, 0.42, "POST-REHAB WRIST SPLINT (Rehab Phase)", 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
sp2 = [
    "Type: Volar wrist cock-up thermoplastic splint (custom-moulded)",
    "Position: Wrist in 20–30° extension, thumb free to move",
    "Worn: At night and during high-risk daytime activities (first 6 weeks of rehab)",
    "Purpose: Protect fracture site from inadvertent loading; reduce wrist kinesiophobia",
    "Discontinued: Daytime use stopped at Week 4; nocturnal use until Week 8",
    "Fabricated from: 3.2 mm Polyform thermoplastic material; secured with velcro straps",
    "Review schedule: Checked at each weekly physiotherapy session for fit and pressure areas",
]
add_bullet_tb(s, 6.3, 2.35, 6.7, 3.0, sp2, font_size=13)

add_rect(s, 0.35, 5.5, 12.65, 0.42, GOLD)
add_tb(s, 0.35, 5.5, 12.65, 0.42, "SPLINT WEANING PROTOCOL", 13, bold=True, color=DARK, align=PP_ALIGN.CENTER)
weaning = ["Week 1–2: Full-time splint (except during exercises)", "Week 3–4: Splint during activity; off for supervised exercises", "Week 5–6: Splint only at night + high-risk activities", "Week 7–8: Night splint only", "After Week 8: Splint discontinued (reviewed as per clinical progress)"]
add_bullet_tb(s, 0.35, 5.95, 12.65, 1.3, weaning, font_size=13)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 24 – REASSESSMENT
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "REASSESSMENT RESULTS", "Progress at 1-Week Reassessment (25/06/2025)")
divider_line(s)

add_tb(s, 0.35, 1.9, 12.7, 0.4,
    "Reassessment was performed at 1 week (7 days) of physiotherapy. Significant improvements noted in all parameters.",
    14, italic=True, color=TEAL)

progress = [
    ("NRS Pain (activity)", "8/10", "5/10", "↓ 37.5%"),
    ("NRS Pain (rest)", "4/10", "2/10", "↓ 50%"),
    ("Wrist Flexion ROM", "0–28°", "0–45°", "↑ 17°"),
    ("Wrist Extension ROM", "0–22°", "0–38°", "↑ 16°"),
    ("Thumb Abduction", "0–35°", "0–48°", "↑ 13°"),
    ("Grip Strength (Jamar)", "14 kg", "19 kg", "↑ 35.7%"),
    ("Lateral Pinch Strength", "3 kg", "4.5 kg", "↑ 50%"),
    ("DASH Score", "62/100", "38/100", "↓ 38.7%"),
    ("TSK (Kinesiophobia)", "52/68", "30/68", "↓ 42%"),
    ("Sollerman HFT", "52/80", "68/80", "↑ 30.8%"),
]
headers = ["Parameter", "Baseline (18/06)", "1-Week (25/06)", "Change"]
col_ws = [3.5, 2.8, 2.8, 2.8]
col_xs = [0.35, 3.85, 6.65, 9.45]
for ci, h in enumerate(headers):
    add_rect(s, col_xs[ci], 2.38, col_ws[ci], 0.4, NAVY)
    add_tb(s, col_xs[ci]+0.05, 2.38, col_ws[ci]-0.1, 0.4, h, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
for ri, row in enumerate(progress):
    bg = row_colors[ri % 2]; fc = text_colors[ri % 2]
    for ci, cell in enumerate(row):
        add_rect(s, col_xs[ci], 2.8+ri*0.42, col_ws[ci], 0.4, bg)
        tc = RGBColor(0x1A,0x7A,0x3A) if ci==3 and "↑" in cell else (RGBColor(0x1A,0x7A,0x3A) if ci==3 else fc)
        add_tb(s, col_xs[ci]+0.05, 2.82+ri*0.42, col_ws[ci]-0.1, 0.36, cell, 11, color=tc, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 25 – REFERENCES
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
header_slide(s, "REFERENCES")
divider_line(s)

refs = [
    "1. Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J. 2016;98-B(5):654-659.",
    "2. Rhemrev SJ, Ootes D, Beeres FJ, Meylaerts SA, Schipper IB. Current methods of diagnosis and treatment of scaphoid fractures. Int J Emerg Med. 2011;4:4.",
    "3. Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. Scaphoid fracture epidemiology. J Trauma Acute Care Surg. 2012;72(2):E41-5.",
    "4. Suh N, Grewal R. Controversies and best practices for acute scaphoid fracture management. J Hand Surg Eur Vol. 2018;43(1):4-12.",
    "5. Clementson M, Bjorkman A, Thomsen NOB. Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Rev. 2020;5(2):96-103.",
    "6. Bergh TH, Lindau T, Bernardshaw SV et al. A new definition of wrist sprain necessary after findings in a prospective MRI study. Injury. 2012;43(10):1732-42.",
    "7. Logan AJ, Mason G, Dias J, Makwana N. Can rock climbing lead to Dupuytren's disease, trigger finger, and trigger thumb? J Hand Surg Br. 2005;30(4):422-3.",
    "8. Minkus M et al. Physiotherapy following surgical fixation of scaphoid fractures – a systematic review. Arch Orthop Trauma Surg. 2021;141(9):1573-1582.",
    "9. Physio-Pedia: ICF Model and Goal Writing. https://www.physio-pedia.com/ICF_Model_and_Goal_Writing",
    "10. Mortazavi K, Carlsson IK et al. Hand function following non-surgically treated scaphoid fractures. European J Physiotherapy. 2023;25(4):213-222.",
]
add_bullet_tb(s, 0.35, 1.95, 12.6, 5.3, refs, font_size=12, bullet_color=TEAL, text_color=DARK)

# ══════════════════════════════════════════════════════════════════════
# SLIDE 26 – THANK YOU
# ══════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, NAVY)
add_rect(s, 0, 0, 0.22, 7.5, GOLD)
add_rect(s, 0, 6.0, 13.333, 1.5, RGBColor(0x0D, 0x24, 0x4A))

add_tb(s, 0.5, 1.8, 12.3, 1.4, "THANK YOU", 64, bold=True, color=GOLD, align=PP_ALIGN.CENTER)
add_rect(s, 2.0, 3.1, 9.333, 0.06, GOLD)
add_tb(s, 0.5, 3.3, 12.3, 0.8,
    "for listening attentively and for your healthy Q&A discussion.", 20,
    italic=True, color=WHITE, align=PP_ALIGN.CENTER)
add_tb(s, 0.5, 4.3, 12.3, 0.6,
    "Scaphoid Fracture Rehabilitation – Case Presentation", 16,
    color=RGBColor(0xCC, 0xCC, 0xCC), align=PP_ALIGN.CENTER)
add_tb(s, 0.5, 5.0, 12.3, 0.5,
    "MGM Allied Health Sciences Institute (MAHSI) | MGM Medical College, Indore (M.P.)", 13,
    color=GOLD, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════
# SAVE
# ══════════════════════════════════════════════════════════════════════
output_path = "/tmp/workspace/scaphoid-fracture-ppt/Scaphoid_Fracture_Rehabilitation_50yr_Male.pptx"
buf = BytesIO()
prs.save(buf)
with open(output_path, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {output_path}")
print(f"Slides: {len(prs.slides)}")